Review guide for psychiatric nurse certifications for the generalist and advanced practice nurse in psychiatric and mental health care / Victoria Mosack. – 3rd ed. Assessment guide for psychiatric certifications for the generalist and clinical specialist in psychiatric and mental health care for adults, children and adolescents.
STRATEGY #1 Know YouRSElf
Analysis is the ability to use abstract or logical forms of thought to show relationships and distinguish cause and effect between variables in a situation. What separates the successful test taker from the unsuccessful one is knowing how to prepare for and take a test.
STRATEGY #2 DEvElop YouR
Preparing yourself to be a successful test taker is just as important as studying for the test. The main purpose of this chapter is to help prospective examinees know how to study for and take a test.
Understanding Thought Processes
Thinking occurs at two levels – the lower level of memory and understanding and the higher level of application and analysis (ABP, 1989). Without adequate retrieval of facts, progression through the higher levels of thinking cannot happen easily.
Building Your Thinking Skills
STRATEGY #3 Know ThE ConTEnT
Preparation for Studying
Getting Organized
It is best to study during those times when your alertness is at its peak (Dickenson-Hazard, 1990). Sit down, review the content, and develop a study plan once you know about the exam.
Getting Down to Business
Finally, set an overall goal for yourself—something that will motivate you when you remember it. It's a smart investment of time with the potential payoffs of reduced study stress and better exam performance.
The Actual Studying
Coordinate the content to be studied with the time available (Sides &. Cailles, 1989). They generally provide the content parameters and key concepts of the content that you need to know.
STRATEGY #4 BEComE TEST-wiSE
Ways to be active include: taking notes on the content as you study; construct questions and answer them; take practice tests; or to discuss the content with yourself. Review courses also provide an opportunity to clarify content that is not well understood, as well as to review familiar material (Dickenson-Hazard, 1990).
Technique #1
Although there is no substitute for individual study, some resources, if available, are useful to facilitate learning. They provide an opportunity to think through your knowledge base, with the advantage of hearing another person's perspective.
Technique #4
STRATEGY #5 ApplY BASiC RulES
Technique #2
Technique #3
Considerations for Computerized Examinations
STRATEGY #6 pSYCh YouRSElf up
Technique #5
Technique #6
Technique #7
Some Dos & Don’ts to Remember
Technique #8
Technique #9
SummARY
BiBlioGRAphY
Change
Mental health
Absence of mental health can be perceived as unpleasant for the individual and/or significant others and result in the perception of a need for. Psychotherapeutic interventions – can be speech, poetry writing, social skills training, cooking, modeling assertiveness or expressing emotions.
CoMMuniCation
Social communication is less goal-oriented, more superficial and does not necessarily involve the expectation of help. Although nurse-client relationships may involve some social communication, the main component is therapeutic communication.
Therapeutic Communication includes
Culture and social class influence perceptions and values that influence how communication is sent and received. Therapeutic communication occurs between the nurse and the client and focuses on the client's thoughts, feelings, behaviors, and roles, with the expectation that the nurse's active listening will help the client discover, understand, and change.
Cultural & ethniC FaCtors
Design culturally responsive programs that are available, accessible, appropriate, acceptable, and acceptable to reduce underutilization of mental health services by ethnic groups. Views of health - including culturally based beliefs about mental health/illness, how illness develops, beliefs about what is needed for treatment and how well-being is achieved and "healing" is defined e.g.
Client advoCaCy
Case ManageMent
Assessing, strengthening, and promoting the client's ability to perform activities of daily living (ADLs)—eating, bathing, dressing, etc. Critical Paths – defining the essential treatment interventions that must be performed each day in order to meet the expected time-specific client outcomes; it usually reflects a particular DRG (Farnsworth & Biglow, 1997).
Nursing care plans - more detailed than ITPs and more individualized than critical pathways; use NANDA nursing diagnoses and interventions derived from individual assessment of the client.
Milieu
II, is currently accepted medical use in the US and can lead to moderate or low physical dependence or high psychological dependence. IV Drug has a low potential for abuse compared to Schedule III, is currently used medically in the US and abuse can lead to limited physical and psychological dependence.
Mental health eduCation
Right to independent psychiatric examination—clients can demand evaluation by physician of their choice and must be released if determined not to be mentally ill. Right to be employed if possible—clients cannot be forced to work, and if they choose to as part of therapy, must be paid minimum wage.
Questions
Select the best answer
Which of the following statements would the nurse NOT make in connection with negotiating a contract with the client within the nurse-client relationship. The nurse exceeds her skills as a psychiatric and mental health advanced practice nurse.
BiBliography
Guides research—the theory sets limits on questions to ask and methods to pursue in research.
EvidEncE-basEd PracticE (EbP)
Quasi-experimental: Variables can be manipulated, but subjects are not randomly assigned to control and treatment groups. Non-experimental – researcher measures variables as they occur in nature; uses correlations to determine the nature and extent of the relationship between and among variables; includes prospective and retrospective.
Helicy - evolving innovative pattern change that grows out of human-environment interaction (Rogers, 1983; Falco & Lobo, 1990). The goal of nursing care - to promote adaptive responses according to adaptive ways.
PErsonality thEoriEs
Superego—the censoring power of the personality; conscious and unconscious; evaluate and judge behavior (Scroggs, 1985) 4. Lifestyle—the unique set of behaviors created by each individual to compensate for inferiority and achieve superiority.
Generativity – focus on productivity, creativity, mentoring the next generation versus stagnation – lack of trust, obsessive need for pseudo-intimacy, early disability h. Fundamental Fear Theory (Karen Horney) Because of her focus on the family, some consider Horney to be a social-interpersonal theorist.
ExistEntial/huManistic
People interpret events according to their underlying values or beliefs, and the interpretation can vary. Involves a creative interaction between therapist and client to gain ongoing awareness of what is being felt, felt, and thought 3.
Although customers may not have caused all their problems, they are responsible for the solutions; they need to try harder or be more motivated to change.
Family in transition - the family is a social system in transformation, which must maintain continuity and adapt to internal and external stressors. Warm-up - the protagonist chooses the time, place, scene and supporting egos for his production.
In this theory, the therapist joins the family and works to modify the family structure. Courtship period - when the young reaches adulthood and seeks a mate b. Marriage - when a member leaves the. family of origin to create a new family c. The middle years of marriage - when parents must leave their children d. Retirement and old age—when one. the spouse may die; Adult children can take on the role of caregiver.
Hypothalamic-pituitary-thyroid axis (HPTA) blunts TSH response to thyrotropin-releasing hormone (TRH) in depression. Hypothalamic-pituitary gonadal axis (HPGA) Blunts prolactin response in exogenous obesity Decreases testosterone levels in depression.
QuEstions
Socialization – the process of learning the social roles, skills and knowledge that prepare one to fulfill a role. According to Horney, which of the following is NOT a way for people to protect themselves.
After alcohol, tobacco is the second most commonly used substance in the United States, with 24.6% of the population aged 12 and older having smoked cigarettes in the past month. Which of the following questions would NOT be important in assessing possible withdrawal from alcohol.
QueStionS
Which of the following is least likely to be a limitation of urine drug testing for drugs of abuse. RJ is a 16-year-old who reports to the emergency room in the province one night, accompanied by two of his friends.
State estimates of substance use from the 2006-2007 National Surveys on Drug Use and Health. CBT is an evidence-based therapy that has been shown to be effective in the treatment of substance abuse.
Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA), NSDUH Series H-35, HHS Publication No. SMA 09-4362).
Phobias
Anxiety DisorDers
Other antidepressants may be useful if first-line agents do not effectively reduce anxiety symptoms: Behavioral (most effective treatment) (1) Systematic desensitization. a) Work with the client to develop a list of anxiety-provoking stimuli related to the object/situation, from least to most frightening.
Posttraumatic Stress Disorder (PTSD)
There is evidence that those who dissociate during trauma are at greater risk for PTSD. Serotonin selective reuptake inhibitors (SSRIs) – first-line treatment option (1) for which SSRIs may not be as effective.
Generalized Anxiety Disorder (GAD)
Psychodynamic - anxiety results from unconscious conflict or the emergence of unacceptable impulses (often associated with addictive, sexual or aggressive content). Behavior - anxiety is a conditioned response to a specific stimulus, or an internal learned response (perhaps from imitation.
Panic Disorder
First degree relatives of clients with panic disorder are 4 to 8 times more likely to experience a panic attack and with early onset (before age 20) the rate increases to 17. Abnormal regulation of the noradrenergic systems in the brain is involved in panic attacks and panic disorder .
Obsessive-Compulsive Disorder (OCD)
The family can help the patient avoid situations that trigger OCD, which worsens the cycle of fear. Help staff and patients reinforce verbalization and functional behavior and ignore impairments to minimize secondary gain.
Hypochondriasis
Conversion Disorder
Medical disorders with multiple organ system involvement (AIDS, endocrine disorders, MS, systemic lupus erythematosus (SLE), some neoplasms).
Somatization Disorder
Learn new coping skills including using social relationships and other techniques to reduce anxiety.
Pain Disorder
Focus therapy on clear, congruent communication, role restructuring and increasing self-esteem of family members.
The onset of these disorders can be sudden or gradual, and the duration transient or chronic (APA, 2000; Sadock & Sadock, 2007).
Dissociative Amnesia
Dissociative Fugue
The family may exhibit poor coping mechanisms to deal with internal family conflicts or external stressors. If family dynamics are a source of stress, family therapy can be used to improve communication, problem solving, and crisis management.
Depersonalization Disorder
Biochemical interventions—antidepressants (SSRIs, TCAs, MAOIs), clonidine, anticonvulsants, and benzodiazepines have been reported to be effective in reducing intrusive symptoms, hyperarousal, and anxiety symptoms associated with DID (Sadock & Sadock, 2007). Family therapy is appropriate if family dynamics are stressors or affect coping with anxiety.
Dissociative Identity Disorder (DID) or Multiple Personality Disorder (MPD)
Dissociation helps child to cope by creating new personalities to experience and deal with various aspects of periods of the trauma. Biochemical interventions—no evidence to support the effectiveness of pharmacological interventions (Sadock & Sadock, 2007).
ADjustment DisorDer
Which of the following biochemical approaches is most likely to be used in conjunction with behavioral therapy for his problem. Family therapy with partners and children of DID clients is aimed at which of the following goals.
Answers
BiBliogrAphy
Factors in the etiology and pathogenesis of panic disorder: Revisiting the attachment-dissociation paradigm. Bizarre delusions—involving a phenomenon that would be considered completely implausible in the person's culture.
Overview Of DisOrDers
Hallucinations – false sensory perceptions involving one or more of the five senses (most common: auditory and visual), and which are inconsistent with reality.
Other Psychotic Disorders
Personality disorder - personality disorders with features similar to schizophrenia, e.g. schizotypal, schizoid and borderline personality disorders. Dementia and delirium - especially in the elderly; can manifest itself in irritability, anxiety, isolation and agitation.
Delusional Disorder
Non-psychiatric condition causing psychotic symptoms - medical examination is important to rule out conditions including neoplasm, cerebrovascular disease or trauma, embolism, narcolepsy, encephalitis, Huntington's disease, temporal lobe epilepsy, heavy metal poisoning, neurosyphilis, vitamin B12 deficiency and AIDS .
Psychotic Disorder Due to a General Medical Condition
Brief Psychotic Disorder
Psychotic Disorder Not Otherwise specified
InformatIon Common to
At doses above 8 mg/day potential loss of improvement in negative symptom response. Information common to schizophrenia and other psychotic disorders 125 (1) Mode of action. a) Antagonizes serotonin 2A receptors; partial agonism at D2 receptors and serotonin 1A receptors (2) Side effects. g) Nausea/vomiting (3) Dosage and effect. a) The recommended starting dose is 10 to 15 mg daily; increase dose every other week to a maximum recommended dose of 30 mg/day (b) Anticholinergics may be useful in.
QueStIonS
Discontinuing the neuroleptic, maintaining skin integrity and hydration, and administering bromocriptine. Which of the following is most effective in treating both positive and negative symptoms of schizophrenia.
BIBlIography
The biological roots of mental illness as revealed by a groundbreaking study of identical twins.
Mood disorders—overview
Mood disorders are among the most prevalent mental disorders diagnosed in the general population (17% lifetime prevalence rate); 50%. Possible Possible Symptoms Mood symptoms are a direct result of a substance (drug, toxin, or substance of abuse).
Major Depression (unipolar,
Dysthymic Disorder
Bipolar disorders
Disorder (BPD I) (APA, 2000, Sadock & Sadock, 2007)
Disorder (BP II) (APA, 2000, Sadock & Sadock, 2007)
A repeat length polymorphism in the promoter of this gene has been shown to affect the rate of serotonin uptake and may play a role in depressive symptoms. A disturbance in regulation of biological rhythms that synchronize bodily functions is consistent with the rhythmic cyclic nature of mood disorders.
This shifts the onset of melatonin production and secretion to an earlier time in the evening, resulting in a correction of the disturbed relationship between sleep, temperature and circadian rhythm. Bipolar patients in the manic phase may have phase shifts, loss of pattern and amplitude disturbances.
Edema of the feet or other parts of the body Make sure this is benign and may be temporary. Which of the following is not an initial goal of pharmacological intervention in unipolar depression or bipolar disorder.
BiBlioGraphy
Eating DisorDErs
Anorexia Nervosa (AN)
Mood - depressed (feels sad and lonely, empty and isolated, with self-criticism and feelings of guilt). Orientation - lethargy and confusion due to extreme dehydration caused by self-induced vomiting and excessive use of laxatives.
Information Common to Anorexia and Bulimia
Bulimia Nervosa
Cognitive/behavioral therapy (highly effective in treating bulimia nervosa – most effective when combined with SSRI (fluoxetine)) Give the client in the hospital the opportunity to take responsibility for his own weight gain and reward him for adhering to the treatment regimen.
Reduce the focus on eating or eating with the client once the protocol is established; art and other expressive therapies may be useful in helping the client express feelings. Environmental interventions – the role of the nurse is primarily associated with problem prevention, with an emphasis on the development of adaptive coping strategies to deal with stressful life events.
Gender Identity Disorder
Strong interest in opposite gender role behavior and weak reinforcement of normative gender role behavior by parents. Parental encouragement of cross-gender behavior - mothers of effeminate sons themselves had gender identity conflicts as children, which led them to devalue men and masculinity.
Primary Insomnia
Conduct disorder – presents with a repetitive and resistant behavior pattern, as opposed to an episodic pattern. Biochemical interventions – mixed results with the following agents (Sadock & Sadock, 2007): Carbamazepine – 200 mg twice daily with food 3. Violence, [actual/] risk to others.
Other Sleep Disorders
Intermittent Explosive Disorder
Pathological gambling - chronic and progressive failure to resist impulses to gamble and gambling behavior that compromises, disrupts, or harms personal, family, or professional pursuits. Pyromania - intentional and deliberate setting of fire on more than one occasion; tension or an affective awakening before the fire;
Kleptomania – repeated inability to resist the impulse to steal objects not necessary for personal use or for their monetary value; without premeditation and without much attention to the legal consequences.
Cluster A Personality Disorders
Other Impulse Control Disorders
Biochemical Interventions - There are no empirically supported medications used to treat personality disorders. Schizoid personality disorder - inappropriate, cold, or neglectful early parenting that creates expectations that the relationship will not be satisfying and leads to later protective withdrawal from others.
Cluster B Personality Disorders
Narcissistic personality disorder – craves attention but wants to be admired for superiority rather than weakness or to be dependent 4. Genetic/biological origin (Sadock & Sadock, 2007) – related to history of mood disorders, alcoholism and somatization disorders among family members.
Cluster C Personality Disorders
Genetic/biological origin - associated with family history of mood disorders, alcoholism, and somatization disorders. Questions 179 disorders) – families are overly controlling; a child who is expected to live up to impossible standards and then judged when he falls short.
Other Personality Considerations
Which of the following would be best to use when the nurse is assessing a client's sexual functioning. Which of the following would NOT be a mental status variation for the client with a diagnosis of Pathological Gambling.
Cognitive DisorDers
Delirium
Cognitive impairment or pre-existing brain injury/disease (tumors, traumatic brain injury, dementia) – approximately 25% to 50% of patients diagnosed with dementia are found to have delirium in addition to dementia. Substance-related intoxication, withdrawal, or toxicity—alcohol, drugs (especially those with anticholinergic properties such as benztropine), or other substances have been implicated in the delirium.
