PSYCHIATRIC NURSING - 1. After the 4 th group meeting, the informal l...

PSYCHIATRIC NURSING

THERAPEUTIC COMMUNICATION TREATMENT MODALITIES:

• After the 4

th group meeting, the informal leader makes a statement that she believes she can help the group more than the assigned facilitator and has better credentials. Identify the group dynamics and stage of development.

• The informal leader is “testing,” which is a behavior indicative of a new group trying

to establish trust. This group is still in the orientation phase of development.

• On an in-patient psychiatric unit, clients are expected to get up at a certain time,

attend breakfast at a certain time, and come for their medication at the correct time. What form of therapy is incorporated into this unit? - Milieu.

• The wife of a man killed in a motor vehicle accident has just arrived at the

emergency room and is told of her husband’s death. What nursing actions are appropriate for dealing with this crisis?

• Take woman to a quiet room, ask her if there are family, friends, or clergy you can

call for her. Assess her need for medication and discuss with physician. Stay with her, be firm and directive, and assess previous successful coping strategies.

• A 10 yr. old is admitted to the children’s unit of the psychiatric facility after

stabbing his sister. His behavior is extremely aggressive with the other children on the unit. Using a behavior mo dification approach with positive reinforcement, design a treatment plan for this child.

• Assess what activities he enjoys. Set up a token system – when he displays non-

aggressive behavior, he earns a token good towards participating in the activity selected. He loses a token when he becomes aggressive.

• The 10 yr. old, his sister, mother, and the mother’s live in boyfriend are asked to

attend a therapy meeting. Who is the “client” that will be treated during this session?

• The entire family.

• A 66 yr. old woman is admitted to the psychiatric unit with agitated depression.

She has not responded to antidepressants in the past. What would be the medical treatment of choice for this client?

• Electroconvulsive therapy (ECT).

• Describe the nurse’s role in preparing clients for electroconvulsive therapy

(ECT).

• Give accurate, non-judgmental information about the treatment. Explore client’s

concerns. Administer the following as ordered: Atropine sulfate to dry oral

secretions, a quick-acting barbiturate to induce anesthesia such as Brevital Sodium, and a muscle relaxant such as Anectine. Check emergency equipment and O2 are available.

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• Describe the nursing interventions used to care for a client during and after

electroconvulsive therapy.

• Maintain patent airway. Check vital signs every 15 minutes until alert. Remain with

client following treatment until conscious. Reorient, if confused.

ANXIETY DISORDERS:

• State 5 autonomic responses to anxiety.
• Shortness of breath, heart palpitations, dizziness, diaphoresis, frequent urination.

• Identify the defense mechanism used by a person who feels guilty about

masturbating as a child, and develops a hand-washing compulsion as an adult.

• Undoing.

• Identify anxiety-reducing strategies the nurse can teach.
• Deep breathing techniques, visualization, relaxation techniques, exercise,

biofeedback.

• Which levels of anxiety facilitate learning?
• Mild to moderate.

• A Vietnam veteran is plagued by nightmares and is found trying to strangle his

roommate one night. List, in order of priority, the appropriate nursing interventions.

• Protect roommate from harm. Stay with client. If the client is agitated, administer

anti-anxiety medications as ordered. Arrange for private room. Place client on homicidal precautions at night.

• A client displays a phobic response to flying. Describe the desensitization

process, which would probably be implemented.

• Talk about planes. Look at pictures of planes. Make plans to accompany client

during a visit to airport. Accompany client into a plane. Allow the client to board a plane alone. Accompany the client on a short flight while listening to a relaxation tape.

• A client is in the middle of an extensive ritual, which focuses on food during

lunch. However, the client is scheduled for group therapy, which is about to start. What action should the nurse take?

• Allow client to complete the ritual. Discuss with the group leader the possibility of

allowing the client to enter the group late. Arrange for client to begin lunch either so that the ritual can be completed prior to scheduled activities.

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SOMATOFORM DISORDERS:

• Describe the difference between primary and secondary gains.
• Primary gain is a decrease in anxiety, which results from some effort made to deal

with stress. Secondary gain is the advantage, other than reduced anxiety, which occurs from the sick role.

• Explain the difference between somatization and hypochondriasis.
• Somatization is used to describe a person who has many recurrent complaints with no

organic basis as opposed to someone with hypochondriasis who has unrealistic or exaggerated that they interfere with social and occupational functioning.

• An air traffic controller suddenly suddenly develops blindness. All physical

findings are negative. The client’s history reveals an increased anxiety about job performance and fear about job security. What type of disorder is this? What purpose is the blindness serving? What nursing interventions are indicated?

• Conversion reaction. Decreases the anxiety about job. Assist with ADL, encourage

expression of anger, teach relaxation techniques, and assist with the identification of anxiety related to job security and performance.

• A 42 yr. old secretary has visited 7 different doctors in the last year with a

complaint of chest pain, heart palpitations, and shortness of breath. She is certain she is having a heart attack in spite of the physician’s reassurance that all tests are normal. What type of disorder is this? What nursing actions are indicated?

• Hypochondriacal disorder. Decrease anxiety, teach relaxation techniques, explore

relationship between the symptoms and past experiences with heart disease. Focus interactions away from bodily concerns.

• Five years ago, a woman was involved in a motor vehicle accident that killed her

friend who was a passenger in the car she was driving. Since that time, she has been unable to work because of sever back pain. The pain in unrelieved by prescribed medications. What type of disorder is this? What are the contributing causes? Describe the nursing care.

• Somatization disorder. Unresolved grief, anxiety. Evaluate pain medication use

and/or abuse. Document duration and intensity of pain. Assist client to identify precipitating factors related to request for medication.

DISSOCIATIVE DISORDERS:

• Describe the difference between psychogenic amnesia and a psychogenic fugue.
• Psychogenic amnesia is the sudden inability to recall certain events in one’s life. A

psychogenic fugue state is characterized by the individual leaving home and being unable to recall their identity or their past.

• What is a multiple personality disorder? https://www.coursehero.com/file/6997666/4-NCLEX-Questions-PSYCHIATRIC-NURSING/

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• Presence of two or more distinct personalities within an individual. The personalities

emerge during stress.

• List 3 possible causes of psychogenic amnesia.
• Traumatic event such as a threat of death or injury, an intolerable life situation, or a

natural disaster.

• Describe depersonalization disorder.
• A temporary loss of one’s reality, a loss of the ability to feel and express emotions, or

a sense of “strangeness” in the surrounding environment. These individuals express a fear of “going crazy.”

PERSONALITY DISORDERS:

• Obsessive-Compulsive Personality = Orderliness, rigid.
• Passive-Aggressive Personality = Passively resistant
• Antisocial Personality = Inability to conform to social norms
• Borderline Personality = Needy, always in a crisis, self-mutilating, unable to sustain

relationships, splitting behavior

• Dependent Personality = Unable to make decisions for self, allows others to assume

responsibility for his/her life.

• Narcissistic Personality = Feelings of self-importance and entitlement. May exploit

others to get own needs met.

• Histrionic Personality = Dramatic, flamboyant, needs to be the center of attention
• Paranoid Personality = Suspicious, shows, mistrust of others, is watchful and

secretive

• Schizoid Personality = Isolated and introverted, has no close friends
• Maladaptive Personality = Does not think anything he/she does is wrong, e.g.,

authorities are “out to get them.”

EATING DISORDERS:

• Describe the clinical symptoms of anorexia nervosa.
• weight loss of at least 15% of ideal/original body weight; hair loss; dry skin; irregular

heart rate; decreased pulse; decreased blood pressure; Amenorrhea; dehydration; electrolyte imbalance.

• State 2 psychodynamic differences between anorexia and bulimia.
• Anorexia nervosa deals with issues of control and a struggle between dependence and

independence. Bulimia deals with loss of control (Binge eating) and guilt (purging).

• An anorectic client has her friend bring her several cookbooks so she can plan a

party when she is discharged. What nursing intervention is appropriate in addressing this behavior? https://www.coursehero.com/file/6997666/4-NCLEX-Questions-PSYCHIATRIC-NURSING/ This study resource was shared via CourseHero.com