NR548 Exam 2 Questions and Answers
1. Psychiatric interview: the process by which psychiatric assessment is conducted
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the diagnostic
interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan of care without
rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
,-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing
material): -Nor- malization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true
for you?
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing your
patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have strange
experiences, like hearing voices or thinking that strangers are laughing at them. Has that been
happening to you?
6. Symptom Expectation: communicate that a behavior is in some way normal or expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that
,you will not be ottended by a positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality,
but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you
had any thoughts that you'd be better ott dead?" you might decide to use symptom expectation. "What
kinds of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is higher
than your expectation, so that the patient feels that their actual, lower frequency of the behavior will
not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific behavior in
order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were attected?"
• If patient answers "yes," you can flesh out whether role was being a witness, victim, or perpetrator
, 9. According to Peplau's Theory of Interpersonal Relations,
establishing early rapport allows the role of the nurse to evolve from
stranger to:: resource person, teacher, leader, surrogate, technical expert, and counselor
10. Establishing the Relationship: -Trust is essential for a therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is comfortable
-Ask general questions to arrive at an empathic understanding of how the client feels
1. Psychiatric interview: the process by which psychiatric assessment is conducted
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the course of the diagnostic
interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan of care without
rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
,-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing
material): -Nor- malization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true
for you?
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing your
patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have strange
experiences, like hearing voices or thinking that strangers are laughing at them. Has that been
happening to you?
6. Symptom Expectation: communicate that a behavior is in some way normal or expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that
,you will not be ottended by a positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality,
but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you
had any thoughts that you'd be better ott dead?" you might decide to use symptom expectation. "What
kinds of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is higher
than your expectation, so that the patient feels that their actual, lower frequency of the behavior will
not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific behavior in
order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were attected?"
• If patient answers "yes," you can flesh out whether role was being a witness, victim, or perpetrator
, 9. According to Peplau's Theory of Interpersonal Relations,
establishing early rapport allows the role of the nurse to evolve from
stranger to:: resource person, teacher, leader, surrogate, technical expert, and counselor
10. Establishing the Relationship: -Trust is essential for a therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is comfortable
-Ask general questions to arrive at an empathic understanding of how the client feels
