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NUR4005 Mental Health – Exam 2 Study Guide & Content Review.
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1NUR4005 Mental Health – Exam 2 Study Guide & Content Review – Summer 2018
(Exam covers all assigned readings, assignments, PPTs, videos found in Modules 4 – 7)
1. Always promote SAFETY!
2. Admission of Mental Health Clients – only when in danger to self or others or unable to care for self-due to
a mental health issue. Characteristics of a client who voluntarily is admitted & of a client who is admitted by
commitment.
3. Evaluate client teaching for coping skills has been effective?
4. Therapeutic communication – apply to different situations. ie… suicide comments, nothing to live for,
complaining of symptoms related to their disorder, unrealistic beliefs such as food being poisoned, mania,
delusions, hallucinations, panic attacks, , anxiety, threatening / aggressive behavior (do not ever turn your
back on a client who can potentially harm you; talk client down from aggression or threat of aggression –
set limits).
Role of silence / reflection / listening skills/ setting limits with client behaviors / focusing /
validating / open ended questions
5. Defense Mechanisms: denial / projection / regression / rationalization
6. Characteristics (symptoms / behaviors) of the identified psychopathologies (ie.. depression, schizophrenia,
bipolar, personality disorder, ADHD, Autism, OCD………
Major Depression – too much or too little sleep, poor appetite or increased appetite, loss of
interest, anhedonia (inability to feel pleasure – even in events that previously brought pleasure) ,
disshuffled, poor hygiene, apathetic, lack of motivation, weight gain or loss, lack of emotion, flat
affect, depressed mood, crying, withdrawn, poverty of ideas, can be suicidal, lack of interest in
sexual activities, poor school performance…..
Schizophrenia – varies widely – psychotic behavior, delusions, hallucinations (5 senses), inability to
care for self, bizarre behavior, disorganized thought,
avolition (decrease in the motivation to initiate & perform self-directed purposeful activities),
anergia (abnormal lack of energy),
delusions of grandeur (feeling famous or very important),
paranoia,
flight of ideas (thoughts & ideas leap from topic to topic),
echolalia (unsolicited repetition of vocalizations made by other persons) disconnected
thought patterns,
loose associations,
can be suicidal or homicidal,
increased thirst (fluids),
catatonic (lack of movement)…..
BiPolar Disorder – depression / mania. Clients tend to experience more depression symptoms or
more mania symptoms.
Mania – weight loss, impulsive, over spending on purchases, fast talk, fast movements,
pacing, rapid thoughts, confabulation (make up words), disorganized thought, verbosity
(speaking many words). Decompensation of cardiac system due to poor nutrition, fluid, &
electrolyte balance.
Obsessive – Compulsive Disorder (OCD) – Commonly associated with feelings of guilt &
inadequacies. Obsessions are repetitive thoughts, whereas compulsions are ritualistic behaviors.
Compulsions like – washing hands excessively, aligning items in a certain way all the time to a point
of disturbance & stress if items are not in order. Can lead to panic attacks (SOB, tachycardia, chest
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pain, shakiness, inability to think clearly / rationally). Obsessions are where thoughts continue &
take over the normal thought process & ability to carry out normal activities & ability to make
decisions.
Dissociative disorders:
Dissociative Identity Disorder – Two or more fully developed, distinct, & unique personalities
exist within the client. May have multiple personalities which are not aware of other
personalities. To get back to the host personality – call the person by name. Assess safety as
many times one or more personalities may be aggressive or protective of host.
Dissociative Amnesia - The client blocks out all memories about a specified period.
Post-Traumatic Stress Disorder (PTSD) – Can be triggered by any of the five senses. Dealing with
anxiety associated with a trauma by separating self from it. With treatment they can get back to her
previous level of functioning.
Reactive attachment disorder – Unable to build relationships, difficult to communicate feelings,
superficial relationships only
Eating Disorders – Bulimia & Anorexia Nervosa: Remember that the real problem is not food, the
problem is poor coping mechanisms with a psychosocial origination. The symptoms are food &
weight related.
Treatments should focus on safety & coping. Secondarily you need to monitor their dietary
habits, intake, & purging & binging.
We never order daily weights for these clients as it is not about the weight. A goal may
include “client will gain 2 pounds in 2 weeks” as that would be appropriate, but then just
weigh them once a week or every two weeks.
Major complication of disorder is related to fluid & electrolyte imbalances leading to cardiac
arrest or major cardiac symptoms. It is important to also watch them before, during, & after
meal times.
Symptoms can include: low calcium, weight loss, skin trauma on knuckles (due to purging),
cessation of menses (anorexia), poor teeth enamel / dentation (bulimia), osteoporosis,
fractures, follows strict rules & regulations (anorexia), impaired immune system due to poor
nutrition / protein intake (risk for infections).
Personality Disorders:
Dependent personality disorder - inability to make decisions
Narcissistic personality disorder – It is all about them. Very self-centered.
Paranoid personality disorder – believe everyone is out to get them, everyone is against
them.
Histrionic personality disorder– attention seeking, makes a big deal about the little things.
Antisocial personality disorder– abusive, no sense of remorse.
Schizotypal personality disorder – paranoid, social anxiety, transient psychosis, odd dressing,
talks to self
Borderline personality disorder – manipulation, attention seeking, passive-aggressive
7. Remember Maslow guides us to: first assess that a physical condition is not the cause of the
behaviors before addressing for psychosocial reasons for behaviors.
8. Nursing care & treatments: for each of the psychopathologies.
9. Define delusions vs hallucinations. Delusions are misbeliefs (like I am made of iron & cannot be
harmed), whereas, hallucinations can be displayed through any of the senses (see things, hear
things, taste things, hear voices, smell things, or any combination of them)
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