Clinical Modalities Exam 3 -with 100% verified solutions-

Clinical Modalities Exam 3 -with 100% verified solutions-Clinical Modalities Exam 3 -with 100% verified solutions- rahe-holmes What is the scale that rates stressful events in a person's life? dissociative symptoms Acute Stress Disorder is associated with presence of _____________________________ symptoms. maturational crisis Name a type of crisis that arises internally; follow different stages of growth that humans experience; happens each time a person enters a new stage of life, they realize their old coping skills are inadequate. pre-crisis level of functioning The most reliable outcome for crisis intervention with regard to post-crisis level of functioning is to determine that the patient is at their ___________________ how they handled crisis in the past The best was to assess a patients coping skills is to inquire about _______________________________________ place the trauma in the larger perspectives of their lives. Primary goal of PTSD treatment is to help them what? Phase 1 = problem arises that increases anxiety levels. You would most likely observe anxiety. Phase 2= Usual problem solving techniques don't work, anxiety rises. Trial and error attempts are made to restore balance. Phase 3= Trial and error attempts fail and anxiety rises to severe or panic levels. Phase 4= when these measures don't reduce anxiety, the anxiety overwhelms the person and leads to serious disorganization. This signals the patient is in crisis. What are Caplan's 4 stages of crisis? Psychological first aid What is a set of procedures called that help facilitate survivors' adaptive coping in a disaster? asking if a supportive person can be with them the next few days The PMHNP can best help a person who receives devastating news by ___________________________________ disequilibrium It is important for the PMHNP to understand that when a patient is in crisis they are in a state of ________________________ individual psychotherapy What is the most appropriate modality to use with schizoid personality disorder? assist the client in identifying appropriate coping strategies The best response by PMHNP when speaking with a client with BPD and wants to cut themselves is to_____________________________ dysfunctional behavior but mostly the patient's best effort to cope If a BPD client who has been making progress has an anxiety producing event arise and cuts again this is __________________________________________ ? splitting A client with borderline personality disorder dramatically expresses feelings about each nurse on the staff, stating that only one nurse is understanding and trustworthy — the nurse the client is talking to at the time. This client is demonstrating which behavior? self mutilation ___________________________ is mainly due to fear of abandonment or the increase of independence? perceived rejections BPD is often characterized by an inability to tolerate __________________________? their emotional distress Patients will respond better to limit setting if the PMHNP can reflect back to the client an understanding and validation of ______________________ ? separation-individualization Client's with BPD have not successfully achieved the developmental stage of ________________________ ? paranoid personality disorder Name the personality disorder described below: A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts. A person who has a longstanding feeling of mistrust or suspicion, no hallucinations, no delusions, and no antisocial behavior? paranoid personality disorder Clients with which disorder do not trust easily and its best to use a respectful neutral approach? project blame for their own shortcomings on others Clients with paranoid personality disorder are critical of others because they _____________________ ? narcissitic personality disorder characterized by inflated or grandiose sense of themselves and an extreme need for admiration (expect others to notice their special qualities, even when their accomplishments are ordinary, and they enjoy basking in the light of adulation; selfabsorbed, lack empathy for others; strong sense of entitlement; tend to be preoccupied with fantasies of success and power, ideal love, or recognition for brilliance or beauty) schemas Conceptual frameworks a person uses to make sense of the world is __________________________ ? cognitive therapy What is the modality that prioritizes a client's schema? mindfulness Being alert, mentally present, and cognitively flexible while going through life's everyday activities and tasks. pain is better than not feeling anything at all Self-mutilation occurs because a client may feel that ___________________________________ abandonment Self mutilation results from feelings of ________________________ manipulative Self mutilation can be a _______________________gesture? safety plan Self mutilation can occur after a ______________ _______________ is put in place? DBT Which modality helps replace irrational thoughts? Dialectal behavioral therapy What is the only psychotherapy to demonstrate any efficacy in treatment of ANY PDs? boundaries Respecting a patients ______________________ is important in establishing a therapeutic relationship with a patient with BPB. Dependent personality disorder Name the personality disorders described below: A person who gets others to assume responsibility, has difficulty expressing disagreement, and often has an abusive spouse? A personality disorder characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of. dichotomous thinking View a situation in only two categories instead of on a continuum (all or none; black or white) MCI expectant category ... Gerald Caplan pioneer in the crisis intervention movement; popularized classifications of groups as primary, secondary, and tertiary Crisis Phase 1 A problem arises that contributes to increase in anxiety levels. The anxiety stimulates the implementation of usual problem-solving techniques of the person. This is crisis phase _______ ? Crisis Phase 2 The usual problem-solving techniques are ineffective. Anxiety levels continue to rise. Trial-and-error attempts are made to restore balance. This is crisis phase _______ ? Crisis Phase 3 The trial-and-error attempts fail. The anxiety escalates to severe or panic levels. The person adopts automatic relief behaviors. This is crisis phase _______ ? Crisis Phase 4 When these measures do not reduce anxiety, anxiety can overwhelm the person and lead to serious personality disorganization, which signals the person is in crisis. This is crisis phase _______ ? Crisis Development Stage 1 Normal stress and anxiety level - the background of crisis development brought about by the minor annoyances and frustrations of everyday life. Individuals at this stage are rational and in control of their emotions and behavior. This is crisis development stage _____ ? Crisis Development Stage 2 Rising anxiety level - a heightened condition typically including rapid heart rate and respiration. The person might appear lost or confused about how to solve a problem. Voice may be pitched higher or quaver with accelerated speech patterns. Small nervous habits such as finger or foot tapping may be manifested. This is crisis development stage _____ ? Crisis Development Stage 3 Severe stress and increasing anxiety - a person's reasoning capacity is seriously diminished, with fixation on the here and now. Behavior typically becomes boisterous or disruptive. Communication may include shouting, swearing, argumentation, and threats. Physical indications include pacing, clenched fists, perspiring, and rapid shallow breathing. This is crisis development stage _____ ? Crisis Development Stage 4 Acute crisis - characterized by unbearable anxiety and loss of cognitive, emotional, and behavioral control, with urgent need to end the emotional pain. A person in crisis is unable to solve problems or process information rationally without help. Behaviors of persons in crisis are erratic and unpredictable to a point that they may pose a danger to themselves and others. This is crisis development stage _____ ? 1. Pre-warning of the disaster. 2. Disaster event occurs. 3. Recuperative effort. Natural and man-made disaster can be conceptualized in what three phases: Pre-warning of the disaster This disaster phase entails preparing victims for possible evacuation of the environment, mobilization of resources, and review of community disaster plans. Disaster event occurs The rescuers provide resources, assistance, and support as needed to preserve the biopsychosocial functioning and survival of the victims. Recuperative effort The focus is to implement strategies for healing the sick and injured, preventing complications of health problems, repairing damages, and reconstructing the community Mass Casualty Incident Strategies ... Immediate - Code Red - Priority 1 Injuries are life threatening but survivable with minimal intervention. Individuals in the group can progress rapidly to expectant if treatment is delayed. Delayed - Code Yellow - Priority 2 Injuries are significant and require medical care but can wait hours w/o threat to life or limb. Individuals in this group receive treatment only after immediate casualties are treated. Minimal - Code Green - level 3 Injuries are minor and treatment can be delayed hours to days. This group should be moved away from main triage area. Expectant - Code 4 - Black Injuries are extensive and chances of survival are unlikely even with definite care. persons in this group should be separated from other casualties but not abandoned. Comfort measures provided when possible. Delayed (yellow) injuries 2 Stable abdominal wounds w/o evidence of hemorrhage, soft tissue injuries, maxillofacial wounds without airway compromise, vascular injuries with adequate collateral circulation, genitourinary tract disruption, ORIF, debridement, external fixation, most eye and CNS injuries. Minimal (green) injuries 3 upper extremity fractures, minor burns, sprains, small lacerations, behavioral/psychological disorders. Expectant (black) injuries 4 unresponsive patients with penetrating head wounds, high spinal cord injuries, multiple organ wounds, 2nd-3rd degree burns > 60% of body surface, seizures or vomiting within 24 hours of radiation exposure, profound shock, agonal respirations, no pulse, no b/p, pupils fixed and dilated. psych resolution of individual's immediate crisis and restoration to pre-crisis level of functioning Minimal goal in disaster Improve function to above pre-crisis level Maximal goal in disaster Maturational Crisis an experience, such as puberty, adolescence, young adulthood, marriage, or the aging process, in which one's lifestyle is continually subject to change Immediate (red) 1 injuries Sucking chest wound, airway obstruction secondary to mechanical cause, shock, hemothorax, tension pneumothorax, asphyxia, unstable chest and abdominal wounds, incomplete amputations, open fractures of long bones, and 2nd/3rd dissociative The person with an acute stress disorder has ________________ symptoms and persistently re-experiences the event. chronic By definition, there is no such thing as a ________________ crisis 4 to 6 weeks A crisis is generally regarded as time limited, lasting no more than ________________________ 1. Create a sense of safety 2. Comforting and consoling the individual 3. Providing information 4. Providing support for reality based tasks 5. Diffusing guilt 6. Facilitating a sense of mastery Name 6 communication strategies in Psychological First Aid positive coping skills The role of the PMH-APRN is to provide a framework of support systems that guide the client through the crisis and facilitate the development and use of _____________________________ suicide or homicide The PMH-APRN must be acutely aware that a person in crisis may be at high risk for _____________ suicide The PMH-APRN should assess for unusual behaviors and determine the level of involvement of the person with the crisis. In addition, assess for evidence of selfmutilation activities that may indicate the use of self-preservation measures to avoid ________ biological assessment look up psychological domain/assessment ______________________ assessment focuses on the victim's emotions and coping strengths. In the beginning of the crisis, the victim may report the feeling of numbness and shock. Responses to psychological distress should be differentiated from symptoms of psychiatric illnesses of the victim. Social Domain/Assessment Assessment of the impact of the crisis on the victim's ________________ functioning is essential because a crisis usually severely disrupts these proficiencies. The PMH-APRN should assess the severity of the crisis to determine the capability of the individual or the community to respond in a supportive way. individual, the family, and the community The nursing interventions for the social domain include the ______________________________________ Caplan phase 1 A problem arises that contributes to increase in anxiety levels. The anxiety stimulates the implementation of usual problem-solving techniques of the person. serious personality disorganization, which signals the person is in crisis. -After Caplan phase 1, the usual problem-solving techniques are ineffective. Anxiety levels continue to rise. Trial-and-error attempts are made to restore balance. -The trial-and-error attempts fail. The anxiety escalates to severe or panic levels. The person adopts automatic relief behaviors. -When these measures do not reduce anxiety, anxiety can overwhelm the person and lead to_______________________________ adaptive or nonadaptive biopsychosocial responses A crisis results from a stressful event for which coping mechanisms fail to provide adequate adaptive skills to address the perceived challenge or threat. It is a time limiting event that triggers either ______________________________ responses to maturational, situational, or interpersonal experiences. seeking emotional and instrumental support, ventilating their feelings, selfdistraction, planning, using humor and/or their individual religious beliefs. Most individuals demonstrate resilience when faced with a crisis or a disaster situation. Resilient individuals respond adaptively by using healthy coping strategies that include: depression, anxiety disorders, substance misuse disorder Individuals who are not able to respond adaptively to stressors are at risk of developing: provide a list of support systems and assist the patient in the development and use of positive coping skills. In a crisis situation, the goal for the individual experiencing the crisis is to assist them in returning to their precrisis level of functioning. In order to accomplish this goal the nurse must be able to short- and long-term adaptive functioning and coping. Psychological First Aid is designed to reduce the initial distress caused by traumatic events and to foster (1) consistent with research evidence on risk and resilience following trauma; (2) applicable and practical in field settings; (3) appropriate for developmental levels across the lifespan; and (4) culturally informed and delivered in a flexible manner. Principles and techniques of Psychological First Aid meet four basic standards. They are: a broad range of early reactions (for example, physical, psychological, behavioral, spiritual). Psychological First Aid does not assume that all survivors will develop severe mental health problems or long-term difficulties in recovery. Instead, it is based on an understanding that disaster survivors and others affected by such events will experience Psychological First Aid intervention strategies are intended for use with children, adolescents, parents/caretakers, families, and adults exposed to disaster or terrorism. Psychological First Aid can also be provided to first responders and other disaster relief workers. Who is Psychological First Aid For? Psychological First Aid is designed for delivery by mental health and other disaster response workers who provide early assistance to affected children, families, and adults as part of an organized disaster response effort. These providers may be imbedded in a variety of response units, including first responder teams, incident command systems, primary and emergency health care, school crisis response teams, faith-based organizations, Community Emergency Response Teams (CERT), Medical Reserve Corps, the Citizens Corps, and other disaster relief organizations. Who Delivers Psychological First Aid? Psychological First Aid is a supportive intervention for use in the immediate aftermath of disasters and terrorism. When Should Psychological First Aid Be Used? Psychological First Aid is designed for delivery in diverse settings. Mental health and other disaster response workers may be called upon to provide Psychological First Aid in general population shelters, special needs shelters, field hospitals and medical triage areas, acute care facilities (for example, Emergency Departments), staging areas or respite centers for first responders or other relief workers, emergency operations centers, crisis hotlines or phone banks, feeding locations, disaster assistance service centers, family reception and assistance centers, homes, businesses, and other community settings. Where Should Psychological First Aid Be Used? make rapid assessments of survivors' immediate concerns and needs, and to implement supportive activities in a flexible manner. Psychological First Aid includes basic information-gathering techniques to help providers: field-tested, evidence-informed strategies that can be provided in a variety of disaster settings. Psychological First Aid relies on what strategies? survivors of various ages and backgrounds. Psychological First Aid emphasizes developmentally and culturally appropriate interventions for important information for youth, adults, and families for their use over the course of recovery. Psychological First Aid includes handouts that provide • Establish a human connection in a non-intrusive, compassionate manner. • Enhance immediate and ongoing safety, and provide physical and emotional comfort. • Calm and orient emotionally-overwhelmed or distraught survivors. • Help survivors to tell you specifically what their immediate needs and concerns are, and gather additional information as appropriate. • Offer practical assistance and information to help survivors address their immediate needs and concerns. • Connect survivors as soon as possible to social support networks, including family members, friends, neighbors, and community helping resources. • Support adaptive coping, acknowledge coping efforts and strengths, and empower survivors; encourage adults, children, and families to take an active role in their recovery. • Provide information that may help survivors cope effectively with the psychological impact of disasters. • Be clear about your availability, and (when appropriate) linking the survivor to another member of a disaster response team or to local recovery systems, mental health services, public-sector services, and organizations. Basic Objectives of Psychological First Aid BPD patients engage in impulsive behavior: alcohol and drug use, promiscuity and self -injurious acts. Self -injurious acts are associated with a childhood history of neglect and the purpose of these acts is to relieve negative emotions. Patients report feeling better after the act. Rationale for self-mutilation in borderline PD: a previous history of suicidal thinking or suicidal behavior, recurring participation in impulsive behavior, having an unstable or inaccurate sense of self and having recurring or persistent feelings of meaninglessness. The researchers also concluded that the development of dissociation tends to increase the frequency of self-harming behavior in people affected by BPD. Four specific borderline personality disorder symptoms are statistically associated with heightened risks for involvement in non-suicidal self-harm. These symptoms are: A reality oriented approach is more advantageous than in depth interpretations of the unconscious.Additionally, there are two general modalities for working with the client with BPD: Clarification in which the transference is more explicitly analyzed than in a traditional psychotherapy (the client becomes rapidly aware of his/her distortions about the therapist). Confrontation in which the therapist directly points out how the transferential distortions impact heir interpersonal relationships with others. Strategies for development of therapeutic relationship with patient • structured communication techniques in addressing externalized rage and internalized suicidal and self-injurious behavior • using "predicting" paradigms to defuse self- destructive impulsivity and to confront splitting behavior • resolving "damned if you do, and damned if you don't" obstacles in relationship disturbances • soothing abandonment fears with "transitional objects" • maintaining consistency and therapeutic boundaries while exhibiting caring concern • validating the "feeling bad about feeling bad" helplessness of borderline emptiness • confronting "faking it" fears and "chameleon" mood changes • confronting splitting, while validating identity Strategies for dealing with common behaviors in BPD: separation-individuation and projective identification The psychoanalytic views of BPD focus on two important psychoanalytic concepts: a sense of self, a permanent sense of significant others (object constancy), and integration of seeing both bad and good components of self A person with BPD has not achieved the normal and healthy developmental stage of separation-individuation, during which a child develops: primary caregiver and develop a separate and distinct personality or self-identity. Those with BPD lack the ability to separate from the: inconsistent or insensitive to the needs of the child. The child develops ambivalent feelings regarding interpersonal relationships and therefore has no basis for establishing trusting and secure relationships in the future. Psychoanalytic theory suggests that BPD separation difficulties occur because the primary caregivers' behaviors have been: personal boundaries and in interpersonal interactions and relationships. Often, these clients falsely attribute to others their own unacceptable feelings, impulses, or thoughts, termed projective identification. BPD: Children experience feelings of intense fear and anger in separating themselves from others. This problem continues into adulthood, and they continue to experience difficulties in maintaining: Projective identification _____________ ______________ is believed to play an important role in the development of BPD and is a defense mechanism by which people with BPD protect their fragile self-image. rejection For example, when overwhelmed by anxiety or anger at being disregarded by another, they defend against the intensity of these feelings by unconsciously blaming others for what happens to them. They project their feelings onto a significant other with the unconscious hope that the other knows how to deal with it. Projective identification becomes a defensive way of interacting with the world, which leads to more: Extraordinarily unstable affect, mood, behavior, object relations, and self-image The characteristic sx of BPD are: crisis, and mood swings are common. They feel both dependent and hostile and generally have very strained interpersonal relationships. Often dependent on those close to them yet when frustrated they express rage toward their close friends. Clinical features of BPD include always in a state of: being alone and will often frantically search for companionship regardless of how unsatisfying. They will accept a stranger as a friend, or behave in a promiscuous manner A person with BPD cannot tolerate: anger, or to numb themselves to overwhelming affect. They usually express feeling bored, empty with a lack of a sense of identity. Their perspective of others is "all good or all bad". The self-mutilation with BPD is often associated with seeking help from others, an expression of: Hospitalization is helpful for pts who are excessively impulsive, self-destructive or self-mutilating. There are set limits, and observation. Some patients can remain in the hospital for up to a year. Supportive strategies for dealing with self-harm: DBT What is the psychosocial treatment developed by Marsha M. Linehan specifically to treat individuals with borderline personality disorder? #1 An individual component in which the therapist and client discuss issues that come up during the week, recorded on diary cards and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority, followed by therapy interfering behaviors. #2 The group, which ordinarily meets once weekly for about 2 - 2.5 hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills, and distress tolerance skills. What are the two part of DBT? telephone consultation In DBT, ________________ _____________ is available for pts feeling like they are headed towards a crisis that could lead to injurious behavior SSRIs and antipsychotics What two drug classes can help with impulsivity? their having a good object and a bad object and is used as a defense against anxiety Splitting is characterized by love and hate The splitting defense mechanism causes pts to _______ _____ _______ the therapist and others in the environment to elicit help from others, express anger, or numb themselves to overwhelming affect. Suicidal or self-mutilating behaviors in bpd are a way to: • Spending • Sex • Substance abuse • Reckless driving • Binge eating Impulsive bpd behaviors that are potentially self-damaging: • Frequent displaces of temper • Constant anger • Recurrent physical fights Examples of inappropriate, intense anger or difficulty controlling anger in BPD: Tumultuous ________________ interpersonal relationships are also common in BPD. • Alcohol- serious mental and physical birth defects. • Fetal Alcohol Syndrome- affects one third of alcoholic women; growth retardation of fetal origin; delayed development, hyperactivity, attention deficit. • Marijuana- low infant birth weight, prematurity, withdrawal symptoms, tremors, hyperemesis. • Crack Cocaine- behavioral abnormalities, irritability, crying, delayed desire for human contact. • Heroin- severe withdrawal symptoms. Etiology and symptoms of Maternal Drug Use with alcohol, marijuana, crack cocaine, and heroin. Adverse childhood experiences ___________ __________ ____________ alter the trajectory of development in a given individual, and that during early development the brain is especially vulnerable to injury. the preschool years Developmental language disorders, often are diagnosed in: elementary school Mental retardation or specific learning problems are diagnosed until after the child begins: interact with peers Disruptive behavior disorder becomes apparent at the time the child begins to: the demands of sustained attention are made in school Attention deficit disorders are diagnosed when: Schizophrenia and bipolar disorder _____________ and _________ are rare in preschool/school-aged children. adolescent Psychological maladjustment, self-loathing, disturbance of conduct, substance abuse, affective disorders, and other impairing psychiatric disorders emerge in approximately 20% of the __________________ population. greater conflicts with families and for feeling alienated from their families. Psychologically disturbed children are at greater risk for psychiatric disorders during adolescence. These adolescents are at increased risk for: identity versus role confusion Adolescence undergo which stage per Erikson? Adolescents who are socially isolated, feel socially rejected, and/or become overly identified with an idol to the exclusion of all other activities Adolescents who are at greater risk for serious emotional problems and psychiatric intervention include: role confusion and decreased cohesive and confident sense of identity. Failure to develop a solid identity results in the adolescent having: Flooding ______________ is a form of behavior therapy based on the principles of respondent conditioning. It is sometimes referred to as exposure therapy or prolonged exposure therapy. reintegrating their repressed emotions with their current awareness. Flooding, a psychotherapeutic technique, is used to treat phobia and anxiety disorders including post-traumatic stress disorder. It works by exposing the patient to their painful memories, with the goal of: phobias Flooding is a psychotherapeutic method for overcoming __________________ systematic desensitization. Flooding is a faster yet less efficient and more traumatic method of ridding fears when compared with _______________ ____________________ replace their fear with relaxation. Flooding: In order to demonstrate the irrationality of the fear, a psychologist would put a person in a situation where they would face their phobia at its worst. Under controlled conditions and using psychologically-proven relaxation techniques, the subject attempts to: quick and usually effective. The flooding experience can often be traumatic for a person, but may be necessary if the phobia is causing them significant life disturbances. The advantage to flooding is that it is: interactions among family members need attention in order to address specific problems exhibited by the child. Family therapy goes beyond family involvement in the child's treatment to focus on treatment of the entire family. This method is selected when: increase the likelihood that improvements in the child's mental health will occur and will be supported in the home with consistent and sustained family patterns. The goal of family therapy is to: nurture change Family therapy, also referred to as, family systems therapy, and family counseling, works with family dynamics to _____________ ________________ Family therapy ____________ _____________ emphasizes the importance of family relationships as a factor in achieving changes in mental, emotional and behavioral health. developmental status Older children can be involved with more typical family therapy approaches. The ______________ ____________ of the child's capabilities and the nature of the child's problems should guide the PMH-APRN's decisions with the family regarding the specific strategies to use. a teen's particular concerns and situation in life The best psychotherapy for teenagers entails a collaborative, person-to-person dialogue which addresses: life coaching. A therapist can be a mentor, a "thinking partner"—someone who can help to generate new ideas, to figure things out, or help to take a new approach to oneself, relationships, or situations. This collaborative, person-to-person psychotherapy provides an emotionally safe place for teenagers to explore how they feel about things and what to do about them. It evolves into what feels and looks more like __________ ___________ than psychotherapy. marital dysfunction. Collusion between a child and a parent can create dysfunction within the other parent or within a sibling, or a dysfunctional relationship between siblings can create dysfunction within a parent, which can subsequently create ____________ ________________ have experienced trauma, which is difficult to describe in words. Observing play and engaging in play with children can be extremely informative in assessing developmental abilities, and in understanding sensitive situations. This is particularly relevant for young children, and for children who: communicate through play The following items constitute a well-balanced play area: multi-generational families of dolls of various races; dolls representing special roles and feelings, such as police officer, doctor, and soldier; dollhouse furnishings with or without a doll house; toy animals; puppets; paper, crayons, paint, and blunt-ended scissors; ball; clay; rubber items such as hammer, knife, and guns; building blocks, cars, trucks and airplanes; and eating utensils. The toys should enable children to: