NUR3525-Mental Health
Exam 3: Roadmap to Success
Chapters 4, 12-19, & 26
Spring 2022-Dr. McCloud
1. Reminder: Every interaction is an opportunity for therapeutic intervention.
2. Group therapy provides the opportunity to learn and practice new coping skills.
3. The therapeutic community provides a structured schedule of activities in which interpersonal
interaction and communication with others are emphasized. In the milieu, time is also devoted to
personal problems and focus groups. Structured programming is often missing in the home
environment.
4. The milieu manager should search newly admitted clients for hazardous objects. Safety of the client
and others is the priority. Nurses are responsible for ensuring that the client’s safety and physiological
needs are met within the milieu.
5. Nurses are responsible for the management of medication administration on inpatient psychiatric
units; however, nurses must work with clients to foster independence and provide experiences that
would foster increased self-esteem.
6. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or
inability to assume personal responsibility.
7. A client expressing thoughts of harming himself or herself is at risk for harm and experiencing a
psychiatric emergency. The nurse’s priority is the client’s safety. The nurse must assess the client for risk
of harm and provide appropriate interventions.
8. Setting firm limits communicates which behaviors are acceptable and those that are not. Delineating
consequences of behavior increases the client’s awareness of the impact of actions and encourages the
client to take responsibility for feelings.
9. Maintaining a calm demeanor reduces client’s anxiety and encourages a sense of safety.
10. Assertiveness training assists people with maintaining their own self-respect and meeting their
needs while respecting the rights of others.
11. An individual displaying nonassertive (sometimes called passive) behavior seeks to please others at
the expense of his or her own basic human rights.
12. Individuals who demonstrate assertive behavior stand up for their own rights while protecting the
rights of others. Feelings are expressed openly and honestly.
13. Responding as a “broken record,” which involves persistently repeating in a calm voice what is
wanted.
14. Self-esteem refers to the degree of regard or respect that individuals have for themselves and is a
measure of worth that they place on their abilities and judgments. Many factors influence the
development of self-esteem over a person’s life span.
15. Review: Erikson’s stage of intimacy versus isolation. Erikson’s stages of development are assessed
by chronological age, not task achievement.
16. Self-esteem, not self-concept, is the degree of regard that individuals have for themselves. This
student statement indicates a need for further teaching.
17. Reminder: Safety of the client and of others is the priority over physical and social needs.
18. Valproic acid (Depakote) is an anticonvulsant. For many years, the drug of choice for treatment and
management of bipolar mania was lithium carbonate; however, in recent years, anticonvulsant drugs
have been found to have mood-stabilizing effects, either alone or in combination with lithium.
19. Olanzapine (Zyprexa) is an atypical antipsychotic used in acute manic episodes to reduce
hyperactivity until the lithium carbonate (Eskalith) takes effect. Lithium carbonate may take 1 to 3 weeks
to reach a therapeutic level and decrease hyperactivity. Although olanzapine has sedative effects, it is
used to treat acute mania and schizophrenia. Olanzapine can cause extrapyramidal side effects, which
can be alleviated by benztropine (Cogentin).
20. Weight gain is a common side effect of lithium carbonate. The nurse should educate the client on
the importance of medication compliance and discuss concerns with the prescribing physician if the
client does not wish to continue taking the medication.
21. Bipolar disorder is more prevalent in higher socioeconomic groups.
22. Anger and aggression are significantly different. Please review the differences.
23. Displacement occurs when an individual discharges anger against a person (the nurse) unrelated to
the true target of the anger (the spouse).
24. JCAHO requires that a physician or LIP must reissue a new order for restraints every 4 hours for
adults, every 1 hour for clients younger than 9, and every 2 hours for clients 9 to 17 years.
25. A physician or LIP must perform an in-person evaluation of the client no later than 4 a.m. Per JCAHO
standards, an in-person evaluation by a physician or LIP must be conducted within 1 hour of the
initiation of restraints.
26. Reminder: Touching a client may be perceived as a threat and provoke further violence.
27. Helping the client identify appropriate problem-solving behaviors and alternative ways to
release tension is a therapeutic nursing intervention. Prevention is the key issue in managing
aggressive or violent behavior.
28. A client with a specific plan is at very high risk of attempting suicide. The appropriate
nursing diagnosis for this client is “risk for suicide.”
29. A sudden increase in mood rating and change in affect may indicate the client is at serious
risk for suicide. Serious suicide risk may occur early during treatment with antidepressants.
30. Suicide is a behavior. It is not a diagnosis, disorder, or affliction.
31. Shaping is a technique in which reinforcements are given for increasingly closer
approximations to the desired response.
32. The Premack principle is a technique that states a frequently occurring response can serve as
a positive reinforcement for a response that occurs less frequently.
33. Flooding is used to desensitize individuals to phobic stimuli. The individual is flooded with a
continuous presentation (visiting the spider room) of the phobic stimulus until it no longer elicits
anxiety.
34. Systematic desensitization is used to assist an individual overcome fear of a phobic stimulus.
It is systematic in that there is a hierarchy of anxiety-producing events through which the
individual progresses during therapy. Systematic desensitization is a treatment for phobias in
which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus
while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no
anxiety.
35. Covert sensitization relies on an individual’s imagination to produce unpleasant
consequences for undesirable behaviors.
36. Overt sensitization is a type of aversion therapy that links an unpleasant stimulus, such as
nausea, to an undesirable behavior. Sometimes drugs are used to induce unpleasant stimuli such
as severe nausea, palpitation, and headache.
37. Catastrophic thinking is always thinking the worst will occur without considering the
possibility of positive outcomes.
38. Overgeneralization occurs when sweeping conclusions are made based on one incident.
39. Magnification is exaggerating the negative significance of an event.
40. The daily record of dysfunctional thoughts (DRDT) is a tool commonly used in cognitive
therapy to help clients identify automatic thoughts, modify thinking, and generate rational
responses.
41. Lithium carbonate is a mood stabilizer and risperidone is an atypical antipsychotic. The client
taking lithium should avoid excessive use of caffeine, maintain a consistent sodium intake, and
consume at least 2500 to 3000 mL of fluid per day. There is a high risk of developing lithium
toxicity due to the narrow margin between therapeutic doses and toxic levels. There is no need
to restrict sodium intake while taking Lithium. Lithium takes 1 to 3 weeks to take its full effect.
Lithium’s therapeutic range (0.6–1.2 mEq/L) can have toxic side effects and is potentially fatal
when exceeded. The therapeutic level of lithium carbonate is 1.0 to 1.5 mEq/L for acute mania,
and 0.6 to 1.2 mEq/L for maintenance therapy. Symptoms of lithium toxicity include persistent
nausea and vomiting, severe diarrhea, ataxia, blurred vision, tinnitus, excessive urine output,
increasing tremors, and mental confusion.
42. Strategies to help the individual with bipolar disorder take control of and manage his or her
illness include managing lifestyle factors such as sleep time and exercise, becoming an expert on
the disorder, taking medications regularly, and developing a plan for emergencies. Other
strategies include identifying and reducing sources of stress and recognizing symptoms early.
43. Neutral colors and pale accessories are most appropriate for a client experiencing mania.
Clients experiencing mania are subject to frequent mood variations, easily changing from
irritability and anger to sadness and crying, making it necessary to maintain low levels of stimuli
in the client’s environment (low lighting, few people, simple décor, low noise levels). Anxiety
levels rise in a stimulating environment.
44. Reminder: Assessment is the first step of the nursing process and the first step that is required
to figure out what is happening with each patient.
45. Hallucinations and delusions (usually paranoid and grandiose) are common symptoms during
acute mania. Grandiosity is defined as an unrealistic sense of superiority, a sustained view of
oneself as better than others.
46. Risperidone will address the client’s symptoms of psychosis (delusions of grandeur) and has
sedative effects to reduce symptoms of agitation, hyperactivity, and/or insomnia.