NURS 222 – Final Exam Questions and
Correct Answers
Resilience ✅- ability to cope/deal/behave effectively w/ life challenges & stressors
- ability & capacity to secure resources needed to support well-being
- ability to w/stand & recover quickly from difficult situations
- essential for recovery from illness
- closely connected to/characterized by: optimism, sense of mastery, competence
- attribute of a good psych nurse
Diathesis-stress model ✅- diathesis: biological predisposition/sensibility
- stress: environmental stress/trauma
*nature vs nurture
Erikson's ego theory ✅- (1) trust vs mistrust, ages 0-1.5
- (2) autonomy vs shame/doubt, ages 1.5-3
- (3) initiative vs guilt, ages 3-6
- (4) industry vs inferiority, ages 6-12
- (5) identity vs role confusion, ages 12-20
- (6) intimacy vs isolation, ages 20-35
- (7) generatively vs self-absorption, ages 35-65
- (8) integrity vs despair, ages 65+
Peplau's model of nurse-patient relationship ✅pre-orientation: prepare to meet w/ pt
- obtain info about pt from chart, significant others, other healthcare team members
- examine own feelings, fears, anxieties about working w/ pt
- gather assessment data
orientation: DISCUSS CONFIDENTIALITY, establish boundaries & trust
- create an environment for trust & rapport
- pt's problem is discussed & mutually agreed upon
- start planning pt's discharge the moment they are admitted
- goals are established
working: PRACTICE PROBLEM-SOLVING & COPING SKILLS
- maintain trust & rapport
- promote pt's insight & perception of reality
- practice solving problems & coping skills
- continuously evaluate progress toward goal attainment
termination: summarize goals achieved during relationship
- progress has been made toward attainment of goals
- a plan of action for more adaptive coping w/ future situations established
- discuss w/ pt changes that happened during relationship & evaluate outcomes
,Rational-emotive behavior therapy (Ellis) ✅- aims to eradicate irrational beliefs
- recognize thoughts that are not accurate
*targets irrational beliefs & patterns
Cognitive-behavioral therapy (Beck) ✅- tests distorted beliefs & change way of
thinking; reduce symptoms
*identifies distorted thinking & develops better coping mechanisms
Maslow's hierarchy of needs ✅*safety is #1 in psych
- psych pts stuck in safety, they lack love & belonging
5 Principles of bioethics ✅- beneficence: duty to promote good (i.e. advocating for pt
by putting them on a 1 to 1 when having suicidal thoughts)
- autonomy: respecting rights of others to make their own decisions (i.e. refuse meds, pt
has the right to say no always)
- justice: distribute resources/care equally
- fidelity (nonmaleficence): maintaining loyalty & commitment; doing no wrong to a pt
(i.e. can't restrain pt just bc they're annoying you, etc)
- veracity: one's duty to always communicate truthfully
Restraints ✅- physical: hand mitts, limb restraints, belts, vests
- chemical: benzodiazepines, antipsychotics (chemical less restrictive than physical)
- indications: when pt poses imminent danger to themselves or others; only when least
restrictive methods haven't worked (verbal interventions, therapeutic communication,
redirection, calm environment)
- only use as last resort, SELF-DESTRUCTIVE BEHAVIOR DESPITE ALTERNATIVE
INTERVENTIONS
- can place pt in restraints first then call MD for order: in an emergency situation, must
obtain written order w/in 15-30 mins
- TIME LIMITS:
- >/= 18yrs = 4hrs
- 9-17ys = 2hrs
- </= 8yrs = 1hr
- assess circulation at least every 15 mins; ensure-the receives fluids/food, VS, ROM,
toileting q2hrs
- document every 15-30 mins
- pt on restraints = 1 to 1 observation
Nurse/pt relationship ✅- to establish that nurse is: safe, confidential, reliable,
consistent, establish trust & rapport
- relationship w/ clear boundaries
- needs of pt identified & explored
- new coping skills developed
,Therapeutic communication ✅- use active listening: SOLER (sit, open/observe, lean
forward, eye contact, relax)
- always establish trust, security, & rapport (priority)
- no why questions
- open-ended (how, what, tell me, could)
- restating (so are you saying that...?)
- don't feed into delusions/challenges
- always supportive, never give advice
- typically beginning on nurse's part (it sounds like, it appears, it looks like...)
Schizophrenia ✅- symptoms present for at least 6 months
- >2 symptoms present for at least 6 months, behavior disrupts social &/or occupational
environment
- ALWAYS RULE OUT PHYSIOLOGICAL CAUSES (electrolyte imbalance,
hypoglycemia, substance)
- positive & negative symptoms must be present in order to diagnose
SCHIZOPHRENIA - Phases ✅Prodromal: initial decline from normal functioning
- may arise months or yrs before first hospitalization
- clear change from previous level of functioning
- bizarre, paranoid behavior
- withdraws from friends, hobbies, interests
- neglects personal hygiene & grooming
Acute phase aka active: must be hospitalized during this stage
- commonly triggered by stressful events, & begins to have psychotic symptoms
(hallucinations, delusions, incoherence, catatonic behavior)
- overall goal is pt safety & stabilization
Stabilization phase: symptoms are diminishing, movement toward one's previous level
of functioning
Maintenance/residual phase: s/s begin to resemble prodromal phase, symptoms
absent/diminished
SCHIZOPHRENIA - Negative S/S ✅- anhedonia: lack of pleasure/joy, sense of
indifference
- avolition: lack of motivation in activities & hygiene, cannot complete tasks w/o
prompting
- anergia: lack of energy
- alogia: poverty of speech, mumbling a few words in a conversation
- affect: flat, unchanging expression; blunted, narrow range of expression; inappropriate;
bizarre
SCHIZOPHRENIA - Positive S/S: Delusions ✅- ideas of reference: passages in books,
newspapers, shows, etc are directed at him/her; others are talking about him/her
- persecution: he/she is being spied on, tricked, tormented, singled out for harm
(paranoia); *show them everything, esp when trying to give meds
- grandiose: believing that they are all powerful & important
, - somatic: belief that his/her body is changing
- jealous: believing SO is sexually involved w/ another; can be directed towards their
nurse/others on the unit
- nihilistic: catastrophe is about to occur (rile other pts up)
- religiosity: obsessed w/ religious beliefs
- magical thinking: believes that thoughts/actions can control others/situations (wearing
a hat makes them invisible)
- thought insertion: others' thoughts are being inserted into their minds
- thought w/drawal: thoughts removed by outside agency
- thought broadcasting: thoughts are heard by others
SCHIZOPHRENIA - Positive S/S: Disorganized speech ✅- associative looseness:
thinking becomes haphazard, illogical, & difficult to follow; inability to concentrate on a
single thought; can progress to flight of ideas
- flight of ideas: rapid shifts from one unrelated topic to another; incoherent
- clang associations: similar rhyming words
- word salad: words combined randomly in an incoherent way (sprint end slow happy
last book)
- neologisms: unrecognizable words
- echolalia: pt repeats words they hear
- pressured speech: rapid speech w/o pauses
SCHIZOPHRENIA - Positive S/S: Hallucinations ✅- auditory: hearing voices/sounds
- command: instructing pt to perform an action (ask what voices are saying)
- visual: seeing things/people
- tactile: feeling sensations
- olfactory: smelling odors
- gustatory: experiencing tastes
SCHIZOPHRENIA - Positive S/S: Alterations in behavior ✅- catatonia:
rigidity/cataplexy so severe that limbs remain in position they were placed
- motor retardation: slowed movement & motor agitation (pacing, rocking)
- stereotyped behaviors: sweeping the floor
- waxy flexibility: specific position for an extended period of time
- echopraxia: copying gestures
- negativism: doing the opposite
- impaired impulse control: resisting impulses
- gesturing/posturing: unusual illogical gestures
- boundary impairment: pts don't know where body ends & begins
SCHIZOPHRENIA - First gen meds: Low potency ✅- treat positive symptoms
- Chlorpromazine (Thorazine), Thioridazine (Mellaril), Mesoridazine (Serentil)
- S/E: high in sedation, anticholinergic, low EPS, photosensitivity
- anticholinergic: dry mouth, constipation, blurry vision, urinary retention, confusion,
hypotension
