Summer 2022 Page 1 of 3 NURS 4411 Exam 2 Focused Review Mental Health
Nursing
Exam 2 Focused Review
1. Describe a Mental Status Examination: Cognitive and intellectual abilities
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Assess clients orientation to time, person,and place.
○ Assess clients memory, recent and remote.
■ Immediate- ask client to repeat series of numbers or a list of
objects
■ Recent- ask client to recall recent events, like what happen that
week, why they are here for a vist.
■ Remote- a fact from their past that is verifiable with ex. DOB,
mothers maiden name.
■ Pg. 4 ati.
2. Define therapeutic communication skills and nurse/client relationship.
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Words and actions that help achieve health related goals. Some techniques
are
○ Silence, active listening, clarifying techniques, questions.
○ Open ended questions to help clients express feelings of anxiety, and to
validate and to acknowledge those feelings.
3. Differentiate between transference and countertransference
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Transference-pt putting feelings onto the nurse
Countertransference- nurse putting personal feelings onto the pt.
4. Describe client rights to privacy
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Ati pg. 9
Protected by HIPAA
Understand federal and state laws related to confidentiality
Only share information with those who are responsible for implementing the
client’s treatment plan
Do not discuss in public places, no social media
Only if the client provides consent should the nurse share information with
other persons not involved in the treatment
Confidentiality can be broken to warn and protect third parties, and the
reporting of child and vulnerable adult abuse
If the nurse becomes aware that a client’s right to privacy is being violated,
for example, if a conversation in the elevator is overheard, they should
immediately take action to stop the violation.
5. Differentiate between types and criteria for admissions to a mental health
facility.
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Pg. 10 ati
Informal admission- least restrictive form of admission for treatment. Client does
not pose a substantial threat to self or others. Client is free to leave the hospital at
any time. Even against medical advice.
voluntary admission- client or guardian chooses admission to a mental health
facility in order to obtain treatment. Client is considered competent so has the right
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to refuse medication and treatment
Temporary emergency admission- client admitted to emergency mental health
care due to the inability to make decisions regarding care. Medical health providers
can initiate the admission which is then evaluated by a mental health care provider.
Length of temporary admission varies by clients need and state laws but often not to
exceed 15 days.
Involuntary admission- client enters a mental health care facility against their will
for an indefinite period of time. Admission is based on the need for psychiatric
treatment, the risk of harm to self or others, or inability to provide self care.
6. Define and describe the 4 levels of anxiety. Ati. pg. 21
a. Mild- occurs in normal experience in everyday living.
Increases ability to perceive reality
Vague feeling of mild discomfort, restlessness, irritability, impatience,
apprehension.
Ex. finger or foot tapping, fidgeting, lip chewing.
b. Moderate- occurs when mild anxiety escalates
Slight reduction of perception and processing of information occurs, and selective
inattention can occur.
Ability to think clearly is hampered, learning and problem solving still occur.
Concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors,
shakiness, and increased heart rate, and RR.
Client can report somatic manifestations of headache, backache, urinary urgency
and frequency, and insominia.
c. Severe- perception field is greatly reduced with distorted perceptions
Learning and problem solving do not occur.
Functioning is effective: behaviors are automatic.
Characteristics include confusion, feeling of impeding doom, hyperventilation,
tachycardia, withdrawal, loud and rapid speech, aimless activity.
Usually not able to take directions from others.
d. Panic- characterized by markedly distorted behavior.
Client is not able to process what is occurring in the environment and can lose
touch with reality.
Express extreme fright and horror
Severe hyperactivity, flight or immobility.
Can include dysfunction in speech, dilated pupils, severe shakiness, severe
withdrawal, inability to sleep, delusions and hallucinations.
7. Define and describe defense mechanisms. Pg 20
When the ego develops defenses to ward off anxiety by preventing conscious awareness
of threatening feelings. They share two common features they all (exexpt supression)
operate on an unconscious level and they deny, falsify or distory reality to make it less
threatening.
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Adaptive and maladaptive defense mechanisms.
Altruism and sublimation are healthy
8. Define and give examples of the following:
a) Suppression- voluntary denying unpleasant thoughts or feelings.
Adaptive use: a student puts off thinking about a fight they had with a friend so
they can focus on a test.
Maladaptive use: a person who has lost their job states they will worry about
paying bills next week
b) Repression- unconsciously putting unacceptable ideas, thoughts and
emotions out of awareness.
AU: person preparing to give a speech unconsciously forgets about the time
when they were young and kids laughed at them while they were on stage.
MU: a person who has a fear of the dentist keeps forgets to go to their dental
appt.
c) Regression- sudden use of childlike or primitive behaviors that do not
correlate w/ the person's current developmental level.
AU: young child temporarily wet the bed when they learned that their pet died.
MU: a person who has a disagreement with their coworker begins throwing things
at their office.
d) Displacement- shifting feelings related to an obj, person or situation, to
another less threatening person obj or situation.
AU: adolescent angrily punches a punching bag after losing a game.
MU: person who is angry about losing their job, destroys childs favorite toy.
e) Reaction formation- unacceptable feelings or behaviors controlled or kept
out of awareness by overcompensating or demonstrating. Overcompensating or
demonstrating the opp behavior of what is felt.
Au: person who tries to quit smoking repeatedly talks to adolescents about the
dangers of nicotine.
MU: person who resents having to care for an aging parent becomes
overprotective and restricts their freedom.
f) Undoing- performing an act to make up for for prior behavior ( most
commonly seen in children)
AU: adolescents completes their chores without having to be promoted after
having an argument with their parent.
MU: ind buys significant other flowers or a gift after an incident of partner abuse.
g) Rationalization- creating reasonable and acceptable explanations for
unacceptable behavior.
AU: adolescent says “ they must already have a bf” when rejected by another
adolescent.
MU: young adult explains they had to drive home drunk after a party to feed the
dog.
h) Dissociation- disruption in consciousness, memory, identity or perception of
the environment that results in compartmentalization of uncomfortable or
unpleasant aspects of oneself.
AU: parent blocks out the distracting noise of their children in order to focus while
driving in traffic.
MU: a person forgets who they are, following a sexual assault.
i) Denial - pretending the truth is not reality to manage unpleasant anxiety,
causing thoughts or feelings.
Au: a person initially says “ no that can't be true” when told they have cancer.
MU: a parent who was informed that their child was killed in combat tells
everyone one month later that the child is coming home for the holidays.
j) Compensation- emphasizing strengths to make up for weaknesses.
AU: adolescent who is unable to play contact sports excels in academic
competitions.
MU: a person who is shy learns computer skills to avoid socialization.
k) Identification- conscious or unconscious assumption of the characteristics of
another ind or Group.
AU: a child who has a chronic illness pretends to be a nurse for their dolls.
MU: a child who observes their parent be abusive toward the other parent
becomes a bully at school.
l) Intellectualization - separation of emotions and logical facts when analyzing
or coping with a situation or event.
AU: law enforcement officer blocks out the emotional aspect of a crime so they
can objectively focus on the investigation.
MU: a person who learns they have a terminal illness focuses on creating a will
and financial matters rather than acknowledging their grief.
m) Conversion- responding to stress through the unconscious development of
physical manifestations not caused by a physical illness.
AU: none
MU: a person experiencing deafness when their partner tells them that they want
a divorce.
n) Splitting- demonstrating an inability to reconcile neg and pos attributes of
self or others into a cohesive image.
AU: none
MU: a client tells a nurse that the nurse is the only one who cares about them,
yet the following day, the client refuses to talk to that nurse.
o) Projection- attributing ones unacceptable thoughts and feelings onto another
who does not have them.
AU: none
MU: married client who is attracted to another person accuses their partner of
having an extramarital affair.
9. Compare and contrast Posttraumatic Stress Disorder (PTSD), Acute Stress
Disorder (ASD), Adjustment disorder and Dissociative disorders. Pg.
61-63 ati
PTSD: exposure to traumatic events causes anxiety, detachment, and other
manifestations about the event for longer than 1 month following the event.
Manifestations can last for years.
ASD: exposure to traumatic events causes anxiety; detachment and other
manifestations about the event for atleast 3 days but for no more than 1 month
following the event.
Adjustment disorder: a stressor triggers a reaction causing changes in mood and /
or dysfunction in performing usual activities. The stressor and effects are less
severe than with ASD or PTSD.
Dissociative disorder:
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depersonalization/derealization disorder- temporary changes in awareness
displaying depersonalization and derealization, or both in response to stress.
Depersonalization is the feeling that a person is observing ones own personality or
body from a distance. Derealization is the feeling that outside events are unreal or
part of a dream, or that objects appear larger or smaller than they should.
Dissociative amnesia- inability to recall personal information related to
traumatic or stressful events. The amnesia can be of events of a certain period of
time or just certain details.
Dissociative fugue-dissociative amnesia in which the client travels to a new area
and is unable to remember ones own identity and atleast some of ones past. Can
last weeks to months and usually follows a traumatic event.
DID- client displays more than one distinct personality, with a stressful event
precipitating the change from one personality to another.
10. Describe the patient-centered care for ASD, PTSD, adjustment
disorder, and dissociative disorders. Ati pg. 62
ASD, PTSD, ADJUSTMENT DISORDER
Establish a theraputic relationship and encourage client to share feelings.
Provide safe non threatening routine env. Asses pt for suicidal ideations, and
take precautions as needed. Use multiple strategies to decrease anxiety like
music therapy, guided imagery, massage, relaxation therapy, breathing
techniques.
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ASD, TPDS, and adjustment disorder:
○ Establish a therapeutic relationship, and encourage the client to share feelings
○ Provide a safe, nonthreatening, routine environment
○ Assess clients for suicidal ideation, and take precautions as needed
○ Use multiple strategies to decrease anxiety (music, guided imagery, massage,
relaxation, breathing)
○ If the client is a child, involve caregivers in treatment if possible, and use play,
art, and other age-appropriate strategies to decrease stress.
Dissociative disorders
○ During dissociative periods, helpt the client make decisions to lower stress
○ When the client shows readiness, encourage independence and decision
making
○ Use grounding techniques (having the client clap hands or touch an object)
○ Avoid giving the client too much information about past events to prevent
increased stress
11. Define the following psychotherapy and behavioral therapies: ati pg. 59 ch
2 book
a) Cognitive behavioral therapy - anxiety response can be decreased by
changing cognitive distortions. Uses cognitive reframing to help the client identify
negative thoughts that produce anxiety, examine the cause, and develop
supportive ideas that replace negative self talk.
b) Relaxation training- used to control pain, tension and anxiety.
c) Modeling techniques - allows client to see a demonstration of
appropriateness in a stressful situation. Goal of therapy is that the client will
imitate the behavior.
d) Operant conditioning a method of learning that occurs through rewards and
punishment for voluntary behavior.
e) Systemic desensitization - involves the development of behavior tasks
customized to the pts specific fears. These tasks are presented to the pt while
using learned relaxation techniques.
f) Aversion therapy- used to treat behaviors such as alcoholism, paraphilic
disorders, shoplifting, violent and aggresive haviors and self mutilation, it is the
pairing of a negative stimulus with a specific target behavior therefor suppressing
the behavior. Example: painting foul tasting substance on nails to prevent nail
biting, using chemicals that induce nausea/vomiting, odors
g) Flooding- exposing client to a great deal of undesirable stimulus in an
attempt to turnoff the anxiety response. Useful for clients who have phobias
h) Response prevention - focuses on preventing the client from performing a
compulsive behavior w/ intent that anxiety will diminish.
i) Thought stopping- teach client to say “stop” when negative thoughts or
compulsive behavior arise.
12. What are the pharmacotherapy options for treating Panic Disorder, GAD, PTSD,
and OCD? Ati pg.115
Panic disorder13. What are the therapeutic counseling modality options for treating Panic
Disorder, GAD, PTSD, and OCD?
14. Know major medications used to treat anxiety disorders:
Summer 2022 Page 2 of 3 NURS 4411 Exam 2 Focused Review Mental Health
Nursing
a. Benzodiazepine sedative hypnotic anxiolytics: lorazepam, alprazolam,
clonazepam, diazepam
b. Atypical anxiolytic/nonbarbiturate anxiolytics: buspirone
c. Selected antidepressants: beta blocker, propranolol.
15. What are the common characteristics for all personality disorders?
inflexibility/ maladaptive responses to stress.
Compulsiveness and lack of social restraint.
Inability to emotionally connect in social and professional relationships.
Tendency to provoke interpersonal conflict.
16. Name and describe the personality disorders in:
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Cluster A- (Odd or eccentric traits)
○ Paranoid: Characterized by distrust and suspiciousness toward others based
on unfounded beliefs that others want to harm, exploit, or deceive the person
○ Schizoid: Characterized by emotional detachment, disinterest in close
relationships, and indifference to praise or criticism; often uncooperative.
○ Schizotypal: Chacaterized by odd beliefs leading to interpersonal difficulties,
an exxentric appearance, and magical thinking or perceptual distortions that
are not clear delusions or hallucinations.
Cluster B- (Dramatic, emotional, or erratic)
○ Antisocial: Characterized by disregard for others with exploitation, lack of
empathy, repeated unlawful actions, deceit, failure to accept personal
responsibility; evidence of conduct disorder before age 15, sense of
entitlement, manipulative, impulsive, and seductive behaviors; nonadherenece
to traditional morals and values; verbally charming and engaging.
○ Borderline: Characterized by instability of affect, identity, and relationships,
as well as splitting behaviors, manipulation, impulsiveness, and fear of
abandonment; often self-injurious and potentially suicidal; ideas of reference
are common; often accompanied by impulsivity.
○ Histrionic: Characterized by emotional attention-seeking behavior, in which
the person needs to be the center of attention; often seductive and flirtatious.
○ Narcissistic: Characterized by arrogance, grandiose views of self-importance,
the need for consistent admiration, and lack of empathy for others that strains
most relationships; often sensitive to criticism.
Cluster C- (Anxious or fearful; insecurity and inadequacy)
○ Avoidant: Characterized by social inhibition and voidance of all situations that
require interpersonal contact, despite wanting close relationships, due to
extreme fear of rejection; having feeling of inadequacy and are anxious in
social situation.
○ Dependent: Characterized by extreme dependency in a close relationship
with an urgen search to find a replacement when one relationship ends
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Obsessive-Compulsive: Characterized by indecisiveness and perfectionism
with a focus on orderliness and control to the extent that the individual might
not be able to accomplish a given task
17. Describe nursing interventions for personality disorders
ch . 16 ati
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Self-assessment is vital for nurses caring for clients who have personality disorders
and should be performed prior to care.
○ Clients who have personality disorders can evoke intense emotions in the
nurse.
○ Awareness of personal reactions to stress promotes effective nursing care.
○ Therapeutic communication and intervention are promoted when client
behaviors are anticipated.
○ The nurse should repeat the self-assessment if experiencing a personal stress
response to client behavior.
Milieu management focuses on appropriate social interaction within a group context.
Safety is always a priority concern because some clients who have a personality
disorder are at risk for self-injury or violence.
18. Define and describe substance withdrawal.
When the concentration of the substance is in the blood stream declines and experiences
physiologic adverse effects.
19. Define and describe tolerance.
Tolerance occurs when the client requires an increased amount of the substance to
achieve the desired effect.
20. What are the overall guidelines for nursing interventions for substance
abuse?
21. Know the following drugs used to treat substance abuse disorders:
a. Disulfiram- Alcohol abstinence
b. Naltrexone- Alcohol withdrawal + abstinence
c. Acamprosate- Alcohol abstinence
d. Methadone substitution- Opioid withdrawal
e. Clonidine- opioid withdrawal
f. Buprenorphine- opioid withdrawal
g. Bupropion- Nicotine withdrawal
h. Vareniclin-Nicotine abstinence
22. Define and describe suicide.
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Suicide is the intentional acto of killing oneself.
Suicidal ideation occurs when a client is having thought about committing suicide.
Clients can have feelings of hopelessness, helplessness and inner pain.
23. Define and describe suicide risk factors for older adult clients.
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Untreated depression
Loss of employment and finances
Feelings of isolation and powerlessness
Prior attempts at suicide ( older adult clients are more liekly to succeed)
Change in functional ability
Declining physical health
Alcohol or other substance use disorders
Loss of loved ones
24. Describe the four assessment guidelines for suicide.
Pg 178 ati
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BIOLOGICAL FACTORS
○ Family history of suicide
○ Physical disorders (AIDS, cancer, cardiovascular disease, stroke, chronic
kidney disease, cirrhosis, demntia, epilepsy, head injury, Huntington’s disease,
and multiple sclerosis)
PSYCHOSOCIAL FACTORS
○ Sense of hopelessness
○ Intense emotions (rage, anger, or guilt)
○ Poor interpersonal relationships at home, school, and work
○ Developmental stressors, such as those experienced by adolescents
○ History of trauma/abuse
CULTURAL FACTORS
○ American Indian and Alakan Native ethnic groups have the highest rate of
suicide
ENVIRONMENTAL FACTORS
○ Access to lethal methods, such as firearms
○ Lack of access to adequate mental health care
○ Unemployment
25. Describe the presenting signs and symptoms of suicide behavior. (p. 177)
● Assess verbal and nonverbal clues.
● Suicidal comments usually are made to someone that the client perceives as
supportive.
● Comments can be:
○ Overt: “There is just no reason for me to go on living.”
○ Covert: “Everything is looking pretty grim for me.”
● A sudden change in mood from sad and depressed to happy and peaceful can indicate
a client’s intention to commit suicide.
● Physical Assessment Findings: Lacerations, scratches, and scars that could indicate
previous attempts at self-harm.
26. Describe the overall nursing interventions for suicide precautions. (p. 178)
● Suicide precautions include milieu therapy within the facility.
○ Initiate one-on-one constant supervision around the clock, always having the
client in sight and close. Documentation should indicate which staff member is
accountable for the client, with specific start and stop times. There is an
increased risk for suicide during staff rotation times.
○ Document the client’s location, mood, quoted statements, and behavior every
15 minutes or per facility protocol.
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Search the client’s belongings with the client present. Remove all glass, metal
silverware, electrical cords, vases, belts, shoelaces, metal nail files, tweezers,
matches, razors, perfume, shampoo, plastic bags, and other potentially
harmful items from the client’s room and vicinity.
Allow the client to use only plastic eating utensils. Count utensils when
brought into and out of the client’s room.
Check the environment for possible hazards (windows that open, overhead
pipes that are easily accessible, non-breakaway shower rods, non-recessed
shower nozzles.
Ensure that the client’s hands are always visible, even when sleeping.
Do not assign to a private room and keep the door open at all times.
Ensure that the client swallows all medications. Clients can try to hard
medication until there is enough for a suicide attempt.
Identify whether the client’s current medications can be lethal with exceeding
the prescribed dose. If so, collaborate with the provider to have less
dangerous medications substituted, if possible.
Restrict visitors from bringing possibly harmful items to the client.
27. Define and describe no-suicide or no-harm contract and
one-on-one supervision. (p. 179)
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A verbal or written agreement is made to not harm themselves, but instead, seek
help.
○ A no-suicide contract is not legally binding and should only be used according
to facility policy.
○ A no-suicide contract can be beneficial, but it should not replace other suicide
prevention strategies.
○ A no-suicide contract can be used as a tool to develop and maintain trust
between the nurse and the client.
○ A no-suicide contract is discouraged for clients who are in crisis, under the
influence of substances, psychotic, very impulsive, and/or very
angry/agitated.
28. Name the common drugs in the following classes: SSRI’s, SNRI’s,
TCA’s and MAOI’s
TCAs- amitriptyline, imipramine, doxipine, amoxapine, nortriptyline,
trimipramine
MAOIs- isocarboxazid, phenelzine
SNRIs- venlafaxine, duloxetine, desvenlafaxine
SSRIs-,fluoxetine, fluvoxamine, escitalopram, sertraline, paroxetine
29. Describe two criteria for the use of seclusion or restraint over
verbal intervention.
Use restraints only after less restrictive interventions have failed.
30. Describe factors and influences contributing to child and adolescent
mental disorders, and develop intervention strategies for these young
clients.
● Genetic links or chromosomal abnormalities- are associated with some disorders
(schizophrenia, bipolar disorder, autism spectrum disorder, ADHD, and intellectual
developmental disorder).
● Biochemical- Alterations in neurotransmitters, including norepinephrine, serotonin,
or dopamine, contribute to some mental health disorders.
● Social and environmental- Severe marital discord, low socioeconomic status, large
families, overcrowding, parental criminality, substance use disorders, maternal
psychiatric disorders, parental depression, and foster care placement are all risk
factors.
● Cultural and ethnic- Difficulty with assimilation, lack of cultural role models, and
lack of support from the dominant culture can contribute to mental health issues.
● Resiliency- The ability to adapt to changes in the environment, form nurturing
relationships, exhibit effective coping strategies, and use problem-solving skills can
help an at-risk child avoid the development of a mental health disorder.
● Witnessing or experiencing traumatic events- (physical or sexual abuse) during
the formative years are risk factors.
31. Identify characteristics of mental health and positive youth
development in children and adolescents.
● Ability to appropriately interpret reality, as well as having a correct perception of the
surrounding environment
● Positive self-concept
● Ability to cope with stress and anxiety in an age-appropriate way
● Mastery of developmental tasks
● Ability to express oneself spontaneously and creatively
● Ability to develop and maintain satisfying relationships
32. Compare and contrast at least six treatment modalities for children and
adolescents.
● Pharmacological therapy
● Family therapy
● Cognitive-behavioral therapy
● Grief and trauma intervention (GTI)
● Group therapy
● Play or music therapy
● Mutual storytelling
33. Describe clinical features and behaviors of at least three child and
adolescent psychiatric disorders.
● Separation anxiety disorder
○ This type of disorder is characterized by excessive anxiety when a child is
separated from or anticipating separation from home or parents that is
developmentally inappropriate. The anxiety can develop into a school phobia
or phobia of being left alone. Depression is also common.
○ Anxiety can develop after a specific stressor (death of a relative or pet, illness,
move, assault).
○ Anxiety can progress to a panic disorder or type of phobia.
● Posttraumatic stress disorder
○ PTSD is precipitated by experiencing, witnessing, or learning of a traumatic
event.
○ Children and adolescents who have PTSD exhibit psychological indications of
anxiety, depression, phobia, or conversion reactions.
If the anxiety resulting from PTSD is displayed externally, it is often
manifested as irritability and aggression with family and friends, poor
academic performance, somatic reports, belief that life will be short, and
difficulty sleeping.
○ Small children can show a decrease in play or engage in play that involves
aspects of the traumatic events.
Intellectual developmental disorder
○ Clients who have intellectual developmental disorder have an onset of deficits
and impairments during the developmental period of infancy or childhood.
○ The client has intellectual deficits with mental abilities (reasoning, abstract
thinking, academic learning, learning from prior experiences).
○ Clients demonstrate impaired ability to maintain personal independence and
social responsibility, including activities of daily living, social participation, and
the need for ongoing support at school.
○ Deficits in the disorder range from mild to severe.
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34. Define the following:
a. adjustment disorder- a stressor triggers a rxn causing changes in mood or
dysfunction causing changes in mood/ or dysfunction outperforming usual activities.
Stressor and effects are less severe than with ASD or PTSD.
b. attention deficit hyperactivity disorder (ADHD): Inability of a person to
control behaviors requiring sustained attention.
c. conduct disorder: Behavioral problems, comorbid disorders like ADHD,
depression, anxiety, substance use disorder
d. oppositional defiant disorder: Recurrent pattern of negativity, disobedience,
hostility, defiance, stubbornness, argumentativeness, limit testing, unwillingness to
compromise, refusal to accept responsibility for misbehavior
e. separation anxiety disorder: characterized by excessive anxiety when a child is
separated from or anticipating separation from home or parents that is
developmentally inappropriate.
f. pervasive developmental disorder (PDD):
g. posttraumatic stress disorder (PTSD): Precipitated by experiencing,
witnessing, or learning of a traumatic event.
h. principle of least restrictive intervention:
i. disruptive mood dysregulation disorder: clients exhibit recurrent temper
outbursts that are severe and do not correlate with situation
j. intermittent explosive disorder: Exhibit recurrent episodic violent and
aggressive behavior with the possibility of hurting people, property, or animals.
k. autism spectrum disorder: a complex neurodevelopmental disorder thought to
be of genetic origin with a wide spectrum of behaviors affecting an individual’s ability
to communicate and interact with others. Cognitive and language is delayed. Inability
to maintain eye contact, repetitive actions, and strict observance of routines.
l. intellectual development disorder: Clients have an onset of deficits and
impairments during the developmental period of infancy or childhood.
m. resilience: The ability to adapt to changes in the environment, form nurturing
relationships, exhibit effective coping strategies, and use problem-solving skills can
help an at-risk child avoid the development of a mental health disorder.
35. Name and describe the common stimulant medication used to
treat ADHD.
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(P. 169)
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Methylphenidate and amphetamine salts: Psychostimulant drugs.
36. Name and describe the common non-stimulant medication
used to treat ADHD.
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(p. 169)
Atomoxetine: non-stimulant selective norepinephrine reuptake inhibitor
37. Name and describe the common types of psychotherapy used to treat
children with ADHD, bipolar, and depression.
38. Review your common (prototype) SSRI’s, Tricyclics, MAOI’s, Anxiolytics,
typical and atypical antipsychotics, lithium, and anticonvulsants used to treat
children with mental illness.
39. Differentiate symptoms and treatment for dissociative disorders.
40. Describe the behaviors shown in bipolar disorders and the
phases of the disease.
Pg. 73
Phases:
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Acute Phase
○ Hospitalization can be required.
○ Reduction of mania and client safety are the goals of treatment.
○ Rist of harm to self or others is determineds.
○ One-to-one supervision can be indicated for client safety.
Continuation phase
○ Treatment is generally 4-9 months in duration.
○ Relapse prevention through educations, medication adherence, and
psychotherapy is the goal of treatment.
Maintenance phase
○ Treatment generally continues throughout the client’s lifetime.
○ Prevention of future manic episodes is the goal of treatment.
Behaviors:
● MANIA: An abnormally elevated mood, which can also be described as expansive or
irritable; usually requires hospitalization. Manic episodes last at least 1 week.
● HYPMOMANIA: A less sever episode of mania that lasts at lest 4 days accompanied
by three or more manifestations of mania. Hopsitalization is not required, and the
client who has hypomania is less impaired. Hypomania can progress to mania.
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RAPID CYCLING: Four or more episodes of hypomania or acute mania within 1 year
and associated with increase recurrence rate and resistance to treatment.
41. Differentiate between manic and depressive characteristics of
bipolar disorders. ( ati pg. 74)
- Manic characteristics: agitation, irritable, restlessness, flight of ideas,
rapid and continuous speech with sudden and frequent topic change,
grandiose view of self and abilities, impulsive, demanding and
manipulative, distractiability, poor judgement, attention seeking,
inappropriate behavior, decreased sleep, neglect of ADLs including
nutrition and hydration, possible presence of delusions and
hallucinations, denial of illness.
- Depressive characterisitcs: flat, blunt, labile affect, tearfulness,
crying, lack of energy, anhendonia: loss of pleasure and lack of interest
in activities, hobbies and sexual activity, physical reports of
discomfort/pain, difficulty concentrating, focusingm problem solving,
self destructive behavior, including suicidal idealtion, decrease in
personal hygiene, loss or increase in appetite and/or sleep, disturbed
sleep, psychomotor retardation or agitation.
42. Describe three types of bipolar disorders.
Pg.73
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Bipolar I Disorder: The client has at least one episode of mania alternating with
major depression.
Bipolar II Disorder: The client has one or more hypomanic episodes alternating
with major depressive episodes.
Cyclothymic Disorder: The client has at least 2 years of repeated hypomanic
manifestations that do not meet the criteria for hypomanic episodes alternating with
minor depressive episodes.
43. Review medications used to treat bipolar disorders (mechanism of
action/ side effects/ precautions)
A. Mood stabilizer: Lithium carbonate - Anticonvulsants that act as mood stabilizers:
valproate and carbamazepine treat acute mania; lamotrigine is used for maintenance
therapy in bipolar mania.
B. Antiepileptic medications: valproic acid, carbamazepine, lamotrigine, oxcarbazepine,
topiramate- Anticonvulsants that act as mood stabilizers: valproate and
carbamazepine treat acute mania; lamotrigine is used for maintenance therapy in
bipolar mania.
44. Review medication dosage calculation for oral medication administration.
45. Describe the differences between delirium and neurocognitive
disorder (dementia).
Pg.88 ati
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Delirium:
○ ONSET: Rapid over a short period of time (hours to days)
○ MANIFESTATIONS: Impairments in memory, judgment, ability to focus, and
ability to calculate, which can fluctuate throughout the day. Disorientation and
confusion often worse at night and early morning.
○ LOC is usually altered and can rapidly fluctuate.
○ 4 Types:
■ Hyperactive with agitation and restlessness
■ Hypoactive with apathy and quietness
■ Mixed, having a combination of hyper and hypo manifestations
■ Unclassified for those whose manifestations to not classify into the
other categories
○ Restlessness, anxiety, motor agitation, and fluctuating moods are common.
Personality change is rapid.
○ Some perceptual disturbances can be present, such as hallucinations and
illusions.
○ Change in reality can cause fear, panic, and anger.
○ Can cause vital signs to become unstable requiring interventions.
○ Should be considered a medical emergency.
○ CAUSE: Often associated with hospitalization of older adult clients.
○ Medical conditions (infection) malnutruition, depression, electorlyte imbalance
or substance use.
○ Surgery, often secondary to withdrawal from illegal substances or alcohol, or
impaired respiratory function.
○ OUTCOME: Reversible if diagnosis and treatment of underlying cause are
prompt.
Neurocognitive Disorder
○ ONSET: Gradual deterioration of function over months or years.
○ MANIFESTATIONS: Impairments in memory, judgment, speech (aphasia),
ability to recognize familiar objects (agnosia), executive functioning
(managing daily tasks), and movement (apraxia); impairments do not change
throughout the day.
○ LOC is usually unchanged.
○ Restlessness and agitation are common; sundowning can occur.
○ Personality change is gradual.
○ Vital signs are stable unless other illness is present.
○ CAUSE: Cognitive deficits are not related to another mental health disorder.
○ Advanced age is the primary risk factor. Other causes include genetics,
sedentary lifestyle, metabolic syndrome, and diabetes mellitus.
○ Subtypes of neurocognitive disorder can be related to:
■ Alzheimer’s disease
■ Traumatic brain injury
■ Parkinson’s disease
■ Other disorders affecting eht neurologic system
○ OUTCOME: Irreversible and progressive.
46. Name and describe the stages of Alzheimer’s disease. Pg438
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Mild alzheimers disease (early stage): the person and their loved
ones notice memory lapses. Still may be able to function independently
but may experience difficulty retrieving correct words, names previously
known. Trouble with names when introduced to new people, greater
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difficulty performing tasks in social or work settings, forgetting material
that was just read, losing/misplacing valuable objects, trouble planning or
organizing.
Moderate Alzheimers disease (middle stage): the person confuses
words, gets frustrated or angry, or acts in unexpected ways such as
refusing to bathe. Symptoms become noticable to thers abd the person
may forget events or own personal history, become moody or withdrawn,
especially in social or mentally challenging situations, unable to recall own
address or phone number or high school/college they attended, confused
on where they are or datem need help choosing proper clothing for
season/occasion, trouble controlling bowels/bladder, change sleep pattern
such as sleeping during the day and becoming restless at night, be at risk
for wandering and becoming lost, become suspicious and delusional or
compulsive, for example repetitive behavior like hand wringing or tissue
shredding
Severe Alzheimers disease (late stage): the person loses the ability to
respond to their environment to carry on conversations and eventually to
control movement. They may still say words or phrases but
communicating pain becomes difficult. Personality changes may take place
and individuals need extensive help with ADLs. the person may require
full time assistance with ADLs, lose awareness of recent experiences and
of their surroundings, experience changes in physical abilities including
ability to walk, sit and eventually swallow, have increased difficulty
communicating, become vulnerable to infections especially pnenomina
47. Describe the defense mechanisms manifested by clients experiencing
cognitive changes.
Pg.87
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Denial: Both the client and family members can refuse to believe that changes (loss
of memory) are taking place, even when those changes are obvious to others.
Confabulation: The client can make up sotries when questioned about events or
activities that they do not remember. This can seem like lying, but it is actually an
unconscious attempt to save self-esteem and prevent admitting the inablitiy to
remember the occasion.
Perseveration: The client avoids answering questions by repeating phrases or
behavior. This is another unconscious attempt to maintain self-esteem when memory
has failed.
48. Identify home safety measures for the client experiencing
neurocognitive disorders.
Pg.90
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Remove scatter rugs.
Install door locks that cannot be easily opened.
Lock water heater thermostat and turn water temperature down to a safe level.
Provide good lighting, especially on stairs.
Install a handrail on stairs, and mark step edges with colored tap.
Place mattresses on the floor.
Remove clutter, keeping clear, wide pathways for walking through a room.
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Secure electrical cords to baseboards.
Store cleaning supplies in locked cupboards.
Install handrails in bathrooms.
49. Describe the appropriate nursing communication measures for the
client experiencing neurocognitive disorders.
Pg. 89
● Communicate in a calm, reassuring tone.
● Speak in positively worded phrases. Do not argue or question hallucinations or
delusions.
● Reinforce reality.
● Reinforce orientation to time, place, and person.
● Introduce self to client with each new contact.
● Establish eye contact and use short, simple sentences when speaking to the client.
Focus on one item of information at a time.
● Encourage reminiscence about happy times. Talk about familiar things.
● Break instructions and activities into short time frames.
● Limit the number of choices when dressing or eating.
● Minimize the need for decision-making and abstract thinking to avoid frustration.
● Avoid confrontation.
● Approach slowly and from the front. Address the client by name.
● Encourage family visitation as appropriate.