NURS 214A Examination #2 Guidelines
Your NURS 214A Examination #2 covers chapters from weeks 5 through 9. The specific
chapters are 2, 7, 10, 13, 14, 15, 16, 22, 25, 27, and 28. However, you will need to focus on the
following:
1. Theories & Therapies-There are specific theories guiding nursing interventions in
psychiatric alterations. In psychoanalytic theory, can you differentiate between Id, Ego,
and Superego? Review Erikson theory of psychosocial development. In each of the
milestones what tasks should be accomplished based on age category? What’s operant
conditioning? Does the reward system help in controlling patients’ behaviors? Sullivan’s
term security operations and Freud’s term defense mechanisms. How does Abraham
Maslow’s Hierarchy of Needs theory apply to caring for specific needs of patients? Many
factors lead to mental illness, therefore, as a nurse you cannot believe only in one cause
of mental illness.
2. The Nursing Process & Standards of Care-Nursing assessment is very important in order
to solve problems. History taking is also essential when a patient is brought to the
hospital to receive care. As a nurse you can receive information from whoever brings the
patient, if terribly sick or incoherent. It’s not unusual to hear patient questioning their
own religiosity such as Christianity, Jewish, or Muslim. Whenever this occurs it’s
referred to as spiritual distress. When asking questions during admission and the patient
finds it very sensitive or traumatizing, you as a nurse should not push further on that
question until the time is right, and the patient is strong enough for such a question. It
may be related to rape, divorce, loss of property or job, death of loved one etc.
3. Stress Response & Stress Management-Nurses must understand the importance of coping
in stress management. Talking with friends and attending support groups can make a
difference. What do you understand by stressors? Define what stressor is. How would
you explain the term if asked by your patient? As an individual, you may rate your stress
level low on a scale while your friend’s rate on the scale was on high. The difference in
the rating is usually due to the perception.
4. Bipolar & Related Disorders- Review the signs and symptoms of bipolar disorders. In the
manic phase the patient can have a flight of ideas and grandiosity. In grandiose state
patient can attribute a higher status such as president, king, queen etc. to self. Sleep and
adequate nutrition constitute significant problems. Poor judgment and hyperactivity,
always exceedingly happy (Euphoria) without any reasons. As a nurse you will always
emphasize to a manic patient you are available to help but should not hit or attack anyone
on the unit.
5. Depressive Disorders-Depression is pathological disturbance of mood towards sadness
and pessimism. Fluoxetine or Prozac is a safe prescription on discharge for those with
multiple suicide attempts. Do not encourage the psychiatrist to prescribe Amitriptyline
because it can be lethal in overdose. When taking Fluoxetine patient should report
any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right
away. A depressive patient who becomes angry when asked for any possibility of suicide
is probably planning to self-harm and should be monitored closely. Guilt is a common
accompaniment to depression; therefore, a nurse must take note of this whenever any
patient voice out statement of guilt like “I should have done better for my sister that died
few years ago due to cancer”.
6. Anxiety & Obsessive-Compulsive Disorders- What’s the effect of anxiety on
comprehension? If a patient becomes confused and disoriented due to anxiety, you as a
nurse should stop teaching or educating but only give support. An elderly patient on
Benzodiazepine has a high fall risk. What will be your nursing intervention on the
prescription?
7. Trauma, Stressor-Related & Dissociative Disorders-What are the symptoms of PTSD?
What do you understand by dissociative identity disorder? alters are separate
personalities with their own characteristics that take over during stress. It’s an
unconscious coping mechanism. Dissociative symptoms are not under the person’s
conscious control. Remember that running amok falls under Culture-bound
syndromes that are not dissociative disorders.
8. Substance Use & Addictive Disorders-Define substance use disorders. What is the
antidote for Opioid overdose? What are the signs and symptoms of opioid overdose?
Naltrexone is a very good medication that prevents relapse. Read more about this and
differentiate between Naloxone (Narcan) and Naltrexone. Collaborating with patients is
very important during treatment plan. However, it’s also important to review the patient’s
readiness to change to effect intervention. What are the comorbidities with substance
abuse? Hepatitis C, pancreatitis, diabetes, HIV, and liver cirrhosis. Define tolerance.
9. Suicide & Non-Suicidal Self Injury-Suicide is common among mentally ill patients. Find
out if a patient has access to any intended means of committing suicide. A suicidal patient
on antidepressant for about 5 days then becoming more talkative and fuller of energy is a
red flag that he/she may attempt suicide and hence should be on close watch. As
depression lifts, physical energy becomes available to carry out suicide.
10. Anger, Aggression & Violence -Child, Older Adult & Intimate Partner Violence - The
limbic system, the prefrontal cortex, and neurotransmitters have been implicated in
playing a part in aggression. How do you manage aggressive patient? Safety
considerations for staff include enlisting other staff to be present, keeping a safe distance
from the patient, and approaching the patient in a nonthreatening or nonconfrontational
manner. Pacing and talking to self loudly are precursors to aggression on the units.
Acknowledge what the patient is doing and offer help. Trauma informed care is an
older concept of care used currently to help in violence reduction in disruptive clients.