EXAM 1 Mental Health

What is the definition of resilience in mental health?

The ability to adapt and recover from adversity, trauma, and significant stress.

What core shift in patient care distinguishes the Mental Health Recovery Model from traditional medical models?

It shifts primary responsibility and control of care from the healthcare provider to the patient, emphasizing empowerment and partnership.

Which neurotransmitter functions as the primary inhibitory neurotransmitter in the brain?

GABA (Gamma-Aminobutyric Acid)

A decrease in which neurotransmitter is primarily implicated in anxiety disorders?

GABA

Which neurotransmitter is responsible for regulation of mood, sleep, and appetite, and is decreased in depression?

Serotonin

Which neurotransmitter involved in motivation, pleasure, and movement becomes dysregulated in addiction and schizophrenia?

Dopamine

Which major excitatory neurotransmitter can lead to neurotoxicity when present in excess?

Glutamate

A deficit in which neurotransmitter is characteristically seen in Alzheimer's disease?

Acetylcholine

What is the sequence of steps in chemical synaptic transmission? (there are 5)

1 Synthesis in presynaptic neuron

2 Storage in vesicles

3 Release into synaptic cleft

4 Binding to post-synaptic receptors

5 Degradation or reuptake

Which anatomical system in the brain serves as the principal emotional center involved in anxiety responses?

The Limbic System

What hormone sequence is activated along the HPA-axis during a stress response?

Hypothalamus releases CRH → Pituitary releases ACTH → Adrenals release Cortisol.

What are three negative systemic consequences of prolonged, elevated cortisol levels from chronic stress?

Impaired memory, suppressed immune function, and disrupted mood regulation.

By what pharmacological mechanism do benzodiazepines like alprazolam reduce anxiety?

By enhancing GABA receptor activity, increasing central nervous system inhibition.

Why are benzodiazepines restricted to short-term clinical management of anxiety?

Because tolerance, physical dependence, and addiction risk develop over time.

Combining benzodiazepines with which substance creates the greatest risk for lethal respiratory depression?

Alcohol

Why are Selective Serotonin Reuptake Inhibitors (SSRIs) preferred over benzodiazepines for long-term Generalized Anxiety Disorder (GAD) treatment?

They do not cause tolerance or addiction and effectively maintain elevated serotonin availability long-term.

how many weeks do SSRIs require to demonstrate full therapeutic effect?

2-4 weeks

What primary feature distinguishes pathological anxiety from normal anxiety?

Pathological anxiety lasts significantly longer, is disproportionate to the actual threat, and generalizes to nonthreatening situations.

What foundational premise underlies Cognitive Behavioral Therapy (CBT)?

Individual thoughts and cognitive appraisal dictate emotional and behavioral responses. NOT external events themselves

What is cognitive restructuring?

A CBT technique that teaches patients to identify, challenge, and modify irrational thoughts or cognitive distortions.

what is Personalization?

The cognitive distortion where an individual assumes personal responsibility for external events outside their control.

How does Freud's psychoanalytic model define the roles of the Id, Ego, and Superego?

Id: Primitive, pleasure-seeking drives. Ego: Realistic problem-solver mediating reality. Superego: Moral conscience influenced by social standards.

What is the difference between transference and countertransference?

Transference: Patient unconsciously projects feelings onto the therapist. Countertransference: Therapist unconsciously projects personal feelings onto the patient.

Which psychotherapeutic defense mechanism involves rejecting unacceptable personal qualities in oneself and attributing them to others?

projection

What defense mechanism is characterized by an inability to integrate good and bad qualities of self or others into a cohesive whole?

Splitting

What defense mechanism is demonstrated when an individual addresses emotional conflicts through actions rather than feelings or reflection?

Acting-out behaviors

In ethical practice, what does the principle of Autonomy dictate?

Respecting a patient's right to self-determination and independent decision-making regarding their healthcare.

Which bioethical principle mandates treating all patients fairly and equitably?

Justice

What is Beneficence?

The ethical duty requires healthcare professionals to act in ways that benefit or promote the well-being of others

What legal requirement was established by the Mental Health Parity and Addiction Equity Act (2010)?

Insurance plans covering mental health or substance abuse must provide benefits equal to physical health coverage.

What legal mechanism allows a hospitalized or involuntarily committed patient to challenge unlawful confinement in court?

Writ of Habeas Corpus

What does the Least Restrictive Alternative doctrine mandate in psychiatric treatment?

Healthcare providers must utilize the least restrictive measures necessary to achieve effective patient stabilization and safety.

What legal doctrine established by the Tarasoff court rulings obligates psychiatric clinicians to notify identifiable potential victims of credible patient threats?

Duty to Warn and Protect

What sequential nursing chain-of-command action is required when a physician prescribes a medication order known to be unsafe?

Withhold the medication, state concerns directly to the prescribing physician, and escalate to the nursing supervisor if unchanged.

What must a nurse ensure before discontinuing care to avoid charges of patient abandonment?

A formal, safe reassignment of patient responsibility to another qualified healthcare professional.

What four legal elements are required to prove nursing malpractice or negligence?

Duty of care

Breach of duty

Causation

Damages

Is a patient's statement, "I feel sad," classified as objective or subjective data in a Mental Status Exam (MSE)?

Subjective data (self-reported patient experience).

In a Mental Status Exam, what aspect of thought evaluates how thoughts are logically connected versus disorganized?

Thought Process

In a Mental Status Exam, delusional beliefs or suicidal ideation are documented under which specific evaluation category?

Thought content

How should a nurse document speech that is rapid, intense, high-volume, and extremely difficult to interrupt?

Pressured speech

What clinical screening questionnaire score on the SCOFF tool warrants comprehensive assessment for an eating disorder?

Answering 'yes' to 2 or more of the 5 screening questions.

How do key underlying motivations differ between Avoidant Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa?

ARFID restriction stems from sensory processing or fear of choking/vomiting without body image distortion; Anorexia involves fear of weight gain and body image distortion.

What structural focus distinguishes Body Dysmorphic Disorder (BDD) from classic eating disorders?

BDD fixates on a specific defect in a distinct body part; eating disorders fixate globally on body weight, shape, and food.

What physical sign is described as fine, downy hair growing on the body in severe Anorexia Nervosa?

Lanugo

What is Russell's sign?

Calluses, abrasions, or scars on the knuckles/back of the hand caused by repeated self-induced vomiting.

Which physical examination findings are characteristically observed in severe Bulimia Nervosa?

Parotid gland enlargement, dental enamel erosion, Russell's sign, and hypokalemia.

How does Binge-Eating Disorder (BED) differ from Bulimia Nervosa?

BED features recurrent binge eating episodes without inappropriate compensatory behaviors (e.g., purging, excessive exercise).

What major metabolic shift defines the transition into Refeeding Syndrome in severely malnourished patients?

A sudden shift from a catabolic state to an anabolic state upon calorie reintroduction, causing massive intracellular shifts of electrolytes.

What is a catabolic state?

A metabolic condition where the body breaks down its own tissues and fat stores to provide essential energy and nutrients.

What is an anabolic state?

A metabolic state where energy and nutrients are utilized to rebuild tissues and support cellular growth.

Which three serum electrolytes drop precipitously and must be monitored closely during Refeeding Syndrome?

Potassium, Phosphorus, and Magnesium.

What initial caloric restriction guideline prevents the development of Refeeding Syndrome upon reintroducing nutrition?

Initiate feeding slowly at no more than 50% of normal energy requirements.

What is the priority sequence of nursing actions when admitting a patient with severe anorexia at risk for refeeding syndrome?

1 Perform baseline assessment (vitals, weight, nutrition status)

2 Monitor serum K, P, and Mg levels

3 Begin slow nutritional rehabilitation

4 Monitor for fluid overload and dysrhythmias

What nursing protocol is implemented immediately following meals for an inpatient diagnosed with Anorexia Nervosa?

Observe the patient directly and restrict access to the bathroom for 1 to 3 hours post-meal to prevent purging

For what off-label benefit is the atypical antipsychotic Olanzapine prescribed in Anorexia Nervosa?

To promote weight gain and decrease obsessive thoughts regarding food and body image.

Which Schedule II CNS stimulant is FDA-approved for treating moderate-to-severe Binge-Eating Disorder?

Lisdexamfetamine (Vyvanse)

What absolute pharmacological contraindication exists for initiating Vyvanse?

Use of Monoamine Oxidase Inhibitors (MAOIs) within the preceding 14 days.

What is the primary psychological premise explaining Somatic Symptom Disorders?

Inability or difficulty expressing emotional distress and anxiety verbally causes distress to manifest through physical symptoms.

How does Factitious Disorder Imposed on Self differ from Malingering?

Factitious Disorder involves deliberately faking illness to adopt the 'sick role' (internal gain); Malingering involves faking illness for external gains (money, avoiding work or prosecution).

What primary motivation drives Factitious Disorder Imposed on Another (formerly Munchausen by Proxy)?

The perpetrator fabricates or induces illness in a dependent to gain attention, praise, and sympathy.

What is eustress?

Normal, healthy stress that motivates individuals, enhances performance, or initiates positive life changes.

What key principle guides Trauma-Informed Care in healthcare settings?

Recognizing the widespread prevalence of trauma and adapting care systems to prevent retraumatization.

What repeated injury mechanism leads to Chronic Traumatic Encephalopathy (CTE)?

Repeated head impacts or recurrent traumatic brain injuries (TBIs).

What is compassion fatigue?

Emotional exhaustion and secondary traumatic stress resulting from prolonged indirect exposure to patients' trauma and high caregiving demands.

What three major categories of suicide risk factors are evaluated during clinical risk assessment?

1. Health factors (pain, mental illness, TBI)

2. Environmental factors (access to lethal means, loss, stress)

3. Historical factors (prior attempts, family history, ACEs)

What scale is commonly utilized in psychiatric nursing to quantify clinical suicide risk?

Modified SAD PERSONS Scale

Which nursing diagnosis holds highest priority when caring for a client displaying suicidal ideation?

Risk for Suicide and its precautions

In a 5-Axis DSM diagnosis system, what information is classified on Axis 1 versus Axis 2?

Axis 1: Clinical psychiatric diagnoses (e.g., Major Depression). Axis 2: Personality disorders and developmental delays.

In a 5-Axis DSM system, what is recorded on Axis 3 and Axis 4?

Axis 3: General medical conditions influencing mental health. Axis 4: Psychosocial and environmental stressors.

What does a score on Axis 5 of the traditional DSM assessment represent?

Global Assessment of Functioning (GAF) on a scale from 1 to 100.

How does Systematic Desensitization assist patients in overcoming phobias?

By pairing relaxation techniques with gradual, step-by-step exposure to anxiety-provoking stimuli.

What is Aversion Therapy?

A behavioral conditioning therapy that pairs maladaptive behaviors with unpleasant consequences to extinguish unwanted habits.

How does Biofeedback train patients to manage physiological stress responses?

By providing real-time visual or auditory data of autonomic functions (e.g., heart rate, blood pressure) so patients can practice conscious self-regulation.

Dialectical Behavioral Therapy (DBT) was originally designed for which psychiatric condition before expanding to eating disorders?

Borderline Personality Disorder (BPD)

What primary therapeutic goal defines Interpersonal Psychotherapy?

Identifying and modifying current maladaptive interpersonal relationship patterns and expectations

What core concept explains how Cognitive Appraisal influences emotion?

An individual's personal interpretation (appraisal) of an event dictates their emotional response, rather than the event itself.

What defines therapeutic milieu in an inpatient psychiatric setting?

A structured, safe, and supportive physical and social environment optimized for emotional healing and behavioral stabilization.

What key restriction applies to patients admitted under Voluntary Status in Florida if they request release?

The patient must submit a written release request, allowing the clinical team time to re-evaluate them for safe discharge or conversion to involuntary status.

Is a nurse refusing an unsafe assignment automatically guilty of patient abandonment?

No; refusal of an assignment before accepting responsibility and ensuring safe patient handoff does not constitute abandonment.

How should SSRI's be discontinued?

Must be tapered slowly to prevent withdrawal symptoms

SSRI's have a BLACK BOX warning, what age group does tis apply to?

Adolescents under the age of 25