NUR 463 Final Exam Learning Objectives
Mid Term Topic Focus Areas
1. Identify when temporary emergency admissions requirements to a psychiatric unit are met
Section 12 (A & B)
▪ Short term involuntary commitment
▪ Emergency commitment
▪ Lasts 12-72 hours
▪ Danger to self and others
▪ Unable to take care of self
▪ May be initiated by: physician, psychiatrist, qualified psychologist, qualified psychiatric nurse, police officer,
licensed independent clinical social worker
▪ The application for and court authorization of temporary involuntary hospitalization of a person if there is
concern that failure to hospitalize the person would create a likelihood of serious harm
▪ After 3 days, the person must be released or sign a conditional voluntary – section 10 & 11 or the hospital must
petition for a civil commitment under section 7 & 8
2. Recognize the various roles in group
Task Roles
▪ Coordinator: classifies ideas/suggestions that have been made within the group; brings relationships together to
pursue common goals
▪ Evaluator: examines group plans and performance, measuring against group standards and goals
▪ Elaborator: explains and expands upon group plans and ideas
▪ Energizer: encourages and motivates group to perform at its maximum potential
▪ Initiator: outlines the task at hand for the group and proposes methods for solution
▪ Orienter: maintains direction within the group
Maintenance Roles
▪ Compromiser: relieves conflict within the group by assisting members to reach a compromise agreeable to all
▪ Encourager: offers recognition and acceptance of others’ ideas and contributions
▪ Follower: listens attentively to group interaction; is a passive participant
▪ Gatekeeper: encourages tension within the group by intervening when disagreements produce conflict
▪ Harmonizer: minimizes tension within the group by intervening when disagreements produce conflict
Individual (personal) Roles
▪ Aggressor: expresses negativism and hostility toward other members; may use sarcasm in effort to degrade the
status of others
▪ Blocker: resists group efforts; demonstrates rigid and sometimes irrational behaviors that impede group progres
▪ Dominator: manipulates others to gain control, behaves in authoritarian manner
▪ Help-seeker: uses the group the gain sympathy from others; seeks to increase self-confidence from group
feedback; lacks concern for others or for the group as a whole
▪ Monopolizer: maintains control of the group by dominating the conversation
▪ Mute or silent member: does not participate verbally; remains silent for a variety of reasons – may feel
uncomfortable with self-disclosure or may be seeking attention through silence
▪ Recognition seeker: talks about personal accomplishments in an effort to gain attention for self
▪ Seducer: shares intimate details about self with group; is the last reluctant of the group to do so; may frighten
others in the group and inhibit group progress with excessive premature self-disclosure
3. State the purpose of community meeting
Community meetings on mental health unit
▪ Enhance the emotional climate of the therapeutic milieu by promoting:
• Interaction and communication between staff and clients
• Decision making skills of clients
1
, • A feeling of self-worth among clients
• Discussions of common unit objectives (encouraging clients to meet treatment goals and plan for
discharge)
• Discussion of issues or concerns to all members of the unit, including common problems, future activitie
and the introduction of new clients to the unit
• Meetings can be structured so that they are client-led with decisions made by the group as a whole
4. Differentiate between symptoms: delusions versus hallucinations
Delusions and hallucinations are both part of a false reality, but are not the same
Hallucinations: sensory perceptions that do not have any apparent external stimulus/not associated with real external
stimuli
▪ Auditory, command auditory, visual, olfactory, gustatory, and tactile
Delusions: alterations in thought are false fixed beliefs that are irrational and that the individual maintains as true
despite evidence to the contrary; cannot be corrected by reasoning and are usually bizarre
▪ Ideas of reference, persecution, grandeur, somatic, jealousy, being controlled, thought broadcasting, thought
insertion, thought withdrawal, religiosity, and magical thinking
5. Identify the psychiatric patient rights regarding least restrictive intervention and how it applies to
psychiatric nursing practice
Least restrictive measures
▪ Verbal interventions (encouraging the client to de-escalate)
▪ Diversion or redirection
▪ Providing a calm, quiet environment
▪ Decreasing environment stimuli
▪ Offering a PRN medication (though technically a chemical restraint, medications are considered less restrictive
than a mechanical restraint)
▪ When the nurse has tried all least restrictive means, the use of restraints can be initiated – as the last resort
6. Differentiate between the symptoms of schizoaffective disorder versus schizophrenia
*Schizoaffective disorder has mood component
Schizoaffective disorder
▪ Hybrid between mood disorder and schizophrenia
▪ At some point, meets for both mood episode and main schizophrenia symptoms
▪ Delusions/hallucinations present without mood episode for 2 or more weeks over lifetime
Schizophrenia
▪ Must have 2 or more of the following symptoms for a month over last 6 months, including 1, 2, or 3
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly abnormal psychomotor behavior
5. Negative symptoms
▪ Social/occupational dysfunction
▪ Exclusion: medical condition or drug
7. State the nursing diagnoses of AH versus VH
Nursing diagnoses for auditory hallucinations
▪ Risk for violence: self-directed or other-directed (command hallucinations)
▪ Disturbed sensory perception
Nursing diagnoses for visual hallucinations
▪ Disturbed sensory perception
▪ Disturbed thought processes
2
, 8. Recognize the symptoms of depression, including affective symptoms
Expected findings
▪ Anergia (lack of energy)
▪ Anhedonia (lack of pleasure in normal activities)
▪ Anxiety
▪ Reports of sluggishness (most common), or feeling unable to relax and sit still
▪ Vegetative findings, which include a change in eating patterns (usually anorexia in MDD; increased intake in
persistent depressive disorder and PMDD)
• Change in bowel habits (usually constipation)
• Sleep disturbances
• Decreased interest in sexual activity
▪ Somatic reports
• Fatigue
• GI changes
• Pain
Physical assessment findings
▪ The client most often looks sad with blunted affect
▪ The client exhibits poor grooming and lack of hygiene
▪ Psychomotor retardation (slowed physical movement, slumped posture) is more common, but psychomotor
agitation (restlessness, pacing, finger tapping) can also occur
▪ The client becomes socially isolated, showing little or no effort to interact
▪ Slowed speech, decreased verbalization, delayed response
• The client might seem too tired to speak and can sign often
9. Identify which medications are MAOIs and understand foods prohibited in a MAOI diet
Monoamine oxidase inhibitors (MAOIs)
▪ Phenelzine (Nardil)
▪ Isocarboxazid (Marplan)
▪ Tranylcypromine (Parnate)
▪ Selegine: transdermal patch
▪ ~*PMSN*~
▪ Block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for
transmission of impulses
▪ Increased amount of the neurotransmitters at nerve endings intensifies responses and decreases depression
Contraindicated for:
▪ Due to risk for hypertensive crisis, avoid tyramine-rich foods
• Aged cheese, fermented or smoked meats, liver, pepperoni, salami, avocado, figs, bananas, smoked fish,
protein dietary supplements, some beers wines
• ~*Nardil the narwhal can’t eat charcuterie boards*~
10. Identify signs and symptoms of persistent depressive disorder symptoms (Dysthymia)
▪ Characteristics are similar to, if somewhat milder than those ascribed to MDD
▪ Individuals describe mood as sad or <down in the dumps=
▪ No evidence of psychotic symptoms
▪ Essential feature: chronically depressed mood (or possibly irritable mood in children/adolescents) for most of
the day, more days than not, for at least 2 years (1 year for children and adolescents)
▪ Diagnosis identified as:
• Early onset – occurring before age 21
• Late onset – occurring at age 21 or older
11. Priority nursing intervention for a depressed patient
3
, ▪ Priority: assess client for SI and plan/means
▪ Create a safe environment for client
▪ Maintain close observation
▪ Maintain special care in administration of medications
▪ Make rounds at frequent irregular intervals
▪ Encourage client to express feelings
▪ Identify community resources that client can access for support
12. Identify therapeutic communication techniques
▪ Using silence
▪ Accepting – understanding, eye contact/nodding
▪ Giving recognition
▪ Offering self
▪ Giving broad openings
▪ Offering general leads
▪ Placing the event in time or sequence
▪ Making observations
▪ Encouraging description of perceptions
▪ Encouraging comparison
▪ Restating – repeating main idea to reflect understanding and/or chance to continue or clarify if necessary
▪ Focusing – taking notice of single idea encourages specific discussion about relevant issue (don’t do until anxie
lessens)
▪ Exploring
▪ Seeking clarification and validation
▪ Presenting reality
▪ Voicing doubt
▪ Verbalizing the implied – putting into words what the pt has only implied or said indirectly; helpful with pts who
are experiencing impaired verbal communication
▪ Attempting to translate words into feelings – when pt has difficulty identifying feelings or feelings are expressed
indirectly, nurse tries to find clues to underlying feelings
▪ Formulating a plan of action
13. State a therapeutic response to a delusional patient
▪ Do not argue with a client’s delusion but focus on the client’s feelings and possibly offer reasonable explanation
▪ E.g., <I can’t imagine that the president of the U.S. would have a reason to kill a citizen, but it must be frightening
for you to believe that.=
▪ Therapeutic communication: voicing doubt
• Expressing uncertainty about the validity of the pts perceptions is a technique often used with pts
experiencing delusional thinking
14. Identify various ego defense mechanisms
Maladaptive response to stress
▪ When a person uses a defense mechanism, and it interferes with functioning, relationships, and orientation to
reality
Defense Mechanisms
▪ Compensation
▪ Denial
▪ Displacement
▪ Identification
▪ Intellectualization
▪ Introjection
▪ Isolation
4
Mid Term Topic Focus Areas
1. Identify when temporary emergency admissions requirements to a psychiatric unit are met
Section 12 (A & B)
▪ Short term involuntary commitment
▪ Emergency commitment
▪ Lasts 12-72 hours
▪ Danger to self and others
▪ Unable to take care of self
▪ May be initiated by: physician, psychiatrist, qualified psychologist, qualified psychiatric nurse, police officer,
licensed independent clinical social worker
▪ The application for and court authorization of temporary involuntary hospitalization of a person if there is
concern that failure to hospitalize the person would create a likelihood of serious harm
▪ After 3 days, the person must be released or sign a conditional voluntary – section 10 & 11 or the hospital must
petition for a civil commitment under section 7 & 8
2. Recognize the various roles in group
Task Roles
▪ Coordinator: classifies ideas/suggestions that have been made within the group; brings relationships together to
pursue common goals
▪ Evaluator: examines group plans and performance, measuring against group standards and goals
▪ Elaborator: explains and expands upon group plans and ideas
▪ Energizer: encourages and motivates group to perform at its maximum potential
▪ Initiator: outlines the task at hand for the group and proposes methods for solution
▪ Orienter: maintains direction within the group
Maintenance Roles
▪ Compromiser: relieves conflict within the group by assisting members to reach a compromise agreeable to all
▪ Encourager: offers recognition and acceptance of others’ ideas and contributions
▪ Follower: listens attentively to group interaction; is a passive participant
▪ Gatekeeper: encourages tension within the group by intervening when disagreements produce conflict
▪ Harmonizer: minimizes tension within the group by intervening when disagreements produce conflict
Individual (personal) Roles
▪ Aggressor: expresses negativism and hostility toward other members; may use sarcasm in effort to degrade the
status of others
▪ Blocker: resists group efforts; demonstrates rigid and sometimes irrational behaviors that impede group progres
▪ Dominator: manipulates others to gain control, behaves in authoritarian manner
▪ Help-seeker: uses the group the gain sympathy from others; seeks to increase self-confidence from group
feedback; lacks concern for others or for the group as a whole
▪ Monopolizer: maintains control of the group by dominating the conversation
▪ Mute or silent member: does not participate verbally; remains silent for a variety of reasons – may feel
uncomfortable with self-disclosure or may be seeking attention through silence
▪ Recognition seeker: talks about personal accomplishments in an effort to gain attention for self
▪ Seducer: shares intimate details about self with group; is the last reluctant of the group to do so; may frighten
others in the group and inhibit group progress with excessive premature self-disclosure
3. State the purpose of community meeting
Community meetings on mental health unit
▪ Enhance the emotional climate of the therapeutic milieu by promoting:
• Interaction and communication between staff and clients
• Decision making skills of clients
1
, • A feeling of self-worth among clients
• Discussions of common unit objectives (encouraging clients to meet treatment goals and plan for
discharge)
• Discussion of issues or concerns to all members of the unit, including common problems, future activitie
and the introduction of new clients to the unit
• Meetings can be structured so that they are client-led with decisions made by the group as a whole
4. Differentiate between symptoms: delusions versus hallucinations
Delusions and hallucinations are both part of a false reality, but are not the same
Hallucinations: sensory perceptions that do not have any apparent external stimulus/not associated with real external
stimuli
▪ Auditory, command auditory, visual, olfactory, gustatory, and tactile
Delusions: alterations in thought are false fixed beliefs that are irrational and that the individual maintains as true
despite evidence to the contrary; cannot be corrected by reasoning and are usually bizarre
▪ Ideas of reference, persecution, grandeur, somatic, jealousy, being controlled, thought broadcasting, thought
insertion, thought withdrawal, religiosity, and magical thinking
5. Identify the psychiatric patient rights regarding least restrictive intervention and how it applies to
psychiatric nursing practice
Least restrictive measures
▪ Verbal interventions (encouraging the client to de-escalate)
▪ Diversion or redirection
▪ Providing a calm, quiet environment
▪ Decreasing environment stimuli
▪ Offering a PRN medication (though technically a chemical restraint, medications are considered less restrictive
than a mechanical restraint)
▪ When the nurse has tried all least restrictive means, the use of restraints can be initiated – as the last resort
6. Differentiate between the symptoms of schizoaffective disorder versus schizophrenia
*Schizoaffective disorder has mood component
Schizoaffective disorder
▪ Hybrid between mood disorder and schizophrenia
▪ At some point, meets for both mood episode and main schizophrenia symptoms
▪ Delusions/hallucinations present without mood episode for 2 or more weeks over lifetime
Schizophrenia
▪ Must have 2 or more of the following symptoms for a month over last 6 months, including 1, 2, or 3
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly abnormal psychomotor behavior
5. Negative symptoms
▪ Social/occupational dysfunction
▪ Exclusion: medical condition or drug
7. State the nursing diagnoses of AH versus VH
Nursing diagnoses for auditory hallucinations
▪ Risk for violence: self-directed or other-directed (command hallucinations)
▪ Disturbed sensory perception
Nursing diagnoses for visual hallucinations
▪ Disturbed sensory perception
▪ Disturbed thought processes
2
, 8. Recognize the symptoms of depression, including affective symptoms
Expected findings
▪ Anergia (lack of energy)
▪ Anhedonia (lack of pleasure in normal activities)
▪ Anxiety
▪ Reports of sluggishness (most common), or feeling unable to relax and sit still
▪ Vegetative findings, which include a change in eating patterns (usually anorexia in MDD; increased intake in
persistent depressive disorder and PMDD)
• Change in bowel habits (usually constipation)
• Sleep disturbances
• Decreased interest in sexual activity
▪ Somatic reports
• Fatigue
• GI changes
• Pain
Physical assessment findings
▪ The client most often looks sad with blunted affect
▪ The client exhibits poor grooming and lack of hygiene
▪ Psychomotor retardation (slowed physical movement, slumped posture) is more common, but psychomotor
agitation (restlessness, pacing, finger tapping) can also occur
▪ The client becomes socially isolated, showing little or no effort to interact
▪ Slowed speech, decreased verbalization, delayed response
• The client might seem too tired to speak and can sign often
9. Identify which medications are MAOIs and understand foods prohibited in a MAOI diet
Monoamine oxidase inhibitors (MAOIs)
▪ Phenelzine (Nardil)
▪ Isocarboxazid (Marplan)
▪ Tranylcypromine (Parnate)
▪ Selegine: transdermal patch
▪ ~*PMSN*~
▪ Block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for
transmission of impulses
▪ Increased amount of the neurotransmitters at nerve endings intensifies responses and decreases depression
Contraindicated for:
▪ Due to risk for hypertensive crisis, avoid tyramine-rich foods
• Aged cheese, fermented or smoked meats, liver, pepperoni, salami, avocado, figs, bananas, smoked fish,
protein dietary supplements, some beers wines
• ~*Nardil the narwhal can’t eat charcuterie boards*~
10. Identify signs and symptoms of persistent depressive disorder symptoms (Dysthymia)
▪ Characteristics are similar to, if somewhat milder than those ascribed to MDD
▪ Individuals describe mood as sad or <down in the dumps=
▪ No evidence of psychotic symptoms
▪ Essential feature: chronically depressed mood (or possibly irritable mood in children/adolescents) for most of
the day, more days than not, for at least 2 years (1 year for children and adolescents)
▪ Diagnosis identified as:
• Early onset – occurring before age 21
• Late onset – occurring at age 21 or older
11. Priority nursing intervention for a depressed patient
3
, ▪ Priority: assess client for SI and plan/means
▪ Create a safe environment for client
▪ Maintain close observation
▪ Maintain special care in administration of medications
▪ Make rounds at frequent irregular intervals
▪ Encourage client to express feelings
▪ Identify community resources that client can access for support
12. Identify therapeutic communication techniques
▪ Using silence
▪ Accepting – understanding, eye contact/nodding
▪ Giving recognition
▪ Offering self
▪ Giving broad openings
▪ Offering general leads
▪ Placing the event in time or sequence
▪ Making observations
▪ Encouraging description of perceptions
▪ Encouraging comparison
▪ Restating – repeating main idea to reflect understanding and/or chance to continue or clarify if necessary
▪ Focusing – taking notice of single idea encourages specific discussion about relevant issue (don’t do until anxie
lessens)
▪ Exploring
▪ Seeking clarification and validation
▪ Presenting reality
▪ Voicing doubt
▪ Verbalizing the implied – putting into words what the pt has only implied or said indirectly; helpful with pts who
are experiencing impaired verbal communication
▪ Attempting to translate words into feelings – when pt has difficulty identifying feelings or feelings are expressed
indirectly, nurse tries to find clues to underlying feelings
▪ Formulating a plan of action
13. State a therapeutic response to a delusional patient
▪ Do not argue with a client’s delusion but focus on the client’s feelings and possibly offer reasonable explanation
▪ E.g., <I can’t imagine that the president of the U.S. would have a reason to kill a citizen, but it must be frightening
for you to believe that.=
▪ Therapeutic communication: voicing doubt
• Expressing uncertainty about the validity of the pts perceptions is a technique often used with pts
experiencing delusional thinking
14. Identify various ego defense mechanisms
Maladaptive response to stress
▪ When a person uses a defense mechanism, and it interferes with functioning, relationships, and orientation to
reality
Defense Mechanisms
▪ Compensation
▪ Denial
▪ Displacement
▪ Identification
▪ Intellectualization
▪ Introjection
▪ Isolation
4
