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NUR 385 Final Exam
| Question | Answer |
|---|---|
| unconscious and involuntary forgetting of painful ideas, events, or conflicts | repression |
| unconscious refusal to admit an unacceptable idea or behavior | denial |
| unconsciously discharging pent-up feelings to a less threatening object | displacement |
| conscious exclusion from awareness anxiety-producing feelings, ideas, and situations | suppression |
| conscious or unconscious attempts to make or prove that one’s feelings or behaviors are justifiable | rationalization |
| conscious or unconscious using only logical explanations without feelings or an affective component | intellectualization |
| the unconscious separation of painful feelings and emotions from an unacceptable idea, situation, or object | dissociation |
| conscious or unconscious attempt to model oneself after a respected person | identification |
| unconsciously incorporating values and attitudes of others as if they were your own | introjections |
| consciously covering up for a weakness by overemphasizing or making up a desirable trait | compensation |
| consciously or unconsciously channeling instinctual drives into acceptable activities | sublimation |
| a conscious behavior that is the exact opposite of an unconscious feeling | reaction formation |
| consciously doing something to counteract or make up for a transgression or wrongdoing | undoing |
| unconsciously or consciously blaming someone else for one’s difficulties or placing one’s unethical desires on someone else | projection |
| the unconscious expression of intrapsychic conflict symbolically through physical symptoms | conversion |
| unconscious return to an earlier and more comfortable developmental level | regression |
| Psychiatric conditions in which the physical symptoms the client is experiencing cannot be fully explained by a medical problem or another psychiatric disorder | somatoform disorders |
| alleviation of anxiety that the disorder provides, because the conflict is kept out of conscious awareness | primary gain |
| gratification received as a result of how others respond to the patient’s illness. This can prolong the illness | secondary gain |
| Recurrent, frequent, and multiple somatic complaints for several years without physiologic disorder, The location of somatic complaints DOES change, Usually begins before age 30, Unnecessary surgeries/procedures | somatization disorder |
| A sudden loss of neurological function, usually at a time of severe stress, not explained by a physical disorder | conversion disorder |
| the person with conversion disorder may show indifference or lack of concern to the impairment and experience little anxiety over the impairment | la belle indifference |
| The removal of painful feelings, memories, thoughts, or aspects of identity, from conscious awareness | dissociative disorders |
| loss of memory or inability to recall important personal information | amnesia |
| amnesia that occurs after a traumatic event, such as a car accident | recent amnesia |
| unable to remember what occurred during a specific time | localized amnesia |
| ability to recall some events during a specific time | selective amnesia |
| Characterized by sudden travel away from home with the assumption of a new identity or a confusion of one’s identity | dissociative fugue |
| Although the person is oriented to person, place, and time, the sense of reality has changed | depersonalization |
| Occurs when the existence of two or more distinct personalities take control of the person’s behavior | dissociative identity disorder |
| occurs when the person is unable to connect the anxiety to a stimulus | free-floating anxiety |
| may relieve or lower anxiety levels, these are subtle behaviors that the person is unaware of, which may be annoying to other people | automatic relief behaviors |
| solves the problem that is causing the anxiety, so the anxiety is decreased. The patient is objective, rational, and productive | adaptive coping mechanisms |
| temporarily decreases the anxiety but does not solve the problem, so the anxiety eventually returns. Temporary relief allows the patient to return to problem solving | palliative coping mechanisms |
| unsuccessful attempts to decrease the anxiety without attempting to solve the problem. The anxiety remains | maladaptive coping mechanisms |
| is not successful in reducing anxiety or solving the problem. Even minimal functioning becomes difficult, and new problems begin to develop | dysfunctional coping mechanisms |
| Not a disorder, but a condition that can occur in the context of any anxiety, mood, and substance-related disorder, as well as some general medical disorders | panic attack |
| long term treatment meds for panic attacks | SSRI's |
| short term treatment meds for panic attacks | benzodiazepines |
| Profound, irrational, fear response to an external object, activity, or situation | phobias |
| most common method of coping with the fear associated with phobias | avoidance |
| fear of being in a public or open space/place/situation where escape may not be available. Can be very severe | agoraphobia w/o history of panic disorder |
| fear of being embarrassed in public | social phobia |
| fear of a specific object or situation | specific phobia |
| most effective treatment for phobias | cognitive behavioral therapy |
| Symptoms usually occur within 3 months of the trauma and last 1 month or longer, symptoms more severe than ASD | PTSD |
| most important factors leading to likelihood of developing PTSD | severity, duration, proximity |
| Symptoms occur within 1 month following exposure to a traumatic event and last no longer than 1 month, symptoms less severe than PTSD | acute stress disorder |
| Characterized by excessive anxiety and worry that lasts for at least 6 months | generalized anxiety disorder |
| The internal and external manifestations of a person’s, group’s, or community’s learned and shared values, beliefs, and norms used to help individuals function in life and understand and interpret life occurrences | culture |
| The process whereby the nurse shows proficiency in developing cultural awareness, knowledge, and skills to promote effective health care. | cultural competence |
| values detail to time, individuality, and possessions. Prefers to learn through written, hands-on, and visual resources | analytic worldview |
| grounded in a belief in spirituality and the significance of relationships and interactions between and among individuals. Preferred learning style is through verbal communication | relational worldview |
| community needs and concerns are more important that individual ones. Learning styles include meditation and reading. | community worldview |
| interconnectedness exists between humans and the earth and individuals have a responsibility to take care of the earth. Learning style includes quiet observation and contemplation | etiologic worldview |
| the nurse’s ability to acknowledge, value, and accept a patient’s cultural beliefs | cultural preservation |
| the nurse’s ability to work within a patient’s cultural belie system to develop culturally appropriate interventions | cultural negotiation |
| the nurse’s ability to incorporate cultural preservation and negotiation to identify patient needs, develop expected outcomes, and evaluate outcome plans | cultural patterning |
| a spiritual assessment tool to help patients explore spiritual issues | HOPE assessment |
| sources of hope, strength, comfort, meaning, peace, love, and connection | H of HOPE |
| the role of organized religion in their life | O of HOPE |
| personal spirituality and practices | P of HOPE |
| effects on medical care and end of life issues | E of HOPE |
| 1. The human spirit is connected to a transcendent source, or higher power, and is often expressed within the person’s religious community | theistic view |
| 2. An attempt to distinguish itself from a religious perspective by emphasizing aspects of the human spirit and its relationship to other human spirits | humanistic view |
| courage, love, and wisdom | essential byproducts of mature, healthy spirituality |
| • A disruption in the life principle that pervades a person’s entire being and that integrates and transcends one’s biologic and psychosocial nature | spiritual distress |
| objective is to fund research into the efficacy and safety of alternative treatments | National Center for Complementary and Alternative Medicine (NCCAM) |
| Popular treatment for mild to moderate depression, anxiety, seasonal affective disorder, and sleep disturbances | St, John's Wort |
| • Assumed to have an affinity for Benzodiazepine receptors • Reduces anxiety, facilitates cognitive functioning, and improves mood, sometimes to the point of exhilaration Hepatotoxic, not banned in U.S. | kava |
| Improves memory, concentration, and mood in patients with dementia. Helps with depression. Used as an antidote to treat erectile dysfunction caused by antidepressants. Might antagonize the platelet-activating factor and increase effects of coagulants | Gingko |
| • Aids with sleep • Seasonal affective disorder (SAD), thought to be related to altered sunlight, decreased serotonin levels, and increased melatonin | melatonin |
| • Anxiety (most common) and mood disorders (depression, bipolar), severe cognitive impairment, and schizophrenia are prevalent in this population | older adult |
| the rate of suicide is twice the overall national rate | 85 years + |
| o Recent onset of physical illness o Increased severity of physical illness o Functional disability and limited mobility o Poorly treated pain | Risk factors for depression in older adult |
| 0-5 is normal, a score above 5 suggests depression | Geriatric Depression Scale |
| o In older adults with the first episode of major depression, the use of antidepressants usually extends | extends 6-12 months beyond the time of achieving full remission. |
| o Because age-related changes affect drug absorption, distribution, metabolism, and excretion, older adult patients should have an office visit within | 2-4 weeks of initiation |
| are considered first line treatment of depressive disorders in the older adult due to better tolerability, ease of use, and general safety, especially in overdose. They are also used for the treatment of anxiety disorders in older adults | SSRIs |
| are dual-action SNRIs that may be useful in patients with co-morbid pain, Both drugs carry a dose-dependent risk for diastolic hypertension | venlafaxine and duloxetine (Effexor and Cymbalta) |
| dual action SNRIs and SSRIs have resulted in | serotonin syndrome |
| an activating agent that may be used when lethargy is present. It also lowers seizure threshold and is contraindicated in patients with a history of seizures. It causes little sedation, hypotension, anticholinergic side effects, or cardiotoxicity | bupropion |
| produces sedation and may be useful in patients with insomnia, but daytime sedation might occur. Priapism and hyponatremia are associated with the use | trazodone |
| are effective against depression, but they have significant side effects (particularly _cardiac) and are not safe in overdose. | TCAs |
| are rarely used in older adults because they have potentially serious side effects and require dietary restrictions | MAOIs |
| 1. Celexa (citalopram) 2. Lexapro (escitalopram) 3. Prozac (fluoxetine) 4. Luvox (fluvoxamine) 5. Paxil (paroxetine) 6. Zoloft (sertraline) | SSRIs |
| 1. Effexor (venlafaxine) 2. Cymbalta (duloxetine) | SNRIs |
| 1. Asendin (amoxapine) 2. Wellbutrin (bupropion) 3. Remeron (mirtazapine) 4. Serzone (nefazodone) 5. Vestra (reboxetine) 6. Desyrel (trazodone) | atypical antidepressants |
| 1. Elavil (amitriptyline) 2. Anafranil (clomipramine) 3. Norpramin (desipramine) 4. Sinequan (doxepin) 5. Ludiomil (maprotiline) 6. Aventyl, Pamelor (nortriptyline) 7. Vivactil (protiptyline) 8. Surmontil (trimipramine) | tricyclic antidepressants |
| 1. Marplan 2. Nardil 3. Parnate | MAOIs |
| a viable treatment option in the elderly. o Used for depressed patients who have not responded to adequate antidepressant trials. o More commonly used in the older population | ECT |
| highest of all mental disorders in older adults. | anxiety disorders |
| one of the more frequently occurring anxiety disorders in older adults | phobias |
| excessive worry about routine events lasts six months or longer | GAD |
| o Selective Serotonin Reuptake Inhibitors (SSRIs) o Benzodiazepines o Buspirone | pharmacological management of anxiety in older adults |
| should be limited to periods of less than 6 months – for acute anxiety, not chronic anxiety | benzodiazepines |
| are less likely to accumulate and are recommended for use in older adults when a benzodiazepine is indicated | lorazepam and oxazepam |
| an effective non-benzodiazepine anxiolytic in older adults | Buspar |
| may take up to 6 weeks to be effective – another anxiolytic may be needed initially | Buspar |
| is less sedating than benzodiazepines, it produces significant adverse reactions in 20 to 30 percent of older adults taking the drug | Buspar |
| can be given long-term for older adults with chronic anxiety | SSRIs |
| are effective against “positive symptoms” and have a high risk for: o orthostatic hypotention o extrapyramidal symptoms (EPS) o tardive dyskinesia (TD). | 1st generation antipsychotics |
| – high sedation, high anticholinergic effects, low EPS. Dosed in hundreds of milligrams | low potency 1st generation antipsychotics |
| – less sedating, lower anticholinergic, higher EPS. Hosed in one to tens of milligrams | high potency 1st generation antipsychotics |
| an anticholinergic medication. It blocks the effects of acetylcholine | congentin |
| helps to re-establish a normal balance between dopamine and acetylcholine | congentin |
| o Time of onset is from hours to days o Features - muscle spasms of tongue, face, neck, back; opisthotonus (tetanic body spasm) - body is bent backwards and stiffened. o Management - Cogentin | acute dystonia |
| o Time of onset is from 5 – 30 days. o Features bradykinesia, mask-like facies, tremor, cogwheeling, shuffling gait, drooling, rigidity, stooped posture. o Managemant – Cogentin with or without Amantadine (symmetrel), a dopamine agonist | parkinsonism |
| Time of onset is from 5 – 60 days.Features include compulsive, restlessness with symptoms of anxiety and/or agitation. The patient may not be able to be still. Management Benzos, Clonidine, Cogentin, BB (Propranolol) can increase levels of (thioridazine) | akathisia |
| Time of onset is from months to years. Involuntary movements of the face, tongue, and/or truck and limbs. oral-facial dyskinesias. Facial grimacing, Jaw swinging. Repetitive chewing, Tongue thrusting. Choreathetoid movements of extremities. | tardive dyskinesia |
| o Quick onset - hours to days o Results from a physical disorder, drug withdrawal or induction. o Short-term memory impaired o Fluctuating LOC o Thought process fluctuates between illogical/logical | delirium |
| Slow onset – months-years. Usually a primary disorder, could be related to another illness. Short-term memory impaired initially & long-term memory is impaired slowly. Usually, no change in LOC. most are irreversible | dementia |
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