Exam 2: NSG3450/ NSG 3450 (NEW 2026/ 2027 Update) Nursing Practice – Mental Health Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen

Exam 2: NSG3450/ NSG 3450 (NEW 2026/ 2027 Update) Nursing Practice – Mental Health Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- Galen Q. An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." Which response by the nurse is appropriate? ANSWER "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." 3 multiple choice options Q. Select the most appropriate label to complete this nursing diagnosis: ___________ related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening. ANSWER Social isolation 3 multiple choice options Q. The nurse records this entry in a patient’s progress notes:Patient escorted to unit by ER nurse at 2130. Patient’s clothing was dirty. In interview room, patient sat with hands over face, sobbing softly. Did not acknowledge nurse or reply to questions. After several minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, “Let me out of here.” Verbal intervention unsuccessful. Order for stat dose 2 mg haloperidol PO obtained; medication administered at 2150. By 2215, patient stopped shouting and returned to sit wordlessly in chair. Patient placed on one-to-one observation.How should this documentation be evaluated? ANSWER Meets standards 3 multiple choice options Q. y.)A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that appl A:“Tell me more about that situation.” B: “Let’s talk about something else.” C: “I notice you are pacing a lot.” D: “I’ll stay with you a while.” E: “Why did you do that?” ANSWER A, C, D Q. A patient cries as the nurse explores the patient’s feelings about the death of a close friend. The patient sobs, “I shouldn’t be crying like this. It happened a long time ago.” Which responses by the nurse facilitate communication? (Select all that apply.) A: “Why do you think you are so upset?” B: “I can see that you feel sad about this situation.” C: “The loss of a close friend is very painful for you.” D: “Crying is a way of expressing the hurt you are experiencing.” E: “Let’s talk about something else because this subject is upsetting you.” ANSWER B, C, D Q. The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is ANSWER incongruous 3 multiple choice options Q. What is incongruous ANSWER conflicting messages by the speaker Q. A group has two more sessions before it ends. One member was previously vocal and has shown much progress but has now grown silent. What explanation most likely underlies this behavior? The silent member... ANSWER is having trouble dealing with feelings about termination of this group 3 multiple choice options Q. Which remark by a group participant would the nurse expect during the working stage of group therapy? ANSWER "I don't think I agree with your action. It might help you, but it seems like it would upset your family." 3 multiple choice options Q. During a therapy group that uses existential/Gestalt theory, patients shared feelings that occurred at the time of their admission. After a brief silence, one member says, "Several people have described feeling angry. I would like to hear from members who had other feelings." Which group role is evident by this comment? ANSWER Encourager 3 multiple choice options Q. A patient says, "Please don't share information about me with the other people." How should the nurse respond? ANSWER "I will not share information with your family or friends without your permission, but I will share information about you with other staff." 3 multiple choice options Q. A nurse assessed a patient who reluctantly participated in activities, answered questions with minimal responses, and rarely made eye contact. What information should be included when documenting the assessment? (Select all that apply.) A: The patient was uncooperative B: The patient’s subjective responses C: Only data obtained from the patient’s verbal responses D: A description of the patient’s behavior during the interview E: Analysis of why the patient was unresponsive during the interview ANSWER B, D Q. A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? ANSWER Prescribe psychotropic medication. 3 multiple choice options Q. What information is conveyed by nursing diagnoses? (Select all that apply.) A: Medical judgments about the disorder B: Unmet patient needs currently present C: Goals and outcomes for the plan of care D: Supporting data that validate the diagnoses E: Probable causes that will be targets for nursing interventions ANSWER B, D, E Q. A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is most therapeutic? ANSWER "It sounds like you're concerned about your privacy." 3 multiple choice options Q. A school age child tells the school nurse, "Other kids call me mean names and will not sit with me at lunch. Nobody likes me." Select the nurse's most therapeutic response. ANSWER "Tell me more about how you feel." 3 multiple choice options Q. A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." ANSWER "I'd like to sit with you for a while to help you get comfortable talking to me." 3 multiple choice options Q. Three members of a therapy group share covert glances as other members of the group describe problems. When one makes a statement that subtly criticizes another speaker, the others nod in agreement. Which group dynamic should the leader suspect? ANSWER Some members are acting as a subgroup instead of as members of the main group. 3 multiple choice options Q. During a group therapy session, a newly admitted patient suddenly says to the nurse, "How old are you? You seem too young to be leading a group." Select the nurse's most appropriate response. ANSWER "You are wondering whether I have enough experience to lead this group?" 3 multiple choice options Q. A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I will be glad when I can help someone else." This statement reflects ANSWER altruism. 3 multiple choice options Q. Which behavior shows that a nurse values autonomy? The nurse... ANSWER discusses options and helps the patient weigh the consequences. 3 multiple choice options Q. A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship? ANSWER Begin at the orientation phase. 3 multiple choice options Q. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse's best action? ANSWER Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card. 3 multiple choice options Q. Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? ANSWER "I hear evil voices that tell me to do bad things." 3 multiple choice options When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in milieu management. 3 multiple choice options What is milieu a person's social environment A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, "Encourage patient to attend one psychoeducational group daily"? Implementation 3 multiple choice options During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: "The time we spend together is to discuss your concerns." 3 multiple choice options During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication. "I notice you keep looking toward the door." 3 multiple choice options Data from the patient primary sources Secondary sources data from other people or sources HEADSSS psychosocial interview technique H Home environment (e.g., relations with parents and siblings) E Education and employment (e.g., school performance) A Activities (e.g., sports participation, after-school activities, peer relations) D Drug, alcohol, or tobacco use S Sexuality (e.g., whether the patient is sexually active, practices safe sex, or uses contraception) S Suicide risk or symptoms of depression or other mental disorder S "Savagery" (e.g., violence or abuse in home environment or in neighborhood) SADPERSONS scale S- sex A- age D- depression P- previously attempt E- Excessive alcohol R- Rational thinking S- Single O- Organized plan N- No social supports S- Stated future attempts Problem focuses diagnosis current state + related factors + Evidence What factors affect communication? environment, developmental variations, gender, personal space, territoriality, sociocultural factors, roles and relationships One has power complementary Both have power symmetrical Therapeutic Communication Techniques 1) ACTIVE LISTENING - Shows clients that they have your undivided attention 2) OPEN-ENDED QUESTIONS - Used initially to encourage clients to tell their story in their own way. Ask questions in a language that a client can understand 3) CLARIFYING - Questioning clients about specific details in greater depth or directing them toward relevant parts of the history. 4) SUMMARIZING - Validates the accuracy of the story. Communication style, eye contact and touch are cultural considerations Clarifying techniques paraphrasing, restating, reflecting, exploring Tactics to avoid Arguing, minimizing, or challenging the patient Giving false reassurance Interpreting or speculating Probing into sensitive areas the patient doesn't want to discuss Trying to "sell" the patient on accepting treatment Joining in attacks patients launch on others Participation in criticizing other staff members Proxemics study of personal space: Intimate distance (0 to 18 inches) Personal distance (18 to 40 inches) Social distance (4 to 12 feet) Public distance (12 feet or more) process of recording -Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse -Useful tool for identifying communication patterns Goals and functions of the nurse-patient relationship facilitate expression of distressing thoughts and feelings assist with problem solving facilitate with ADL promote self care and independence provide medication education promote recovery model and respect boundaries Boundaries exist to protect patients expected and accepted transference and countertransference differential power between the nurse and the patient Factors to encourage and promote patients growth be genuine empathy positive regard group membership - Heterogenous group - Homogeneous - Closed group - Open group - Subgroup Individual group roles aggressor, blocker, recognition seeker, self-confessor, playboy, dominator, help seeker, special interest pleader exerts control over the group and does not encourage much interaction among members autocratic leader Supports extensive group interaction in the process of problem solving democratic leader Allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Laissez-faire leader Dealing with challenging member behaviors Monopolizing member Complaining member who rejects help Demoralizing member Silent member mental status examination used to evaluate an individuals cognitive process Psychosocial Assessment describing to the patient why treatment is necessary An unmet need that describes the state of the patient at present Problem Linked to the diagnostic label with the words related to Probable cause Signs (objective and measurable) and symptoms (objective and reported by the patient). the as evidence by Supporting data The nurse should consider specific principles when planning interventions: The should be Safe, compatible and appropriate, realistic and individualized, and evidence based Healthcare teaching for psychiatric nurse teaching includes: coping skills, self-care activities, stress management, problem solving skills, relapse prevention, conflict management, and interpersonal relationships. A psychiatric philosophy that involves a secure environment including people, settings, structure, and emotional climate to support recovery. Milieu therapy psycotherapy person talks with a therapist to help them understand and overcome their mental disorders - initiated for the purpose of friendship, socialization, enjoyment, or accomplishment of a task - Mutual needs are met - Communication to give advice, give, or ask for help - Content of communication superficial Personal relationship Nurse maximizes communication skills, understanding of human behaviors, and personal strengths to enhance patient's growth. Therapeutic relationship Never ___________ the patients feeling and don't give _________ prematurely minimize advise When the patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in the patients past life Transference It occurs when the nurse unconsciously displaces feelings related to significant figures in the nurses past into the patient Countertransference consists of a nurse who has the skills and expertise and a patient who wants to feel better, find solutions to problems, explore methods to improve quality of life, or find an advocate Professional nurse-patient relationship refers to the nurse's ability to be open, honest, and authentic in interactions with patients Genuineness occurs when the helping person attempts to understand the world from the patient's perspective Empathy refers to the patient as a full partner in care whose values, preferences, and needs are respected Patient centered care Using silence (therapeutic communication) Using the absence of verbal communication to permit client to collect thoughts or control emotions or give time to consider alternatives. No verbal comment, but remain attentive, interested, and/or expectant. nurses focus, respond, and remember what the patient is saying verbally and non-verbally active listening When you restate the basic content of a patient's message in different, usually fewer words paraphrasing AN active listening strategy that helps the nurse to understand what the patient is saying and it also lets the patient know that they're being heard Restating encourage patients to share information about experience, perceptions, or responses to a situation open ended questions _______________ ended questions can give you specific and needed information closed This approach of questioning conveys a lack of respect for sensitivity to the patients needs excessive, rapid questioning Giving approval or disapproval Do not impose your own attitudes, values, beliefs, and moral standards on others while in the professional helping role. People have the right to be themselves and make their own decisions. Avoid using terms such as should, ought, good, bad, right, or wrong. Agreeing, disagreeing, or sharing your personal opinion sends the subtle message that you have the right to make value judgments about patient decisions. Instead, offer options and help the other person anticipate the consequences of decisions. The problem and its solution belong to the patient, not the nurse. (Example: Pt: "I really want to go visit my uncles in New York, but I'm not sure I'm up for the trip." Nurse: "I don't think it's a good idea to try to travel that far." A better response is, "It sounds like you miss your family. Let's talk about your options for maintaining contact.") [Nontherapeutic Communication Techniques] "____" demands for a justification for actions and implies wrongdoing why When assessing adolescence, assuring ____________ will gain rapport between the nurse and the patient. However, there are some things that must be reported if an adolescent says such as "I'm going to kill myself" or "I plan on hurting/killing my parent(s)". confidentiality __________ are created to separate the patients from the nurses boundaries Blurring of boundaries can occur when the nurse's needs are met at the ____________ of the patients need's expense mutually contradictory messages, usually given by a person in power double-bind messages curative factors in group therapy 1. instillation of hope 2. universality 3. cohesiveness 4. imparting information 5. altruism 6. imitative behavior 7. interpersonal learning 8. corrective recapitulation 9. development of socializing techniques 10. catharsis 11. existential factors Criticizes and attacks others' ideas and feelings aggressor asks for sympathy of group excessively help seeker acts disinterested in group process Mute Seeks attention by boasting and discussing achievements Recognition seeker verbalizes feelings or observations beyond the scope of the group topic Seducer Do it my way or makes decisions independently Autocratic leader Decide how to do it or make decisions as a group Democratic leader Don't care how you do ow when you do it, just have it done on time Laissez-faire leader -remind entire group to provide equal chances to contribute -speak directly to member, privately when necessary Monopolizing member Listen objectively; ask in private about cause of anger; empathize matter-of-factly Demoralizing member fight or flight response an emotional and physiological reaction to an emergency that increases readiness for action increases BP, heart rate, respirations, and cardiac output alarm stage of GAS organism recognizes stress, begins to respond Hypothalamus signals the adrenal glands to release adrenaline which activates the sympathetic system The hypothalamic-pituitary-adrenal axis releases ACTH which goes to the adrenal cortex which then releases extra cortisol which increases glucose and muscle endurance. Digrestion also decreases. The parasympathetic system will then slowly stop the alarm stage Resistant stage of GAS sustained and optimal resistance to stressors exhaustion stage the third stage of the GAS, characterized by weakened resistance and possible deterioration Is this stage continues, overexposure to cortisol can lead to vulnerability to stress related illnesses. Major depressive disorders, sleep disorders, digestive problems, heart disease, and weight gain distress negative stress Eustress positive stress Stress may result in _________ in the immune system malfunction Physiological stressors environmental conditions (trauma and excessive cold or heat) and physical conditions (infection,hemorrhage,hunger, and pain). Psychological stressors events such as divorce, loss of a job, unmanageable debt, the death of a loved one, retirement, and fear of a terrorist attack Serotonin synthesis Becomes more active during stress mediated by corticosteroid can cause anger provides immediate and exact information regarding muscle activity, brain waves, skin temp, heart rate, blood pressure, and other bodily functions Biofeedback Deep breathing exercises patient concentrates on breathing and muscle movement; oxygenates blood stream and brain oxygen supply Focus on pleasant imaged to replace negative or stressful feelings guided imagery Meditation the focusing of attention to clear one's mind and produce relaxation Is to change an individuals perceptions of stress by reassessing a situation and replacing irrational beliefs Cognitive reframing Overall feeling of apprehension, uneasiness, uncertainty, or dread from real or perceived threat Anxiety Is normal anxiety necessary for survival? Yes Sees, hears, and grasps more information, and problem solving become more effective. Physical symptoms include slight discomfort, restlessness, irritability, or mild tension-relieving behaviors. Normal Mild anxiety Sees, hears, and grasps less information and may demonstrate selective inattention, where only certain things in the environment are seen or heard unless they are pointed out Sympathetic nervous system symptoms begin to kick in Pounding heart, increase HR and RR, perspirations and mild somatic symptoms Voice shaking and tremors Can be normal Moderate anxiety Learning and problem solving are not possible at this level and the person may be dazed and confused not normal Severe anxiety Unable to process what is going on in the environment, pacing, running, shouting, screaming, hallucinations, erratic/uncoordinated/impulsive behaviors not normal Panic Autonomic coping styles that protect people from anxiety and enable them to maintain their self-image by blocking feelings, conflicts, and memories Defense mechanisms Developmentally inappropriate levels of concern over being away from a significant other Separation anxiety disorder persistent irrational fear of a specific object, activity, or situation that leads to a desire for avoidance or actual avoidance of the object, activity, or situation Specific phobia displacement (defense mechanism) - The transfer of feelings from one target to another that is considered less threatening or that is neutral. EX: A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse. projection (defense mechanism) - Attributing feelings or impulses unacceptable to ones self to another person. EX: Sue feels a strong sexual attraction to her track coach and tells her friend, "Hes coming on to me!" Rationalization (defense mechanism) - Attempting to make excuses or formulate logical reasons to justifying unacceptable feelings or behaviors. EX: John tells the rehab nurse, "I drink because its the only way I can deal with my bad marriage and awful job." reaction formation (defense mechanism) - Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career. Regression (defense mechanism) - Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning. EX: When 2 year old Jay is hospitalized for tonsillitis he will drink only from a bottle, although his mother states he has been drinking from a cup for over 6 months. Repression (defense mechanism) - Involuntary blocking of unpleasant feelings and experiences from ones awareness. EX: An accident victim can remember nothing about the accident sublimation (defense mechanism) - Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. EX: Mom of son killed by drunk driver, president of MADD. Dissociation (defense mechanism) process that enables a person to split mental functions in a manner that allows them to express forbidden or unconscious impulses without taking responsibility for the action; unable to remember the disowned behavior (fugue states, amnesia) Intellectualization Defense Mechanism - An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis. Compensation : Defense Mechanism - Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. EX: A handicapped boy is unable to participate in football, so he compensates by becoming a great scholar. GABA plays a role in anxiety panic attacks symptoms numbness or tingling sensation (finger, toes or lips) shortness of breath/smothering sensation heart palpitations (rapid/irregular heartbeat) fear of going crazy/out of control nausea/abdominal distress choking sweating hot flashes or chills trembling or shaking dizziness or fainting fear of illness or death Excessive anxiety or fear about being in places or situation from which escape might be difficult or embarrassing agoraphobia Severe anxiety provoked by exposure to a social or a performance situation that could be evaluated negatively by others Social anxiety disorder Excessive worry that lasts for months generalized anxiety disorder Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind Obsessions Ritualistic behaviors and individual feels driven to perform in an attempt to reduce anxiety Compulsions obsessive-compulsive disorder (OCD) an anxiety disorder characterized by unwanted repetitive thoughts (obsessions) and/or actions (compulsions) Excoriation Skin sore or abrasion produced by scratching or scraping pulling out hair to reduce anxiety Trichotillomania Disturbance caused by a stressful event or a threat normal coping mechanisms fail Acute Crisis A successful outcome for a crisis depends on 1. the realistic perception of the event 2. adequate situational supports 3. adequate coping mechanisms Albert Robert's crisis intervention model stage 1: quickly enacted assessment of the crisis as well as immediate action if needed to prevent death. stage 2: establish rapport and rapidly establish relationship stage 3: Identify major problems stage 4: Deal with feelings and emotions stage 5: Generate and explore alternatives stage 6: develop and formulate an action plan stage 7: follow-up plan and agreement traumatic and external event that happens unexpectedly Adventitious crisis New developmental stage is reached old coping skills no longer effective leads to increased tension and anxiety Maturational crisis Person is exposed to a serious stressor or problem, which results in increased anxiety coping methods and defense mechanisms Phase 1 of crisis Defense mechanisms failed and threat persists Phase 2 of crisis Trial-and-error attempts fail ↓ Anxiety can escalate to severe and panic levels ↓ Automatic relief behaviors mobilized (i.e., withdrawal and flight) ↓ Some form of resolution may be made (i.e., compromising needs or redefining situation) Phase 3 of crisis Problem is not solved and new coping skills are ineffective Phase 4 of crisis Modalities of Crisis Intervention Emergency rooms Telephone hotlines Peer crisis services Crisis intervention teams (CITs) Crisis stabilization beds Short-term residential services 5 Phase Disaster Management Continuum 1. Preparedness 2. Mitigation 3. Response 4. Recovery 5. Evaluation 2 main goals for patients during a crisis 1. safety 2. anxiety reduction Department of Homeland Security (DHS) Federal agency responsible for preventing terrorist attacks within the United States, reducing America's vulnerability to terrorism, and minimizing the damage and assisting in recovery from attacks that do occur. PTSD (Post Traumatic Stress Disorder) in adolescence symptoms Reduction of play Repetitive play (reenactment of traumatic event) Negative emotions (fearful) Anger Shame and guilt Epidemiology in trauma-related disorder for adolescence Witness murder or SA, school shooting and violence Comorbidities in children with trauma related disorders Depression Behavioral issues Somatic complaints Intervention stages for child trauma Stage 1: Provide safety and stabilization Stage 2: Reduce arousal and regulate emotion through symptom reduction Stage 3: Catch up on developmental and societal skills; develop a value Interventions for a child with PTSD Establish trust and safety Use developmentally appropriate language Teach relaxation techniques Use art and play to promote expression of feelings Involve caretakers in 1:1s, unless they are the cause of trauma Educate child and caretakers about grief process Assist caretakers in resolving personal distress Coordinate with social work for protections Reactive Attachment Disorder in children, a pattern of inhibited, withdrawn behavior toward adult caregivers Interventions for RAD in children Improving interactions between child and caregiver Holding therapy? Disinhibited Social Engagement Disorder condition in which a child shows no inhibitions whatsoever in approaching adults Attach to anyone and trust anyone PTSD in adults interventions Manage anxiety Increase self esteem Improve coping skills acute stress disorder An anxiety disorder in which fear and related symptoms are experienced soon after a traumatic event and last less than a month Symptoms persist for 3 days Diagnosis made within a month After the one month, the symptoms will resolve or becomes PTSD adjustment disorder an emotional disturbance caused by ongoing stressors within the range of common experience dissociative disorders disorders in which conscious awareness becomes separated (dissociated) from previous memories, thoughts, and feelings Occurs after significant adverse experiences Involuntary depersonalization/derealization disorder a dissociative disorder marked by the presence of persistent and recurrent episodes of depersonalization (focus on self), derealization (Focus on outside world), or both dissociative amnesia Dissociative disorder characterized by the sudden and extensive inability to recall important personal information, usually of a traumatic or stressful nature. Usually related to specific traumatic event dissociative fugue Sudden unexpected travel and inability to recall one's identity Traumatic event occurred dissociative identity disorder A rare dissociative disorder in which a person exhibits two or more distinct and alternating personalities. Also called multiple personality disorder. Dissociative disorder planning Phase 1: Establishing safety, stabilization, and symptom reduction Phase 2: Confronting, working through, and integrating traumatic memories Phase 3: Identity integration and rehabilitation What is the initial action associated with the assessment of a patient's spiritual beliefs? Asking the patient what role spirituality plays in their daily life keep the group focused on its main purpose and get the work done task roles keep the group together, help each person feel worthwhile and included, and create a sense of group cohesion maintenance roles have nothing to do with helping the group but instead relate to specific personalities, personal agendas, and desires for having personal needs met Individual roles ____________ promote the active of GABA by binding to a specific site on the GABAa receptor complex Benzodiazepines Benzodiazepines causes a reduction of cellular excitation, causing a calming effect sleep-inducing hypnotic Patients taking Doxepine (helps patients stay asleep) should avoid ________ severe urinary retention, glaucoma, or those taking MAOIs Buspirone (Buspar) Antianxiety agent. Increase the efficacy of GABA to reduce anxiety. Used for generalized anxiety disorder and panic disorder, insomnia, alcohol withdrawal, induction of anesthesia. Precautions/Interactions: used with caution in clients who have substance use disorder and liver disease. Contraindicated for clients taking MAOIs. Side effects: CNS depression, paradoxical response (insomnia, excitation, euphoria), withdrawal symptoms, risk of abuse and potential for overdose. Characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that could be evaluated negatively by others Social anxiety disorder Intense excessive anxiety or fear about being in places or situations from which help might not be available, and escape might be either difficult or embarrassing Agoraphobia Mood changes can be associated with __________ rhythm disturbances circadian Increased ________ plays a role in learning and memory acetylcholine _____________ is the neurotransmitter found in high concentration in the parasympathetic nervous system Acetylcholine The therapeutic action of neurotransmitter inhibitors that block reuptake bring about what response? Increased concentration of the blocked neurotransmitter in the synaptic gap A client taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop? Dopamine-blocking effects (think parkinsons) _________ may cause produce neutropenia, which any signs of infection should be reported immediately Clozapine When a new client is hospitalized, a nurse takes the client on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in what nursing action? milieu management At what point in the nurse-patient relationship should a nurse plan to first address termination? During the orientation phase SSRIs are used to treat ___________ such as fluoxetine, Sertraline, paroxetine Obsessive compulsion disorder Postencephalatic syndrome, post anoxic event, TBI, Huntington's disease, seizures, cerebral infarctions can cause Obsessive compulsive disorders Rapid onset Combination of 2+ serotonin agonists Mental health status changes o Agitation o Pressured speech Autonomic Instability o Tachycardia o Diarrheao Shiveringo Diaphoresis o Mydriasis Neuromuscular Abnormalities o Clonus o Hyperreflexia o Tremoro Seizure Serotonin syndrome Anxiety disorders tend to cluster in families The _________ plays a role in anxiety disorders reduction in play, repetitive play that includes aspects of traumatic event, social withdrawal, negative emotions (fear, guilt, anger, horror, sadness, shame, or confusion) Manifestation of PTSD in children Focus on somatic (physical) symptoms to the point of excessive concern, preoccupation, and fear High level of help seeking Symptoms: chest pain, fatigue, dizziness, headache, swelling, back pain, and numbness Maladaptive response High level of functional impairment Somatic symptom disorder -Extreme worry and fear about the possibility of having a disease -Actual symptoms and complaint of symptoms are mild or absent -Obsessive, intrusive thoughts hard to dismiss Illness anxiety disorder -Neurological symptoms in the absence of a neurological diagnosis -Presence of deficits in voluntary motor or sensory functions -Common symptoms: paralysis, blindness, movement and gait disorders, numbness, paresthesias, loss of vision or hearing, or episodes resembling epilepsy -“La belle indifference” versus distress: lack of emotional concern about often dramatic symptoms -Comorbidity: depression, anxiety, PTSD, personality disorders, other somatic disorder Conversion disorder -Pattern of behavioral outbursts characterized by inability to control aggressive impulses -Aggression is Verbal or physical, targeted toward persons, animals, property or themselves -Rage to remorse -Can impair: o Interpersonal relationships o Occupational difficulties o Legal problems Intermitten Explosive disorder -Behavior is usually abnormally aggressive -Leads to destruction of property or physical injury -Coercion into an activity against one's will -Rights of others are violated, and societal norms or rules are disregarded Complications: o Academic failure, school suspensions and dropouts, juvenile delinquency, drug and alcohol abuse, and juvenile court involvement Conduct disorder repeated deliberate fire setting pyromania Failed urges to resist stealing not needed for personal or monetary value Kleptomania You must experience anxiety for _________ months to be officially diagnosis with GAD 6 GAD mostly affects _______ Women Panic attacks that are no real danger or have an apparent cause Unwarranted Real reason for the panic Warranted Panic attacks can be mistaken for ________ Heart attacks Child does not speak due to fears of negative responses or evaluations; speaks at home and around family but nowhere else Selective mutism swallowing hair trichophagia _________ are the first line of defense for anxiety and OCD SSRIs Used for treatment-resistant conditions MAOIs Benzodiazepines are only used for a __________ period short Inhibited and emotionally-withdrawn behavior towards adult caregivers Does not seek comfort from caregiver Stems from a lack of bonding experiences with primary caregiver by 8 months Reactive Attachment Disorder Child overly friendly; no fear of strangers Not fazed by separation with caregivers Disinhibited social engagement disorder Binds to GABA receptors Benzodiazepines Lack of memory surrounding traumatic event Dissociative amnesia Feeling of detachment from your own body environment Derealization Consciously pretends to be ill to meet emotional needs wants to be dependent Factitious disorder Act of fabricating an illness or exaggerating symptoms done to gain something Malingering Extremely difficult and defiant behavior, exceeds the boundaries of social acceptance Oppositional defiant disorder adjustment disorder an emotional disturbance caused by ongoing stressors within the range of common experience Who is at risk for PTSD? police, soldiers, high crime neighborhoods, and first response academic failure school suspensions and dropouts juvenile delinquency drug and alcohol abuse juvenile court involvement Leaving this untreated can cause Antisocial Personality disorder and more aggressive Conduct disorder When taking benzodiazepines (benzo's) what must you avoid? caffeine What are the best ways to treat patients with OCD? SSRIs or CBT Sitting with the patient and offering your time is called what? Offering self Typically provided in the orientation phase Restate basic content with fewer words paraphrasing repeating key words restating Stressful or traumatic experiences, including abuse, neglect, and a range of household dysfunction, such as witnessing domestic violence or growing up with substance abuse, mental disorders, parental discord, or crime in the home. Adverse Childhood Experiences (ACE) Old coping skills are no longer effective Increased anxiety and fear New developmental stage reached Maturational crisis