NSG 526 EXPECTED EXAM 1 /WITH COMPLETE SOLUTION 2023/2025 EXAM COMPLETE QUESTIONS AND 100% SOLUTION 2024/2025 LATEST UPDATE GRADED A+

NSG 526 EXPECTED EXAM 1 /WITH COMPLETE SOLUTION 2023/2025 EXAM COMPLETE QUESTIONS AND 100% SOLUTION 2024/2025 LATEST UPDATE GRADED A+ -An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one -Socially deviant behavior (i.e. political, religious, or sexual) and conflicts that are primarily between the individual and society (unless the behaviors are due to a dysfunction) - CORRECT ANSWER-What is not considered a mental disorder? -Associated with significant distress or disability in social, occupation, or other important activities -Significant disturbance in cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning - CORRECT ANSWER-What is considered a mental disorder per the DSM5? -Define NP roles -Identify competencies assumed to be held by all NPs who function in a particular role -Varies broadly from state to state - CORRECT ANSWERPurpose of Scope of Practice? -Authoritative statements regarding the quality and type of practice that should be provided -Provide a way to judge the nature of care provided -Reflect the expectation for the care that should be provided to clients with various illnesses -Reflect professional agreement focused on the minimum levels of acceptable performance -Can be used to legally describe the standard of care that must be met by a provider -May be precise protocols that must be followed or more general guidelines that recommend actions - CORRECT ANSWERPurpose of Standard of Practice? Understand the patient's illness to evaluate the effect on their lives and create a beginning diagnosis and treatment plan - CORRECT ANSWER-Purpose of Psychiatric Interview? -Create a relationship with client by being calming, warm, understanding, kind, respectful, concerned and focused -Able to help patient better if a therapeutic alliance was formed - CORRECT ANSWER-What is a Therapeutic Alliance? -Therapist and patient work collaboratively to create therapeutic change through an affectionate bond -Agreement on goals of therapy -The therapist's ability to be empathetic and involved in therapy -The ability of the patient to do the work of therapy - CORRECT ANSWER-Important components of a therapeutic alliance? Holistic treatment that relies on the nurse's processing of that the patient is experiencing - CORRECT ANSWER-What is Psychotherapy? -Her application of Sullivan's theory of anxiety to nursing practice -Described the effects of different levels of anxiety (mild, moderate, severe, and panic) on perception and learning -Promoted interventions to lower anxiety, with the aim of improving clients' abilities to think and function at more satisfactory levels - CORRECT ANSWER-Peplau's most universal contribution to PMHNPs? -Observation, interpretation, and intervention (The PMHNP observes and listens to the client, developing impressions about the client's situation) - CORRECT ANSWERPer Peplau, skills of a MH nurse? -The processes by which the nurse helps clients make positive changes in their health care status and well-being -Believed that illness offered a unique opportunity for experiential learning, personal growth, and improved coping strategies and that PMH-APRNs play a unique role in facilitating this growth - CORRECT ANSWER-What is the main idea for Peplau's Theory of Interpersonal Relationships? -Silence -Accepting -Giving recognition -Giving information -Offering self -Giving broad openings -Offering general leads -Placing the event in time or sequence -Making observation -Encouraging description of perceptions -Encouraging comparison -Reflection -Exploring -Seeking clarification -Presenting reality -Voicing doubt -Verbalizing the implied -Attempting to translate into feelings -Encouraging formulation of a plan of action -Summarizing - CORRECT ANSWER-Therapeutic Communication Techniques? -Reassuring -Approving -Disapproving -Rejecting -Advising -Probing -Challenging -Defending -Requesting an explanation -Indication the existence of an external source -Belittling feelings -Making stereotypical comments -Giving literal responses -Introducing an unrelated topic - CORRECT ANSWER-NonTherapeutic Techniques? -Orientation -Identification -Exploitation -Resolution - CORRECT ANSWER-Four Phases of the Nursing Model? -The PMHNP addresses individual and family problems with the patient -Assess identified problems during the orientation phase -Determines the underlying healthcare issues with the patient -Collects psychiatric data -Establish a trusting relationship - CORRECT ANSWER- Psychotherapy Process? By applying core principles of psychotherapy, as well as, nursing theory - CORRECT ANSWER-How does the patient recover through adaption? Avoid taking patients with similar problems or put aside personal pathology - CORRECT ANSWER-What does the PMHNP need to avoid? -Focus on difficulties patient is experiencing in current relationships and the ways the relationships can be handled -Change pattern of communication -Alter expectations within relationships -Use social supports to help patients deal with stressors and improve their environment -Relieve symptoms -Build social skills - CORRECT ANSWER-Goals for Interpersonal Therapy? -Complicated bereavement/grief -Marital and interpersonal conflicts, such as role disputes -Life events, such as role transitions -Isolation, lack of support, interpersonal deficits - CORRECT ANSWER-Indications for Interpersonal Therapy? Therapist identifies depressive symptoms, evaluates patient, generates a diagnosis, obtain information on how the patient handles relationships - CORRECT ANSWER-Early Phase of Interpersonal Therapy? Patient and therapist derive more specific strategies to deal with stressors - CORRECT ANSWER-Middle Phase of Interpersonal Therapy? -Consolidate gains -Foster independence in the person -Review risk of relapse and reappearance of depressive symptoms -To contract again for continuation of treatment as needed - CORRECT ANSWER-Termination Phase of Interpersonal Therapy? Facilitate changes by the patient in order to address identified problems - CORRECT ANSWER-Purpose of Group Therapy? Assure dominant members are brought to the attention of the group, so they are able to address issues within the process CORRECT ANSWER-Role of leader in group therapy? - A person explaining to the group ways that person is able to cope with things - CORRECT ANSWER-Role of information giver in group therapy? A technique where special favors or awards are given to assure patient participation and involvement in group therapy - CORRECT ANSWER-Role of Reinforcement in group therapy? Increase subjectivity about thoughts governing their behavior. This is done by: -homework assignments -dream description -looking at ideas and beliefs the patient has about themselves - CORRECT ANSWER-Goal of Cognitive Behavioral Therapy (CBT)? -Encouraging patient to analyze early parental relationships -Underlying meaning of behavior -Identification of negative thoughts -Effect of thoughts on feelings and behaviors - CORRECT ANSWER-CBT Interventions? -Anxiety -Bipolar Disorder -Eating Disorders -Borderline Personality Disorder - CORRECT ANSWERInterpersonal Therapy (IPT) is useful for? 1. Infancy (birth to 18 months) 2. Childhood (18 months to 6 yrs.) 3. Juvenile (6 to 9 yrs.) 4. Preadolescence (9-12 yrs.) 5. Early Adolescence (12-14 yrs.) 6. Late Adolescence (14-21 yrs.) - CORRECT ANSWER-Stages of Development? Gratification of needs - CORRECT ANSWER-Characteristic of Infancy? Delayed gratification - CORRECT ANSWER-Characteristic of Childhood? Formation of peer group - CORRECT ANSWER-Characteristic of Juvenile? Developing relationships within same gender - CORRECT ANSWER-Characteristic of Preadolescence? Identity - CORRECT ANSWER-Characteristic of Early Adolescence? Forming lasting and intimate relationships - CORRECT ANSWER-Characteristic of Late Adolescence? -Good me vs Bad me: based on social appraisal and the anxiety that results from negative feedback -Not me: unknown, repressed component of self - CORRECT ANSWER-What are the 3 types of self? Measures that the individual employs to reduce anxiety and enhance security - CORRECT ANSWER-How does Sullivan's theory define security operation? All of the security operations that an individual uses to defend against anxiety and ensure self-esteem - CORRECT ANSWERHow does Sullivan's theory define self system? -Significant time spent in a home-like environment -Interact with similar individuals -Conduct different activities throughout the day -May attend group or individual therapy sessions -Establish treatment goals for themselves and community -Learn new ways to respond from peers and counselors - CORRECT ANSWER-What is Milieu Therapy? Return to larger society when goals have been met - CORRECT ANSWER-Goal of Milieu Therapy? -Broad term referring to psychotherapy, behavior analytics, or a combination of the two -Focus on behaviors or in combination with thoughts and feelings that might be causing them - CORRECT ANSWER-What is Behavioral Therapy? -Treatment method in which the client expresses all thoughts freely and without censoring self -Freud concluded that talking about emotional issues had the potential to heal the wounds causing mental illness - CORRECT ANSWER-What is Psychoanalysis? -General appearance, attitude, behavior -Speech -Mood and Affect -Thought content -Thought process -Impulse Control -Cognition and Sensorium - CORRECT ANSWER-Components of Mental Status Exam (MSE)? -General description of what the patient talked about -I.E. information and description related to symptoms or circumstances of depression, anxiety, compulsions, phobias, delusions, SI/SH/HI/AVH - CORRECT ANSWER-How to describe thought content? Clinical tool to determine suicide risk -Sex -Age -Depression -Previous Attempts -Ethanol Abuse -Relational Loss -Social Supports Lacking -Organized Plan -No Souse -Sickness - CORRECT ANSWER-SAD PERSONs Scale? The way in which a client thinks - CORRECT ANSWER-What is Thought Process? -Shifting of idea -Illogical -Difficulty to follow - CORRECT ANSWER-What is Loose Association? Wanders to a related topic but never makes it back to the original topic - CORRECT ANSWER-What is Tangential Thinking? Completely nonsensical combination of words - CORRECT ANSWER-What is Word Salad? Made up words - CORRECT ANSWER-What is Neologisms? Gets lost in details but eventually makes it make to the original topic - CORRECT ANSWER-What is Circumstantial Thought? Thinking process stops and mind goes "blank" - CORRECT ANSWER-What is Thought Blocking? -Often seen in mania -Pressured speech -Rapid topic changes -Topics may relate but in strange ways - CORRECT ANSWERWhat is Flight of Ideas? -Often indicates dementia -Fabrication of information to fill in missing gaps - CORRECT ANSWER-What is Confabulation? -Only understands things literally -Common in schizophrenic patients - CORRECT ANSWER-What is Concrete Thought Process? -Able to think abstractly -Can be determined by asking patient how a chair and table are similar or "why should people in glass houses not throw stones?" - CORRECT ANSWER-What is Abstract Thought Processes? Describes whether the patient is in good contact of their environment or is there is a distortion of reality (Typically presents as hallucinations) - CORRECT ANSWER-What are Perceptual Disturbances? -Misinterpretation of true stimuli -I.E. a curtain in a dark room is mistaken for a person - CORRECT ANSWER-What are Illusions? -Sensations experienced by the client without real external stimuli -Patient may not have intact reality testing, which is the ability to accept evidence that these perceptions re not real - CORRECT ANSWER-What are Hallucinations? -Visual -Gustatory (taste) -Olfactory (smell) -Tactile - CORRECT ANSWER-These hallucinations may indicate a medical illness , substance intoxication or withdrawal? False sensory perceptions that occur while falling asleep and while awakening from sleep - CORRECT ANSWER-What are Hypnagogic and Hypnopompic Hallucinations? -Sensorium can be obtained while observing patient during the evaluation -Memory can be tested by having the patient remember and repeat 3 objects -Concentration can be tested by counting backwards from 100 by 7s - CORRECT ANSWER-Ways to test Cognition and Abstraction? Clinical disorders -does not include personality disorders or mental retardation - CORRECT ANSWER-DSM-5 Axis 1? Personality Disorders and Mental Retardation - CORRECT ANSWER-DSM-5 Axis 2? General Medical Conditions (medical issues that causes the mental disorder) - CORRECT ANSWER-DSM-5 Axis 3? Psychosocial and environmental problems - CORRECT ANSWER-DSM-5 Axis 4 Global Assessment of Functioning (GAF) - CORRECT ANSWER- DSM-5 Axis 5 -Scoring system that is used to assess how well an individual is functioning in their daily lives -Scores range from 0 to 100 - CORRECT ANSWER-What is GAF? 100 - no symptoms 90 - minimal symptoms with good functioning 80 - transient symptoms that are expected reactions to psychosocial stressors 70 - mild symptoms or mild difficulty in social, occupation, school 60 - moderate symptoms or mild difficulty in social, occupation, school 50 - serious symptoms or mild difficulty in social, occupation, school 40 - some impairment in reality testing or communication or serious impairment in work, school, family relations, etc. 30 - behavior is considerably influence by delusions or hallucinations or serious impairment in judgement, communication or inability to function 20 - some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication 10 - persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death - CORRECT ANSWER-GAF Scoring System? -The idea that from the earliest ages, children possess sexual feelings and motivations -sexual instinct or drive directs a person toward action -sexual drives are oral, anal, or genital -stages are associated with a characteristic psychosocial process -stages have been organized according to hierarchy of dominant body zones - CORRECT ANSWER-What is Freud's Psychosexual stages of development? -Freud believed that sexual instincts, together with the nature of nurturing relationships, play a role in the formation of psychiatric disorders -Sexual stimulation exerts a predominant force on mental activity throughout the life -force = libido - CORRECT ANSWER-Relation between Freud's theory and mental disorders? -Birth to 18 months -Focused on oral pleasures (sucking) -Too much or too little can result in oral fixation or oral personality, which is evidence by preoccupation with oral activities -May have stronger tendency to smoke, drink alcohol, over eat, or bite nails - Potential personality: overly dependent, gullible, perpetual followers, pessimism, aggression - CORRECT ANSWERPsychosexual stage: Oral? -18 months to 3 yrs -Focused on eliminating and retaining feces -Learn to control anal stimulation through pressure from society -Potential personality: obsession with cleanliness, perfection, controlling (anal retentive), messy, disorganized (anal expulsive) - CORRECT ANSWER-Psychosexual stage: Anal? -3 yrs to 6 yrs -Pleasure zone switches to genitals -Boys may develop unconscious sexual desires for their mother, which can result in seeing father as competition. Will fight for mothers affection -Oedipus complex: fear of castration as punishment for having these feelings (can be opposite with girls) -When the boy identifies with father, they become masculine, identifies as males, repress sexual feelings towards mother -A fixation in this stage can cause sexual deviancies, weak/confused sexual identity - CORRECT ANSWERPsychosocial stage: Phallic -6 to 12 yrs -sexual urges remain represses -children interact and play mostly with same sex peers - CORRECT ANSWER-Psychosocial stage: Latency? -12yrs+ -begins at the start of puberty -sexual urges are awakened -through past lessons, adolescents direct their sexual urges onto opposite sex peers with the primary focus of pleasure in genitals - CORRECT ANSWER-Psychsexual stage: Genital? -only personality present at birth -unconscious and includes instinctive and primitive behaviors -driven by pleasure principle, which is the immediate gratification of all desires (anxiety if no instant gratification) - CORRECT ANSWER-Freud's ID? -develops from the ID -functions in the conscious, preconscious, and unconscious mind -personality component responsible for dealing with reality -ego represents one component of your full personality -ego provides direction and guidance - CORRECT ANSWERFreud's Ego? -emerges around age 5 -holds the moral standards and ideals -provides guidelines for making judgements -has 2 parts (conscience and ego ideal) - CORRECT ANSWERFreud's Superego? -birth to 18 months conflict: trust vs mistrust -important events: feeding -outcome: hope - CORRECT ANSWER-Erikson's Stage of Development: Infancy? -2 to 3 years -conflict: autonomy vs shame and doubt -important events: toilet training -outcome: will - CORRECT ANSWER-Erikson's Stage of Development: Early childhood? -3 to 5 years -conflict: initiative vs guilt -important events: exploration -outcome: purpose - CORRECT ANSWER-Erikson's Stage of Development: Preschool -6 to 11 years -conflict: industry vs inferiority -important event: school -outcome: confidence - CORRECT ANSWER-Erikson's Stage of Development: School Age? -12 to 18 years -conflict: identity vs role confusion -important events: social relationships -outcome: fidelity - CORRECT ANSWER-Erikson's Stage of Development: Adolescence? -19 to 40 years -conflict: intimacy vs isolation -important events: relationships -outcome: love - CORRECT ANSWER-Erikson's Stage of Development: Young Adult? -40 to 65 years -conflict: generativity vs stagnation -important events: work and parenthood -outcome: care - CORRECT ANSWER-Erikson's Stage of Development: Middle Adult? -65 to death -conflict: ego integrity vs despair -important events: reflection on life -outcome: wisdom - CORRECT ANSWER-Erikson's Stage of Development: Maturity? -involves self awareness (introspection, physical and emotional sensation) and executive functions (focusing, planning, judgement, social functioning) -regulate emotion and motor behavior -associated with schizophrenia, attention disorders, OCD, mood disorders - CORRECT ANSWER-Function of the frontal lobe? -coordination of sensation and motor behavior (coordination of language functions) -spatial orientation (knowing where your body is, physical sensation) -recognition of people and objects - CORRECT ANSWERFunction of Parietal lobe? -memory formation: language (Wernicke's area) and learning -associated with euphoria, auditory hallucinations, and delusions (impaired left lobe) -right lobe impairment: dysphoria, depression, irritability, inappropriate affect - CORRECT ANSWER-Function of temporal lobe? -vision and visual memory -impairment can cause visual defects, blindness and visual hallucinations - CORRECT ANSWER-Function of Occipital lobe? -used in treatment planning to justify a level of care, specify treatment needs, provide rationale for legal adjudication , immediate safety measures and ensure reasonable cost containment -hypothesis about the causes, precipitants and maintaining influence of a person's psychological, interpersonal, and behavioral problems -description of chief features - CORRECT ANSWER-What is case formulation? 1. Symptoms and problems 2. Precipitating events or stressors 3. Predisposing life events or stressors 4. Mechanisms or causes of the problem 5. Other contributing factors - CORRECT ANSWER-5 Broad Categories of Case Formulation? Biological -genes -physical health -disabilities Psychological/behavioral factors -lifestyle -stress -health beliefs -self esteem -coping skills Social Conditions -cultural influences -family relationships/circumstances -social support -peers -school - CORRECT ANSWER-What are the Biopsychosocial Assessment Domains? -Family history of psychiatric illness -Early loss of a nurturing relationship -Stressful life events -Low social support - CORRECT ANSWER-What psychosocial factors influence depression? -interviewer should know the reason the patient was brought in for an evaluation -area should be secured for safety -patient needs to know that the clinician cannot withhold any information from the team that will affect treatment or safety - CORRECT ANSWER-Important things to communicate to the patient during an initial psychiatric assessment? -allows the patient to answer in any way that he or she chooses -do not force patient to follow one particular train of thought -does not define the focus of interest -useful to begin interview - CORRECT ANSWER-Key points to Open Ended Questions? -focuses on one particular problem -gathers specific information -limited responses (yes or no) - CORRECT ANSWER-Key points to Closed Ended Questions? A phenomenon that occurs when people redirect emotions or feelings about one person to an entirely separate individual For example, displacement onto the PMHNP of feelings toward a parent/authoritative figure - CORRECT ANSWER-Definition of Transference? When the provider unconsciously displaces patterns of behaviors/emotional reactions onto the patient as if they were a significant figure from earlier in the provider's life - CORRECT ANSWER-Definition of Counter Transference? -affect the thought processes and senses, which may distort or completely transform the interaction -high levels of anxiety will cause the patient or provider to inaccurately process the information - CORRECT ANSWER-How can perceptual differences affect the interview? Involves providing the patient with a rational understanding of their disorder and options for treatment. The patient will then use that information to make a decision for themselves. - CORRECT ANSWER-What is autonomy? -healing with hands -energy is believed to be transferred by laying the hands over specific parts of the body to aid in the process of healing -should only be used if the patient's culture, social, and moral views allow it - CORRECT ANSWER-What is therapeutic use of touch? -Poor -Fair -Good -Intense It is important that the provider takes in account the patient's current condition, and past history to understand why the eye contact is the way it is. - CORRECT ANSWER-Descriptors of lack of eye contact during the interview? It adds 2 additional elements I: Implementation consideration of the services provided E: the evaluation of service provision R: client's response to the diagnostic process, treatment planning, and intervention efforts - CORRECT ANSWER-How is a SOAPIER note different from a SOAP? Orientation -establish rapport -set parameters -purpose of meeting -formal/informal contracts of responsibilities -termination begins Working -maintain relationship -gather further data -promote clients problem solving skills, self esteem, use of language -facilitate changes -overcome resistance behaviors -evaluate problems and goals Termination -deal with intense feelings regarding the experience -summarize goals and objectives -evaluate outcome attainment -review patient's plan for future -finalize termination - CORRECT ANSWER-Phases of the therapeutic patient/nurse relationship? Building -define the structure, size, composition, purpose and time of group -task and maintenance functions may be discussed and demonstrated Working -facilitates communicate and ensures that meetings begin and end on time Termination -ensure each member summarized individual accomplishments -gives positive and negative feedback regarding the group experience - CORRECT ANSWER-The PMHNPs role in relationship building, maintaining and terminating? -questionnaires, interviews, checklists, outcome assessments -standardized assessments ensure consistent, comprehensive evaluations -establish baseline for follow ups (healthcare administrators and payors are increasingly requiring standardized assessments to justify services or quality of care) - CORRECT ANSWER-What are the psychiatric symptoms measurement scales? A social readjustment rating scale that lists 43 life events associated with varying amounts of disruption and stress in average people's lives. -Each event, called a life change unit (LCU), has a different "weight" for stress -The more events the patient adds, the higher the score -The higher the score, and the larger the weight of the event, the more likely the patient will become ill -Each event has a dedicated number of LCUs (i.e. death of spouse is 100 LCUs) -Accumulation of 200 or more LCUs in a single year increases the risk of developing a psychosomatic disorder in that year - CORRECT ANSWER-What is the Holmes and Rahe Stress Scale?