Mental Health Nursing Exam 1

Front 1

What is the Mental Health Continuum? (Notes)

Back 1

- Mental Health Status Can be in a Range and Fluctuate
- Mild, Moderate, Severe, Psychosis

Front 2

What is Mental Health? Mental illness? (P.5)

Back 2

- Mental Health – Knowledge of Self; Meets Basic Needs; Assumes Responsibility for Behavoiur and Self-Growth; Maintains Relationship, Communicates Directly with Others

- Mental Illness – Person has Distorted View of Self; Unable to Maintain Personal Relationships; Unable to Adapt to Environment

Front 3

What Does the ANA State About the Focus of Psychiatric Nurses? (P.18)

Back 3

- Diagnosis and Treatment of Human Response to Actual or Potential Mental Problems
- Uses Theories of Human Behaviour as Science and Purposeful use of Self as Art
- Basic Level – Health Promotion, Intake Screening, Community Action
- Advanced Level – Psychotherapy, Psychobiological, Medications

Front 4

What are the Differences Between the Basic Psychiatric Nurse Clinician and the Advanced Practice Nurse? (P.19,8)

Back 4

- Basic – Works with Individuals Families, Communities, Groups to Promote Health, Assess Dysfunciton, Assist Clients to Regain or Improve Coping, and Prevent Disability

- Advanced – Full Range of Activities Mental Health Promotion, Illness Care, Diagnosis and Treatment of Mental Disorder; Provides Psychotherapy; Prescribes Medication

Front 5

Review the History of Mental Illness; What Advances Took Place in the 20th Century? (P.17)

Back 5

- American Psychiatric Association Established a Committee on Training Schools
- Johns Hopkins Taught Psychiatric Care in Nursing
- In 1930’s Somatic Therapy, Deep Sleep, Insulin Shock, and Electroshock
- In 1946 Congress Passed NIMH; Provides Funds for Education & Research
- Coming of Age came with way Mental Illness was Viewed and Treated
- Progression as Treatment from Confinement to Therapy

Front 6

What is a Theory? A Conceptual Framework, a Concept? (P.26)

Back 6

- Theory – Way to Abstract or Generalize Knowledge for Individual Circumstances
- Theory – Set of Interrelated Concepts that Provide Testable Relationships and Direction
- Theory – Group of Concepts Linked together to Understand Phenomenon
- Concepts – Basic Building Blocks of a Theory
- Conceptual Framework – Group of Concepts Linked to Provide Organizing or Viewing

Front 7

Describe Freud’s Framework? (P.40)

Back 7

- Personality – (Id, Ego, Superego)
- Stages of Psychosexual Development (Oral, Anal, and Phallic)

Front 8

Describe Piaget’s Framework, Maslow’s, Erickson’s? (P.42, 44, 47)

Back 8

- Piaget – Stage Theory of Cognitive Development
- Maslow – Hierarchy of Needs to Promote Human Behaviour
- Erickson – Psychosocial Development; Development Emphasis on Social Growth

Front 9

Who was Hildegarde Peplau? (P.27)

Back 9

- Described Nursing as Therapeutic Interpersonal for Growth of Nurse and Patient
- Three Phases of Nursing (Orientation, Working, and Termination)

Front 10

What is the DSM-IV TR? (P.75)

Back 10

- Updated Version in 2000 by American Psychiatric Association
- Text Revision Emphasizes Incremental Changes; Diagnosis and Criteria Unchanged
- Description of Diagnosis has Changed
- Five Axis of Assessment

Front 11

What is the ICD-9/CM? (P.72)

Back 11

- Comprehensive Listing of Clinical Diagnosis with Unique Numerical Code
- Clinical Modification – Accommodates More Complex Diagnostic Coding

Front 12

What is the NANDA Taxonomy of Nursing Diagnosis? (P.76)

Back 12

- Statement of Phenomenon of Concern to Nurses

Front 13

What are NIC and NOC? (P.82)

Back 13

- Nursing Intervention Classifications – Activities Nurses Carry Out to Assist Client Status or Behaviour
- Nursing Outcomes Classification – Relates Diagnosis; Interventions; Outcomes

Front 14

What are the Advantages of Computerization of Health Records? (P.82)

Back 14

- Frequent Availability or Paper Records
- Reduce Costs; Increase Revenues
- Prevents Loss

Front 15

What is Physical Space Between People? How Does this Effect Boundaries? (P.91)

Back 15

- Space Two Between People has Great Meaning in Communication
- Four Zones in North America
- Public – 12ft; Social 9-12ft; Personal 18in – 4ft; Intimate <18in
- Use Space Between Persons to Understand & Interpret Non-Verbal Behaviours

Front 16

Review all Therapeutic Communication Techniques? (P.93)

Back 16

- Listening, Silence, Broad Openings, Restating, Clarification, Reflection, Focusing
- Informing Suggestions, Confronting

Front 17

Define the Nursing Process? (P.96)

Back 17

- Way of Thinking that Allows Nurses to Reflect on Care and Work in Organized Manner

Front 18

What are Common Defense Mechanisms how are they Used? (P.94)

Back 18

- Unconscious Responses Used to Protect Self from Internal & External Stressors
- Denial, Projection, Repression, Rationalization, Introjection, Displacement
- Reaction Formation, Regression, Suppression, Sublimation, Symbolization

Front 19

What is the Difference Between Transference and Counter-Transference? (P.723)

Back 19

- Transference – Clients Reflect on Therapists in ways Reflecting Own Past Experiences
- Counter Transference – Nurses Experience Strong Emotions Towards Client

Front 20

What are the Steps in the Nursing Process? (P.96)

Back 20

- Assessment, Nursing Diagnosis, Outcomes, Planning/Interventions, and Evaluations

Front 21

What is Outcome Identification? (P.98)

Back 21

- Each ND Must be Identified with Specific Outcomes (Short & Long Term)

Front 22

What is the Johari Window how does it Relate to You as a Person and a Nurse? (Notes)

Back 22

- Known to Self and Others; Known Only to Others
- Known Only to Self; Know Neither to Self Nor Others
- “Healthy Person” is Known to Self and Others

Front 23

Define and Give Descriptions of Each Phase of the Nurse Client Relationship? (P.100)

Back 23

- Preinteraction – Look Into Chart; History
- Orientation – Get to Know and Establish Trust
- Working – Implementing Interventions to Achieve Outcomes
- Termination – End of Relationship Because Client has Achieved Independence

Front 24

Define Culture, What is the Effects of Culture on Therapeutic Management in Psychiatric-Mental Health Care? (P.106, 108)

Back 24

- Culture- Complex whole, Including Knowledge, Belief, Art, Morals, Law, Custom
- If Clients Belief System is Different then Effect of Treatment Must Be Considered

Front 25

What is Cultural Blindness? (P.107)

Back 25

- Misguided Attempt to Treat All Persons Fairly by Ignoring Differences
- Acting as if Differences Don’t Exist

Front 26

What Communication Barriers Must be Overcome when the Client and the Nurse do not Speak the same Language? (P.111)

Back 26

- Non-Verbal Communications Must be Interperted
- Translators Must Know Must Be Culturally Aware Not Simply Translate Language

Front 27

What is a Controlled Trial? A Blinded Trial? Double Blinded Trial? (P.120)

Back 27

- Controlled Trials – Epidemiological Studies Conducted Like True Experiments
- Blinded – Subjects Do Not Know if they are Receiving Treatment or Placebo
- Double Blinded – Neither Subject or Person Evaluating Know

Front 28

What is Interrater Reliability? (P.122)

Back 28

- DSM Diagnosis have Substantial Agreement Between Different Evaluators
- Accord on Diagnosis Between Different Evaluators on the Same Examination

Front 29

What is an Epidemiological Study? (P.120)

Back 29

- Controlled Clinical Trials Conducted Like True Experiments

Front 30

What is the Tip of the Iceberg Phenomenon? (P.125)

Back 30

- Many Persons have Symptoms but Few Seek Care

Front 31

What is Epidemiology? Epidemic? Endemic? (P.120)

Back 31

- Epidemiology – Study of Causes and Distribution of Injuries
- Epidemic – Disease that Spreads within a Population
- Endemic – Constantly and Regularly Found in Population

Front 32

What are Neurotransmitter? What Effects do they have in Mental llness? (P.62, Notes)

Back 32

- Neurotransmitters – Unique Chemical Messengers that Travel from Axon of One Cell to Dendrite of Another

- Dopamine – Too Much Schizophrenia; Too Little Parkinsons & Depression
- Norepinephrine – Too Much Mania & Anxiety; Too Little Depression
- Seratonin – Too Much Axiety; Too Little Depression
- Gaba – Too Much Reduces Anxiety; Too Little More Anxiety
- Ach – Too Much Depression; Too Little Parkinsons & Alzheimers
- Histamine – Too Little Depression

Front 33

Review Basic Brain Anatomy know Functions of Thalamus Limbic System, Hypothalamus, Cortex, Cerebellum? (P.56-58)

Back 33

- Thalamus – Relays Wide Range Sensory Input to Cerebral Cortex; Critical Structure for Consciousness
- Hypothalamus – Central Brain Structure Involved in ANS and Endocrine System; Plays Role in Nervous Mechanisms Underlining Moods and Motivational States
- Cortex – Part of Brain Consisting of Four Lobes: Frontal, Temporal, Parietal, Occipital
- Cerebellum – Large Portion of Base of Brain; Coordinates Voluntary Movements

Front 34

What Functions does the Brain Regulate? (Notes)

Back 34

- Monitor External World
- Monitor Composition of Body Fluids
- Regulates Skeletal Muscle Contractions
- Regulates Internal Organs
- Regulates/Initiates Basic Drives
- Conscious Sensation
- Memory
- Mood
- Thought
- Regulates Sleep Cycle
- Language

Front 35

What are the Differences Diagnostically between an MRI and a CT Scan? (P.59)

Back 35

- Magnetic Resonance Imaging – Can Separate out Feature of the Brain (Magnetic Field)
- Computerized Tomography – Uses X-rays to Form Image

Front 36

What does a PET Scan Measure? (P.192)

Back 36

- Positive Emission Tomography
- Tool to Measure Blood Flow Patterns in the Brain
- Uptake of Neurotransmitters

Front 37

How do Antipsychotic Medications Produce Desired Effects? (P.684)

Back 37

- Bind to Specific Brain Receptor; Most Act on CNS; Specifically Bind to Dopamine

Front 38

What are the Movement Disorders? Dystonia, Akathisia Oculogyric Crisis? Tardive Dyskinesia? (P.242, 689)

Back 38

- Dystonia – Muscle Spasms Last Few Seconds to Days; Localized to Few Muscles
- Akathisia – Affects Motor Function and Behaviour
- Oculogyric Crsis – Extraocular Spasm Forces Eues to a Fixed Upward Gaze
- Tardive Dyskinesia – Troublesome Movement Disorder Found in Schizophrenia

Front 39

What is the Older Terminology of Antipsychotic Medications? (P.686)

Back 39

- Neuroleptic

Front 40

What is a Therapeutic Window? (P. 887)

Back 40

- Time for Peak Effectiveness of a Drug

Front 41

What is a Half Life? (P.684)

Back 41

- Time Required for Plasma Concentration to Decrease to Half of Initial Value

Front 42

Where do Most Psychiatric Drugs Act? (P.688)

Back 42

- Bind to Brain Dopamine Receptors;
- Produce Degree of Indifference to Internal and External Stimuli
- Ignore Stimuli but Respond to Pain

Front 43

. Know Positive and Negative Symptoms and How they Respond to 1st and 2nd Generation Antipsychotic Medications? (P.686, 688)

Back 43

- Positive – Hallucinations, Delusions, Disorganized Thought Process, Paranoia
- Negative – Withdrawl, Lack of Initiative, Failure to Maintain Hygiene
- Postive Symptoms Result in Socailly Disruptive Behaviours; Doing To
- Negative Symptoms Do Not Respond to Classical Antipsychotics; Withdrawing
- 1st – Associated with Movement Disorders
- 2nd -

Front 44

What does it Mean High Potency and Low Potency? (P.686)

Back 44

- High - Only Small Amount has Significant Antipsychotic Effects
- Low – Requires Larger Doses to Produce Significant Antipsychotic Effects

Front 45

Know Neurotransmitters? What Disorder is Connected with Excess or Deficient Neurotransmitters?

Back 45

See #32

Front 46

Know Absorption Times i.e. Pills etc? (P.?)

Back 46

- All Current Antipsychotics are Well Absorbed Given Orally & Intermuscular Injection
- Oral 1 to 4 hrs; Injection 15 to 30 min

Front 47

Know the Differences Between Long Acting and Short Acting Preparations of Antipsychotic Medications? (P.688)

Back 47

- Short Acting – Antipsychotic Meds are well Absorbed 15-30 min Injection; 1-4 hrs PO
- Have Effect of 24 hrs or Less

- Long Acting – Long Duration of Action; Given by Injection Only
- Manufactured as Preparation of Sesame Oil
- Oil Slows Diffusion Into Adjacent Muscle
- However Once Diffused Becomes Rapidly Dissolved

Front 48

Know Major Classifications of Drugs: for example Mood Stabilizers, Antipsychotics, Stimulants? (P. 684, David, Google)

Back 48

- Mood Stabilizers – Used to Treat Mood Disorders
- Depression (Antidepressants); Mania (Mood Stabilizers)
- Antipsychotics – Control Symptoms of Psychosis such as Hallucinations
- Controls Bizarre or Paranoid Behaviour
- Stimulants – Drugs Increase Activity of SNS and Produce Sense of Euphoria

Front 49

Know Downside of Taking TCA’s? (P.692)

Back 49

- Tricyclic Antidepressants
- First Clinical Antidepressants; Used to Treat Mood Disorders
- “Dirty Drugs” Act on Many Receptor Systems
- Cause Blurred Vision, Dry Mouth, Rapid Heart Rate, Constipation, Urinary Retention

Front 50

Why is Clozaril a Dangerous Drug to Take? (P.243, 686)

Back 50

- Occasionally and Severely Causes Agranulocytosis
- Death of WBCs that is Fatal in Certain Clients
- Comes at the Risk of Life-Threatening Bone Marrow Depression

Front 51

What is Lithium, How is it Used? What are the Side Effects? What Cautions must you take with this Drug? (P.700)

Back 51

- Used to Prevent and Control Mania

- Side Effects Include Thirst and Polyuria
- Also Causes Termors which Effect Fine Motor Activities
- Chronic Diarrhea Can be a Sign of Early Toxicity

- Cardiotoxic and Not Used in 1st Trimester of Pregnancy
- Interacts with Body Sodium Metabolism

Front 52

What is Serotonin Syndrome, Neuroleptic Malignant Syndrome? (P.695)

Back 52

- Rare and Potentially Dangerous Interaction with MAOI
- Caused by SSRI and MAOI Interaction
- Agitation, Sweating, Rigidity, Fever, Hyperreflexia, Coma, or Death

Front 53

What do You Need to Watch Out for with MAOI’s? (P.697)

Back 53

- Inhibit Metabolism and Detoxification of Biogenic Amines
- Injestion May Cause Severe Stimulation of Nervous System Pathways
- Sympathomimetic Drugs Available OTC Must be Avoided
- Avoid Foods Containing Tyramine (Cheese, Salami, Sauerkraut, Beer, Yeasts, etc…)
- Avoid Beverages Such as Beer & Red Wines

Front 54

What Problematic Interactions with Drugs Can Interfere with Antipsychotic Medication?

Back 54

- Sorry, Can’t Find it Either

Front 55

What are the Signs and Symptoms of Angranulocytosis? (P.701)

Back 55

- Loss of Functioning Polymorphonuclear White Blood Cells
- Leads to Serious Infections
- Persons Require Wekly Testing of Blood Counts & Often of Liver Enzymes

Front 56

What are SSRI’s What are Side Effects of these Drugs, What do they Treat? (P.694)

Back 56

- Selective Seratonin Reuptake Inhibitors
- First-Line Medications for Moderate Depression
- Obsessive Compulsive Disorders; Bulimia; PMS
- Inhibit Reuptake of Seratonin After Release into Neural Synapse
- Long Elimination Half-Life of 2 wks

Front 57

What are MAOI’s? What Cautions Must You Take with these Drugs? (P.696)

Back 57

- Used to Treat Depression; Has Dangerous Reactions with Certain Drugs & Foods
- Should be Used Only with Highly Motivated Clients
- Works by Blocking Monoamine Oxidase which Metabolises (Norepinephrine, Serotonin, Dopamine)
- See # 53