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This is the second half of a test prep study guide.

Can I get help with Chapter 15 through 39 please. This is the second half of a test prep study guide. Any help will be a lifesaver!


Chapter 15, Families and Family Interventions

Discussion Topics

Learning Objective

1. Mark is a 22-year-old college student and is the primary caregiver for his 15-year-old brother. Mark's younger brother was just diagnosed with a mental illness.

a.             If you were in Mark's place, what effect would the mental illness have on you?

b.             Think of a time when a family member was suffering from an illness or when stress was occurring in your family. What were your needs during this time? What kind of nursing support would have been helpful?

1

2. Sam and Joan have been married for 25 years and have three children: Max, who is 23; Janet, who is 19; and Sarah, who is 15. Janet has just been diagnosed with a mental illness.

a.             Describe the objective and subjective burdens each family member may experience.

b.             Describe the meaning this diagnosis may have to Janet's parents, younger sibling, and older sibling.

5, 6

3. Bobbie is a 54-year-old woman who has been diagnosed with bipolar disorder. Her husband, Larry, has been very supportive and accepting of the mental illness diagnosis. Her two children, ages 15 and 17 are worried that they might also develop bipolar disorder but are also very supportive of their mother. The family feels that they do not have the knowledge and skills to handle the condition and decide to enroll in family consultation.

a.             Why do you believe it is important to involve the family in the treatment of clients?

b.             Describe family consultation. How is it different from family therapy?

c.             Describe the components of family consultation.

d.             Describe the role of the nurse as a family consultant.

4, 8, 9

4. You are caring for a patient with an anxiety disorder on the psychiatric unit. The family is present with the patient. Your instructor talked in the mental health course about cognitive, affective, and behavioral psychiatric nursing interventions.

a.             What are cognitive, affective, and behavioral psychiatric nursing interventions?

b.             Give some examples of cognitive, affective, and behavioral psychiatric nursing interventions you could apply to the care of this family.

3


Discussion Topics, Mohr

Chapter 16, Psychopharmacology


Discussion Topics Learning

Objective


1. You are caring for a 52-year- old woman who has been prescribed a major antipsychotic (neuroleptic) agent. After explaining the potential side effect, the client refuses to take the medication.

a. How would you feel about taking a major antipsychotic (neuroleptic) agent, realizing the many side effects that these medications can cause?

b. For psychoactive medications to be effective, client adherence is essential. How would you respond to a client who continually fails to follow his or her medication regimen?



2. Carmen is a 40-year- old woman who suffers from severe depression. Her physician has tried several different antidepressants that have been unsuccessful in treating her condition. The physician is now considering placing Carmen on a tricyclic antidepressant or a monoamine oxidase inhibitor.

a. What type of client education would you want to provide to a client who is prescribed a tricyclic antidepressant?

b. What type of client education would you want to provide to a client who is prescribed a monoamine oxidase inhibitor?



3. Lenny is a 53-year- old man who has been diagnosed with bipolar disorder. He is seeing a psychiatric nurse practitioner, who has prescribed lithium.

a. What type of client education would you want to provide to a client who is prescribed lithium?

b. What are the therapeutic and toxic blood levels of lithium?



4. A client in your care is very anxious about taking his newly prescribed medication for depression, Pristiq. You attempt to alleviate his concerns about taking a new drug through medication education.

a. Explain the FDA's process of approving new drugs.

b. Discuss the principles of adherence and efficacy in relation to psychotropic medications.

c. Identify the classification, neurotransmitters involved, and the disorders for which the client's medication is prescribed.

d. What is the action, recommended dosage, and route of administration, side effects, potential adverse effects, contraindications, and nursing implications for the client's medication, Pristiq?



Discussion Topics, Mohr

Chapter 17, Integrative Therapies


Discussion Topics

Learning Objective

1. One of your family members is diagnosed with a medical condition and chooses to use both traditional Western treatments and complementary and alternative medicine (CAM) therapies.

a.             What are your personal feelings and beliefs about CAM approaches to healing? Have you ever sought treatment with an alternative approach? If so, what were the results? How has this affected your role as a nurse?

b.             How do you feel about the client who rejects traditional medicine and seeks alternative measures for a health problem?

1, 2

2. While caring for a client with depression, he tells you that when his sister was suffering from the same condition, she used herbs and acupuncture. He tells you that he would like to know more about CAM therapies.

a.             What is the difference between complementary and alternative treatments?

b.             Identify and describe one type of CAM therapy for each category of the National Center for Complementary and Alternative Medicine classifications.

1, 3

3. During your psychiatric-mental health rotation at a hospital, you are asked to give the other nurses a presentation about CAM treatments for psychiatric conditions.

a.             Choose one of the following conditions: anxiety disorders, mood disorders, addictive disorders, or cognitive disorders. Identify and explain at least one CAM treatment that can be used for your chosen condition. Also list any potential side effects, if any.

4, 5

Discussion Topics, Mohr

Chapter 18, Somatic Therapies


Discussion Topics

Learning Objective

1. Electroconvulsive therapy (ECT) has been found to be an effective treatment for mental health disorders.

a.             What is the indication for ECT?

b.             How has your perception of ECT changed after learning more about the procedure?

c.             Describe the potential side effects of ECT and the nurse's role in caring for a client receiving ECT.

2, 3

2. Jackson has been diagnosed with seasonal affective disorder after suffering from depression over the fall and winter months for the past 3 years.

a.             List the information that you would provide Jackson about phototherapy.

4

3. A client wishes to know more about nonpharmacological somatic therapies.

a.             Compare and contract transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation, and psychosurgery.

5, 7

4. Your nursing instructor has been teaching on somatic therapies in the mental health class today. Your client has an order for a somatic therapy the following day, so you go in to provide client education.

a.             What are somatic therapies? 

b.             Discuss the different types included in this classification.

c.             Which somatic therapy do you believe is most effective and why?

1


Discussion Topics, Mohr

Chapter 19, Inpatient Care Settings


Discussion Topics

Learning Objective

1. While doing a clinical rotation in a psychiatric-mental health facility, a client is involuntarily committed.

a.             Would you feel differently caring for a client who was voluntarily or involuntarily committed?

b.             Have you ever witnessed a client be involuntarily committed inappropriately? If yes, how did that make you feel? If not, how would that make you feel?

c.             Do you believe that involuntary commitment orders are necessary? Why or why not?

2

2. You are caring for a psychiatric-mental health client who would like more information on different mental health care settings.

a.             What are the different levels of care for inpatient settings?

b.             Define and explain the different types of inpatient settings.

1

3. You are working for a psychiatric-mental health facility that uses traditional milieu therapy.

a.             Explain the five steps of milieu therapy.

b.             Explain one of the roles of the nurse in milieu therapy (fostering self-care; providing client education; conducting community meetings or life skills groups; administering medications; or working with support groups).

c.             Do you believe milieu therapy is effective? Why or why not?

3, 4

Discussion Topics, Mohr

Chapter 20, Community and Home Psychiatric Care


Discussion Topics

Learning Objective

1. During your psychiatric-mental health nursing rotation, you have been asked to spend several days with a home health nurse.

a.             How would you feel about caring for someone in his or her home?

b.             What are some reasons that you would prefer to have a family member treated in your home rather than in an institutional setting?

c.             What difficulties do you think a psychiatric home care nurse might encounter in the home compared with the hospital setting?

d.             What would you find challenging and rewarding about working in the home setting?

10, 11

2. Jeremy is a 42-year old man who suffers from severe and persistent mental illness. His family is interested in finding out more about preventative services.

a.             What is the difference between primary, secondary, and tertiary prevention services?

b.             Provide a list of community services available in your local area. Identify the services as primary, secondary, or tertiary.

1, 2

3. Your local community is looking to increase the mental health services available to citizens. A community support system is being developed and will be run by the health department.

a.             List and explain the three tenets of community support systems.

b.             List one of the principles that are basic to psychiatric rehabilitation. Explain how an institution could strive to achieve this principle.

3, 4, 5


Discussion Topics, Mohr

Chapter 21, Forensic Psychiatric Nursing


Discussion Topics

Learning Objective

1. You have just graduated from nursing school and you are considering working in forensic nursing. 

a.             Explain the psychiatric nurse's role in the forensic milieu.

b.             What are your fears in dealing with people in correctional facilities?

c.             What do you think would be most difficult about working with the forensic client?

d.             Have you ever witnessed acting-out behavior in a client? What happened? How did it make you feel? What do you think about this situation now? Were there any clues that this behavior was imminent? Looking at this situation now, could it have been prevented?

1

2. You are interviewing a forensic nurse who works in a correctional facility. The nurse begins to discuss the issues associated with special populations.

a.             Choose one of the special populations that forensic nurses may interact with (juvenile offenders, female offenders, older adult offenders, offenders with HIV/AIDS or hepatitis, or offenders with terminal illness). Discuss some of the issues that a forensic nurse faces when dealing with these special populations.

2

3. While performing a clinical rotation in a hospital, you are assigned to a client that has been admitted from a local correctional facility. He was admitted with severe chest pain and it was confirmed that the client had a myocardial infarction. When assessing the client, you must be accompanied by a police officer and he must un-cuff the client from the bed so that you can perform a total assessment. When you read the client's chart, you find out that he is incarcerated for the attempted murder of a child.

a.             Would you treat this client differently than any other client who was admitted with a myocardial infarction?

b.             How is security for the forensic nurse incorporated into client care and what type of challenges does this present?

1, 2

4. You have just graduated from nursing school and started a job at the local correctional facility in the health clinic. Your first client is a female who has just been transferred to the correctional facility today. She has a diagnosis of terminal cancer. You learn she has three children and a husband that are devastated about her incarceration. The client reports being extremely worried about her family.

a.             What are the potential blocks to the assessment process with this client?

b.             What are potential nursing diagnoses for this client? What interventions could be used for each diagnosis (use the textbook for support)?

c.             What strategies would you adopt when working with the client's family? Provide examples of how you could implement these strategies.

3


Discussion Topics, Mohr

Chapter 22, Sleep Disorders


Discussion Topics

Learning Objective

1. After you've worked the 7 am to 7 pm day shift for three years, your place of employment requires that you work the night shift for one year.

a.             Define the term sleep. Have you ever experienced sleep deprivation? If so, how did you feel physically? Emotionally?

b.             How well do you feel you sleep at night? Do you feel rested when you awaken in the morning?

c.             Do you participate in any routines or rituals before going to bed? If so, why?

d.             Do you believe that your abilities as a nurse would be compromised if you were working with sleep deprivation? Why or why not?

1, 3, 4

2. Timothy is 52 years old and has just developed problems with sleeping. After conducting an interview with Timothy, it is determined that the use of alcohol, tobacco, and caffeine may be interfering with his sleep.

a.             List the changes in sleep patterns that occur from infancy through the elderly years.

b.             How does the use of alcohol, tobacco, and caffeine interfere with sleep?

2, 4

3. After feeling down for several months and having difficulty sleeping, Chris decided to seek help from a healthcare provider. Chris was diagnosed with major depression and was placed on an antidepressant.

a.             What effect does major depression have on sleep?

b.             How can the different types of medications used to treat depression effect sleep?

3, 6, 7

4. Your 69 year old female patient is admitted for a sleep study. She complains of sleep difficulty nightly.

a.             Explain the normal changes in sleep across the lifespan to the patient.

b.             What diagnostic testing would you anticipate this patient having?

c.             How can the nurse assess for sleep difficulty?

d.             What are some recommendations you can make for good sleep hygiene?

e.             What is an appropriate nursing diagnosis for this patient? What interventions would you use to assist the patient and why?

2, 5, 6, 8


Discussion Topics, Mohr

Chapter 23, Anxiety Disorders


Discussion Topics

Learning Objective

1. You are caring for a client who is experiencing severe anxiety. Think about a time in your life when you have experienced anxiety.

a.             Define anxiety.

b.             What are your common symptoms when anxious? Pay attention to your body response and connect the response to the feeling of anxiety. Classify these as cognitive, affective, physiologic, or behavioral.

c.             How is your response to anxiety similar and different when the anxiety is related to your personal life and to your experience as a nursing student?

d.             What techniques do you use to reduce your own anxiety? Do they work? Do you use several techniques or only a few? Do you smoke, drink, or use food to reduce your anxiety?

1, 5

2. Alex is a 54-year-old man who has been suffering from extreme anxiety after being robbed by a man at gun point. He does not understand how anxiety results from being robbed.

a.             Discuss the proposed etiology for Anxiety Disorders (PTSD) with Alex.

b.             Compare and contrast acute stress disorder and post-traumatic stress disorder.

c.             Describe the effects anxiety can have on sensation, cognition, and verbal ability.

4, 5, 6

3. Marsha is a 38-year-old woman who has been diagnosed with an anxiety disorder. She has little knowledge about anxiety and believes she is alone in her diagnosis. She is also curious about the different treatment options available to treat anxiety.

a.             Explain to Marsha what is meant by the term anxiety disorder.

b.             To help her understand she is not alone, discuss the prevalence of anxiety disorders with Marsha.

c.             Explain one of the cognitive-behavioral therapies used to treat anxiety.

d.             Marsha's psychiatrist has decided to place her on medication. What types of medications can be used to treat anxiety? Choose one of these medications and list client education you would want to provide to a client.

2, 3, 7


Discussion Topics, Mohr

Chapter 24, Somatoform, Dissociative, and Sexual Disorders


Discussion Topics

Learning Objective

1. Mary is a 64-year-old woman who complains of chronic pain in her left arm, shoulder, and back. She has been through many diagnostic tests and no physical cause for the source of her pain can be found.

a.             How do you feel about clients who constantly complain about various physical symptoms? How do you react when a client constantly complains about such symptoms? Do you think that your reaction to the clients interferes with developing a therapeutic relationship?

b.             What do you believe about clients who have physical complaints but no demonstrated physiologic reason for them?

1, 2

2. Josephine is a 21-year-old woman who was sexual abused from the ages of 8 to 12. She has just been diagnosed with dissociative identity disorder.

a.             What kinds of feelings do you experience when you think about working with clients who have been victims of severe physical or sexual abuse? How might these feelings affect your nursing care?

b.             Reflect on times when you have been forgetful or not paying attention. How did these experiences make you feel when you realized they had occurred?

c.             What nursing diagnosis would be appropriate to use with this patient? What interventions do you believe are needed (use the textbook for support)?

5, 6, 7

3. During a patient interview, you are required to obtain information about a client's sexual history.

a.             Have you experienced a situation in which a client shared concerns about sexual issues with you? How did you feel? Were you comfortable listening? Did you seek advice about how to respond to the client?

b.             What are your feelings about people who are homosexual or bisexual? How do personal feelings influence your role as a professional nurse?

c.             Have you ever had a problem, concern, or question related to sexual behavior? If so, how did you resolve it? Did you talk with anyone? In whom did you choose to confide? What was it about that person that made you feel comfortable discussing your concerns?

8, 9


Discussion Topics, Mohr

Chapter 25, Personality Disorders


Discussion Topics

Learning Objective

1. After learning about the personality disorders in class, a classmate turns to you and says he has some of the symptoms of about three different personality disorders.

a.             Do you notice aspects of your own personality in the descriptions of some of the personality disorders? If yes, how does that make you feel? What is the difference between finding some characteristics of a disorder and an actual diagnosis?

1, 2

2. You are caring for a client that is showing manifestations of a personality disorder. Another nurse asks you if his symptoms fit into the A, B, or C cluster of personality disorders.

a.             What are the differences between cluster A, B, and C personality disorders?

b.             Provide a description and symptoms of one personality disorder that falls into each cluster.

5

3. While working in a psychiatric mental health facility, you are assigned to Kenny, a 34-year-old man who has just been diagnosed with a personality disorder. Kenny says to you, "can't they just give me a pill so that I can feel better?"

a.             What are the different treatment options that are available for a client with a personality disorder?

b.             Identify what treatment modality is best for each personality disorder and how the treatment is believed to help the disorder.

6

4. You have been a psychiatric nurse for 10 years working with children. You are being transferred to the adult unit where you will be working with clients with Personality Disorders and you have no experience in this area. 

a.             Why is self-care important for the nurse when working with patients with this diagnosis?

b.             What self-care activities will you employ and why?

8


Discussion Topics, Mohr

Chapter 26, Eating Disorders


Discussion Topics

Learning Objective

1. After being assigned to a client suffering from an eating disorder, you begin to examine your own opinions regarding weight, dieting, and eating disorders.

a.             How do you feel about your current weight as compared with what you consider to be your ideal weight?

b.             Are you currently on a diet? Have you ever tried to lose weight? If so, what methods did you use? How successful were you?

c.             How do you feel about people with an eating disorder? Does it make a difference if the disorder is anorexia, bulimia, or overeating?

d.             How common are eating disorders? Who are those at highest risk of developing an eating disorder?

1, 3

2. Kindra has been diagnosed with anorexia nervosa and her older sister has bulimia. During a therapy session, Kindra states that she believes that her and her sister's disease are her parent's fault. "They are too controlling, they always try to tell us what to do. I think that is why my sister and I have problems."

a.             Compare and contrast the biological, psychosocial, sociocultural, and family-based theories of eating disorders.

2

3. Beth is the mother of three teenagers, two girls and one boy. She is worried that one of her daughters might be developing an eating disorder. "One of my daughters does not eat as much as my other two children. I notice that she has been losing a lot of weight and she exercises all of the time." She asks you to provide her with some information on eating disorders.

a.             What is the difference between anorexia nervosa, bulimia nervosa, and binge-eating disorder?

b.             What physical assessment and laboratory findings may be present in those with an eating disorder?

c.             What treatment modalities are important for a client with an eating disorder? Which do you believe is the most effective and why (use your textbook for support)?

3, 4, 5


Discussion Topics, Mohr

Chapter 27, Depressive Disorders


Discussion Topics

Learning Objective

1. Depression is often referred to as the common cold of mental illness because it affects so many individuals at some point in their lives.

a.             When was the last time you felt "down" or sad? What were the circumstances? Did you consciously attempt anything about this feeling, or did the feeling just "go away"?

b.             Have you noticed any particular events or circumstances in your life that are related to feelings of sadness or "feeling down"?

c.             What is the incidence and prevalence of depressive disorders in the United States population?

d.             What coping measures do you use to deal with feelings of sadness or depression?

1

2. While working in a local hospital, a client is admitted that you believe might be suffering from depression.

a.             What are the signs and symptoms of depression?

b.             Compare and contrast the different etiological theories of depression. 

2, 3

3. Sandra has been suffering from severe depression for the past year and has just decided to seek help for her condition. Her healthcare provider is deciding upon appropriate treatment of her disorder.

a.             List information you would provide to a patient who is prescribed a Selective Serotonin Reuptake Inhibitor, Tricyclic Antidepressant, or a Monoamine Oxidase Inhibitor.

b.             Identify Somatic therapies that can be used to treat depression.

4


Discussion Topics, Mohr

Chapter 28, Bipolar Disorders


Discussion Topics

Learning Objective

1. While doing a clinical rotation through a psychiatric mental health facility, you are assigned to a client who is in the manic phase of bipolar disorder.

a.             How prevalent are bipolar disorders in the United States?

b.             What are the signs and symptoms of bipolar disorder?

c.             How do you think you would react to a client in a manic state? How would your approach to a manic client be different from your approach to other clients?

1, 2, 4

2. Eva is a 24-year-old woman who has just been diagnosed with bipolar disorder. She is upset by the diagnosis and asks you if she developed the condition because she drank alcohol before she turned 18.

a.             How would you respond to Eva?

b.             What are the different factors that are believed to play a role in bipolar disorder? How do they influence the disorder?

3

3. After diagnosing Adam with bipolar disorder, a physician decides to use combination therapy involving both medication and psychotherapy.

a.             What medication education would the nurse want to include in the plan of care for a patient prescribed Lithium or Lamotrigine (Lamictal)?

b.             How could you encourage medication compliance in a bipolar client?

5, 6


Discussion Topics, Mohr

Chapter 29, Thought Disorders


Discussion Topics

Learning Objective

1. While working on a psychiatric mental health unit, you are assigned to Elizabeth, a 54-year-old woman with schizophrenia.

a.             What is schizophrenia? What is the prevalence of the disorder?

b.             What is your perception of the client with schizophrenia?

c.             When thinking about interacting with someone who is experiencing hallucinations or delusions, what do you find most upsetting? What would help you feel more comfortable?

1, 2

2. Markus, now 42, was diagnosed with schizophrenia at the age of 24. While Markus was prescribed medication, he will take it for several months and then stop. During the times when Markus has been off of his medication, he has shown signs of schizophrenia that fall into all three of the dimensions of symptoms.

a.             List the three dimensions of symptoms. Identify and explain one manifestation in each dimension.

b.             List and explain the subtypes of schizophrenia.

4, 5

3. You are caring for two clients suffering from schizophrenia. One is being placed on a traditional antipsychotic and the other is being placed on an atypical antipsychotic.

a.             What information/patient teaching would you want to provide to a client who is being placed on a traditional antipsychotic or atypical antipsychotic?

b.             What kind of medication is best for a client with a history of noncompliance with medications and why?

c.             How can EPS especially TD be assessed for effectively?

6, 8


Discussion Topics, Mohr

Chapter 30, Substance Use Disorders


Discussion Topics

Learning Objective

1. While caring for a patient with substance abuse issues, you begin to evaluate your own opinions regarding abused substances.

a.             Do you have different attitudes about someone who is addicted to/dependent on prescription drugs compared with someone who is addicted to/dependent on alcohol or street drugs?

b.             Have you ever experienced any adverse consequences related to the use of a substance?

c.             Jot down about your feelings related to alcohol and substance abuse. Speculate how these feelings may influence your work as a nurse with clients who are substance-dependent?

d.             What is the incidence and prevalence of substance use disorders?

1, 2

2. Randy is a 43-year-old man who has been a heavy drinker since the age of 25. Because of his dependency on alcohol, he has a hard time keeping a job and has been divorced twice. He has decided to go to a treatment center to try and overcome his addiction. While in a group therapy session, Randy states, "I don't know why I drink, my father did too. I guess I learned it from him."

a.             What etiological factors are believed to be influential over substance abuse behaviors?

3

3. Shannon has suffered from Major Depressive Disorder for five years. She has used various types of controlled substances over the years and due to the amount she has used, she needs larger and larger doses in order to achieve a "high."

a.             What are the effects of the different controlled substances and what are the symptoms of an overdose?

b.             What is a co-morbid disorder? What is the incidence of co-occurring disorders? What is the significance of recognizing Shannon has having a co-occurring disorder?

c.             What two main components of interdisciplinary treatment are you likely to see used with this patient and why?

5, 6, 8


Discussion Topics, Mohr

Chapter 31, Cognitive Disorders


Discussion Topics

Learning Objective

1. After discussing cognitive disorders in class, you begin thinking about experiences you have had with those who suffer from these conditions.

a.             What is a cognitive disorder? Have you ever had a family member who was diagnosed with a cognitive disorder? What feelings were evoked by the changes that result when someone has this kind of disorder?

b.             Think about any clients you may have cared for with a cognitive disorder. What were some of the difficulties involved in nursing care? How did you feel about caring for these clients? What did you learn about yourself?

c.             If a genetic marker or a diagnostic test became available for Alzheimer's disease, would you want to be tested? Why or why not?

1

2. You are caring for a client who has been diagnosed with dementia. When speaking to the client's family, it becomes evident that they are not very familiar with the disease process.

a.             The family of this client wishes to know more about the symptoms of dementia. Identify and explain a symptom that may be seen in clients with dementia.

b.             The family also tells you that there have been two other family members that have been diagnosed with Alzheimer's disease and would like to know what causes the disease. What information would you provide about the etiology of Alzheimer's disease?

3, 4

3. You are working in a doctor's office and a 55-year-old man comes in with his 77-year-old father who is experiencing signs of dementia. He wishes to find out about potential treatments for his father's condition.

a.             What are the recommended psychosocial and pharmacological treatments for delirium and dementia?

b.             The doctor is deciding between prescribing Rivastigmine (Exelon) or donepezil (Aricept). What information would you want to provide for these medications?

5


Discussion Topics, Mohr

Chapter 32, Anger and Aggression


Discussion Topics

Learning Objective

1. Anger is an emotion that everyone experiences at some time in their life.

a.             What situations usually make you angry? How do you handle your anger? Are you satisfied with your ability to control your anger? If not, what could you improve?

b.             Have you ever felt angry with a client? Analyze this situation. What was the specific client behavior? What did you say to the client? How does this situation remind you of other situations in which you became angry? What other emotions did you feel?

c.             What are some factors that could increase the risk of anger, aggression, and violence in the psychiatric setting? What role does the inpatient healthcare environment play when conflict aggression and violence occur?

1, 2

2. Kyle is a 42-year old man that has been admitted to a psychiatric-mental health facility with bipolar disorder. Kyle became frustrated and aggravated when he and another client were playing a game and he was losing. He picked up a book and threw it at another client.

a.             Compare and contrast the different cognitive behavioral interventions for an aggressive client.

b.             Discuss the controversies associated with the use of restraint and seclusion.

c.             Discuss the legal issues associated with restraint and seclusion.

3, 4

3. You are a nurse working in a psychiatric-mental health facility. One of the clients you are caring for is becoming increasingly angry and aggressive.

a.             What signs of escalating aggressiveness would you look for?

b.             What actions would you take to ensure your safety and the safety of other clients?

5


Discussion Topics, Mohr

Chapter 33, Violence and Abuse


Discussion Topics

Learning Objective

1. While conducting an admission interview with Rebecca, she tells you that her husband hits her when she comes home late from work.

a.             Identify the feelings and attitudes you have regarding someone who is abusive and also someone who is a victim of abuse. Would your feelings differ if the victim was a child? An elderly person?

b.             Would your personal experiences and emotions affect your responses to clients who are either victims or abusers? If so, how? If not, why?

c.             What are your beliefs and attitudes about women who are victims of sexual assault? Do you think that women can prevent this? If so, how?

1

2. Peter is a 14-year-old boy who is becoming increasingly violent. He has been suspended from school for punching another boy in the face. His mother suspects that he has joined a gang.

a.             List and explain the different risk factors for youth violence.

b.             What protective factors can prevent youth violence?

3

3. Veronica is a 32-year-old single mother of two children, ages 5 and 7. Veronica works two jobs to support her and her children. She is becoming increasingly stressed and strained. Lately she has been yelling at her children regularly and has begun hitting her 7-year-old son.

a.             What are the different types of child maltreatment?

b.             What effects can child maltreatment have on child functioning?

5

4. Michelle presented to the Emergency room as a victim of sexual abuse. You are the nurse assigned to care for her.

a.             What is sexual assault?

b.             Describe the phases of rape trauma syndrome to Michelle.

c.             What would your primary nursing diagnosis be? What nursing interventions would be appropriate for this client?

7, 8, 9

Discussion Topics, Mohr

Chapter 34, Suicide and Suicidal Behavior


Discussion Topics

Learning Objective

1. While working in a hospital, you are assigned to a client who is recovering from an attempted suicide?

a.             When you hear that someone has attempted suicide, what type of emotion does that evoke in you?

b.             Do you think you would treat a severely depressed person and a severely depressed person who attempted suicide differently? Why or why not?

1

2. Francis is a 43-year-old woman who recently lost her husband of 20 years. Because she was unable to focus on her work, she was fired from her job. Francis could see no way out of her current situation and attempted suicide.

a.             List and describe risk factors for suicide.

b.             List and describe the protective factors for suicide.

5

3. You are a nurse working is a psychiatric-mental health facility and have been asked to finish a suicide assessment on a client.

a.             What are the different areas you would need to assess? List at least two questions you would ask to assess each area.

b.             What affects can suicide have on those left behind?

6, 8


Discussion Topics, Mohr

Chapter 35, Crisis Intervention


Discussion Topics

Learning Objective

1. There have been several major adventitious crises in the past several years that have affected large numbers of people.

    a. Have you ever experienced a personal crisis? If so, think about the precipitating factors and the measures you took to help resolve it. Identify ways in which this experience affected you.

    b. How did you feel after the attacks of September 11, 2001? Examine how this incident affected you.

    c. How did you feel when you saw or experienced the devastation caused by Hurricane Katrina? Examine how this incident affected you.

1, 2

2. Many individuals experience a maturational crisis at some point in their life.

    a. Provide an example of a maturational crisis. Identify a behavior that may be manifested in each crisis phase.

    b. Develop a list of resources available to an individual experiencing the maturational crisis that you specified.

1, 3

3. After helping a client through a crisis, you become interested in the role of crisis intervener.

    a. What are the most important skills for a crisis intervener and how these skills are implemented in a crisis?

    b. Compare and contrast the variations in crisis intervention, including the team approach, crisis groups, and families in crisis.

3, 6


Discussion Topics, Mohr

Chapter 36, Pediatric Clients


Discussion Topics

Learning Objective

1. Adolescence is a time in life when many changes occur both emotionally and physically.

a.             Think about your own adolescent development. What were major problems for you at this time? How did you cope? What resources did you use?

b.             What was your relationship with your parents like during adolescence? How did it change as you progressed through your teens?

c.             What was your relationship with your peers during adolescence? What were your interests in terms of school, recreational, and social activities? How did you achieve balance at this time?

d.             Discuss the role of the psychiatric nurse in working with adolescents.

2, 3, 6

2. You are caring for a 6-year-old client who is experiencing developmental delays.

a.             Compare and contrast the different traditional developmental theories.

b.             Provide an example of a manifestation of each stage of Kohlberg's moral development theory.

1

3. Joan is an 11-year old female that is beginning to shown signs of a mental illness.

a.             List and describe two of the risk factors associated with mental illness in children.

b.             List and describe two of the psychosocial modalities of treatment used for children.

4, 5

4. You have just learned about Attention Deficit Hyperactivity Disorder (ADHD) in class. A peer missed class and you are assisting her in studying for an exam.

a.             What nursing diagnoses are appropriate for a child experiencing ADHD? 

b.             List two interventions for each diagnosis.

7


Discussion Topics, Mohr

Chapter 37, Older Adult Clients


Discussion Topics

Learning Objective

1. As a nursing student, you care for many individuals who fall into the older adult category. In the United States, an individual age 65 and older is considered an older adult. 

a.             Think about the older adult clients you have cared for in your nursing practice. What adaptations did you make in your care based on aging changes?

b.             How do you feel about aging and getting older?

c.             What attitudes, personality traits, and health practices do you believe can pose a problem for people as they age?

1, 2

2. You are caring for an 84-year-old woman who is taking 15 different medications.

a.             How does aging affect pharmacokinetics and Pharmacodynamics?

b.             What health promotion teaching would you want to perform for an older adult taking many medications?

6, 8

3. While caring for a 74-year-old man, you notice that he is experiencing several normal age-related physical changes. 

a.             What normal changes to the nervous and sensory system; cardiovascular system; respiratory system; renal and urinary system; musculoskeletal system; and gastrointestinal system would you expect?

b.             How would you alter your communication techniques when interacting with an older adult?

3


Discussion Topics, Mohr

Chapter 38, Homeless Clients


Discussion Topics

Learning Objective

1. After caring for a mentally ill client who is homeless, you begin to think about the number of people in the U.S. who are homeless. Annually, approximately 3.5 million people in the U.S. are homeless.

a.             What is the meaning of home to you? What do you value most about your home?

b.             Imagine if you did not have a home. What would you do? Where would you turn for help?

c.             What is your perception of people who are homeless? What do you think are causes of homelessness?

1

2. While doing a clinical rotation at a psychiatric mental health facility, you are assigned to a Tray, a 42-year-old man. He is about to the discharged from the facility. When you ask him where he will go when he leaves, he tells you that he is homeless and will be living on the street.

a.             What are the factors that contribute to homelessness in those who are mentally ill?

b.             Identify community programs or agencies that are available for homeless clients in your area.

2

3. You are discussing the issues facing mentally ill homeless clients with another student.

a.             Provide an argument for and against the following statement: Current mental health laws are inadequate and do not provide the most therapeutic environment for people with mental illness.

b.             List and describe the barriers that prevent homeless individuals from receiving care.

c.             What are some specific healthcare concerns of homeless mentally ill individuals?

3, 4


Discussion Topics, Mohr

Chapter 39, Clients With Medical Illnesses


Discussion Topics

Learning Objective

1. While working in a hospital, you have a patient admitted to the floor that is displaying signs of psychological disturbance.

a.             Would you feel differently about a client who has a psychological disturbance secondary to a medical condition compared to a client that does not have a medical condition? Would you care for these two clients any differently?

b.             Think of a time when you or a family member has been diagnosed with a medical condition. What type of psychological affects did this diagnosis have on you or your family member?

1

2. Martin was hospitalized after experiencing severe chest pain that radiated to his left arm. He was diagnosed as having had a myocardial infarction.

a.             What reactions may occur in clients who h

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