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N3381 - Exam 1 (Psych - S. Justice) Questions
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What are the 5 A's of integrating EBP into clinical practice? ask a question acquire literature appraise the literature apply the evidence assess the performance What is the weakest level of evidence? (2) opinions of authorities reports of expert committees What is the highest/strongest level of evidence? systematic review or meta-analysis of a randomized control trial (RCT) What type of drug would be prescribed for smoking cessation and why? Name of drug to be prescribed? (generic & brand name) NDRI (norepinephrine dopamine reuptake inhibitor) inhibits nicotine acetylcholine receptors & reduces addictive actions of nicotine
bupropion aka Wellbutrin Define RCT randomized control trial What is the term for a step-by-step guideline prepared in a flowchart or decision-tree format? clinical algorithm What is the term for a "map" for specified treatments to occur within a specific time frame shown to improve clinical outcome? clinical/critical pathways What are the 3 areas within the art of nursing? caring attending (intensity of presence) patient advocacy decorticate vs decerebrate decorticate: corpse like decerebrate: head and arms extended mood vs affect
How long can a temporary emergency admission for mental health care be? no longer than 15 days What are the criteria for involuntary admission? (4)
- presence of mental illness
- poses danger to self or others
- demonstrates inability to meet basic necessities (food, water, shelter)
- requires treatment but unable to seek it voluntarily due to illness How many physicians are required to certify an involuntary admission? 2 (varies state to state but generally 2) An involuntary admission is limited to _____. 60 days, then psych & legal review of admission is required What are the restraint OR seclusion time limits for the following age groups; 18+ 9- 8 or younger
18+ = 4 hours 9-17 = 2 hours 8 and under = 1 hour Define transference client views nurse as having same characteristics of another person who is significant in client's life Define countertransference nurse displaces characteristics of people in their past onto a client What are the 4 main models in mental health care?
- recovery model
- EBP model (aka medical model)
- trauma-informed care model
- patient-centered care Define recovery model (3)
- consumer & family driven
- consumers are partners
- recovery oriented Define EBP model
- uses scientific evidence to guide care
- aka medical model
- increases gap b/w research and practice
- informed consent, including refusal of tx
- respecting patients wishes even if you disagree
- protecting against threats to well-being
- being informed about best practices Define prevelance estimated population of people living with a mental illness Define incidence annual diagnosis rate of a disease (# of new cases each year) What are the 3 elements of stigma? knowledge/ignorance attitude/prejudice behavior/discrimination Term for "biologically based mental illness" psychobiological disorder (caused by a neurotransmitter dysfunction, abnormal brain structure, or genetic factors) What are the recognized psychobiological disorders? (8) schizophrenia bipolar major depression OCD & panic disorders PTSD
autism anorexia ADHD What is the leading cause of disability in the US? major depressive order Which prominent mental disorder affects twice as many women as men? major depressive disorder What prominent disorder frequently co-occurs with depressive disorders, eating disorders, and/or substance abuse? anxiety disorder About 1 in 3 cases of _________ develops into agoraphobia. panic disorder (agoraphobia = excessive fear of being in places/situations help is not available and escape may be difficult or embarrassing) When do symptoms of OCD usually first occur? childhood or adolescence What is most likely to be a precursor to developing agoraphobia? panic disorder (1 in 3 develop)
Define the "least restrictive alternative doctrine" mandates least dramatic means be taken to achieve a specific purpose What is involuntary outpatient commitment? preventative court order issued before onset of psychiatric crisis, usually tied to receipt of goods (ex: must go to outpatient psych in order to get food stamps) The Tarasoff was instrumental in establishing what? duty to warn AND duty to protect (therapist warned police but they didn't see a threat, she was murdered 2 months later) Regarding restraint and seclusion, what elements must be documented? (3)
- behavior leading to restraint
- time place in restraint
- time released from restraint How often should restrained/secluded patient be observed for physical needs, safety, or comfort? every 15-30 minutes How often should observations be charted for restrained/secluded patient? every 15-30 minutes
Duty is measured by Standard of Care What is the purpose of MSE? mental status examination to evaluate the current cognitive processes What type of data does an MSE collect? objective What MSE will evaluate patient's cognition? SLUMS (St. Louis University Mental Status) What data is collected during MSE? (8) (Poor Aunt Polly is BAT Shit Crazy) Personal information Appearance Perceptual disturbances Behavior Affect & mood Thought Speech Cognition A psychosocial assessment during MSE should include assessment of ____ (2)
- Standard 5A: coordination of care
- Standard 5B: health teaching & health promotion
- Standard 5E: pharma, biological & integrative therapies
- Standard 5F: milieu therapy
- Standard 5G: therapeutic relationship & counseling What are the advanced level interventions of a PMH-APRN? (3)
- prescriptive authority & treatment
- psychotherapy
- consultation Define SOAPIE Subjective data Objective data Assessment Planning Interventions Evaluation Psychotropic drugs target what? alterations in neurotransmitters What are the lobes of the brain and what do they do? (4) frontal: thought processes (goals, plans, actions) parietal: sensory & motor (concepts, abstraction, reading, math) temporal: auditory (language, speech, expression of emotions) occipital: visual
What brain lobe does voluntary motor ability start in? frontal lobe (thought processes, thought about voluntarily moving) Which lobe of the brain is connected to expression of emotion? temporal lobe (auditory) connects w/ limbic system which allows expressions of emotion PET (positron-emission tomography) and SPECT are tests for which disorders? (3) What do they show? shows evidence of metabolic changes in UNMEDICATED patients depression schizophrenia OCD Which neuroimaging study maps the effects of psychotropic medications? functional magnetic resonance imaging (fMRI) antipsychotics now prescribed at fraction of what they used to be due to these imaging studies Which neuroimaging study is best used on unmedicated patients?
(pg 41 Box 4-2) What is the neurotransmitter associated with schizophrenia and what is its quantity? What method is this neurotransmitter destroyed? dopamine in excess destroyed via reuptake process (monoamine oxidase) What are the monoamine neurotransmitters? (4) dopamine norepinephrine serotonin histamine What disorders are associated with a decrease in dopamine? (2) Increase? (2) monoamine decrease: parkinsons, depression increase: schizophrenia, mania
What disorders are associated with a decrease in norepinephrine? (1) Increase? (1) monoamine decrease: depression increase: anxiety states What disorders are associated with a decrease in serotonin? (1) Increase? (1) monoamine decrease: depression increase: anxiety states (note same as norepinephrine) What disorders are associated with high levels of histamines? (2) anxiety depression (note the OPPOSITE of dopamine, serotonin, & norepi) What are the amino acid neurotransmitters? (2) GABA (gamma-amino butyric acid) glutamate
decrease: alzheimers, huntingtons, parkinsons increase: depression What are the peptide neurotransmitters? (3) aka neuromodulators substance P somatostatin neurotensin What is the role of substance P? (2) What type of neurotransmitter is it? peptide - neuromodulator regulation of mood & anxiety role in pain management What disorders are associated with a decrease in somatostatin? (1) Increase? (1) peptide - neuromodulator decrease: alzheimers increase: huntingtons Describe the role of neurotensin with schizophrenia peptide - neuromodulator
decreased levels of spinal fluid in patients w/ schizo Monoamines are divided into what 2 subgroups? What neurotransmitters belong in which group? catecholamines : norepi, epi, dopamine idolamines : serotonin What is the role of MAOIs? monoamine oxidase inhibitors inhibit the destruction of monoamines by MAO (leaves more monoamines for neurotransmission via reuptake) Examples of MAOIs (3) list both generic and brand names phenelzine/Nardil tranylcypromine/Parnate selegiline/EMSAM (transdermal route) What is a significant risk factor for patients taking MAOIs? Where is it frequently found? (6) hypertensive crisis if ingest tyramine found in: OTC, beer, wine, aged cheeses, organ meats, avocados Dietary restrictions for _____ must be maintained for ____ weeks after stopping ______ due to risk of hypertensive crisis.
