Mental Health Practice Exam

An inability to remain still. It is a neuropsychiatric syndrome that is associated with psychomotor restlessness.
-Generally experiences an intense sensation of unease or an inner reselessness that usually involves the lower extremities

-Manage with antiparkinsonian agents, beta blockers, or lorazepan/diazepam
-Monitor for increased risk for suicide

-Rapid onset (hours or days)
-Impairments in memory, judgment, ability to focus, and ability to calculate, which can fluctuate throughout the day.
-Disorientation and confusion often worse at night and early morning
-Level of consciousness is usually altered and can rapidly fluctuate
*Should be considered a medical emergency

Examples: Methylphenidate, dextroamphetamine
-Increases dopamine and norephinephrine levels increasing alertness, attention, motivation, and mood

Uses cognitive reframing to help the client identify negative thoughts that produce anxiety, examine the cause, and develop supportive ideas that replace negative self-talk

Used to control pain, tension, and anxiety. Helps teach people to relax their bodies and minds.
Examples: Deep breathing, progressive muscle relaxation, guided imagery, meditation

A technique that allows a client to see a demonstration of appropriate behavior in a stressful situation. The goal of therapy is that the client will imitate the behavior

-Physiological needs: food, water, warmth, rest
-Safety needs: security, safety
-Belongingness and love needs: intimate relationships, friends
-Esteem needs: prestige and feeling of accomplishment
-Self-actualization: achieving one's full potential, including creative activities

-Often caused by unanticipated loss or change experienced in everyday, often unanticipated life events (divorce or job change)

Achievinng new developmental stages, which requires learning additional coping mechanisms
-Examples: getting married or retiring

Escalating anxiety from a threat activates increased defense responses

Anxiety continues escalating as defense responses fail, functioning becomes disorganized, and the client resorts to trial-and-error attempts to resolve anxiety

Trial-and-error methods of resolution fail, and the client's anxiety escalates to severe or panic levels, leading to flight or withdrawal behaviors

The client experiences overwhelming anxiety that can lead to anguish and apprehension, feelings of powerlessness and being overwhelmed, dissociative findings (depersonalization, detachment from reality), depression, confusion, and/or violence against others or self

-Hypokalemia due to purging and starvation
-Electrolyte imbalances depending on method of purging
-Decreased bone density
-ECG changes (prolonged QT interval)

They may have calluses or scars on their hands (Russell's sign)

A defense mechanism that involves dealing with anxiety by reaching out to others
-Example: A nurse who lost a family member in a fire is a volunteer firefighter

A defense mechanism that involves dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
-Example: A person who has feelings of anger and hostility toward their work supervisor sublimates those feelings by working out vigorously at the gym during their lunch period

A defense mechanism that involves voluntarily denying unpleasant thoughts and feelings
-Adaptive use: a student puts off thinking about a fight they had with a friend so they can focus on a test
-Maladaptive use: a person who has lost their job states they will worry about paying bills next week

A defense mechanism that involves unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness
-Adaptive use: a person preparing to give a speech unconsciously forgets about the time when they were young and kids laughed at them while on stage
-Maladaptive use: a person who has a fear of the dentist continually forgets to go to their dental appointments

A defense mechanism that involves sudden use of childlike or primitive behaviors that do not correlate with the person's current developmental level
-Adaptive use: a young child temporarily wets the bed when they learn that their pet died
-Maladaptive use: a person who has a disagreement with a co-worker begins throwing things at their office

A defense mechanism that involves shifting feelings related to an object, person, or situation to another less threatening object, person, or situation
-Adaptive use: an adolescent angrily punches a punching bag after losing a game
-Maladaptive use: a person who is angry about losing their job destroys their child's favorite toy

A defense mechanism that involves overcompensating or demonstrating the opposite behavior of what is felt
-Adaptive use: a person who is trying to quit smoking repeatedly talks to adolescents about the dangers of nicotine
-Maladaptive use: a person who dislikes their neighbor tells others what a great neighbor she is

A defense mechanism that involves performing an act to make up for prior behavior (most commonly seen in children)
-Adaptive use: an adolescent completes their chores without being prompted after having an argument with their parent
-Maladaptive use: an individual buys their significant other flowers and gifts after an incident of partner abuse

A defense mechanism that involves creating reasonable and acceptable explanations for unacceptable behavior
-Adaptive use: an adolescent says, "they must already have a boyfriend" when rejected by another adolescent
-Maladaptive use: a young adult explains they had to drive themselves home from a party after drinking alcohol because they had to feed the dog

A defense mechanism that involves creating compartmentalization or lack of connection between the person's identity, memory, or how they perceive the environment
-Adaptive use: a parent blocks out the distracting noise from their children in order to focus while driving in traffic
-Maladaptive use: a person forgets their identity after a sexual assault

A defense mechanism that involves pretending the truth is not reality to manage unpleasant, anxiety-causing thoughts or feelings
-Adaptive use: a person initially says, "No, that can't be true" when told they have cancer
-Maladaptive use: a parent who is informed that their child was killed in combat tells everyone one month later that the child is coming home for the holidays

A defense mechanism that involves emphasizing strengths to make up for weaknesses
-Adaptive use: an adolescent who is physically unable to play contact sports excels in academic competitions
-Maladaptive use: a person who is shy learns computer skills to avoid socialization

A defense mechanism that involves conscious or unconscious assumption of the characteristics of another individual or group
-Adaptive use: a child who has a chronic illness pretends to be a nurse for their dolls
-Maladaptive use: a child who observes their parent be abusive toward the other parent becomes a bully at school

A defense mechanism that involves the separation of emotions and logical facts when analyzing or coping with a situation or event
-Adaptive use: a law enforcement officer blocks out the emotional aspect of a crime so they can objectively focus on the investigation
-Maladaptive use: a person who learns they have a terminal illness focuses on creating a will and financial matters rather than acknowledging their grief

A defense mechanism that involves responding to stress through the unconscious development of physical manifestations not caused by a physical illness
-Maladaptive use: a person experiences deafness after their partner tells them they want a divorce

A defense mechanism that involves demonstrating an inability to reconcile negative and positive attributes of self or others
-Maladaptive use: a client tells a nurse that she is the only one who cares about her, yet the following day, the same client refuses to talk to the nurse

A defense mechanism that involves attributing one's unacceptable thoughts and feelings onto another who does not have them
-Maladaptive use: a married client who is attracted to another person accuses their partner of having an extramarital affair

Manifestations of biological and neurological changes that are a result of sustained toxic stress.
-May have symptoms like GI discomfort, body aches, and shortness of breath; alterations in executive functioning (language and problem solving) may also be present

-Normal experience of everyday living
-It increases one's ability to perceive reality
-There is an identifiable cause of the anxiety
-Vague feeling of mild discomfort, restlessness, irritability, impatience, and apprehension

-Slightly reduced perception and processing of information occurs, and selective inattention can occur
-Ability to think clearly is hampered, concentration difficulties, tiredness, pacing, change in voice pitch, voice tremors, shakiness, and increased HR and RR

-Perceptual field is greatly reduced with distorted perceptions
-Learning and problem-solving do not occur
-Confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud and rapid speech, and aimless activity

-Characterized by markedly disturbed behavior
-Not able to process what is occurring in the environment and can lose touch with reality
-Severe hyperactivity, flight, or immobility, dysfunction in speech, dilated pupils, severe shakiness, severe withdrawal, inability to sleep, delusions, and hallucinations

-Cluster A (odd or eccentric traits)
-Characterized by distrust and suspiciousness toward others based on unfounded beliefs that others want to harm, exploit, or deceive the person

-Cluster A (odd or eccentric traits)
-Characterized by emotional detachment, disinterest in close relationships, and indifference to praise or criticism; often uncooperative

-Cluster A (odd or eccentric traits)
-Characterized by odd beliefs leading to interpersonal difficulties, an eccentric appearance, and magical thinking or perceptual distortions that are not clear delusions or hallucinations

-Cluster B (dramatic, emotional, or erratic traits)
-Characterized by disregard for others with exploitation, lack of empathy, repeated unlawful actions, deceit, failure to accept personal responsibility; evidence of conduct disorder before age 15, sense of entitlement, manipulative, impulsive, and seductive behaviors; nonadherence to traditional morals and values

-Cluster B (dramatic, emotional, or erratic traits)
-Characterized by instability in affect, identity, and relationships, as well as splitting behaviors, manipulation, impulsiveness, and fear of abandonment; often self-injurious and potentially suicidal; ideas of reference are common; often accompanied by impulsivity

-Cluster B (dramatic, emotional, or erratic traits)
-Characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious

-Cluster B (dramatic, emotional, or erratic traits)
-Characterized by arrogance, grandiose views of self-importance, the need for consistent admiration, and a lack of empathy for others that strains most relationships; often sensitive to criticism

-Cluster C (anxious or fearful traits; insecurity and inadequacy)
-Characterized by social inhibition and avoidance of all situations that require interpersonal contact, despite wanting close relationships, due to extreme fear of rejection; have feelings of inadequacy and are anxious in social situations

-Cluster C (anxious or fearful traits; insecurity and inadequacy)
-Characterized by extreme dependency in a close relationship with an urgent search to find a replacement when one relationship ends

-Cluster C (anxious or fearful traits; insecurity and inadequacy)
-Characterized by indecisiveness and perfectionism with a focus on orderliness and control to the extent that the individual might not be able to accomplish a given task

-A three-stage process that describes the physiological changes your body goes through when under stress developed by Hans Selye

-Alarm stage: Body functions are heightened to respond to stressors, also called fight-or-flight response
-Resistance stage: Body functions normalize while responding to the stressor. The body attempts to cope with the stressor and return to homeostasis.
-Exhaustion stage: Body functions are no longer able to maintain a response to the stressor, and the client cannot adapt. The end of this stage results in recovery or death.

-Pre-orientation
-Orientation
-Working
-Termination

-Recognize the needs of client through review of chart information
-Self-evaluation of personal thoughts, concerns, feelings, beliefs, and behaviors which may impact client care
-Prepare for tasks required during client care

-Introduce self to client and state the purpose of the meeting
-Set the contract: meeting time, place, frequency, duration, and date of termination
-Discuss confidentiality
-Build trust by establishing rapport, expectations, and boundaries
-Set goals with the client

-Maintain relationship according to the contract
-Facilitate the client's expression of needs and issues
-Encourage the client to problem-solve
-Promote the client's self esteem
-Foster positive behavioral change
-Re-evaluate the client's problems and goals, and assist with revisioins of plans as necessary

-Provide opportunity for the client to discuss thoughts and feelings about termination and loss
-Discuss the client's previous experience with seperations and loss
-Summarize goals and achievements
-Review memories of work in the sessions
-Maintain limits of final termination

Provider must give the client:
-The purpose of the procedure
-A complete description of the procedure
-A description of the professionals who will perform and participate in the procedure
-A description of the potential harm, pain, or discomfort that might occur
-Options for other treatments
-The option to refuse treatment and the consequences of doing so

The quality of doing good; can be described as charity

The client's right to make their own decisions. However, the client must accept the consequences of those decisions.

Fair and equal treatment for all

-A complex set of behaviors related to eating that share many similarities to anxiety related disorders
-Clients may describe feeling out of control in other areas of their lives and use food as a coping mechanism
-May also have distorted perceptions of what they look like, which affects how they feel about themselves

An eating disorder characterized by:
-Persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health
-Fear of gaining weight or becoming overweight
-Disturbance in self-perceived weight or shape

-Occurs most often in female clients from adolescence to young adulthood
-Onset can be associated with a stressful life event, such as college

-Restricting: The individual drastically restricts food intake and does not binge or purge
-Binge-eating/purging type: The individual engages in binge eating or purging behaviors

An eating disorder characterized by:
-Clients recurrently eat large quantities of food over a short period of time (binge eating), which can be followed by inappropriate compensatory behaviors (self-induced vomiting), to rid the body of the excess calories
-Binge eating and inappropriate compensatory behavior both occur on average of once per week for 3 months
-Clients have a sense of lack of control over eating

-Average age of onset in female clients is late adolescence or early adulthood
-Occurs most commonly in female clients

-Purging: The client uses self-induced vomiting, laxatives, diuretics, and/or enemas to lose or maintain weight
-Nonpurging type: The client can compensate for binge eating through other means (excessive exercise and the misuse of laxatives, diuretics, and/or enemas)

Regurgitating food after eating it (behaviors may be referred to as "chewing and spitting")

An eating disorder characterized by:
-Clients recurrently eat large quantities of food over short periods of time without the use of compensatory behaviors associated with bulimia nervosa
-Clients experience distress following the binge-eating episode
-An excessive food consumption must be accompanied by a sense of lack of control
-At least once per week for 3 months

-Age 18 years and older: 4 hr
-Age 9-17: 2 hr
-Age 8 years and younger: 1 hr

A civil wrong doing, in which monetary damages can potentially be awarded to the plaintiff (injured party) and collected from the defendent (responsible party)

Willful actions that damage a client's property or violate client rights

-False imprisonment
-Assault
-Battery
-Invasion of privacy

Actions or inactions that cause unintended harm as a result of failing to meet one's duty of care in either a personal or professional situation

-Negligence
-Malpractice

A pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opioid withdrawal)

A medication used to decrease unpleasant effects resulting from abstinence (dysphoria, anxiety, restlessness) in substance-abuse treatment

A medication used for nicotine withdrawal that decreases nicotine craving and manifestations of withdrawal

-Useful for clients with neurocognitive disorders.
-A process of communication with a disoriented older adult client by respecting and validating their feelings in a time or place that is real to them, even though it does not relate to actual reality

A therapeutic technique that involves teaching a client to say or shout, "stop," when negative thoughts or compulsive behaviors arise and substitute a positive thought. The goal over time is for the client to use the command silently

The client receives positive rewards for positive behavior (positive reinforcement)

Therapy that is planned, progressive, or graduated exposure to anxiety-provoking stimuli in real-life situations, or by imagining events that cause anxiety. During exposure, the client used relaxation techniques to suppress anxiety response.

Pairing a maladaptive behavior with a punishment or unpleasant stimuli to promote a change in the behavior

Examples: fluoxetine, citalopram, escitalopram, paroxetine
MOA: Selectively blocks reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin
-Considered first-line treatment for depression
-Can take 1-3 weeks or longer before pharmacological benefits take effect

-Sexual dysfunction: anorgasmia, impotence, decreased libido
-CNS stimulation: inability to sleep, agitation, anxiety, headache
-Neuroleptic malignant syndrome (monitor for fever, respiratory distress, and tachycardia)
-Suicidal thoughts
-Weight loss followed by weight gain with long-term treatment

-Potentially life-threatening condition that occurs when there is an excessive amount of serotonin in the body
-Manifestations include: confusion, agitation, poor concentration, hostility; disorientation, hallucinations, delirium; seizures leading to status epilepticus; tachycardia leading to cardiovascular shock; diaphoresis; fever; nausea, vomiting, diarrhea, and abdominal pain

-MAOIs, TCAs, and St. John's wort increase the risk for serotonin syndrome
-Concurrent use of warfarin and fluoxetine can increase risk for bleeding
-Avoid concurrent use of fluoxetine and tricyclic antidepressants and lithium
-Concurrent use of fluoxetine and NSAIDs or anticoagulants can increase risk for bleeding

Examples: Venlafaxine, desenlafaxine, duloxetine
-MOA: Blocks reuptake of norepinephrine as well as serotonin with effects similar to SSRIs
-Used to treat major depression, generalized anxiety disorder, social anxiety disorder, panic disorder

-Nausea, anorexia, weight loss, bowel alterations
-Headache, insomnia, anxiety
-Hypertension, tachycardia
-Neuroleptic malignant syndrome
-Suicidal thoughts
-Dizziness, blurred vision
-Withdrawal syndrome
-Sexual dysfunction and serotonin syndrome

-Physical exhaustion and possible death
-A client in a true manic state will not stop moving, and does not eat, drink, or sleep. This can become a medical emergency

A screening tool that tests the cognitive function of the client. It is an assessment of the client's current memory, speech, and cognition.

-Should not consume foods high in tyramine as it can lead to hypertensive crisis
-Foods that contain tyramine: aged cheese, yeast, smoked or aged meats

-Chest pain
-Severe headache
-Nausea and vomiting
-Tachycardia
-Palpitations
-Fever

Naltrexone (opioid antagonist)

-Bupropion
-Varenicline

Phenobarbital

-Sodium
-Low sodium level increases the risk for lithium toxicity
-An increased intake of sodium can decrease lithium levels, causing it to be less therapeutic

Decreased energy

-Restrict the client's sodium intake
-Client is at risk for ascites

-Common manifestation of bipolar disorder
-Client's speech is rapid and changes instantaneously from one idea to the next

Duty to tell the truth

Ask the client to explain similarities between objects or to explain the meaning of a common proverb or figure-of-speech

-Change in hospital rooms
-Older adult
-Vision and hearing loss
-Recent surgical procedures
-Infection

Lack of pleasure or interest in activities or the lack of the capacity to experience pleasure

Atropine sulfate IM 30 min prior to procedure to decrease secretions in order to prevent aspiration that can be caused by the vagal stimulation induced by ECT

A data collection tool used to guide medication therapy for clients who are prescribed antipsychotic medications

Questions regarding the client's interests and hobbies

-Rapid or pressured speech
-Provocative behavior
-Insomnia

-Weight gain
-Insomnia
-Muscle cramps

-Hypertension
-Mental alertness
-Tachycardia
-Dilated pupils

Therapy modality that uses electrical currents to induce brief seizure activity while the client is anesthetized.

Memory loss and confusion
-Short-term memory loss, confusion, and disorientation occurs immediately following the procedure and can persist for several hours
-Memory loss can persist for several weeks

Examples: Lithium carbonate
MOA: Produces neurochemical changes in the brain, including serotonin receptor blockade
-Controls episodes of acute mania and helps prevent the return of mania or depression

-CBC
-Blood electrolytes
-Renal function tests
-Thyroid function tests

Examples: phenelzine, isocarboxazid
MOA: Block MAOI enzymes in the brain, thereby increasing the amount of norepinephrine, dopamine, serotonin, and tyramine available for transmission of impulses. This increases the amount of neurotransmitters at nerve endings and intensifies responses, relieving depression

Fulfillment of promises

A commitment to do no harm

An anxiety disorder characterized by intense fear and avoidance of situations where escape might be difficult or help may not be available

Phobia of being alone

Phobia of animals

Phobia of heights

Extensive scarring of the liver caused by necrotic injury or a chronic reaction to inflammation over a prolonged period of time. Normal liver tissue is replaced with fibrotic tissue that lacks function.

-Bacteria, sediment, white blood cells (WBC), and red blood cells (RBC)
-Positive leukocyte esterase and nitrites (68-88% positive results indicates UTI)

-Melatonin
-Valerian
-Chamomile

-Complete exercise 3 hr before bedtime
-Establish a bedtime routine and a regular sleep pattern
-Arrange the sleep environment for comfort
-Limit alcohol, caffeine, and nicotine at lease 4 hr before bedtime
-Limit fluids 2 to 4 hr before bedtime
-Engage in muscle relaxation if anxious or stressed