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NR 326 EXAM 1 STUDY GUIDE, Exams of Nursing

Cambridge Technical InstituteNursing

NR 326 EXAM 1 STUDY GUIDENR 326 EXAM 1 STUDY GUIDE

Typology: Exams

2025/2026

Available from 01/08/2026

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NR 326 EXAM 1 STUDY GUIDE
Mental Health and Illness
Mental Health
•Success adaption to stressor from the internal or external environment observed as
thoughts, feelings, and behaviors that are age appropriate and congruent with local
and cultural norms
Mental Illness
•Maladaptive (inappropriate) responses to stressor from the internal or external
environment evidenced by thoughts, feelings, and behaviors that are incongruent
with local cultural norms and interfere with the individual’s social, occupational, and
or
physical functioning
Risk Factors
•Nature (family history and genetics)
•Nurture (environment)
Factors to Consider
•Normal vs. abnormal, age, situation/environment, culture, baseline, genetics, Erikson stag
•Ability to: think rationally, communicate appropriately, learn, grow emotionally,
be resilient, have a healthy self-esteem
•What factors affect this: support system, family influence, cultural beliefs and values,
negative influences, environmental perceptions of mental illness, labeling of people
The DSM- 5
•Primary diagnosis: see in clinical and is reason for admission
oExample: eating disorder
•Secondary diagnosis: follows primary but isn’t the focus of treatment plan
oExample: anxiety
•Affects ability to function and inability to cope with crisis/stressor
•This is how patients are diagnosed – based on symptoms
Defense Mechanism
Defense Mechanism
•Why are they used: respond to conflict, help protect people from anxiety, not feel
certain feelings
•How are they used: adaptive and maladaptive
•When are they used: hide a variety of thoughts
•Chronic use is when it becomes a problem
Types of Defense Mechanisms
•Rationalization “justifying”: creating an acceptable reason for unacceptable behavior
oExample: “I wanted restraints because the nurses need more practice”
oExample: “I drink when I’m bored because I have nothing else to do”
oExample: “I failed the test because the questions were stupid”
•Suppression “stuffing”: stuff feelings – conscious denial and don’t want to deal with it at
this moment
oExample: “I’m not going to talk about that”
oExample: “I’m not going to focus on planning my wedding because I have
to study”
•Denial “refusing”: to accept reality
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NR 326 EXAM 1 STUDY GUIDE

Mental Health and Illness

Mental Health

  • Success adaption to stressor from the internal or external environment observed as thoughts, feelings, and behaviors that are age appropriate and congruent with local and cultural norms

Mental Illness

  • Maladaptive (inappropriate) responses to stressor from the internal or external environment evidenced by thoughts, feelings, and behaviors that are incongruent with local cultural norms and interfere with the individual’s social, occupational, and or physical functioning

Risk Factors

  • Nature (family history and genetics)
  • Nurture (environment)

Factors to Consider

  • Normal vs. abnormal, age, situation/environment, culture, baseline, genetics, Erikson stag
  • Ability to: think rationally, communicate appropriately, learn, grow emotionally, be resilient, have a healthy self-esteem
  • What factors affect this: support system, family influence, cultural beliefs and values, negative influences, environmental perceptions of mental illness, labeling of people

The DSM- 5

  • Primary diagnosis: see in clinical and is reason for admission o Example: eating disorder
  • Secondary diagnosis: follows primary but isn’t the focus of treatment plan o Example: anxiety
  • Affects ability to function and inability to cope with crisis/stressor
  • This is how patients are diagnosed – based on symptoms

Defense Mechanism

Defense Mechanism

  • Why are they used: respond to conflict, help protect people from anxiety, not feel certain feelings
  • How are they used: adaptive and maladaptive
  • When are they used: hide a variety of thoughts
  • Chronic use is when it becomes a problem

Types of Defense Mechanisms

  • Rationalization “justifying”: creating an acceptable reason for unacceptable behavior o Example: “I wanted restraints because the nurses need more practice” o Example: “I drink when I’m bored because I have nothing else to do” o Example: “I failed the test because the questions were stupid”
  • Suppression “stuffing”: stuff feelings – conscious denial and don’t want to deal with it at this moment o Example: “I’m not going to talk about that” o Example: “I’m not going to focus on planning my wedding because I have to study”
  • Denial “refusing”: to accept reality

o Example: grief, loss, substance abuse

  • Displacement “shifting”: feelings from one thing to another – taking it out on someone else that isn’t related o Example: “boss yells at you and you pick a fight with husband or yell at kids o Example: “patient doesn’t get discharged and goes in room and gets into fight with roommate
  • Projection “reverse”: somebody else feels that way to you – not me it’s you o Example: patient hates going to group – I don’t want to go to group because everyone hates me o Example: romantic feelings for coworker – that coworker is sexually harassing them or coworker like them
  • Altruism “helping”: meeting the needs of others through helping to meet your own self- satisfaction and not dealing with your own issues o Example: nurses when they tell people to diet, sleep, and take meds but don’t do it themselves
  • Reaction formation “opposite”: treat the exact opposite of how you feel – kill them with kindness o Example: family comes to visits and patient has been complaining about them then acts all happy when they are here
  • Repression “removal”: blocking something out – unconscious and not intentional o Example: abuse (sexual) o Example: traumatic experience at the dentist and forgets to make appointments
  • Undoing “cancel”: bad behavior done and then do a good behavior thinking it will undo behavior o Example: eat a bunch of food then go workout o Example: husband and wife huge argument and then next day buys wife a nice gift
  • Regression “backwards”: resort to an earlier stage of development when faced with stressed o Example: adult throws tantrum, sucking thumb
  • Compensation “covering up”: real weakness or flaw or perceived weakness or flaw by emphasizing a different trait o Example: student isn’t smart and struggling in school, so they focus on body building instead
  • Sublimation “substituting”: angry at someone/something then go do another activity o Example: angry at boss so go exercise Legal & Ethical

Basic Ethical Principles

  • Autonomy: the client has personal choice and the ability to make decisions about care o Example: the client prescribed medication but declines to take it
  • Beneficence: “be good”, advocating for the client, doing what is in the client’s best interest o Example: the nurse intervenes when a family member makes a harmful decision on behalf of the client
  • Nonmaleficence: “no harm” ensuring client safety and the absence of harm

Relationship Development

Relationship Development

  • Hildegard Peplau: therapeutic nurse-patient relationship o Being fully present, listening, communication hope, and developing trust o Focus and foundation of what psychiatric nursing was established on
  • Goals of therapeutic relationship: to promote a climate of healing, growth, and/or illness prevention o Built on trust, facilitating communication of thoughts and feelings, goal- orientated, promoting self-care and independence, assist with problem solving, and clear boundaries
  • Therapeutic use of self: ability to use one’s personality consciously to establish rapport and structure interventions
  • Factors that affect the therapeutic relationship o Enhance: genuineness, empathy (understanding without experiencing), sympathy (feeling), time, trust, respect, listening, self-advocacy o Inhibit: judgement, transference and countertransference, boundaries
  • Transference and countertransference o Inappropriate (positive or negative), not conscious, boundary crossing o Needs to be addressed o Transference: patient unconsciously displaced emotional reactions and patterns of behavior onto others ▪ Example: you remind me of my mother o Countertransference: nurse displaces feelings related to people in nurse pasts onto the patient ▪ Example: nurses husband is an alcoholic and now caring for an intoxicated male patient

Phases of the Nurse-Patient Development

  • Pre-interaction: gather client information through report, team, family members, and chart
  • Orientation phase: will become acquainted with the client to begin to establish trust
  • Working phase: where most of the therapeutic work is completed
  • Termination phase: occurs when a patient is discharged, or a treatment plan goals have been reached Therapeutic Communication

Techniques with Examples

  • “You must think I am an idiot for crying. I miss my mother so much”

o Exploring: tell me more

o Reflection: it sounds like you miss your mom or it sounds like you are sad (think

of a feeling)

  • “I hate my mom and dad for making me stay here! They’re the ones who need to be hospitalized, not me!

o Observation: I noticed you are angry about being hospitalized (I notice or I

see then followed by a behavior)

o Reflection: you seem upset about being here (think of a feeling)

NR 326 EXAM 1 STUDY GUIDE

  • “You are the only one I can trust. Promise me you will not tell anyone what I am about to tell you”

o Offering self: I will sit here and listen to you

o Reflection: it sounds like you are unsure if you can trust me or you are concerned

about confidentiality

  • “There are bugs all over me, crawling everywhere!! Can’t you see them? o Presenting reality: There are no bugs, you are safe here o Reflection: you seem scared or it sounds like you are feeling anxious
  • “I am tired of everyone wanting to know my business! Just leave me alone! o Reflection: It sounds like you are feeling overwhelmed o Validation: I bet you are frustrated with all these questions
  • “I’m not taking any of those meds. You are Satan and you’re trying to poison me” o Present reality: I am your nurse and I want to help you with these meds o Reflection: It sounds like you are scared to take your meds
  • “I’m having sexual thoughts about the nurse over there. I’m not sure what I will do.” o Exploring: can you tell me more about your thoughts o Restating: your saying you’re having sexual thoughts about the nurse and don’t know what to do
  • “I don’t want to do this anymore” o Restating: you are saying you don’t want to do this anymore o Exploring: tell me, explain what it is you don’t want to do
  • “I don’t really want to talk. Where are you from?” o Offering self: I will be here to listen or where are you from o Reflection: it sounds like you are bothered/uncomfortable with talking
  • “I don’t know what to do about my husband, he started having an affair. What do you think I should do? o Offer self: I am here to listen if you need to talk, or it sounds like you are conflicted about what to do o Restating: so your husband had an affair?

Non-Therapeutic Communication

  • Giving reassurance devalues the client’s feelings by indicated there is no cause for their feelings
  • Rejecting
  • Approval (I am glad, I am happy)
  • Giving advice (you should, you will)
  • Asking “why?”
  • Defending
  • Introducing an unrelated topic
  • External power: “what made you” Psychotropic Medications

Different Chemicals Associated with Mental Disorders

  • Acetylcholine o Too much: depression o Too little in the hippocampus: dementia

NR 326 EXAM 1 STUDY GUIDE

Crisis Intervention & Anger/Aggression Management

Types of Crises

  • A crisis is an acute, time-limited event during which a client experiences an emotional response that cannot be managed with the client’s normal coping mechanisms
  • Maturational/Developmental: a situation in which a client us unable to move towards a different level of development – this can include a mid-life experience
  • Psychiatric emergency: a situation where general function is severely impaired, and the client is unable to assume personal responsibility for behavior. The patient is rendered incompetent to prevent injury to self or others o Examples: suicide risk, overdose, acute psychosis, uncontrolled anger, and acute suicide interpretation
  • Disposition: triggered by an external situational stressor o Example: illness or death
  • Life-transition: planned transition in life, where feel loss of control o Examples: college, marriage, move to new home
  • Traumatic Stress: crisis caused by an unexpected external stressor for which the client has no control over o Examples: violent crime, accidents, sexual assault, or abuse
  • Crisis reflecting psychopathology: this may be triggered by an underlying mental health pathology and may require further workup o Examples: severe depression, generalized anxiety, sudden awareness of mortality
  • Patient safety: o Assess for suicidal or homicidal ideations o Stay with the client o Use therapeutic communication o Prioritize care to address physical needs first
  • Assess coping skills: o Use strategies to decrease anxiety o Relaxation techniques o Identify and teach coping skills o Assist client in development of action plans

Recognize Cues

  • The single best predictor of violence is a history of violence
  • Anger is a normal feeling and an emotional response to frustration as perceived by the individual
  • Aggression is a behavior or action that results in verbal or physical attack
  • Verbal and nonverbal cues (physical)
  • Suspiciousness or paranoid thinking
  • Substance use
  • Possession of a weapon: ask the patient if they have something that can hurt them or others (knife, gun, sharps)
  • Simply ask the patient when you get angry or upset do you ever get aggressive (for example – throw things, punch walls, hit things)
  • Most important to assess and hopefully prevent aggression

De-Escalation

  • Give simple short phrases, stay calm, give them choices, don’t lie
  • Meeting the needs before by approaching in a calm way
  • Important to be proactive than reactive – anticipate and observing
  • Problem: safety and priority is harm to others because that involved more people then potential harm to self
  • Safety: o De-escalation is #1 priority o Reduce stimuli o Know the layout
  • Therapeutic relationship: o Calm voice o Teamwork
  • Outcomes: o Verbalize feelings instead of acting them out o Deep-breathing techniques o Client is more calm, appropriate o Responding to staff redirection o Medication effectiveness if applicable Theories/Therapeutic Groups

Psychological Theories

  • Psychoanalytic Theory (Freud): o Developed psychoanalysis (talk therapy) o Cause of suffering – events in childhood have influence on adult life
  • Psychosocial Development (Erikson): o Be aware of where the patient is developmentally – it may not match up with age and developmental stage ▪ Work through stage that they never did pass in order to move through the stages
  • Interpersonal Theory (Sullivan): o Believed that individual behavior and personality development are the direct result of interpersonal relationships o Human behavior could be observed in social interaction with others (group setting) o Helps to give insight or judgement into issues and how to change if necessary
  • Humanistic Theory (Maslow): o Priority: do or die (if I don’t do this for my patient will they die?) o Breathing as an issue with suicide – ASSESS FOR SUCIDIE FIRST o Safety does not mean suicide o S: safety and stay with patient o E: express feeling o A: assist patients with problem solving o The patient has not had any sleep in 4 days and is verbally agitated ▪ Nurse encourages patient to rest in their room

Milieu Therapy

Somatic Symptom & Dissociation Disorders

Somatic Symptom Disorder

  • Psychiatric disorders when a patient experiences medical or physical symptoms for no medical reason o Chest pain – cardiology work up and everything is clear but still reporting chest pain o Pain (head, back, chest, abdomen, joints), GI (N/V, dysphagia, constipation), cardiac (palpitation, SOB, dizziness)
  • “A client reports dysphagia and poor appetite. All medical record indicates no medical problems.”
  • Sensory perception (safety concern): no real suicidal or homicidal concerns o Safety: treat them as if they have the symptom o Therapeutic relationship: gradually lessen the time spent discussing the physical complaint, matter-of-fact approach, help patient shift focus from somatic (migraine right before group starts) to feelings (give them medication prior to group and discuss with patient ahead of time), observation (acknowledge that every time group is about to being you seem to get a migraine), reflection techniques o Medical: acknowledge and document, reinforce
  • Illness Anxiety Disorder o Complaint of a headache/migraine but they think they have a brain tumor o Has the world illness anxiety in it so anxious about an illness o Symptoms can be anywhere from absent to minimal ▪ Don’t have a symptom but think it is coming o “A client reports dysphagia and poor appetite. The client insists that they have throat cancer.”
  • Conversion Disorder o Sickest of the three o Patient has a physical symptom that affects voluntary and motor responses o “La Belle Indifference” – comes and goes and no reaction with the patient o Seizures – pseudoseizure and fake pregnancy (pseudocyesis), involuntary movements, paralysis, blindness o “After a stressful family meeting, the client has the inability to walk”

Dissociative Identity Disorder

  • Create multiple personalities, finding unfamiliar clothes in closet, being called an unfamiliar name by strangers, core personality is unaware
  • Are at risk for suicide so make sure they are in a safe environment o Harm to self, disturbed sensory perception, impaired memory o Safety: reality orientation o Therapeutic communication: acknowledge patient dissociation, encourage patient to verbalize their anxiety, teach coping strategies for stress-ground techniques (tapping, clapping)
  • “A client begins referring to self as another name and acting in a childlike manner when the nurse asks about how the client’s group therapy went.”

NR 326 EXAM 1 STUDY GUIDE

The Bereaved Individual

Grief, Loss, and Mourning

  • Normal grief: uncomplicated, emotions can include anger, resentment, withdrawal, hopelessness, and guilt but should change to acceptance with time o Client should achieve some acceptance by 6 months after the loss o Denial, anger, withdrawn, resentment, crying, acceptance
  • Problem list: o Risk for self-harm o Dysfunctional grieving
  • Therapeutic relationship: o Provide support through the grief process = empathy o Encourage patient to express feelings about the loss and how the loss will affect his or her life ▪ “this must be hard for you” “I’m sorry you are hurting”
  • Anticipatory grief: implies the “letting go” of an object or person before the loss (terminal illness)
  • Dysfunctional: chronic, delayed, exaggerated grief = dx, masked, somatic
  • Disenfranchised grief: this grief entails an experienced loss that cannot be publicly shared or is not socially accepted (suicide and abortion)
  • Necessary loss: part of the cycle of life; anticipated, but can still be intensely felt
  • Actual loss: any loss of a valued person or item
  • Perceived loss: any loss defined by a client that is not obvious to others
  • Maturational loss: losses normally expected due to the developmental processes of life
  • Situational loss: unanticipated loss caused by external event Suicide Prevention

Assessment

  • Self-assessment, risk factors, suicidal (thoughts, plan, access & lethality, suicide history, suicidal S/S), determine support system, protective factors
  • Anyone who is suicidal is priority – assess client’s history of sucidie attempts
  • Suicidal ideation: thought of suicide o Are you having any thoughts of wanting to kill yourself/end your life? o If yes – do you have a plan o Is there a way I can prevent it as a nurse – do they have access to their plan and is the plan going to kill them
  • Suicidal threat: verbalize attempt o I am going to do this if this doesn’t happen
  • Suicide rehearsal: has a plan and planning out the plan o Buying the Tylenol, researching it, day, time

Risk Factors

  • Psychiatric disorders: anyone who has a mental illness is at risk
  • Previous attempt “when” 25 years ago vs. yesterday – time frame of last attempt
  • Substance use: altered mental status

NR 326 EXAM 1 STUDY GUIDE

Treatment

  • Combination of medication and therapy o Antidepressants: SSRI/SNRI, Atypical, Tricyclic, MAOI, Herbal supplements & vitamins ▪ SSRI (Selective Serotonin Reuptake Inhibitor): prevent/block the reuptake of serotonin in the synaptic space, therefore intensifying the effects of serotonin ▪ SNRI (Serotonin and Norepinephrine Reuptake Inhibitor): increase the levels of serotonin and norepinephrine available ▪ Atypical: blocks reuptake/recycling of dopamine – making more dopamine available) – more serious side effects and would not give to someone who has a history of epilepsy or seizure disorder ▪ Tricyclic: block reuptake of NE and serotonin (trying to work on 2 neurotransmitters) – make more available o SSRI: first line for depression ▪ Safe minimal side effects ▪ Full effect takes 4-6 weeks of final dose decided ▪ Ineffective would be no symptom improvement ▪ Paroxetine has more adverse effects than other SSRI – most anticholinergic so use caution with elderly and confused o Therapy: exercise (endorphins), CBT (reframing thought to change feeling to change behavior), ECT (when medications don’t work), TMS, light therapy (vitamin D)

Serotonin Syndrome

  • Too much serotonin: 2-72 hours after start of dosage
  • Signs/Symptoms: o Agitation, pressured speech, tachycardia, diarrhea, shivering, diaphoresis, mydriasis (pupil dilation), clonus, hyperreflexia, tremor, seizure, trismus (spasm of jaw causing mouth to remain tightly closed o Stop the meds – benzos help with reducing agitation (cooling blankets, artificial ventilation)
  • Notify provider: o Fever, diaphoresis, tremor, tachycardia, muscle rigidity
  • Education about increase serotonin, monitor for S/S, and to stop medication and notify provider immediately (no St. John’s Wort with any psych med)

MonoAmine Oxidase Inhibitors

  • Block MAO in brain – increase amount of NE, dopamine, serotonin available for transmission
  • Absolute last option for antidepressant – fatal o Food, med, deadly side effect o Excessive levels of serotonin and dietary restrictions
  • Selegiline – patch: rotate site, last 72 hours, remove last one before putting new one on, dispose correctly and label it
  • Tyramine foods: no hard cheese or aged cheese, chocolate, aged or cured meats, fermented foods (wine and beer), overripe foods and fruits, sauces, beans
  • Keep log of current medications and blood pressure – cold meds, blood pressure meds, and any other antidepressants are all restricted
  • HTN crisis and serotonin syndrome Bipolar Disorder

Signs and Symptoms

  • Combination of really low and really high moods – usually come in during depressed mood
  • Flight of ideas
  • Grandiose thinking (think they can do anything)
  • Speech: tangential (loose association), rhyming, fast, pressured, hyperverbal (cannot stop talking)
  • Hallucinations
  • Insomnia
  • Mania
  • Irritable SSRIs Paroxetine Sertraline Fluoxetine Escitalopram Highly effective 7-10 days S ick to stomach S exual dysfunction R eally sweaty I nsomnia Administer in PM Push Fluids Monitor Na levels Monitor for SS SNRIs Duloxetine Venlafaxine Highly effective 7-10 days S ick to stomach N o libido R eally tired I nsomnia Monitor for SS Atypical "Other uses" Trazodone Bupropion Used for sleep Smoking cessation ZZZZ - sedation Dry mouth BP Insomnia Agitation Weight loss Seizures – contraindicated Avoid ETOH Hard candy/gum Give with food Tricyclic "amy tripped in the desert" Amitriptyline imipramine 6 weeks Sedation, Sweating Orthostatic Hypotension Anticholinergic Seizures Change positions slow Fiber and fluids Administer in PM
  • When to call physician: patient has become toxic (lithium level higher than 1.5)
    • hypernatremia and call if sodium levels are not within range (135-145)

Mood Stabilizers

  • If lithium doesn’t work (symptoms don’t change, adverse effects, patient can’t follow directions on labs or diet)
  • Lamotrigine (Lamictal): Steven-Johnson Syndrome (adverse effect), double or blurred vision
  • Valproic Acid/Valproate (Depakote): GI, Hepatotoxicity, Pancreatitis, Thrombocytopenia o Concerned with pancreatitis and hepatotoxicity o “Let us know if you have abdominal pain, N/V/D and give with food if upset stomach”
  • Carbamazepine (Tegretol): double or blurred vision, vertigo, 3 blood dyscrasias o Anemia: not enough health RBC o Leukopenia: low WBC o Thrombocytopenia: low platelets o “Let us know if you are feeling tired, dizzy, weak, sick, trouble seeing then take it at night and don’t drive”
  • Nursing treatment/therapies: milieu therapy, group and/or family therapy, CBT, and ECT
  • Nursing evaluation: RN should notice changes in pt behaviors, speech, and sleep patterns, medication compliance, hydration
  • Deadly side effect vs. not o N/V/D fine unless you are on Lithium Electroconvulsive Therapy

What is ECT?

  • ECT uses electrical current to induce a therapeutic seizure (controlled grand mal) while the client is under anesthesia – exact way it works is unknown, but said to electrical stimulation = increases in circulating levels of NT (dopamine, serotonin, NE) o Major depressive disorder/suicidal, schizophrenia disorders, acute manic episodes, rapid cycling
  • Requires 6-15 treatments scheduled 3 times per week, NPO after midnight, PT receives IV, short-acting anesthetic, muscle relaxant, atropine (to reduce aspiration risk) and O o May be mildly confused after treatment o Patient will be tired, may have headache, and short-term memory loss – rest in room – pain management (headache, nausea, jaw pain)
  • Can be used on pregnant woman without damage to unborn baby and for epilepsy
  • Cannot be sued for increased ICP, high risk pregnancy, COPD, severe osteoporosis

RN Considerations

  • NPO, MAOI and Lithium discontinued 2 weeks prior
  • Succinylcholine – muscle paralysis to avoid injury during seizure o Muscle relaxer and muscle paralytic
  • Baseline vitals and mental status
  • Informed consent from doctor