CMN 548 Official Study Guide test
UNIT 2 STUGY GUIDE CARLAT READINGS
Required Readings for this Unit:
Chapters 1-13, 19-20
Chapter 1-13:
1. What are the four tasks of the diagnostic interview? P. 4
• Build a therapeutic alliance
• Obtain a psychiatric database
• Interview for diagnoses
• Negotiate a tmt plan and communicate it to your pt
1 Complete the table below to create an overview of the phases of the diagnostic
interview: p. 6
Phase Time Allotted Major Tasks
Opening Phase 5-10 min Meet pt
Learn about them
Let them talk about self
Body 30-40 min - Come up with initial diagnostic hypothesis Ch 20
- Map out interview strategy
Hx of present illness Ch14
- Hx of depression, SI, subst abuse Ch 23,23,26
- Family hx
- Asmt that pt meets DSM criteria Ch 20, 21, 24
- Social/development hx Ch 18
- Medical hx Ch 16
- Psychiatric ROS section III
Closing Tasks 5-10 min - Discussion of assessment
- Come up with negotiated agreement
1 Complete the table below which identifies strategies related to preparation for the
diagnostic interview: p. 9-11
Strategy Rationale (how does facilitate the interview process)
Arrive earlier than the patient Prep allows for reduced stress, sets up mellower interview
Prevent interruptions ▪ Ask the clinic secretary to take messages for you.
▪ Ask the page operator to hold all but urgent pages.
,CMN 548 Official Study Guide test
▪ Put your pager on vibrate mode and only answer urgent
pages.
▪ Sign your pages out to a colleague
Don’t overbook patients Allows for time to evaluate and write up/dictate notes
Leave time for notes Schedule enough time for charting-know how much you need
1 From the information on using paper tools effectively, complete the following
table:
Tool Purpose Advantages Disadvantages
Long Form Takes notes on it during Ensures thorough Pts may feel alienated when
P11 interview process data evaluation, notes being completed in front
saves time of them
Short Form Used for rough notes Presents less of Less thorough evaluation
P11 barrier between
clinician and pt
Pocket Card Reminds clinicians what Allows for max Information not clearly spelled
topics to cover interaction btween out, requires more memory
clinician and pt from clinician
Patient Given to pt before first Allows more time to Some pts may view
Questionnaire appt focus on issues questionnaire as a burden
during appt
Patient Pts like receiving, a tool Increases pts sense May provide too much info,
Handouts that often helps to of actively pts may be overwhelmed with
increase pt compliance participation in tmt all the info provided.
1 What are the “rules” regarding the patients contacting the provider?
• Never give out personal phone number
• If you give out phone specify times when you’re available to be called
• If you have voice mail, have pts call there instead of personal phone
• When on vacation, sign pts out to a clinician.
1 How should the provider handle missed appointments?
Inform you at least 24 hrs in advance of any missed appointments or there will be
a charge.
Repeated missed sessions- figure out why pt is missing continued appts. Is it for
legitimate reasons, or is pt acting out feelings of anxiety or hostility.
,CMN 548 Official Study Guide test
If clinician just returned from vacation, pt may be acting out feelings of
abandonment.
2. What are some strategies for “being warm, courteous, and emotionally
sensitive”?
• Empathic or sympathetic statements P.19
• Direct feelings questions P.19
• Reflective statements P.19
If you do not like pt, Ch 13.
1 What can the advanced practice nurse do to “actively defuse the strangeness of
the clinical situation”? P.20
• Greet pt naturally
• Get to know pt as a first patient
• Educate the pt about the nature of the interview
• Address your pts projections
1 What is the benefit in the advanced practice nurse allowing the patient to “give
the opening word?” P.23
- gives pt feeling clinican is interested in listening, establishes rapport
How long should this portion of the interview last?
Allow pt 5 mins of free speech
What is a good type of “opening question”? P.23
Open-ended questions that invite pt to tell story.
- What was it that brought you to the clinic today
- What brings you to see me today
- What sorts of things have been troubling you
- How can I be of help to you
- What can I do for you
Solution-focused interviewing is exploring what the pts goals are for the interview.
Instead of asking what brings you in? or what troubles you?
Ask…what would make this a helpful visit?
or… what would you like to see different from coming here?
this approach may work well with reluctant patients.
Miracle question:
Imagine that tonight you go to bed like you normally would then imagine while
youre asleep… a miracle happens…imagine that because of the miracle your
problem (depression or whatever) goes away. What will your day be like
tomorrow?
, CMN 548 Official Study Guide test
10. How can the advanced practice nurse “project competence” during the psychiatric
interview?
- Kinds of questions you ask
- Dressing professionally
- Adopting a general attitude of confidence
- Providing meaningful feedback at the end of the interview
11. Complete the table below to summarize strategies for approaching threatening
topics:
Strategy When to Use It When Not to Use It Examples
Normalization For eliciting sensitive When the behavior is See P.26
or embarrassing info. violent or sexual abusive
Symptom When you want the pt Use only when you See P.27
Expectation think you will not be suspect pt has engaged
offended by a +ve in the behavior. You
response… such as wouldn’t ask a 70 yr old
with drug use, women being assessed
suicidality. for dementia “what kind
of recreation drugs are
you using?”
Symptom Often used with Reserve for appropriate See P.28
Exaggeration symptom expectation situations. If you don’t
when attempting to suspect a pt is drinking
clarify the severity of don’t ask them how
symptoms. many cases of beer they
drink each day.
Reduction of Guilt When seeking to P.28
reduce a pts guilt When obtaining a
about a specific hx of domestic
behavior in order to violence and other
discover what they antisocial behavior.
have been doing.
Using Familiar Pts more likely to P.29
Language admit to socially
undesirable behavior if
they feel clinician
speaks the same
language..
“standard” language
vs “familiar” language
UNIT 2 STUGY GUIDE CARLAT READINGS
Required Readings for this Unit:
Chapters 1-13, 19-20
Chapter 1-13:
1. What are the four tasks of the diagnostic interview? P. 4
• Build a therapeutic alliance
• Obtain a psychiatric database
• Interview for diagnoses
• Negotiate a tmt plan and communicate it to your pt
1 Complete the table below to create an overview of the phases of the diagnostic
interview: p. 6
Phase Time Allotted Major Tasks
Opening Phase 5-10 min Meet pt
Learn about them
Let them talk about self
Body 30-40 min - Come up with initial diagnostic hypothesis Ch 20
- Map out interview strategy
Hx of present illness Ch14
- Hx of depression, SI, subst abuse Ch 23,23,26
- Family hx
- Asmt that pt meets DSM criteria Ch 20, 21, 24
- Social/development hx Ch 18
- Medical hx Ch 16
- Psychiatric ROS section III
Closing Tasks 5-10 min - Discussion of assessment
- Come up with negotiated agreement
1 Complete the table below which identifies strategies related to preparation for the
diagnostic interview: p. 9-11
Strategy Rationale (how does facilitate the interview process)
Arrive earlier than the patient Prep allows for reduced stress, sets up mellower interview
Prevent interruptions ▪ Ask the clinic secretary to take messages for you.
▪ Ask the page operator to hold all but urgent pages.
,CMN 548 Official Study Guide test
▪ Put your pager on vibrate mode and only answer urgent
pages.
▪ Sign your pages out to a colleague
Don’t overbook patients Allows for time to evaluate and write up/dictate notes
Leave time for notes Schedule enough time for charting-know how much you need
1 From the information on using paper tools effectively, complete the following
table:
Tool Purpose Advantages Disadvantages
Long Form Takes notes on it during Ensures thorough Pts may feel alienated when
P11 interview process data evaluation, notes being completed in front
saves time of them
Short Form Used for rough notes Presents less of Less thorough evaluation
P11 barrier between
clinician and pt
Pocket Card Reminds clinicians what Allows for max Information not clearly spelled
topics to cover interaction btween out, requires more memory
clinician and pt from clinician
Patient Given to pt before first Allows more time to Some pts may view
Questionnaire appt focus on issues questionnaire as a burden
during appt
Patient Pts like receiving, a tool Increases pts sense May provide too much info,
Handouts that often helps to of actively pts may be overwhelmed with
increase pt compliance participation in tmt all the info provided.
1 What are the “rules” regarding the patients contacting the provider?
• Never give out personal phone number
• If you give out phone specify times when you’re available to be called
• If you have voice mail, have pts call there instead of personal phone
• When on vacation, sign pts out to a clinician.
1 How should the provider handle missed appointments?
Inform you at least 24 hrs in advance of any missed appointments or there will be
a charge.
Repeated missed sessions- figure out why pt is missing continued appts. Is it for
legitimate reasons, or is pt acting out feelings of anxiety or hostility.
,CMN 548 Official Study Guide test
If clinician just returned from vacation, pt may be acting out feelings of
abandonment.
2. What are some strategies for “being warm, courteous, and emotionally
sensitive”?
• Empathic or sympathetic statements P.19
• Direct feelings questions P.19
• Reflective statements P.19
If you do not like pt, Ch 13.
1 What can the advanced practice nurse do to “actively defuse the strangeness of
the clinical situation”? P.20
• Greet pt naturally
• Get to know pt as a first patient
• Educate the pt about the nature of the interview
• Address your pts projections
1 What is the benefit in the advanced practice nurse allowing the patient to “give
the opening word?” P.23
- gives pt feeling clinican is interested in listening, establishes rapport
How long should this portion of the interview last?
Allow pt 5 mins of free speech
What is a good type of “opening question”? P.23
Open-ended questions that invite pt to tell story.
- What was it that brought you to the clinic today
- What brings you to see me today
- What sorts of things have been troubling you
- How can I be of help to you
- What can I do for you
Solution-focused interviewing is exploring what the pts goals are for the interview.
Instead of asking what brings you in? or what troubles you?
Ask…what would make this a helpful visit?
or… what would you like to see different from coming here?
this approach may work well with reluctant patients.
Miracle question:
Imagine that tonight you go to bed like you normally would then imagine while
youre asleep… a miracle happens…imagine that because of the miracle your
problem (depression or whatever) goes away. What will your day be like
tomorrow?
, CMN 548 Official Study Guide test
10. How can the advanced practice nurse “project competence” during the psychiatric
interview?
- Kinds of questions you ask
- Dressing professionally
- Adopting a general attitude of confidence
- Providing meaningful feedback at the end of the interview
11. Complete the table below to summarize strategies for approaching threatening
topics:
Strategy When to Use It When Not to Use It Examples
Normalization For eliciting sensitive When the behavior is See P.26
or embarrassing info. violent or sexual abusive
Symptom When you want the pt Use only when you See P.27
Expectation think you will not be suspect pt has engaged
offended by a +ve in the behavior. You
response… such as wouldn’t ask a 70 yr old
with drug use, women being assessed
suicidality. for dementia “what kind
of recreation drugs are
you using?”
Symptom Often used with Reserve for appropriate See P.28
Exaggeration symptom expectation situations. If you don’t
when attempting to suspect a pt is drinking
clarify the severity of don’t ask them how
symptoms. many cases of beer they
drink each day.
Reduction of Guilt When seeking to P.28
reduce a pts guilt When obtaining a
about a specific hx of domestic
behavior in order to violence and other
discover what they antisocial behavior.
have been doing.
Using Familiar Pts more likely to P.29
Language admit to socially
undesirable behavior if
they feel clinician
speaks the same
language..
“standard” language
vs “familiar” language
