1
Q
A client is brought to the emergency department stating, “I’m scared because the Federal Bureau of Investigation is now tapping my home phone, and I can hear them talking between my two telephones during the night.” The client’s eyes dart around the room while the nurse is trying to interview the client, and the client is tapping the client’s fingers on the table. Which action should the nurse prioritize?
A. Reassure the client that the client is in a safe place where the client will be helped.
B. Speak with the client about calling members of the client’s family to come in.
C. Give the haloperidol IM to reduce the client’s paranoia.Give the haloperidol IM to reduce the client’s paranoia.
D. Assess the client’s family for dysfunctional dynamics
A
A. Reassure the client that the client is in a safe place where the client will be helped.
2
Q
A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder when identifying that the client is at risk for developing what?
A. Substance use disorder
B. Major depression
C. Schizophrenia
D. Personality disorder
A
C. Schizophrenia
3
Q
What interventions does the nurse use to promote therapeutic communication with the client diagnosed with obsessive-compulsive disorder (OCD)?
A. Ask the client to avoid discussing ritualistic behaviors with friends.
B. Explain to the client that anxiety is irrational.
C. Explore the thoughts and feelings that trouble the client.
D. Inform the client that these thoughts cannot be controlled
A
C. Explore the thoughts and feelings that trouble the client.
4
Q
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client?
A. Neuroleptic malignant syndrome
B. Akathisia
C. Parkinsonism
D. Tardive dyskinesia
A
A. Neuroleptic malignant syndrome
5
Q
Which statement made by a client raises the greatest concern that the client may be experiencing intimate partner violence?
A. “I don’t know what else I can do to keep my partner from getting angry at me.”
B. “My partner doesn’t like it when I go out with my friends.”
C. “My partner was so much nicer when we started dating.”
D. “My partner’s parent physically abused the spouse for years.”
A
A. “I don’t know what else I can do to keep my partner from getting angry at me.”
6
Q
The nurse is educating a client that is experiencing mild anxiety. Which statement made by the client indicates that the education is effective?
A. “There are no physical symptoms with anxiety.”
B. “I need to eliminate all of the stress in my life.”
C. “I need to take medication for my anxiety every day.”
D. “Some degree of anxiety is beneficial for learning.”
A
D. “Some degree of anxiety is beneficial for learning.”
7
Q
A client is diagnosed with a delusional disorder. While providing care to the client, the nurse assesses the client’s delusions. Which would be least appropriate for the nurse to do?
A. Try to change the client’s delusional belief
B. Determine the impact of the delusion on the client’s safety
C. Evaluate the significance to the client
D. Avoid dwelling on the delusion
A
A. Try to change the client’s delusional belief
8
Q
A client brought to the outpatient department by a family member is diagnosed with obsessive-compulsive disorder (OCD). What characteristic of OCD does the nurse expect to find during the assessment of the client?
A. Increase in the amount of time spent with the family.
B. Reduced body and mind coordination.
C. Decrease in the level of intelligence.
D. Rituals that interfere with occupational function.
A
D. Rituals that interfere with occupational function.
9
Q
The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety?
A. The client has impaired cognitive skills.
B. The client is focused in an activity.
C. The client is unable to communicate verbally.
D. The client is nervous and agitated.
A
D. The client is nervous and agitated.
10
Q
What does the nurse find on assessment of the thought processes of a client with obsessive-compulsive disorder (OCD)?
A. The client’s intellectual functioning is deteriorating.
B. The client has gradual memory loss.
C. The obsessions become intense as the client tries to stop the behavior.
D. Obsessions occur when the client is not engaged in an activity.
A
C. The obsessions become intense as the client tries to stop the behavior.
11
Q
A nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which statement would the nurse include when describing panic disorder?
A. “Typically, individuals experience this disorder after the age of 30 years.”
B. “Persons rarely have an underlying comorbid condition of depression.”
C. “People with panic attacks often have fewer attacks if they also have agoraphobia.”
D. “Individuals may believe that they are having a heart attack when a panic attack occurs.”
A
D. “Individuals may believe that they are having a heart attack when a panic attack occurs.”
12
Q
A client has been prescribed clozapine for schizoaffective disorder (SCA) with depression. The nurse should explain to the client that one advantage of clozapine is that it can provide what?
A. Reduction of hospitalizations and risk for suicide
B. Cost savings
C. Combination with lithium for greater effect
D. Weight loss
A
A. Reduction of hospitalizations and risk for suicide
13
Q
A client is late for work every day because the client spends about 20 minutes checking and rechecking the lights and water taps before leaving home. What kind of behavior does the nurse understand is exhibited by the client?
A. The client is particular about resource management.
B. The client is exhibiting attention-seeking behavior.
C. The client is trying to reduce anxiety by repeating specific tasks.
D. The client is intentionally reporting late to work.
A
C. The client is trying to reduce anxiety by repeating specific tasks.
14
Q
A client is watching the news and tells the nurse that the newscaster is sending a message to the client. What term is used to identify this symptom?
A. Delusion
B. Hallucination
C. Idea of reference
D. Flight of idea
A
C. Idea of reference
15
Q
Assessment of violence potential is an important part of nursing care on the inpatient unit. Which is an indicator that the client with schizophrenia may be at high risk for violence while in the hospital?
A. The client is suspicious of the nursing staff.
B. The client has never used substances or alcohol.
C. The client reports feeling that everyone on the unit is “out to get me.”
D. The client assaulted an officer prior to admission.
A
D. The client assaulted an officer prior to admission.
16
Q
The community health nurse meets with the family members of an older adult client that will be living with them, since the client is no longer able to live alone. Which will the nurse include in the plan of care as a preventive measure against older adult abuse?
A. Reassure the primary caregiver that they are in the best position to provide care to the client.
B. Provide the primary caregiver with resources to meet the client’s needs.
C. Assist in the transfer of legal authority for care to the primary caregiver.
D. Teach the primary caregiver skills to meet all of the client’s needs.
A
B. Provide the primary caregiver with resources to meet the client’s needs.
17
Q
One of the primary goals in caring for the client with schizophrenia is to establish clear, consistent, open communication. Which nursing intervention would be most effective in accomplishing this goal?
A. Arrange for the client to go home as soon as possible on a day pass.
B. Supervise all of the client’s activities of daily living.
C. Assist the client to do at least one physical activity each day.
D. Present reality in clear, simple language, and demonstrate patience.
A
D. Present reality in clear, simple language, and demonstrate patience.
18
Q
A client with a persecutory delusion has been explaining to the nurse the specifics of the conspiracy against the client. The client pauses and says, “I get the feeling that you don’t actually believe that what I’m telling you is true.” How should the nurse respond?
A. “What makes you think that I don’t believe you?”
B. “What you’re telling me is difficult for me to believe. This may be real for you, but not me.”
C. “What’s important to me is that it’s real for you.”
D. “The conspiracy that you’re explaining to me is actually a delusion.”
A
B. “What you’re telling me is difficult for me to believe. This may be real for you, but not me.”
19
Q
A client has been taking haloperidol for 5 years when the client is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of what?
A. Progressed schizophrenia
B. Extrapyramidal side effects
C. Psychosis
D. Tardive dyskinesia
A
B. Extrapyramidal side effects
20
Q
A nursing student is preparing to care for a client diagnosed with schizophrenia. When interacting with the client, the student notices that the client is highly suspicious and guarded, stating, “They’re out to get me.” The student identifies this as what?
A. Autistic thinking
B. Stilted language
C. Pressured speech
D. Paranoia
A
D. Paranoia
21
Q
A client states, “I will just die if I don’t get this job.” The nurse then asks the client, “What will be the worst that will happen if you don’t get the job?” Which outcome does the nurse attempt to achieve?
A. Clarify the client’s meaning
B. Assess whether the client has health problems compounded by stress
C. Assist the client to make alternative plans for the future
D. Help the client appraise their situation more realistically
A
D. Help the client appraise their situation more realistically
22
Q
During the admission assessment of a 27-year-old client who has been diagnosed with an anxiety disorder, the nurse observes that the client is becoming increasingly restless and agitated. How should the nurse respond to this development?
A. Provide education regarding the level of anxiety that the client may be experiencing.
B. Explain to the client that the client’s current feelings of anxiety have the potential to foster better coping skills in the future.
C. Increase the speed of the assessment in order to ensure that it is completed sooner and inform the client that the nurse is doing so.
D. Inform the client that the assessment can be postponed if the client is finding it overwhelming.
A
D. Inform the client that the assessment can be postponed if the client is finding it overwhelming.
23
Q
An emergency department nurse is caring for client who was involved in a house fire and who is crying hysterically and stating, “I can’t believe this has happened!”. The client has a third-degree burn on their left arm. What is the nurse’s priority intervention for the client?
A. Assess the extent of the burns.
B. Maintain a calm presence.
C. Assess the client’s support system.
D. Assess the client’s mental status.
A
A. Assess the extent of the burns.
24
Q
An adult client being admitted to the psychiatric-mental health unit is experiencing severe anxiety. What is the nurse’s priority action for the client?
A. Encourage the client to problem solve.
B. Leave the client alone.
C. Teach relaxation techniques.
D. Decrease the client’s anxiety level.
A
D. Decrease the client’s anxiety level.
25
A nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate?
A. The nurse tells the client that they must leave to go report the client's symptoms to the psychiatrist on duty.
B. The nurse demonstrates empathy for the client by trying to mimic the client's state of anxiety.
C. The nurse tells the client that this is an acute exacerbation with a positive prognosis and low morbidity.
D. The nurse stays with the client, emphasizing safety and that the nurse will remain with the client.
D. The nurse stays with the client, emphasizing safety and that the nurse will remain with the client.
26
After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive?
A. "You should not have let your anger build up like it did."
B. "I will not allow you to get that angry again."
C. "What could you have done when you first started to feel angry?"
D. "You still need to work on your problem-solving skills."
C. "What could you have done when you first started to feel angry?"
27
Which client behavior does the nurse recognize as being an initial part of the trigger phase of the aggression cycle?
A. Client loudly verbalizes guilt and remorse.
B. Client is overreacting to minor stimuli.
C. Client paces with fists clenched.
D. Client throws a chair across the room.
B. Client is overreacting to minor stimuli.
28
A client being seen in the clinic was having visual hallucinations 8 weeks ago during a crisis. The client’s history includes depression and anxiety. Which assessment is most important for the nurse to conduct?
A. Assess the client’s activities of daily living.
B. Assess for the presence of hallucinations.
C. Assess the client’s mood.
D. Assess the client’s appearance.
B. Assess for the presence of hallucinations.
29
How does the nurse help to decrease anxiety and build confidence in a client with obsessive-compulsive disorder?
A. Help the client find alternative methods to deal with anxiety.
B. Provide the client with a quiet and dimly lit room.
C. Provide opportunities to perform tasks usually avoided by the client.
D. Permit minimal interactions with other clients during the therapy.
A. Help the client find alternative methods to deal with anxiety.
30
During an interview, a rape victim says, "I don’t think of anything else but the incident. I think I have had enough problems in life and there is no purpose for my life, either. Now all I need is to go back to the Lord Almighty.” The nurse advises the client to be admitted in the psychiatric facility. What would be the reason for the nurse to ask the client to be admitted?
A. The client may have negative feelings about the self.
B. The client may be extremely depressed.
C. The client may be unable to cope with the stress.
D. The client may have suicidal ideation.
D. The client may have suicidal ideation.
31
A client with schizophrenia is reluctant to take prescribed oral medication. Which is the most therapeutic response by the nurse to this refusal?
A. "If you refuse these pills, you'll have to get an injection."
B. "You know you have to take this medicine for your own good."
C. "I can see that you're uncomfortable now, so we can wait until tomorrow."
D. "What is it about the medicine that you don't like?"
D. "What is it about the medicine that you don't like?"
32
A client who has a major depressive episode tells a nurse that, for the past 2 weeks, the client has been hearing voices and at times thinks that they are being followed. History reveals that the client had these alternating symptoms before. The client also has experienced time with neither of these symptoms and has been able to function adequately. The nurse interprets these findings as suggesting which condition?
A. Undifferentiated schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Paranoid schizophrenia
B. Schizoaffective disorder
33
The nurse is preparing to interview a female client who is a victim of intimate partner violence (IPV). Which action would the nurse take to establish rapport with the client?
A. Express personal feelings about the situation.
B. Focus on current injuries.
C. Start with the least sensitive area.
D. Question explanations about the event.
C. Start with the least sensitive area.
34
A hospitalized client diagnosed with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer?
A. Propranolol
B. Aripiprazole
C. Risperidone
D. Diphenhydramine
D. Diphenhydramine
35
The family members of a military veteran are distraught that the client has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse's most appropriate action?
A. Educate the family about the usual emotional responses to returning home from military service
B. Organize a family meeting where family members can tell the client how they feel
C. Educate the family about the relationship between hyperarousal and emotional distance
D. Assess the client for signs and symptoms associated with post-traumatic stress disorder
D. Assess the client for signs and symptoms associated with post-traumatic stress disorder
36
The nurse provides education to a group regarding the physiologic response to acute stress. Which participant statement indicates a need for additional teaching?
A. “My blood glucose will likely increase to provide additional energy.”
B. “My heart rate and respiratory rate will likely be increased.”
C. "My blood pressure will likely decrease.”
D. “I will be less likely to bleed if I experience a cut.”
C. "My blood pressure will likely decrease.”
37
A frightened young female calls the emergency department and tearfully tells the nurse, “I've been raped! Please help me!” Before telling the client what to do, the nurse would need to know if
A. If the client had bathed, douched, or changed clothes
B. If the client was injured, was in a safe place, and had transportation available
C. If the client has insurance, if they could get to the hospital by themself, and if pregnancy is a possibility
D. If the client knew their assailant, knew their own location, and had notified the police
B. If the client was injured, was in a safe place, and had transportation available
38
The nurse is assessing a 6-year-old child suspected of being emotionally abused. Which assessment finding should the nurse further investigate related to potential emotional abuse?
A. The nurse assesses inconsistent development and mild language delays.
B. The child lives with a single parent who is often busy but ensures the child's basic needs are met.
C. Despite attending day care regularly, the child appears withdrawn but engages when prompted.
D. During the exam, the child appears anxious and avoids interaction with adults.
D. During the exam, the child appears anxious and avoids interaction with adults.
39
A nursing instructor teaching about sexual assault identifies a need for further instruction when one of the students makes which statement?
A. "Fondling can be a type of sexual assault."
B. "Sexual assault occurs about once every 2 minutes in the United States."
C. "It is not considered rape if it occurs with same-sex couples."
D. "Sexual assault involves nonconsenting sexual activity."
C. "It is not considered rape if it occurs with same-sex couples."
40
In which phase of the aggression cycle is the client removed from restraint or seclusion as soon as they meet the behavioral criteria?
A. Postcrisis
B. Escalation
C. Crisis
D. Triggering
A. Postcrisis
41
The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what?
A. Twice as often as in heterosexual couples
B. Same frequency as in heterosexual couples
C. Half as frequent as in heterosexual couples
D. Three times more frequent as in heterosexual couples
B. Same frequency as in heterosexual couples.
42
When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor?
A. family dysfunction
B. legal problems
C. gender
D. limited coping skills
D. limited coping skills
43
A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of:
A. weight loss.
B. nausea.
C. infection.
D. hypotension.
C. infection.
44
A client with schizophrenia is attending a follow-up appointment at the community mental health clinic. The client reports to the nurse, "I stopped taking the antipsychotic medication because I can't get an erection with my partner anymore." Which response by the nurse will enhance the client's well-being?
A. "It is important for you to take an antipsychotic medication, but perhaps a different type will be less likely to affect your sexual functioning. I would like to call your health care provider about this."
B. "You should avoid having sex with your partner anyway. Do you really want them to get pregnant?"
C. "It sounds like that is a problem for you. Don't you still find them to be sexy enough?"
D. "Sexual dysfunction is a temporary side effect and should get better once your body is used to the medication."
A. "It is important for you to take an antipsychotic medication, but perhaps a different type will be less likely to affect your sexual functioning. I would like to call your health care provider about this."
45
The client has been diagnosed with schizophrenia. Which element(s) indicate to the nurse the presence of avolition? Select all that apply.
A. lack of ambition
B. unkept appearance
C. incapable of decisions
D. paranoid delusions
E. persistent anergia
A. lack of ambition
B. unkept appearance
C. incapable of decisions
E. persistent anergia
46
All except which are considered clinical symptoms of anxiety?
A. Motor excitement
B. Extreme restlessness
C. Tearfulness and sadness
D. Palpitations
C. Tearfulness and sadness
47
Which has not been proposed as a potential mechanism for the etiology of thought disorders?
A. Hemispheric brain dysfunction
B. Dysregulation of neurotransmitter systems
C. Genetic predispositions
D. Neglect in childhood
D. Neglect in childhood
48
A client experiences panic attacks when confronted with riding in elevators. The nurse is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. Which technique will the nurse employ to assist the client with overcoming the phobia?
A. Flooding
B. Combination therapy
C. Systematic desensitization
D. Cognitive restructuring
C. Systematic desensitization
49
The inpatient psychiatric nurse removes the restraints from a client who had an aggressive episode earlier and is currently calm and rational. The client asks if they can attend the group. Which response demonstrates insight into the postcrisis phase of anger and aggression?
A. Recommend the client wait another day before interacting with their peers.
B. Tell them they can attend but have a staff member stand next to them.
C. Encourage the client to attend with the expectation that they will remain nonaggressive.
D. Remind the client that if they are aggressive, they will be asked to leave.
C. Encourage the client to attend with the expectation that they will remain nonaggressive.
50
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder?
Relapse
51
What is hostility?
Often considered an underlying emotional state or attitude.
Also called verbal aggression
Emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior
It may be expressed when a person feels threatened or powerless
52
What is aggression?
Generally defined as behavior intended to cause harm
53
What is physical aggression?
The behavior in which person attacks or injures another person or involves destruction of personal property
54
What is similar between hostility and aggression?
Both meant to harm or punish another person or force into compliance
55
True or False: Expression of anger is vital for growth and development?
True
56
What is catharsis?
Aggressive but safe activities such as hitting a punching bag or yelling
57
What is the downside to catharsis?
Can increase rather than alleviate anger feeling
May be contraindicated
58
What does the appropriate expression of anger involve?
Assertive communication skills that lead to problem-solving or conflict resolution
59
Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger:
A. Encourage exercise
B. Encourage verbalization
C. Improve self-esteem
D. Isolate from others
B. Encourage verbalization
60
A client suddenly jumps up from a chair and begins yelling and cursing at the nurse. The best response by the nurse would be:
A. “I can see that you need attention; you should calmly ask for what you want.”
B. “I don’t want to hear that kind of language; don’t ever do that again.”
C. “I will limit your smoking privileges if you can’t control yourself.”
D. “You seem angry. Tell me more about how you’re feeling.”
D. “You seem angry. Tell me more about how you’re feeling.”
61
Phases of hostility and aggression
1. Triggering
2. Escalation
3. Crisis
4. Recovery
5. Postcrisis
62
What is the triggering phase?
S/S/Behavior?
An event or circumstances in the environment initiates the client’s response, which is often anger or hostility.
S/S/Behavior: Restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, anger
63
What is the nurse's role in the triggering phase?
- Approach in non-threating calm manner
- DO NOT SHOW FEAR
- de-escalate clients emotion
- convey empathy
- use clear, short, & simple statements
- offer patient their PRN med
- suggest going to a quiet area to decrease stimulation
- walking may relax/calm client
64
What is the escalation phase?
S/S/Behavior?
The client’s responses represent escalating behaviors that indicate movement toward a loss of control.
S/S/Behavior: Pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly
65
What is the nurse's role in the escalation phase?
- TAKE CONTROL OF THE SITUATION
- use calm & firm voice
- tell client aggressive behavior is not acceptable
- direct them to take a time-out to cool off
- if client refused meds during trigger offer again
- 4-6 staff members readily available to "show force"
66
What is the crisis phase?
S/S/Behavior?
During an emotional and physical crisis, the client loses control.
S/S/Behavior: Loss of emotional and physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, inability to communicate clearly
67
What is the nurse's role in the crisis phase?
- staff must take charge of situation for safety of client, staff, & other clients
- decision to use seclusion or restraints should be based on facility protocol IF RESTRAINTS ARE USED MUST RECEIVE PHYSICIAN ORDER IMMEDIATELY AFTER
- inform patient why they are being restrained
- if PRN med wasn't taken early order can be given for the emergency situation
68
What is the recovery phase?
S/S/Behavior?
The client regains physical and emotional control.
S/S/Behavior: Lowering of voice; decreased muscle tension; clearer, more rational communication; physical relaxation
69
What is the nurse's role in the recovery phase?
Nurse's role: Encourage patient to talk about the situation or triggers; help client relax
70
What is the postcrisis phase?
S/S/Behavior?
The client attempts reconciliation with others and returns to the level of functioning before the aggressive incident and its antecedents.
S/S/Behavior: Remorse; apologies; crying; quiet, withdrawn behavior
71
What is the nurse's role in the postcrisis phase?
- client removed from restraints when he/she meets behavioral criteria
- client given feedback about behavior
- expectations of handling feelings or events in nonaggressive manner in the future
72
What is the best intervention of anger/hostility/aggression?
Prevention
- Assess history
- Assess for risk of becoming violent- then plan intervention
- Know what anger “looks like”
- Your powers of observation are essential
73
True or False: Most psychiatric clients are aggressive.
False
Most psychiatric clients are not aggressive, but some exhibit angry, hostile, or aggressive behavior caused by a specific underlying condition or circumstance, rather than an inherent trait of mental illness itself.
74
Etiology of hostility and aggression is associated with.... (according to the neurobiologic theories)
Possible decreased serotonin, increased dopamine and norepinephrine
Structural damage to limbic system
Damage to frontal or temporal lobes
75
Etiology of hostility and aggression is associated with.... (according to the psychosocial theories)
Failure to develop impulse control (d/t: dysfunctional families w/ poor parenting &/or inconsistent response to children's behaviors)
Interpersonal rejection
76
What is impulse control?
Ability to delay gratification
77
What is lithium used to treat regarding an aggressive client?
Bipolar disorder, conduct disorders (in children), intellectual disability
78
What is Carbamazepine (Tegretol) or valproate (Depakota) used to treat regarding an aggressive client?
Aggression associated with dementia, psychosis, personality disorders
79
What are some atypical antipsychotics used to treat aggressive clients?
What are they effective with?
clozapine (Clozaril), risperidone (Risperdal), and olanzapine (Zyprexa)
Effective with dementia, brain injury, intellectual disability, personality disorders
80
What are Benzodiazepines used to treat regarding an aggressive client?
Dementia
81
What are Haloperidol (Haldol) and lorazepam (Ativan) (combined) used for regarding regards aggressive client?
Decrease agitation or aggression and psychotic symptoms
82
Triggering phase- nurse management
-approach in calm manner
-convey empathy
- listen
- offer PRN meds
-suggest quiet area
83
Escalation phase: nurse management
- take control
- provider directions
- direct client to quiet place
- offer medications
- if ineffective ( show of force)
84
Crisis phase: nurse management
- take control of situation as determined by facility policy
- use restraint or seclusion only if necessary, only with trained staff, 4-6 staff members, inform client behavior out of control
85
Recovery phase: nurse management
-talk about situation
- help client relax/sleep
- help client explore alternatives
- assess/document any injuries
- debrief staff
86
Post-Crisis phase
-Remove patient from any restraint or seclusion to rejoin milieu.
-Calmly discuss behavior (no lecturing or chastising); allow patient to return to activities, groups, and so forth.
-Focus on appropriate expression of feelings, resolution of problems or conflicts in nonaggressive manner.
87
During the post crisis phase or final phase of the five phase aggression cycle, the focus of the nurse is:
A. Encouraging the client in the expression of feelings, with resolution and reconciliation with others
B. Taking control of the situation and using seclusion to prevent further aggression
C. Administering medications to keep aggression under control
D. Identifying the event or circumstance that triggers a client’s anger or hostility
A. Encouraging the client in the expression of feelings, with resolution and reconciliation with others
88
The etiology of hostility and aggression is associated with:
A. Maternal drug use during pregnancy
B. Structural damage to the limbic system in the brain
C. Long term use of drugs and alcohol
D. A disruption in the immune system
B. Structural damage to the limbic system in the brain
89
A client who has been very physically and verbally aggressive arrives at the emergency department for a psychiatric assessment. The best approach by the nurse would be to:
A. Have a sense of humor to show a lack of fear.
B. Provide close contact to increase the client’s sense of safety and security.
C. Use brief statements and questions to obtain information.
D. Use open-ended questions so the client can elaborate about feelings.
C. Use brief statements and questions to obtain information.
90
What are overt actions?
Visible and direct expressions of hostility, such as verbal outbursts and physical threats.
91
What are passive activities?
Hostility manifested through passive behaviors, like refusing to perform assigned tasks or exhibiting an uncooperative attitude.
92
What are some qualities/skills a nurse needs to have when dealing with anger/aggression/hostility
- Assertive communication skills,
- Conflict resolution skills,
- Ability to see that client’s behavior/anger is not personal or a sign of nurse’s failure, and
- Ability to deal with own fear when clients are aggressive or threatening
93
What gender is most likely to suppress anger?
Females
94
What is abuse?
The wrongful use and maltreatment of another person
95
What are characteristics of violent families?
- Social isolation
- Abuse of power and control
- Alcohol and other drug abuse
- Intergenerational transmission process
96
True or False
The prevalence of intimate partner violence is the same in same-sex relationships as in heterosexual relationships.
True
Same-sex victims have fewer protections
97
Sodomy
Anal intercourse as a crime
98
What is the cycle of abuse and violence?
Violent episode→ honeymoon phase→ tension-building → violent episode
The cycle repeats over and over
99
What is the abuse screening/assessment: SAFE?
S- stress/safety
A- afraid/abused
F- friends/family
E- emergency plan
100
The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the location of the bruises, what should the nurse do next?
A. Collect more data by asking the client when and how the bruises occurred
B. Call the nursing supervisor immediately to alert to elder abuse
C. Follow the facility’s policy for reporting abuse to the social worker
D. Notify the physician that you suspect abuse
A. Collect more data by asking the client when and how the bruises occurred
101
A frightened young woman calls the emergency department and tearfully tells the nurse, “I’ve been raped! Please help me! Before telling the client what to do, the nurse would need to know:
A. If the client was injured, was in a safe place, and had transportation available.
B. If the client knew her assailant, knew her location, and had notified the police.
C. If she has insurance, if she could get to the hospital by herself, if pregnancy is a possibility.
D. If she had bathed, douched, or changed clothes.
A. If the client was injured, was in a safe place, and had transportation available.
102
What are some psychiatric problems related to trauma/stress?
- Adjustment disorder
- Depression
- Complicated grieving
- Acute stress disorder
- Posttraumatic stress disorder (PTSD)
- Dissociative disorder
103
What is PTSD?
Disturbing behavior resulting from a traumatic event at least 3 months after the trauma occurs
104
The PTSD-3 major elements of the disorder are what?
- Persistent nightmares
- Emotional numbness
- Hypervigilance/Hyperarousal
105
What is the difference between acute stress disorder and PTSD?
Acute stress disorder = event occurred <1 month
PTSD = event occurred = or >1 month
PTSD is chronic in nature with periods of exacerbation during increased stress
PTSD can lead to other psychiatric disorders such as depression/anxiety/substance abuse.
106
A client with post traumatic stress disorder (PTSD) is visiting the clinic for a weekly checkup. The nurse would want to assess which of the following with PTSD diagnosis? Select All That Apply
A. Sleep pattern and sleep disturbances
B. Hypervigilance and irritability
C. Avoidance of activities reminiscent of the trauma
D. Visual and auditory hallucination and paranoid delusions
A. Sleep pattern and sleep disturbances
B. Hypervigilance and irritability
C. Avoidance of activities reminiscent of the trauma
107
The nurse is assessing a client with post traumatic stress disorder. Which of the following statements by the client is least likely?
A. “I can’t concentrate at work, but I’m fine at home.”
B. “I have recurrent nightmare that my life is in danger.”
C. “My family is concern that I’m drinking too much.”
D. “Sometimes I can’t breathe, and I feel my heart pounding.”
A. “I can’t concentrate at work, but I’m fine at home.”
108
What is dissociation?
A subconscious defense mechanism used to prevent recognition of a horrific or traumatic event.
The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a loss of reality as in psychosis.
109
What is dissociative amnesia?
A condition characterized by a significant inability to recall important personal information, typically triggered by stress or trauma
110
What is D.I.D.?
Dissociative identity disorder (formerly multiple personality disorder)
A mental health condition where an individual experiences two or more distinct personality states, or alters, which recurrently take control of their behavior and thinking.
111
What is depersonalization/derealization disorder?
A dissociative disorder characterized by persistent or recurrent experiences of depersonalization and/or derealization
112
A college student is very upset and reports that while driving to school to take a final exam, she found herslf in the car on the other side of the city. She crites, “I don’t remember driving in that direction. I’ve missed my exam and my teacher will not believe what happened.” The nurse assess this experience as a:
A. Dissociative experience
B. Psychotic episode
C. Lie
D. Panic attack
A. Dissociative experience
113
Which of the following is true about the use of touch with a client with dissociative identity disorder?
A. It is best not to touch the client without his or her permission.
B. Make sure the client knows the touch is friendly and supportive.
C. Touch the client only if you are in his or her direct line of vision.
D. Touch will convey a sense of security to the client.
A. It is best not to touch the client without his or her permission.
114
What is stress?
The wear and tear that life causes on the body.
It occurs when a person has difficulty dealing with life situations, problems, and goals.
115
What is anxiety?
A vague feeling of dread or apprehension in response to external or internal stimuli
116
What are the levels of anxiety?
Mild
Moderate
Severe
Panic
117
What is mild anxiety?
Sensation that something is different
S/S include: Restlessness, increased motivation, irritability, alert, can solve problems, sharpened senses
118
What is moderate anxiety?
Feeling that something is definitely wrong
S/S include:
-Focus on immediate concerns
-difficulty staying attentive and being able to learn, but can be directed to focus
-muscle tension
- increased rate of speech
-GI upset
119
What is severe anxiety?
A state where feelings of fear, worry, or panic are intense, excessive, and significantly disruptive to daily life
S/S include:
-significant reduction in perceptual field; focus is on specific detail only
-all behavior is aimed at relieving anxiety
-much direction needed to focus on another area
- cannot solve problems
awe/dread/horror
crying
120
What is the panic level of anxiety?
Fight, flight, or freeze responses
S/S include: Unable to focus.
Not a learning opportunity.
Hallucinate.
Not able to have an intelligent conversation.
Not much you can do except give medication.
Doesn't recognize danger, possibly suicidal
121
What are some key points for working with anxious clients?
Be aware of nurse’s own anxiety level
Assessment of person’s anxiety level
Use short, simple, easy-to-understand sentences
Lower the person’s anxiety level to moderate or mild before proceeding with anything else
Low, calm, soothing voice
Safety during panic level
Short-term use of anxiolytics
122
What are some anxiolytic drugs?
Benzodiazepines & Non-benzodiazepines
Benzodiazepines
- Diazepam (Valium)
- Alprazolam (Xanax)
- Chlordiazepoxide (Librium)
- Lorazepam (Ativan)
- Clonazepam (Klonopin)
- Oxazepam (Serax)
Non-benzodiazepines
Buspirone (BuSpar)
Meprobamate (Miltown, Equanil)
123
The client has been taking buspirone (Buspar) for my anxiety disorder. He tells the nurse, “I am not really better, and I have been taking the medication faithfully for the past 3 days just like it says on this prescription bottle.” Which action should the nurse do first?
A. Tell the client to continue taking the medication as prescribed because it takes some weeks for a full therapeutic effect.
B. Tell the client to stop taking the medication and to call the healthcare provider.
C. Encourage the client to double the dose of his medication.
D. Ask the client if he has resumed smoking cigarettes.
A. Tell the client to continue taking the medication as prescribed because it takes some weeks for a full therapeutic effect.
124
A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:
A. Insomnia and an inability to concentrate
B. Severe anxiety and fear
C. Depression and weight loss
D. Withdrawal and failure to distinguish reality from fantasy
B. Severe anxiety and fear
125
The nurse is assessing a client who has just experienced a crisis. The nurse should first assess this client for which behavior?
A. effective problem solving
B. level of anxiety
C. attention span
D. help-seeking
B. level of anxiety
126
What is agoraphobia?
An anxiety disorder characterized by intense fear and avoidance of situations where escape might be difficult or help unavailable if anxiety symptoms (especially panic) occur.
127
What is a panic disorder?
When a person has recurrent, unexpected panic attacks followed by at least 1 month of persistent concern or worry about future attacks, 1/2 of people have agoraphobia
128
What are panic attacks?
Involve 15- to 30-minute episodes of intense, escalating anxiety with emotional fear and physiologic discomfort
They are abrupt
129
What are phobias?
An illogical, intense, persistent fear of a specific object or social situation that causes extreme distress and interferes with normal life functioning
130
What is generalized anxiety disorder (GAD)?
Excessive worry and anxiety that is unwanted, more days than not ( 50% of time for 6 months or more)
S/S: -uneasiness
- irritability
- muscle tension
- fatigue
- difficulty thinking
- sleep alterations
131
What are the 5 etiologies of anxiety theories?
Biological theories
- Genetic theories: Anxiety may have an inherited component
Neurochemical theories
- Neurotransmitters may be dysfunctional in persons with anxiety disorders (GABA, NE, and serotonin)
Psychodynamic theories
- Intrapsychic/psychoanalytic theories: Overuse of defense mechanisms
Interpersonal theory (Sullivan, Peplau)
- Results from problems in interpersonal relationships
Behavioral theory
- “Learned” behavioral response
132
How do asian cultures often express anxiety?
Often express through somatic symptoms, headaches, backaches, fatigue, dizziness, stomach problems
133
Hispanics & anxiety
High anxiety, sadness, agitation, weight loss, weakness, HR changes
134
What therapy is most often used to treat anxiety?
Cognitive-behavioral therapy
135
What is positive reframing?
Turning negative messages into positive ones
136
What is decatastrophizing?
Making a more realistic appraisal of the situation
137
What is assertiveness training?
Learning to negotiate interpersonal situations
138
What is the treatment of choice for anxiety disorders in elderly?
SSRI antidepressants
139
What is the goal of stress management?
Effective management, not total elimination of anxiety
140
What is primary gain? (panic disorder)
The relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress
141
What is secondary gain? (panic disorder)
The attention received from others as a result of these behaviors
142
What are some treatments for panic disorders?
Cognitive-behavioral techniques
Deep breathing and relaxation
Medications:
Benzodiazepines
SSRI antidepressants
Tricyclic antidepressants
Antihypertensives-(clonidine, propranolol) (Blocks effects of epinephrine and norepinephrine)
143
Which finding would a nurse expect to assess in a client with a panic disorder?
A. Rational thinking
B. Blaming of others
C. Automatisms
D. Organized thoughts
C. Automatisms
144
What is systematic desensitization?
Gradually exposing the individual to the feared object or situation while simultaneously teaching them relaxation techniques. The exposure is done in a step-by-step, hierarchical manner, starting with the least anxiety-provoking stimulus and slowly progressing to more intense ones, allowing the individual to habituate to the fear response.
Slower & gentler than flooding
Over several visits
145
What is flooding?
Rapid and prolonged exposure to the most feared object or situation. The idea is that by preventing escape, the individual will eventually realize that the feared outcome does not occur and the anxiety will decrease through extinction. This technique can be very effective but is often done under strict clinical supervision due to its intensity.
Faster than systematic desensitization
Over a few visits (less than systematic desensitization)
146
What are the most effective treatments for generalized anxiety disorder (GAD)?
Buspirone and SSRI or SNRI antidepressants
147
What is OCD?
Obsessive-Compulsive Disorder
Classified as anxiety disorder but with unique manifestations in the way patients attempt to decrease or reduce anxiety
Diagnosed once thoughts or behaviors consume the person to the point where the thoughts or actions interfere with personal, social, and/or occupational functioning.
148
What are obsessions?
Recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses
149
What are compulsions?
Ritualistic or repetitive behaviors that a person carries out continuously in an attempt to decrease/neutralize
anxiety
150
What are the following?
1. Checking rituals
2. Counting rituals
3. Washing/scrubbing
4. Praying/chanting
1. Touching/rubbing/tapping
2. Ordering (arranging and
rearranging)
3. Exhibiting rigid performance
4. Having aggressive urges
151
What medications are used to treat OCD?
What are the behavioral therapies used for OCD?
Medications: First line: SSRI antidepressants (fluvoxamine, Sertraline)
Second line: SNRI (venlafaxine)
Treatment resistant OCD: Second generation antipsychotics (risperidone, aripiprazole)
Behavioral therapies:
Exposure therapy: Deliberately confronting situation and stimuli that client usually tries to avoid.
Response prevention: Delay or avoid performing the rituals. Learn to tolerate the thoughts and anxiety
152
Which treatment option is appropriate for clients experiencing OCD?
A. Avoidance therapy
B. Response–reaction therapy
C. Memory flooding
D. Exposure therapy
D. Exposure therapy
153
What are some self-soothing behaviors?
Excoriation (skin picking)
Onychophagia (nail biting)
Trichotillomania (hair pulling)
Reward-seeking behaviors:
- Kleptomania (compulsive stealing)
- Oniomania (compulsive buying)
- Hoarding (excessive acquisition)
- Pyromania (fire setting)
154
What are the core features that characterize schizophrenia?
Distorted and bizarre thoughts, perceptions, and emotions, movements, behavior
155
What are the positive (hard) symptoms of schizophrenia?
Why are they positive?
Ex: Hallucinations
Delusion
Bizarre behavior
Disorganized speech
Ambivalence
They are positive because they are symptoms that are added to the person's experience and are often more overt.
156
What are the negative (soft) symptoms of schizophrenia?
Why are they negative?
Examples: Avolition: Motivation
Apathy
Asociality
Alogia
Anhedonia
Affect/Flat/Blunt
Atonia
They are negative because they are symptoms that reflect a lack or deficit in normal functions
157
Hallucination
A perception in the absence of an external stimulus (e.g., hearing voices when no one is speaking).
158
Delusion
A fixed, false belief that is not amenable to change in light of conflicting evidence (e.g., believing one is a famous historical figure or is being persecuted).
False beliefs
159
Bizarre (Bx) behavoir
Behavior that is unusual, unpredictable, and does not make sense to others.
160
Disorganized speech
A disturbance in the form of thought, characterized by incoherent speech, tangentiality, or looseness of associations.
161
Ambivalence
The state of having mixed feelings or contradictory ideas about something or someone.
162
Avolition: Motivation
A severe reduction in motivation or ability to initiate and persist in goal-directed activities.
163
Apathy
A lack of interest, enthusiasm, or concern.
164
Asociality
Lack of motivation for social interaction, or a preference for solitary activities.
165
Alogia
A poverty of speech, either in the amount or content of speech.
166
Anhedonia
The inability to experience pleasure from activities usually found enjoyable, such as exercise, hobbies, social interactions, or sexual activity.
167
Affect/Flat/Blunt
Refers to a severe reduction in the range and intensity of emotional expression. "Flat affect" means showing virtually no emotional expression. "Blunted Affect," which is a reduction in the intensity of emotional expression, but less severe than flat affect.
168
Atonia
A lack of muscle tone. Reduced spontaneous movement or motor activity (which can be related to low tone or apathy)
169
What is the peak incidence of onset schizophrenia for males and females?
The peak incidence of onset is 15 to 25 years of age for men and 25 to 35 years of age for women.
170
What is Schizophreniform?
Symptoms very similar to schizophrenia, lasting for a shorter period
- specifically between 1 and 6 months. If the symptoms persist beyond 6 months, the diagnosis typically changes to schizophrenia.
171
Echopraxia
Involuntary repetition of another person's movements, gestures, or facial expressions
172
Flight of ideas
Symptom of mania that involves an abruptly switching in conversation from one topic to another
173
Catatonia
Psychologically induced immobility is occasionally marked by periods of agitation or excitement
174
Ideas of references
False impressions that external events have special meaning for the person
175
A client with chronic schizophrenia received an atypical antipsychotic for three months. The nurse concludes the client is experiencing improvement of negative symptoms if a family member says which of the following? Select all that apply.
A. We walked together for 15 minutes, and I could see no evidence he was “hearing voices.”
B. For the past week, he has gotten up, dressed, and took a walk early each morning.
C. It’s been more than a month since he said he is a Martian prince.
D. We went to a musical concert, and he smiled and applauded the musician.
E. I’ve noticed his thoughts are better organized.
B. For the past week, he has gotten up, dressed, and took a walk early each morning.
D. We went to a musical concert, and he smiled and applauded the musician.
176
Schizotypical personality disorder
A personality disorder characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior.
177
True or False
A particular pathologic structure that is the case of schizophrenia has never been identified.
True
178
Schizophrenia etiology theories/beliefs
- genetic factors (polygenic)
- less brain tissue & CSF
- dopamine excess and serotonin modulation of dopamine (or excess)
- possible d/t infections in pregnant women (influenza epidemics/respiratory ailments)
179
True or False
African Americans, Caucasian Americans, Asians, and Hispanic Americans appear to require comparable therapeutic doses of antipsychotic medication.
False
Asians clients need lower doses of drugs such as haloperidol (Haldol) to obtain the same effects.
180
What are the neurologic side effects of psychopharmacology for schizophrenia?
Extrapyramidal side effects
Acute dystonic reactions
Akathisia
Pseudo-Parkinsonism
▫ Tardive dyskinesia
▫ Seizures
▫ Neuroleptic malignant syndrome
181
EPS (Extrapyramidal Side Effects)
Acute, reversible motor symptoms (e.g., dystonia, akathisia, parkinsonism) usually appear early in treatment with antipsychotics, especially first-generation. Treatable with anticholinergics.
182
TD (Tardive Dyskinesia)
Chronic, involuntary, repetitive movements (often oral-facial, but can be trunk/limbs) that typically develop after long-term antipsychotic use. Often irreversible, challenging to treat.
183
NMS (Neuroleptic Malignant Syndrome)
A rare, life-threatening emergency with severe muscle rigidity, high fever, altered mental status, and autonomic instability. Can occur at any point with antipsychotic use. Requires immediate medical intervention.
184
What are the non-neurologic side effects of psychopharmacology for schizophrenia?
▫ Weight gain, sedation, photosensitivity
▫ Anticholinergic symptoms (dry mouth, blurred vision, constipation, urinary retention)
▫ Orthostatic hypotension
▫ Agranulocytosis (clozapine)
185
Which item is a neurologic side effect of antipsychotic therapy?
A. Blurred vision
B. Agranulocytosis
C. Sedation
D. Tardive dyskinesia
D. Tardive dyskinesia
186
Conventional antipsychotics' role in treating schizophrenia?
Control the "positive" symptoms of Schizophrenia, such as hallucinations, delusions and confusion, no effect on negative symptoms
187
Atypical antipsychotics role in treating schizophrenia?
Diminish positive symptoms
Lessen negative symptoms
188
What are the goals of psychiatric rehabilitation of schizophrenia?
What are the strategies?
Early intervention?
▫ Managing own life
▫ Making effective treatment decisions
▫ Having improved quality of life
189
Drugs to treat EPS
Amantadine (Symmetrel)
Benztropine ( Cogentin)
Biperiden ( Akineton)
Diphenydramine (Benadryl)
Trihexyphenidyl (Artane)
190
Drugs to treat TD
Deutetrabenazine (Austedo, Teva)
Vaalbenazine (Ingrezza)
191
Benzodiazepines
Alprazolam ( xanax)
chlordiazepoxide ( librium) (alcohol withdrawal)
Diazepam (Valium) (alcohol withdrawal)
Klonopin (Clonazepam)
Lorazepam (ativan) (alcohol withdrawal)
192
Benzo black box warnings
- risk for addiction
- risk for resp depression with opioid use
- not safe for pregnancy
- do not take with alcohol
- do not abruptly discontinue may lead to death
193
Antianxiety meds patient teaching
-no alcohol with benzos
- be aware of decreased response time, slower reflexes, possible sedative effects
- never discontinue benzos abruptly can be fatal
- be aware of physical dependance and additiction
194
Non-benzo hypnotics
Zolpidem (Ambien)
Zaleplon (Sonata)
Eszopiclone (Lunesta)
195
Non-benzo hypnotics indications/nurse management
Used for short-term insomnia
interacts with GABA receptors
-take at bedtime, allow for 7-8 hours of uninterrupted sleep
don't take with heavy meals may delay absorption
196
Non-benzo anxiolytic
buspirone (Buspar) - slow onset
197
Non-benzo anxiolytics/sedative/hypnotics
Meprobamate (Miltown, Equanil) - rapid
198
carbamazepine & valproate treat what?
Treat aggression assoc. with dementia, psychosis, and personality disorders
199
clozapine, risperidone, & olanzapine treat what?
(atypical antipsychotics) Treat aggression with dementia, brain injury, intellectual disability, and personality disorders
200
haloperidol & lorazepam treat what?
Used in combo to decrease agitation or aggression and psychotic symptoms
201
Benzodiazepines side effects?
Dizziness, clumsiness, sedation, headaches, fatigue, sexual dysfunction. blurred vision, dry throat and mouth, constipation, & high potential for abuse and dependence
202
Benzodiazepines nursing implications?
Avoid other CNS depressants, such as antihistamines and alcohol.
Avoid caffeine.
Take care with potentially hazardous activities such as driving.
Rise slowly from lying of sitting position.
Use sugar-free beverages or hard candy.
Drink adequate fluids.
Take only as prescribed.
Do not stop taking the drug abruptly
203
diazepam (Valium) & alprazolam (Xanax)
Speed on onset?
Half-life in hours?
Onset: Fast
Half-life: 20-100 hr
204
alprazolam (Xanax)
Speed on onset?
Half-life in hours?
Onset: Intermediate
Half-life: 6-12 hr.
205
chlordiazepoxide (Librium)
Speed on onset?
Half-life in hours?
Onset: Intermediate
Half-life: 5-30 hr
206
lorazepam (Ativan)
Speed on onset?
Half-life in hours?
Onset: Intermediate
Half-life: 10-20 hr
207
clonazepam (Klonopin)
Speed on onset?
Half-life in hours?
Onset: Slow
Half-life: 18-50 hr
208
oxazepam (Serax)
Speed on onset?
Half-life in hours?
Onset: Slow
Half-life: 4-15 hr
209
Nonbenzodiazepines side effects?
Dizziness, restlessness, agitation, drowsiness, headache, weakness, nausea, vomiting, paradoxical excitement or euphoria
210
Nonbenzodiazepines nursing implications?
Rise slowly from sitting position.
Take care with potentially hazardous activities, such as driving.
Take with food.
Report persistent restlessness, agitation, excitement, or euphoria to the physician.
211
buspirone (BuSpar)
Speed on onset?
Onset: Very Slow
212
meprobamate (Miltown, Equanil)
Speed on onset?
Onset: Rapid
213
What populations are anxiety disorders seen in more?
More in women under 45, and separated/divorced, lower socio-economic statuses
214
What are the steps in the general adaption syndrome (GAS)?
1. Threat - begins the process
2. Alarm reaction
3. Stage of resistance
4. Recovery or Stage of exhaustion
5. Outcomes of exhaustion
6. Rest & recovery or Death
215
What is the alarm reaction in the general adaptation syndrome (GAS)?
What happens to the body during this stage?
This is the initial "fight-or-flight" response, characterized by neuroendocrine activity leading to:
1. Increased heart rate and blood pressure.
2. Increased respirations and metabolism.
3. Peripheral vasoconstriction and water retention.
4. Dilated pupils and bronchi.
5. Increased mental alertness.
216
What is the stage of resistance in the general adaptation syndrome (GAS)?
If the threat persists, the body attempts to adapt and cope with the stressor. Neuroendocrine activity returns toward normal, and local adaptation syndrome (LAS) and various coping and defense mechanisms are employed.
217
What is the stage of exhaustion in the general adaptation syndrome (GAS)?
What happens during this stage?
Prolonged or overwhelming stress leads to the exhaustion of the body's resources. This stage is marked by:
1. Decreased vital signs (ventilation, blood pressure, pulse, and respirations).
2. Potential for panic or crisis.
3. Overall exhaustion.
218
What is Local Adaptation Syndrome (LAS)?
A localized response of the body to stress, often employed during the resistance stage of general adaption syndrome (GAS).
219
Rumination
Repetitive thinking or preoccupation with a particular subject, often contributing to anxiety and distress.
220
Selective Mutism
An anxiety disorder where a person is unable to speak in specific social situations despite being able to speak in other situations
Psych NUR 162
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