NURS B412 FINAL EXAM STUDY GUIDE WITH
COMPLETE SOLUTION
Mental status exam - answer
Cultural Considerations - answer
Recovery-based system: - answer- Mental illnesses and emotional disturbances are treatable
- Recovery is an expectation
T or F during seclusion and restraint a client can request a temporary timeout - answerTrue,
during seclusion and restraint a client can request a temporary timeout
Restraints are either _______ or ________ - answerPhysical, Chemical
T or F: Seclusion or restraint should be for the shortest duration necessary and if less restrictive
measures are not sufficient - answerTrue, Seclusion or restraint should be for the shortest
duration necessary and only if less restrictive measures are not sufficient
What are some examples of less restrictive measures to try first before seclusion or restraint? -
answer- Verbal interventions
- Diversion or redirection
- Calm, quiet environment
- Offer prn med (technically a chemical restraint)
Cultural considerations - answerCulture impacts interpretation
,SOLER
(Active listening technique) - answer- Sit
- Open posture
- Lean in towards
- Eye contact
- Relax
Empathy: - answerConvey an objective awareness of feelings, emotions, and behaviors of others
Clarifying techniques: - answer- Restating
- Reflecting
- Paraphrasing
- Exploring
Restating - answeruse the client's exact words
Reflecting - answerdirects focus on client for client to examine their feelings
Paraphrasing - answerrestate client's feelings for client to confirm
Exploring - answerallows nurse to gather more information regarding important topics mentioned
by the client
Nursing interventions for severe to panic-level anxiety: - answerProvide safe environment and stay
with client
- Minimizes risk to client
Provide quiet environment
, - Prevent intensification of current level of anxiety
Meds and restraint only after less restrictive interventions have failed
- Prevent harm to client or others
Encourage gross motor activities such as walking
- Provides outlet for pent-up tension, endorphin release, improve mental well-being
Set limits. Use firm, short, simple statements. Repetition. Speak slow
- Minimize risk to client. Facilitates understanding
Direct client to acknowledge reality and focus on what is present in the environment
- Reduce client's anxiety level
Boundaries of therapeutic relationship: - answer- Blurred boundaries
- Transference
-Countertransference
Blurred boundaries - answerRelationship meets needs of nurse rather than client, or relationship
becomes social rather than therapeutic
Transference - answerClient views HCT member as having characteristics of someone in their life
- Behaviors - client expects exclusive services from the nurse, compares the nurse to a former
authority figure (ex. parent)
Countertransference - answerHCT member displaces characteristics of people in their past onto a
client
- Behaviors - nurse overidentifies with, competes with and argues with client (ex. nurse feels angry
for no reason if client reminds them of someone who elicited feeling)
Classical psychoanalysis - answerAssessing unconscious thoughts and feelings and resolve conflict
by talking to a psychoanalyst
COMPLETE SOLUTION
Mental status exam - answer
Cultural Considerations - answer
Recovery-based system: - answer- Mental illnesses and emotional disturbances are treatable
- Recovery is an expectation
T or F during seclusion and restraint a client can request a temporary timeout - answerTrue,
during seclusion and restraint a client can request a temporary timeout
Restraints are either _______ or ________ - answerPhysical, Chemical
T or F: Seclusion or restraint should be for the shortest duration necessary and if less restrictive
measures are not sufficient - answerTrue, Seclusion or restraint should be for the shortest
duration necessary and only if less restrictive measures are not sufficient
What are some examples of less restrictive measures to try first before seclusion or restraint? -
answer- Verbal interventions
- Diversion or redirection
- Calm, quiet environment
- Offer prn med (technically a chemical restraint)
Cultural considerations - answerCulture impacts interpretation
,SOLER
(Active listening technique) - answer- Sit
- Open posture
- Lean in towards
- Eye contact
- Relax
Empathy: - answerConvey an objective awareness of feelings, emotions, and behaviors of others
Clarifying techniques: - answer- Restating
- Reflecting
- Paraphrasing
- Exploring
Restating - answeruse the client's exact words
Reflecting - answerdirects focus on client for client to examine their feelings
Paraphrasing - answerrestate client's feelings for client to confirm
Exploring - answerallows nurse to gather more information regarding important topics mentioned
by the client
Nursing interventions for severe to panic-level anxiety: - answerProvide safe environment and stay
with client
- Minimizes risk to client
Provide quiet environment
, - Prevent intensification of current level of anxiety
Meds and restraint only after less restrictive interventions have failed
- Prevent harm to client or others
Encourage gross motor activities such as walking
- Provides outlet for pent-up tension, endorphin release, improve mental well-being
Set limits. Use firm, short, simple statements. Repetition. Speak slow
- Minimize risk to client. Facilitates understanding
Direct client to acknowledge reality and focus on what is present in the environment
- Reduce client's anxiety level
Boundaries of therapeutic relationship: - answer- Blurred boundaries
- Transference
-Countertransference
Blurred boundaries - answerRelationship meets needs of nurse rather than client, or relationship
becomes social rather than therapeutic
Transference - answerClient views HCT member as having characteristics of someone in their life
- Behaviors - client expects exclusive services from the nurse, compares the nurse to a former
authority figure (ex. parent)
Countertransference - answerHCT member displaces characteristics of people in their past onto a
client
- Behaviors - nurse overidentifies with, competes with and argues with client (ex. nurse feels angry
for no reason if client reminds them of someone who elicited feeling)
Classical psychoanalysis - answerAssessing unconscious thoughts and feelings and resolve conflict
by talking to a psychoanalyst
