NR 548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse Practitioner
Exam 2 Week 3-4 Covered Latest update 2025/2026
1. Psychiatric interview: the process by which psychiatric assessment is conduct- ed
-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
G G G G G G G G
• begins during the initial or opening phase of the interview
G G G G G G G G G
-fundamental component of successful therapy G G G G
• Without trust, adherence to treatment recommendations may be compromised
G G G G G G G G
• interview may not elicit the information needed to formulate an appropriate dx & plan
G G G G G G G G G G G G G
G of care without rapport & trust
G G G G G
3. Creating rapport: tips: -Be Yourself G G G G
-Be Warm, Courteous, and Emotionally Sensitive
G G G G G
-Actively Defuse the Strangeness of the Clinical Situation
G G G G G G G
-Give Your Patient the Opening Word
G G G G G
-Gain Your Patient's Trust by Projecting Competence
G G G G G G
4. How to approach threatening topics (sensitive/embarrassing material): -
G G G G G G G
-Normalization
-Symptom Expectation G
-Symptom Exaggeration G
-Reduction of Guilt G G
-Use Familiar Language When Asking about Behaviors
G G G G G G
5. Normalization: Introducing Q with some type of normalizing statement G G G G G G G G
,-two principal ways to do this:
G G G G G
1. start the question by implying that the behavior is a normal or understandable
G G G G G G G G G G G G
G response to a mood or situation
G G G G G
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this
G G G G G G G G G G G G G
G been true for you?
G G G
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing
G G G G G G G G G G G G G
G your patient that she is not alone
G G G G G G
• ex: I've talked to several patients who've said that their depression causes them to have
G G G G G G G G G G G G G G
strange experiences, like hearing voices or thinking that strangers are laughing at them. Has
G G G G G G G G G G G G G G
G that been happening to you?
G G G G
, 6. Symptom Expectation: communicate that a behavior is in some way normal or
G G G G G G G G G G G
G expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior
G G G G G G G G G G G G G G G
G and that you will not be offended by a positive response
G G G G G G G G G G
-high index of suspicion of some self-destructive activity
G G G G G G G
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You
G G G G G G G G G G G
G suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather tha
G G G G G G G G G G G G G G G G
G gingerly asking "Have you had any thoughts that you'd be better off dead?" you might
G G G G G G G G G G G G G G
G decide to use symptom expectation. "What kinds of ways to hurt yourself have you
G G G G G G G G G G G G G
G thought about?" G
*reserve this technique for situations in which it seems appropriate
G G G G G G G G G
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is higher
G G G G G G G G G G G
G than your expectation, so that the patient feels that their actual, lower frequency of the
G G G G G G G G G G G G G G
G behavior will not be perceived by you as being "bad."
G G G G G G G G G
-helpful in clarifying the severity of symptoms
G G G G G G
*reserve this technique for situations in which it seems appropriate
G G G G G G G G G
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific
G G G G G G G G G G G G
Psychiatric-Mental Health Nurse Practitioner
Exam 2 Week 3-4 Covered Latest update 2025/2026
1. Psychiatric interview: the process by which psychiatric assessment is conduct- ed
-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
G G G G G G G G
• begins during the initial or opening phase of the interview
G G G G G G G G G
-fundamental component of successful therapy G G G G
• Without trust, adherence to treatment recommendations may be compromised
G G G G G G G G
• interview may not elicit the information needed to formulate an appropriate dx & plan
G G G G G G G G G G G G G
G of care without rapport & trust
G G G G G
3. Creating rapport: tips: -Be Yourself G G G G
-Be Warm, Courteous, and Emotionally Sensitive
G G G G G
-Actively Defuse the Strangeness of the Clinical Situation
G G G G G G G
-Give Your Patient the Opening Word
G G G G G
-Gain Your Patient's Trust by Projecting Competence
G G G G G G
4. How to approach threatening topics (sensitive/embarrassing material): -
G G G G G G G
-Normalization
-Symptom Expectation G
-Symptom Exaggeration G
-Reduction of Guilt G G
-Use Familiar Language When Asking about Behaviors
G G G G G G
5. Normalization: Introducing Q with some type of normalizing statement G G G G G G G G
,-two principal ways to do this:
G G G G G
1. start the question by implying that the behavior is a normal or understandable
G G G G G G G G G G G G
G response to a mood or situation
G G G G G
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this
G G G G G G G G G G G G G
G been true for you?
G G G
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing
G G G G G G G G G G G G G
G your patient that she is not alone
G G G G G G
• ex: I've talked to several patients who've said that their depression causes them to have
G G G G G G G G G G G G G G
strange experiences, like hearing voices or thinking that strangers are laughing at them. Has
G G G G G G G G G G G G G G
G that been happening to you?
G G G G
, 6. Symptom Expectation: communicate that a behavior is in some way normal or
G G G G G G G G G G G
G expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior
G G G G G G G G G G G G G G G
G and that you will not be offended by a positive response
G G G G G G G G G G
-high index of suspicion of some self-destructive activity
G G G G G G G
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You
G G G G G G G G G G G
G suspect suicidality, but you sense that the patient may be too ashamed to admit it. Rather tha
G G G G G G G G G G G G G G G G
G gingerly asking "Have you had any thoughts that you'd be better off dead?" you might
G G G G G G G G G G G G G G
G decide to use symptom expectation. "What kinds of ways to hurt yourself have you
G G G G G G G G G G G G G
G thought about?" G
*reserve this technique for situations in which it seems appropriate
G G G G G G G G G
7. Symptom Exaggeration: suggesting a frequency of a problematic behavior that is higher
G G G G G G G G G G G
G than your expectation, so that the patient feels that their actual, lower frequency of the
G G G G G G G G G G G G G G
G behavior will not be perceived by you as being "bad."
G G G G G G G G G
-helpful in clarifying the severity of symptoms
G G G G G G
*reserve this technique for situations in which it seems appropriate
G G G G G G G G G
8. Reduction of guilt: seeks to directly reduce a patient's guilt about a specific
G G G G G G G G G G G G
