Mental Health Critical Thinking, Questionnaire Example

1. Hyperactivity (pacing and restlessness), defensive responses to criticism, easily offended, intense or lack of eye contact, facial expressions, body language (clenched fists or waving the arms), rapid breathing, aggressive postures, verbal cues (loud, rapid talking), and drug/alcohol abuse/intoxication.
2. Ask the client if his/her plan is lethal and to describe the plan in detail; whether he/she has access to the intended method of suicide; if he/she has experienced mood swings (sad and depressed to happy and peaceful); if his/her energy levels have altered, and if so, has the client started taking any kind of medication (antidepressant) which may increase energy levels.
3. When using restraints, the nurse must know and follow federal, state, and facility guidelines; whether the case warrants the use of seclusion and/or restraints; if restraints are used, they should be used for the shortest period of time possible; ask the client whether he/she will volunteer for temporary seclusion; make a decision on whether to use physical or chemical restraints.
4. In order to incorporate spiritual/cultural needs, a nurse must first utilize the nursing process based on the standards of care designed by the ANA, the APNA, and the ISPMHN, and then incorporate a holistic approach (biological, social, psychological, and spiritual aspects) via the client’s perceptions of his/her own health and beliefs about illness and wellness based on the client’s culture.
5. A nurse could teach a client how to look at irrational cognitions or thoughts in a better realistic light and to restructure thoughts in a more positive way. A nurse could also teach a client new behavioral and relaxation techniques, such as how to meditate via the use of guided imagery, a series of images that promotes relaxation.
6. Medication compliance is of great importance in relation to a client with a mental disorder because if a client does not adhere to his/her medication regimen, the disorder in question may progress even further and all previous treatments will be made redundant. Also, medication compliance will help a client to maintain as normal a life as possible until more effective medication treatments are available.
7. In children, signs of abuse may include unusual bruising, burn marks, fractures with unusual features, such as forearm spiral fractures, bite marks, head injuries; in older adults, a nurse would look for bruises, lacerations, abrasions, and fractures. As to a priority intervention, all states have mandatory reporting laws that require nurses to report any signs of suspected physical abuse.
8. Through the use of cognitive reframing, a nurse can decrease stress and anxiety by changing a client’s cognitive distortions via identifying negative thoughts that produce anxiety and then develop ways to replace this negativity. A person under stress may exhibit odd behaviors and talk in a rapid or slow way. A nurse could also teach clients to express their feelings in a non-aggressive manner.
9. To help reduce anxiety via OCD, a nurse could use behavioral therapies via relaxation training, modeling or demonstrating appropriate behavior in a stressful situation, systematic desensitization by mastering relaxation techniques, and through flooding or turning off the anxiety response.
10. Create consistent routines within the environment; create clear boundaries and expectations; create an appropriate reward system for positive behavior.
11. Repression–a person forgetting dental appointments because of fear; Denial–a person who refuses to accept the death of a loved one; Projection–a person blames his/her substance abuse on parents for refusing to buy him/her a car; Rationalization–lame excuses for having to leave a party after drinking; Displacement–a person angry over losing his job destroys a child’s favorite toy; Sublimation- a person angry over his job works out at the gym to decrease his/her anger; Isolation–a person refuses to go to work out of fear; Regression–a person regresses to former behavior.
12. How to identify grieving behaviors, such as crying and anxiety; therapeutic communication via naming emotions that a client is experiencing; how to accept the loss of a loved one; how to move on with one’s life after the death of a loved one; how to create new relationships; and how to seek out support from family members and friends.
13. Denial, or not accepting a terminal diagnosis (” don’t believe my wife is dying”); anger, or lashing out at other people (“It’s all your fault she’s dying!”); bargaining, or negotiating more time for a cure (“Maybe they’ll discover a cure soon”); depression, or expressing sadness over the inability to alter the condition (“I feel so sad that I cannot do anything about it”); acceptance, or recognizing the fate of a loved one (“I guess her death is inevitable”).
14. For example, when a husband knows that his wife is dying from a terminal illness, he can anticipate that he will be grieving after her death, i.e., knowing the outcome ahead of time and being prepared for it.
15. A persistent elevated mood; agitation and irritability; a dislike of criticism; an increase in speaking and activities; rapid, continuous speech; grandiose views of oneself; impulsive activities; easy to be distracted; poor judgment, attention seeking behavior. Interventions include providing a safe environment during mania phases, assessment for suicidal thoughts, and client protection.
16. Alcohol–slurred speech, motor incapacity, decreased anxiety, decreased level of consciousness; CNS–extreme euphoria, constricted pupils, decreased breathing, level of consciousness. Abuse–a consistent behavior of using mood and mind-altering drugs like alcohol and cocaine; dependence–relying to a great extent on the use of drugs, taking drugs on a daily basis; addiction–a loss of control and continuing participation in using drugs; co-dependency–a common behavior by the significant other/family/friends
17. of an individual with substance or process dependency. As to recovery, some clients face rejection by friends who are also addicted and are often tempted to return to using drugs and/or alcohol (peer pressure).
18. Delirium–memory impairment, judgment impairment, inability to focus, an altered level of consciousness, confusion during the night, rapid personality changes; Dementia–the gradual deterioration of normal body/mind functions and a gradual deterioration of the personality. As to orientation, a nurse can use the Functional Dementia Scale, a tool that shows the client’s ability for selfcare, the extent of memory loss, mood changes, and the degree of danger to self and others. Therapeutic interventions may include educating
19. family and caregivers about dementia, methods of care, and adaptation of the home environment. Also, provide support for caregivers, recommend local support groups for caregivers, and establish a routine.
20. Symptoms usually include a depressed mood, difficulty sleeping or excessive
21. sleeping, indecisiveness or a decreased ability to concentrate, suicidal ideation, an increase or decrease in motor activity, the inability to feel pleasure, and an increase or decrease in weight of more than 5% of total body weight over one month. One priority intervention would be to remain alert for overt and covert signs that the client is planning to commit suicide, along with close observation or one-to-one supervision.
22. When assessing a client that bears evidence of self-mutilation, 1), assess the client’s memory for recent and past events, his/her orientation to time, place, and person, the client’s knowledge of his/her identity, the client’s mood, recent history of behavior (self-destructive or aggressive, hostile behavior, cognition and thought processes, sleeping patterns, the abuse of alcohol or other chemicals, and the risk for suicide or additional self-mutilation.
23. Positive symptoms may include hallucinations, delusions, disorganized speech, bizarre or extremely odd behavior, such as constantly walking backwards; negative symptoms may include affect (a narrow range of normal expression or flat facial expressions that never alter, alogia or poverty of thought or speech, avolition or a lack of motivation in activities and hygiene, anhedonia or a lack of pleasure or joy, and anergia or a complete lack of energy. As to managing a client with schizophrenia, a nurse might
24. provide a structured, safe environment in order to decrease anxiety and distract the client from constant thinking about hallucinations, or provide milieu therapy via a mental
25. health or community facility and individual psychotherapy.
26. The implementation of a nutritional therapy plan may include providing a highly structured environment in an inpatient eating disorder unit; the development of a trusting nurse-client relationship; the use of a positive approach to promote self-esteem and a positive body image; encouragement to make decisions and to participate in a plan designed to create self-control related to eating; and the establishment of realistic goals for weight loss.
27. Behavioral modifications and/or psychobiological interventions may include the use of dialectical behavior therapy and cognitive behavioral therapy, both of which focus on gradual and consistent behavioral alterations while also providing self-acceptance and validation, especially for clients prone to suicidal thoughts.
28. Lithium carbonate is used to control acute mania and in some cases, alcoholism, bulimia, and schizophrenia. As to therapeutic levels, initial treatment levels should be 0.8 to 1.4 mEq/L., while maintenance level must range between 0.4 to 1.0 mEq/L. The early signs of toxicity includes diarrhea, nausea, vomiting, thirst, polyuria, muscle weakness, and slurred speech, while advanced signs includes mental confusion, poor coordination, coarse tremors, and gastrointestinal distress. Dietary considerations may include encouraging clients to maintain a diet adequate in sodium and to drink 2,000 to
29. 3,000 mL of water/day.
30. Clients must be advised to chew sugarless gum, eat foods high in fiber, and increase their fluid intake to 2 to 3 L/day from food and beverage sources; avoid foods with tyramine, such as ripe avocados, figs, fermented or smoked meats, liver, dried or cured fish, most cheeses, some beer and wine, protein dietary supplements.
31. ECT is used to treat severe depression, certain types of schizophrenia, and acute manic episodes. As to preparing a client for ECT, the typical course of treatment is three times a week for a total of six to twelve treatments; the nurse must use therapeutic communication prior to the procedure and throughout the course of treatments and discuss the procedure with the client; also, informed consent must be obtained from the client and/or guardians. Side effects may include memory loss, confusion, and disorientation.
32. Thorazine, Haloperidol (Haldol), Fluphenazine (Prolixin), Molindone (Moban), Loxapine (Loxitane), Thioridazine (Mellaril), and Thiothixene (Navane). Signs and symptoms include sudden high fever, blood pressure fluctuations. dysrhythmias, muscle rigidity, changes in level of consciousness, and coma. Nursing interventions may include chewing sugarless gum, sipping on water, avoiding hazardous activities, wearing sunglasses when outdoors, eating foods high in fiber, participating in regular exercise, maintaining fluid intake of 2 to 3 L/day from beverages and food sources, and voiding just before taking the medication.
33. Hypertensive crisis occurs when a client’s blood pressure rises too quickly and to dangerous levels which causes hypertensivity. The most common type of medication that causes this condition is Buspirone. Nursing interventions may include advising clients to take the medication with meals to prevent gastric disturbances, relating that the effects of the drug will occur immediately, and that tolerance, dependence, or withdrawal symptoms should not occur while taking this drug.

References

Wissmann, J., Ed., et al. (2008). Practical nurse mental health nursing review module edition 7.1. Assessment Technologies Institute.

Knippa, A., et al. (2011). Practical nurse mental health nursing review module edition 8.0. Assessment Technologies Institute.