Nursing Bullets for Psychiatric Review

• A patient who has a chosen method and a plan to commit suicide in the next 48 to 72 hours is at high risk for suicide.
• The therapeutic serum level for lithium is 0.5 to 1.5 mEq/L.
• Phobic disorders are treated with desensitization therapy, which gradually exposes a patient to an anxiety-producing stimulus.
• Dysfunctional grieving is absent or prolonged grief.
• During phase I of the nurse-patient relationship (beginning, or orientation, phase), the nurse obtains an initial history and the nurse and the patient agree to a contract.
• During phase II of the nurse-patient relationship (middle, or working, phase), the patient discusses his problems, behavioral changes occur, and self-defeating behavior is resolved or reduced.
• During phase III of the nurse-patient relationship (termination, or resolution, phase), the nurse terminates the therapeutic relationship and gives the patient positive feedback on his accomplishments.
• According to Freud, a person between ages 12 and 20 is in the genital stage, during which he learns independence, has an increased interest in members of the opposite sex, and establishes an identity.
• According to Erikson, the identity-versus-role confusion stage occurs between ages 12 and 20.
• Tolerance is the need for increasing amounts of a substance to achieve an effect that formerly was achieved with lesser amounts.
• Suicide is the third leading cause of death among white teenagers.
• Most teenagers who kill themselves made a previous suicide attempt and left telltale signs of their plans.
• In Erikson’s stage of generativity versus despair, generativity (investment of the self in the interest of the larger community) is expressed through procreation, work, community service, and creative endeavors.
• Alcoholics Anonymous recommends a 12-step program to achieve sobriety.
• Signs and symptoms of anorexia nervosa include amenorrhea, excessive weight loss, lanugo (fine body hair), abdominal distention, and electrolyte disturbances.
• A serum lithium level that exceeds 2.0 mEq/L is considered toxic.
• Public Law 94-247 (Child Abuse and Neglect Act of 1973) requires reporting of suspected cases of child abuse to child protection services.
• The nurse should suspect sexual abuse in a young child who has blood in the feces or urine, penile or vaginal discharge, genital trauma that isn’t readily explained, or a sexually transmitted disease.
• An alcoholic uses alcohol to cope with the stresses of life.
• The human personality operates on three levels: conscious, preconscious, and unconscious.
• Asking a patient an open-ended question is one of the best ways to elicit or clarify information.
• The diagnosis of autism is often made when a child is between ages 2 and 3.
• Defense mechanisms protect the personality by reducing stress and anxiety.
• Suppression is voluntary exclusion of stress-producing thoughts from the consciousness.
• In psychodrama, life situations are approximated in a structured environment, allowing the participant to recreate and enact scenes to gain insight and to practice new skills.
• Psychodrama is a therapeutic technique that’s used with groups to help participants gain new perception and self-awareness by acting out their own or assigned problems.
• A patient who is taking disulfiram (Antabuse) must avoid ingesting products that contain alcohol, such as cough syrup, fruitcake, and sauces and soups made with cooking wine.
• A patient who is admitted to a psychiatric hospital involuntarily loses the right to sign out against medical advice.
• “People who live in glass houses shouldn’t throw stones” and “A rolling stone gathers no moss” are examples of proverbs used during a psychiatric interview to determine a patient’s ability to think abstractly. (Schizophrenic patients think in concrete terms and might interpret the glass house proverb as “If you throw a stone in a glass house, the house will break.”)
• Signs of lithium toxicity include diarrhea, tremors, nausea, muscle weakness, ataxia, and confusion.
• A labile affect is characterized by rapid shifts of emotions and mood.
• Amnesia is loss of memory from an organic or inorganic cause.
• A person who has borderline personality disorder is demanding and judgmental in interpersonal relationships and will attempt to split staff by pointing to discrepancies in the treatment plan.

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