PMHN Exam 3 |137 Questions with Verified Answers
Dissociative disorders: - CORRECT ANSWER 1. Depersonalization/derealization
2. Dissociative
... [Show More] amnesia
3. Dissociative fugue
4. Dissociative identify
Depersonalization/derealization disorder: - CORRECT ANSWER Temporary change in awareness displaying depersonalization, derealization or both.
Depersonalization: - CORRECT ANSWER Feeling of observing own personality or body from a distance.
Out of body experience
Derealization: - CORRECT ANSWER Feeling that outside events are unreal or part of a dream.
Dissociative amnesia: - CORRECT ANSWER Inability to recall personal information r/t traumatic or stressful events.
Can include events in a certain time period or just certain details.
Dissociative fugue: - CORRECT ANSWER Ind travels to a new area & is unable to remember their identity & some of their past.
Usually follows a traumatic event & can last weeks to months.
Fugue: Far, travels far away
Dissociative identify disorder: - CORRECT ANSWER Ind displays more than 1 personality.
Stressful event precipitates change between personalities.
Depersonalization/derealization, expected findings: - CORRECT ANSWER Reports feeling detached from one's own body
Dissociative amnesia, expected findings: - CORRECT ANSWER Lack of memory that can range from name, DOB to entire lifetime.
Dissociative identity disorder, expected findings: - CORRECT ANSWER Ind displays 2+ separate personalities. Personalities can be very distinct & different from each other.
Dissociative disorders, RN care: - CORRECT ANSWER 1. Help make decisions to lower stress during dissociative periods
2. Use grounding techniques (pt clap or touch object)
3. Avoid giving pt too much info about past to prevent increased stress
Dissociative disorders, pt teachings: - CORRECT ANSWER 1. Anxiety reducing strategies
2. Verbalize negative feelings
3. Progress at own pace
Dissociative disorders, med tx: - CORRECT ANSWER Med may not be prescribed unless depression or anxiety are present & require tx.
Somatization: - CORRECT ANSWER Expression of psychological distress through physical symptoms.
Somatic symptom disorder, RF: - CORRECT ANSWER 1. 1st relative w/ SSD
2. Decreased level or neurotransmitters (serotonin & endorphin)
3. Depressive, personality or anxiety disorder
4. Childhood trauma, abuse or neglect
5. Learned helplessness
Somatic symptom disorder, expected findings: - CORRECT ANSWER 1. Manifestations disrupt daily life
2. Preoccupation with symptoms
3. Increased anxiety about symptoms
4. Symptoms present for over 6 m
5. Probable alcohol/substance use
6. Overmedicate w/ analgesic & antianxiety
7. High health service user
Somatic symptom disorder, diagnostics: - CORRECT ANSWER 1. Labs, CT & MRI to r/o underlying pathology
2. Patient health questionnaire 15 (identify presence of 15 most commonly reported somatic manifestations
Somatic symptom disorder, RN care: - CORRECT ANSWER 1. Accept sym. as real to the pt
2. Assess SI & thoughts of SH
3. Identify cultural impact on pt view of health/illness
4. Identify 2nd gains from sym.
5.Report sym to provider
6. Encourage ind in self-care
7. Encourage verbalization of feelings
8. Encourage exercise
9. Educate on alternative coping mechanisms & assertivness techniques
Reattribution tx: - CORRECT ANSWER Helps pt identify link between physical manifestations & psychological factors while promoting sense of caring & understanding.
Reattribution tx, 4 stages: - CORRECT ANSWER 1. Feeling understood
2. Broadening the agenda
3. Making the link
4. Negotiating further tx
SSD, medication: - CORRECT ANSWER 1. Analgesics
2. Antidepressants
3. Anxiolytics (antianxiety)
Illness anxiety disorder: - CORRECT ANSWER Hypochondriasis
IAD, RF: - CORRECT ANSWER 1. 1st relative w/ IAD
2. Previous losses or disappointments r/i anger, guilt or hostility
3. Childhood trauma, abuse or neglect
4. Depressive or anxiety disorders
5. Major life stressor
6. Low self-esteem
IAD, EF: - CORRECT ANSWER 1. Anxiety about serious illness present, last for months
2. Preoccupation with health-related performances (health-exams, e.g. breast exam)
3. Either heath seeking behavior or care-avoidant (d/t increased anxiety in HC settings)
Conversion disorder: - CORRECT ANSWER Functional neurological disorder.
Person experiences very specific genuine physical symptoms for which no physiological basis can be found.
Deficits in voluntary motor or sensory functions (blindness, paralysis, seizures, gait disorder, hearing loss)
CD, RF: - CORRECT ANSWER 1. Relative w/ CD
2. Childhood physical or sexual abuse
3. Comorbid psychiatric conditions
4. Comorbid medical or neurological condition
5. Recent acute stressful event
6. Female
7. Adolescent or young adult
8. Low socioeconomic &/or educational status
CD, EF: - CORRECT ANSWER 1. Manifestation: alteration in voluntary or sensory function
2. False pregnancy (in ind w/ desire to be pregnant)
CD, motor dysfunction: - CORRECT ANSWER 1. Paralysis
2. Movement/gait disorders
3. Seizure-like movements
CD, sensory dysfunction: - CORRECT ANSWER 1. Blindness
2. Aphonia (inability to speak)
3. Anosmia (inability to smell)
4. Numbness
5. Deafness
6. Tingling/burning sensations
Factitious disorder: - CORRECT ANSWER Condition in which a ind consciously acts as if they have a physical or mental illness without having it.
Munchausen syndrome - CORRECT ANSWER Factitious disorder
Munchausen syndrome by proxy: - CORRECT ANSWER Factitious disorder imposed on another.
FD, characteristics: - CORRECT ANSWER 1. Average or above average IQ
2. Reports new s/s following test w/ negative results
3. Differs from malingering
4. Not motivated by personal gains aside from fulfillment of emotional needs (attention)
5. Self harm to self
6. FD imposed, harm to another
Malingering: - CORRECT ANSWER Deliberate faking of a physical or psychological disorder motivated by gain.
FD, RF: - CORRECT ANSWER 1. Hx of emotional/physical distress, child abuse or frq/chronic childhood illnesses
2. Impaired neurological ability for information processing
3. Dependent personality
4. Boarderline personality disorder
Mental health disorder prevenetion: - CORRECT ANSWER 1. Primary
2. Secondary
3. Tertiary
Primary prevention: - CORRECT ANSWER Services aimed at reducing the incidence of mental disorders w/in the population
Primary prevention, example: - CORRECT ANSWER Sex ed to reduce rate or teen pregnancy
Secondary prevention: - CORRECT ANSWER Interventions aimed at minimizing early symptoms of psychiatric illness & directed toward reducing prevalence & duration of illness.
Tx s/s & decreasing length/severity of disorder.
Secondary prevention, example: - CORRECT ANSWER Administering lorazepam to pt experiencing a panic attack.
Tertiary prevention: - CORRECT ANSWER Aimed at reducing the residual defects that are assoc w/ severe & persistent mental illness.
Tertiary prevention, example: - CORRECT ANSWER Life skills training at group home for those w/ chronic schizophrenia
Populations at risk for mental health disorders: - CORRECT ANSWER 1. Maturational crises (age-related)
2. Situational
3. Ind w/ severe & persisten mental illness
4. Homeless
Emotional cycle of deployment - CORRECT ANSWER
Emotional cycle of deployment, 3 phases: - CORRECT ANSWER 1. Pre deployment
2. Deployment
3. Post deployment
Emotional cycle of deployment, pre deployment: - CORRECT ANSWER 1. Anticipation of departure
2. Detachment & w/drawal
Emotional cycle of deployment, deployment: - CORRECT ANSWER 1. Emotional disorganization
2. Recovery & stabilization
3. Anticipation of return
Emotional cycle of deployment, post deployment: - CORRECT ANSWER 1. Return adjustment & renegotiation
2. Reintegration & stabilization
Priority RN dx for LGBTQ+ pt w/ mental illness: - CORRECT ANSWER 1. R/f suicide
2. Disturbed personal identity
3. Low self-esteem
4. Ineffective coping assoc. w/ gender identity
5. Social isolation
TCA: - CORRECT ANSWER Tricyclic antidepressant
Panic disorder & generalized anxiety disorder, meds: - CORRECT ANSWER 1. Benzos
2. Buspirone (anxiolytics, antianxiety)
3. Tricyclics
4. SSRIs
5. SNRIs
6. Propranolol (antiHTN, beta blocker)
7. Clonidine (antiHTN)
Body dysmorphic disorders, meds: - CORRECT ANSWER 1. Clomipramine (TCA)
2. Fluoxetine (SSRI)
Phobic disorders, meds: - CORRECT ANSWER 1. Benzos
2. Tricyclics
3. SSRIs
4. Propranolol (antiHTN)
OCD, meds: - CORRECT ANSWER 1. SSRIs
2. Clomipramine (tricyclic antidepressant)
Trichotillomania: - CORRECT ANSWER Hair pulling disorders
Trichotillomania, meds: - CORRECT ANSWER 1. Chlorpromazine (antipsychotic, 1st gen)
2. Amitripyyline (TCA)
3. Lithium carbonate (antimanic, tx BPD)
4. SSRIs/ pimozide
5. Olanzapine (antipsychotic, 2nd gen)
Systemic desensitization, elements: - CORRECT ANSWER 1. Training in relaxation techniques
2. Progressive exposure to phobic stimuli while in a relaxed state
Implosion therapy: - CORRECT ANSWER Flooding
Full exposure to fear inducing stimulus, session ends when anxiety is no longer induced.
Relaxation techniques are not taught prior.
Panic & generalized anxiety disorder, med class tx: - CORRECT ANSWER 1. Anxiolytics
2. Antidepressants
3. AntiHTN
4. Anticonvulsants (e.g. pregabalin)
Phobic disorders, med class tx: - CORRECT ANSWER 1. Anxiolytics
2. Antidepressants
3. AntiHTN
OCD & BDD, med class tx: - CORRECT ANSWER Antidepressants
Trichotillomania, med class tx: - CORRECT ANSWER No meds have demonstrated consistent benefits.
SSRIs had yielded moderate results for some pt.
1st line of tx for PTSD: - CORRECT ANSWER SSRIs
E.g. Paroxetine & sertaline
PTSD, med tx: - CORRECT ANSWER 1. SSRIs
2. Anxiolytics
3. AntiHTN
PTSD, anxiolytics: - CORRECT ANSWER 1. Benzos are usually avoided d/t potential of addiction & worsening of symptoms but can be used.
2. Buspirone is preferred if SSRIs are non-therapeutic, less addictive than benzos, more similar to SSRIs
PTSD, antiHTN: - CORRECT ANSWER Used to alleviate symptoms associated.
1. Propranolol (beta blocker)
2. Clonidine (alpha 2 receptor agonist)
Dx assoc w/ anxiety disoders: - CORRECT ANSWER 1. Panic anxiety (panic disorder & GAD)
2. Powerlessness (panic disorder & GAD)
3. Fear (phobias)
4. Social isolation (agoraphobia)
5. Ineffective coping (OCD)
6. Ineffective role performance (OCD)
7. Disturbed body image (BDD)
8. Ineffective impulse control (hair-pulling disorder)
Prolonged exposure therapy: - CORRECT ANSWER 1. Similar to flooding
2. 4 main parts:
a. Education about tx
b. breathing retraining for relaxation
c. Imagined exposure through repeated discussion about trauma w/ therapist
d. Exposure to real-word situations r/t trauma
Eye movement & desensitization & reprocessing: - CORRECT ANSWER 1. Emphasizes brain's information processing system & memories of disturbing experiences as the basis of pathology
2. 5 -12 sessions are required to achieve lasting effects
3. 8 phases
EMDR, phases: - CORRECT ANSWER Phase 1: Hx & tx planning
Phase 2: Preparation
Phase 3: Assessment
Phase 4: Desensitization
Phase 5: Installation
Phase 6: Body scan
Phase 7: Closure
Phase 8: Reevaluation
Antianxiety meds: - CORRECT ANSWER 1. Hydroxyzine (Vistaril)
2. Alprazolam (Xanax)
3. Chlordiazepoxide (Librium)
4. Clonazepam (Klonopin)
5. Diazepam (Valium)
6. Lorazepam (Ativan)
7. Buspirone (BuSpar)
Cycle of violence, phases: - CORRECT ANSWER Phase 1: Tension-building
Phase 2: Acute battering incident
Phase 3: Calm, loving, respite (honeymoon phase)
SANE: - CORRECT ANSWER Sexual Assault Nurse Examiner
SANE, characteristics: - CORRECT ANSWER 1. Forensic nurse qualification
2. Conduct sexual assault evidentiary exam for rape victims
3. Specially trained in the medical, psychological & forensic examination of a sexual assault victim
Trauma informed care, 4 Rs: - CORRECT ANSWER 1. Realize
2. Recognize
3. Respond
4. Resist
The nurse should determine that anxiety can be differentiated from phobias by what? - CORRECT ANSWER 1. Anxiety is often nonspecific or unknown
2. Phobias are specific
3. Phobias are more intense than anxiety
A client is diagnosed with conversion disorder.
What would be appropriate interventions for the care plan of disturbed sensory perception? - CORRECT ANSWER 1. Identify primary or secondary gains that the physical symptom may be providing for the client
2. Do not reinforce the clients attempts to use the disability as a manipulative tool to avoid participation in therapeutic activities
3. Do not focus on the disability, & encourage client to be as independent as possible
4. Maintain nonjudgmental attitude when providing assistance to the client
A patient is seeking help for the specific phobia of fear of snakes(Ophidiophobia).
You have initiated the nursing diagnosis of panic anxiety.
Short term behavioral therapy goals have been met when they are able to: - CORRECT ANSWER Report less anxiety when viewing photos of snakes
Which questions can assist the nurse in evaluating outcomes for survivors of abuse? - CORRECT ANSWER 1. Have available resources been identified?
2. Has the individual been reassured of their safety?
3. Has trust been established w/ at least one person?
4. Does the individual display a decrease in panic anxiety?
Which short term goal would be most appropriate for a client who has been diagnosed w/ generalized anxiety disorder (GAD)? - CORRECT ANSWER The client will state ways to intervene when anxiety escalates
What is the best treatment modality for a client w/ phobic behaviors? - CORRECT ANSWER Behavior modification to desensitize the client's reactions
From a biological theory perspective, which of the following predisposes individuals to be abusive? - CORRECT ANSWER Various levels of norepinephrine, dopamine, & serotonin
You are admitting a client who presents w/ a hx of abuse, is very tearful & traumatized.
Which statements would cause you concern that conducting a suicide risk assessment was necessary? - CORRECT ANSWER 1. "My father likes to go hunting, maybe I should take his gun out into the woods too"
2. "I'm so depressed, I can't stand this anymore"
3. "I'm so tired of this pain. I just want to go to sleep"
You are working with a child with gender dysphoria.
What are the most likely nursing diagnoses you will initiate? - CORRECT ANSWER 1. Low self-esteem
2. Impaired social interaction
Community mental health has adopted the public health model that includes primary, secondary & tertiary prevention. What best describes tertiary prevention? - CORRECT ANSWER Services aimed at reducing the residual defects that are associated w/ severe & persistent mental illness
A young mother in a severely abusive relationship is admitted to the psychiatric unit after an attempted suicide. The client tells the nurse, "I'm sure things will be better between us once I go home." Which is the most appropriate nursing response? - CORRECT ANSWER "Let's develop a safety plan in case he becomes violent in the future."
Habit Reversal Training (HRT): - CORRECT ANSWER Becoming aware of the habit, substituting another response, receiving social support
Systematic desensitization: - CORRECT ANSWER Train in relaxation techniques, then gradually expose to the fearful stimuli
Implosion therapy (flooding): - CORRECT ANSWER Either imagine or participate in situations that one finds very frightening
The primary healthcare provider has prescribed Haloperidol lactate 10 mg IM & Ativan 1 mg IM. The haloperidol is supplied as 5mg/ml . The Ativan is supplied as 2mg/ml. How many milliliters (ml) total will the nurse administer? - CORRECT ANSWER 2.5 mL
Generalized amnesia: - CORRECT ANSWER The individual has amnesia for their identity & total life history
Selective amnesia: - CORRECT ANSWER The individual can recall only certain incidents associated w/ a stressful event for a specific period after the event
Localized amnesia: - CORRECT ANSWER Unable to recall all incidents associated w/ a stressful period. It may be broader than a single event, such as the inability too remember months or years of child abuse
Two months ago, Ms. T was sexually assaulted while jogging in an isolated park. She is hospitalized for suicidal ideation at this time. She awakens in the middle of the night screaming about having nightmares of the incident.
What is the most appropriate initial nursing intervention? - CORRECT ANSWER Stay w/ Ms. T until the anxiety has subsided
Your patient has been diagnosed w/ dissociative amnesia. They have amnesia for their identity & total life history.
What type of amnesia is this called? - CORRECT ANSWER Generalized amnesia
A nurse is implementing care w/in the parameters of tertiary prevention.
Which nursing action is an example of this type of care? - CORRECT ANSWER Teaching a client w/ schizophrenia to cook meals, make a grocery list, & establish a budget
Prazosin, an antihypertensive, is most commonly used on psych floors for what indication? - CORRECT ANSWER Nightmares
A client tells the nurse that she refuses to eat in a restaurant because she is afraid other people will laugh at the way she eats.
The nurse understands that this behavior is associated w/ which illness? - CORRECT ANSWER Social phobia
Which of the following nursing interventions would be most therapeutic for a client who is having a panic attack? - CORRECT ANSWER Remain w/ the client
The nurse needs to know that the effect of allowing a client to engage in ritualistic behavior (such as cleaning the room several times a day) will be to: - CORRECT ANSWER Reduce the client's anxiety
A 12-year-old girl suddenly refuses to change for gym, participate in physical activities, has difficulty walking & sitting, & will not eat her food at lunchtime.
What should the school nurse consider when assessing this child's symptoms? - CORRECT ANSWER Sexual abuse
Amnesia is to ________, as Substance abuse is to ____________ - CORRECT ANSWER Repression; Denial
Paroxetine (Paxil): - CORRECT ANSWER Selective Serotonin Reuptake Inhibitor (depression, PTSD)
Gabapentin: - CORRECT ANSWER Anticonvulsant (mood stabilizer)
Propranolol: - CORRECT ANSWER Antihypertensive (nightmares)
Haloperidol (Haldol): - CORRECT ANSWER Antipsychotic (psychosis)
Alprazolam (Xanax): - CORRECT ANSWER Benzodiazepine (antianxiety)
Which of the following medications is considered to be a first-line medication of choice in the treatment of PTSD? - CORRECT ANSWER Paroxetine (SSRI)
Following a severely stressful experience, the client's behavior indicates a nursing diagnosis of personal identity disturbance & memory impairment.
Which disorder is characterized by this diagnosis? - CORRECT ANSWER Dissociative disorder
What are symptoms that clients with PTSD may display? - CORRECT ANSWER 1. Emotional numbing
2. Flashbacks
3. Suicidal ideations
What should the nurse plan to teach a client who is taking alprazolam three times a day? - CORRECT ANSWER That there is a potential for dependence & tolerance
Primary prevention example: - CORRECT ANSWER Handing out educational flyers about mental health awareness at a community event
Secondary prevention example: - CORRECT ANSWER Staffing a suicide hotline
Tertiary prevention example: - CORRECT ANSWER A patient w/ Major Depression gets outpatient ECT's on a monthly basis
Primary gain: - CORRECT ANSWER The sick person learns they may avoid stressful obligations; may postpone unwelcome challenges; is excused from troublesome duties
Secondary gain: - CORRECT ANSWER The sick person becomes the prominent focus of attention because of their illness
Common behavioral therapies for someone with a phobia includes: - CORRECT ANSWER 1. Implosion therapy (flooding)
2. Systematic desensitization
When would the nurse suspect that a parent is engaging in child abuse? - CORRECT ANSWER 1. Tx for physical injury is delayed
2. Describes child as evil or in negative terms
3. Offer conflicting, unconvincing explanations for child's injury
Providing nursing education on drug abuse to a high-school class is an example of which level of preventive care? - CORRECT ANSWER Primary prevention
The primary healthcare provider prescribed Synthroid 75 mcg po daily. The supply you have available is Synthroid 0.15 mg tab (scored). How many tab will you administer? - CORRECT ANSWER 0.5 tab
What phases fit into post-deployment? - CORRECT ANSWER 1. Readjustment & renegotiation
2. Reintegration & stabilization
A client has a specific phobia where they are afraid of bears. On their drive to work they have to pass a billboard w/ a bear on it. This intensely felt, irrational fear causes them to drive an extra 10 minutes to avoid the seeing the billboard.
What technique does the nurse know to be helpful w/ phobias? - CORRECT ANSWER Cognitive restructuring w/ systematic desensitization
A nurse is caring for a client who is being evaluated for panic attacks. Which symptoms, reported by the client, would support this diagnosis? - CORRECT ANSWER 1. Chest pain or discomfort
2. Accelerated HR
3. N or abdominal distress
What would be the focus of the preliminary nursing care plan for a client admitted to the unit w/ a tentative diagnosis of somatization disorder? - CORRECT ANSWER Encouraging the client to discuss the history of the physical complaints
A female client is admitted w/ a black eye & bruises on her arms. She indicates that she plans to stay in the abusive relationship because she is worried for herself & what might happen to her kids. What is the most appropriate intervention? - CORRECT ANSWER Provide a list of community resources for her
What would be considered forms of elder abuse? - CORRECT ANSWER 1. Continually yelling at them after they took the wrong meds by accident
2. Using their social security check to pay your own house bills
3. Dumping a grandparent at the hospital inappropriately
After an examination & treatment for rape, the nurse prepares to discharge a client from the emergency department (ED). Which discharge teaching should the nurse provide? - CORRECT ANSWER Information on available community resources
A client with gender dysphoria has the nursing diagnosis of low self-esteem w/ the short term goal of verbalizing positive statements about themself.
What are appropriate interventions? - CORRECT ANSWER 1. Encourage client in activities in which they are likely to achieve success
2. Help identify behaviors they would like to change, & if realistic assist them in problem solving ways to bring about the change
3. Help client focus on aspects of their life for which positive feelings exist
A nursing instructor is teaching about case management.
What student statement indicates that learning has occurred? - CORRECT ANSWER "Case management provides coordination of services required to meet client needs."
A client is unable to stop dressing & undressing many times throughout the day.
The nurse determines that this behavior is a(n): - CORRECT ANSWER Compulsion
A client diagnosed w/ DID switches personalities when confronted w/ destructive behavior.
The nurse recognizes that this dissociation serves which function? - CORRECT ANSWER It serves to isolate painful events so that the primary self is protected
A client with OCD keep returning to their room, flipping the lights on & off, & checking the drawers for their belongings. You are successful in getting them to the Cognitive Behavioral group.
Which statement by the client indicates they are employing cognitive restructuring techniques they learned? - CORRECT ANSWER "There is little likelihood my belongings will be missing when I return from group"
A client with OCD is having difficulty making it to the psychoeducational group because they keep returning to their room, flipping the lights on & off, & checking the drawers for their belongings. Each time you try to encourage them to group they repeat this behavior.
What is the best nursing response? - CORRECT ANSWER Allow the behavior
A nurse is conducting a psycho-educational group about anxiety.
What statement by the nurse is accurate? - CORRECT ANSWER "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it"
Your are trying to decide what dosage of anti-anxiety med you should get your patient. In thinking about the levels of anxiety what symptoms tell you they are having severe anxiety (not panic anxiety)? They feel: - CORRECT ANSWER 1. Afraid
2. Confused
3. Agitated
4. Withdrawn
5. May find it difficult to think clearly
6. Breathing may quicken
7. Sweat
8. Muscles become tense
You are taking care of a patient w/ PTSD. They express concern about adding Alprazolam to their medication regimen.
Which statement by the client would indicate the need for further med education? - CORRECT ANSWER "Alprazolam has a high potential for extrapyramidal side effects"
EPSE do not apply to benzos.
You are doing a clinical on Adolescent Psychiatry. When thinking about the cycle of abuse, which behavior by the client indicates they have may have been exposed to abuse? - CORRECT ANSWER 1. The child is fearful of adults & shrinks away from them
2. The child has difficulty walking & sitting down
3. Bullies other children w/ verbal threats [Show Less]