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Foundations of Mental Health Development: Theories II. Defense Mechanism III. Therapeutic Modalities IV. Maladaptive Patterns of Behavior a. Anxiety Response and Related Disorders b. Emotional Responses and Mood disorders c. Schizoprenia and other psychotic and mood disorders d. Social responses and personality disorders e. Substance Related Disorders f. Psychophysiologic responses, somatoform and sleep disorders g. Abuse and Violence h. Eating disorders i. Sexual Disorders j. Emotional Disorders of infants, children and adolescents V. Psychiatric Medications
A. ERICK ERICKSON: Psychosocial Age 0 -18 mos 18 mos -3 yrs STAGE INFANT
FOUNDATIONS OF MENTAL HEALTH DEVELOPMENT: THEORIES
Developmental Tasks Trust vs. Mistrust Autonomy vs. Shame & Doubt. Initiative vs. Guilt
Needs that should be Met Attention specially when hungry; important factor is feeding Complement and Appreciation for things done; Toilet-training should be completed Options and alternatives given from which the child can choose on their own but with adult supervision(example : which toy to play, what food to eat); Opportunities for exploration of self and reality Involvement in competitive activities like academic/ school competencies and games Establishment of friends, Belongingness to peers Intimate Relationships; Love Being a worthy and productive member of the society, being a responsible parent Recollection of life in the past, Sense of Accomplishment
PRE-SCHOOL/ EARLY CHILDHOOD
Industry vs Inferiority
13-18 years 19-25 years 26-45 years
ADOLESCENCE YOUNG ADULTHOOD MIDDLE ADULTHOOD LATE ADULTHOOD
Identity vs Confusion Intimacy vs. Isolation Generativity vs. Stagnation Integrity vs. Despair
Id 46- death C.
If a specific developmental tasks are not met within the stage, person SIGMEUND FREUD: Psychosexual Stage may manifest psychologic problem related to the missed Sexualthe task in development ORAL– 0 to 18 months past. • Sucking – mouth – survival: feeding ANAL – 18 months to 3 years • • • • • Toilet training sense of control (autonomy)
PHALLIC – 3 to 6 years old
penis and vagina starts to masturbate love of parent of opposite sex > Oedipal complex – boy loves mother
Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out > Electra complex LATENT – 6 to 12 years old - girl loves dad
• School age – school phobia – 1
st time to go to school – separation anxiety sublimation – putting anger into something more productive - putting all energies into schooling
• Important figures – teacher, peers (same sex)
• (sexual energy sleep) GENITAL – 12 years to 18 years old • increased sexual energy
Childhood Trauma and Unexpressed Feelings can cause conflicts in succeeding stages in life
D. ABRAHAM MASLOW: Hierarchy of Needs
I. II. III.
Physiologic Needs – needs such as air, food, water, shelter, rest, sleep, sex, activity and temperature maintenance are crucial for survival Safety and Security Needs – the need for safety has both physical and physiologic aspects Love and Belonging Needs – the third level of needs includes giving and receiving affection, attaining a place in a group and maintaining the feeling of belonging others
IV. Self-Esteem Needs – the individual needs both self-esteem and esteem from V.
Self-Actualization – when the need for self-esteem is satisfied, the individual strives for self-actualization, the innate need to develop one’s maximum potential and realize one’s abilities and qualities
Needs must be fulfilled in order. One cannot progress to the next level if the previous level has not been successfully satisfied.
II . DEFENSE MECHANISMS - coping mechanisms to stress. Compensation Conversion Denial Displacement “making up” for a real or imagined inability or deficiency to maintain selfesteem .transfer of mental conflict to physical symptom to release tension or anxiety Unconcious refusal to face reality - “I am not an addict” Transfer of feelings such as anger from one person to another– Father shouted and got angry with the first child then shouts also to the other child after. Detaching or separating strong conflict from one’s conciousness– Ex. Traumatic amnesia- forgetting the vehicular accident which killed significant other. Stucked in a certain stage of development.
Exaggeration of certain actions by displaying exactly the opposite behavior. feelings with good or acceptable reasons. ideas. Taking in the character of one person by ingesting the attitudes. Replacement of consciously unacceptable emotions. Used to maintain self-respect. Attributing to oneself the good qualities of another. Going back to past level of behavior to feel more comfortable and reduce anxiety. Unconciously justifying ideas. Active listening – nodding. fear and permits dependency. Student who receives low grades dropped from school and worked as busboy. – Ex. 12 years old wets bed like an infant. prevent guilt.Ex. THERAPEUTIC MODALITIES Family Therapy Crisis Intervention Expressive Therapy Self-Help Groups Therapeutic communication Behavior Modification Milieu Therapy Group Therapy Therapeutic Communication THERAPEUTIC 1.value based judgment Avoid too much flattery. when.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Identification Introjection The “imitator” . Clarification – “What do you mean when you say dwakledoo?” NON-THERAPEUTIC “Don’t worry. “Nice weather today”. drives by those that are more acceptable. Blames others for wroing doing . active participation 5. 215 .Offer self – “I’ll stay/sit with you” 2. Make observations. “Burrying alive mechanism” – unable to recall painful or unpleasant thoughts. be happy” Do not ask “WHY” . Voluntarily forgetting unacceptable thought but able to recall at will. actions.Showing true feelings but regrets after. A student was late and blames the alarm clock for failing to alarm. Explore – use what.identify a certain behavior from a certain role model. leaning.Looks for a scapegoat. eye contact. feeling and attitude of what he normally would show. Broad opening – “How are you?” “You 7. puts patient in defensive position. forward. Projection Rationalization Reaction formation Regression Repression Sublimation Substitution Suppression Undoing II. “You see/I have observed/I have noticed…” 6. Ex. how 3.. Patient claiming that he is Jesus.. “You have the most beautiful hair in the ward”. Change the subject “Everything’s going to be alright” – giving false reassurance Ignore the patient Prejudgmental. Silence 4. philosophy of other person. Rejection of unwanted characteristic of oneself and assigns them to others. Conciously re-channeling of unacceptable behavior into activities that is socially acceptable. attitudes. – Ex. Feeling guilty for doing something. where.
apprehension or tension that a person experiences in response to an unknowm object or situation. Establishes open communication an healthy interactions within the family. Assessment b. • The environment is as close as to the “real world” Group Therapy Accdg. Implementing Techniques of intervention and Resolution of the Crisis d. drawing. Punishment Reinforcement Milieu Therapy • An environment that is organized to assist patients to control behavior and give opportunity to utilize psychosocial skills in coping with self. Planning therapeutic interventions c. to Nudelman: Group therapy is “an identifiable group of at least three people who share common goal.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out 8. treatment to phobias 3. Refocusing – “We were talking about the exam…” 11. Four Methods: a.Period to resolve initial feelings and achieve a sense of the group identification and definition of purpose Middle or Working Phase – Exploration of relationships and conflicts . IV.” 4. singing. Beginning or Orientation Phase b. Restating – “I don’t want to eat” (Word per word repetition) “You don’t want to eat?” 9. MALADAPTIVE PATTERNS OF BEHAVIOR ANXIETY –A Feeling of uncertainty. Do not impose your opinion Behavior Modification Reconditioning Desensitization -taking out maladaptive behavior. behavior get used Arguing with the patient. Share feelings and reflections about the group. etc.shares feedback with one another as they prepare to leave the group. c. unlearning the maladaptive -frequent exposure to undesirable stimulus to make individual to it and decrease anxiety despite of exposure. others and environment. uneasiness. Focusing – “Tell me more about this” 2. 216 . General leads – “And then…/what else/go on…” 10. Anticipatory Planning Expressive Therapy . • Three Phases of Group therapy: a. Person is expected to leave the group with the Family Therapy Treating family members in a modified group therapy. – Ex.Additional therapeutic modalities used to aid in assessment where expression of feelings can be relayed through dancing. Ending or Termination Phase . Crisis Intervention An attempt to resolve an immediate crisis when a person’s life goals are obstructed and usual problem-solving methods fails.
Priority: safety.most common. washing of hands. c. b. happens without warning. fear of being alone in 217 . voice tremors. physiologic changes. Do not interrupt with rituals Allow time to complete rituals and gradually decrease time allotment for such act Avoid injury Increase self-esteem and encourage expression of self PHOBIA Types of Phobia: 1. verbalization of danger Nursing Interventions Listen to patient Remain calm Listen to patient Remain calm Reassurance and support Severe Patient cannot make decisions. concentrating. Stay with the patient. Sympathetic nervous system activation. opening / closing. Generalized anxiety disorder 6 months excessive worrying Client having difficulty sleeping. 3.fear of heights Hydrophobia – fear of water Irrational fear of an object. the crowd where there is no escape Examples of phobias: Acrophobia. Examples: Rituals. 2. unable to focus on reality Suicidal. d. Do not do anything to the patient . Narrowed ability to perceive occurs and concentrates on only one thing Pacing. client is not able to relax. Ability to perceive is reduced Cannot communicate clearly Stay with the client Encourage deep breaths or breathe into paper bag Remove stimuli Stay with the client. activity or situation Simple Phovia – fear of object or situation Social Phobias – fear of exposure Agoraphobia. disaster. Post traumatic stress disorder . rigidity Defense Mechanisms present: Displacement. trauma. prevent from injury Encourage deep breaths or breathe into paper bag Remove stimuli Panic Total ability to perceive is lost. undoing. eating Fatigue and palpitations experienced Panic attack • • occurs for only 15-20 minutes. OBSSESSIVE COMPULSIVE DISORDER -A condition of recurrent and persistent urge to repeat an act purposefully to prevent some future event or situation.victims of rape. Personality is disintegrated. speed in speaking. unpleasant circumstances. Frequent rearranging. reaction formation Nursing Interventions: a. war zones.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Levels of Anxiety MILD Moderate Description Increased alertness.
Patient prepares living will. 3. ECT is administered. “Why me?” Bargaining – closing a deal to the cheapest possible price.fear of animals Behavior modifications Relaxation Desensitization Expression of feelings Anti-depressant DEPRESSION decrease serotonin. ideas or desires 4. do not give complex one’s Risk factors: • sex – male (more successful) female (hesitant) • age – 15 to 25 years old or above 45 • depression • patient with previous attempts will try again • alcoholics • irrational • lacks social support • organized plan – greater risk • no family • with terminal sickness SCHIZOPRENIA . b. d.retreat from reality 2. flat or blunt ed emotional response 3. 4. shifts from one subject to another Other manifestations beside’s 4 A’s 218 . attitudes. Affect .fear of fire Zoophobia. lightning Ceraunophobia –fear of thunder Claustrophobia. Autism .fear of enclosed places Hematophobia. - Suicide cues: • “I wont be a problem any longer” • “Remember me when I’m gone” • “This is my last day” • “This is my wedding ring give it to my son” • there is a sudden change in mood Intervention: • direct question – “Are you going to commit suicide?” • irregular interval of visit to patient’s room • early in the morning and during endorsement period – time the patient commits suicide • give simple task. “This cant be happening. 1. 2. “If only… I will” Depression – silence Acceptance – client acts according to situation.inappropriate. thunder. Ambivalence – contradictory or opposing emotions. 5. this cant be real” Anger – blaming.fear of doctors Nyctophobia – fear of night Ochlophobia – fear of crowds Pyrophobia.A serious psychiatric disorder characterized by impaired communication with loss of contact to reality 4 A’s of Schizoprenia (Bleuler) 1. Denial – getting away from reality.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Androphobia – fear of men Astraphobia – fear of storms. Iatrophobia. Associative Disturbance – unable to think logically.fear of blood Nursing Intervention: a. e. If unresponsive to medications. c.
thought disturbance. Echolalia – repeat what is said by the nurse. Neuroleptic malignant syndrome – hyperthermia. 2. unstable BP. Catatonic rigidity. contracted 4. pallor 6. Echopraxia – repeats what the nurse’s do. Delusions – false belief. auditory.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out 1. 8. Undifferentiated Residual Mixture of behaviors State of partial remission THOUGHT PROCESS DISTURBANCE 1. 9. 3. 7. Suspicious. 3. hallucinations. tactile Extra Pyramidal Side Effects (EPS) Cause: increase in acetylcholine and decrease in dopamine Symptoms of EPS: 1. Concrete association 12. Akathisia – restless and with inability to sit still 2. diaphoresis. Ambivalence – pulled by two opposing forces. Waxy flexibility – bizarre positioning Expressionless c. Hallucination – may be stimuli. 4. regression. Looseness of association – topics have connection but no thought. Clang association – uses word that rhyme. increase CPK. 3. 4. Inability to complete a task 6. leucopenia Use of Therapeutic communication Prevent injury Orient to reality Medications: anti-psychotic Nursing Management: 1. AUTISM 219 . Photosensitivity – wear shades or put on sunscreen 7. mistrust of others. Neologism – invents new words not in the dictionary. social withdrawal a.assume position and does not move Negativism-resistant to all instructions Unexpected shifts of behavior Hallucinations –persecutory or grandeur Delusions Angry. 5. d. hypochondriasis. fever. Mood swings: getting angry. puffy cheeks. Impaired reaction to the environment 7. 3. 5. 1. 2. grandeur – thinks he’s somebody persecution – thinks that there is somebody after him ideas of reference – thinks he’s being talk about 11. b. overly religious 4. Delusions Illusions Hallucinations Loss of ego 5. 2. depressed. malaise. 10. Akinisia – rigidity of the body 3. joyous without any reason Types of Schizoprenia Disorganized Catatonic Incoherent. 5. c. Magical thinking – believes he has magical powers. Agranulocytosis – sore throat. Irreversible. e. 6. Psychomotor symptoms b. Neologism – invents new words not in the dictionary. Tardive dyskenisia – lip smacking tongue is protruding. Word salad – mixes word that don’t rhyme. Paranoid Suspiciousness a. Dystonia – affects neck • Torticollis – wry neck • Oculogyric crisis – fixed stare • Opisthotonus – arched back. 4. 2. visual.
impatient. Disturbed self-image Parent-child conflicts Past and present experiences resulting to feeling of dependency & helplessness Warning Signs of Possibility of Anorexia Nervosa: 1. 3 months amenorrhea. Denying hunger Symptoms: • • • • • Dry. 2. 220 . Calorie counting. improve social interaction. dieting. shifts from one activity to the other • Destructive and hyperactive: unable to sit still.echolalias. easily distracted • talkative Nursing Intervention: • safety • provide place to study. Depressed mood 6. repetitive • communication – difficulty communicating Nursing Intervention: • constancy • promote safety • expressive therapy – uses art. Amenorrhea or irregular menses 7. eat play. flaky or cracked skin Brittle hair and nails. poor eye contact. Contributing Factors: 1. poetry. underweight <85% of expected fat. flat affect.an attention-getting device. hair beginning to fall out Amenorrhea or menstrual irregularity Constipation Hypothermia • • • • • Skeletal-like appearance Presence of lanugo Intense fear of becoming obese Distorted body image as continues to see self as fat 3. Hostility and desire to control others 4.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out . Drastic weight loss in the presence of unusual eating habits 2. wants constancy • behavior – ritualistic behavior. usually teenagers Starvation. Obsession with neatness including frequency in mirror-gazing 3. decreasing risk for injury. can’t express verbally Manifestations: • appearance – neat. Wearing loose-fitting to mask physical appearance as it changes 8. a psychotic disorder. early manifestation of schizophrenia. obsessive compulsive. failure to recognize problem Most common in women (90-95%).can progress to conduct disorder to anti-social behavior • short attention span • impulsive . excessive exercise 5. keeps on running and climbing • • May occur at age 3 and lasts for at least 6 months but often diagnosed upon entrance to school Id dominant: mother or the nurse will act as superego Manifestations: • appearance – dirty • behavior – clumsy. ATTENTION DEFICIT HYPERACTIVITY DISORDER . be able to express feelings. bath • schedule time for all activities • set limits ANOREXIA NERVOSA diet.
10. discouragement or hopelessness Mania – a mood disorder characterized by psychomotor over-activity or excitement. dental carries. 7. 9. Flight of ideas Manipulative or demanding behavior Destructive / Combative Delusions of grandeur Impaired judgment Nursing Intervention: 1. Rupture of the diaphragm 12. stress and obese Depression – a mood state characterized by a feeling of sadness.2 poles. starch Priority: • fluid volume balance • weight gain – monitor weight. stay 1 hour after eating. Heart failure 7. 10. Rupture of the stomach 5. Dehydration 9.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out • • Decreased BP. 7. 8. irreversible Cong. 7. Rectal prolapse or abcess 11. BIPOLAR DISORDER . Irritable bowel syndrome or abnormal dilatation of the colon 10. normal weight. 2. happy (more dominant) and sad. insomnia without fatigue. Fungal infections of the vagina or rectum Nursing intervention for ANOREXIA NERVOSA AND BULEMIA 1. Dilatation of the esophagus 4. PR. Chronic enlargement of the parotid gland 8. Rupture of the esophagus 3. irregular menstruation. Overactivity or excitement Insomnia without fatigue Euphoria or elated mood Distractibility Pressured speech 6. Establish nutrition pattern Setting limits State that three meals a day is necessary to maintain a healthy body Allow some control in decision making Teach stress management. 9. 8. Chronic edema 14. Heart problems. Dental erosion 13. electrolyte imbalance • • Loss of appetite Total lack of concern about symptoms BULEMIA NERVOSA -Binge eating and purging . distractibility. basal metabolic rate DHN. Electrolyte imbalance or abnormalities.Depression and Mania . and pressured speech. affects more female than male >20 years of age. 6. 4. euphoria or a state of elation. 3.give task 221 . Chronic inflammation of the lining of the esophagus 2. despair. accompany in toilet Complications: 1. Mixed – experiences both manic and depressive phases Symptoms of Manic Phase: 6. journal keeping Monitor eating pattern and weight Anti-depressant 5. dejection. PICA – eating non-nutritive foods like ice. Divert attention . leading to arrhythmias of the heart and metabollic alkalosis 6. malnutrition. knows the problem but ashamed and embarrassed. eating pattern. diarrhea.
Difficulty dealing with reality 6. 5. do not follow rules from childhood until adulthood Borderline – suicidal.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out 2. violent Passive/aggressive – with hidden resistance. 4. 6. 3. manipulative. Maladaptive behaviors are inflexible. or excuses for drinking 4. believes that he can stand on his own. center of attention Narcissistic – insensitive. 3. Schizoid – doesn’t care about people. exaggerated self esteem. organized. Denial of the maladaptive behavior being exhibited. 2. ambitious. arrogant. provide time to do rituals Paranoid – always jealous. Poor job performance 7. sudden change of mood. have talent but with no confidence Anti-social – law breaker. such as anxiety or depression Clinical Types of Personality Disorder 1. Chronic absenteeism from work 2. 10. Overuse of rationalization. 2. suspicious. Avoid giving group games – any competition will increase anxiety Give activities that uses gross motor skills to provide outlet of energy Displacement like punching bag PERSONALITY DISORDER Characteristics of a Personality Disorder 1. Wernickes – motor side effects Korsakoff – memory – confabulation 222 . ALCOHOL ABUSE . dramatic. grandiosity Obsessive-compulsive – perfectionist. Complications: Gradually avoid alcohol Aversion therapy Anti-abuse (DISULFIRAM) May refer to group therapy 1. never had a best friend. escape from problem. self absorbed. 9. constancy in environment. Disturbance of mood. peer pressure Manifestations of Individual under Abuse of alcohol: 1. Avoidant – avoid group – fear criticism. 3. Minor stress is poorly tolerated which furthers the increase in the ability to cope. Disruption of home. Frequent job changes 6. 3. self mutilation Dependent – decrease self esteem. superficial relationship. avoid groups and activities – no enjoyment 2. dependent. 2. 7. marital and family relationships 5. 4. poor decision making skills Histrionics – excited.socializing. Defective ego functioning 5. 4. Deterioration of health Intervention: 1. 4. Repeated job-related accidents 3. but always on the go 8.
patient had cocaine intoxication. tachypnea. Substance abuse moments: DOWNER: alcohol barbiturates opiates narcotics marijuana Toxic effects: decrease respiratory rate. Delirium tremors – 24 72 hours after alcohol intake due to sympathetic nervous system activation (with tremors. cant be trained severe mental retardation – 20-35 moderate – 35-50 – can be trained. All of the patients vital signs will shoot up just the same with uppers (e. pre-operational stage mild – 50-70 – (mild 7) mental age is 7 -12. educable.. seizure. give downers Signs of overdose: identify if drug is upper or downer check effect signs of widrawal If patients take a downer. hallucinations. illusions) SUBSTANCE ABUSE 1. patient will manifest bradypnea or coma).Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out 3. During withdrawal. decrease heart rate constricted pupil moist mouth dilated blood vessel coma asleep decreased gastro-intestinal constriction decrease genitor-urethral retention decrease blood pressure state of euphoria 2. can go to school borderline – 70-90 normal 90 – 110 223 . If he stops taking it (during withdrawal). patient will manifest hyperactivity. Depressed – sits down on chair UPPERS: cocaine hallucinogen amphetamines seizure tachypnea increase heart rate pupils dilate dry mouth decrease in appetite diarrhea Toxic effects: profound mental retardation – IQ <20 – thinks like an infant.g. patient will experience the opposite effect of a downer. all vital signs are down. mental age is 2-7 years old. Nervous – tremors.
Denial of pregnancy b. Anomia – don’t know name of object Agnosia – problem with senses (smell. Depression during pregnancy c. Resentment towards the child i. Inability to tolerate the child’s crying. touch) Aphasia – can’t say what he wanted to say Apraxia – can’t do what he wanted to do Dissociative fugue – takes a new personality from a far away place. 2. 7. difficulty ealking or sitting Unusual sexual behavior Poor peer relations Sexual assaults Explanation and injury mismatch Poor hygiene and dress Needs unattended Behavioral Fear of strangers Labile behavior Rigid. Fear of delivery e. Physical Abuse 2. 4. lacerations Neglect Emotional Maltreatment Decreased self-esteem. Emotional Maltreatment 4.A result of a potentially abusive or neglectful parents resulting to maltreatment of children Characteristics of potentially abusive or neglectful parents : a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out CHILD ABUSE . Lack of support form husband or family f. distant Fatigue Withdrawal Engaged in substance abuse ALZHEIMER 1. hear. behavioral problems Sexual Abuse Venereal disease Pregnancy Itching in genitals. Undue concern about the unborn child’s sex and how g. New place. Sexual Abuse Area Physical Abuse Physical Multiple injuries in various stages of healing Unexplained bruises. 6. 3. fractures. hypochondriasis Developmental lag Sleep disorders. Neglect 3. taste. viewing child as being too demanding Areas of Child Abuse: 1. new identity Dissociative identity disorder – multiple personality Dissociative amnesia – he don’t know who he is and where he is Anti-parkinson drugs • • • • • • • • cogentin artane parlodel akineton benadryl larodopa eldepryl symmetrel Anti-cholinergic/Anti-parasympathetic • mono amine oxidase inhibitors marplan nardil parnate Alcoholics • disulfiram • anti depressants Electro-Convulsive Therapy (ECT) – 224 . Unwanted child d. Fear that the child will be one of too many children h. 5.
Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out -if the medication the patient was taking did not take effect ECT is administered. weight gain Toxic Level: Vomiting.inhibit absorption Anti-psychotc. seizure b. seizures. dizziness. drowsiness. memory loss (distinct symptoms) Anti-mania PSYCHIATRIC MEDICATIONS Drug: LITHIUM Anti-depressant MAO Inhibitors – Isocarboxacid. slurred speech. restlessness Nursing Intervention Careful observations for signs and symptoms of toxicity WOF Hypertensive crisis. diaphoresis. headache w/c can lead to intracranial hemorrhage and bleed-> death 225 . fatigue. lethargy. temporary. photosensitivity. perspiration.Maprotiline Drug Interaction Diuretics increases level of toxicity ACT may cause neurotoxicity Concommittant use with: Anti-HPN –causes hypo/hypertension Antacids. Pre-ECT: • sign informed consent • NPO 6 hours • give atropine sulfate • give barbiturate • succinylcholine chloride – to relax muscles Post-ECT • side lying lateral • side effects: headache. coma. Postural Hypotension Side Effects Initial Dosage: Fine tremor. muscle twitching. nausea. thirst. palpitations.potentiate anti-cholinergic effects CNS depressant-potentiate effectsn Anti-cholinergic Effect: Dry mouth Constipation Urinary retention Blurred vision Glaucoma Cardio Effects: a. tremors. Amitryptilne Tetracyclic Anti-depressant . Phenelzine Tricyclic Anti-depressant – Imipramine. ataxia. anxiety. Arrhythmias Rashes.elevated BP. lethargy. chest pain. polyuria. diarrhea.
Phallilc stage d. Autonomous behavior. The concepts of positive mental health that maybe used in evaluating the individual’s mental status are: a. Phallic stage d. rigid contact of subordinates c.. Becomes opinionated in home and community affairs c.N. Fear c. honest Situation: Ms. Repression c. The sum total of the individual’s internal and external patterns of adjustment to life is called: a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Far Eastern University Institute of Nursing In-House Review Program Post-test: Psychiatric nursing Prof. Introjects parents and teachers ideals 9. Much less than other’s needs d. Much more than others’s and more 10. Ego Ideal 4. Denial d. Samson recognizes that their needs are: a. Prevent destructive behavior c. Undoing c. The listening technique by the nurse must have been: a. During toilet training period. R. Substitution d. Improved social skill 226 . Maturity b. Reaction Formation 18. Passive b. encouraging c. Mastery of one’s environment. Psychodynamic 3. integrative capacity. Restating b. Permissiveness. Psychodynamic c. Adjustment 11. “Is something bothering you?” c. Active d. patient. Personality d. Strict. Questions 8 – 16 refer to this situation. A week after she received word about her father’s loss of job.” This is an example of a. Latency stage 5. Latency stage 7. A nurse says to the client. Flexible. is the poorest in academics but excels in ward work. Strict. Overcompensation c. 8. Anal stage c. Phallilc d. Omitted c. Different in each other’s needs b. A woman was raped when she was 12 years old but no longer remember the incident. Compensation b. strict but kind d. Samson should understand that the following behavior of her adolescent clients are normal: a. Substitution 12. the mother should be: a. 1. the nurse may ask the following except: a. Ego c. Self-respect. The Conscious self which deals with reality is: a. M. Inflexible. Much like the needs of other difficult c. Repression c. Problem in hearing or speech d. Superego d. When asked what her plans were. she marked. Poor comprehension 16. something?” 17. To help him be aware of this anxiety. basic trust should start to develop during the: a. Samson is the only nurse in the rural health unit. Conflict b. The complete emotional and physical development of an individual is called a. Mary. The community nurse observes that the father of a client is anxious. vague and unexplainable feeling of apprehension and uncertainty experienced by individual termed: a. Ms. Depends more on parents advice d. consistent. Nursing of old clients is more effective when Mr. Oral stage b. “Are you uncomfortable?” d. Decrease neurotic symptoms b. Variation in language b. “Are you upset about e. Suppression b. indulgence. She is using which of the following defense mechanism? a. Parents and others who are taking care of children should understand that negativism via feces retention is a normal behavior during what stage of personality development? a. Mary is using the mental mechanism: a. Projection b. she received word that her father lost his job and could no longer support her in college. Character c. Displacement 15. An unpleasant. Anal stage c. Develop homosexual attraction b. Behavior b. While dancing with her friends. “Tell me more about this pain you have been having. inflexible b. Latency 6. “Why are you restless” b. According to Erick Erickson. narcissism b. Introjection 13. Decrease psychotic symptoms d. Denial d. The following are barriers to effective communication except: a. The major reasons for treating clients with severe psychiatric problem with MAOI is to a. “I’ll think a. She has clients in different stages of personality development. Michael Laboy. diffused. a senior nursing student. Listening c. self awareness d. crisis intervention was done to Mary by the school nurse. rigid.A. ID b. self actualization. Oral stage b. Displacement d. Retentive 14. Incorporation d. avoidance of quick decision 2.N.
friendliness d. delusion. Tell her not to worry with her c. left for Saudi Arabia. Permissiveness of parents towards their children b. the nurse try the following approach: a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Situation: Mr. Prado utilizes which of the following defense mechanism to overcome her conflict? a. maybe considered life threatening d. Recognize early emotional conflicts and meet emotional needs of the child b. hallucination b. 32. has non-organic dysfunction 35. Santos because he: a. The treatment of choice prescribed by the psychiatrist for Mrs. Passivity. Nurse may observe the following symptoms manifested by Mrs. Schizophrenic disorder. Santos a. Conversion disorder c. Involutional psychosis c. psycho physiologic disorder 33. Avoid sharing the house chores with children d. surgical treatment 31. The nurse should use the following attitudes for Mr. Answer that he says the same thing to other nurses b. Give the children opportunities to be independent and assume responsibilities Situation: Jimmy. affective disorder d. Somatoform disorder b. Provide a wholesome environment b. community health worker should educate parent’s to: a. childhood schizophrenia 38. The first priority in the nursing care of Jimmy is to: a. involves central nervous system functioning c. childhood schizophrenia 37. Is not intelligent b. Psychosis c. Talk another topic 24. psychosexual disorder c. a nurse. Fidelity 21. Mrs. Prado a. anxiety. This present attack occurred 3 days after his sister. trusting. Empathy d. major tranquilizer b. Substitution b. To meet Mrs. friedliness. Obsessive-compulsive disorder 26. Limit setting c. Allow her to verbalize feelings d. 25. Sociopathetic personality disturbance-antisocial reaction 20. Tell her there is nothing wrong 29. caution. the nurse should: a. Santos. Hypochondriasis d. anxiety disorder b. An element most critical when talking to psychiatric patient is a. The asthmatic attack started at the age of 5 when his mother started working in a factory as soon as his father died. Safety b. Psychotherapy c. indulgence and pampering b. Give physical punishment to maintain disciple d. Arthritis 27. The illness of Jimmy is an example of a. dependence. undifferentiated b. Anxiety neurosis c. Alcoholic initially exhibit all of the following defense mechanism except 227 . Schizophrenia b. Kindness. The psychiatric would most probably diagnose Mr. Separation from mother after wedding b. parents in the community should be taught to: a. organic disorders d. To prevent anxiety disorders seminar to that Mrs. Tell her relatives to ignore the symptoms b. Refuses help c. None of the above Situation: Mrs. was referred to a psychiatrist by a general practitioner because of severe pain in her right arm specially when moved. He was unreliable and irresponsible in his past jobs. He was sent to the forensic psychiatric ward for observation. ambivalence. Compensation c. has difficulty in relating with others 23. Thank him for his compliment d. Undemanding. Prado would be: a. Assess clients for other signs and symptoms 36. Santos: a. 19. Provide a non stressful environment d. a 32 year old jobless mason. Prado’s disorder could be a. Fulfillment of all wishes and desires of children d. Anxiety. Hallucination. Determine when symptoms appear c. Questions 25 – 31 refer to this situation. suspiciousness 28. Questions 32 – 35 refer to his situation. When Mr. senile psychosis d. A severe disturbance in psychological functioning in which the individual’s ability to distinguish. Santos remarks that the nurse is more patient than the others. Washing expensive clothes d. Conversion d. had been arrested and jailed for various crimes. Have enough people to serve the child at home b. Recently. Mrs. Psychoneurosis b. To prevent Jimmy’s disorders. a 28 year old secretary. ten year old pupil. Teach the child meticulous habit c. The precipitating cause of Mrs. several times. Endeavour to meet the desires of children c. Anxiety. She attributed her illness to typing and washing her expensive clothes. Watchfulness. This started after her wedding when she left her mother who attended to all her needs. was to the community hospital because of an acute asthmatic attack. Remember that Mr. Santos as having: a. electric shock therapy d. is on symbolic level b. Prado’s immediate needs. Avoid disappointing children 34. Santos manipulates people c. Psychotherapy may not be effective for Mr. is very psychotic d. friendliness 22. The illness of Jimmy differs from psychoneurotic disorders in that it: a. immaturity c. Prado was diagnosed as having anxiety disorder with the following specific sub-type: a. After several tests and examinations. delusion d. Prado. One of the major functional psychosis is: a. Typing c. Multiple personality d. Prado. Narcissism. evaluate and test reality is defective: a. he hold up and killed a taxi driver. she was found to have no physical or nerve injury. Isolation 30. carefulness c. Questions 19 – 24 refer to this situation. Cooperation of parents and civic officials in creating constructive changes in the environment c. Which of the following may help in they intervention of the disorder of Mr.
to learn to trust one person. Disturbed mother-child relationship in latency d. 48. schizophrenic paranoid type c. concerned and non-judgment in her attitude towards the patient b. assist him to develop satisfying relations with others d. simple schizophrenia b. encourage independence as much as possible c. 41. The defense mechanism most likely used by this patient include a combination of a. repression and projection b. She believed that the communist had wired the neighborhood and that she had a responsibility to prevent war: she believed that she pregnant in spite of every indication to the contrary: 55. on admission include: a. Projection This significant factor in the development of schizophrenia mentioned above is usually include: a. When Mrs. the nurse must instruct the patient to avoid tyramine-containing foods like. Take over from the patient the responsibility to take care of his needs c. incoherent speech b. Extreme self-centeredness d. Disturbed mother-child relationship in childhood c. This type of schizophrenia: Gen. Catatonic schizophrenia The destructive feature of schizophrenia reactions presents a cycle of extreme withdrawal. characteristics a. Involve him in activities where he can succeed c. becomes extremely suspicious. Leave the patient alone when he is unresponsive d. 43. allow to participate in competitive games d. Cheese c. has no delusions or hallucinations b. L. hebephrenic schizophrenia in one type where: a. All of these 54. delusions d. Disturbed mother-child relationship in infancy b. repression and regression d. Make reality a pleasant experience for the patient b. increase his self-esteem b. Being warn. all of these 52. 42. Altruism c. treat him as an adult and avoid the tendency to take over for him d. Fresh juice d. The nurse may convey this to the patient by: a. suspicious patient d. Short and long term goal(s) that would be helpful in caring for this patient is to: a. L. Neologisms c. Considering the symptom(s) described above. The characteristic symptom exhibited by Mrs. all of these 57. catatonic schizophrenia The distinctive feature of this type of schizophrenia is: a. waxy flexibility d. Auditory hallucination c. is an example of what defense mechanism a. L to join other patients in the social hall c. In addition to this. Do everything to help the patient The basic task of the nurse to show respect to the patient as a person. Rationalization d. L. personality disorganization is most severe b. symptom and extreme psychomotor agitation with destructive and assaulative behavior. helping her relate better with other people 39. with opportunities to be with others all the time 58. the following behavior symptom(s) are present: a. 45. a. Except a. In caring for a withdrawn patient is to: a. you will most likely have the impression that she is a: a. hebephrenic schizophrenia c. schizophrenic b. paranoid 56. L. L. 47. Rationalization c. Lack of interest and feelings b. repression and sublimation c. Denial b. helps Mrs. agitation c. Asks Mrs. had difficulty relating with other people goals to be included in planning for her care should include: a. Because of her difficulty in grasping reality Mrs. allow him to show off his talents 49. to do the activities she likes b. has hallucination only 51. distortions of reality are grossly affected d. Mrs. Hallucination b. altruism c. Avoid all This particular symptom is common among schizophrenia patients: a. Both of these In order to help the patient improve his self-concept. Denial b. 44. L was very withdrawn from the real world around her. paranoid schizophrenia d. Based on the Symptom presented by Mrs. has delusions but no hallucination d. L. none of these When admitted to the hospital. assaultiveness One important goal to help the patient is for the nurse to: a. A only d. Visual hallucination b. provide all his physical needs b. 40. All of these When administering MAO inhibitors. provides Mrs. then gradually others d. thought processes are severely impaired c. Behavior at early infantile level d. L. the nurse may: a. Projection Mafia boss makes large donations to charity. 228 . encourage aggressive activities to overcome his withdrawal Hebephrenic schizophrenia is usually described as having inappropriate behavior or flat effect: 53. repression and introjection 50. Wine b. stimulate him into purposeful activity every day c. Lack of connecting ideas in speech c. Spending time with the patient even if he appears unresponsive c. Involver him in activities with other patient b. Gustatory hallucination d. has delusions and hallucinations c. Insights d. encourage Mrs. the nurse: a. 46. Disturbed mother-child relationship in adolescence The characteristic symptoms of schizophrenia as described by Eugene Bleuler include: a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out a. Hallucinations and delusions b.
Educational background 72. 61. “I can see you feel tired. After the assessment and the admitting procedures were completed. the patient shouted: “You want to kill me _ just like them?” this is a. A token economy system is based on the principles of a. Denial c. Sublimation 74. To alleviate this. The nurse should avoid laughing or talking with others c. Ethnic background b. 60. 229 . 67. then gradually with other e. leave the patient alone. When this occur the nurse should do one of the following: a. a paranoid delusion c. The nurse should watch the patient closely to prevent suicide d. a persecutory delusion In a situation like this. Altruism b. Clozapine(Clozaril) 71. and un-systematized delusions b. Haloperidol. She will spend time with him each morning from 10:00am until 10:30pm in a specific corner of the dayroom. Psychoanalytic theory c. flight of ideas b. Ill check on you later because I’m also busy. Which of the following is the desired effect of antipsychotic drugs? a. Denial c. Increase the level of melatonin d. 65. Increase the level of dopamine Situation: Patient Mario is admitted for alcoholism. he might refuse his meal. 64. Guilty feelings alleviated by unsolicited generosity towards others a. leave the patient until his symptom subsides d. ideas of reference d. Attempt to establish trusting relationship d. delusions are not true c. an anti depressant drugs is ordered such as a. Provide a structured environment b. unreasonable. One morning a patient says to the nurse. “Go away and leave me along. thus. does not argue or disagree with patient d. Saying the job was not important anyway. all of these In spite of his delusion the nurse can help the patient to take his medications regularly by a. Rationalization 73. “What seems to be your problem” d.” The nurse responds therapeutically when she replies a. a delusion of grandeur d. well systematized delusion c. after getting fired a. None of these Basically a paranoid patient like Mrs. Imipramine hydrochloride b. The patient’s behavior mentioned above is a descriptive example of another symptom characteristic of paranoid schizophrenia called: a. 66. helping her to develop a trusting relationship d. can be dominating and manipulative b. presents reality b. Socio-economic level c. can be hypercritical and destructive d. Denial d. L. Diazepam (Valium} c. Instill hope in daytime c. “Why do you want me to leave?” 70. the nurse needs to: a. b. orient the patient to reality b. 76. Displacement b. let patient watch other patient eat their meals d. Before the nursing aide could leave the room. Lowers dopamine receptors b. The nurse should not listen to the patient because he has impaired thinking b. In assessment of a person in crisis which one of the following information is most important? a. explain to the patient that everyone shares the same food c. Clinical depression is common among bulimic patient. Regression d. delusions are protective d. Humor c. requesting for an order for injections if patient refuses for medication telling the patient he can not leave the ward unless he takes his medication telling the patient he will be given ECT if he does not take his medicines d. (Haldol) b. Increase the level of serotonin c. Turning back the maturational clock and going back to earlier modes of dealing with world a. Hallucination b. another paranoid patient was severed his food on an individual tray from the hospital kitchen. with one person. it would be helpful for the patient if the nurse: a. 62. associative looseness c. does not mix medication with food c. All I want is to rest. helping her with reality testing c. 59. presents: a. the nurse explains that she will try to be available to talk with Mario when needed. delusions are pure imagination by the patient One day.” b. offer him canned food or foods in shell c. none of these 68. Life experiences d. severe regressive behavior d. Sublimation 75. Projection b. all of these One caution the nurse should take in dealing with paranoid patients is: a. projection 69. 63. The main rationale for communicating these planned nursing interventions is to a. Provide time for completing nursing responsibilities 77. “I am going to stay with you for a while” c. ignore the patient It is important for the nurse to take note that paranoid patients in general: a. psychomotor The paranoid patient has tendency to present persecutory delusions of being poisoned. delusion cannot be reasoned away b. Reaction formation d. tell the patient she may not leave the room until she eat In the planning further care for this patient.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out b. all of these Which of the following concepts is important for the nurse to remember in working with a patient who is delusions? a. he will eat when he is hungry b. may have grandiose delusions c.
Isolation d. Tantrums c. Dissociative disorder b. Redemption of token for concrete rewards. Interpersonal. Projection Proclaiming logical reasons for actions actually performed for other reasons. Denial b. 89. Systematic desensitization d. Based on the above finding. 88. Referral for evaluation for electroconvulsive therapy 82. 94. Fine tremors. When did first started drinking?” d. 86. How should the nurse responds? a. 91. Projection An unacceptable internal impulses is attribute to an external source a. 93. being a nurse she should a. Identification Describing murder in graphic details with no emotional response a. Stay clean of processed foods d. During the panic attack it’s primary responsibility of the nurse to a. vomiting. nausea. Restless shuffling gate and involuntary movements There is aware that lithium is contraindicated when patient exhibit dysfunctions of the a. GI system b. Fixation d. Continue administering the medication as ordered Early signs of lithium toxicity include a. Isolation d. ]I’d like to learn more about how your drinking behavior. Recently she has been increasingly afraid of riding elevator. The success of token economy system depends on a. Call the physician immediately to report the laboratory result b. Identification Partially remaining at a more childish level of development a. dizziness and trembling while in the elevator. Tina was examined by an emergency department physician who found no physiologic basis for her symptoms. This morning. Flexibility of the staff members in allowing for slippage when the patient is having a difficult day 79. palpitations. Projection Modeling behavior after another person a. 92. Psychosocial theory c. 230 . the nurse notes that her serum lithium is 1mEq/liter. One week after Tere begins taking lithium. such as candy. Displacement b. Displacement c. Behavioral modification theory d. The psychiatrist order lorazepan (Ativan) 1 mg orally three times a day. 87. Fixation b. 96. soda. she experienced shortness of breath. Isolation d. Tina begins outpatient counseling session with psychiatrist. Let the patient verbalize d. This is common during the withdrawal phase of alcoholism” b. Compulsive disorder d. and diarrhea b. Flooding/Implosion b. Reaction Formation d. Avoid caffeine intake 83. Avoid dried products b. Reproductive system c. You may see and feel things that aren’t real?” Situation: Tina is the new staff nurse of unit on the 28th floor of St Lukes. Denial c. Idolization d. Group therapy c. Denial b. Stay with patients b. Modelization b. Tantrums c. usually to avoid self-blame a. Setting behavior goals high enough to motivate the patient d. Group therapy c. Referral for evaluation for ECT 84. Displacement Avoidance of awareness of some painful reality a. While Tina is taking the medication. Endocrine system d. Systematic Desensitization d. Modelization b. Isolation c. Psychoanalytical oriented psychotherapy b. Reactivation d. Get anti manic medication c. Projection Mother yells at a child because she is angry at her husband a. Denial c. Respiratory system A man who want another women thinks his wife is cheating on him a. Denial c. Isolation d. Displacement A common reaction in newly diagnosed AIDS and cancer patient a. “Of course it’s normal. Phobic disorder c. 90. Tantrums c. 80. theory 78. I don’t see anything because your skin is clean” c. Ataxia. Consistency of all staff members in rewarding targeted behaviors b. a. Observe the patient closely for signs of lithium toxicity Withold the next dose and repeat the blood works d. Avoid fermented drinks c. Refer it to the physician 85. How should the nurse respond? . “I wouldn’t be too concerned at this point. Somatization disorder 81. Tantrums c. Denial c. Mario is complaining of bugs along the skin. Denial b. Rationalization b. Rationalization b. Isolation d. Tina is most likely suffering from a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out b. 95. or others snacks c. Which nursing intervention would be most helpful in reducing Tina’s levcel of anxiety a. confusion and seizures c. This therapy of continous rapid presentation of the phobic stimulus may show quicker results but relapse is more common or client may become terrified and withdrawn from therapy a. “You are experiencing alcohol withdrawal. Elevated white blood cell count and orthostatic hypotension d.
A 13. D 48. B 31. Miss Washington has not explained the purpose of the group clearly enough. The patient is showing signs of which of the following a. A 55. Abels has monopolized most of the conversation in the group. A 84. Anger c. the nurse observed a patient to have extra pyramidal side effects. D 89. B 70. D 20. Displacement c. 101. A 12. d. Pankowski tells everyone of his apprehension about going to visit his daughter for a weekend. D 67. “Did I say something wrong?” c. B 98. Abels’ comments. D 54. B 44. “How could he do this to me? I just won’t have it. b. B 28. let’s go play some cards. D 23. C 73. What is the best nursing response when initiating contact with her? a. A 15. A 63. C 77. An interpretation of these comments is not possible after only one meeting. A 94. B 25. Take him aside and kindly tell him that the others deserve a chance to talk. D 95. Thomas. Socio-cultural history if each resident.” 110. “I’ll stay with you for awhile. Tell her. “What were you thinking just now?” 107. 109.” or. Ask her. C 58. d. B 8. Anorexia b. d. D 86. Over period of several weeks. B 56. Sanchez most likely displaying at this time? a.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out 97. Abraham. Abels to another group. c.” d. “Tell me more about your anger. C 104. B 45. Dissociation c. How might the group facilitator best handle this? a. A 87. the purpose of the group is to promote social interaction. The reason for each resident’s admission to the nursing home. A 11. D 65. RN. B 26. A 50. Seizures SITUATION: Joan Washington. Mrs.” b. B 49. Thomas begins to become more reclusive and refuses to leave her room. Thomas. C 107. b. D 66. Fixation 99. D 64. B 18. A 5. Suspicious b. A 76. Which of the following best describes Mrs. Ignore Mr. A 38. The residents are anxious (a typical response). Temporary. Mrs. C 17. “Come. After the initial assessment Mr. Tell her. B 105. D 59. B 62. c. Regression c. Resolution Answer Key: PSYCHIATRIC NURSING Set 1 1. Resistant 106. D 102. D 68. has been assigned as co facilitator for a group of elderly residents in a local nursing home. Mrs. Which of the following information would be most useful to discuss at today’s client-care meeting? a. Anemia c. C 69. D 42. Incongruent d. B 53. During one group. “Have you ever had those feelings before? d. Thomas. tell Mr. D 19. A 97. Which of the following stages of the grief reaction is Mrs. A 10. B 92. A 34. A 33. B 41. Mrs. A 79. C 14. Transfer Mr. what would be an appropriate response for the nurse to make? a. Mrs. “I wonder what you’re really thinking. Miss Washington introduces herself and asks each member to do the same. b. Continue to allow her time to formulate her thoughts. What is the best response to this behavior? a. C 106. C 2.” d. Parkinsonism d. D 32. B 103. A 75.” Why so we need to come to this group anyway?” This behavior probably means.” 108. “Mr. A 27. “I’ m concerned about your silence. C 82. C 74. drastic changers in personality. too. C 36. Thomas’ behavior? a. Suppression b. 102. Denial d. Pankowski how you handled similar feelings. D 46. Thomas reflects on what the nurse has said and begins to think. D 109. B 7. D 52. B 99. The usual activity patterns of each resident.” Just say the first thing that comes to mind. B 9. 103. The group of residents is composed of eight men age 70 to 85. D 83. even though she is smiling. A 90. D 80. She says she is quite angry and thoroughly disgusted. “We wouldn’t let you go if you weren’t able. c. Mrs. Psychological testing d. Demanding c. SITUATION: Jane Thomas is 57-year-old woman who was admitted to the psychiatric unit the weekend. C 93. B 6. C 57. C 72.” b. What information might be useful to the nurse at this time? a. B 40. C 78. memory. “You tell us the leader. The interaction patterns in the group. What would your best response be? a. B 24. Denial d. C 110. Approaches for present behavior. “Your smile does not seem to match what you are saying. C 105. Tactfully share your perception with the group and wonder aloud why they let it occur. C 3. C 39. B 16. Villareal suddenly kicked a chair because the nurse wont listen to her a. the only responses she receives are comments such as. A 47. When Miss Washington asks the group what kinds of things would like to focus on.” b.” c. After taking haldol. D 35. After 1 minute. A 61. B 81. D 22. Diagnosis b. Denial b. Case history c. A 108.” d. Denial b. C 29. Bargaining d. Villareal suddenly urinated on his pants a. B 37. Thomas. Disposition d. 231 . Projection 100. C 60. A 96.” c. D 91. B 4. C 21. The residents are angry about being in the group. B 51. A 85. Reaction formation b. C 30. Mr. Mr. A 71. b. “Maybe others in the group have had similar feelings. Mr.” 104. B 100. consciousness or motor behavior to avoid emotional stress a. “What’s on your mind?” SITUATION: Ruby Sanchez comes to the mental clinic and relates that since the death if her husband she feels really miserable. “Have I done something to frighten you?” c. Displacement 98. During the first meeting. C 43. and they will occur often. C 88. C 101. She states in a loud voice. a.
urinate. unconscious –cannot recall repression – involuntary forgetting of something unpleasant experience ex.do what you want B.Far Eastern University-Institute of Nursing In-House Nursing Review Hand-out Morally and ethically acceptable behavior Conscience . highest level of awareness 3. smoke. SIGMEUND FREUD: Psychoanalytic Stage 2. have sex pleasure principle .think before deciding Ego eat. conscious – easy recall of events . forgot the name of ex-boyfriend’s present girlfriend (third-party) suppression – voluntarily or conscious forgetting of unpleasant experience Mind-Setting 232 . drink.is it good or bad? Superego -conscious .what is more beneficial in touch with reality . pre-conscious –about to to recall certain events 4.
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