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A. Neurotransmitters 8. Agreeing: telling client know that you think, feel alike; nurse
verbalizes agreement
Dopamine Dopamine is generally excitatory and is 9. Disagreeing: letting client know that you do not agree; telling
synthesized from tyrosine, a dietary amino acid. client that you do not believe he is right
* Antipsychotic medications work by blocking 10. Probing: questioning client about a topic he has indicated he
dopamine receptors and reducing dopamine does not want to discuss.
activity. 11. Denial: refusing to recognize client’s perception
Norepinephrine It plays a role in mood regulation. 12. Changing topic: letting client know you do not want to discuss
a problem by introducing a new topic.
Epinephrine Controls the fight-or-flight response in the
peripheral nervous system.
Serotonin The function of serotonin is mostly inhibitory, D. Defense Mechanism
involved in the control of food intake, sleep and
wakefulness, temperature regulation, pain Denial: Refusal to acknowledge a part of reality
control, sexual behavior, and regulation of Repression: threatening thoughts are pushed into the
emotions unconscious, anxiety and other symptoms are observed; client
Acetylcholine It can be excitatory or inhibitory. It is unable to have conscious awareness of conflicts or events that
synthesized from dietary choline found in red are source of anxiety
meat and vegetables and has been found to Suppression: consciously putting a threatening / distressing
affect the sleep-wake cycle and to signal muscles thought out of one’s awareness
to become active. Rationalization: Developing an acceptable, justifiable (to self)
Gamma- Is a major inhibitory neurotransmitter in the reason for behavior
Aminobutyric brain and has been found to modulate other Reaction-formation: engaging in behavior that is opposite of
Acid (GABA) neurotransmitter systems rather than to provide true desires
a direct stimulus. Sublimation: anxiety channeled into socially acceptable
behavior
Compensation: making up for a deficit by success in another
field/area
B. Therapeutic Communications Projection: placing own undesirable trait onto another;
blaming others for own difficulty
1. Silence: client able to think about self/problems; does not Displacement: Directing feelings about one object/person
feel pressure or obligation to speak towards a less threatening object/person
2. Offering self: offer to provide comfort to client by presence. Identification: taking onto oneself the traits of others that one
3. Accepting: Indicate nonjudgmental acceptance of client and admires
his perceptions by nodding and following what client says. Introjection: symbolic incorporation of another into one’s
4. Giving recognition: indicate to client your awareness of him personality
and his behaviors. Conversion: anxiety converted into a physical symptom that is
5. Making observations: verbalize what you perceive motor or sensory in nature
6. Encourage description: ask client to verbalize his perception Symbolization: representing an idea or object by a substitute
7. Using broad openings: encourage client to introduce topic of object or sign
conversation Dissociation: separation or splitting off of one aspect of mental
8. Offering general leads: encourage client to continue discussing process from conscious awareness
topic. Undoing: behavior that is opposite of earlier unacceptable
9. Reflecting: direct client’s questions/ statements back to behavior or thought
encourage expression of ideas and feelings. Regression: behavior that reflects an earlier level of
10. Restating: repeat what client has said. development. Adults hospitalized with serious illnesses
11. Focusing: encourage the client to stay on topic/point. sometimes will engage in regressive behaviors.
12. Exploring: encourage client to express feelings or ideas in more Isolation: separating emotional aspects of content from
depth cognitive aspects of thought.
13. Clarification: encourage the client to make idea or feeling more Splitting: viewing self, others, or situations as all good or all
explicit, understandable. bad.
14. Presenting reality: report events/situations as they really are.
15. Translating into feelings: encourage client to verbalize E. Therapeutic Nurse-Patient Relationship
feelings expressed in another way.
16. Suggesting collaboration: offer to work with client towards
Three (3) phases of nurse-client relationship
goal
POSSIBLE TOPICS ON PSYCHIATRIC NURSING FOR THE UPCOMING JULY 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE
students on the possible topics that might be part of the upcoming July 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
JULY 2012 PNLE PEARLS OF SUCCESS
Transeference: occurs when client transfers Characterized by hyperactivity and euphoria that may
conflicts/feelings from past to the nurse. become sarcasm or hostility
Example: client becomes overly dependent, clinging to nurse Assessment findings
who represents (unconsciously to client) the nurturing client Hyperactivity to the point of physical exhaustion
desires from own mother. Flamboyant dress/makeup
Sexual acting out
Countertranseference: occurs when nurse responds to Impulsive behaviors
client emotionally, as if in a personal, not Flight of ideas: inability to finish one thought before
jumping to another
professional/therapeutic relationship.
Loud, domineering, manipulative behavior
Example: Nurse is sarcastic and judgmental to client who has a Distractibility
history of drug abuse. Client represents (unconsciously to Dehydration, nutritional deficits
nurse) the nurse’s brother who has abused drugs. Delusions of grandeur
Possible short-term depression (risk for suicide)
Hostility, aggression
F. Anxiety
Experienced as a sense of emotional or physical Nursing Intervention:
distress as the individual responds to an unknown
Determine what client is attempting to tell you; use
threat or thwarting of unmet needs. active listening.
Assist client in focusing on a topic
Levels of Anxiety
Offer finger foods, high-nutrition foods, and fluids.
Provide quite environment, decrease stimuli
Mild Increased awareness; ability to solve problems,
Stay with client, use silence
learn; increase in perceptual field; minimal muscle
tension.
Remove harmful objects
Moderate Optimal level for learning, perceptual field narrows
Be accepting of hostile statements.
to pay attention to particular details, increased
Do not argue with client
tension to solve problems or meet challenges.
Use distraction to diver client from behaviors that
Severe Sympathetic nervous system (flight/fight are harmful to self or others.
response): increase in BP, pulse and respirations;
Administer medications as ordered and observe for
narrowed perceptual field, fixed vision, dilated effects/side effects.
pupils, can perceive scattered details or only one Teach clients early sings of toxicity
detail; difficulty in problem solving. Maintain fluid and salt intake
Panic Decrease in VS (release of sympathetic response), Avoid diuretics
distorted perceptual field, inability to solve
problems, disorganized behavior, feelings of
Monitor lithium blood levels
helplessness/terror.
Assist in dressing, bathing
Set limits on disruptive behaviors.
Nursing Interventions:
Determine the level of client’s anxiety by
assessing the verbal and non-verbal behaviors
and physiologic symptoms.
Determine cause of anxiety with client.
Stay with client.
Reduce anxiety by remaining calm yourself, use
silence, or speak slowly and softly.
Help client recognize own anxious behavior.
POSSIBLE TOPICS ON PSYCHIATRIC NURSING FOR THE UPCOMING JULY 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE
students on the possible topics that might be part of the upcoming July 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
JULY 2012 PNLE PEARLS OF SUCCESS
POSSIBLE TOPICS ON PSYCHIATRIC NURSING FOR THE UPCOMING JULY 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE
students on the possible topics that might be part of the upcoming July 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
JULY 2012 PNLE PEARLS OF SUCCESS
Amenorrhea
Nursing Interventions:
Monitor VS N. Child Abuse
Measure I&O
Nursing Assessment:
Weigh client 3 times/week at the same time
(check to be sure client has not hidden heavy Physical Abuse Sexual Abuse
objects or water loaded before being weighed, Pattern of bruises/welts Pain/itching of genitals
weigh in hospital gown). Burns (cigarette, scald, rope) Bruised/bleeding genitals
Do not comment on weight loss or gain. Unexplained Stains/blood on underwear
Set limits on time allotted for eating. fractures/dislocations Withdrawn or aggressive
Record amount eaten. Withdrawn or aggressive behavior
behavior Unusual sexual behaviors
Stay with client during meals, focusing on
Unusual fear of parent/desire to
client, not on food. please parent
Accompany client to bathroom for at least ½
hour after eating to prevent self-induced Nursing Interventions
vomiting. Provide SAFETY ENVIRONMENT
Individual/family therapy may be necessary. Provide nursing care specific to
Encourage client to express feelings. physical/emotional symptoms
Help client to set realistic goal for self and to Conduct interview in private with child and
reduce need for being perfect. parent/s separated
Encourage client to discuss own body image; Inform parent/s of requirement to report
present reality; do not argue with client. suspected abuse.
Teach client relaxation techniques. Do not probe for information or try to prove
Help client identify interests and positive abuse
aspects of self. Be supportive and nonjudgmental
Provide referrals for assistance and therapy
M. Alcohol Withdrawal Syndrome
POSSIBLE TOPICS ON PSYCHIATRIC NURSING FOR THE UPCOMING JULY 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE
students on the possible topics that might be part of the upcoming July 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
JULY 2012 PNLE PEARLS OF SUCCESS
O. Personality Disorders
POSSIBLE TOPICS ON PSYCHIATRIC NURSING FOR THE UPCOMING JULY 2012 PNLE
*Patterned on the previous board exams from December 2006 – December 2011… the purpose of this note is to GUIDE
students on the possible topics that might be part of the upcoming July 2012 PNLE