Mental Health Nursing Exam 2: Assessment and Disorders

What are common problems associated with alterations in mental health?

Depression, anxiety, and altered mental status.

Define depression.

A mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities.

What are key characteristics of depression?

Depressed mood or loss of pleasure for ≥2 weeks, sleep disturbances, appetite/weight changes, abnormal lack of energy or agitation.

What screening questions are used for depression?

"During the past 2 weeks have you often felt down, depressed, or hopeless?" and "During the past month have you often had little interest or pleasure in doing things?"

What is a critical assessment for suicide risk?

"Have you thought about hurting yourself? Do you have a plan? Do you have the means?"

What are risk factors for depression?

Previous depressive episodes, lack of social support, physical illness in older adults, and high suicide rates in males 65+.

What nursing interventions are important for patients at risk of suicide?

Evaluate risk of harm, protect patients with specific suicide plans, assess past treatments, and identify protective factors.

Define anxiety.

A normal human reaction that becomes problematic when prolonged, exaggerated, and interferes with function.

What are key characteristics of anxiety?

Ranges from no anxiety to severe anxiety to panic; represents response to stress and coping mechanisms.

What is delirium?

A disturbance in attention and awareness, developing over a short period and considered a medical emergency.

What are key characteristics of delirium?

Acute change from baseline, severity fluctuates, altered level of consciousness, impaired memory, and emotional state changes.

What are common risk factors for delirium?

Impaired cerebral oxidative metabolism, dementia, increased age, and severe illness.

Define dementia.

Chronic, progressive neurocognitive disorder characterized by failing memory, cognitive impairment, behavioral abnormalities, and personality changes.

What distinguishes dementia from delirium?

Dementia is not reversible, while delirium can be treated.

What are common cognitive changes in dementia?

Memory loss, difficulty communicating, problem solving, and coordination.

What psychological changes may occur in dementia?

Personality changes, depression, anxiety, inappropriate behavior, and hallucinations.

What are key assessment questions for stress?

"Have there been any recent changes in your life? How have these changes affected your stress level?"

What are common stressors to assess?

Money, relationships, bullying, death of a loved one, employment problems, and caregiving responsibilities.

What tools can be used for stress assessment?

Social Readjustment Rating Scale, Everyday Hassles Scale, and Perceived Stress Scale.

What are physical signs of stress?

Increased heart rate, hyperventilation, musculoskeletal pain, insomnia, and irritability.

What are the two main categories of coping mechanisms?

Problem-Focused Coping and Emotion-Focused Coping.

What is problem-focused coping?

Aims at changing or removing the stressor through actions like setting priorities and seeking advice.

What is emotion-focused coping?

Manages emotions when stressor occurs, such as discussing feelings or using relaxation techniques.

What are some nursing interventions for stress management?

Relaxation breathing, imagery, music therapy, exercise, and journaling.

What is schizophrenia?

A chronic group of mental disorders characterized by disruptions in thought processes, perception, emotional responsiveness, and social interactions.

What is the significance of assessing both verbal and nonverbal behaviors?

Lack of congruence requires further exploration to understand the patient's condition.

What is the prevalence of mental disorders in the United States?

0.25% to 0.64%

What are the three categories of clinical findings in mental disorders?

Positive symptoms, negative symptoms, cognitive symptoms.

Name three positive symptoms of mental disorders.

Hallucinations, delusions, thought disorders.

What are negative symptoms in mental disorders?

Flat affect, reduced feelings of pleasure, difficulty beginning and sustaining activities.

What cognitive symptoms may be present in mental disorders?

Difficulty understanding information, paying attention, and using information immediately after learning.

What is PTSD?

A mental disorder that may develop after exposure to a potentially traumatic event.

What are common triggering events for PTSD?

Violent personal assaults, disasters, accidents, combat, and other forms of violence.

What is the lifetime prevalence of PTSD in US adults?

3.6%

What is a key characteristic of PTSD?

People feel stressed or frightened even when no longer in danger.

What is the assessment approach for alcohol use disorders?

Use a matter-of-fact, nonjudgmental approach.

What screening tool is used for alcohol use disorders?

AUDIT (Alcohol Use Disorders Identification Test).

What is Alcohol Withdrawal Syndrome (AWS)?

A condition that occurs in ~8% of hospitalized patients with alcohol use disorder.

What are critical assessment questions for suicide risk?

1. Have you thought about hurting yourself? 2. Do you have a plan? 3. Do you have the means? 4. Is there anything that would prevent you from carrying out your plan? 5. What has kept you from hurting yourself in the past?

What is the definition of bipolar disorder?

A chronic illness with recurrent episodes of depression or mania.

What are the two types of bipolar disorder?

Bipolar I and Bipolar II.

What characterizes the manic phase of bipolar disorder?

Excessive emotional displays, hyperactivity, decreased need for sleep, impaired concentration.

What are common symptoms of Generalized Anxiety Disorder (GAD)?

Restlessness, muscle tension, irritability, fatigue, difficulty concentrating, and difficulty sleeping.

What is the prevalence of OCD in adults?

1.2% (with women affected three times more than men).

Define panic disorder.

A condition characterized by multiple disabling panic attacks.

What is agoraphobia?

Phobic avoidance of places where escape/help isn't readily available.

What are the three types of memory assessed in mental status evaluations?

Immediate/registration, recent memory, remote memory.

How is immediate memory tested?

By asking the patient to repeat three unrelated words immediately.

What is the Serial Sevens Test?

A test where the patient subtracts 7 from 100 and continues subtracting 7 from each answer.

What is the documentation for orientation assessment?

Note as 'oriented x4' (person, place, time, situation) or specify deficits.

What is a common complication of anxiety disorders?

Substance abuse from self-medication.

What is the first-line treatment for Generalized Anxiety Disorder?

SNRIs (venlafaxine) or SSRIs (paroxetine, escitalopram).

What are the symptoms of panic attacks?

Lightheadedness, rapid heart rate, difficulty breathing, chest discomfort, sweating, weakness.

What is the duration of panic attacks?

Several minutes to an hour; occurs spontaneously.

What is the purpose of naming common objects in a patient assessment?

To evaluate the patient's communication skills.

What should a patient be asked to do to assess repetition skills?

Repeat a phrase such as 'No ifs, ands, or buts.'

How can a patient's reading ability be assessed?

By writing a command and asking the patient to read and follow it.

What is the goal of asking a patient to write a sentence during an assessment?

To ensure the sentence has a subject and verb, without assessing grammar or punctuation.

What does copying overlapping geometric figures assess?

The patient's visual-motor skills and spatial awareness.

What factors should be ensured before testing a patient's communication skills?

The patient must be able to see, speak, read, and write.

What types of hypothetical questions can be used to assess judgment and reasoning?

Questions like 'What is a reasonable price for a cup of coffee?' or 'What would you do if you found a stamped, addressed envelope on the sidewalk?'

What aspects should be evaluated when assessing a patient's judgment?

Appropriateness of responses, problem-solving ability, and insight into situations.

What does assessing proverb interpretation reveal about a patient?

It assesses their abstract reasoning abilities.

What might an inability to think abstractly indicate?

Cognitive impairment or dementia.

What contextual factors should be considered during patient assessments?

Culture, age, and education level.

What are some indicators of cognitive and perceptual ability during assessments?

Appropriateness of responses and whether they match the questions asked.

What are some factors that can affect a patient's intellectual capacity?

Impaired cognition, hallucinations, delusions, and dementia.

What is the critical assessment focus regarding a patient's understanding and adherence?

Determining the patient's understanding of their disease and ability to carry out treatments.

What is the Mini-Mental State Examination (MMSE) used for?

To assess cognitive orientation, attention, calculation, recall, language, and spatial orientation.

What does the Quick Dementia Rating Scale (QDRS) evaluate?

Similar cognitive functions as the MMSE, completed in a 5-minute interview.

What is required as part of the Medicare/Medicaid yearly wellness visit?

Cognitive screening to detect changes early.

What should be documented during patient assessments?

Specific findings rather than general statements.

What are the seven major areas to observe in a general survey?

Body features, mental state, speech, body movements, obvious physical signs, nutrition status, and behavior.

What does incongruence between verbal and nonverbal communication indicate?

A potential need for further assessment and validation of the patient's true feelings.

What are common indicators of depression in a patient?

Slumped shoulders, downcast eyes, flat affect, and poor hygiene.

What are some signs of anxiety in a patient?

Restlessness, fidgeting, flushed skin, and rapid speech.

What are the three symptom categories of schizophrenia?

Positive symptoms, negative symptoms, and cognitive symptoms.

What is the lifetime prevalence of bipolar disorder in the U.S.?

Approximately 4.4%.

What is a key point regarding incongruence in patient communication?

It is a red flag indicating the patient may not be expressing their true feelings.

What should nurses control during patient interactions?

Their own facial expressions to maintain a neutral and caring environment.