Mental health exam 2

What are the five phases of the assault cycle?

• Triggering

• Escalation

• Crisis

• Recovery

• Post-crisis Depression

What is the triggering phase?

The first phase of the assault cycle in which a stressful event or trigger causes increasing anxiety. The patient is still able to regain control if appropriate interventions occur early.

What behaviors may be seen during the triggering phase?

• Anxiety

• Restlessness

• Irritability

• Pacing

• Muscle tension

• Clenched fists

• Raised voice

• Frustration

What is the nurse's priority during the triggering phase?

Prevent escalation by:

• Using therapeutic communication

• Remaining calm

• Identifying the trigger

• Encouraging the patient to verbalize feelings

• Offering coping strategies or PRN medication if prescribed

• Reducing environmental stimulation

What is the escalation phase?

The patient begins losing emotional control, and behaviors become increasingly threatening. At this point, de-escalation techniques are essential to prevent progression to violence.

What behaviors are seen during the escalation phase?

• Loud voice

• Swearing

• Threatening statements

• Intense pacing

• Demanding behavior

• Refusal to cooperate

• Invading personal space

What are the nursing interventions during the escalation phase?

• Stay calm.

• Speak in a low, clear voice.

• Set clear, consistent limits.

• Offer choices when possible.

• Reduce stimulation.

• Maintain a safe distance.

• Have additional staff available if needed.

• Avoid arguing or threatening the patient.

What is the crisis phase?

The patient has completely lost control and may become physically aggressive or violent, creating an immediate safety risk.

What behaviors occur during the crisis phase?

• Physical aggression

• Throwing objects

• Hitting or kicking

• Destroying property

• Attempting to harm self or others

What is the nurse's priority during the crisis phase?

Safety.

• Protect the patient and others.

• Call for assistance.

• Use emergency medications if ordered.

• Use seclusion or restraints only when less restrictive interventions have failed and the patient poses an immediate danger.

What is the recovery phase?

The patient begins regaining self-control. Emotional and physical tension gradually decrease, and behavior becomes less threatening.

What nursing interventions are appropriate during the recovery phase?

• Continue to monitor the patient.

• Offer food or fluids if appropriate.

• Allow time for rest.

• Maintain a calm environment.

• Avoid immediately discussing the incident in detail.

What is the post-crisis depression phase?

The patient may experience:

• Guilt

• Shame

• Embarrassment

• Fatigue

• Depression

• Remorse after losing control

What are the nurse's responsibilities during the post-crisis depression phase?

• Debrief the incident.

• Help the patient identify triggers.

• Discuss more effective coping strategies.

• Revise the care plan if needed.

• Reinforce successful coping skills for future situations.

What is the overall nursing goal throughout the assault cycle?

To recognize early warning signs, intervene before the patient reaches the crisis phase, maintain safety, and help the patient develop healthier coping strategies to prevent future aggressive behavior.

During which phase of the assault cycle is intervention most effective?

Triggering phase. Early intervention using therapeutic communication and de-escalation techniques can often prevent progression to the escalation and crisis phases.

When should seclusion or restraints be used during the assault cycle?

Only during the crisis phase, and only when the patient presents an immediate danger to self or others after less restrictive interventions have been unsuccessful.

What drug is considered first-line for pediatric depression?

Fluoxetine (Prozac) is the first-line SSRI commonly used for pediatric major depressive disorder and is FDA approved for children 8 years and older.

At what age is Prozac (fluoxetine) FDA approved for Obsessive-Compulsive Disorder (OCD)?

7 years and older.

What are the three core symptoms of ADHD?

• Inattention

• Hyperactivity

• Impulsivity

What are common symptoms of inattention in ADHD?

• Difficulty sustaining attention

• Easily distracted

• Frequently loses things

• Forgetful in daily activities

• Difficulty organizing tasks

• Does not seem to listen when spoken to directly

• Often fails to finish schoolwork or chores

What diagnostic criteria must be met for ADHD?

• Symptoms begin before age 12

• Symptoms are present in two or more settings (such as home and school)

• Symptoms interfere with social, academic, or occupational functioning

• Symptoms are not better explained by another disorder

What are the three stages of recovery from violence and trauma?

• Impact

• Recoil

• Reorganization

What occurs during the Impact stage of recovery?

Impact Stage (minutes to days):

• Shock

• Denial

• Disbelief

• Confusion

• Fear

• Horror

• Anger

• Shame

• Helplessness and vulnerability

• Sleep and eating disturbances

• May experience severe anxiety, intrusive memories, or dissociation

What are the nursing interventions during the Impact stage?

• Provide crisis intervention

• Ensure physical safety and emotional security

• Give simple directions

• Avoid blaming or accusing the survivor

• Provide crisis hotline numbers and appropriate referrals

What occurs during the Recoil stage of recovery?

Recoil Stage (weeks to months):

• Attempts to adapt to the trauma

• Periods of acting "normal"

• Begins talking about the trauma and emotions

• Needs support and temporary dependence

• Gradually realizes the full impact of the trauma

What are the nursing interventions during the Recoil stage?

• Encourage support groups

• Provide short-term counseling

• Validate the survivor's experiences

• Reinforce the survivor's rights

• Refer to appropriate therapy and victim support services

What occurs during the Reorganization stage of recovery?

Reorganization Stage (months to years):

• Anxiety, fear, and anger gradually decrease

• Reviews and organizes what happened

• Regains a sense of control and self-protection

• Grief begins to resolve

• If recovery does not occur, symptoms may persist as PTSD

What are the nursing interventions during the Reorganization stage?

• Provide long-term counseling if needed

• Assess for PTSD, anxiety, or depression

• Continue emotional support

• Encourage development of healthy coping strategies and resilience

During which stage of recovery does the survivor begin talking about the trauma and expressing feelings?

Recoil Stage. During this stage, survivors begin processing the event, discussing their emotions, and recognizing the full impact of the trauma.

What are common assessment cues that may indicate partner abuse?

• Repeated vague physical complaints

• Unexplained injuries

• Injuries with unlikely explanations

• Multiple bruises in different stages of healing

• Fearful or anxious behavior

• Isolation from family and friends

• Low self-esteem

• Depression or anxiety

• Substance abuse

• Suicidal thoughts or attempts

What vague physical symptoms may be clues to partner abuse?

• Back pain

• Abdominal pain

• Indigestion

• Headaches

• Hyperventilation

• Anxiety

• Insomnia

• Fatigue

• Anorexia

• Heart palpitations

What injury patterns should make the nurse suspect abuse?

• Injuries with inconsistent explanations

• Hidden injuries under clothing

• Head, neck, or genital injuries

• Burns

• Scars

• Multiple fractures

• Bruises in different stages of healing

• Injuries with recognizable patterns (belt, cigarette, teeth, ring, gun, knife, fingertips)

What behavioral cues may indicate partner abuse?

• Flinches or startles around partner

• Appears fearful

• Tries to prevent partner from becoming angry

• Denies problems in the relationship

• Makes excuses for the partner's behavior

• Constantly justifies the partner's actions

• Appears isolated from family and friends

What emotional cues may indicate abuse?

• Guilt

• Depression

• Anxiety

• Low self-esteem

• Feelings of failure

• Concealed anger

• Fear of the abuser

What should the nurse do if partner abuse is suspected?

• Interview the patient privately

• Recognize assessment clues

• Convey that help is available

• Reassure the survivor that the abuse is not their fault

• Acknowledge fears and ambivalence

• Do not rush or pressure the survivor to leave the relationship

What nursing interventions are recommended for a patient experiencing partner abuse?

• Assess immediate safety.

• Recommend a shelter or safe house if danger is present.

• Encourage medical evaluation for injuries.

• Teach that no one deserves abuse.

• Explain the cycle of violence.

• Provide emergency phone numbers.

• Help develop an emergency escape plan.

• Inform the patient about legal protections and protective orders.

How should the nurse communicate with a survivor of partner abuse?

• Convey that the survivor is not alone.

• Reinforce that they have worth and dignity.

• Acknowledge fears and mixed feelings about leaving.

• Do not pressure the survivor to leave.

• Build self-esteem, confidence, independence, and hope.

What is the USP Seal of Verification?

The USP (United States Pharmacopeia) Verified Seal indicates that a dietary supplement has been independently tested for quality, purity, strength, and manufacturing standards.

It helps ensure the product contains what the label says it contains.

What does the USP Verified Seal mean?

A supplement with the USP seal:

• Contains the listed ingredients in the stated amounts.

• Has been tested for harmful contaminants.

• Meets quality manufacturing standards.

• Dissolves properly so the body can absorb it.

Who are considered victims of terrorism?

• People who are injured or killed

• Police, fire, and rescue personnel

• Businesses and employees

• Family and friends of victims

• Anyone who witnessed the event directly or through the media

What are common emotional effects of terrorism?

• Shock

• Disbelief

• Fear

• Anxiety

• Powerlessness

• Panic

• Anger

• Rage

• Helplessness

• Hopelessness

• Depression

• PTSD

• Nightmares and flashbacks

• Hyperarousal

• Withdrawal and isolation

What is the major goal of recovery after terrorism?

To regain a sense of trust, safety, and security while acknowledging that future terrorist attacks are possible.

What helps most survivors recover after a terrorist event?

Most survivors recover with:

• Support from loved ones, coworkers, and friends

• Memorial or religious services

• Community meetings

• Sleep

• Stress-management and relaxation techniques

• Physical activity

• Returning to normal daily activities

What should the nurse teach about recovery after terrorism?

• Recovery may take longer than expected.

• The severity and duration of the trauma affect recovery.

• Long-term counseling may be needed for PTSD, anxiety, depression, or other post-traumatic symptoms.

How have communities prepared for future terrorist attacks?

Most cities have developed coordinated disaster response plans involving:

• Police

• Fire departments

• Rescue agencies

• Hospitals

• Mental health services

• Local, state, and federal emergency management agencies

What are common childhood manifestations of childhood sexual abuse?

• Disturbed growth and development

• Early protector/caretaker role at own expense

• Ambivalence and denial of the abuse

• Sleep disturbances

• Eating disturbances

• Enuresis (bedwetting)

• Anxiety and depression

• Aggression

What behavioral manifestations of childhood sexual abuse may be seen in children?

• Sexualized play

• Sexual aggression

• Poor impulse control

• Somatization (physical complaints without a medical cause)

• Running away

• Truancy

What emotional manifestations are common in children who have experienced sexual abuse?

• Fear

• Shame

• Self-blame

• Anxiety

• Depression

• Self-destructive behaviors

What are common adolescent manifestations of childhood sexual abuse?

• Overt dysfunctional coping

• Impulsive acting out

• Self-destructive behaviors

• Self-mutilation

• Suicide attempts

• Sleep disorders

• Eating disorders

• Substance abuse

• Running away

• Truancy

• Delinquency

• Prostitution

• Early marriage

What are common adult manifestations of childhood sexual abuse?

• Memory disturbances

• Anxiety

• Relationship problems

• Addiction

• Body (somatic) symptoms

• Detachment

• Need for control

• Self-punishment

• Anger

• Sexual identity concerns

A teenager has a history of childhood sexual abuse. Which behaviors should the nurse recognize as possible manifestations?

• Self-mutilation

• Suicide attempts

• Substance abuse

• Running away

• Delinquency

• Eating disorders

• Sleep disturbances

These are classic adolescent manifestations of childhood sexual abuse.

What are the four essential questions the nurse should ask when assessing suicide risk?

• Suicidal thoughts (ideation)

• Suicidal intent

• Plan

• Lethality/accessibility of the plan

What are examples of direct suicide assessment questions?

• "Have you had thoughts of hurting yourself?"

• "Have you thought about ending your life?"

• "Do you have a plan?"

• "How would you do it?"

• "Do you have access to that method?"

What factors increase the likelihood that a suicide attempt will be completed?

• More severe depression

• Greater hopelessness

• A detailed plan

• A highly lethal method

• Easy access to the method

When should suicide assessments be performed?

• On admission

• When precautions or privilege levels change

• With changes in mental status

• After medication or treatment changes

• Prior to discharge

What are major risk factors for suicide?

• Previous suicide attempt (strongest predictor)

• History of childhood trauma or abuse

• Alcohol or drug abuse

• Family history of suicide

• Social isolation

• Recent loss or bereavement

• Serious illness or chronic pain

• Access to lethal means

• Recent psychiatric hospitalization

What warning signs or cues should the nurse look for in a suicidal patient?

• Hopelessness

• Severe depression

• Withdrawal or isolation

• Giving away possessions

• Talking about death or wanting to die

• Sudden behavioral changes

• Increased substance use

• Previous suicide attempts

• Self-harm behaviors

What are the major risk factors for human trafficking?

• Poverty

• Young age

• Limited education

• Homelessness

• Lack of family support

• History of physical, emotional, or sexual abuse

• Living in a high-crime area

• Family violence

Women and children are especially vulnerable.

What tactics do traffickers use to recruit and control victims?

Traffickers may use:

• Promises of money

• Promises of a "better life"

• Deception

• Threats

• Coercion

• Force

• Kidnapping

What assessment findings may make the nurse suspect human trafficking?

Look for:

• Fearful or anxious behavior

• Signs of physical, emotional, or sexual abuse

• PTSD symptoms

• Substance abuse

• Poor hygiene or unmet basic needs

• Difficulty trusting others

• A patient who appears controlled, intimidated, or unable to speak freely about their situation