Final Exam: PRN 1562/ PRN1562 (Latest 2024/ 2025 Update) Principles of Mental Health Nursing Review| Questions and Verified Answers|100% Correct| Grade A- Rasmussen
Final Exam: PRN 1562/ PRN1562 (Latest
2024/ 2025 Update) Principles of Mental
Health Nursing Review| Questions and
Verified Answers|100% Correct| Grade ARasmussen
Q: Behavior Disorders
Answer:
Conduct Disorder
ADHD
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Q: Conduct Disorder
Answer:
· (violates the rights of others; antisocial later in life; lack empathy and remorse)
- Repetitive/persistent pattern of behavior that violates the rights of others.
- Bullying, using weapon, deliberate destruction of property.
Q: ·ADHD
Answer: - Issues with following rules, paying attention, easily distracted, forgetful, impaired time
management - CNS stimulants for treatment (give early in day to avoid insomnia, lack of appetite, headache)
Q: Oppositional Defiant Disorder (more to authority figure)
Answer:
- Characterized by angry/irritable mood
- Defiant Behavior
- At least 6 months
Q: ·Intermittent Explosive Disorder
Answer: - Anger outburst disproportionate to event.
- Typically, destruction of property- not physical harm.
Symptom control if given medication
Q: Treatment focus: Behavior Disorders
Answer:
Behavior Modifications
Q: Psychotic is
Answer:
associated with schizophrenia
Q: Prodromal Phase (before first psychotic episode):
Answer: - changes in premorbid levels of functioning (they begin to decline in basic ADLs)
- Lasts until first psychotic episode
Q: Psychotic (acute phase)
Answer:
- Active symptoms of disorder
- Usually requires hospitalization
Q: Psychotic Stabilization Phase:
Answer: - Medical Rule Out
- Begin Medication Regimen
- Focus on Safety
Q: Psychotic Maintenance Phase:
Answer: - Medication compliance
- Family Education
- Residual Symptoms
- Focus on relapse prevention
Q: positive Psychotic symptoms (considering it “adding” to the person)
Answer:
delusions and hallucinations
Q: Hallucinations include
Answer:
all 5 senses
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Personality Disorders
Cluster A- odd, eccentric
paranoid,
schizoid,
schizotypal
paranoid personality disorder
paranoid about those around them; not trusting
schizoid personality disorder
no attachment; they don’t need closer or personal relationships
schizotypal personality disorder
very eccentric, odd magical thinking and beliefs
Nursing interventions: Personality Disorders Cluster A- odd, eccentric
focus on safety and communication
Cluster B-Personality Disorders Erratic, Dramatic, Emotional
Antisocial
Borderline
Histrionic
Narcissistic
Antisocial
does NOT mean they don’t like people; don’t conform to society. Ex: Ted Bundy; con-artists, no remorse, no moral values, lie, steal, feel no responsibility. Don’t let them be in a position of power ex: judge, public speaker
Borderline
self-mutilation and suicide prone behaviors; I hate you, I love you. If you leave me, I’ll hurt myself. Suicidal gesture for attention; emotional instability, sees relationships to not feel abandoned/alone
Histrionic
· Regina George in personality; Very dramatic; speak, act, dress to get attention)
Narcissistic (They’re better than you, they anticipate you are aware that they’re better than you; grandiosity, shallow relationships focused on what others can do for them, arrogant
Nursing interventions: Cluster B-Personality Disorders Erratic, Dramatic, Emotional
focus on dealing with manipulation- setting boundaries. Set clear rules on behaviors and enforce them consistently
Cluster C (fearful, anxious)
avoidant, dependent, obsessive-compulsive
Avoidant
fearful of rejection; social anxiety or phobia; social skills training is beneficial
Dependent
afraid of being alone; depending on someone ex: anxious if caregiver is sick or away
Obsessive-Compulsive
don’t confuse with OCD; we’re not going to see ritual; individual who is a perfectionist and unable to delegate or let go of things
Nursing interventions: Cluster C (fearful, anxious)
focus social skills training and reduce anxiety
eating disorders
anorexia nervosa and bulimia nervosa
anorexia nervosa
(lower body weight) cognitive distortions, poor prognosis. Low blood pressure, low HR, electrolyte imbalance leading to cardiac issue, medical care in hospital, lanugo, problems with body temp regulations. When in treatment: self esteem issues, identifying triggers, emotions and food relationship
Bulimia Nervosa
(normal, slightly overweight) emotional relationship (identify trigger)
Binge Eating
(obese over time) emotional relationship (identify trigger). Classified in 2 hours you ate the entire thanksgiving spread by yourself
Priority concern: eating disorders
Electrolyte imbalances.
Behavior Disorders
Conduct Disorder
ADHD
Oppositional Defiant Disorder
Intermittent Explosive Disorder
Conduct Disorder
· (violates the rights of others; antisocial later in life; lack empathy and remorse)
- Repetitive/persistent pattern of behavior that violates the rights of others.
- Bullying, using weapon, deliberate destruction of property.
·ADHD
- Issues with following rules, paying attention, easily distracted, forgetful, impaired time management
- CNS stimulants for treatment (give early in day to avoid insomnia, lack of appetite, headache)
Oppositional Defiant Disorder (more to authority figure)
- Characterized by angry/irritable mood
- Defiant Behavior
- At least 6 months
·Intermittent Explosive Disorder
- Anger outburst disproportionate to event.
- Typically, destruction of property- not physical harm.
Symptom control if given medication
Treatment focus: Behavior Disorders
Behavior Modifications
Psychotic is
associated with schizophrenia
Prodromal Phase (before first psychotic episode):
- changes in premorbid levels of functioning (they begin to decline in basic ADLs)
- Lasts until first psychotic episode
Psychotic (acute phase)
- Active symptoms of disorder
- Usually requires hospitalization
Psychotic Stabilization Phase:
- Medical Rule Out
- Begin Medication Regimen
- Focus on Safety
Psychotic Maintenance Phase:
- Medication compliance
- Family Education
- Residual Symptoms
- Focus on relapse prevention
positive Psychotic symptoms (considering it “adding” to the person)
delusions and hallucinations
Hallucinations include
all 5 senses
Delusions include
fives, false beliefs- persecution (government is trying to poison food), grandeur (all powerful), reference (billboard speaks to me), control/influence (outside entity is controlling them; puppet on string), somatic (changing within them)
Nursing considerations: Psychotic
- Present Reality
- Safety
Psychotic Negative symptoms (consider it “taking away” something from the person):
Flat affect
Avolition
Angeria
Anhedonia
Flat affect
(limited range of emotions)
Avolition
lack of motivation; an inability to take action or become goal oriented
Angeria
Lack of energy; passivity, lack of persistence at work or school
Anhedonia
a diminished ability to experience pleasure
Loose Associations
(by a thread, it sort of made sense to them)
Clang Association
(forceful rhyming, Dr. Suess book)
Psychotic Changes in Speech
disturbances in the thought processes
Circumstantiality
(all over the place)
Perseveration
- (same topic even with disruption)
Neologisms
creation of new words
Word Salad
Incoherent mixture of words, phrases, and sentences
Tangentiality
Abrupt changing of focus to a loosely associated topic
Echolalia
automatic and immediate repetition of what others say
Nursing intervention: Psychotic Changes in Speech
presenting reality (“when you say such and such word, what does that mean?” “I’m having a hard time following what you’re saying”) and redirect them. Don’t fake it.
Psychotic Medications
1st generation (treats positive symptoms):
- Affects: focuses on dopamine
- Side effects: anticholinergic, insomnia, orthostatic hypotension
Psychotic Medications
1st generation (treats positive symptoms): Major considerations:
Tardive Dyskinesia
Acute Dystonia
Akathisia
Tardive Dyskinesia
spasms of the mouth, tongue, lip-smacking, facial grimacing (not reversible, no antidote/cure)
Acute Dystonia
muscle stiffness (especially neck and head)
Akathisia
restlessness, pill rolling, pacing (rocking back and forth in a chair, shifting weight from side to side)
Neuroleptic Malignancy Syndrome (NMS)
Results from use of Typical Antipsychotic (Ex: Haldol)
Neuroleptic Malignancy Syndrome (NMS) s/s
Symptoms: Severe muscle rigidity, confusion, agitation, increased temperature (104+), pulse and BP
Neuroleptic Malignancy Syndrome (NMS)Interventions Interventions:
- Stop the medication
- Dantrolene (fever reducing agents)
- Cool body to reduce fever
- Maintain hydration with IV fluids
- Treat cardiac dysrhythmias
Psychotic Medications
2nd generation – Affects:
impacts dopamine and serotonin
Psychotic Medications
2nd generation Side effects
weight gain, sexual dysfunction, sedation, GI disturbances
Major considerations: Clozapine (results in agranulocytosis; monitor WBCs)
Somatoform Disorders
Do not have a physiological cause.
somatoform disorders: major kinds
Conversion Disorder
Factitious Disorder
Body Dysmorphic Disorder
Conversion Disorder
(labella indifference… eh I can’t see anymore, cool) Validate not caused by medical issue. Refocus on emotions.
Factitious Disorder
(I’m making myself sick, or someone I care for sick) Consider “Secondary Gains” (what can they get out of someone taking care of them, or taking care of someone)
Types of crises
Situational/external, maturational/internal, and adventitious/out
Situational crisis
External sources such as a job change, motor vehicle crash, death, or severe illness provoke situational crises.
maturational crisis
son leaves for college or fear of upcoming retirement
natural life event
community/adventitious crisis
town hit by tornado
external disaster
Priority concern for a client dealing with crisis
Understand their perception of the crises. Lower levels of anxiety. Focus on safety and not leaving alone. Reducing stimuli. Potentially looking at medication
What are + coping?
+: talk therapy, journaling, aroma therapy, exercise, church, social supports
What are – coping?
-: drug, alcohol, avoidance, denial.
Children/Adolescents · Autism Spectrum Disorder are
- Classified by level of support
- Deficits in social relationships
- Resistance to change- strict adherence to routines/rituals
Treatment modalities for children and adolescents:
Consider mental development, there are different approaches for therapy for this age group.
play therapy
relevant to child’s developmental stage. Allows for opportunities to work through emotions and act out conflicts or stressful situations.
Psychodrama
· the use of dramatic techniques to explore an experience, develop new perspectives, and have an opportunity to try new behaviors. Typically for older children/adolescents.
Therapeutic games
a nonthreatening way to develop rapport and may help children who have difficulties talking about their feelings and problems
Bibliotherapy
the use of children’s books to help express feelings
therapeutic drawing
allows for expression of thoughts, feelings, tensions through artwork
Music therapy
may include the use of music, songs, and instruments to allow for the expression of feelings.
Reporting: Suspected abuse
You don’t have to prove it! If someone is honest and says they’re being abused, you ask if they want to press charges. If they don’t, document and let charge nurse know. Be compassionate or empathetic
Abuse Nursing Interventions
Nonjudgmental approach. Education. Resources
IPV (intimate partner violence)
Abuse such as physical,sexual, threats, psychological or emotional violence towards spouse, BF/GF, same sex or heterosexual
cycles of IPV (intimate partner violence)
tension building
-verbal or mild battery
acute battering
-discharge of tension
reconciliation
-honeymoon phase
Ageism
discrimination due to age
Highest risk of suicide
White men 85 years and older who use firearms as mode of choice
Stages of Grief
denial, anger, bargaining, depression, acceptance
Stage I: Denial
▪ the individual has difficulty believing the loss has occurred. This stage may provide protection from the pain of reality.
Stage II: Anger
This is the stage when reality sets in. Feelings associated with this stage include sadness, guilt, shame, helplessness, and hopelessness. Self-blame or blaming of others may lead to feelings of anger toward the self and others.
Stage III: Bargaining
At this stage in the grief response, the individual attempts to strike a bargain with God for a second chance, or for more time. The person acknowledges the loss, or impending loss, but holds out hope for additional alternatives.
Stage IV: Depression
In this stage, the individual mourns for that which has been or will be lost. This is a very painful stage, during which the individual must confront feelings associated with having lost someone or something of value (called reactive depression). An example might be the individual who is mourning a change in body image. Feelings associated with an impending loss (called preparatory depression) are also confronted.
Stave V: Acceptance
the individual accepts or is resigned to the loss. Methods for coping have been established.
Stages of Grief Nursing Interventions
Give permission to do so. Validate how they feel. Therapeutic communication. Don’t minimize emotions. Fully express. “This must be very difficult; I can’t imagine what you’re going through.”