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60 Cards in this Set

  • Front
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State of well being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and make a contribution to the community.
Mental health
Clinically significant behavioral or psychological syndrome marked by the patient’s distress, disability, or the risk of suffering disability or loss of freedom
Mental illness
Describes definable diagnosis such as depression, anxiety, schizophrenia, and bipolar disorder
Mental disorder
____ is used to diagnose a psychiatric disorder; a system using 5 axes to classify mental disorders
DSM-IV-TSR
Which of the following disorders would be included on Axis I of the DSM IV-TR?
a. Major depression, schizophrenia, and alcoholism
b. Narcissistic, borderline, and paranoid personality disorders
c. Diabetes type I or II, Parkinson’s disease, and seizure disorders
d. Mental retardation and psychosocial stressors such as divorce
A. Axis 1 refers to the collection of signs and symptoms that make up a particular disorder (e.g., schizophrenia, depression)
Axis 2 refers to personality disorders and mental retardation (e.g., narcissistic, borderline)
Axis 3 indicates any general medical conditions relevant to the medical disorder (e.g., diabetes, Parkinson’s disease)
Axis 4 describes psychosocial and environmental problems that may affect diagnosis, treatment, and prognosis or the mental disorder (psychosocial stressors such as divorce)
A nurse suspects that a client has a personality disorder in addition to displaying symptoms of a mood disorder. To determine whether these observations are correct, the nurse could look in the client's medical record on the DSM-IV-TR


a. Axis I
b. Axis II
c. Axis III
d. Axis IV
Axes I and II were separated to ensure that the possible presence of long-term disturbance is considered when attention is directed to the current one. For example, a heroin addict would be diagnosed on axis I as having a substance-related disorder; this client might also have a longstanding antisocial personality disorder, which would be noted on axis II.
Sullivan viewed anxiety as:
a. emotional experience felt after the age of 5 years
b. adults trying to go beyond experiences of guilt and pain
c. a sign of guilt in adults
d. any painful feeling or emotion arising from social insecurity
d. According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied
Freud’s theory suggests that individuals cope with anxiety by using
a. suppression
b. defense mechanisms
c. security operations
d. the superego
b. The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings
Sullivan’s theory describes security operations as measures that the person uses to reduce anxiety and enhance security
The role of the psychiatric nurse is:
a. help patient prepare a support system that will promote mental health on discharge from the hospital
b. diagnosing and treating of human responses to actual or potential mental health problems
c. provide assistance to patients in meeting basic needs and also help the community to remain supportive, safe, and healthy
d. provide medical diagnosis and treatments on a consultation basis
b. the psychiatric nurse’s roles include diagnosing and treating responses to psychiatric disorders and promote mental health through assessment, diagnosis, and treatment
social workers help patients prepare a support system that will promote mental health on discharge from the hospital
mental health workers function under direction and supervision of RNs to provide assistance to patients in meeting basic needs and also help the community to remain supportive, safe, and healthy
physicians provide medical diagnosis and treatments on a consultation basis
Which of the following nursing actions is appropriate in maintaining a safe therapeutic
inpatient milieu? [Select all that apply]
a. Interact frequently with both individuals and groups on the unit
b. Initiate and support group interactions via therapeutic groups and activities
c. Provide and encourage opportunities to practice social and other life skills
d. Collaborate with housekeeping to provide a safe, pleasant environment
All of the above. Promoting engagement via social interaction and therapeutic activities with staff and peers helps enhance self-worth and develop social skills. Development or enhancement of social, communication, and coping skills are essential areas of focus for most mental health inpatients and can be accomplished through role playing, role modeling, therapeutic groups, and other therapeutic activities. Housekeeping practices may need to be modified for a mental health inpatient unit where patients are ambulatory. Patients are sometimes prone to spills due to medication-induced tremors, requiring more frequent mopping; cleaning supplies and chemicals must be safe and kept secure from patient access
An ongoing, critically important responsibility of nurses working on an inpatient psychiatric unit is
a. providing negative feedback
b. sympathetic listening
c. milieu management
d. fostering research
c. Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital
according to the continuum of psychiatric mental health treatment, a locked inpatient unit is an example of:
a. transitional outpatient treatment
b. ongoing outpatient treatment
c. most acute treatment
d. intensive outpatient treatment
c. a locked inpatient unit is an example of the most acute treatment
community mental health centers are ongoing outpatient treatment options
PHP, psychiatric home care, intensive substance abuse programs are intensive outpatient treatments
Psychosocial rehabilitation programs are part of the transitional outpatient treatment
Which information will be of greater importance to planning care for a client receiving mental health care in his home than to planning care for a client receiving services on an inpatient unit?
a. Strengths and deficits of client
b. Mental status examination
c. Presenting problem and referring party
d. Housing adequacy and stability
d. For hospitalized clients the treatment team does not have to worry about whether the client has a clean, safe place to stay and adequate food to eat. For the client receiving care in the community, these are legitimate planning concerns.
Your friend has just been laid off from his job. Which of the following responses on your part would most likely contribute to enhanced resilience?
a. Using your connections to set up an interview with your employer
b. Supporting him in arranging, preparing for, and completing multiple interviews
c. Connecting him with a friend of the family who owns his own business
d. Helping him to understand that the layoff resulted from troubles in the economy and is not his fault
b. Resilience develops from the process of resolving distress through adaptive coping. It is enhanced when a person experiences success as a result of his own efforts, which gives the person an increased sense of control or mastery over stressful events. This is illustrated in the choice involving helping your friend to obtain and succeed in interviewing for a replacement job. In the other choices, you are helping the person deal with his situation and/or find a replacement job but not in a manner that leads him to experience success via his own efforts. As a result, these approaches do not provide your friend with an opportunity to experience a sense of mastery over stress, so they are less likely to contribute to increased resiliency
A numeric scale that gives an indication of the person’s best level of psychological, social, and occupational functioning.
The Global assessment functioning (GAF) is a numeric scale (1 through 100, where 1 indicates persistent danger of severely hurting oneself or others and 100 indicates superior functioning in wide range of activities) used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of a person.
You are about to interview a newly admitted patient on your inpatient mental health unit. This is his first experience with psychiatric treatment. Which of the following interventions would be appropriate for this patient? [select all that apply]
a. Ensure that the individual understands his rights as a patient on your unit
b. Carefully check all clothing and possessions for potentially dangerous items
c. Discuss outpatient care options for after discharge
d. Anticipate and address possible increased anxiety and shame
A, B, D. checking for items that might be dangerous to this or other patients is one of the first and most important nursing interventions in a new admission situation. They may also be anxious, embarrassed, or ashamed about their condition and/or being on a mental health unit. Anxiety can increase patient distress and lead to behavioral concerns such as agitation or resistance; it should be assessed and addressed early in treatment. Ensuring that new patients understand their rights as mental health clients is also an essential nursing duty.
Discharge planning should start early, but insufficient information is available at this time to begin such planning, and other concerns take a priority immediately after admission
____ is the shared belief, values and practices of a group that shape their thinking and behavior in patterned ways
Culture
____ is the tendency to believe that every member of a group is like all other members
Stereotyping
____ Describes opinion that one’s own beliefs, values and practices are the best, preferred, or the only way (culturally inappropriate nursing care)
Ethnocentrism
A nurse in a mental health facility is assigned to take care of a patient from an East Asian background. One important factor about the culture that the nurse should remember regarding patient care is:
a. The patient’s culture value autonomy, independence and self reliance
b. The patient’s culture believes that there is separation of mind and body
c. The patient’s culture believes that disease is lack of harmony with nature
d. The patient’s culture value family interdependency and group decision making
D. eastern tradition value family interdependence and group decision making
Western tradition believes on individuality, valuing autonomy, independence and self reliance
Indigenous cultures believe that disease is caused by lack of harmony with nature
The nurse assesses the wellness beliefs and values of a client from another culture best when asking:
a. "How can I help you get better?"
b. "What do you think is making you ill?"
c. "What do you think will make you better?"
d. Did you do something to cause the illness?"
b. Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.
____ describes the differences in responses to medications among racial and ethnic groups
Ethnopharmacology
____ means respecting the rights of others to make their own decisions
Autonomy
____ means maintaining loyalty and commitment to the patient and doing no wrong to the patient
Fidelity
By spending extra time to help calm an extremely anxious patient, the nurse practices which ethnic principle?
a. Fidelity
b. Beneficence
c. Justice
d. Veracity
b. beneficence is the duty to act to benefit or promote the good to others
fidelity is maintaining loyalty and commitment to the patient (e.g., maintaining nursing expertise through nursing education)
justice is the duty to distribute care equally, regardless of personal attributes (e.g., nurse devotes equal attention to someone who has attempted suicide as to someone who suffered a brain aneurysm)
veracity describes one’s duty to communicate truthfully (e.g., patient teaching regarding medications)
when a patient has been admitted to a mental health facility on an involuntary basis, it basically means:
a. Admission is sought by the patient through a written application to the facility
b. admission is sought by the patient, there is no formal or written application
c. Admission without the patient’s consent, usually necessary when the patient presents a danger to self or others or is unable to meet his or her own basic needs
c. involuntary admission is necessary whenever a person is in need of psychiatric treatment and presents a danger to self or others or is unable to meet his/her own basic needs
voluntary admission is sought by the patient or patient’s guardian through a written application to the facility
an informal admission is a type of voluntary admission where there is no formal or written application
When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rule, the correct assumption is that the client was admitted:
a. For a non-emergency
b. Per legal requirements
c. Involuntarily
d. Voluntarily
D. Voluntary admission occurs when the client is willing to be admitted and agrees to comply with hospital and unit rules.
A client who is to be discharged the next day tells the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take?
a. Call the client's wife and report the threat
b. Report the incident to the client's therapist and document
c. Immediately cancel the client's discharge
d. None, because no explicit threat has been made
B. The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.
Tarasoff ruling states that the therapist has a duty to warn an intended victim and duty to protect the victim from danger – it includes notification of the potential victim, victim’s family, and the police. If the therapist failed to take action, he /she is held liable for:
Negligence
Which right of the client has been violated if he is medicated over his objection?
a. Right to informed consent
b. Right to punitive damages
c. Dignity and respect
d. Right to treatment
a. Before being given medication the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If in a nonemergency situation he is given medication after refusing, his right to informed consent has been violated.
____ means a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat
Anxiety
___ is a reaction to a specific danger
Fear
A nurse is doing an assessment on a patient in a mental health facility. During the assessment, the nurse noticed the patient is becoming restless, continuously tapping her foot, and fidgeting. According to Peplau, the patient is experiencing what level of anxiety?
a. Mild anxiety
b. Moderate
c. Severe anxiety
d. Panic
A. persons who experience mild anxiety show symptoms like tapping their feet, fidgeting, restlessness, or irritability.
A person who has moderate anxiety have symptoms like increased pulse, respiratory rate, and may demonstrate selective inattention
Someone who has severe anxiety experience somatic symptoms (headache, nausea, dizziness), may experience hyperventilation and a sense of impending doom or dread
Behavior resulting from panic may be manifested as pacing, running, shouting, screaming, or withdrawal
____ are automatic coping styles that protect people from anxiety and maintain self-image by blocking feelings, conflicts, and memories
Defense mechanisms
A nursing student who is about to go take a trip realizes that he hasn’t studied for their NUR 151 exam next week. He said “I’ll just study for it when I get back on Sunday.” He puts all his books and notes aside and prepared his things needed for his trip. The nursing student is using what type of defense mechanism?
a. Regression
b. Suppression
c. Displacement
d. Compensation
b. suppression is the conscious denial of a disturbing situation or feeling
regression is reverting to an earlier, more primitive childlike pattern of behavior that may or may not have been previously exhibited (e.g., 4 year old boy with a new baby brother starts sucking his thumb and wanting a bottle)
displacement is transference of emotions associated with a particular situation to another nonthreatening situation (e.g., a patient criticizes the nurse after the family fails to visit)
compensation is used to make up for perceived deficiencies and cover up short comings to protect the conscious mind from recognizing them (e.g., an individual drinks alcohol when self esteem is low to temporarily diffuse discomfort)
A man reacts to news of the death of a loved one by saying, “no, I don’t believe you. The doctor said he was fine.” Is displaying what type of defense mechanism?
a. Rationalization
b. Dissociation
c. Denial
d. Undoing
c. denial involves escaping unpleasant anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence
rationalization consists of justifying illogical or unreasonable ideas or feelings by developing acceptable explanations that satisfy the teller as well as the listener (“I didn’t get the raise because the boss doesn’t like me”)
dissociation is the disruption in the usually integrated functions of consciousness or perception of the environment (day dreaming while in a 5–hour long lecture)
undoing is when a person makes up for an act or communication (after flirting with the male secretary, a woman brings her husband tickets to a concert he wants to see)
The theory that describes anxiety results from distortions in thinking and perception
a. Behavioral theory
b. Cognitive theory
c. Freud’s theory
d. Sullivan’s theory
B. cognitive theory.
Behavioral theory explains that anxiety is a learned response that can be unlearned
Freud states that defense mechanisms manage anxiety
Sullivan’s theory describes anxiety as a result of unmet early needs
The norepinephrine theory states that people who have panic attacks have ____ brain stem and thus triggers the ____ response
a. More sensitive ; rest and digest
b. More sensitive ; fight or flight
c. Less sensitive ; rest and digest
d. Less sensitive ; fight or flight
b. the brain stem is more sensitive thus triggers the fight or flight response
a nurse is doing an assessment on a patient who has been experiencing anxiety symptoms for 6 months. The patient reported worrying about getting fired from his job, and constantly checking on his kids to make sure they are alright. The patient also mentioned having trouble sleeping and wakes up often during the night. The patient shows signs and symptoms of what type of anxiety disorder?
a. Obsessive compulsive disorder
b. Panic disorder
c. Generalized anxiety disorder
d. Post traumatic stress disorder
C. excessive anxiety or worry about numerous things lasting for6 months, and sleep disturbance are signs of GAD.
A physician ordered imipramine (Tofanil) for a patient for anxiety. The nurse taking care of the patient should know that one of the drug’s main side effects is ____
Tachycardia
Duloxetine (Cymbalta), an antidepressant also used as an anxiety medication can cause what primary side effect?
a. Blurred vision
b. Constipation
c. Tachycardia
d. Hypertension
D. SNRIs (serotonin-norepinephrine reuptake inhibitors) such as Duloxentine (Cymbalta) can cause hypertension
Blurred vision, constipation, and tachycardia are all side effects of Tricyclics – imipramine (Tofanil)
The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal:
a. A sibling with the disorder
b. Hx of childhood trauma
c. An eating disorder
d. A phobia as well
A. Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population.
____ are thoughts, impulses or images that persist and recur, so they can’t be dismissed from the mind
Obsession
____ are ritualistic behaviors a person feels driven to perform in an attempt to reduce anxiety
Compulsion
A potential problem that should be investigated for a client with severe obsessive-compulsive disorder is
a. Command hallucinations
b. Altered state of consciousness
c. Sleep disturbance
d. Excessive socialization
c. Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.
A disorder characterized by persistent reexperiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others, to which the individual responded with intense fear, helplessness, or horror
Post traumatic stress disorder (PTSD)
An enduring pattern of experience and behavior that deviates significantly from the expectations within the individual’s culture
Personality disorder
Persons diagnosed with disorders that belong to this specific cluster of personality disorders share characteristics of eccentric and odd behaviors, such as social isolation and detachment.
a. Cluster A
b. Cluster B
c. Cluster C
A. cluster A personality disorders have odd or eccentric characteristics
Persons diagnosed with cluster B PD show patterns of responding to life demands with dramatic, emotional, and erratic behaviors
Cluster C PDs are characterized by patterns of anxious and fearful behaviors
A client is diagnosed with schizoid personality disorder. The symptoms that support the diagnosis includes: [select all that apply]
a. Emotional detachment, shows indifference to praise or criticism
b. Very emotional, attention seeking, and dramatic
c. Having odd beliefs, magical thinking, and perceptual distortions
d. Distrust and suspiciousness towards others
A. persons who have schizoid PD experience emotional detachment and show indifference to praise or criticism
Histrionic people are very emotional, attention seeking, and dramatic
Schizotypical PD is expressed in odd characteristics such as having odd beliefs, magical thinking and perceptual distortions
Distrust and suspiciousness towards others is characterized in persons who have paranoid PD
Characteristic behaviors the nurse will assess in the antisocial client are
a. perfectionism, preoccupation with detail, and verbosity
b. deceitfulness, impulsiveness, and lack of empathy.
c. avoidance of interpersonal contact and preoccupation with being criticized.
d. need for others to assume responsibility for decision-making and seeks nurture.
B. Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
Splitting is the primary defense or coping style used by persons with what type of PD?
a. Histrionic
b. Narcissistic
c. Borderline
d. Antisocial
C. splitting is the primary defense used by persons with Borderline PD where the person labels one person as “all good” while the other is “all bad”
Social inhibition, low self esteem, avoidance of all situations requiring social contact and fear of rejection are all characteristics of what personality disorder?
a. Antisocial
b. Avoidant
c. Paranoid
d. Narcissistic
B. the central characteristics of individuals who have avoidant PD, are an extreme sensitivity to rejection abd robust avoidance of interpersonal situations
Antisocial people have consistent disregard to others, neglect responsibilities, and no remorse for hurting others
Paranoid PD is characterized by distrust and suspiciousness towards others
Narcissistic PD has the primary feature of arrogance w/ a grandiose view of self importance
A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess?
a. Odd, eccentric
b. Anxious, fearful
c. Dramatic, emotional, erratic
d. Disoriented, disorganized
B. Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. These individuals have difficulty making independent decisions and are constantly seeking reassurance. They have deeply held convictions of personal incompetence, with the fear that they cannot survive on their own. They frequently seek treatment for anxiety or mood disorders related to a loss.
The priority nursing intervention for a client with borderline personality disorder is to:
a. respect the client's need for social isolation
b. protect other clients from manipulation
c. assess for suicidal and self-mutilating behaviors
d. provide clear, consistent limits and boundaries
C. One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress
Physician ordered Thorazine 75 mg. available is Thorazine 100mg/mL. How much must be administered?
0.75 ml (75mg x 1ml / 100 mg)
Doctor's order: Apresoline 25 mg, Available: Apresoline 50 mg/tablet. Dosage to be given:
½ tablet
A client is ordered 37.5 milligrams of Clomipramine. 25 milligram tablets are available. How many tablets will you give?
1.5 tablets (37.5 mg / 25 mg)
A physician ordered the nurse to administer to a client 520 mg of a medication PO in 24H and has to be given Q6H. How many mg will the client receive for each dose?
130 mg per dose (520 mg ÷ 4 doses)
Which physiological change is associated with generalized anxiety disorder (GAD)?

a. increase in acetylcholine
b. increased histamine
c. increased dopamine
d. increased norepinephrine
D. norepinephrine increases in people experiencing anxiety

increase in acetylcholine is related to depression

increased dopamine is related to schizophrenia

increased histamine is related to weight gain
The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is:

a. to provide information about client psychosocial background

b. legal protection

c. to determine if the anxiety is of primary or secondary origin

d. to establish nursing diagnoses of priority
C. The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause