Exam One
The exam will consist of 50 multiple choice questions. The following are items that should be
studied as part of your review and will be on the quiz:
1. DSM 5 classification of Psychiatric illness.
The DSM-5 is a diagnostic manual. It does not provide theories of cause, management, or
treatment options. It lists 22 major categories of mental disorders with more than 150 individual
illnesses. The DSM-5 is organized in an attempt to follow the lifespan with
neurodevelopmental disorders that occur early in life listed first and neurocognitive disorders
that occur at the end of life listed last. It is organized this way to assist the diagnostic decision-
making process.
, PER MODULE MATERIAL: When working with the DSM-5 the PMH-APRN must remember
that normal reactions to stressful events are not considered mental disorders. The DSM-5
conceptualizes each of the mental disorders as a clinically significant behavioral or
psychological syndrome or pattern that occurs in an individual and is associated with present
distress (e.g., a painful symptom), disability (i.e., impairment in one or more important areas of
functioning), or with a significantly increased risk of suffering death, pain, disability, or an
important loss of freedom (APA, 2013). This syndrome or pattern must not be merely an
expected and transient response to a particular event, such as the death of a loved one. Whatever
its original causes, the behavior must currently be considered a manifestation of a behavioral,
ppsychological, or biological dysfunction to be classified as a mental disorder. Deviant behaviors
(e.g., political, religious, or sexual) and conflicts between the individual and society are not
considered mental orders per se, but if the deviance or conflict is a symptom of dysfunction in
the individual, then it may be considered a symptom of the illness.
2. Scope and standards of Practice:
Scope of practice:
, ● Define NP roles and actions
● Identifies competencies assumed to be held by all NPs who function in a particular role
● Varies broadly from state to state
● Advanced practice PMHNP standards are identified in Psychiatric-Mental Health Nursing: Scope
and Standards of Practice
Standard of Practice
● Authoritative statements regarding the quality and type of practice that should be provided
● Provide a way to judge the nature of care provided
● Reflect the expectation for the care that should be provided to clients with various illnesses
● Reflect professional agreement focused on the minimum levels of acceptable performance
● Can be used to legally describe the standard of care that must be met by a provider
● May be precise protocols that must be followed or more general guidelines that
recommend actions
3. Purpose of the Psychiatric Interview: is to gather information necessary to understand, diagnose,
and treat the client. Per textbook (Perese)-The purpose of the psychiatric interview are to
understand the patient’s illness to evaluate the effect of the illness on the patient’s life and create
a beginning diagnosis and treatment plan.
4. Therapeutic alliance: The clinician uses his or her therapeutic self-calm, warm, understanding,
kind, respectful, concerned, and focused to create a therapeutic alliance. It is through the
therapeutic alliance in the context of an ongoing relationship that the clinician is able to help the
patient change. The patient has likely had questions in his or her mind and since deciding to seek
help such as “Will I be safe or threatened, or will I be rejected?” and “Can this person help me?”
-An important part in building a therapeutic relationship is to help the patient feel accepted.
Regardless of the patient’s actual presentation, the clinician should assume that the patient is
anxious and seek to maintain the anxiety within workable limits. The clinician needs to
demonstrate empathy which is the ability to understand what the patient feels, by using
empathetic statements such as “It sounds to me as if you have been feeling some very painful
emotions.”
-Important components of therapeutic alliance:
1. The therapist and patient work collaboratively to create therapeutic change through
an affectionate bond
2. Agreement on goals of therapy
3. The therapist’s ability to be empathetic and involved in therapy
4. The ability of the patient to do the work of therapy
**The therapeutic alliance is the key to successful psychotherapy. It is the strength of the bond and
connection that can be built between you and your therapist over time. Without a trusting and respectful
therapeutic alliance, no meaningful therapy can happen.
, 5. Hildegard Peplau’s Interpersonal relations In Nursing- earliest modern nursing theory. Enabled
nursing to establish the groundwork for Advanced Practice Nursing (APN) (first role was Clinical
Nurse Specialist in Psychiatric Nursing).
6. Psychotherapy- holistic treatment that relies on the nurse’s processing of what the patient
is experiencing.
7. Peplau’s Theory integrated with the psychological theories of interpersonal relations
and communication.
Peplau emphasized the art of communication to highlight the importance of nursing interventions
in facilitating achievement of quality clients–centered care and quality of life (Haber, 2000). The
PMH-APRN must establish and maintain a therapeutic relationship in which the client will feel
safe and hopeful that positive change is possible. Once a therapeutic relationship is established,
specific needs and problems can be identified, and the nurse can work with the client on
increasing problem-solving skills, learning new coping behaviors, and experiencing more
appropriate and satisfying ways of relating to others. To do this, the advanced practice
psychiatric mental health nurse must have a sound knowledge of communication skills. PMH-
APRNs must become more aware of their own interpersonal methods, eliminating obstructive,
non-therapeutic communication techniques and developing additional responses that maximize
nurse-client interactions and increase the use of helpful therapeutic communication techniques.
THERAPEUTIC COMMUNICATIONS TECHNIQUES
Therapeutic Definitions Examples
Techniques
Silence Purposeful absence of verbal Nodding, maintaining eye contact
communication while continuing to
focus on the client
Accepting Indicating (verbally and Nodding: Yes, um-hmm, I follow what
nonverbally) that what is heard is you said.
acknowledged; does not necessarily
indicate agreement with what was
said
The exam will consist of 50 multiple choice questions. The following are items that should be
studied as part of your review and will be on the quiz:
1. DSM 5 classification of Psychiatric illness.
The DSM-5 is a diagnostic manual. It does not provide theories of cause, management, or
treatment options. It lists 22 major categories of mental disorders with more than 150 individual
illnesses. The DSM-5 is organized in an attempt to follow the lifespan with
neurodevelopmental disorders that occur early in life listed first and neurocognitive disorders
that occur at the end of life listed last. It is organized this way to assist the diagnostic decision-
making process.
, PER MODULE MATERIAL: When working with the DSM-5 the PMH-APRN must remember
that normal reactions to stressful events are not considered mental disorders. The DSM-5
conceptualizes each of the mental disorders as a clinically significant behavioral or
psychological syndrome or pattern that occurs in an individual and is associated with present
distress (e.g., a painful symptom), disability (i.e., impairment in one or more important areas of
functioning), or with a significantly increased risk of suffering death, pain, disability, or an
important loss of freedom (APA, 2013). This syndrome or pattern must not be merely an
expected and transient response to a particular event, such as the death of a loved one. Whatever
its original causes, the behavior must currently be considered a manifestation of a behavioral,
ppsychological, or biological dysfunction to be classified as a mental disorder. Deviant behaviors
(e.g., political, religious, or sexual) and conflicts between the individual and society are not
considered mental orders per se, but if the deviance or conflict is a symptom of dysfunction in
the individual, then it may be considered a symptom of the illness.
2. Scope and standards of Practice:
Scope of practice:
, ● Define NP roles and actions
● Identifies competencies assumed to be held by all NPs who function in a particular role
● Varies broadly from state to state
● Advanced practice PMHNP standards are identified in Psychiatric-Mental Health Nursing: Scope
and Standards of Practice
Standard of Practice
● Authoritative statements regarding the quality and type of practice that should be provided
● Provide a way to judge the nature of care provided
● Reflect the expectation for the care that should be provided to clients with various illnesses
● Reflect professional agreement focused on the minimum levels of acceptable performance
● Can be used to legally describe the standard of care that must be met by a provider
● May be precise protocols that must be followed or more general guidelines that
recommend actions
3. Purpose of the Psychiatric Interview: is to gather information necessary to understand, diagnose,
and treat the client. Per textbook (Perese)-The purpose of the psychiatric interview are to
understand the patient’s illness to evaluate the effect of the illness on the patient’s life and create
a beginning diagnosis and treatment plan.
4. Therapeutic alliance: The clinician uses his or her therapeutic self-calm, warm, understanding,
kind, respectful, concerned, and focused to create a therapeutic alliance. It is through the
therapeutic alliance in the context of an ongoing relationship that the clinician is able to help the
patient change. The patient has likely had questions in his or her mind and since deciding to seek
help such as “Will I be safe or threatened, or will I be rejected?” and “Can this person help me?”
-An important part in building a therapeutic relationship is to help the patient feel accepted.
Regardless of the patient’s actual presentation, the clinician should assume that the patient is
anxious and seek to maintain the anxiety within workable limits. The clinician needs to
demonstrate empathy which is the ability to understand what the patient feels, by using
empathetic statements such as “It sounds to me as if you have been feeling some very painful
emotions.”
-Important components of therapeutic alliance:
1. The therapist and patient work collaboratively to create therapeutic change through
an affectionate bond
2. Agreement on goals of therapy
3. The therapist’s ability to be empathetic and involved in therapy
4. The ability of the patient to do the work of therapy
**The therapeutic alliance is the key to successful psychotherapy. It is the strength of the bond and
connection that can be built between you and your therapist over time. Without a trusting and respectful
therapeutic alliance, no meaningful therapy can happen.
, 5. Hildegard Peplau’s Interpersonal relations In Nursing- earliest modern nursing theory. Enabled
nursing to establish the groundwork for Advanced Practice Nursing (APN) (first role was Clinical
Nurse Specialist in Psychiatric Nursing).
6. Psychotherapy- holistic treatment that relies on the nurse’s processing of what the patient
is experiencing.
7. Peplau’s Theory integrated with the psychological theories of interpersonal relations
and communication.
Peplau emphasized the art of communication to highlight the importance of nursing interventions
in facilitating achievement of quality clients–centered care and quality of life (Haber, 2000). The
PMH-APRN must establish and maintain a therapeutic relationship in which the client will feel
safe and hopeful that positive change is possible. Once a therapeutic relationship is established,
specific needs and problems can be identified, and the nurse can work with the client on
increasing problem-solving skills, learning new coping behaviors, and experiencing more
appropriate and satisfying ways of relating to others. To do this, the advanced practice
psychiatric mental health nurse must have a sound knowledge of communication skills. PMH-
APRNs must become more aware of their own interpersonal methods, eliminating obstructive,
non-therapeutic communication techniques and developing additional responses that maximize
nurse-client interactions and increase the use of helpful therapeutic communication techniques.
THERAPEUTIC COMMUNICATIONS TECHNIQUES
Therapeutic Definitions Examples
Techniques
Silence Purposeful absence of verbal Nodding, maintaining eye contact
communication while continuing to
focus on the client
Accepting Indicating (verbally and Nodding: Yes, um-hmm, I follow what
nonverbally) that what is heard is you said.
acknowledged; does not necessarily
indicate agreement with what was
said
