Psych Quiz 1

7/29/2019 Psych Quiz 1

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N292: QUIZ ONE STUDY GUIDE (34 QUESTIONS

Communication Techniques (2 Questions):

Therapeutico Using silence: allows client to take control of the discussion

Nodding; maintaining eye contacto Accepting: conveys positive regard

Yes, um-hmm, I follow what you saido Giving recognition: acknowledging, indicating awareness

I noticed youve combed your hair. I see youre dressed this morningo Offering self: making oneself available

Ill sit with you Ill stay with you for 15 minuteso Giving broad openings: allows client to select the topic

Where would you like to start?What is on your mind this morning?o Offering general leads: encourages client to continue

And then? Go ono Placing event in time or sequence: clarifies the relationship of events in time

Was that before or after? What happened just before that?o Encouraging description of perception: asking client to verbalize what is being

perceived

What is happening? Describe what you are hearingo Encouraging comparison: asking client to compare similarities and differences in ideas,

experiences, or interpersonal relationships

Has this happened before does this remind you of anything?o

Restating: lets client know whether an expressed statement has or has not beenunderstood

o Reflecting: directs questions or feelings back to client so that they may be recognizedand accepted

Are you wondering if? Do you think that?o Focusing: taking notice of a single idea or even a single wordo Exploring: delving further into a subject, idea, experience, or relationship

Tell me more about that.Describe that to meo Seeking clarification and validation: striving to explain what is vague and searching for

mutual understanding

Im not sure I follow what you are saying. Do you mean to say that?o Presenting reality: clarifying misconceptions that client may be expressing

I dont hear anyone talking I amyour nurse, this is a hospitalo Voicing doubt:expressing uncertainty as to the reality of clients perception

I find that hard to believe. That seems quite unusualo Verbalizing the implied: putting into words what client has only implied


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o Attempting to translate words into feelings: putting into words the feelings the clienthas expressed indirectly

o Formulating plan of action: striving to prevent anger or anxiety escalating tounmanageable level when stressor recurs

How might you handle this next time? What are some safe ways you couldexpress your anger?

o Summarizing: clarifying main points of discussion and providing closure Today I have understood you to say

Nontherapeutico Reassurance: indicating there is no cause for concern; may discourage client from

further expression of feelings if client believes the feelings will only be downplayed or

ridiculed

Youre going to be fine. I wouldnt even worry about that if I were you.o Rejecting:refusing to consider clients ideas, feelings or behavior

I dontwant to hear about that. Lets not discuss depressing subjectso Approving or disapproving: implies that the nurse has the right to pass judgment on the

goodness or badness of client behavior

Oh yes, thats what Id do. Thats goodo Agreeing or disagreeing: implies that the nurse has the right to pass judgment on

whether clients ideas or opinions are right or wrong

o Giving advice: tell the client what to do; implies that the nurse knows what is best forclient and that client is incapable of any self-direction.

I think you shouldwhy dont you?o Probing: asking persistent questions; pushing for answers to issues client does not wish

to discuss causes client to feel used and valued only for what is shared with nurse

tell me your psychiatric historyo Defending: to defend what client has criticized implies the client has no right to express

ideas, opinions, or feelings

All staff here is caring people. Your doctor is the best in the cityo Requesting an explanation: asking for reasons; asking why implies the client must

defend his or her behavior or feelings

Why would you say a thing like that? Why do you feel that way?o Indicating the existence of an external source of power: encourages client to project

blame for his or her thoughts

What made you do that? What makes you say that?o Belittling feelings expressed: dismissing importance of clients feelings (usually an

attempt to be cheerful) causes client to feel insignificant or unimportant

o Making stereotyped comments, clichs, and trite expressions: meaningless in a nurse-client relationship

Tomorrow will be a better day. This too shall pass.o Using denial: blocks discussion with client and avoids helping client identify and explore

areas of difficulty


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o Interpreting: results in therapist telling client meaning of his or her experience.o Introducing an unrelated topic: causes the nurse to take over the direction of the

discussion.

Defense Mechanisms (1 question):

Compensation: over achievement in one area to offset real or perceived deficiencies in anotherarea

o Student with little interest in sports works hard to be on honor roll Conversion: expression of emotional conflict through development of a physical symptom

o Child who is expected to go to college develops blindness but is unconcerned about it Denial: failure to acknowledge obvious ideas, conflicts, or situations that are emotionally painful

or anxiety provoking

o Person with newly diagnosed terminal illness is cheerful and makes no mention ofillness

Displacement: ventilation of intense feelings toward persons less threatening than the one9s)who aroused those feelings

o Person who is mad at the boss yells at his/her spouse Identification: unconscious modeling of the behaviors, attitudes, and values of another person

o Teenager espouses beliefs and behavior of an admired relative, although unaware ofdoing so

Intellectualization: separation of emotion of a painful event or situation from the facts involved;acknowledging the facts but not emotion

o Person involved in a serious car accident discusses what happened with no emotionalexpression

Introjection:acceptance of another persons values, beliefs, and attitudes as ones own; act likesomeone else

o Person who dislikes guns becomes an avid hunter, just like best friend Projection: attributing unacceptable thoughts, feelings or actions to someone else

o Person with many prejudices loudly identifies others as bigots Rationalization: justification of unacceptable thoughts, feelings or behavior with logical

sounding reasons

o Student cheats on test and claims everyone does it, therefore it is necessary to cheat tobe able to get passing grades

Reaction formation: unacceptable thoughts and feelings are handled by exhibiting the oppositebehavior

o Person with sexist ideas does volunteer work for a womans organization Regression: go backward in developmental level; act like a child Repression: exclusion of emotionally painful or anxiety provoking thoughts and feelings from

conscious awareness

Sublimation: substitution of socially acceptable behavior for impulses or desires that areunacceptable to the person


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o Person who is trying o stop smoking chews gum constantly Suppression: conscious exclusion of unacceptable thoughts and feelings from conscious

awareness

o Student decides not to think about a parents illness in order to study for a test Undoing: exhibiting acceptable behavior to make up or negate previous unacceptable behavior

o Person who has been cheating on a spouse sends the spouse a bouquet of rosesNurse-Client Relationship (3 questions):

Therapeutic nurse-client relationship: must have mutual respect, and be purposeful, goaloriented, and client focused. Essential conditions for development of relationship include:

o Rapport: acceptance, warmth, interesto Trust: basis of therapeutic relationshipo Respect: positive regardo Genuineness: honest, real, truthfulo Empathy: communicate understanding of clients thoughts or feelingso Sympathy: shared feelings; less objective; focus on relieving nurses distress

Transference: client transfers feelings and behavioral dispositions formed towards a personfrom past; how patient feels and acts towards nurse

Counter transference: nurses behavioral and emotional response to client; signs of countertransference:

o Over-identifying with cliento Social or personal relationshipo Give adviceo Encourages dependenceo

Uncomfortable with cliento Difficulty setting limitso Defends client to other staff

Phases:o Pre Interaction: review record; consider own feelings, attitudeo Orientation: establish trust, set goals, collect data, develop plano Working: promote insight, problem solve, overcome resistanceo Termination: make plans for continuing care, share feelings.

Legal/Ethical Issues (2 questions):

Scope of practice: includes legal boundaries set by the state and standards set by ANAo State practice act provides legal definitiono ANA Standards of Nursing Practice Act

Assessment Diagnosis Outcomes identification Planning

quality of practice education practice evaluation collegiality


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Implementation evaluation collaboration ethics

research resource utilization leadership

ANA code of ethics: respect, dignity, privacy, protection of information, protection of patientshealth & safety, accountability, professional relationships

o Guiding principles of ethics: Autonomy:clients right to make decisions Beneficence:act in clients best interest; do no harm Justice: treat people equally and fairly Veracity: tell t he truth Nonmaleficence: avoid causing harm Confidentiality: non-disclosure of information with which we are entrusted

Informed consent: (principle of autonomy) must have capacity to understand, be informed ofchoices, risks, side effects, and alternatives, document discussion

Patient rights: humane treatment, adequate staff, therapeutic setting, participate in treatmentplan, safe discharge plan, least restrictive environment, advanced directives, refuse treatment

(including medications)

Conceptual Frameworks for Treatment and Personality Development (4 questions):

Conceptual Model: framework of related conceptso Ericksons eight stages ofMan: personality develops through stages which over lap, and

individuals work on tasks from more than one stage at a time. May become fixed in a

certain stage and remain developmentally delayed; however it is possible for behaviors

to be modified and corrected in a later stage

Trust vs. Mistrust (0-1) Autonomy vs. Shame and doubt (1-3); separation from parent, starts to get

control over environment

Initiative vs. guilt (3-6) Industry vs. Inferiority(6-12) Identity vs. Role confusion (12-18) Intimacy vs. Isolation (18-25) Generativity vs. stagnation (25-45); focuses on doing something productive Ego integrity vs. Despair (45-death)

o Maslows Hierarchy: works upward Self Actualization (feeling of self-fulfillment & realization of potential) Self-esteem & esteem of others Love & belonging Safety & security Physiological Needs

o Psychoanalytical Model (Freud)


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Levels of consciousness: conscious, preconscious, unconscious (largest level) Structure of personality: Id, ego, super ego Psychosexual development: Oral (nursing baby), Anal (potty training), Phallic

(sexual interests) Genital (reproduction)

o Interpersonal model (Sullivan) Persons relationship with others, need for satisfaction & security, dynamisms,

anxiety as a central factor, security operations (apathy, preoccupation), self

concept (good me, bad me not me)

o Theory of Object Relations (Mahler) Based on separation; the individuation process of infant from the maternal

figure or primary caregiver

Phase I: Autistic Phase II: Symbiotic Phase III: Separation/individuation

o Differentiation (5-10 months)o Practicing (10-16 months)o Rapprochement (16-24months); if emotional needs not met

results in fear of abandonment

o Consolidation (24-36 months)- mother seen as separate butloving person; able to integrate good and bad

o Attachment theory (Bowlby) Attachment refers to a lasting emotional bond between infant & caregiver Secure attachments linked to ability to modulate stress, tolerate frustration &

develop intimate relationship; affect development of right hemisphere of brain

(limbic system)

o Behavioral Model (Pavlov & Skinner): any therapy that work with shaping behavior Classical conditioning(Pavlov- dog/bell): involuntary behavior associated with

event

Operant Conditioning(skinner): voluntary behavior related to environment Increasing desired behavior with positive (rewards) and Negative (undesired

stimulus) reinforcement

Decreasing a behavior by punishment, response cost & extinctiono Cognitive Model: any therapy that works with changing behavior and how someone

thinks about something

distorted or negative thought patters -> maladaptive feelings and behaviors;patterns of thinking are learned& become automatic

o Neurobiological Model: neurons, transmitters, receptors Brain & nervous system basic to understanding mental illnesses and disorders Neurotransmitters: chemical signal that activate postsynaptic receptors

Mental Status Exam (3questions):


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B.E.S.T.o Behavior and general appearanceo Emotions: mood and affecto Speech: rate, style, tone, odditieso Thought content/ process, obsessions, circumstantiality, tangentiality, flight of ideas,

thought blocking, confabulation, concrete vs. abstract

P.I.C.K.o Perceptual disturbances: illusions (misinterpretation of stimulus), hallucinations (hear

or see something no one else sees), depersonalization, derealization

o Impulse controlo Cognition & Sensorium: level of consciousness, orientation, concentration, memory,

MMSE, intellectual functioning

o Knowledge, insight judgment ABCS

o Appearance & Affect Clothing, neatness, cleanliness, makeup, hygiene, grooming, odor; overall

physical appearance/health

Stated mood, appropriate/inappropriate, attitude toward interviewer range (depth or diversity): wide/full, constricted/narrow, blunted/flat Stability (change)L stable/consistent, labile/rapidly changing

o Behavior Activity, gait, abnormal movements, coordination, pace, energy level, posture,

restless arm/leg movements

o Cognitive Functioning Intellect

Attention and concentration: sufficient/deficient, easily distracted,short attention span, poor concentration

o Test: serial sevens, repeat series of numbers forwards &backwards, spell WORLD backwards

Capacity for abstraction: ability to abstract or concrete thinkingo Test: give meaning of 2 proverbs; explain how 2 items are

similar

Fund of knowledge: adequate/inadequateo Test: name 5 large cities in U.S.; name current president,

governor Insight: present or absent

o Test: understanding of why they are in the hospital; what theysee as their problem

Orientation: to person, place, timeo Test: ask name, where they are and date

Short-term Memory: intact or impairs


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o Test: repeat names of 3 objects immediately and after 5minutes

Judgment: good, fair, pooro Test: what would you do if discovered fire in a movie theater or

if found stamped, addressed envelope in the street

Thought Clarity: coherent, incoherent, confused, vague, unclear in meaning Content: rhymes, homicidal or suicidal ideation, delusions,

hallucinations, ideas of reference, paranoia, obsessions, compulsions,

grandiosity, phobias

Flow: spontaneous, guarded, blocking, flight of ideas, tangential,circumstantial, poverty of thought (single word answers)

Level of Consciousness Describe as alert, responsive, drowsy, stuporous, comatose

o Speech Amount: talkative, taciturn, silent Rate: rapid, fast, slow, hesitant Clarity: clear, slurred, mumbling, lisping Pressure: pressured, intense, explosive Volume: loud, soft, whispering, inaudible

DSM (1 question)

Axis I: Clinical disorderso Primary Issue they are dealing with

Axis II: Personality disorders and mental retardation Axis III: Physical or Medical disorders Axis IV: Psychosocial and environmental factors

o Social stressors: divorced, homeless, unemployed Axis V: Global Assessment of Functioning (scale 1-100)

Schizophrenia (10 questions) including application of nursing process, antipsychotic meds (general &

side effects, not specific meds)

Schizophrenia

Psychotic symptoms for at least 6 months not related to medical condition or substance useImpaired social, academic and occupational functioning

Can be single episode, episodic, continuous, in full or partial remission

Paranoid type suspicious, may be argumentative, auditory hallucinations are common


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Disorganized type (hebephrenic) regressed, giggling, bizarre behavior, impaired socializationand affect, incoherent communication

Catatonic type extreme psychomotor retardation (stupor) or purposeless movements(excitement)

Undifferentiated bizarre behavior, hallucinations, delusions, incoherent speech (not fit othertypes)

Schizophrenia disturbs

Thought processes (delusions) Perception (hallucinations) Affect (impaired socialization) Speech & Behavior (disorganized, bizarre)

Premorbid Phase shy, withdrawn, few friends, poor school performance Prodromal phase poor functioning, non-specific symptoms, thought & perceptual disturbance

develop late in this phase

Active phase Psychotic symptoms are prominent

Delusions Hallucinations Disorganized speech and behavior Impairment in work, social relations, and self-care

Residual phase Follows an acute episode Symptoms similar to prodromal phase Flat affect and impairment in role functioning are prominent Negative symptoms remain


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Positive Symptoms Negative Symptoms

Hallucinations Illusions

Affective flattening Apathy

Delusions Anhedonia

Thought disorders Avolition

Disorganized speech and behaviors Ambivalence

Attentional problems

Alogia

Appearance deteriorated

ABCs of Mental Status

Appearance & Affect Behavior Cognitive Functioning Speech

Thought Content

Delusions False personal beliefs Inconsistent with reality Not generally accepted by others with same cultural background Content relates to underlying anxiety or fear

Types of Delusions (False Beliefs)


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Delusions of Persecution (threatened) Delusions of Grandeur (special powers) Delusions of Reference (insignificant remarks have personal meaning newspaper

headlines)

Delusions of Control (another person controls thoughts, behavior) Somatic Delusions (about bodily function disease, pregnancy) Nihilistic Delusions (nonexistence of self, world ending)

Other types of thought disturbance

Religious Preoccupation (use religious ideas to explain behavior) Paranoia (suspicious; food poisoned) Magical Thinking (thoughts or behavior can cause or prevent something happening) Looseness of association Unrelated topics Nonsensical speech -Neologisms new words Concrete thinking literal interpretations Clang associations often rhyming Word salad random words without meaning Repeat anothers words Echolalia Circumstantiality overly detailed Tangentialityunrelated topics; doesnt get to the point Mutism inability or refusal to speak Perseveration repeats same word or idea

Perceptions

Hallucinations - False sensory perceptions Auditory (most common in schizophrenia) Visual Tactile


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Olfactory Gustatory Kinetic

Illusions misperceptions of real external stimuliDisorganized Behavior

Repeat actions of others Echopraxia Repeat words - Echolalia Catatonia decreased reactivity to surroundings

Catatonic stupor (immobility, posturing, waxy flexibility, mutism) Excitement (unprovoked, excessive motor activity)

Complications

Risk of Suicide Risk of Chronic Fluid Imbalance polydipsia, water intoxication, seizures, hyponatremia, (heavy

smoking increases risk)

Medication side-effectsNursing Diagnoses

Outcomes

Will not harm self or others Will shower and wash clothes Will be compliant with medications Will exhibit less agitated behavior Will decrease hallucinationsInterventions

Establish trusting relationship Frequent, short contact Monitor symptoms & intervene early


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Facilitate adherence to medications Distract client from hallucinations Provide safe, structured environment and reduce stimuli in environment Connect symptom improvement to medication effect Individual approach rather than group Risk for violence:

Protect client from harming self or others Decrease stimuli Remove dangerous objects Provide physical outlets Medications Observation Assess for suicidal ideation

Disturbed thought processes (delusions): Reassure in safe place Help identify underlying anxiety (may reduce delusions) Accept but do not share belief Dont challenge delusions (they are not rational) Use reasonable doubt Talk about real events and people; Evaluate but dont dwell on irrational thoughts Provide reality based activities If suspicious, avoid touch, laughing or talking where client can see but not hear If suspicious, use same staff as much as possible

Disturbed sensory perception (Hallucinations):


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Observe for signs client is hallucinating Early interventions can prevent aggression Evaluate content of hallucinations (commands) Do not touch without warning; allow space Accepting, non-judgmental attitude Do not reinforce hallucination, say voices Reassure voices may be frightening, but not real Help client learn relationship between anxiety and the hallucination; explore what

precipitates hallucination

Provide reality based activities to help distract from hallucinations and reduce anxiety Impaired verbal communication:

Seek validation & clarification (Do you mean...?) Give feedback (I do not understand what you mean.) Helps client see he is not

understood and engages client in improving communication

Consistent staff assignments to promote trust Convey empathy: Verbalize the implied; That must have been upsetting. Anticipate and meet clients needs for safety and comfort until able to communicate

effectively

Orient to reality; call by name Social Isolation

Acceptance Brief, frequent contacts Slow introduction to group activities Initially accompany to groups to help client feel more secure Give recognition for interactions with others

Evaluation

Absence of threats to safety of self and others


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Takes medications as prescribed Interacts appropriately with others Participates in unit activities and groups Begins to modify responses to hallucinations

Antipsychotic Meds

Typical Atypical

Chlorpromazine (Thorazine) Risperidone (Risperdal) Thioridazine (Mellaril)

Olanzapine (Zyprexa) Fluphenazine (Prolixin) Quetiapine (Seroquel) Perphenazine (Trilafon) Ziprasidone (Geodon) Trifluoperzine (Stelazine) Clozapine (Clozaril) Thiothixene (Navane) Aripiprazole (Abilify) Haloperidol (Haldol)

**** DepotLong acting preparations

Fluphenazine decanoate (Prolixin) Haloperidol decanoate (Haldol) Risperidone microspheres (Risperdal Consta)


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Symptoms Controlled by Antipsychotics

Agitation Paranoia Apathy* Racing thoughts Delusions Rage Emotional withdrawal* Severe impulsiveness Feelings of unreality Social discomfort or isolation* Hallucinations Unclear thoughts Ideas of reference Uncontrollable hostility Lack of motivation* Uncontrollable negativism Lack of pleasure* Lack of spontaneity*

Common Side Effects

Antidyskinetic meds (3) Used to treat muscular side effects of Antipsychotics

Benztropine (Cogentin) Biperiden (Akineton) Orphenadrine (Norflex) Diphenhydramine (Benadryl) Procyclidine (Kemadrin) Trihexyphenidyl (Artane)

EPS Orthostatic Hypotension Sedation Weight Gain Temperature Dysregulation Neuroleptic Malignant Syndrome Photosensitivity Seizures (Typicals, Clozaril)

Hypergylcemia (Atypicals) Hypercholesterolimia Hypertriglycerides Diabetes mellitus Agranulocytosis (Clozaril) Myocarditis (with Clozaril) Prolonged QT (Invega,

Geodon)


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Amantadine (Symmetrel)

Med math (1).

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Psych Quiz 1