NR605 Midterm Exam Diagnosis and Management in Psychiatric Mental Health 2025

________ developed the concept of attachment theory - -Bowlby -his studies of the maternal-infant bond -individuals form attachments to others and that separation or the threat of separation can lead to distress and depression A client and her husband approach the psychotherapist at a mutual friend's party. The client introduces her husband to the provider who returns the greeting. May or may not be a boundary violation Boundary violation Not a boundary violation - -Not a boundary violation Rationale: This is not a boundary violation because the client approached the psychotherapist. If the psychotherapist approached the client, it would be a boundary violation A client has a florist shop in town. The psychotherapist needs to send an arrangement to a friend and typically orders from another shop when he remembers that his client owns a shop. He orders the flowers from the client's shop. May or may not be a boundary violation Boundary violation Not a boundary violation - -Boundary violation Rationale: This is probably a boundary violation. It's helpful to avoid dual relationships when possible. A client who is alert and oriented declines the PMHNP's treatment recommendation for an antipsychotic in a non-emergent situation. Informed consent required Exception to informed consent - -Informed consent required Rationale: The client has the capacity to consent and the situation is not emergent. The ethic of autonomy provides for the client to refuse treatment options. A client with depression is unhappy about the performance of the anti-depressant that has been prescribed and would like to discuss alternate treatment options with the PMHNP. NR605 NR605 Informed consent required Exception to informed consent - -Informed consent required Rationale: Clients have a right to information about treatment options with associated risks and benefits. A no-suicide or no-harm contract: - --not a legal document but rather an agreement between the client and therapist about what the client should do if they become suicidal -involves a commitment by the client to not commit suicide. -may not be effective in a crisis and is not a substitute for clinical judgment. -only as beneficial as the therapeutic alliance A psychotherapist agrees to a blind date with a client's sister. May or may not be a boundary violation Boundary violation Not a boundary violation - -May or may not be a boundary violation Rationale: This may or may not be a boundary violation depending on whether the client is a current client. Refer to state-specific guidelines for information about boundaries with former clients. A psychotherapist holds the client's hand during the client's retelling of a traumatic event after the client reaches out. May or may not be a boundary violation Boundary violation Not a boundary violation - -Not a boundary violation Rationale: This is not a boundary violation. Touch may be therapeutic in certain situations. A psychotherapist shares her history of sexual assault with a client who has had a similar experience. May or may not be a boundary violation Boundary violation Not a boundary violation - -May or may not be a boundary violation Rationale: This may or may not be a boundary violation. Some forms of psychotherapy may include self-disclosure as part of the therapeutic alliance. A psychotherapist was in a car accident and needs auto body work completed. When the psychotherapist arrives at the auto body shop suggested by the insurance company, NR605 NR605 she realizes that the shop is managed by one of her clients. The psychotherapist schedules the needed repairs. May or may not be a boundary violation Boundary violation Not a boundary violation - -May or may not be a boundary violation Rationale: This may or may not be a boundary violation. Dual relationships may be problematic; however, if the psychotherapist resides in a small town and the body shop is the only shop approved by insurance, it may not be a boundary violation. A very anxious client is seeking treatment for anxiety symptoms. When the PMHNP begins to explain the treatment options, the client says she is too anxious to hear them and asks that the PMHNP select the best option. Exception to informed consent Informed consent required - -Exception to informed consent Rationale: Clients may choose to waive their right to informed consent. Ahmad recently experienced a nasty breakup with his girlfriend after she cheated on him. While he would like to call her to vent his anger and frustration, instead, he channels his energy into training for a marathon. -Displacement -Denial -Sublimation -Projection -Regression -Repression -Rationalization -Intellectualization - -Sublimation Sublimation occurs when a person transfers unacceptable impulses into socially acceptable forms. Aleksander received an inferior performance evaluation at work. When he arrived home after a long day, he shouted at his 3-year-old daughter for leaving her toys out in the playroom. -Displacement -Denial -Sublimation -Projection -Regression -Repression NR605 NR605 -Rationalization -Intellectualization - -Displacement Displacement occurs when a person expresses an emotion, such as anger or frustration, towards a "safe" person rather than towards the cause of the emotion. An agitated, hallucinating client with a diagnosis of schizophrenia and no designated decision-maker threatens to shoot his neighbors. The client acts out violently towards the security guard in the emergency department. The PMHNP orders haloperidol and lorazepam for the client. Exception to informed consent Informed consent required - -Exception to informed consent Rationale: The client does not have the capacity to provide consent. Anderson has been having an affair with his secretary at work. He has become highly suspicious of his wife and frequently accuses her of being attracted to her boss. -Displacement -Denial -Sublimation -Projection -Regression -Repression -Rationalization -Intellectualization - -Projection Projection involves ascribing one's feelings to another person. Brief Psychodynamic Therapy - --used when the client has a specific issue or conflict such as difficulty in relationships, school or work, or communication. -time-limited form of psychotherapy • occurs fewer days per week over a shorter length of time • typically 20-30 sessions with a termination date set at the beginning of therapy -Goals: enhancement of self-awareness and understanding the impact of the past on present behavior -Therapeutic Techniques: pressure, or encouragement, to examine feelings and situations; challenge to defenses, and head-on collision to overcome defenses. Characteristics of IPT - --Time-limited: usually 12-16 weekly sessions -Focused -Based on current relationships -Interpersonal, not intrapsychic, cognitive, or behavioral -Aware of personality, but not focused on it NR605 NR605 Cieran's boss is routinely rude and abrupt with him. Today she accused him of arriving late to work though he was on time. Rather than confront his boss, Cieran wonders whether his boss has difficulties at home that make her irritable.