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Nurs 334 Exam 2

A term for psychological and physical stimuli that interfere with normal functions and require adaptive behaviors? Stressors
Name 3 effects of stress on the body? Neurotransmitter changes, immune response, sympathetic nervous system response.
What are nursing interventions for Stress? Id the stressor, how the pt has coped with the stress in the past, insure safety and physical stability, monitor physical symptoms (HR, BP, BG, and immune response)
What 4 aspects of a patient's life demonstrate coping skills? Health sustaining habits (diet); Life satisfaction (job); Social support (family); effective responses and healthy responses to stress
Term for a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is known or unknown? Anxiety
What are the four levels of anxiety? Mild: heightened sense of awareness Moderate: may have difficulty concentrating Severe: perceptual field is greatly reduced Panic: the most extreme level; can’t process situation and losses touch with reality
What are 4 anxiety disorders? Panic disorders, Phobias, OCD, and Generalized Anxiety Disorder (pg 138)
Condition know for a sudden onset of extreme apprehension or fear; usually associated with feelings of impending doom. Panic Disorder
Condition know for an intense and excessive anxiety about being in places or situations from which escape might be difficult or embarrassing such as outside, home alone, or traveling in a car/bus/plane. Agoraphobia
Condition know for a persistent, irrational fear of a specific object, activity, or situation that leads to a desire to avoid or actual avoidance Phobias
Condition with two parts: 1: thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. 2: ritualistic behaviors that an individual feels driven to perform in an attempt to reduce anxiety. Obsessive-Compulsive Disorder
Condition with excessive worry/anxiety about many things that last for 6 months or more. Generalized Anxiety Disorder
Type of medication that is commonly used only for Generalized Anxiety Disorder? BuSpar
Condition in which repeated re-experiencing of a highly traumatic event that involved actual or threatened death or serious injury to self or others (symptoms 1st 3 months usually) Post-traumatic stress disorder
Condition which occurs within 1 month of a traumatic event, pt must display 3 or more dissociative symptoms; resolves within 4 weeks. (Cristina after plane crash) Acute Stress Disorder
Which emotion is more eroding: fear or anxiety? Anxiety: it can impact self-worth, self-esteem, and stability.
Which neurotransmitters regulate signals for anxiety? Epinephrine, Norepinephrine, dopamine, serotonin, and GABA
A pt is screaming and running amok and seems to be having hallucinations. Which level of anxiety is the pt experiencing? Panic, make sure the pt doesn't get exhausted or hurt.
What prompts defense mechanisms? anxiety
T/F: defense mechanisms always lead to negative coping skills? False: DM can be healthy and help protect people from feelings and memories that can provoke overwhelming anxiety.
Name that defense mechanism: conscious denial of a disturbing situation or feeling? Suppresion
Name that defense mechanism: attributes faults to others, scapegoating? Projection
Name that defense mechanism: return to an earlier, comforting and less mature way of behaving when disappointed? Regression
Name that defense mechanism: transforming anxiety on an unconscious level into a physical symptom that has no organic cause? Somatization
Type of anxiety related to a direct physiological result of a medical condition such as hyperthyrodism, PE, or cardiac dysruthmias? Anxiety due to a medical problem
How should a nurse assess anxiety? Use Maslow to guide assessment, look for a physical cause of the anxiety, keep the pt safe, reduce panic, help pt explore cause of anxiety
What tool can be used to screen for anxiety? Hamilton Rating Scale
What are some nursing interventions for anxiety? ID cause of anxiety, how pt has coped before, anticipate anxiety provoking situations, encourage pt share feelings, focus on pt concerns, explore measures for anxiety relief, etc.
Common medications for anxiety? • Antidepressants: SSRIs, MAOIs, SNRIs • Anxiolyic: Benzodiazepines, Buspar, Beta-blockers, TCAs
What is the 1st line of drug tx for anxiety? SSRIs
Term for a tendency to experience and report bodily symptoms that have no physical explanation. Somatoform Disorders
What are some assessments a nurse may make about a pt with somatoform disorders? pt is dramatic about symptoms (thinks a HA means a brain tumor), pt can't see relationship between sypmtoms and interpersonal conflict, secondary gains, dependence on meds, difficulty communicating emotions
Term for a pt who is consciously pretending to be ill to get emotional needs met and attain the status of "patient" Factitious disorder
Name for the most severe type of factious disorder where the patient intentionally harms self to gain medical attention? Munchausen syndrome
A conscious process of intentionally producing symptoms for the goal of material gains? May complain of back pain to get disability. Malingering
Condition where a person in stressful situation experiences some type of memory loss about themselves or their surroundings. Dissociative Disorders
What are the 4 types of dissociative disorders? Depersonalization disorder, Dissociative amnesia, Dissociative fugue, Dissociative identity disorder
What should a nurse assess in a pt with a dissociative disorder? Memory, mood, use of drugs/ETOH, impact on family, suicide risk
Interventions for Dissociative Disorders? Milieu management, health teaching about illness and coping, antidepressents or anxiolytic drugs for co-morbid conditions.
Sudden, unexpected travel away from home or one's place of work with inability to remember the past. May be confused about identity or assume a new identity. Dissociative Fugue
Existance of 2 or more distinct subpersonalities, each with its own patterns of relating, perceiving, and thinking. Dissociative Identity Disorder
Persistant or recurrent experience of feeling detached from and outside of one's mental processes or body? Depersonilization Disorder
One or more episodes of inability to recall important information-- usually of a traumatic or stressful nature? Dissociative Amnesia
What is the most common psychiatric disorder? Major Depressive Disorder
Name that disorder: represents a change in previous functions and causes social or occupational impairment, must have 5 or more symptoms of: depressed mood, anhedonia, sig. weight loss, insomnia/hypersomnia, ↓ or ↑ motor activity, anergia, ect... major depressive disorder
Name that condition: occurs over a 2 yr period (1 yr for young), depressed mood, s/s cause distress in social & occupational function, and pt has 2 or more s/s: ↓ or ↑ appetite, insomnia/hypersomnia, fatigue, ↓ self-esteem, poor concentration, dispair Dysthymia
What are traits of psychotic depression? breaks with reality (Hallucinations, delusions)
What are traits of catatonic depression? Peculiar voluntary movement, echopraxia or echolalia, and negativism
What are traits of melancholic depression? anorexia/weight loss, diurnal varitations with symptoms worse in the morning, early morning waking.
What are traits of postpartum depression? Within 4 weeks of delivery symptoms begin such as severe anxiety and possible psychotic features
What are traits or seasonal affective disorder or SAD? Depression occurs in fall or winter and remits in the spring.
What are traits of atypical depression? Appetite changes or weight gain, hypersomnia, extreme sensitivity to perceived interpersonal rejection, leaden paralysis, and high levels of anxiety.
Which depressive disorder carries a high risk for suicide? Recurrent brief depression: symptoms last 1 day to 1 week but reoccurs at least once a month for a year or more.
Which is a more severe illness: Major depressive disorder or Dysthymia disorder? DD is much less severe than MDD (pg 220)
T/F: Dysthymic disorder has a late onset with symptoms beginning when someone is in their 40's. False: DD has an early and insidious onset
Define anhedonia? A lack of enjoyment in life: it is a key symptom of depression.
What are some common feeling of someone with depression? Feeling worthless, guilt, helplessness, and anger or irritablity.
What are the 3 phases in treatment for depression? Acute: 6-12 weeks to reduce s/s and restore social and work function. Continuation: 4 - 9 months to prevent relapse. Maintenance: 1 yr or more to prevent further episodes.
What is the 1st priority in planning care for a patient with depression? safety
T/F: exercise is an effect form of treatment for depression? True: it ↑ serotonin and self-perception
A condition that presents with episodes of severe mania to severe depression with periods of normal moods between? Bipolar Disorder
Define Cyclothymia: Hypomania alternating with mild depression lasting at least 2 years
What is the common age of onset of someone with Bipolar Disorder? 20 years old, usually starts as a depressive episode
How is cognitive functioning affected in bipolar disorder? Cognitive impairment is a core feature of bipolar. Cognitive deficits correlate with the # of manic episodes.
What are symptoms of serotonin syndrome? abdominal pain, diarrhea, sweating, fever, tachycardia, ↑ BP, delirium, muscle spasms, ↑ motor activity, irritability, hostility, and mood change. Severe: ↑ fever, cardio shock, death.
What are common treatments for major depression disorder? Medication, electroconvulsion therapy, vagus nerve stimulation, light therapy, exercise, St. John's Wort, & Transcranial magnetic stimulation.
What are common s/s seen in Bipolar disorder? ↑ self-esteem/grandiosity, ↓ need for sleep, talkative, flighty ideas/racing thoughts, distracted, ↑ in goal-directed activity, risky pleasurable activity participation.
What is an emergent situation in a person with bipolar experiencing mania? Nonstop physical activity and lack of sleep and food can lead to exhaustion and even death if not treated.
What are clang associations? The stringing together of words because of their rhyming sound without regard to their meaning. Think nicki minaj.
What is the #1 goal during the acute phase (acute mania) of bipolar? To prevent injury: keep hydrated, monitor cardiac status, tissue integrity (no cutting), and get enough sleep.
What type of medications may be used for bipolar? Mood stabilizers most common (lithium or olanzapine) but may add antidepressants, anti-anxiety, and anti-psychotics.
What may Divalproex (Depakote) be used to treat? Bipolar pt's who don't respond to lithium who are in acute mania.
Term for intense feelings of pain and hopelessness coupled with the belief that there is not a solution. Suicidal ideation
What age group is at greatest risk for suicide? Elderly over 65 years
What is the 1st thing a nurse does during a suicide assessment? Establish a therapeutic relationship
What are some strategies & questions for suicidal assessment? Normalize, Challenge, Chronologize, Overestimate, Prohibit, Delve, Eulogize, and get Corroboration from others.
What number on a SAD PERSONS scale indicates major risk needing hospitalization? 7 - 10
What does SAD PERSONS stand for? Sex, Age, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness
When is it time to admit someone considering suicide? A specific plan, with lethal means and access to the method is considered high risk and should be hospitalized.
What are the 4 stages of Schizophrenia? Prodromal (withdrawal), Acute (delusions), Maintenance (getting tx), Stabilization
What are the 5 types of schizophrenia? paranoid, catatonic, disorganized, undifferentiated, and residual
What are common positive symptoms of schizophrenia (florid psychotic symptoms)? Hallucinations, delusions, impaired abstract thought, associative looseness (thinking illogical, personal boundary issues, bizarre behaviors
What are common negative symptoms of schizophrenia? Changes in affect (flat affect), apathy, anhedonia, poor social functioning, poverty of thought.
What are common drugs used to treat schizophrenia? Antipsycotics: either 1st (conventional) or 2nd generation (atypical)
What are major side-effects of conventional or 1st generation antipsychotics? Extrapyramidal symptoms, Neuroleptic malignant syndrome (dopamine blockage), and agranulocytosis.
Somatoform Disorder with one or two neurological complaints? Ex: a woman developing tingling in her hands w/o ability to move them after her husband decides to divorce her and she will have to go back to work. Conversion Disorder
A Somatoform Disorder with many physical complaints affecting many organs. Ex: nurse isn't sure which illness pt came in for since there are so many. Somatization disorder
A Somatoform Disorder characterized less by a focus on symptoms than by the pt's beliefs that they have a specific disease. Ex: man obsessed with resting his liver because he believes he has liver cancer even though 6 doctors have told him he is fine. Hypochondriasis
A Somatoform Disorder with symptoms of pain that are either solely related to or significantly exacerbated by psychosocial factors. Ex: man pulls his back after wife tells him she wants to go back to school. Pain disorder
A Somatoform Disorder with a false belief or exaggerated perception that a body part is defective. Body dysmorphic disorder
Term for an enduring pattern of behavior that is both conscious and unconscious and reflects a means of adapting to a particular environment and its cultural, ethnic, and community standards Personality
What 4 common characteristics do people with personality disorders share? Inflexible and maladaptive responses to stress, disability in working & loving, tendency to evoke intense interpersonal conflict, capacity to "get under the skin" of others.
Personality disorder characterized by a belief that others are lying, cheating, exploiting, or trying to harm them; perception of hidden malicious meaning in benign comments; inability to work with others, emotionally detached, and hostile to others. Paranoid Personality Disorder
Personality disorder characterized by no desire to have human relationships, fixation on personal thoughts/fantasizes, emotional coldness/detachment, indifferent to praise or criticism, choose solitary activities. Schizoid Personality Disorders
Personality disorder characterized by behavior or appearance that is odd, eccentric, or peculiar; odd elaborate style of dressing, speaking, and interacting; magical thinking; unusual perceptual experiences; unhappy with lack of friends. Schizotypal Personality Disorder
Personality disorder characterized by chronic irresponsibility and unreliability, lack of regard for the law and others, persistent lying and stealing, conning others for gain, no remorse for hurting others, believes other people should follow the rules. Antisocial Personality Disorder
Personality disorder with difficulty controlling emotions, stormy relationships w/ intense anger, identity disturbance, frantic to avoid abandonment, frequent changes in mood/opinions/plans, chronic emptiness, impulsiveness, and harm to self. Borderline Personality Disorder
Personality disorder exhibiting attention grabbing w/ self-dramatization, sexual clothing and behavior, excessive concern w/ appearance, seek other's approval, false sense of intimacy, sudden emotion shifts, talk to impress w/ lack of detail. Histrionic Personality Disorder
Personality disorder with an inflated sense of importance or achievements, constant attention seeking, manipulate others for gain, no regard for others, arrogant/haughty, expect special tx, envious of others and belief others envy them. Narcissistic Personality Disorder
Personality disorder with hypersensitivity to criticism/rejection, self-imposed social isolation, obsessed with being criticized, wants close relationships but shies away from them, avoids interpersonal contact, view selfs as social inept or inferior. Avoidant Personality Disorder
Personality Dis with a preoccupation for details/rules/lists/order; perfection interfere with completion of task; not able to share responsibility w/ others, devotes time to work instead of fun/friendships; financial stinginess, keeps broken objects Obsessive-Compulsive Disorder
Personality Disorder with the fear of disagreeing with others may lead to a loss of approval, preoccupied with fear of being left alone; exaggerated fear of not being able to care for self. Dependent Personality Disorder
What axis is a personality disorder found on? Axis II
What are common Axis I diagnosises? Depression, substance abuse,somatozation, eating disorders, PTSD, and anxiety disorders.
What are common defenses some with a personality disorder may use? Splitting, dissociation, psychotic denial, primitive idealization, ommipotence/devaluation, projective identification
Eating disorder where pt engages in self-starvation, express intense fear of gaining weight, and have disturbance in self-evaluation or weight and its importance? Anorexia Nervosa
Eating disorder where pt engages in repeated episodes of binge eating followed by inappropriate compensatory behaviors such as self-induces vomiting; misuse of laxatives, diuretics; fasting, or excessive exercise. Bulimia Nervosa
What does EDNOS mean? Eating disorders not otherwise specified: it is a category that includes someone who doesn't meet all the criteria for anorexia or bulimia.
What is binge eating disorder? A type of EDNOS where a person will binge eat when distress but doesn't use techniques like vomiting or exercise to compensate.
When is a pt admitted to the hospital for anorexia? weight loss > 30% over 6 months, inability to gain weight w/ outpt tx, severe hypothermia <96.8 F, HR < 40 bpm, systolic BP < 70, hypokalemia, and ECG changes like dysrythmias.
What is the 1st priority for tx with bulimia? Stabilization with electrolytes and cardiac function.
What co-morbidity is often present with binge-eaters? Depression; also bipolar and personality disorders.
What does dependence or addiction mean? A tolerance to the drug occurs and the person has to take more and more of the drug to "stay normal" or prevent withdrawal.
What are the 3 Cs of addiction? Craving to Compulsive, Continued use despite adverse consequences, loss of Control
What is the most common substance problem in the US? Alcohol abuse and dependence
What is the difference between tolerance and withdrawal? Tolerance means needing a greater amount of drug to get desired effect. Withdrawal means physical and psychological symptoms present when reducing or stopping the drug.
What are some s/s of alcohol withdrawal? 2+ s/s: N/V, anxiety, hallucinations, autonomic hyperactivity (sweating, pulse > 100), psychomotor agitation, insomnia, grand mal seizures, increased hand tremor.
What are s/s of substance-induced delirium? Impaired consciousness, Changes in cognition (memory, language, illusions, hallucinations), develops over hours to days and fluctuates over a day, symptoms develop during withdrawal
How long does it take for alcohol delirium to begin after the last drink? Will peak within 48-72 hours and last 2-3 days.
What drugs are commonly used to tx alcohol withdrawal? Benzodiazepines (sedative), magnesium sulfate or thiamine (seizure control), beta blockers/ alpha blockers/folic acid/multivitamin (alleviation of autonomic nervous system)
What are common personality traits that can be risk factors for someone to commit suicide? Poor problem solvers, troubled emotional lives, low emotional pain threshold, impulsive, engage in extreme solutions. Acute risk factors may also include: anxiety, insomnia, and substance abuse.
What are risk factors that should be assessed for in someone contemplating suicide? Presence of a plan, previous attempt, history of mental disorder or substance abuse, impulsive or aggressive tendencies, adverse life events--loss, hopelessness, isolation, family history of above listed events including physical & sexual abuse, etc.
What are common risk factors for youth committing suicide? Substance abuse, aggression, disruptive behaviors, depression, and social isolation. Some lesser factors are: frequent running away, family loss or instability, frequent problems w/parents, withdrawal from family/friends, sexual orien, unplanned preg.
Which age group is at highest risk of suicide in the nation? 65 years and older--many times they have visited their Dr within the month and even day of suicide.
Which gender is more likely to complete a suicide? Men, although women attempt 3xs more often, men are more successful.
What is the difference between an overt and covert suicidal statement. Overt are blatant declarations a person can't go on living such as "I wish I were dead." Covert are statement with suicidal undertones such as "I won't be a problem much longer."
What are 3 important questions to ask regarding the lethality of the suicide plan? How detailed is the plan? How lethal is the proposed method? Availability of means?
What are 4 important ideas to convey to a suicidal patient? The crisis is temporary. Unbearable pain can be survived. Help is available. You are not alone.
What does the term postvention mean? Intervention for the family and friends of someone who has completed suicide. It is used to help lessen guilt, anger, grief, pain and other difficult emotions.
What characteristics does a resilient child have? A temperament that can adapt to environmental changes, ability to form a nurturing relationship with other adults when parent isn't available, able to distance self from emotional chaos of parent/family, social intelligence, and ability to problem-solve.
What is the most common developmental disorder? Mental retardation: supposedly affects 1% of the population (I'm guessing that's some serious under-reporting)
A child exhibits impaired social interaction, impaired communication and imagination, and Preoccupation with repetitive activities with rigid adherence to routines and rituals. What diagnosis may the Dr. make? Autism Spectrum Disorder; also referred to as Pervasive Developmental Disorders
What differences are noted in Asperger’s Syndrome compared to Autism? Differs from Autism in that it has a later onset with no significant delay in developmental/cognitive skills. S/S-repetitive behaviors, problems modulating social relationships, and idiosyncratic interests. Often withdrawn and suffer social isolation
Disorder characterized by an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention Deficit Hyperactivity Disorder
A child exhibits careless mistakes in school work, does not seem to listen when spoken to directly, does not follow through on instructions, has difficulty organizing tasks, is easily distracted, & is often forgetful. What dx should the nurse expect? Attention Deficit Hyperactivity Disorder
What are examples of impulsivity in ADHD? Blurting out answers, difficulty waiting for turn, and interrupts others conversations.
A disorder described as a persistant pattern of behavior in which the rights of others and are-appropriate societal rules are violated. Maybe exhibit aggression toward animals & people, destruction of property, deceitfulness or theft, & rule violation. Conduct disorder
Disorder characterized by a recurrent pattern of negativistic, disobedient, hostile, and defiant behavior toward authority figures without seriously violating the basic rights of others. May only exhibit these behaviors in the home. Oppositional Defiant Disorder
T/F: a child with ODD feels like others are unreasonable and their behavior is not defiant in nature. True: the behaviors such as stubbornness, argumentativeness, testing the limits, and refusal to accept responsibility for their misdeeds are seen by the child as being subjected to unfair treatment by others. (May your children never have this)
A disorder marked by verbal and motor tics that may appear as early as age 2 but on average begin at age 7. Tourette's disorder
What are the two co-morbidities often present with Tourette's syndrome? ADHD and OCD
What is Bibliotherapy? Using child or adolescent literature to help the child express feelings in a supportive environment. Children identify with characters in books which helps them deal with difficult situations.
Define temperament? The style of behavior a child habitually uses to cope with the demands and expectations of the environment.
How common are anxiety disorders in children? Anxiety disorders are the most prevalent of all disorders in children and adolescence. They affect about 10% of all children.
A disorder characterized by excessive distress when separated from a parent or home, excessive worry someone will be lost or kidnapped, fear of being home alone, refusal to sleep away from home, refusal to go to school or elsewhere w/o parent, etc. Separation Anxiety
How is behavioral therapy – operant conditioning used to help children? “Good” behavior is rewarded, Point system is used, least restrictive interventions are applied
How is limit setting used to help children? Use clear, sharp statements about prohibited behavior; Offer guidance for performing a behavior that is expected. Limit setting will also protect other patients from the teen’s thoughtless or aggressive behavior.
Created by: ewooda05