ZOOM session psychology 10/5

1. If a patient who is depressed says, “I don’t feel like my life is worth living anymore” what is the most therapeutic response
by the nurse?
a. “I value your life and I am concerned that you are concerned.”
b. To empathize, reflect and value their statement and focus on their feelings and showing empathy. By reflecting you are
allowing them to explore what they feel further.
c. Therapeutic communication is never closed ended questions (always reflecting) Listening, reflecting, and exploring
further

2. When someone has an outburst in an inpatient ward, what is a therapeutic intervention? A client who has an escalation of
anger in an inpatient unit. What is the most therapeutic response?
a. Showing empathy for the outburst and finding out what is causing this display of anger (being present to find out
what the issue is)

3. Seyle stress adaptation – alarm stage, resistance stage, exhaustion stage – a patient is complaining to you that they are
losing sleep and have muscle aches and headaches, missing work and physically unwell. = exhaustion stage

4. Legally, when can someone be taken from their home and to a hospital from their home against their will (section-12 =
healthcare provider) section 32 if its by a family member. A person is vocalization suicidal ideations, a threat to others,
delusional and unable to care for themselves (bathe) = criteria for involuntary admissions that can result in bodily harm to
themselves, or others can cause a 72 hour hold for an evaluation

a. Family member not taking their medications because they don’t want to (NO)
b. Actively trying to end their lives by not taking their medication (schizophrenic, or manic state)

5. When are providers allowed to break confidentially?

a. Clients divulge to them that they are going to harm others

6. Mental health patients seeking treatment in the ED (usually not taken as priority because their illness cannot be seen)
a. They are often competing with medical patients and not likely to go to the ED as much where they feel the stigma

- SSRIs SNRIs = first line / TCA = NOT first line because potential for abuse is high /
7. MAOIs – food interactions (tyramine = aged foods, hard cheeses and meats, salami, olives wine, cured meats cannot be
eaten with MAOIs) cured meats, pepperoni, red wine
a. PEPERONNI = NO MAOIs

8. Suicide and depression when a person talks about “doesn’t want to be here anymore” – TALK ABOUT it FIRST AND MOST
a. Are you thinking of harming yourself (or killing yourself) Best response answer, NAME, are you thinking of harming
yourself, are you thinking of killing yourself
b. NO TELL ME MORE (NOT OPEN ENDED)

9. When someone has depression on an inpatient unit, what’s the best care plan to get them to do their ADLs. They have
Anergia (lack of energy) care plan when a person wont or cant get out of bed.
a. Hygiene, getting dressed and getting out of bed “I will help you get out of bed, I will help you get dressed.”
b. No threatening
c. No seclusion

10. If someone is newly admitted to an inpatient unit and you are trying to assess them for risk of suicide, what is the one thing
you need to know from their history to determine their risk of suicide?
a. Have they had any history of suicide attempts?

- Chronic stress will lead to a decreased immune system – leaves you susceptible to lower immune responses
11. You have a patient who is experiencing chronic stress which physical finding will this person exhibit which physical
finding would you expect? Fever?

12. You see your patient has completed their ADLs and used good hygiene, what is your most therapeutic response?
 a. “I see you are well groomed today” “I see you are groomed today” (Simple reflection and exploring)  open ended and
therapeutic because you are giving a positive recognition

13. ECT side effects  temporary and short-term memory loss, temporary confusion, transient headache SATA

14. Someone who has MDD and might have attempted suicide and did not complete the suicide, they are not happy about still
being alive “I don’t know why I am still here, and I feel like I should have died” what is your response?

a. NEVER IS A CLOSED ENDED QUESTION! Why?

b. NEVER POSITIVE RESPONSE
Reflective open-ended and emphatic answer that encourages further discussion “I hear what you’re saying that your life
has no meaning” Patient says their life has no meaning and they feel worthless  reflection is saying so you’re telling me
that you feel like your life has no meaning

15. Supporting your patients wish to be their own boss, to not take medications, to not follow the prescribed course of
treatment, competent – autonomy?

16. You are admitting a patient with severe depression – be with them, talk calmy, short direct communication, offer them time
and direction

17. If a patient is in their room and they look overwhelmed and you walk by and they say “I don’t feel well, I do not want to talk
now” what is your response as the nurse?

a. Nonverbal communication (offer silence/ reflection) “I hear you and I am going to stay here in case you do want to talk”
you’ll stay with them but not talk unless they wish

18. Children and adolescents and depression = 3 major differences: depressed teens are irritable and critical and sarcastic and
abusive to their friends and family, appear restless and agitated and angry, fidgety SATA! Irritability & low self-esteem &
restless at night/ bad dreams (difficult sleeping) 3 criteria

19. What are the major risk factors for suicide in general?

a. Males are at a higher risk (they complete it more) male gender, group 55+ older (not the 85), schizophrenia Major risk
factors for suicide in general  schizophrenia, men, 55+

20. Someone comes into the facility, and they report they are sad, moody and depressed. What is your priority nursing
assessment?
a. SAFTY!! (Suicide risk)

21. Mental status examination (altered LOC) when you check an MSE (mental status exam) – level of orientation A&O x 4, long
term memory, recall ability, ability to perform calculations. Repetitions and calculations, orientations, NOT COPING SKILLS
Patient with dementia  MSE is assessing the LEVEL OF orientation, calculation, long term memory, and recall

22. ECT – major side effects (Temporary memory loss**), headaches

23. A patient is saying they have no desire to continue living and are helpless and hopeless, what is your follow-up to that?
 DIRECT QUESTIONS about if they have plan or intent to harm themselves or commit suicide ( even if it vague or not
vague statements)

24. Wellbutrin  works on dopamine and norepinephrine (do not touch serotonin at all) so it works quicker  educate them
they might feel antidepressant effect in a couple weeks (less than the four weeks of Prozac) educate them it would take half
the time of traditional antidepressants

25. Someone has had a suicide attempt what kind of precautions? Suicide precautions = priority action of the nurse would be
with a known suicide attempt then its  suicide precautions until proven otherwise

26. Patient is having an outburst and theows a chair and your choices are  seclude, restrain, medicate, empathize with
patient, and attempt to deescalate.
27. What patient is at highest risk for suicide?

a. Patient who is passively suicidal/ depressed, don’t care if they don’t wake up, but do not have a plan.
b. Depressed and angry or depressed and impulsive Then you have patients who are inherently angry and quick/impulsive
= they are at more risk for suicide or self-harm.

Before you are able to form a therapeutic relationship with a patient or client, what do you need to know most – NEED TO
KNOW YOURSELF FIRST BEFORE YOU KNOW THE PATIENT. Don’t bring in your own personal values so you will be biased.
Aware of your own shit. Before you can have a therapeutic environment with your patient, what do you need to undersnd
about yourself?

28. When are mechanical restraints an option? When there is completely destructive behavior and you have tried every other
intervention (protecting everyone else around that person)

ZOOM recording from 10/12

29. Patient who is depressed – want to take them somewhere quiet and private

30. You have a patient who is making negative bold statements that are concerning – what is the best repones?
 this is very concerning for me, I care about you, can you please tell me more

31. If someone is (anxious) pacing the hallways – what is the best response to a person who needs some redirecting but says “I
don’t want to talk about or be around anyone right now”  when you’re ready ill be here

32. A crisis intervention for someone who has acute anxiety (red flag buzzwords = acute anxiety & crisis intervention)

 SAFTY / PROTECTING PATIENT FROM HARM (automatically)

33. When someone experiences outward anger or hostility  its due to inward pain – nurses first response is to try to get at
the core of what is causing the outward display. A patient is having an outburst on an unit = empathy

34. A patient who is calling in sick to work, running low grade temp, sleeping. If they experienced an external stressor, what
stage would they be in?

35. According to Maslow’s which patient on a psych unit would need priority intervention by the nurse

36. Mental health patients have gone to the ER less and less because they feel like they aren’t getting the same care as medical
patients – why do you think the stigma is true?

 they see themselves competing with the medically ill patients for the time and feel they don’t take priority (because you
cant see it)

37. When (disorder) affects your ADLs and PROPORTION  when it impairs your reality and when it impairs your normal life
functioning (depression and anxiety)

38. If someone tells you they would be better off dead or better off gone  what is your first response. ARE YOU THINKING OF
HARMING YOURSELF

39. A patient in bed for weeks, not showering with severe depression  how would you give that information to a patient who
had severe depression  sit at their level, eye contact, speaking slowly and with simple direct

40. Have someone who is feeling sad but they don’t want to talk now – I’ll stay for a few minutes and you let me know if you
change your mind, and if you don’t then ill move along

41. A patient comes on the unit and has OCD  how will you make their schedule? Allow leeway and planning for them to
explore their rituals into their schedule (at least first)
42. Agoraphobia (fear of being somewhere where you can not readily escape from) a patient who is getting ready for discharge
and you’re writing what her goals  don’t make the goals too high ex: sitting on a park bench

43. Bipolar patient who is in the manic phase (loud, fast, disruptive) what room assignment should they be given? 2 choices
semi private room 2 choices are private room  private room that is QUIET (want less sensory stimulation i.e. not the room
across from the gym)

44. Fear of a specific phobic stimulus

45. Lithium – used for bipolar disorder – need to monitor the blood levels to watch for toxicity  know the lab levels!

46. A bipolar Patient coming to you at 330 in the morning, demanding you call doctor immediately – what is the response of
the nurse – EMPATHETIC RESPONSE “I can see you are very upset, can you tell me more..”