NSG 3450/ NSG3450 Exam 4 (NEW 2026/2027 Update) Nursing Practice – Mental Health | Verified Questions & Answers | 100% Correct Solutions | Grade A – Galen

NSG 3450/ NSG3450 Exam 4 (NEW 2026/2027 Update) Nursing Practice – Mental Health | Verified Questions & Answers | 100% Correct Solutions | Grade A – Galen Q. Which statement demonstrates a well-structured attempt at limit setting? ANSWER a. "Hitting me when you are angry is unacceptable." Q. Which activity is most appropriate for a child with ADHD? ANSWER d. Tennis Q. Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner: ANSWER b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd." Q. What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply. ANSWER a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" d. "Where do you see yourself in 10 years?" Q. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply. ANSWER a. Limited language skills b. Level of cognitive development c. Level of emotional development Q. Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive: ANSWER (1) a. With the patient, identify the behaviors that are unacceptable and consequences associated with harmful behaviors (2) d. Offering a PRN medication by mouth (3) c. Allowing the patient to take a time-out and sit in his or her room (4) e. Placing the patient in a locked seclusion room (5) b. Placing the patient in physical restraints Q. In pediatric mental health, there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply. ANSWER a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit d. Premature termination of services Q. Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is: ANSWER c. Resilience Q. April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that: ANSWER b. Time-out is no longer an effective therapeutic measure. Q. Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: ANSWER b. Cerebellum maturation Q. Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply. ANSWER a. Always afraid that others will steal his belongings. b. Displays unusual interest in numbers and specific topics. c. Has increasingly unusual thoughts and uses words oddly. d. Demonstrates increasing difficulty with concentration. Q. Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply. ANSWER a. Screening 15- to 25-year-olds for early symptoms. c. Teaching ways to cope and build resiliency. d. Educating about the risk of psychosis with marijuana use. Q. To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for ANSWER e. Metabolic syndrome Q. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? ANSWER d. She should experience a reduction in hallucinations. Q. Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? ANSWER d. Paranoia Q. Which therapeutic communication statement might a psychiatric-mental health registered nurse use when ANSWER a patient's nursing diagnosis is hallucinations? Select all that apply. a. "I know you say you hear voices, but I cannot hear them." c. "Tell me more about what you hear." Q. When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that ANSWER d. They are not actually ill. Q. Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) a week ago. You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. ANSWER a. Hold his medication and contact his prescriber stat. b. Wipe him with a washcloth that has been wetted with cold water or alcohol. Q. Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disorder and can be an effort to: Select all that apply. ANSWER a. Self-medicate for social discomfort. b. Cope with anxiety. c. Enhance mood. Q. A patient reports that "the voices are really bad today." Helpful nursing responses would include ANSWER d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music. Q. Which statement made by the primary caregiver of a person with dementia demonstrates an accurate understanding of providing the person with a safe environment? ANSWER c. "We've installed locks on all the outside doors." Q. Which statement made by a family member tends to support a diagnosis of delirium rather than dementia? ANSWER a. "She was fine last night but this morning she was confused." Q. In terms of the pathophysiology responsible for both delirium and dementia, which intervention would be appropriate for delirium specifically? ANSWER b. Monitoring neurological status on an ongoing basis Q. What side effects should the nurse monitor for while caring for a patient taking donepezil (Aricept)? Select all that apply. ANSWER a. Insomnia c. Bradycardia d. Signs of dizziness e. Reports of headache Q. What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day? ANSWER a. It increases input throughout the day Q. Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner understands that Ophelia seems to have a deficit in her ANSWER d. Social cognition ability Q. After talking with her 85-year-old mother, Nancy became concerned enough to drive to her home and check on her. Her mother's appearance was disheveled, her words were nonsensical, she smelled strongly of urine, and there was a stain on her dressing gown. Because she is a nurse, Nancy recognizes that her mother's condition is likely due to ANSWER c. A urinary tract infection Q. Lucia, 70 years old, recently underwent a major orthopedic surgical procedure. On postoperative day 3, she responds to the nurse who has been caring for her with affection. At other times, however, she tells the nurse to leave because she does not recognize her and asks to have another nurse care for her, specifically naming the nurse as the "nice one." The most likely reason for Lucia's behavior is that she is ANSWER c. Experiencing an acute delirium Q. Since his wife's death 2 months earlier, Aaron, 90 years of age and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating, disrupted sleep, and lacks energy. His family has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which of the following responses would be most appropriate? ANSWER d. Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder. Q. Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse stress, as well as which of the following? Select all that apply. ANSWER a. Expressing emotions by journaling c. Engaging in exercise and relaxation activities d. Having realistic patient expectations Q. Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual's personality? ANSWER b. "I'll need to learn more about this patient's cultural beliefs." Q. When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention? ANSWER d. "I'd really like to hurt her for hurting me." What is the current accepted professional view of the effect of culture on the development of a personality disorder? a. There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders. Which personality disorders are generally associated with behaviors described as "odd or eccentric"? Select all that apply. a. Paranoid b. Schizoid Which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? Select all that apply. a. Regularly attempts to split the staff b. Attempts to undo feelings of anger by offering to do favors c. Regresses to rocking and humming to sooth self when fearful Personality disorders often co-occur with mood and eating disorders. A young woman is undergoing treatment at an eating disorders clinic and her nurse suspects that she may also have a cluster B personality disorder because of her b. Dramatic response to frustration Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry's treatment will most likely d. Manifest as small incremental changes Connor is a 28-year-old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and that people call him a loner. Connor has recently been "giving lectures" to pigeons at the university fountains. He is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed as schizotypal a. Can be made aware of their delusions Garret's wife of 8 years is divorcing him because their marriage never developed a warm or loving atmosphere. Garrett states in therapy, "I have always been a loner," and says that he was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of bupropion (Wellbutrin) to c. Increase the pleasure of living Josie, a 27-year-old patient, complains that most of the staff do not like her. She says she can tell whether you are a caring person. Josie is unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect? b. Borderline Which individuals are most at risk for displaying aggressive behavior? Select all that apply. a. An adolescent embarrassed in front of friends. b. A young male who feels rejected by the social group. d. A middle-aged adult who feels that concerns are going unheard. e. A patient who was discovered telling a lie. A newly admitted male patient has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint? b. "I'll call the primary provider and get an as-needed (prn) seclusion/restraint order." Which intervention(s) should the nurse implement when helping a patient who expresses anger in an inappropriate manner? Select all that apply. a. Approach the patient in a calm, reassuring manner. b. Provide suggestions regarding acceptable ways of communicating anger. d. Set limits on the angry behavior that will be tolerated. Which guidelines should direct nursing care when deescalating an angry patient? Select all that apply. a. Intervene as quickly as possible. b. Identify the trigger for the anger. c. Behave calmly and respectfully. d. Recognize the patient's need for increased personal space. Which comorbid condition would result in cautious use of an SSRI for a patient with chronic aggression? d. Bipolar disorder Patrick is a widower with four daughters. He enjoyed a healthy relationship with each of them until they reached puberty. As the girls began to mature physically, he acted in an aggressive manner, often beating them without provocation. Patrick is most likely acting on: c. Frustration of unhealthy desire A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression? b. "An obvious change in behavior is a risk factor for aggression." An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through: c. Brief, frequent, nonthreatening encounters A 24-hour observation is a good choice for restraint in which of the following patients? a. An inmate with suicidal ideation on hospice care Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are conditions that: d. Contraindicate restraint and seclusion. Which statement made by a new mother should be explored further by the nurse? b. "I think the baby cries just to make me angry." Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a. Phobias b. Low self-esteem c. Major depressive disorder e. Posttraumatic stress disorder What situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? b. The caregiver was neglected as a child. What safety-related responsibility does the nurse have in any situation of suspected abuse? d. Report suspected abuse to the proper authorities. The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter Secondary effects of abuse often manifest as arrested development in children due to the fact that: b. Energy for development is diverted to coping The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a. Establish trust and rapport The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to: b. Their limited options. An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family. Which statement made by a sexually assaulted patient strongly suggests the drug gamma-hydroxybutyric acid (GHB) was involved in the attack? b. "The drink I was given had a salty taste to it." Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority? d. "Do you have any thoughts about harming yourself?" Which statement is an accurate depiction of sexual assault? b. Most rapes occur in the home. Which signs and symptoms are associated with rape-trauma and rape-trauma response? Select all that apply. a. Outbursts of anger b. Major depressive disorder d. Flashbacks e. Amnesia for the event Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime? a. Multiracial The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction to trauma, resulting in which of the following? d. All of the above A young woman named Carly was raped after closing shift behind the restaurant where she works. Six months have passed and Carly has not been able to return to work, refuses to go out to eat, and feels that she has less value as a woman now that she has been raped. Carly's clinical presentation suggests: c. Avoidance Ron is a victim of assault and has revealed to his family and friends the fact that he was raped. The family reacts with horror and disgust, and the nurse caring for Ron recognizes that c. Ron's family will also need support. Perpetrators of sexual assault are often incarcerated but frequently do not undergo therapy. Samuel, convicted of rape and sentenced to 15 years in prison, has asked to see a therapist. The psychiatric nurse practitioner is surprised to learn of the request, as many perpetrators c. Do not acknowledge the need for change. You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response? a. "I'm here to listen, and we can talk about your feelings." During an interview with a patient, which question asked of an older adult is associated with the Patient Self-Determination Act? b. "Have you discussed your end-of-life choices with your family or designated surrogate?" Which statement made by a nurse requires immediate correction by the supervisor? c. "Cognitive decline is normal in patients who are 65 and older." Considering psychosocial role theory, which patient demonstrates healthy adjustment to aging? c. The retiree who volunteers 3 days a week at the local library The older patient is discussing chronic pain and asks the primary care provider for a prescription. Which medication should the nurse anticipate being ordered rather than an opioid? a. Gabapentin Which statement by an older patient with a mild neurocognitive disorder demonstrates a safe response to beginning a new medication? b. "My daughter comes with me to appointments so that we get all the information we need." Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order? b. Xanax Fred is an older adult with spinal stenosis and who is being treated with a short-term prescription of opioids for an acute episode of back pain. His nurse recognizes additional teaching is necessary when Fred states: d. "My wife and I share my Norco for our aches and pains." Ling works as a registered nurse in an Alzheimer's care home. Ling has a specialized rapport-building technique she uses called reminiscence. She uses this technique by: d. Encouraging the residents to talk about pleasurable past events. Marco, age 83, has dementia and difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding? b. Apraxia Programs recommended for ambulatory patients who do not need 24-hour nursing care with structured activities along with nursing and medical supervision, intervention, and treatment are called: d. Partial hospitalization programs The forensic nurse examiner is attempting to reconstruct the mental state of an individual accused of a hit-and-run automobile accident. Which question or questions would help to achieve that goal? Select all that apply. a. "Were you under the influence of illegal substances at the time of the accident?" b. "What were you feeling when you realized you had hit someone crossing the street?" d. "Can you remember the events leading up to the accident?" e. "Had you and your friends been drinking before the accident?" A forensic nurse examiner is interviewing an individual accused of a homicide. Which question should the nurse ask in preparation for a possible legal insanity defense? b. "Do you ever hear voices that no one else can hear?" Which nurse would qualify as a fact witness in a case dealing with a physically abused young child? d. A pediatric intensive care unit nurse Which intervention focused on children supports the Healthy People 2030 goals related to injury and violence prevention? Select all that apply. b. Identifying risk-taking behaviors among high school students that often result in injury c. Holding a focus group discussion regarding the reasons why students bring weapons onto school property d. Holding a community forum to identify the main sources of violence to which children are exposed Forensic nursing combines scientific knowledge and inquiry in an effort to serve c. Victims and perpetrators of crime In understanding the role of victim and perpetrator, the act of evidence collection is enhanced. What knowledge base can be helpful in caring for the injured victim? d. Medical-surgical nursing skills For a competency hearing, the psychiatric forensic nurse has been asked to evaluate an incarcerated patient who has mental health problems. As the patient is being considered for sentencing, what is the psychiatric forensic nurse's role? Select all that apply. a. Assessing the patient for level of competency d. Completing a formal report to the court To determine a patient's legal sanity or competency, the psychiatric forensic nurse must assess all of the following, except d. The patient's social network You are caring for Naomi, who has been arrested and is found to be at risk for alcohol and drug use. Which approach is the most useful in treating Naomi? b. Providing an immediate drug/alcohol treatment plan Which activity does a correctional nurse not fulfill within the corrections setting? c. Providing psychotherapy An emotional response to frustration of desires, threat to one's needs (emotional or physical), or a challenge Anger Action or behavior that results in verbal or physical attack Aggression In the hospital, violence is most frequent in Psychiatric units Emergency departments Geriatric units Comorbidities for anger and aggression PTSD substance abuse depression, anxiety, PD's and psychosis The limbic system is responsible for aggression The amygdala is responsible for emotion Serotonin Dopamine Gaba responsible for emotions and anger Nursing diagnosis for patients with anger Ineffective coping Risk for violence Nursing implementations for anger Psychological interventions Consideration for staff safety Pharmacological interventions If a patient is escalating and is around other patients, what should you do? Get the other patients out De-escalation Listen to the patient Offer the things they want or need Don't demand Give respectable answers Consideration for staff safety Avoid wearing dangling ear rings, necklaces, and scarves Ensure there is enough staff for back up Always know the layout of the area ' Do not stand directly in front of the patient or in front of the doorway If the patient's behavior begins to escalate, provide feedback Avoid confrontation B-52 Benadryl 50mg 5 mg Haldol 2 mg Ativan Beware in elderly and those with prolonged QT antianxiety agents and antipsychotics are used in the treatment of acute symptoms of anger and aggression Haldol Ativan B-52 Acute anger patient nursing implementation Health teaching and promotion Case management Team work and safety - Restraints or seclusions might be necessary Involuntary confinement alone in a room that the patient is physically prevented from leaving Seclusion Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely Restraints Guidelines for use of mechanical restraints 1. Indications for use 2. Legal Requirements 3. Documentation 4. Clinical Assessments 5. Observation 6. Release procedure 7. Restraint tips Types of abuse Physical Visa Psychological Sexual Controlling Financial Digital Emotional Examples of physical abuse -Shaking, biting, hitting, burning, throwing, kicking, gagging, twisting, binding, starving, poking, choking, scalding, cutting. Damaging property Taking prescriptions Leaving in places Driving recklessly forcing drug or alcohol use Examples of emotional abuse Ignores partner's feelings, Ridicules or insults women / men as a group, Ridicules partner's beliefs, Withholds approval, Criticizes, Insults and/or drives away partner's family friends, Humilities partner in public / private, Refuses to socialize with partner, Takes away car keys / money / personal property, Threatens to leave, Threatens partner's family / friends, Punishes children when angry with partner, Threatens to kidnap children if partner leaves, Abuses pets to hurt partner, Tells partner about affairs, Harasses partner about affairs, real or imagined, Manipulates partner with lies / contradictions Example of sexual abuse all of the above Financial abuse examples Forging to elder signature and cashing his her check Forcing client to sign any document Misusing or stealing the elders clients possession Forcing the elderly to contribute for utilities Forcing the elderly to contribute money for food Making them put their paycheck into a certain account stealing money Giving tax return Examples of digital abuse Who you can or can't be friends with on social media Sending inapproporate memes Pressuring to sext Going through phone Tagging in unkind pictures Comorbidities for abuse Anxiety depression suicidal idealization. Men are less likely to report abuse Childhood trauma is a common trait of people who will eventually cause abuse Violence requires perpetrator vulnerable person crisis situation Characteristics of a perpetrator -consider their own needs more important than the needs of others -poor social skills -extreme pathological jealousy -may control family finances cycle of violence Tension-building stage Acute battering stage Honeymoon stage Cycle of abuse **** 1) tensions building (pushing, verbal abuse, victim ignores or accepts, they don't want it to escalate, victim tries to minimize the abuse) 2) incident ( Tension peaks, verbal, emotional, and physical abuse, anger, blaming, arguing, threats, intimidation) 3) reconciliation (Abuser apologizes, gives excuses, blames the victim, denies the abuse occurred, abuser says the abuse was not as bad as the victim claims) 4) calm (Incident is "forgotten", no abuse is taken place, "honeymoon phase") Pregnancy may trigger or increase violence Violence may escalate when wife makes a move for independence Greatest risk for violence is when the women attempt to leave relationship Characteristic of vulnerable persons: children - product of unwanted pregnancy - Reminds parent of someone they do not like - interference with emotional binding between parent Characteristic of vulnerable persons: older adults - poor mental health - Dependent on perpetrator - Female, older than 75 years old, white, living with a relative - Always screen for abuse TEN4 Any bruising especially if the baby is not pulling up or taking steps T- torso E- Ears N- Neck Assessment should include Violence indicators Level of anxiety and coping responses Family coping patterns Support systems Suicide and/or homicide potential Drug and alcohol use Nursing diagnosis Risk for injury risk for violence Implementation Report abuse Counseling Case management Therapeutic environment Promotion of self care activities Health teaching and promotion Prevention of abuse Primary prevention - Measures taken to prevent the occurrence of abuse Secondary prevention - Early intervention in abusive situations to minimize their disabling or long-term effects Tertiary prevention - Facilitating the healing and rehabilitative process - Providing support - Assisting survivors of violence to achieve their optimal level of safety, health, and well-being Sexual assault and sexual violence Unwanted sexual advances and sexual harassment Stranger rape Marital rape Date rape Drug-facilitated sexual assault Incest Human sex trafficking Female genital mutilation Rape nonconsensual sexual penetration of the body using physical force, the threat of bodily harm or incapacitation with drugs or alcohol Physical effects of sexual assault Depression Suicide Anxiety fear low self esteem effects of incest -negative self-image -depression -eating disorders -personality disorders -self-destructive behaviors -substance abuse Sexual Assault Nurse Examiner (SANE) a registered nurse specially trained to provide care to sexual assault patients. The SANE conducts medical forensic examinations and can serve as an expert witness. Best practice guidelines **** Head to toe physical assessment for signs of injury Detailed genital examination Evidence of collection and preservation Documentation of physical findings Treatment, discharge planning, and follow up care Rape-trauma syndrome a two-stage set of symptoms that follow the trauma of being raped, consisting of physical, emotional, and behavioral stress reactions Outcomes Absence of any residual trauma Forensic Nursing help investigate crimes like sexual and physical assault and accidental death Forensic nursing functions ******* -Provide direct services to crime victims and perpetrators of crime -Consultation services to colleagues in nursing, medical, and law-related agencies -Expert court testimony -Offer input on policy changes in the corrections setting -Offer evaluation services for inmates Care of adult and pediatric victims of sexual assault SANE nurse legal sanity able to distinguish right from wrong legal insanity inability to tell right from wrong irresistible impulse Guilty By Mental Illness (GBMI) Hostage negotiator role Being on call around the clock to assist law enforcement officers on the scene Providing suggestions regarding negotiation techniques Assessing the mental status of the perpetrator Providing a link to mental health agencies Participating in a critique of the hostage incident Assessing released hostages Assessing the stress level of the hostage negotiator Providing training in communication skills to law enforcement officers Criminal profiler attempts to provide law enforcement officials with specific information about the type of individual who may have committed a certain crime correctional nursing Advanced education and clinical practice as a forensic nurse Defined by location of the work or legal status of the patient Provides treatment and services for inmates with chronic mental health diagnoses Custody versus caring debate Splitting DOnt have the ability to view both positive and negative aspects of a whole, which results as viewing a person as wonderful or awful. Feelings of entitlement, an exaggerated in ones own belief, and a lack of empathy. People with this disorder suffer from a weak self-esteem and hypersensitivity to criticisms. Narcissistic Personality Disorder Walter white Extremely sensitive to rejection, feel inadequate, and are socially inhibited. Avoid interpersonal contact owing to fears of rejection or criticisms. Avoidant personality disorder Ricky Williams Excitable and dramatic yet are often also high functioning. Extroversion, flamboyance, and colorful personalities. Histrionic personality disorder Paris Hilton Trisha Paytis a pattern of submissive and clinging behavior related to an excessive need to be taken care of. This need results in intense fear of separation. Dependent personality disorder Bella from Twilight Donkey from Shrek Dory Lifelong pattern of social withdrawal No interest in being with someone in a sexual or mutual relationship Loner Schizoid personality disorder Manny the mammoth Symptoms are very strange and unusual Have magical thinking, strange speaking patterns or languages Have to protect these patients Schizotypal personality disorder WIlly Wonka The world is out to get me District and suspicious of others based on the beliefs unsupported by evidence, that others want to exploit, harm, or deceive the person. Paranoid personality Nemos dad boarderline personality disorder unstable identity and interpersonal relationships, as well as by chronic feelings of emptiness and a history of suicidality, Impulsivity Emotional liability emotional dysregulation Self-destructive behaviors the hulk Limited emotional expression Stubbornness Perseverance Orderliness Perfectionism Obsessive-compulsive personality disorder antisocial personality disorder A personality disorder in which the person (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members. May be aggressive and ruthless or a clever con artist. The Grinch Jeffery Dahmer resilience the personal strength that helps most people cope with stress and recover from adversity and even trauma Children who are/ were abused may mimic the behaviors of their _______ later on in life abuser Interviewing, testing, observing the child during the assessment The initial __________ with the child is key interview General Interventions for Children and Adolescents Behavioral interventions Play therapy Bibliotherapy Expressive arts therapy Journaling Music therapy Family interventions Psychopharmacology Disruptive behavior management (use least restrictive intervention first) Advanced Practice Interventions Individual and group therapy Psychoeducation Medication prescription and monitoring Basic health assessment Cognitive remediation Family therapy Younger children: Used play and ideas Grade school: Combine play neurodevelopmental disorders neurologically based disorders that are revealed in a clinically significant way during a child's developing years Communication disorders, motor disorders, specific learning disorder, intellectual developmental disorder, ASD, ADHD communication disorders Problems making sounds Difficulty understanding or using words in context May be evident by inability to follow directions Expressive language disorder Social communication disorder Motor Disorders a group of disorders characterized by motor symptoms such as tics (sudden nonrhythmic and rapid movement or vocalizations), stereotypic movements (Repetitive, purposeless movements for 4 weeks or more), or dyscoordination (Impaired in motor skill development, coordination below Childs developmental age) How to treat tic disorders? Behavior techniques Medications Deep brain stimulation Type of tic disorders Tourette's disorder (Multiple motor tics and at least one vocal tics) more than a year persistent motor or vocal tic disorder (One or more motor or vocal tics) Provisional tic disorder (one or more motor and vocal tics for less than a year) Tic disorders must occur before the age of _______ 15 What medications can be used for tic disorders? First and second generation anti-psychotics specific learning disorder a marked deficit in a particular area of learning that is not caused by an apparent physical disability, or by an unusually stressful home environment Dyslexia (reading) Dyscalculia (math) Dysgraphia (written expression) Usually identify in school years Intellectual Development Disorder below-average intellectual functioning Deficits in intellectual functioning, social functioning, and daily functioning begin in childhood Autism Spectrum Disorder A disorder characterized by deficits in social relatedness and communication skills that are often accompanied by repetitive, ritualistic behavior. Extremely resistant to change Appears in early childhood Degrees of severity in autism Level 1: requires support Level 2: Requires substantial support Level 3: Requires very substantial support ADHD (Attention-Deficit Hyperactivity Disorder) a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity Especially before the age of 12 Creates low self-esteem Assess level of physical activity, attention span, and talkativeness Make sure to nutrition needs are met Hyperactivity, freedom from injury, self-esteem, positive coping skills are the wanted outcomes medications to treat ADHD ritalin/concerta adderall XR atomoxetine guanfacine (tenex) intuniv Help reduce impulsiveness Watch out for appetite suppression Monitor kids sleep 1 in 40,000 children get schizo 18-24 year olds will primarily experience their first schizophrenic episode in college Substance abuse is high with Schizophrenia ______ is 5x more likely in patients with schizophrenia suicide Polydipsia is common with schizophrenia which can cause hyponatremia Schizophrenia is ________ inherited 80% risk positive schizophrenia symptoms delusions and hallucinations Alterations in speech Concrete thinking- inability to think abstractly false fixed belief delusion Alterations in speech Word Salad Clang association Neologisms Echolalia Alterations in perception Depersonalization Hallucinations Illusions Command hallucinations Derealization negative symptoms of schizophrenia Absence of essential qualities Anhedonia (no pleasure) Avolition (loss of motivation) Asociality Affective blunting Apathy Alogia (poverty of speech) first generation antipsychotics Chlorpromazine Haloperidol Only target positive symptoms for schizophrenia EPS symptoms EACh side effects Tardive Dyskinesia Pseudoparkinsonism second generation antipsychotics drugs that alleviate schizophrenia without producing movement problems Positive and negative symptoms Minimum side effects All antipsychotic meds can cause Neuroleptic malignant syndrome Is depression a normal part of aging? No it is not White males over the age of ____ have the highest suicide rate of any segment of the population. 65 7 times more likely Most common anxiety disorder in elderly generalized anxiety disorder benzos should be avoided in elderly populations to avoid falls and sedation Delirium is acute or chronic? acute The most common neurocognitive disease in the elderly is alzheimers Alcohol use disorder in elderly urinary retention malnutrition Falls Electrolyte imbalance Pain can effect appetite Sleep mental health PAINAD scale Patients whose dementia is so advanced that they cannot verbally communicate caregiver burden stress responses experienced during prolonged periods of home care by family caregivers Ageism prejudice or discrimination on the basis of a person's age Advanced Directive (AD) A legal document in which an individual gives written instructions expressing his or her wishes regarding health care in the event that person can no longer make those decisions. PSDA (Patient Self-Determination Act) law that requires all health care facilities to provide patients with information and assistance in the preparation of advanced directives psychiatric advance directives Those with serious mental illness can designate a health care agent to make treatment decisions during an illness relapse. living will A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. directive to physicians A written document specifying the patients wish to be allowed to die without heroic or extraordinary measures. delirium is reversible Delirium mental disorder marked by confusion; uncontrolled excitement; ADJ. delirious Global disturbance of cognition Psychmotor disturbance Emotion dysregulation Disturbance of circadian rhythm Impairment of consciousness and attention illusion Seeing something that is actually there, but seeing it as a different form Up to 80% of intensive care patient experience delirium Four cardinal features of delirium 1. Acute onset and fluctuating course 2. Reduced ability to direct, focus, shift, and sustain attention 3. Disorganized thinking 4. Disturbance of consciousness First thing to assess for delirium ask family or friends to see what base line is on patient Look at labs Look at medications If physical symptoms are present such as increased pulse, dilated pupils, and flushed face, these could be signs of delirium Nursing diagnosis for delirium Risk for injury Acute confusion Risk for deficient fluid volume Disturbed sleep pattern Impaired verbal communication Fear Self-care deficits Impaired social interaction Outcomes from delirium Patient will remain safe and free from injury Free from falls Continue to orient Nursing implementation during delirium Prevent physical harm and electrolyte imbalance Minimize use of restraints (can cause confusion) Attempt to relieve stress Progressive deterioration of cognitive functioning and global impairment of intellect dementia Does not interfere with ADLs; does not necessarily progress Mild dementia Interferes with daily functioning and independence Major dementia Types of Dementia Alzheimer's Disease Vascular Dementia Lewy Body Dementia Frontotemporal Dementia Risk factors for Alzheimers disease -Age - by age 85, 50% of individuals show signs -Genetic factors -Environmental factors - stroke, head injury, Type 2 diabetes, and CVD all increase risk -Lifestyle factors - exercising, cognitive activity, low level of alcohol consumption decrease risk - Unhealthy lifestyle Hippocampus function learning and memory Important to distinguish normal __________ and _________ in dementia forgetfulness memory deficits Confabulation creation of stories or answers in place of actual memories to maintain self-esteem Perseveration repetition of phrases or behavior Symptoms of Alzheimer's Disease Memory impairment Disturbances in executive functioning Aphasia: Loss of language ability Apraxia: Loss of purposeful movement Agnosia: Loss of sensory ability to recognize objects Diagnostic tests for Alzheimers •Computed tomography scan (CT) •Positron emission tomography (PET) •Mental status questionnaires •Mini-Mental State Examination •Complete physical and neurological exam •Complete medical and psychiatric history •Review of recent symptoms, meds, and nutrition Nursing diagnosis for alzheimers •Risk for wandering •Risk for injury •Impaired verbal communication •Impaired environmental interpretation syndrome •Impaired memory •Confusion •Caregiver role strain •Anticipatory grieving potential for burns poly pharmacy drink wrong fluids in home Nurse should assist regularly with _______________ for patients with dementia or Alzheimers eating and drinking ACE inhibitors Aricept Exalon Razadyne Treatment for dementia Cause slow down the procession of the disease, does not cure or reverse NMDA receptor antagonist Targets glutamate activity Memantine SE: Dizziness, agitation, headache, constipation, confusion For moderate to severe alzheimers Always check expiration dates on medications After bruising is reported on a older adult, what should the RN do next? Measure and note characteristics of bruises Which therapeutic statement should the nurse say after they see bruises bruises I have a legal obligation to report this type of abuse Paranoid personality disorder plan of care avoid laughing or whispering infant of client What should the RN implement when a antisocial male request a certain RN and gets belligerent when another RN is assigned Advise the client that the assignments are not based on the clients request When preparing to administer a domestic violence screening tool to a female client, which statement should the RN provide Everybody gets screened for abuse RN is providing strategies for a female client on abuse, what should the nurse Have a bag ready that has extra clothes for self and children in the case of a unexpected evacuation Patient is experienced intimate partner violence, what should the nurse do if there is any bruising or signs of physical abuse Photographs if allowed by patient Patient stops antipsychotic meds and is on mental unit, what should the nurse do if the patient is experiencing hallucinations. What should the nurse ask? "What are the voices saying?" Clozaril Antipsychotic may cause agranulocytosis An older adult client has been identified as a victim of psychological abuse. Which action by the nurse is the priority nursing intervention? Removing the client from any situation that presents immediate danger The home care nurse is doing an assessment interview with an older adult who asks the nurse to buy some groceries for her because she is not feeling well today. Which statement would the nurse use in response? "lets discuss how we can solve this problem" A client prescribed a stimulant reports to the nurse difficulty falling asleep at night. The nurse instructs the client on how to minimize sleep disorders. On assessment, which statement by the client indicated that teaching has been effective? "Ill take the medication at least 6 hours before bedtime" A client has been diagnoses with narcissistic personality disorder. The nurse knows further teaching is required when the patient states their disorder causes which of the following characteristics? Inflexible and preoccupied with details and rules The RN is providing care for a client diagnosed with borderline personality disorder who has self-inflicted laceration on the abdomen. Which approach should the RN use when changing the clients dressing? Preform the dressing change in a non-judgmental manner A female client with OCPD is admitted to the hospital for cardiac catheterization. The afternoon before the procedure, the client begins to keep detailed noted of the nursing care she is receiving, and reports her findings to the RN at night time. Which action should be implemented? Encourage the client to express her feelings regarding the upcoming procedure A client diagnosed with delirium anxiously stares, "look at the spiders on the wall." Which response by the nurse addresses the client's concerns therapeutically? "I know that you are frightened and see spiders on the wall, but I do not see any spiders on the wall." *chronically depressed older male client of a long term care facility becomes more reclusive and today refuses to leave room. What is the most therapeutic response to give the patient? "May I sit with you for a while" A older homeless client visits the psychiatric unit to obtain a prescription renewal for Xanax. During the health assessment, the client complains of chest pain. Which action should the nurse take first? Determine if Xanax was taken recently A female client on the unit begins to toss chairs around. When another client objects to the disturbance and shouts, "I am the boss here. I do what I want." Which nursing problem best supports these observations? Risk for other related violence related to disruptive behavior A client diagnosed with schizophrenia states to the nurse, "I am a spy for the FBI, am an eye, an eye in the sky." Based on this information, the nurse knows that the client is exhibiting which abnormal thought process? Clang association A male client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. That intervention is best for the nurse to implement? Escort the client to his room A stimulant is prescribed for a child with a diagnosis of attention deficit hyper activity disorder. At which time of day would the nurse instruct the mother to administer the medication? In the morning and sometime around noontime meal The nurse int he day center is told that a child with autism will be attending the center. The nurse collaborates with the staff of the day care center and plans activities that will see the child's needs. Which priority consideration would the nurse incorporate in planning for the child? Safety A client with schizophrenia who is taking Haldol begins exhibiting tremors of the extremities. Which intervention should the nurse implement? Consult with the healthcare provider but anticipate a reduction in dose on the addition of an anticholinergic medication The client diagnosis with paranoid schizophrenia has been taking halloo for several years. Which statement indicated the need for additional teaching concerning this medication? "I am more susceptible to colds and the flu when taking this medication" A nursing student is asked to conduct a clinical conference about autism. Which characteristic associated with autism would the student plan to include? Lack of social interaction and awareness Children with conduct disorder may be diagnosed with which disorder as adults? Antisocial personality disorder A nurse is counseling the parents of a child with oppositional defiant disorder (ODD). What does the nurse advise the parents for dealing with the maladaptive behavior of their child? The parents should ignore the child's behavior unless they are doing something to harm themselves or others A client is diagnosed with ODD. Which assessment finding would indicate the the client needs medications? Presence of comorbid psychiatric disorder The nurse reviews the clients health care record and notes that the client is taking donepezil. Understanding the purpose of these medications, the nurse knows what? Slows the progression of the Alzheimers The nurse is preforming a neurological assessment on a client with a diagnosis of dementia and assessing the function of the frontal lobe of the brain. Which would the nurse assess to yield the best information about this area of functioning? Insight, judgment, and planning The 5 As in negative symptoms 1. Alogia- without speech 2. Avolition- without motivation 3. Anhedonia- without fun 4. Affect- without emotional expression 5. Asociality- without interest in social situations When a patient is experiencing hallucinations, verbal or visual, what is the best thing for the nurse to say? "I understand that you are hearing/seeing these things, but I do not see them" catatonic schizophrenia A type of schizophrenia marked by striking motor disturbances, ranging from muscular rigidity to random motor activity. Always ask ____________ questions when assessing the schizophrenia symptoms a patient is experiencing open ended Suicide risk in schizophrenic patients is __________ HIGH after taking antipsychotics for a while, the patient has a Increased BP, muscle rigidity, and increased temperature. What could this be indicating? Neuroleptic malignant syndrome When a patient is taking clozapine, what lab value should be monitored? White blood cells WBC range 4,500-11,000 Cluster A personality disorders (odd/eccentric) paranoid, schizoid, schizotypal Cluster B: Dramatic, Emotional, Erratic antisocial, borderline, histrionic, narcissistic Cluster C disorders avoidant, dependent, obsessive-compulsive When a patient with antisocial personality disorder keeps requesting and has questions, what is the best thing to do? Only allow one person to give the answers instead of multiple staff members to avoid getting manipulated Splitting demonstrating an inability to reconcile negative and positive attributes of self or others When do limits absolutely need to be set with patients with personality disorders? If they are verbally or physically abusive to other patients A nursing diagnosis for almost all personality disorders Impaired social interaction agnoisa inability to recognize objects Apraxia impaired ability to carry out motor activities despite intact motor function Confabulation the unintended false recollection of episodic memories In late stage dementia, what is the main nursing priority? Nutrition and hydration maintenance