NR320 Mental Health Nursing Exam Study guide

NR320 Mental Health Nursing Exam Study guide

What are the common attitudes of society to those with mental illness?

Stigma created

Labeling people which encourages stigma

What is the role of the nurse advocate in mental illness?

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• Being a client advocate in psychiatric nursing means helping the client fulfill needs that, without assistance and because of the client’s illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves.
• Nurses serve in this manner to protect the client’s rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make.
• Nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services. NR320 Mental Health Nursing Exam Study guide.
• Nurses also advocate for their patients indirectly by serving in organizations that support and serve to improve health care for all individuals, and by participating in policy-making legislation that affects health care of the public.
• The nurse acts as client advocate to ensure that the following three major elements of informed consent have been addressed:
• Knowledge: The client has received adequate information on which to base his or her decision.
• Competency: The individual’s cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has a legal representative.
• Free will: The individual has given consent voluntarily without pressure or coercion from others. NR320 Mental Health Nursing Exam Study guide.

What is therapeutic use of self and how is this used by the nurse?

• Therapeutic use of self: someone who is open
• By having the ability to use their own personality consciously and in full awareness in an attempt to establish association and to structure nursing interventions.
• Nurses must possess self-awareness, self- understanding, and a philosophical belief about life, death and the overall human condition.
• The nurse needs to be aware of their feelings and how it can impact how you take care of the patient, eg parent taking care of pedophile
• Example of use of self: when you approach them with a problem they make themselves available to you, and spend time with you to explain the issue so you understand, vs saying “it’s in the book” therefore putting it all on you and closing themselves to you

 

Define boundaries and give an example of how the nurse uses this.

A boundary indicates a border or a limit. It determines the extent of acceptable limits. Many types of boundaries exist. Examples include the following:

• ▀ Material boundaries. These are physical property that can be seen, such as fences that border land.
• ▀ Social boundaries. These are established within a culture and define how individuals are expected to behave in social situations.
• ▀ Personal boundaries. These are boundaries that individuals define for themselves. They include physical distance boundaries, or just how close individuals will allow others to invade their physical space; and emotional boundaries, or how much individuals choose to disclose of their most private and intimate selves to others. NR320 Mental Health Nursing Exam Study guide.
• ▀ Professional boundaries. These boundaries limit and outline expectations for appropriate professional relationships with clients. They separate therapeutic behavior from any other behavior that, well intentioned or not, could lessen the benefit of care to clients

 

• Over helping or doing for the patient what they should do for themselves

• Controlling
• The nurse needs are met at the expense of the patient
• Giving advice to the patient
• Self-disclosure
• Gift-giving
• Touch
• Friendship or romantic association
• Sharing personal information or work concerns with the client
• Receiving of gifts or continued contact/ communication with the client after discharge
• Favoring a client’s care over another
• Keeping secrets with a client NR320 Mental Health Nursing Exam Study guide
• Changing dress style for working with a particular client
• Swapping client assignments to care for a particular client
• Giving special attention or treatment to one client over others
• Spending free time with a client
• Frequently thinking about the client when away from work

 

Discuss Maslow’s hierarchy of needs and how this is used with mental health patients.

 

Basic needs need to be met before progressing to the next level

Maslow described self-actualization as being “psychologically healthy, fully human, highly evolved, and fully mature.” He believed that “healthy,” or “self-actualized,” individuals possessed the following characteristics:

• An appropriate perception of reality
• The ability to accept oneself, others, and human nature
• The ability to manifest spontaneity
• The capacity for focusing concentration on problem solving

A need for detachment and desire for privacy

• Independence, autonomy, and a resistance to enculturation
• An intensity of emotional reaction
• A frequency of “peak” experiences that validates the worthwhileness, richness, and beauty of life
• An identification with humankind
• The ability to achieve satisfactory interpersonal relationships
• A democratic character structure and strong sense of ethics
• Creativeness
• A degree of nonconformance

 

What are the criterion for inpatient hospitalization?

If in danger of self or others

Group Two

What is the duty to warn and how is this used in mental health?

Duty to Warn: you have to warn and break confidentiality if someone tells you they are going to hurt someone

 

• under certain circumstances, a therapist might be required to warn an individual, notify police, or take whatever steps are necessary to protect the intended victim from harm.
• This duty to protect can also “occur in instances when patients, because of their vulnerable state and their inability to distinguish potentially harmful situations, must be protected by healthcare providers

What is the difference between typical and Atypical antipsychotics?

Typical: first generation

Examples:

Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Thioridazine (Mellaril), Thiothixene (Navane), Trifluoperazine (Stelazine), Haloperidol (Haldol)

• IM, long term therapy

Atypical: second generation

Examples: 

Zyprexa, Risperdal, Seroquel, Geodon, Abilify

Clozaril- used as a last resort due to the dangerous side effect of agranulocytosis

Side Effects: less, weight gain, sedation

Side Effects: EPS, anticholinergic, NMS

Interactions: hypotension when taken with antihypertensive

newer, more expensive, less side effects, sexual side effect

• Extreme gain weight: develop diabetes
• Tell the pt about SS so they can decide if they want to refuse
• What to say if they ask about your opinion; weigh pros and cons, empathy: I’ve seen it work on others, talk to family, sounds like you’re having a hard time making a decision (what more do you need to know, I’ll get back to you after google,

 

What are signs and symptoms of Neuroleptic Malignant Syndrome?

• NMS; emergency, patients are going to die (bc of fever) 2 weeks after med
• Fever, change in LOC, muscle rigidity, Hyperflexia (lower extremities), tremor, clonus, increased bowel sounds (diarrhea), autonomic instability (hypertensive), tachycardia, agitation, diaphoresis (sweating)
• absolutely stop meds, transfer them to ER

Neuroleptic malignant syndrome (NMS) (more common with the typical than the atypical antipsychotics) *This is a relatively rare, but potentially fatal, complication of treatment with antipsychotic drugs. Routine assessments should include temperature and observation for parkinsonian symptoms. *Onset can occur within hours or even years after drug initiation, and progression is rapid over the following 24 to 72 hours.

What is Seratonin Syndrome and when does it occur?

• Monoamine Oxidase Inhibitors (MAOI’s)

– inhibit both types of enzymes (MOA A and MAO B) that metabolizes

serotonin and norepinephrine

• Causing Serotonin syndrome (anxiety/restlessness, hyperthermia, myoclonus (involuntary twitching)

What is the Low Tyramine Diet and what foods are prohibited?

• Hypertensive crisis occurs if the individual consumes foods containing tyramine while receiving MAOI therapy
• Low Tyramine diet: red wine, aged cheese, smoked and process meats, salami, sausage, peperoni, corned beef, chicken or beef liver, soy sauce, brewer yeast

What are signs and symptoms of akathesia?

• Trouble standing still
• Restless
• Paces the floor
• Feet in constant motion, rocking back and forth

Ask “what are you taking, are you always restless?”

 

Group 3

Define CBT and discuss how this is used?

• Aaron Beck

The individual identifies thought distortions

• Examines evidence for those thought distortions
• Reformats negative thinking and replaces with more realistic thoughts
• Learn to use healthy coping mechanisms in order to not return to thought distortions
• Some type of negative thinking

“I always fail my test” take that thought and go through the facts “do you fail the test 100% of the time?”

• What feelings do you get “I’m a loser”
• With this example a positive behavior would be studying more
  talk yourself out of it, “ok, stop I know what I’m doing, I know I’ve studied and a B would be OK”
• “I’m the black ship in my family”
• What to say: is to really true, is no one really speaking to you?
• Eventually: healthy coping (CBT in groups or individually)
• What we think about something it affects how you feel and the behavior
• Goals of cognitive therapy
• Monitor his or her negative, automatic thoughts.
• Recognize the connections between cognition, affect, and behavior.
• Examine the evidence for and against distorted automatic thoughts.
• Substitute more realistic interpretations for these biased cognitions.
• Learn to identify and alter the dysfunctional beliefs that predispose him or her to distort experiences.

Cognitive therapy is highly structured and short-term, lasting from 12 to 16 weeks

suggested that if a client does not improve within 25 weeks of therapy, a reevaluation of the diagnosis should be made.

 

• Automatic Thoughts-Thoughts that occur rapidly in response to a situation and without rational analysis. They are often negative and based on erroneous logic.

What is operant conditioning and how is it used in the inpatient area?

Operant: Voluntary behavior reinforced positive/ negative reinforcement

• Operant conditioning occurs when a specific behavior is reinforced. A positive reinforcement is a response to the specific behavior that is pleasurable or offers a reward. A negative reinforcement is a response to the specific behavior that prevents an undesirable result from occurring.
• Anger responses can be learned through operant conditioning. For example, when a child wants something and has been told “no” by a parent, he or she might have a temper tantrum. If, when the temper tantrum begins, the parent lets the child have what is wanted, the anger has been positively reinforced (or rewarded).
• An example of learning by negative reinforcement follows: A mother asks the child to pick up her toys and the child becomes angry and has a temper tantrum. If, when the temper tantrum begins, the mother thinks, “Oh, it’s not worth all this!” and picks up the toys herself, the anger has been negatively reinforced (the child was rewarded by not having to pick up her toys).

What is the purpose of therapeutic communication?

“To relate therapeutically with a patient it is necessary for the nurse to understand his or her role and its relationship to the patient’s illness. They describe the role of the nurse as providing the client with the opportunity to accomplish the following:

• Identify and explore problems in relating to others.
• Discover healthy ways of meeting emotional needs.
• Experience a satisfying interpersonal relationship.

 

What are open ended questions and how are they used in therapeutic communication?

Open-ended questions have an inviting quality and they encourage authentic responses and two-way communication in both personal and professional relationships.

Open-ended questions typically start with “why”, “how”, or phrases like “I would like to know more about”, “Tell me about”, or “I am interested in hearing more about.”

Name the 4 parts of the therapeutic nurse patient relationship and describe the tasks of each stage.

1. Preinteraction/Preorientation phase (Prior to meeting the patient)

• Self-Assessment: Examine one’s own feelings, fears, and anxieties about working with a particular client.
• Sizing each other up
• Obtain information from secondary sources about the client from chart (significant others, health team members)

2. Orientation (Introductory) phase

• Establish rapport
• Establish parameters of relationship
• Clarify roles of nurse and patient
  • You are the authority figure and the patient is there for help
• Create an environment for trust and rapport.
• Contracting and collaborating in relationship
  • Talk about what they are capable of doing, what he needs to be doing, what they can handle, negotiating care plan NR320 Mental Health Nursing Exam Study guide

3.Working phase (most of the work you will do)

• Explore areas in patients life that cause problems
• Gather and analyze data (comprehensive assessment for analyzing)
• Promoting patient problem solving
• Facilitating and practicing behavioral changes
  • Teach new coping skills but they need to be expected to practice them while they are in the hospital to help them guide and modify any behaviors
• Evaluate and redefine any problems
  • Constantly going through the care plan to make sure patient followed plan of care (do they need revision or more time?)
• Expect the patient to use ineffective coping mechanisms until they could be taught otherwise
• 2 things that the patient or the nurse does:
  • Transference: Occurs when the client unconsciously displaces (or “transfers”) to the nurse feelings formed toward a person from the past, e.g., abusive fatheràmay act same way as their abusive father and the patient will automatically take their “baggage” and place it on you
    • Be aware how this can impact the patient’s feelings/relationship toward nurse
  • Countertransference: Refers to the nurse’s behavioral and emotional response to the client, e.g., abusive fatheràpatient is an abusive father and that can impact nurse’s feelings NR320 Mental Health Nursing Exam Study guide
  • Be aware how this can impact your feelings/relationship with the patient

4. Termination phase

• Discuss ways to incorporate new coping system
• Reinforcing education received during relationship
• Mutually evaluating patient’s progress and goal attainment
  • Not just the nurse making the decision that patient could go home, it’s the whole team making that decision
  • Not delusional, having hallucinations, being able to use coping mechanisms learned
  • Are they safe to go back into community? NR320 Mental Health Nursing Exam Study guide

Group 4

What is a therapeutic relationship about?

• Professional, goal directed, scientifically based
• Basic communicationàto develop a trusting relationship for the best outcome for your patient
  • Establish trust
  • Demonstrate nonjudgmental attitude
  • Offers self and being empathetic
  • Uses active listening
  • Accepts and supports the client’s feelings
• Consistency
• Pacing: Patient’s pace, not the nurses
• Listening
• Constant self-assessment
  • May need to do this several times
• Positive initial assessment
• Promoting patient comfort, balancing control and establishing trust
  • Trust is gained over time

What are blurred boundaries? How can these occur in the inpatient area?

• Professional boundary concerns commonly include warning signs such as:
  • Over helping or doing for the patient what they should do for themselves
  • Controlling them where you are asserting authority and assuming control for the patient’s own good. NR320 Mental Health Nursing Exam Study guide.
  • The Nurses needs are met at the expense of the patient’s needs
    • Taking money from a patient
  • Focus on patient’s needs and problems not nurses
  • Boundaries and roles remain plain and clear
    • No confusion on what the nurse’s and patient’s job is
  • Nonjudgmental attitude of nurse toward patient
  • Nurse does not enmesh or influence the patient
    • Hard with children because you want to parent them to fulfill your own needs not the patients
    • They will come to you and ask what they should do. You need to make sure they have the information to make a sound decision for themselves.
    • The Nurse does not make the decision
    • Enmesh: Don’t share with them what your problems are.  The focus is on the patient.  By sharing with the patient you confuse what your role is.

 

What is proxemics? What is the correct therapeutic distance between you and your patient?

Space between you and patient

What is a situational crisis? Why do individuals have them? NR320 Mental Health Nursing Exam Study guide

• Dispositional/Situational: Occur when a life event upsets a patient’s equilibrium
  • Arises for external rather than internal source: usually unanticipated
  • Usually a situational stressor
  • Usually involves a loss or change that threatens a person’s self concept and self esteem
  • Loss of job, death of a loved one, change in financial status, divorce NR320 Mental Health Nursing Exam Study guide
  • Support system will help determine the severity of the crisis
  • Good support group will lessen the severity vs. if a person has to face it alone

What is a debrief and what is the purpose of them?

1. Post Assaultive stage: Critical debriefing

• Talk about what happened, what are some things they could do next time
• To prevent any further incidents

What is the main goal of de-escalation and physical management techniques?

2. Pre-assaultive stage: De-escalation stage

• Exhibiting anxiety or agitation
• Slowly starting to escalate
• Nurse should be able to recognize this stage and intervene by distracting them, take nap, phone call, PRN, doctor 1:1
• Make sure no one gets hurt
• NR320 Mental Health Nursing Exam Study guide

Group 5

What are the anticholinergic side effects of the antipsychotics?

blurred vision, constipation, dry mouth, dizziness, and difficulty urinating.

Older people, and especially those with NCD, are particularly sensitive to these effects because of decreased cholinergic reserves. Many elderly individuals are also at increased risk for developing an anticholinergic toxicity syndrome because of the additive anticholinergic effects of multiple medications

What are some extrapyramidal side effects of the antipsychotics?

EPS symptoms

Side effect of med

Akathisia: what are you taking, are you always restless

Acute dystonia: diff muscle spasm in face, not as common.  More serious bc laryngeal spasm

Taradice dsykenisa: more serious, irreversible, stick tongue out a lot

• All preventable, TD can’t go back
• Result for long time treatment
• AIMS assess symptoms of EPS
• NR320 Mental Health Nursing Exam Study guide

What is dialectal behavioral therapy (DBT)? How is this used in mental health?

Dialectical behavior therapy (DBT) is a type of psychotherapy that was originally developed by Marsha Linehan, PhD, as a treatment for the chronic self-injurious and parasuicidal behavior of clients with borderline personality disorder. It is a complex, eclectic treatment that combines the concepts of cognitive, behavioral, and interpersonal therapies with Eastern mindfulness practices five functions of DBT:

• To enhance behavioral capabilities
• To improve motivation to change
• To ensure that new capabilities generalize to the natural environment
• To structure the treatment environment such that client and therapist capabilities are supported and effective behaviors are reinforced
• To enhance therapist capabilities and motivation to treat clients effectively

What are the components of it? NR320 Mental Health Nursing Exam Study guide

Mindfulness: being focused and learning to live in the present moment, instead of focusing on a million things at once

Regulating emotions: reduce the intensity if emotional pain until the feeling passes

Distress Tolerance: learn the defuse stressful or painful situations resulting in better health

Interpersonal Effectiveness: understand how to set boundaries and clearly express your needs, : it encourages people to express their needs appropriately, adolescents, marital or relationships needs, not getting emotional support and start trying to get their attention in a bad way. Teach them to express their needs instead of doing things that won’t get the point across

 

What is evidence based practiced and how is it used in mental health?

In controlled studies, DBT has been shown to diminish self-destructive behaviors in clients with borderline personality disorder. Additionally, DBT has shown to decrease the drop-out rate from treatment and the number of hospitalizations. Improvement has also been shown in reducing anger and in global and social adjustment scores (Dimeff & Linehan, 2001). This method of treatment is now being used with other disorders, including substance use disorders, eating disorders, schizophrenia, and post-traumatic stress disorder NR320 Mental Health Nursing Exam Study guide

What is incongruent communication ?

Group 6

Explain what a breach of privacy is and how it might occur in a facility?

 

Discuss intervention for CBT and how these might be used for a patient.

• The individual identifies thought distortions
• Examines evidence for those thought distortions
• Reformats negative thinking and replaces with more realistic thoughts
• Learn to use healthy coping mechanisms in order to not return to thought distortions

 

What is the therapist trying to do in CBT?

identifying negative thinking and emotions and restructuring them into positive thinking.

 

How do you evaluate the outcome of care for a patient, using the multidisciplinary team? NR320 Mental Health Nursing Exam Study guide

 

What are ways to work with patients to work on triggers nonaggressively?

 

What is the difference between sympathy and empathy?

• Empathy vs. sympathy
  • Empathy is the ability to vicariously feel or identify what the patient is feeling, versus sympathy is where and individual begins to identify with the patient to the extent of feeling sorry for them.
  • Empathy opens up communication
  • Use of open ended sentences to gain more information
  • Sympathy will not gain additional information (shut them down)
  • This may result in a Nurse crossing the professional line. Warning signs:
    1. Self-disclosure
    2. Gift-giving
    3. Touch
    4. Friendship or romantic association
    5. Sharing personal information or work concerns with the client
    6. Receiving of gifts or continued contact/ communication with the client after discharge

 

What is akathisia

See pic above

a state of agitation, distress, and restlessness that is an occasional side-effect of antipsychotic and antidepressant drugs NR320 Mental Health Nursing Exam Study guide