Mental Health Nursing Practice Exam

Mental Health Nursing Practice Exam

A few weeks ago, you wrote a result note for a patient. Where can you find the text of this result note now?

Chart Review

In which activity will you document the administration of an immunization?

Immunizations

When working in a telephone or refill encounter, what do you need to do to ensure that the encounter will be routed to the intended recipient?

Send and close the patient workspace

How can you tell when a patient has arrived at the clinic and is ready to be roomed?

The status column changes to Arrive

When choosing the Letters action in In-Basket what activity does it take you into to complete the letter?

Communications

You are reviewing a patient’s result in your In-Basket and want to send it to MyChart. Which button should you click?

Result Release

You are working in a telephone encounter with a patient. In which section of the telephone encounter navigator should you document that you received an incoming call from the patient?

Contacts

You’ve been included as a recipient of a result note. In which In-Basket folder would you find the note?

Result Notes

You are working with a physician for the first time today, and need to be able to see her schedule. What steps should you take to accomplish this?

In the department folder, find the physician and drag and drop the provider on to your My Patients for today

T or F – You can access the letters active from an In Basket Results message.

True

You send a patient’s prescription request to a physician. The physician approves the prescription. In which In Basket folder do you receive notification approval?

Rx Response

If a patient has a standing order for a lab test, you can release one of the orders from ?

Order Review

T or F – The most efficient way to view information about allergies or medications for a patient is to double-click the appointment from the schedule.

False

T or F – In the navigator’s Allergies section, click Mark as Reviewed only when you have added a new allergen.

False

When documenting the administration of a medication, which pieces of information can you enter?

Site/ Dose/ Billing Code

Your patient tells you that she takes an over-the-counter medication. In which navigator section should you document this?

Medications

If your patient cannot remember the exact date of the appendectomy he had when he was eight years old, what should you enter in the date field of the surgical history ?

The date is free text, so enter “Age 8”

You are the last person to work with this patient in this room / You plan to return soon to work more with this patient

Click Secure instead of Log Out when…

A patient presents sick visit complaining of a sore throat and fever. Where would you document these symptoms to trigger History of Present Illness forms in the NoteWriter?

List sore throat and fever as Chief Complaints

The physician told you to do a point of care test (she already ordered it). Now you received & have the results and need to record it in Epic. In the patient’s workspace, in which activity do you do this?

Enter/Edit Results

T or F You can find results notes in Chart Review?

True

When working in sections that have a lot of fields, like the Vital Signs section, what is the fastest way to move from one field to the next?

Press Tab

T or F – In order to document a historical administration of an immunization reported to you by your patient, you must first place an order in Order Entry.

False

When working with a pool message in the Results folder, to indicate to other members of the pool that you are following up on a message, what SHOULD you do?

Take responsibility for the message

What is the most efficient way to include the text of a Pt. Call Back message in the documentation of the telephone encounter?

With the message selected, click Tel Call (Telephone Encounter) and click Yes when asked to include the message in the documentation.

A state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community

mental health – WHO

10 components of recovery (SAMHSA, 2011)

self-directed
2. individual- and person -centred
3. empowering
4. holistic
5. nonlinear
6. strengths-based
7. peer-supported
8. respect
9. responsibility
10. hop

the quantitative study of the distribution of mental disorders in human populations

epidemiology

Freud’s Psychoanalytic Theory

– advanced the first theory of personality development

– articulated levels of awareness (unconscious, preconscious and conscious) and demonstrated the influence of our unconscious behaviour on everyday life, as evidence by use of defence mechanisms

– identified 3 psychological processes of personality (id, ego, superego)

– 5 stages of psychosexual stages articulate developmental theories of personality

Erikson’s Ego Theory

– expanded on Freud’s developmental stages to include middle age through old age

– called his stages psychosocial stages and emphasized the social aspect of personality development; development extended beyond the Mother/Father/Child triangle and included society that occurred throughout the lifespa

Harry Stack Sullivan’s Interpersonal Theory

the foundation of Hildegard Peplau’s nursing theory of interpersonal relationships

– focuses on interpersonal processes that can be observed in a social framework believing that therapy should educate patients and assist them in gaining personal insight

– the nurse must interact with the patient as an authentic human being; mutuality, respect for the patient, unconditional acceptance, and empathy

Tidal Model

created by Phill Barker II (used at ROH)

focuses on the lived experience of the person-in-care and is based on the assumptions that people are their life stories and that they generate meaning through such stories

10 commitments:
-Value the voice
-Respect the language
-Develop genuine curiosity
-Become the apprentice
-Reveal (the person’s) personal wisdom
-Be transparent
-Use the available toolkit (the person’s story – what has worked)
-Craft the gift of time (reframing how we see time – how do we use this time?)
-Know that change is constant

Hildegard Peplau’s theory of interpersonal relationships in nursing

the theory that is mainly concerned with the processes by which the nurse helps patients make positive changes in their health care status and well-being; illness offers a unique opportunity for experiential learning, personal growth, and improved coping strategies that psychiatric nurses play a unique role in facilitating

an interpersonal relations in nursing model that comprises three overlapping themes:

1. the orientation phase

2. the working phase

3. the termination phase

Pharmacodynamics

refers to the biochemical and physiological effects of drugs on the body, which include the mechanisms of drug action and its effect

Pharmacokinetics

refers to the actions of the body on the drug and involves absorption (how much of the drug enters the circulation) and distribution of an administered drug

determines the blood levels of drug, therefore determines dosage

Anti anxiety and Hypnotic Drugs

GABA is the major inhibitory neurotransmitter in the CNS; include 4 types:

1. benzodiazipnes
2. short-acting sedative-hypnotic sleep drugs
3. buspirone hydrochloride
4. SSRI’s

Benzodiazepines

promote the activity of GABA by binding to a specific receptor on the GABA(A) receptor complex and results in inhibited cellular excitation because neurotransmitters cannot be released leading to a calming effect

at higher doses, all cause sedation (hypnotic effect); effective as anticonvulsants for their ability to reduce the neuronal overexcitement of alcohol withdrawal

Benzodiazepines

– diazepam
– clonazepam
– alprazolam
– lorazepam
– temazepam
– triazolam
– nitrazepam
– oxazepam

zopiclone

a short-acting sedative-hypnotic sleep drug, termed z-drug

it is unrelated to existing hypnotics, but promotes GABA and inhibits the release of neurotransmitters with a fast onset of action

2 hour half-life; causes unpleasant bitter taste upon awakening

Buspirone hydrochloride

an anxiolytic drug that is used for the short-term relief of excessive anxiety without having strong sedative-hypnotic properties; does not leave the pt sleepy or sluggish (not a CNS depressant)

mechanism is not clearly understood, but seems to moderately enhance the effects of serotonin; so-called a partial serotonin agonist

Anti-depressant drugs

tricyclic antidepressants
2. selective serotonin reuptake inhibitors (SSRIs)
3. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Monamine hypothesis of depression

there is a deficiency in one or more of the three neurotransmitters – serotonin, norepinephrine, or dopamine; theory suggests increasing these alleviates depression

Monamine receptors hypothesis of depression

suggest that low levels of neurotransmitters cause postsynaptic receptors to be up-regulated (increased in sensitivity or number)

increasing of neurotransmitters by antidepressants results in down-regulation (desensitization) of key receptors; delayed length of time for down-regulation may explain why it takes so long for antidepressants to work, especially if they rapidly increase neurotransmitters

Tricyclic antidepressants

widely used prior to SSRIs; no longer considered first-line treatment (advert effects)

thought to act primarily by blocking the reuptake of norepinephrine for the secondary amines and of both norepinephrine and serotonin for the tertiary amines which prevents NE from coming into contact w/its degrading enzyme, MAO

– nortriptyline hydrochloride
– amitriptyline hydrochloride
– imipramine hydrochloride

SSRIs

preferentially block the reuptake and, therefore, the destruction of serotonin; have less ability to block the acetylcholine muscarinic and histamine-1 than TCAs, therefore more selective action.

adverse effects may include spinal reflexes of orgasm, apathy, low libido and nausea/vomitting

-Fluoxetine hydrochloride
-Paroxetine hydrochloride
-Citalopram hydrobromide
-Escitalopram oxalate
-Fluvoxamine maleate
-Sertraline hydrochloride

SNRIs

medications that increase both serotonin and norepinephrine

venlafaxine hydrochloride
venlafaxine succinate
duloxetine hydrochloride

venlafaxine hydrochloride and venlafaxine succinate

potent inhibitor of neuronal serotonin and norepinephrine reuptake and weak inhibitor of dopamine reuptake

has the flexibility of working as an SSRI at lower doses and as an SNRI at higher doses

Duloxetine hydrochloride

an SNRI that has an equal balance of inhibitor effects of norepinephrine and serotonin reuptake; greater noradrenergic effect that does velafaxine hydrochloride

indicated for acute and maintenance treatment of major depressive disorder, for acute treatment of generalized anxiety disorder, for managing neuropathic pain associated with diabetic peripheral neuropathy, and for managing fibromylagia

SNDIs

class that only has one drug, Mirtazapine

increases norepinephrine, dopamine, and serotonin (5-HT) transmission by blocking central presynaptic alpha-adrenergic inhibitory receptors

has a rapid onset and has anti anxiety and antidepressant effects

MAOIs

a group of anti-depressant drugs that prevent the destruction of monamine by inhibiting the action of monoamine oxidase

phenelzineu sulfate
tranylcypromine
selegiline hydrochloride

Monoamines

a type of organic compound and include the neurotransmitters NE, E, dopamine and serotonin, as well as many different food substances and drugs

monoamine oxidase (MAO)

an enzyme that destroys monamines

bupropion hydrochloride

effective both as an antidepressant and for smoking cessation

seems to act as a dopamine-norepinephrine reuptake inhibitor and also inhibits nicotinic acetylcholine receptors to reduce the addictive action of nicotine

does not cause sexual adverse effects (no serotonin action), but may cause insomnia, tremor, anorexia and weight loss

trazodone hydrochloride

a serotonin antagonist and reuptake inhibitor (SARI) and is not a first choice for antidepressant treatment; often given with another antidepressant drug because sedation

mood stabilizers

lithium carbonate

anticonvulsant drugs:
– valproate
– carbamazepine
– lamotrigine
– gabapentin
– topiramate
– oxcarbazepine

lithium carbonate

a mood stabilizer used to treat patients with bipolar disorders

mechanism of action is far from understood; may interact with the electrical impulses along neurons