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PN 3003 VARIATIONS (MENTAL HEALTH) EXAM
QUESTIONS WITH COMPLETE SOLUTIONS
“definition of mental health vs mental illness - CORRECT ANSWER mental health:
-state of wellbeing in one's own abilities & normal stresses of life -only in a complete state of wellbeing when physical, mental, and social well-being is intact mental illness: -disturbance in a person's cognition, emotions, or behaviors"
"describe bargaining stage of grief - CORRECT ANSWER -an attempt to postpone acceptance
of reality -frequent labile moods -continued anger & unwillingness to accept loss"
"describe depression stage of grief - CORRECT ANSWER -deep sense of loss as reality of what
happened or anticipated settles -may withdraw from social interaction -predominant affect is feelings or emptiness or loss -sadness & grief can be intertwined w/ good days of positive emotions -sometimes this period can be overwhelming & recovery from depth of sorrow unlikely w/o professional help"
"describe acceptance stage of grief - CORRECT ANSWER -person begins to experience peace
& serenity -time for letting go & allowing life to provide new experiences & relationships"
"describe psychotherapy - CORRECT ANSWER use of psychological methods, particularly
when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems"
"describe cognitive behavioral therapy (CBT) - CORRECT ANSWER based on cognitive model
that focuses on identifying & correcting distorted thinking patterns that can lead to emotional stress & problem behaviors -it is believed that clients respond in stressful situations based on subjective perception of an event -once misperception identified, clients can change their behaviors by changing their maladaptive thinking about themselves & experiences"
"describe orientation phase - CORRECT ANSWER pt & nurse getting to know each other
-involves explaining purpose of nurse-pt interaction for building trust, establishing roles, & identifying problems & expectations"
"describe working stage - CORRECT ANSWER where outcomes & interventions toward
behavior change are planned & goals are developed to improve client's well being"
"describe termination phase - CORRECT ANSWER allows client to depend on themselves
while developing improved adaptive skills (end of nurse-pt relationship) -important to discuss termination w/ client & respond to any feelings/concerns"
"what components are included in mental status examination? - CORRECT ANSWER
appearance: grooming, eye contact, posture attitude: cooperative or uncooperative, friendly, hostile speech pattern: speed, volume, slurring mood & affect LOC/LOO memory: recent or short-term perceptions: hallucinations, illusions, etc. judgement: problem-solving, decision-making abilities thought processes: speed, content, logical or illogical" "differentiate each characteristic empathy genuineness acceptance
self awareness - CORRECT ANSWER empathy
-seeing, understanding, & sharing others viewpoints w/o judgement genuineness -attribute of realness & concerns that fosters an honest & caring foundation for trust acceptance -ability to see the client as a person w/ worthy & dignity who isn't judged or labeled by the standards of another self-awareness -consciousness of one's own individuality & personality w/ an attitude of openness to make positive changes"
"what are the types of anxiety disorders? - CORRECT ANSWER -generalized anxiety disorder
-panic disorder
-urinary urgency -muscle tension -anticipatory anxiety -fear of embarrassment or ridicule"
"incidence & etiology of social anxiety disorder - CORRECT ANSWER -equally common in
men & women -onset usually occurs in childhood or early adolescence -onset can be abrupt after an event occurs or it can be slow -runs in families"
"post traumatic stress disorder - CORRECT ANSWER an anxiety disorder has been subjected
to a traumatic event"
"s+s of PTSD - CORRECT ANSWER -intense feeling or fear and dread following a traumatic
event -mental reruns of the event -emotional numbness following the event -avoidance of people, places, or things associated w/ event -insomnia -↑ vigilance or watchfulness -startles easily -irritability and aggressiveness -depression -impaired social or work functioning -difficulty in interpersonal relationships"
"incidence & etiology of PTSD - CORRECT ANSWER -more common in females & can be seen
in any age group -also more common if there is a family hx of the disorder"
"obsessive compulsive disorder - CORRECT ANSWER An anxiety disorder characterized by
unwanted repetitive thoughts (obsession) and/ or actions (compulsions) for more than 1hr daily"
"define mood - CORRECT ANSWER an emotion that is prolonged to the point it color one's
entire psychological thinking"
"define affect - CORRECT ANSWER facial expression displayed in association with mood"
"euphoria - CORRECT ANSWER excessive feeling of happiness which has the possibility of
escalating to mania"
"define mania - CORRECT ANSWER frenzied, unstable mood, may be out of touch w/ reality"
"what is the DSM-V? - CORRECT ANSWER diagnostic and statistical manual of mental
disorders -list of criteria that one must meet in order to be diagnosed with psychological disorder -allows for precision and consistency in diagnosis research based -includes depressive, bipolar & related disorders"
"what are the types of mood disorders? - CORRECT ANSWER -major depressive disorder
-persistent depressive disorder (dysthymia) -bipolar -cyclothymic"
"depression - CORRECT ANSWER A prolonged feeling of helplessness, hopelessness, and
sadness for a duration of over 2 weeks or longer"
"s+s of major depressive disorders - CORRECT ANSWER -hopelessness, worthlessness
-guilt & self blame -crying episodes -sleep disturbances -weight & appetite changes -↓ sex drive -poor concentration & memory lapse -irritability -anxiety -↑ somatic complaints -difficulty making decisions -anhedonia & anergia -thoughts of death & suicide"
"incidence & etiology of major depressive disorders - CORRECT ANSWER -more common in
females & who have familial hx -people aged 14-16 & 65+ have a higher incidence"
"Persistent Depressive Disorder (Dysthymia) - CORRECT ANSWER Moderate depression
that persists for two years or more"
"s+s of persistent depressive disorder - CORRECT ANSWER -chronic depression syndrome
when one believes they have more power, wealth, smarts, or other grand traits than what is true delusion of persecution: -when one is convinced that someone is mistreating, conspiring against, or planning to harm them or their loved one"
"fluoxetine - CORRECT ANSWER brand: Prozac
class: SSRIs (inhibits reuptake of 5TN in the CNS) uses: major depression, OCD, bulimia, panic -monitor for serotonin syndrome"
"citalopram - CORRECT ANSWER brand: Celexa
class: antidepressant/SSRI (inhibits reuptake of serotonin in the CNS) uses: depression -monitor for serotonin syndrome, suicidal thoughts, neuroleptic malignant syndrome"
"bupropion - CORRECT ANSWER brand: Wellbutrin
class: antidepressant/aminoketones (decreases reuptake of dopamine in CNS) uses: depression w/ psychotherapy, seasonal depression, smoking cessation -monitor any suicidal thoughts/behavior, seizures"
"lithium - CORRECT ANSWER brand: Lithobid
class: mood stabilizer (alters cation transport in nerve & muscle) uses: tx of acute manic & mixed episodes associated w/ bipolar 1 disorder -monitor for toxicity with specific timeframes for bw -metallic taste in mouth is normal -↑ risk for dehydration; encourage fluids - tinnitus indicates a type of kidney malfunction Life threatening effects: arrythmias, bradycardia, renal toxicity, epileptiform seizures, coma"
"Illusions vs Hallucinations vs Delusions - CORRECT ANSWER illusions
-misperceptions of real external stimuli (ex: a black box is seen as a snake) hallucinations -false perception of objects or events involving sight, smell, touch & taste (ex: hearing voices no one else hears) delusions -belief that is clearly false (ex: thinking one is being stalked)"
"define psychosis & its 3 types - CORRECT ANSWER loss of contact with reality
-have hallucinations & delusions -perceptual disturbances
-disorganized thinking -behavior alterations"
"describe residual stage of schizophrenia - CORRECT ANSWER -looks like prodromal phase
-obvious psychosis has subsided, but pt may exhibit negative symptoms like social withdrawal, lack of emotions, anhedonia"
"negative symptoms seen in a schizophrenic patient - CORRECT ANSWER -blunt or flat
affect -lack of motivation -lack of emotion -substance use -violence -depression & suicidal acts -social withdrawal -violent behavior -anhedonia -anergia -avolition (the decrease in the ability to initiate and persist in self-directed purposeful activities)"
"what are the various themes of delusions a schizophrenic patient can have? - CORRECT
ANSWER depressive (have committed terrible deeds)
somatic (their body is disintegrating into another substance or infested w/ insects) persecution (others are out to get them)"
"what should a nurse include in pt education regarding antipsychotic drugs? - CORRECT
ANSWER -take meds as directed
-S+S of tardive dyskinesia, EPS -take meds w/ food or milk to decrease stomach irritation -avoid taking meds within 1hr of taking antacids or antidiarrheals (can decrease effectiveness of antipsychotic drugs) -can take several days to weeks for full effects of meds -drowsiness can occur -avoid direct sunlight & use sunscreen -avoid vigorous exercise & overheating -phenothiazines can turn urine pinkish red, red, brownish red -avoid alcoholic drinks (will increase CNS action) -avoid standing up too fast (orthostatic hypotension)"
"clozapine - CORRECT ANSWER brand: Clozaril
"incidence & etiology of avoidant personality disorder - CORRECT ANSWER -seen frequently
in women & men -shyness & fear of situations during childhood increases chance of development -evidence shows decrease in age"
"dependent personality disorder - CORRECT ANSWER inability to make decisions, extreme
fear of being alone, abusive relationships common"
"s+s dependent personality disorder - CORRECT ANSWER -consistent, extreme dependence
on others -self perceived helpless & incompetent -insecurity, self doubt, self care decision avoidance -independent activities not an option"
"incidence & etiology of dependent personality disorder - CORRECT ANSWER -more dx in
women than men -one of the most frequently reported personality disorder -children & adolescencs who experience"
"obsessive compulsive personality disorder - CORRECT ANSWER conscientious, highly
organized, & preoccupied w/ order & perfection"
"s+s obsessive compulsive personality disorder - CORRECT ANSWER -rigid, controlling
-highly critical of self & others -difficult to feel accomplishment satisfaction -rigid morals & ethics -relationships serious & shallow"
"incidence & etiology of obsessive compulsive personality disorder - CORRECT ANSWER -
twice as often in men than women"
"Types of Somatoform disorders - CORRECT ANSWER -somatic symptom disorder
-illness anxiety disorder (formerly hypochondriasis) -conversion disorder (functional neuroleptic symptom disorder) -factitious disorder"
"soma vs somatization - CORRECT ANSWER soma: refers to the body
somatization: physical expression of stress and emotions d/t significant psychological stress"
"somatic symptom disorder - CORRECT ANSWER one or more somatic symptoms that
suggests physical illness/injury but are unexplained by medical findings"
"s+s of somatic symptom disorder - CORRECT ANSWER -recurring somatic complaints
usually continue for several years (may include pain) -excessive worry or anxiety over physical health symptoms that are disruptive to the person's life -exaggerated belief in the severity of their symptoms & health -excessive time is devoted to investigating their health symptoms -anxiety & depression"
"incidence & etiology of somatic symptom disorder - CORRECT ANSWER -seen more in
women than men -coexistence of PTSD, excessive anxiety or depression is common & imposed disability -tends to run in families"
"illness anxiety disorder (formerly hypochondriasis) - CORRECT ANSWER may or may not
have a medical condition, but have unwarranted fear & anxiety over the possibility of an existing undiagnosed illness"
"s+s of illness anxiety disorder (formerly hypochondriasis) - CORRECT ANSWER -repeated
health care visits seeking verification of fears -excessive amt of anxiety -symptoms reported in specific detail but don't follow those types of pathologic condition -perceived illness focal point of existence -physician shopping -perception of incompetent medical care -impaired social family relationships"
"conversion disorder - CORRECT ANSWER sensory or neurologic impairment that isn't
supported by results of diagnostic testing"
"s+s of conversion disorder - CORRECT ANSWER -lack of conscious control over symptoms
-loss of balance or paralysis of a limb -loss of swallowing, speaking, seeing, or hearing -loss of pain or touch sensation -impaired functioning in social or work related areas caused by symptoms -a la belle indifference (little anxiety/concern over symptoms) -seizures or convulsion type behavior inconsistent w/ usual symptom pattern -lack of physical change or disability -functional ability & symptoms inconsistent w/ usual neuropathic disorders"
"what are the substance classes recognized by the DSM-5? - CORRECT ANSWER -alcohol
-caffeine -stimulants (amphetamines, cocaine) -hallucinogens (includes PCP/PHENCYCLIDINE) -inhalants, opioids -sedatives, hypnotics, anxiolytics -other (or unknown) substance intoxication"
"what can lead to substance abuse? - CORRECT ANSWER -genetics, family influences
-peer pressure -environmental stress factors -personality characteristics -chronic physiologic disease -codependency -enabling"
"how does codependence & substance use/abuse affect family dynamics? - CORRECT
ANSWER tend to feel a responsibility for drug user's problem & internalize guilt for behaviors
of that person -due to that, they will do anything to sustain the relationship and enable the drug user -will be defensive towards their behaviors -family can become dysfunctional"
"what is the cycle of addiction? - CORRECT ANSWER precontemplation
-addict hasn't yet considered stopping behavior or use of substances contemplation -addict is starting to consider making a change in behavior preparation -addict is mentally & possibly physically making a change action -addict has taken an action, like tx, self-help groups or counseling. tx has been provided & addict has stopped using maintenance -addict is maintaining their new lifestyle & behavior, following a recovery program"
"which disorders are classified as substance induced disorders? - CORRECT ANSWER -
substance intoxication -substance withdrawal"
"substance intoxication & s+s - CORRECT ANSWER maladaptive behavioral & psychological
changes R/T effects of substances on CNS signs & symptoms -disturbances in areas of perception, sleep-wake cycle -attention, concentration, thinking & judgement -flushed appearance, blood shot eyes -increased RR & BP"
"substance withdrawal & s+s - CORRECT ANSWER symptom-specific maladaptive changes
in behavior -occurs when blood or tissue concentrations of drug declines signs & symptoms -develops several hours to a few days after cessation -unpleasant symptoms occur so pt most likely to seek relief by re-ingesting drug"
"what is CIWA? - CORRECT ANSWER Clinical Institute Withdrawal Assessment
-most common method to tx alcohol withdrawal symptoms -benzos are the meds used -helps prevent DTs from occurring"
"substance-specific use disorders & its types - CORRECT ANSWER patterns of cognitive,
behavioral & physiological symptoms resulting from continued substance abuse symptoms range from: -mild: 2-3 symptoms -moderate: 4-5 symptoms -severe: over 6 symptoms types: alcohol use disorder, cannabis, inhalant, opioid, stimulant, caffeine, nicotine, sedative/anxiolytic, substance abuse by HCPs"
"what is Wernicke-Korsakoff syndrome & the s+s? - CORRECT ANSWER type of alcohol use
disorder encephalopathy & psychosis; nutritional disease of nervous system in alcoholics -primarily caused by thiamine & niacin deficiency, chronic use of alcohol -significant cerebral deterioration & actual cell death occurs w/ chronic & permanent impairment signs & symptoms -progressive memory loss
heart rhythm disturbances -exposure to chemicals in glue can lead to an arrhythmia which then can lead to fatal heart failure sudden sniffing death -inhalants force heart to beat rapidly & erratically until user goes to cardiac /resp arrest"
"opioid related disorders & S+S - CORRECT ANSWER heroin most abused drug
-rx meds like oxycodone, hydrocodone -dependence: compulsive, prolonged self admin for no legit medical reason -effects: initial high, then apathy, depressed mood, motor functioning problems, impaired judgement -drug related crime"
"stimulant use disorder & S+S - CORRECT ANSWER crack most common form of cocaine
-easily vaporized, inhaled = potent euphoric effect -methamphetamines changes any function in neuron containing dopamine signs & symptoms -mood changes, weight loss, malnutrition -chronic use = mental & physical complications -psychosis resembling schizophrenia: violent, erratic behavior"
"caffeine related disorder & S+S - CORRECT ANSWER caffeine is found in coffee, soda, tea,
OTC pain relievers, cold remedies, chocolates, anti-drowsiness & weight loss agents, etc. no link between intake & criteria for substance abuse or dependence -caffeine intoxication & withdrawal may be clinically significant -heavy use is 4-6 caffeinated beverages a day signs & symptoms -mild sensory alterations -anxiety, agitation, restlessness, sweating & diarrhea"
"nicotine related disorder & S+S - CORRECT ANSWER not considered a maladaptive drug,
but included in DSM-5 for abuse & dependence -primarily found in all forms of tobacco signs & symptoms -rapid dependence: tobacco odor, cough, excessive wrinkles, chronic pulmonary disease -↑ risk: lung, oral, & other cancers, cardiovascular & cerebrovascular disease"
"sedative, hypnotic or anxiolytic use disorder & S+S - CORRECT ANSWER includes: benzos,
carbamates, barbiturates, rx sleep & antianxiety drugs -brain depressants: particularly lethal when mixed w/ alcohol signs & symptoms -maladaptive behavioral & psychological changes -accidental overdoses/resp arrests"
"what is detoxification? - CORRECT ANSWER first phase of dependency tx
-immediate withdrawal from the drug: 3-5 days -physical & psychological effects -unsupervised withdrawal from drug dependence can result in death -meds available to ease detoxification"
"what are the types of eating disorders? - CORRECT ANSWER -anorexia nervosa
-binge eating disorder -bulimia nervosa"
"what is the CAGE questionnaire? - CORRECT ANSWER used to screen for alcohol
dependency and see if there's any concerns for withdrawal to start CIWA
- "Have you ever felt you should Cut down on your drinking?"
- "Have people Annoyed you by criticizing your drinking?"
- "Have you ever felt Guilty about your drinking?"
- "Have you ever had a drink first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover?" a positive answer to 2+ questions indicates the pt abuses alcohol"
"anorexia nervosa & S+S - CORRECT ANSWER a person who restricts calories to maintain
least essential normal body disorder, has an intense fear of weight gain & significant self-image disturbance -maintenance of subnormal weight levels for age/height (below 85% or BMI <17.5kg) signs & symptoms -weight loss achieved via dieting, starvation, excessive exercise -binge eating: eating more food than usual in a discrete time span -purging: emptying digestive tract via self induced vomiting; use of laxatives & diuretics -malnutrition, anemia -amenorrhea, dehydration -lanugo"
"circumstatiality - CORRECT ANSWER can't be selective when speaking & describes in
length, great detail"
"echolalia - CORRECT ANSWER involuntary parrot-like repetition of words spoken by
others; twitching seen"
"flight of ideas - CORRECT ANSWER rapid shift between topics that are unrelated to each
other"
"loose association - CORRECT ANSWER a thought that has little or no logical connection to
the next one"
"primary gain vs secondary gain - CORRECT ANSWER primary: anxiety is diverted to the
physical problem (ex: stressing over final, deciding to skip it = no more anxiety) secondary: receiving attention from another (ex: attention from teacher, classmates, etc)"
"repression vs regression - CORRECT ANSWER repression
-suppressing a thought or desire so it remains unconscious ex: child gets bitten by a dog & develops intense phobia of dogs later in adulthood & doesn't remember experience as a child regression -defense mechanism where person reverts back to an earlier stage of development ex: in periods of stress, person may revert to bedwetting or thumb sucking"
"define displacement - CORRECT ANSWER defense mechanism where it involves an
individual transferring negative feeling from one person or thing to another ex: a person who is angry at their boss and may take out their anger on a family member"
"define rationalization - CORRECT ANSWER Making excuses for actions or feelings
ex: person is rejected by crush & rationalizes situation by saying they were not attracted to other person anyway"
"define intellectualization - CORRECT ANSWER defense mechanism where person avoid
uncomfortable emotions by focusing on facts & logic
ex: if person A is rude to person B, person B may think about possible reasons for person A's behavior"
"what are the stages of grief? - CORRECT ANSWER denial, anger, bargaining, depression,
acceptance"
"describe denial stage of grief - CORRECT ANSWER -avoiding reality & may act like nothing
happened -allows an adjustment period to gather coping strategies for grieving"
"describe anger stage of grief - CORRECT ANSWER -occurs once reality is real
-expressed in many ways, like crying, expressions of self-blame and guilt -sometimes anger can turn inwards, which results in physical illness and/or psychological dysfunction"
"describe electroconvulsive therapy - CORRECT ANSWER biomedical tx using low voltage
electric shock waves passed through the brain for several seconds to induce short periods of seizures -causes changes in brain chemistry that can immediately reverse symptoms of certain mental illnesses -can be used in depression, psychosis, bipolar, catatonia, severe agitation & aggression in dementia pts -done 2-3x a week, lasting about 6-12 txs -confusion clears within hours while memory loss becomes more persistent"
"what meds are used when performing ECT? - CORRECT ANSWER administered along w/
general anesthesia & muscle relaxants to minimize any seizures impacting entire body & severe muscle contractions that can fracture or dislocate bones"
"when is ECT performed? - CORRECT ANSWER recommended when people who have
symptoms aren't responding to meds or psychosocial txs"
"what is contraindicated for ECT? - CORRECT ANSWER -lithium → contributes to cognitive
side effects (delirium & cognitive problems) -BP meds -benzos"
"what is important to do after ECT completed? - CORRECT ANSWER reorient patient (name,
date, location)"
"what is psychopharmacotherapy - CORRECT ANSWER use of medications to treat
psychological problems"
