NSG 526/ NSG526 Exam 1 – Advanced Psychiatric Mental Health Nursing Practice 2026/2027 | Wilkes | Latest Questions & Verified Answers

NSG 526/ NSG526 Exam 1 – Advanced Psychiatric Mental Health Nursing Practice 2026/2027 | Wilkes | Latest Questions & Verified Answers A syndrome characterized by clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental funcioning They are associated with significant distress, disability in social occupational, or other important activities mental disorder/psychiatric illness Criteria that are offered as guidelines for making diagnoses Diagnostic Criteria When the symptom presentation does not meet full criteria for any disorder and the symptom cause clinically significant distress/impairment what categories should be used in the diagnosis "other specified" "unspecified" When the symptom presentation does not meet full criteria and "other specified" and "unspecified" categories are used in the diagnosis, what should the main diagnosis be corresponding to? main diagnosis should correspond to the most predominant symptoms. ex: Bipolar disorder, unspecified The coding system that is used in the U.S. for diagnosing and documenting psychiatric disorders ICD-10-CM (international classification of disease-10th revision-clinical modification) True or false: the diagnosis of a mental disorder is not equivalent to a need for treatment TRUE - clinicians should treat based on symptom severity, clinical presentation, etc. 1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness. 2. At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section." 3. "psychological factors, like excessive stress have been found to affect medical conditions" 8. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation 3. Reaction formation Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. 11. When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!" 4. the client says to the spouse, "I don't drink too much!" 10. Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality. 2. individuals experiencing psychoses experience little distress The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. They are unaware of their psychological problems 15. How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following? 1. Psychosocial, biological, or developmental process underlying mental functioning 2. Psychological, cognitive, or developmental process underlying mental functioning 3. Psychological, biological, or developmental process underlying mental functioning 4. Psychological, biological, or psychosocial process underlying mental functioning 3. psychological, biological, or developmental process underlying mental functioning. 16. A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span 1. fidgeting 2. laughing inappropriately 4. nail biting Which documentation of a patient's behavior best demonstrates a psychiatric advanced practice nurse's professional observations regarding the patient's psychotic symptoms? A) Isolates self from others. Frequently fell asleep during group. Vital signs stable. B) Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking. C) Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. D) Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin. D. wore four layers of clothing. states "i need protection from evil bacteria trying to pierce my skin" In using the communication technique of reflection, the psychiatric advanced practice nurse: A) Interprets the difference between a patient's thoughts and his or her behaviors. B) Repeats something that the patient has said to encourage the patient to give more information. C) Provides prompts such as "tell me more." D) Seeks more information in order to have a more clear understanding. B. repeats something the patient has said to encourage the patient to give more information Which one of the following is not true regarding the mental status examination? A) Racing thoughts are considered part of the thought process B) Blunted is a term used to describe affect C) Hallucinations are part of thought content D) Delusions are part of thought content C. Hallucinations are a part of thought content. **** Delusions are a part of thought content ** suicidal thoughts, homicidal thoughts, and thoughts of self-harm are all covered in thought content -- think - it is the CONTENT of your thoughts!!! *** The thought process is the WAY in which a client thinks. - often evidenced by their speech ***illusions and hallucinations are covered under perceptual disturbances The PMHNP has a new patient in the clinic. While looking at the materials the patient filled out in the waiting area, the PMHNP ascertains the patient has a substance abuse history. The PMHNP immediately says, "stupid drug addicts, they're so annoying. There such a waste of time. They never want to get better. "This is an example of: A) Projection B) Transference C) Countertransference D) ResistanceFsaf C. countertransference Which comment(s) by an elderly person best indicates successful completion of developmental tasks? Select all that apply. A) "I am proud of my children's successes in life." B) "I should have given to charities more often." C) "My relationship with my father made life more difficult for me." D) "I often wonder what would have happened if I had chosen a different career." A. I am proud of my children's success in life The purposes of the psychiatric interview include all except: A) Gaining an understanding of the patient's illness. B) Obtaining information efficiently. C) Providing education about psychiatric disorders. D) Establishing a therapeutic alliance. C. providing education about psychiatric disorders operates to the pleasure principle. Seeking please and avoiding pain. It drives wishes, desires and fantasies. No real perception of reality. It uses primary process... Seeks to satisfy its needs. ID ID has 2 major instincts, what are they? EROS - focus on pleasure-seeking tendencies such as sexual urges. THANATOS - motivates people to use aggressive urges to destroy. aware of reality and understands that behaviors have consequences. It uses secondary processes... perception, recognition, judgement, memory, reasoning, problem-solving, impulse control and formation of relationships EGO contains morals and values and is developed from our parents through childhood and society. Contains the rules of right and wrong. SUPER EGO 7. What reason does the nurse give the patient for the emphasis and attention being paid to the recovery phase of their treatment plan? a. Recovery care, even when intensive, is less expensive than acute psychiatric care. b. Effective recovery care is likely to result in fewer relapses and subsequent hospitalizations. c. Planning for recovery care is time consuming and involves dealing with many complicated details. d. Recovery care is usually done on an outpatient basis and so is generally better accepted by patients. B. Effective recovery care is likely to result in fewer relapses and susequent hospitalizations. Which activity shows that a therapeutic alliance has been established between the nurse and patient? a. The nurse respects the patients right to privacy when visitors are spending time with the patient. b. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors. c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse. d. The nurse dutifully administers the patients medications on time and with appropriate knowledge of the potential side effects. C. the patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse. 2. When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ED) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by: a. Reviewing the ED chart b. Contacting the admitting physician c. Directing the questions to the family members d. Establishing a line of communication with the patient D. establishing a line of communication with the patient 4. When engaging in outcomes identification, the nurse: a. Interviews and collects patient-focused data b. Re-assesses the patients physical and emotional status evaluation c. Reviews the patients existing problems and projects the results of the nursing care d. Considers the patients presenting symptoms and identifies nursing-related problems C. reviews the patients existing problems and projects the results of the nursing care If a client makes a threat to harm a specific individual, the PMH-APRN must notify that individual per the _________ law. Tarasoff Law Individuals can be involuntarily committed for a psychiatric evaluation for only three reasons. what are they? 1. They are a danger to themselves due to a mental illness. 2. They are a danger to others due to a mental illness. 3. They are gravely disabled due to a mental illness. true or false: Multiple diagnoses must be presented in a hierarchy from the condition of most significance to that of least concern true The main diagnoses is considered the principle diagnosis. I will be documented as: Patient Y meets the criteria for two DSM-5 diagnoses: (F41.1) Generalized Anxiety Disorder (Principal Diagnosis), (F43.21) Adjustment Disorder with Depressed Mood Example of Patient with a Mental Health Disorder and a Primary Medical Condition: Patient X meets the criteria for the following DSM-5 and ICD-10 diagnoses: (250) Diabetes Mellitus (Primary Diagnosis), (F43.12) Post Traumatic Stress Disorder, Chronic. what are the four lobes of the brain 1. frontal 2. temporal 3. occipital 4. Parietal dense collections of nerve cells with common specific functions nuclei This lobe is generally involved in self-awareness (introspection, physical and emotional sensation) and executive functions (focusing, planning, judgment, decision making, and social functioning). This lobe regulates the expression of emotion and of motor behavior. Frontal Lobe This LOBE is noted to be involved in clinical psychiatric syndromes such as schizophrenia, disorders of attention (i.e., ADD), obsessive compulsive disorder, and mood disorders. Frontal lobe This lobe is generally associated with the coordination of sensation and motor behavior (such as the coordination of language functions), spatial orientation (knowing where your body is, in a physical sense), and recognition of people and objects. Parietal This lobe is intimately involved in memory formation: language, and learning. Temporal Lobe euphoria, auditory hallucinations, and delusions are usually associated with impaired function of the dominant (usually left) _______ lobe, temporal lobe dysphoria, depression, irritability, and inappropriate affect are associated with abnormalities of the non-dominant (usually right) ___________ lobe. Temporal lobe lobes associated with vision and visual memory. occipital lobes this tract allows each hemisphere of the brain to receive and send information to the other hemisphere, so that functions can be coordinated between the left and right sides of the brain. Corpus Collosum True or false: the Cingulum has been implicated as abnormal in schizophrenia and ADHD FALSE the Corpus Callosum has been implicated as abnormal in schizophrenia and ADHD As a body (corpus) of nerve fibers of colossal proportions, this tract allows each hemisphere of the brain to receive and send information to the other hemisphere, so that functions can be coordinated between the left and right sides of the brain. It has been implicated as abnormal in schizophrenia and attention deficit hyperactivity disorder (ADHD). Corpus Callosum On the same level as the corpus callosum is the main information highway of emotion, the __________. This central highway seems to be involved with the summation and integration of emotion and thinking in preparation for final input to the hypothalamus, a central integrating station. the _______ facilitates an integration from higher (thinking and emotion) to lower (the hypothalamic nuclei) brain regions. Cingulum ** this is larger in women REWARD tract The various tracts (mesocortical and mesolimbic tracts) involved in the processing of pleasurable experience and reward come together in a pathway called the _____________________ This bundle of reward fibers interconnects areas of the brain involved in the mediation of emotion, learning, arousal, memory, and hormonal control. It runs between the hypothalamus and the septal region. *****This tract has clinical importance in depression, mania, and schizophrenia. Researchers have postulated that there is a fundamental imbalance of activity between the median forebrain bundle reward system and the inhibitory (punishment) center of the brain. In mania, the pleasure centers are hypothesized to be overactive and/or the inhibitory centers, underactive. In depression, the reverse would be so. median forebrain bundle. PUNISHMENT tract This tract follows a path around (peri) the fluid-filled spaces within the interior parts of the brain (the ventricles), connecting the emotional, thinking, and hormonal functions of the brain. This is the primary inhibitory or punishment pathway in the brain; activation of this pathway seems to initiate avoidance behaviors. This tract is in balance with the reward tract, mentioned above. Together they modulate varying degrees of excitation and inhibition of behavior in various areas of the brain involved in learning, emotion, arousal, and hormonal activation. The Periventricular System reinforcement These two pathways carry information between a part of the brain stem called the mid (meso) brain and the limbic system and frontal lobes of the brain, respectively. The pathways that appear most involved in reinforcement are the mesolimbic and mesocortical pathways. These two pathways join to pass through the median forebrain bundle. Abnormal function of nerve cells in these two tracts has been implicated in the positive symptoms of schizophrenia, such as hallucinations (mesolimbic tract), and the deficit symptoms, such as flat affect (mesocortical). Mesolimbic and Mesocortical Tracts kernel-like aggregates of nerve cells, which are the hub of specialized functions The brain has numerous ___________, all of which are involved in a complex network of communication. Certain nuclei have been identified as having a clear role in specific clinical states. nuclei The purpose of the _____________ is to gather information necessary to understand, diagnose, and treat the client. psychiatric interview echopraxia (a mimicking of the interviewer's behavior), catatonia (statue-like immobility), and waxy flexibility (when limbs can be moved by the interviewer into positions that the client maintains) this would be documented under what section of the mental status examination Behavior and general appearance Observe for evidence of dysarthria (physical difficulty in vocalizing), echolalia (the repetition of the interviewer's words), perseveration (the repetition of the same words or themes), aphasia (difficulties in understanding or producing speech), and other disorders or oddities of speech. this would be documented under what section of the mental status examination Speech We ask the patient about DELUSIONS in what section of the mental status examination Thought content intrusive thoughts or ideas that the client recognizes as "crazy" but act in accordance with anyway obsessions delusions involving death or destruction nihilistic delusions delusions involving bodily concerns somatic delusions believing that benign environmental occurrences relate to or have special meaning for the client referential delusions true or false The validity of delusions should not be questioned by the interviewer; such questioning is ineffective in changing the client's beliefs and often causes alienation and anger true evaluation of suicidal and homicidal thoughts are under what section of the MSE thought content what scale can be used to evaluate suicide risk SADPERSONS S sex male A age 19 or 45 D depression P previous attempt E ethanol R rational thinking loss S social supports lacking O organised plan N no partner S sickness **Score one point for each factor Use calculated score to help determine outcome 0-2 home with appropriate follow up 3-6 admit or discharge with appropriate follow up 7-10 admit to hospital illogical , difficult to follow shifting of ideas loose associations when client wanders from the subject at hand to a related one and is unable to come back to the original topic Tangential thinking Tangential thinking is noted under which section of MSE? THOUGHT PROCESS completely nonsensical combination of words word salad made up words neoglisms loose associations, tangential thinking, word salad, and neoglisms often indicate what???? Schizophrenic disorders. demonstrated by clients who get lost in details but eventually return to the relevant thought Circumstantial thought occurs when thinking process stops altogether and the mind goes "blank" thought blocking involves pressures speech with rapid topic changes, the topics may be associated but in a strange way flight of ideas often seen in mania fabrication of information to fill in our memory gaps confabulation - often indicated dementia. A client with a ________thought process as opposed to an abstract thought process is only able to understand conversations literally. concrete A client's ability to think abstractly may be ascertained by assessing the client's interpretation of a proverb such as "people in glass houses should not throw stones" Concrete thought is common in clients with schizophrenic disorders. A concrete thought process is not pathological when exhibited by children, however, who developmentally may not have the capacity for abstract thought until early adolescence are misinterpretations of true stimuli. An example is when a curtain in a dark room is mistaken for a person illusions common in delirium illusions and hallucinations are documented/assessed under what section of the MSE perceptual disturbances defined as sensations experienced by the client without real external stimuli hallucinations documented under perceptual disturbances what are the most common type of hallucination auditory the more unusual hallucinations such as visual, gustatory, olfactory, and tactile hallucinations may indicate what?? medical illness or substance intoxication or withdrawal false sensory perceptions that occur while falling asleep hypnagogic hallucinations false perceptions that occur while waking from sleep hypnopompic hallucinations is a perceptual difficulty in which the client feels unreal, dead, or mechanical depersonalizaiton he sensation that the outside world is unreal derealization True or False: Hypnagogic and hypnopompic hallucinations, derealization, and depersonalization are considered within the normal range of experience and are not considered pathologic unless they cause undue distress or problems with daily functioning. True. the ability to delay, modulate, or inhibit the expression of behaviors and feelings impulse control clues to the client's ability to control their impulses are found in the _______ and ______ of the general interview thought content and process A client who describes a recent history of binge drinking and indiscriminate sexual contacts has ______ impulse control poor impulse control accessing the client's ability to control impulses is an integral part of determining potential for acting on _______ and ______ thoughts suicidal and violent thoughts level of consciousness , orientation, concentration and memory are assessed under what section of the MSE? Cognition and Sensorium the capacity to identify possible course of action, anticipate their consequences, and choose the appropriate behavior judgement evaluate judgment with the "stamped envelope" scenario. the extent of the client's awareness of illness and maladaptive behaviors. insight what are the sections of the MSE? 1. Appearance 2. Attitude 3. Behavior 4. Speech 5. Affect 6. Mood 7. Thought Process 8. Thought Content 9. Perception 10. Orientation 11. Memory/ Concentation 12. Insight / judgement ________ develops when the client experiences feelings toward the nurse/therapist that were originally held toward significant others in his or her life. When this occurs, these feelings become available for exploration with the client. Transference ***This exploration helps the client better understand certain feelings and behaviors _________ is the advance practice psychiatric mental health nurse's unconscious, personal response to the client. Ex: is the client reminds the nurse of someone the nurse does not like, the nurse may unconsciously react as if the client were that individual Countertransference what are the three phases of Hildegard Pepleu's interpersonal relations in nursing? 1. Orientation / Identification Phase. 2. Working / Exploitation phase 3. Termination Phase In this phase of Peplau's nurse-client relationship theory, the nurse-client Establish: Rapport & Trust Set parameters of the relationship (Time frame) Purpose of the meeting Formal or informal contract - spells out the participation & responsibilities of both parties Confidentiality Termination begins First phase - orientation / identification phase What phase of Peplau's nurse-client relationship theory does this activity fall into?: Maintain relationship Gather further data Promote clients:Problem-solving skills, Self-esteem, Use of language Facilitate behavioral change Overcome resistance behaviors Evaluate problems & goals - Redefine them as necessary Promote practice & expression of alternative adaptive behaviors Working/Exploitation phase What phase of Peplau's client-nurse relationship theory does this fall into?: Deal with intense feelings regarding the experience Summarize goals & objectives achieved Evaluates outcome attainment Review client's plans for future Finalize termination Termination phase Holistic treatment that relies on the nurse's processing of that the patient is experiencing pscyhotherapy True or false The use of touch may only be considered after taking in the client's social, cultural, and moral views into account. It should not be the first approach taken by the PMH-APRN in clinical situations. true in a SOAPIE/SOAPIER note, what does I, E, and R stand for? I = implementation of consideration of the services to be provided E = the evaluation of service provision R = response to diagnostic process, treatment planning, and intervention efforts this is an assessment tool/scale used to assess depression. DSM-IV depression diagnostic criteria with other leading major depressive symptoms into a brief self-report tool. a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression PHQ-9 scale 8. The nurse shows an understanding of the appropriate use of nursing outcomes regarding triggers for a patient diagnosed with chronic alcohol abuse when stating: a. Can you work on identifying three situations that cause you to abuse alcohol? b. Ill help you to identify three triggers for your drinking during todays session. c. Im pleased youve identified three situations that trigger your abuse of alcohol. d. Do you think you will be able to avoid the three triggers that cause you to drink? C. i'm pleased you identified three situations that trigger your abuse of alcohol 9. When a patient experiencing acute depression asks what the difference is between a medical and a nursing diagnosis, the nurse responds best when stating: a. Actually they are very similar in that they both are concerned with helping you get better and lead a happier life. b. Medical diagnoses are focused on why you are depressed whereas nursing diagnoses are concerned about making your life less sad. c. Nursing diagnoses are more directed at caring for you, unlike medical diagnoses that focus on finding the cause for your problem. d. The medical diagnosis identifies that you are experiencing depression whereas the nursing diagnosis identifies how the depression is affecting you. D. the medical diagnosis identifies that you are experiencing depression whereas the nursing diagnosis identifies how the depression is affecting you 13. A nurse shows the best understanding of the legal importance of the patients chart when stating: a. You always document in ink and never erase or use white out in the nursing notes. b. It's a document that shows proof that the patient received care that met the expected standards. c. Patient charts are carefully protected from unlawful access by inappropriate individuals or institutions. d. The patient has a legal right to the information contained in the chart but not the original documentation itself. B. it's a document that shows proof that the patient received care that met the expected standards. 15. The nurse assesses a patients judgment by asking: a. Why did you run away? b. When did you first start hearing voices? c. What would you do if you smelled smoke in your home? d. Do you believe you hear voices, or do you think it is in your mind? C. what would you do if you smelled smoke in your home? 19. When reviewing the history of a newly admitted patient diagnosed with severe chronic depression, the nurse is most concerned about patient safety issues when noting: a. The patients Axis II includes a diagnosis of mental retardation b. Documentation that the patient has been noncompliant regarding medications c. The patients current Global Assessment of Functioning (GAF) Scale rating is 9 d. Reference to a recent physical injury resulting from the patients impulsive behavior C. the patient's current global assessment of functioning (GAF) rating is 9 The Global Assessment of Functioning (GAF) Scale is one of the tools use to assess patient functioning and possible prognosis. It is coded on a numerical continuum, with 1 indicating little danger and 10 indicating severe or persistent danger, and possible suicidal potential. Mental deficiency may contribute to issues of safety but it is not a significant risk factor. Noncompliance may contribute to the patients depression but it is not the greatest concern identified. Although past history is considered a predictor of future behavior, this is more related to the safety of others than to the patient. 20. An appropriate nursing diagnosis for a patient who manifests a psychological problem through frequent expressions of unfounded or excessive guilt or shame, states that he is unable to deal with situations, and has a hesitation to try new things would be: a. Hopelessness b. Powerlessness c. Ineffective coping d. Chronic low self-esteem D. chronic low self esteem 22. Care planning for a patient diagnosed with paranoid schizophrenia will include: a. Analyzing effectiveness of care provided b. Determining the patients needs and problems c. Establishing realistic patient-focused outcome criteria d. Identifying priorities of care based on the patients condition D. identifying priorites of care based on the patient's condition. 1. Which nursing action reflects Hildegard Peplaus theoretic framework regarding psychiatric mental health nursing? a. Basing patient outcomes on expected instinctual responses b. Discussing a patients feelings regarding parents and siblings c. Providing the patient with clean clothes and wholesome food d. Centering professional practice in a state run psychiatric facility B. discussing a patient's feelings regarding parents and siblings Peplaus pioneering endeavors and contributions were largely influenced by interpersonal psychotherapy. She believed that disorders evolved in the social context of interpersonal interactions. (i.e., what went on between people). Instinctual responses are more related to intrapersonal interactions. Florence Nightingale was instrumental in the holistic approach to nursing care, whereas Linda Richards practice was centered on institutional care of the mental ill. 5. Which nursing intervention would be appropriately addressed during the orientation phase of the nursepatient relationship? a. Self reflection by the nurse regarding personal biases and prejudices regarding the patient b. Patient works at prioritizing personal needs and develops realistic expected outcomes c. Establishing the contract between the nurse and the patient regarding mutual needs and expectations d. Patient commits to the reinforcement of positive personal characteristics while working on problems and concerns C. establishing the contract between the nurse and the patient regarding mutual needs and expectations. A contract or agreement is established during the orientation phase of the relationship. The contract defines limits and expectations of both the patient and the nurse. Self Reflection occurs during the pre-orientation phase while the remaining options are addressed during the working phase of the relationship. 7. The greatest negative outcome resulting from a nurses fear of a mentally ill patient is that the: a. Nurse will reinforce negative stereotyping of the mentally ill. b. Patient will experience increased bias against the nursing staff. c. Publics fearfulness of the mentally ill will continue to be exaggerated. d. Therapeutic alliance between the nurse and patient will not develop effectively. D. therapeutic alliance between the nurse and patient will not develop effectively Unrealistic preconceived images, stereotyping, and biases have an effect on nurses that, when resulting in fear, will negatively impact the therapeutic effectiveness of the nurse and the care provided. The remaining options do not have the priority that providing quality patient care has. 10. The nurse is effectively facilitating the nurse-patient relationship when: a. Sharing with an angry patient who is verbally abusive that, Although I can accept that you are angry, I cannot and will not accept your verbal abuse. b. Focusing on the patients life experience without relating to the similarities of ones own experiences c. Objectively providing constructive criticism that is directed to helping the patient identify inappropriate behaviors d. Refraining from abandoning the patient regardless of the frustration the interaction causes A. sharing with an angry patient who is verbally abusive that, Although I can accept that you are angry, I cannot and will not accept your verbal abuse 12. Which statement is an example of an inference? a. He is an alcoholic because his wife nags a lot. b. He states he binges after arguing with his wife. c. You say your alcohol intake exceeds a quart a day. d. So you are saying that you were drinking earlier today. A. He is an alcoholic because his wife nags a lot An inference is an interpretation of behavior that is made by finding motive and forming conclusions without having all the necessary information. The nurse interprets the patients behavior, decides on a reason, assigns a motive, and forms a conclusion. The remaining options are validations of observations. 1. Which interactions are likely outcomes of a well-established therapeutic alliance? Select all that apply. a. The nurse states, I'm not here to judge but rather to help. b. The patient states, I really think I can handle this problem now. c. The patient asks his abusive father to attend counseling with him. d. The nurse sets boundaries for a patient who has few social skills. e. The patient with anger issues voluntarily goes into the seclusion room A, B, C, E A. the nurse states, I am not here to judge but rather to help B. the patient states, I really think i can handle this problem now C. The patient asks his abusive father to attend counseling with him E. the patient with anger issues voluntarily goes into the seclusion room 2. Which nursing interventions are directly related to the principles on which a therapeutic alliance is based? Select all that apply. a. Graciously declining to, Come visit when I get discharged. b. Establishing the topic to be discussed at each group session c. Explaining to the patient the purpose of terminating the alliance d. Sharing how the nurse also has experienced the same problems e. Providing subjective feedback to the patient's efforts at therapy A. Graciously declining to, come visit when I get discharged B. Establishing the topic to be discussed at each group session C. explaining to the patient the purpose of terminating the alliance. 9. is considered the founder of modern psychiatric-mental health nursing. A. Peplau B. Travelbee C. Nightingale D. Mahoney A. peplau Peplau's 1952 book Interpersonal Relationships in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing was considered unique because: A. She used her own money to get it published B. It was one the first books to be written by a nurse without a physician co-author C. She invited Sigmund Freud to write the introduction D. It became required reading in medical schools B. it was one of the first books to be written by a nurse without a physician co-author As a result of nurse theorists such as Peplau and Travelbee, was now considered an important part of the patient's recovery. A. Medication B. Therapeutic communication C. Physical therapy D. Activitiestherapy B. Therapeutic Communication What stage does this belong to in Peplau's interpersonal process: 1. Identification 2. exploitation 3. orientation 4. resolution Nurse and patient understand the patient's health care needs and the role the nurse will fulfill in meeting those needs. identification What stage does this belong to in Peplau's interpersonal process: 1. Identification 2. exploitation 3. orientation 4. resolution The nurse explains the likely time frame of the therapeutic relationship while maintaining focus on the patient. orientation What stage does this belong to in Peplau's interpersonal process: 1. Identification 2. exploitation 3. orientation 4. resolution the nurse evaluates the patient's readiness to end the therapeutic relationship, taking care not to end the relationship prematurely. Resolution What stage does this belong to in Peplau's interpersonal process: 1. Identification 2. exploitation 3. orientation 4. resolution The patient progresses from being relatively dependent on the nurse to independence. B. exploitation 3. With which one of the following statements is a nurse showing an awareness of self-conducive to establishing a therapeutic relationship with a patient? A. "I come from a cultural background and have had previous experiences that influence my perception and expectations of the therapeutic relationship." B. "I have the appropriate credentials to perform my role and am very knowledgeable about this patient's diagnosis." C. "I can convey a strong sense of my personality and values to the patient so that the patient knows what to expect from me." D. "I am able to set aside and even eliminate all my biases so that they do not affect the care I give patients A. "I come from a cultural background and have had previous experiences that influence my perception and expectations of the therapeutic relationship." Peplau's original theory of interpersonal relations between the nurse and the patient describes phases. A. 3 B. 2 C. 4 D. 6 C. 4 Peplau described roles a nurse may find himself or herself in when working with a patient. "Clients seeing those who care for them as they would others who have cared for them in their lives, i.e., mother, father, sister, wife, etc." would best identify which role? A. Leader B. teacher C. counselor D. surrogate D. surrogate Which of the following of Erikson's stages of psychosocial development is most appropriate for a 6-year-old child to exhibit? A. Trust versus mistrust B. Industry versus inferiority C. Affiliation and love D. Autonomy versusshame B. identity vs. inferiority A psychologist describes a 10-year-old child as struggling with industry versus inferiority in terms of Erikson's stages of development. What difficulties might one expect this child to have? (select all that apply) A. Not completing homework for school unless a parent sits with him B. Struggling to withstand peer pressure and taking on different identities in different groups C. Feeling utterly dependent on caretakers and being unable to entertain himself alone D. Being preoccupied with death and a feeling of futility E. Attaching no significance to rewards such as praise or allowance money in return for getting good grades or completing chores A. Not completing homework for school unless a parent sits with him E. Attaching no significane to rewards such as. praise or allowance money in return for getting good grades or completing chores When engaging in therapeutic communication for the initial encounter with the patient, which of the following would be most appropriate for the nurse to use? A. Silence B. "What would you like to discuss?" C. "Are you having any problems with anxiety?" D. "Why do you think you came here today?" B. "What would you like to discuss?" A patient states, "I get so anxious sometimes. I just don't know what to do." The nurse responds by saying, "You should try to do some exercise when you start to feel this way. I know it helps me when I get anxious." The nurse is using which of the following? A. Clarifying B. False reassurance C. Validating D. Giving advice D. giving advice 1. Which of the following indicates a nurse is accurately reflecting an awareness of self that is congruent with psychiatric-mental health nursing? A. "I am an adult and a trained professional. My childhood experiences are not relevant to my interactions with patients." B. "My self is continually evolving as a result of personal reflection and interaction with others, including patients." C. "In the professional health care environment, myself isrepresented by my name, my job title, and the decisions and actions I take with respect to patients." D. "When I am at work, my attention needs to be on my patients, not on self-reflection." B. "My self is continually evolving as a result of personal reflection and interaction with others, including patients." Which of the following scenarios shows a nurse in the choosing stage of values clarification? A. A nurse realizes, upon self-reflection, that she was raised to value hard work and has difficulty sympathizing with patients who do not seem to want to work hard at getting better. B. A nurse who is working on her development with her supervisor states that she wants to develop more empathy for the experience of those patients who do not feel motivated to follow a therapeutic plan. C. A nurse helps a patient explore the probable consequences for his life and the lives of his children if he does not keep his therapy appointments. D. A nurse extends her time with a patient beyond what was planned to explore why the patient repeatedly fails to keep appointments with health care and social services providers. B. a nurse who is working on her development with her supervisor states that she wants to develop more empathy for the experience of those patients who do not feel motivated to follow a therapeutic plan A psychiatric-mental health nurse is engaged in a therapeutic dialogue with a patient. The patient states, "I've been feeling so down lately." Which of the following would the nurse identify as being congruent with the patient's statement? A. Wide facial grin B. Low tone of voice C. Fidgeting D. Erect posture B. low tone of voice Empowering is best nourished by A. Suggesting solutions B. Collaborating and sharing power C. Judging the person in distress D. Encouraging the person to verbalize B.Collaborating and sharing power 4. A patient is feeling overwhelmed after a recent promotion at work and has mentioned getting a poor review from her manager, who did not want her to get the promotion. Rather than discuss how to confront her manager or the possibility that she is not a good fit for the position, she insists that her assistant is primarily responsible for her difficulties. Which of the following ego defense mechanisms is this patient engaged in? A. Projection B. Intellectualization C. Displacement D. Sublimation C. displacement Working on a research team, a nurse collects information about patients' mental health status, risk factors for heart disease and stroke, and family history of mental disorder and cardiovascular disease. This nurse is engaged in studying which of the following? A. Cognitive dissonance B. Psychobiology C. Systematic desensitization D. Grand theory formation B. psychobiology Biological psychology theory includes: A. Brain physiology B. Genetics C. Evolution as means for understanding behavior D. All of the aforementioned D. all of the above what are the three phases of interpersonal therapy? 1. initial phase 2. intermediate phase 3. termination phase What may not be documented in psychiatry: 3 • Detailed account of sexuality • Interpersonal conflicts • Issues that may be embarrassing to the patient if disclosed • Third party names 1. detailed account of sexuality 2. interpersonal conflicts 3. issues that may be ermbarrassing to the patient if disclosed 4. third party names how may sessions are typically in the initial phase in interpersonal therapy? first 1-5 sessions. *** after assessing the patient's current psychiatric symptoms and obtaining a history of these symptoms, the therapist gives the patient a formal diagnosis. Psychotherapy notes are notes kept by the psychiatrist during therapy session that pertain to the patient’s personal life and the psychiatrist’s reactions. These records are: Subject to more stringent confidentiality standards They must be kept WITH OR WITHOUT? rest of the medical record WITHOUT, psychotherapy notes kept by the psychiatrist during therapy session should be kept separated from the rest of the medical record a comprehensive assessment of the client's lifetime biologic, psychological, and social functioning. Biopsychosocial history a succinct summary of the client's demographics" name gender marital status ethnicity religion occupation education current living situation identifying datea chronological account of the events leading up to the current contact with the mental health professional. This includes a description of the evolution of the client's symptoms that cover the onset, duration, and change of symptoms over time. Exacerbating and ameliorating factors of the current pscyhological distress must be explored. Changes in somatic functioning (sleep pattern, appetite, cognitive ability, sexual functioning) should also be noted History of Presenting Illness (HPI) in 1967, who studies whether or not stress leads to illness? Holmes and Rahe This scale compiles 43 life events, each event, called a Life Change Unit (LCU) has a different "weight" for stress. When completing this scale, the client should check off which life event they have experienced recently. The more events that the patient has, the higher the score. The higher the score, and the larger the weight of each event, the more likely the client was to become ill. The Holmes and Rahe Stress Scale. This assessment scale can be used for patients with alcohol use disorder. It is a 4 question scale - 0 or 1 pt. for each question asked it asks the following questions: 1. Have you ever felt you needed to Cut down on your drinking? 2. Have people Annoyed you by criticizing your drinking? 3. Have you ever felt Guilty about drinking? 4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover? CAGE assessment tool This scale can be done to examine/measure psychotropic medication-induces motor side effects AIMS scale (Abnormal Involuntary Movement Scale) an account of the client's infancy, childhood, and adolescence. It may provide clues to the origin of current behaviors and aid in the diagnosis. developmental history In this section of the psychiatric evaluation: inquire about the client's family and household members. How have family and significant others responded to the client's illness? Seek the client's permission to involve family members and significant others in the assessment and treatment process, unless this involvement would be counterproductive. Ascertain a history of the client's friendships and sexual patterns. social history what is the first category to assess when completing the neurological exam? mental status exam to rule out biological causes or "medical mimics", this tool can be used (in 5 minutes) to examine a patient's neurological status. the 5-minute neurological examination this exam covers: 1. Mental Status 2. Cranial nerves 3. motor exam 4. sensory exam 5. coordination 6. reflexes 7.. gait a neurologic diagnosis can be divided into what 2 categories? 1. anatomic - localizes a lesion/tumor within a specific area 2. etiologic - specifies the cause of the lesion - is mainly obtained from information provided by the neurologic history (Ex: Lesions of sudden onset - typically due to vascular accidents, such as CVA. Slow progressive lesions - typically due to expanding mass lesions, such as a tumor or abscess) Lesions located either ________ or _________in the nervous system can mimic psychiatric disorders. centrally or peripherally Developed in 1975, this is a screening tool to test the cognitive functioning of older people. it assesses orientation, attention, recall, language, and the ability to follow simple verbal and written commands It provides a total score that places the individual on a scale of cognitive function typically takes 5-10 minutes to complete. the max score is 30 points Mini Mental Status Examination the principle that addresses respect for independence, and self-determination. allowing an individual the freedom of choice and action. encourages the counselor to encourage clients, when appropriate, to make their own decisions and to act on their own values autonomy "treating equals equally and unequal unequally but in proportion to their relevant differences" ** does not mean treating all individuals the same. example: a counselor would give a person who is blind a form that is in braille, or would go through the form with that individual orally, instead of giving him or her a standard written form to fill out. But the counselor would treat him or her the same as any other client in all other regards. justice it means to do good, to be proactive, and also to prevent harm when possible. can come in many forms, such as prevention and early intervention actions that contribute to the betterment of clients. beneficence the concept of not causing harm to others. Often explained as "above all, do no harm," this principle is considered by some to be the most critical of all the principles, even though theoretically they are all of equal weight. This principle reflects both the idea of not inflicting intentional harm, and not engaging in actions that risk harming others. weighing potential harm vs. potential benefits** Nonmaleficence involves the notions of loyalty, faithfulness, and honoring commitments. Clients must be able to trust the counselor and have faith in the therapeutic relationship if growth is to occur. Therefore, the counselor must take care not to threaten the therapeutic relationship or to leave obligations unfulfilled. Fidelity This process is called what? 1. Identify the problem. 2. Apply the ACA Code of Ethics. 3. Determine the nature and dimensions of the dilemma. 4. Generate potential courses of action. 5. Consider the potential consequences of all options and determine a course of action. 6. Evaluate the selected course of action. 7. Implement the course of action The ethical decision-making model. symbolizes and guides the ethical values of the counseling profession throughout the U.S. and around the world; reflects the core values of the profession; and embodies a belief system that undergirds the bedrock principles of autonomy, justice, beneficence, nonmaleficence, and fidelity. the ACA code of ethics ACA =American Counseling Association True or false: ALL 50 states have a MANDATORY duty to warn law (meaning report to authorities if a patient is a harm to self or others, elder abuse, child abuse, etc.) FALSE. not all states have a mandatory duty to warn law. some states permissive or none at all. this medical mimic often presents first with psychiatric symptoms tumors a ________ lobe tumor may cause abrupt changes in personality, flat affect, and/or euphoriaq frontal lobe tumor a _______ tumor may cause visual hallucination occipital lobe tumor a ________ lobe tumor may cause sensory disturbances, agnosia (inability to recognize/identify objects, people, sounds), lack of awareness parietal lobe tumor a _________ lobe tumor may cause mood and memory disturbances, hallucinations (all types) and paranoid delusions) temporal lobe this hormone medical mimic causes the following symptoms: anxiety, depressive or manic episode, psychosis; sensitive to heat, decrease in weight, increased activity, oily skin (acne), tremor, restlessness. Children present as ADHD; Elderly present as dementia Hyperthyroidism This hormone medical mimic causes the following symptoms: fatigue, loss of energy, trouble thinking & depression; sensitive to cold, increase in weight, muscle weakness, excessive hair loss, dry skin, brittle nails, hoarseness, increased BP & cholesterol, decrease in Vitamin B12 hypothyroidism what disease is often confused for dysthymic disorder? Addison's disease (decreased cortisol production) develops when the client experiences feelings toward the nurse therapist that were originally held toward significant others in his or her life transference is the advance practice psychiatric mental health nurse’s unconscious, personal response to the client. For instance, if the client reminds the nurse of someone the nurse does not like, the nurse may unconsciously react as if the client were that individual. countertransference What FREUD stage is from birth to 18 months? ORAL stage Too much or too little gratification can result in an Oral Fixation or Oral Personality which is evidenced by a preoccupation with oral activities. This type of personality may have a stronger tendency to smoke, drink alcohol, over eat, or bite his or her nails. Personality wise, these individuals may become overly dependent upon others, gullible, and perpetual followers. On the other hand, they may also fight these urges and develop pessimism and aggression toward others. What FREUD psychosexual stage is from 18 months to 3 years ANAL stage The child's focus of pleasure in this stage is on eliminating and retaining feces. Through society's pressure, mainly via parents, the child has to learn to control anal stimulation. In terms of personality, after effects of an anal fixation during this stage can result in an obsession with cleanliness, perfection, and control (anal retentive). On the opposite end of the spectrum, they may become messy and disorganized (anal expulsive). What FREUD psychosexual stage is ages 3-6 years Phallic stage The pleasure zone switches to the genitals. Oedipus complex** fixation at this stage could result in sexual deviancies (both overindulging and avoidance) and weak or confused sexual identity according to psychoanalysts. what FREUD psychosexual stage is ages 6-12 years. latency stage It's during this stage that sexual urges remain repressed and children interact and play mostly with same sex peers. What FREUD stage is ages 12+ Genital stage The final stage of psychosexual development begins at the start of puberty when sexual urges are once again awakened. Through the lessons learned during the previous stages, adolescents direct their sexual urges onto opposite sex peers, with the primary focus of pleasure is the genitals. According to Freud's drive theory - what are the two drives? 1. survive - uses aggression (Thanatos) 2. reproduce/seek pleasure (Eros) In Frued's drive theory, what is the "seat of drives" ? ID is the ID conscious or unconscious? unconscious According to Freud, the ______ is half conscious and half unconscious. Aware of reality recognizes what is real and understands that behaviors have consequences. It is involved in actions, judgement, reality testing, impulse control, and formation of relationships. it is also involved in conflict free activities such as thinking, learning, perception, motor control and language EGO the _______, half-conscious and unconscious is the individual's moral conscience that develops through the internalization of the values of parents and society, a process that takes place at age 5-6 years. SUPEREGO _________ therapy focuses on unconscious processes as they are manifested in the client's present behavior. The goals are: client self-awareness and understanding of the influence of the past on present behavior. It enables the client to examine unresolved conflicts and symptoms that arise from past dysfunctional relationships and manifest themselves in the need and desire to abuse substances. Psychodynamic Therapy **it follows the psychoanalytic model by using many of the tools of psychoanalysis such as free association, dream analysis, transference, and countertransference A part of pscyhoanlysis, this is a treatment method in which a client expresses all thoughts freely and without censoring him- or her-self. free association what are the stages of Erikson's developmental theory, (in order) 1. trust vs. mistrust (0-1 yr) 2. autonomy vs. shame and doubt (1-3 yrs) 3. initiative vs. guilt (3-6) 4. industry vs inferiority (6-puberty) 5. Identity vs. role confusion (adolescence) 6. intimacy vs isolation (young adulthood) 7. generativity vs stagnation (mid-adulthood) 8. ego integrity vs. despair (senior citizens) what is the foundational theory for Hildegard Peplau's nursing theory of interpersonal relationship? Sullivan's interpersonal theory a part of Sullivan's interpersonal theory - measures that the individual employs to reduce anxiety and enhance security. security operations A part of Sullivan's interpersonal theory: all of the security operations an individual uses to defend against anxiety and ensure self esteem self system What are the four "problem areas" identified in interpersonal psychotherapy that can be identified as causes of depression/mental illness? 1. Grief 2. Role disputes - conflicts with significant other 3. role transition - problematic change in life status or social or vocational role 4. interpersonal deficit - an inability to initiate or sustain close relationships.