All ATI proctored Mental Health Exams/ reviewed exams/ solution guides; Latest 2022. (first one free ) ATI proctored Mental Health Exam Q&A 2022. What are
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[Show More] cognitive symptoms of psychotic disorder s ✅- -disordered thinking -inability to make decisions -poor problem solving ability -difficult concentrating to perform tasks -Memory deficits Misconstrues trivial events and attaches personal significance to them, such as believing that others, who are discussing the next meal, are talking about them ✅- ideas of reference Feels singled out for harm by others (being hunted down by FBI) ✅- Persecution Believes that she is all powerful and important like a god ✅- grandeur believes that his body is changing in an unusual way, scubas growing a third arm ✅- somatic delusions May feel that her spouse is sexually involved with another individual ✅- Jealousy Believes that a force outside his body is controlling him ✅- being controlled believes that her thoughts are heard by others ✅- thought broacasting believes that others thoughts are being inserted into his mind ✅- thought insertion Believe that her thoughts have been removed form her mind by an outside agency ✅- thought withdrawal is obsessed with religious beliefs ✅- religiosity The client may say sentence after sentence but each sentence may relate to another topic and the listeniner is bale to follow the clients thoughts ✅- flight of ideas Made up words that have meaning only to the client such as i tranged and flitted. ✅- neologisms What are the standardized screen tools for psychotic disorders ✅- -Global assessment of functioning scale -scale for assessment of negative symptoms -brief psychiatric rating scale -Brief psychiatric rating scale -abnormal involuntary movement scale (AIMS) What antidepressants are prescribed for psychotic disorders ✅- Paxil (Peroxetine) -monitor for SI -Notify for deepened depression -Do not stop abruptly What are the anxiolytics/ benzo's used for psychotic disorders? ✅- -Ativan (Lorazepam) -Klonopin -sedative effects -need to get blood tests for ANC -use caution in older adults What are the personality disorders in cluster A ✅- (Odd and eccentric traits) -Paranoid -Schizoid -Schizotypal Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations ✅- schizotypal Dealing with anxiety by reaching out to others. Ex: a nurse who lost a family member in a fire is a volunteer firefighter ✅- Altruism Dealing with unacceptable feelings or impulses by unconsciously substitute acceptable forms of expression. Ex: a person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously a the gym during his lunch period ✅- Sublimation Voluntarily denying unpleasant thoughts and feelings. Ex: A person who has lost his job states he will worry about paying his bills next week ✅- Suppression Putting unacceptable ideas, thoughts, and emotions out of conscious awareness. Ex: a person who has a fear of the dentist's drill continually "forgets" his dental appointments. ✅- Repression What are healthy defense mechanisms? ✅- alturism and sublimation what are intermediate defenses ✅- repression reaction formation displacement rationalization undoing What are immature defenses ✅- projection dissociation splitting denial Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation Ex: A person who is angry about losing his job destroys his child's favorite toy ✅- displacement Overcompensating or demonstrating the opposite behavior of what is felt. Ex: a person who dislikes her sisters daughter offers to babysit so that her sister can go out of town ✅- reaction formation Performing an act to make up for prior behavior. Ex; An adolescent completes his chores without being prompted to after having an argument with his parents. ✅- undoing creating reasonable and acceptable explanations for unacceptable behavior Ex: A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog. ✅- rationalization temporarily blocking memories and perceptions from consciousness Ex: an adolescent witnesses a shooting and is unable to recall any details of the event ✅- dissociation demonstrating an inability to reconcile negative and positive attributes of self or others Ex:a client tells a nurse that she is the only one who cares about her, yet the following day the same client refuses to talk to the nurse ✅- splitting Blaming others for unacceptable thoughts and feelings Ex: a young adult blames his substance use disorder on his parents refusal to buy him a new car ✅- projection pretending the truth is no reality to manage the anxiety of acknowledging what is real. Ex: A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays. ✅- denial Orientation phase of a therapeutic relationship includes what? ✅- -Introduction to client and state purpose -Set the contract: meeting time, place, frequency, duration and date of termination -discuss confidentiality -build trust by establishing expectations and boundaries -set goals with the client -explore the clients ideas, issues, and needs -explore the meaning got testing behaviors -enforce limits on testing or other inappropriate behaviors Working phase of a therapeutic relationship includes what? ✅- -maintain contract -perform ongoing assessment -facilitate the clients expression of needs and issues -encourage pt to problem solve -promote self esteem -foster positive behavioral change -explore and deal with resistance and other defense mechanisms -recognize transference and countertransference -reassess goals and plan -remind client of termination date Termination phase of a therapeutic relationship includes what? ✅- -provide pt tine to discuss thoughts and feelings about termination -discuss the clients experience with separation and loss summarize goals and achievements -review memories of work in the sessions -express own feelings -discuss ways to incorporate new healthy behaviors matinaing limits of final termination What is included in cognitive reframing ✅- -priority restructuring -journal keeping -assertiveness training -monitoring thoughts. A therapist or others serve as a role models for a client, who imitates this modeling to improve behavior ✅- Modeling The client receives positive rewards for positive behavior positive reinforcement ✅- operant conditioning This therapy is the planned, progressive, or graduate exposure to anxiety providing stimuli in relief situation, or by imagining events that case anxiety during exposure the client uses relaxation ✅- systematic desensitization Pairing of a maladaptive behavior with a punishment or unpleasant stimui such as a bitter taste or mild electric shock as punishment for behaviors such as alcohol use disorder violence self mutilation and thumb sucking ✅- aversion therapy This therapy uses various techniques to control pain tension and anxiety ✅- meditation, guided imagery, diaphragmatic breathing, muscle relaxation, and biofeedbacks exposing a client while in the company of a therapist to a great deal of an undesirable stimulus in an attempt to turn off the anxiety response ✅- flooding preventing a client from performing a compulsive behavior with the intent that anxiety will diminish ✅- response prevention teaching a client, when negative thoughts or compulsive behaviors arise, to say or shout, "stop" and substitute a positive thought. this goal over time is for the client to use the command silently ✅- thought stopping This style supports group interacting and decision making to solve problems ✅- democratic the group process progresses without any attempt by the leader to control the direction ✅- laissez-faire The leader completely controls the direction and structure of the group without allowing group interaction or decision making to solve problems ✅- autocratic some group members or the leader may have goals different from the stated group goals that may disrupt group processes ✅- hidden agenda Initial phase of group development includes: ✅- define the purpose and goals of the group -leader sets tone of respect, trust and confidentiality -members get to know each other and the group leader -there is a discussion about termination Working phase of group development includes: ✅- promote problem solving skills to facilitate behavior changes. Power and control issues may dominate in this phase. -group leader uses therapeutic communication to encourage group work toward meeting goals. -members take informal roles within the group, which may interfere with or favor group progress toward goals. Termination phase of group development includes: ✅- This makes the end of group sessions -group members discuss termination issues -the leader summarizes work of the group and individual contributions. one member takes responsibility for problems to keep peace at all costs ✅- placating a member of the family with little power is blamed for problems within the family ✅- scapegoating a third party is drawn into the relationship with two members whose relationship is unstable ✅- triangulation These are emotional issues or themes within a family that continue for atlas three generations such as a pattern of substance use or addictive behavior when the families is under stress, dysfunctional grief pattern triangulation patterns and divorce ✅- multigenerational issues The body's response to an increased demand. The first stage is initial adaptive response aka fight or flight mechanism. If it is prolonged maladaptive responses can occur ✅- General adaptation syndrome What are the fight or flight responses or adaptive responses? ✅- -Apprehension -unhappiness or sorrow -decreased appetite -increased respiratory rate, HR, CO, BP -depressed immune system What are the prolonged stress or maladaptive responses? ✅- -chronic anxiety -depression, chronic pain, sleep disturbances -weight gain or loss -increased risk for MI/ Stroke -poor diabetes control, hypertension, fatigue, irritability, decreased ability to concentrate -increased risk for infection What screen tools do you use for Stress management? ✅- life changing events questionnaire -Holmes -Rahe scale -Lazarus Cognitive Appraisal who can ECT be used on? ✅- - MDD - pt that has rapid cycling of acute manic episodes - schizophrenia spectrum disorders that are less responsive to neuroleptic meds such as schizoaffective disorder High risk pt with ECT ✅- -recent MI - hx of CVA -Cerebrovascular malformation -intracranial mass lesion -increased intracranial pressure What is ECT not successful in? ✅- substance use personality disorder dysthymic disorder What meds should be discontinued before ECT ✅- MAOI Seizure med Lithium usually 2 weeks ahead of time What is injected before ECT to decrease secretions and counteract any vagal stimulation? ✅- atropine sulfate or robinul what short acting anesthetic is used for ECT ✅- brevital (methohexital) IV bolus What muscle relaxant is used ✅- succinylcholine (anectine) Electrical stimulus time vs seizure time ✅- 0.2-0.8 for electrical stimulus 25-60 for seizure activity complications of TMS (transcranial M stimulation) ✅- -mild discomfort -tingling sensation at the site of the electromagnet -lightheadness -seizures are rare but a potential complications of VNS ✅- -voice changes -hoarsness -throat or neck pain -dysphagia -dyspnea with exertion What standardized screen tools would be used for anxiety disorders? ✅- -Hamilton rating scale for anxiety -modified speilberger state anxiety scale -Yale brown obsessive compulsive scale -hoarding scale self report -national stressful events survey What is the first line of treatment for anxiety disorders? ✅- -SSRI such as zoloft (sertraline) Then they can also benefit from antidepressants, sedative hypnotic anxiolytics such as valium, non barbiturate anxiolytics such as buspar, beta blockers, antihistamines. What are the standardized screen tools for depressive disorders? ✅- -Hamilton depression scale -beck depression inventory -geriatirc depression scale (short form) -zung self rating depression scale What SSRI's (selective serotonin reuptake inhibitor) are used for depression? ✅- -celexa (citalopram) -prozac (fluoxetine) -zoloft (Sertraline) What TCA's(tricyclic antidepressants) are used for depression? ✅- -Elavil(amitriptyline) What MAOI's are used for depression ✅- -Nardil (phenelzine) What Atypical antidepressants are used for depression? ✅- -Wellbutrin (bupropion) What SNRI's(serotonin norepinephrine reuptake inhibitor) are used for depression? ✅- -Effexor (venlafaxine) -Cymbalta (duloxetine) When patient is taking SSRI for depression what client teaching needs to be done? ✅- -may cause nausea, headache and CNS stimulation (agitation, insomnia, anxiety) -sexual dysfunciton may occur -observe for serotonn syndrome -No st. Johns wort -watch diet What are affective symptoms ✅- hopelessness suicidal ideation What client teaching is needed with a depressive patient when they are taking TCA? ✅- -Change positions slowly -Chew sugarless gum, eat foods high in fiber, increase fluids to reduce anticholinergic effects What client teaching is need with a depressive patient taking MAOI's ✅- - avoid tyramine foods -avoid all medications including OTC talk to DR first What client teaching is needed with a depressive patient that is taking atypical antidepressants ✅- - watch for HA, dry mouth, GI distress, constipation, increased HR, nausea restlessness or insomnia. Notify DR -monitor diet -dont give to seizure patients What client teaching is needed with a depressive patient that is taking SNRI's ✅- -adverse effects include nausea, weight gain, and sexual dysfunction the client has at least one episode of mania alternating with major depression ✅- Bipolar I The client has one or more hypomanic episodes alternating with major depressive episodes ✅- Bipolar II The client has atlas 2 years of repeated hypomanic manifestations that do not meet the criteria for hypomania episodes alternating with minor depressive episodes. ✅- cyclothymia Risk factors of Bipolar ✅- -Genetics having an immediate family member who has a bipolar disorder -psychological such as a stressful event or major life event -physiological such as neurobiological or neuroendocrine disorder. -substance use disorder What are the standardized screening tools for Bipolar disorders? ✅- -The mood disorders questionnaire. What medications are given for patients that have bipolar disorder? ✅- -Mood stabilizers: Lithium -Anticonvulsants that act as mood stabilizers: Depakote(valproic acid), Klonopin(clonazepam), Lamictal(lamotrigine), nuerontin(gabapentin), Topaz(topiramate) -Benzo's: Ativan(lorazepam) , for sleep -Antidepressants such as Prozac(fluoxetine) to manage depression The client has psychotic thinking or behavior present for atlas 6 months. Areas of functions including school or work, self care, and interpersonal realties are significantly impaired ✅- schizophrenia the client has impairments of personality functioning. However impairment is no as severe as with schizophrenia ✅- Schizotypal personality disorder The client experiences delusional timing for atlas 1 month. Self or interpersonal function is not markedly impaired ✅- delusional disorder What atypical antipsychotics would be prescribed for patients with psychotic disorders? ✅- -risperdal (Risperidone) -zyprexa (Olanzapine) -seroquel(Quetiapine) -Geodon (ziprasidone) -Abilify (aripiprazole) -Clozaril (clozapine) These treat both negative and positive symptoms watch diet Report agitation, dizziness, sedation, and sleep disruption may occur. What are the conventional antipsychotics for psychotic disorders ✅- -Haldol (haloperidol) -Loxitane (Loxapine) -Thorazine (chlorpromazine) -Prolixin (Fluphenazine) Minimize anticholinergic effects get up slowly the client has psychotic manifestations that last between 1 day to 1 mont in duration ✅- brief psychotic disorder The client has manifestation similar to those of schizophrenia, the but duration is from 1 to 6 months and social occupation dysfunction may or may not be present ✅- schizophrenifrom disorder What are the risk factors of personality disorders? ✅- -comorbid substance use disorders -hx or nonviolent and violent crime -sex offenses -childhood abuse or trauma -development factors with a direct link to parenting -Genetic and Biochemical factors What are the common pathological personality characteristics in a personality disorders ✅- -Inflexibility/maladaptive responses to stress -compulsiveness and lack of social restraint -inability to emotionally connect in social and professional relationship -tendency to provoke interpersonal conflict -ability to merge personal boundaries with others. the clients disorder meets both the criteria for schizophrenia and depressive or bipolar disorder ✅- schizoeffective disorder The client experiences psychosis within 1 month of substance intoxication or withdrawal. May be caused by medications intend for therapeutic use ✅- Substance induced psychotic disorder Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person ✅- Paranoid Characterized by emotional detachment, disinterest in close relationships and indifference to praise or criticism; often uncooperative ✅- Schizoid What are the personality disorders in Cluster B ✅- -antisocial -borderline -histrionic -Narcissistic Characterized by instability of affect, identity, and relationships, as well as splitting behaviors, manipulations, impulsiveness, and fear of abandonment; often tries self injury ✅- borderline Characterized by arrogance, grandiose views of self importance, the need for consistent admiration and a lack of empathy for others that strains most relationships; often sensitive to criticism ✅- narcissistic characterized by emotional attention-seeking behavior in which the person needs to be the center of attention often seductive and flirtations ✅- Histrionic Characterized by disregard for others with exploitation, repeated unlawful actions, deceit, and failure to accept personal responsibility ✅- Antisocial What personality disorders are in cluster C ✅- -Avoidant -Dependent -Obsessive compulsive Characterized by perfectionism with a focus on orderliness and control to the extent that the individual may not be able to accomplish a given task ✅- Obsessive compulsive Characterized by extreme dependency in a close relationship with a n urgent search to find a replacement when one relationship ends ✅- Dependent Characterized by social inhibition and avoidance of all situations that rear interpersonal contact, despite wanting close relationships due to extreme fear of rejection;often very anxious in social situations ✅- Avoidant clients who have dependent and histrionic personality disorders often benefit from ✅- assertiveness training and modeling Clients who have schizoid or schizotypal personality disorders ten to ✅- isolate themselves the nurse should respect this need What medications maybe used for personality disorders ✅- Antidepressant anxiolytic antipsychotic mood stabilizers What is dialectical behavior therapy used on what type of patient ✅- self injurious risk factors for cognitive disorders ✅- -parkinson's disease -huntington's disease -hepatic or renal failure -fluid and elctrolyte imbalances -nutritional deficiencys -cardiovascular diseases -infections (HIV/AIDS) -Substance use or withdrawal *More communion older adult clients and clients in and intensive care unit. Ris factors for neurocognitive disorder and Alzheimer's disease ✅- -disorder of the neurological system -advanced age -prior head trauma -genetic factors -family history of Alzheimer's disease and or down syndrome Standardized screening tools for cognitive disorders ✅- -Functional Dementia Scale -Mental or Mini Mental staus Examination -Functional Assessment Screening tool -Global Deterioration Scale -Blessed dementia Scale What medications would you give for a patient that has Delirium ✅- Antipsychotic Antianxiety What medications would you give for a patient that has a neurocognitive disorder ✅- Aricept Exelon Razadyne What are the adverse effects of neurocognitive disorder medications ✅- nausea diarrhea bradycardia What are the medications for anxiety disorder (Benzo) ✅- -xanax (alprazolam) -Valium (Diazapam) -Ativan (lorazepam) -Librium (chlordiazepoxide) -Tranxene ( -Serax (oxazepam) -Kolonopin (clonazepam) What are the atypical anxiolytic ✅- buspar (buspirone) SSRI ✅- Paxil (Paroxetine) Zoloft (sertraline) Lexapro(escitalopram) Prozac(fluoxetine) Luvox (fluvoxamine) ATI MENTAL HEALTH PROCTORED Exam Updated 2022. 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