NSG 526 EXAM 1 QUESTIONS WITH CORRECT ANSWERS., Exams of Nursing

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NSG 526 EXAM 1 QUESTIONS WITH CORRECT

ANSWERS

What is not considered a mental disorder? - CORRECT

ANSWER-✔✔✅-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) What is considered a mental disorder per the DSM5? - CORRECT ANSWER-✔✔✅-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 Purpose of Scope of Practice? - CORRECT ANSWER-✔✔✅-Define NP roles -Identify competencies assumed to be held by all NPs who function in a particular role -Varies broadly from state to state Purpose of Standard of Practice? - CORRECT ANSWER-✔✔✅-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 Purpose of Psychiatric Interview? - CORRECT ANSWER-✔✔✅Understand the patient's illness to evaluate the effect on their lives and create a beginning diagnosis and treatment plan

What is a Therapeutic Alliance? - CORRECT ANSWER-✔✔✅-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 Important components of a therapeutic alliance? - CORRECT ANSWER-✔✔✅-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 What is Psychotherapy? - CORRECT ANSWER-✔✔✅Holistic treatment that relies on the nurse's processing of that the patient is experiencing Peplau's most universal contribution to PMHNPs? - CORRECT ANSWER-✔✔✅-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 Per Peplau, skills of a MH nurse? - CORRECT ANSWER-✔✔✅-Observation, interpretation, and intervention (The PMHNP observes and listens to the client, developing impressions about the client's situation) What is the main idea for Peplau's Theory of Interpersonal Relationships? - CORRECT ANSWER-✔✔✅- 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 Therapeutic Communication Techniques? - CORRECT ANSWER-✔✔✅-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 Non-Therapeutic Techniques? - CORRECT ANSWER-✔✔✅-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 Four Phases of the Nursing Model? - CORRECT ANSWER-✔✔✅-Orientation -Identification -Exploitation -Resolution Psychotherapy Process? - CORRECT ANSWER-✔✔✅-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 How does the patient recover through adaption? - CORRECT ANSWER-✔✔✅By applying core principles of psychotherapy, as well as, nursing theory What does the PMHNP need to avoid? - CORRECT ANSWER-✔✔✅Avoid taking patients with similar problems or put aside personal pathology Goals for Interpersonal Therapy? - CORRECT ANSWER-✔✔✅-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 Indications for Interpersonal Therapy? - CORRECT ANSWER-✔✔✅-Complicated bereavement/grief -Marital and interpersonal conflicts, such as role disputes -Life events, such as role transitions -Isolation, lack of support, interpersonal deficits Early Phase of Interpersonal Therapy? - CORRECT ANSWER-✔✔✅Therapist identifies depressive symptoms, evaluates patient, generates a diagnosis, obtain information on how the patient handles relationships Middle Phase of Interpersonal Therapy? - CORRECT ANSWER-✔✔✅Patient and therapist derive more specific strategies to deal with stressors Termination Phase of Interpersonal Therapy? - CORRECT ANSWER-✔✔✅-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 Purpose of Group Therapy? - CORRECT ANSWER-✔✔✅Facilitate changes by the patient in order to address identified problems Role of leader in group therapy? - CORRECT ANSWER-✔✔✅Assure dominant members are brought to the attention of the group, so they are able to address issues within the process Role of information giver in group therapy? - CORRECT ANSWER-✔✔✅A person explaining to the group ways that person is able to cope with things Role of Reinforcement in group therapy? - CORRECT ANSWER-✔✔✅A technique where special favors or awards are given to assure patient participation and involvement in group therapy

Goal of Cognitive Behavioral Therapy (CBT)? - CORRECT ANSWER-✔✔✅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 CBT Interventions? - CORRECT ANSWER-✔✔✅-Encouraging patient to analyze early parental relationships -Underlying meaning of behavior -Identification of negative thoughts -Effect of thoughts on feelings and behaviors Interpersonal Therapy (IPT) is useful for? - CORRECT ANSWER-✔✔✅-Anxiety -Bipolar Disorder -Eating Disorders -Borderline Personality Disorder Stages of Development? - CORRECT ANSWER-✔✔✅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.) Characteristic of Infancy? - CORRECT ANSWER-✔✔✅Gratification of needs

Characteristic of Childhood? - CORRECT ANSWER-✔✔✅Delayed gratification Characteristic of Juvenile? - CORRECT ANSWER-✔✔✅Formation of peer group Characteristic of Preadolescence? - CORRECT ANSWER-✔✔✅Developing relationships within same gender Characteristic of Early Adolescence? - CORRECT ANSWER-✔✔✅Identity Characteristic of Late Adolescence? - CORRECT ANSWER-✔✔✅Forming lasting and intimate relationships What are the 3 types of self? - CORRECT ANSWER-✔✔✅-Good me vs Bad me: based on social appraisal and the anxiety that results from negative feedback -Not me: unknown, repressed component of self How does Sullivan's theory define security operation? - CORRECT ANSWER-✔✔✅Measures that the individual employs to reduce anxiety and enhance security How does Sullivan's theory define self system? - CORRECT ANSWER-✔✔✅All of the security operations that an individual uses to defend against anxiety and ensure self-esteem What is Milieu Therapy? - CORRECT ANSWER-✔✔✅-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 Goal of Milieu Therapy? - CORRECT ANSWER-✔✔✅Return to larger society when goals have been met

What is Behavioral Therapy? - CORRECT ANSWER-✔✔✅-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 What is Psychoanalysis? - CORRECT ANSWER-✔✔✅-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 Components of Mental Status Exam (MSE)? - CORRECT ANSWER-✔✔✅-General appearance, attitude, behavior -Speech -Mood and Affect -Thought content -Thought process -Impulse Control -Cognition and Sensorium How to describe thought content? - CORRECT ANSWER-✔✔✅-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 SAD PERSONs Scale? - CORRECT ANSWER-✔✔✅Clinical tool to determine suicide risk -Sex -Age -Depression -Previous Attempts -Ethanol Abuse

-Relational Loss -Social Supports Lacking -Organized Plan -No Souse -Sickness What is Thought Process? - CORRECT ANSWER-✔✔✅The way in which a client thinks What is Loose Association? - CORRECT ANSWER-✔✔✅-Shifting of idea -Illogical -Difficulty to follow What is Tangential Thinking? - CORRECT ANSWER-✔✔✅Wanders to a related topic but never makes it back to the original topic What is Word Salad? - CORRECT ANSWER-✔✔✅Completely nonsensical combination of words What is Neologisms? - CORRECT ANSWER-✔✔✅Made up words What is Circumstantial Thought? - CORRECT ANSWER-✔✔✅Gets lost in details but eventually makes it make to the original topic What is Thought Blocking? - CORRECT ANSWER-✔✔✅Thinking process stops and mind goes "blank" What is Flight of Ideas? - CORRECT ANSWER-✔✔✅-Often seen in mania -Pressured speech -Rapid topic changes -Topics may relate but in strange ways

What is Confabulation? - CORRECT ANSWER-✔✔✅-Often indicates dementia -Fabrication of information to fill in missing gaps What is Concrete Thought Process? - CORRECT ANSWER-✔✔✅-Only understands things literally -Common in schizophrenic patients What is Abstract Thought Processes? - CORRECT ANSWER-✔✔✅-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?" What are Perceptual Disturbances? - CORRECT ANSWER-✔✔✅Describes whether the patient is in good contact of their environment or is there is a distortion of reality (Typically presents as hallucinations) What are Illusions? - CORRECT ANSWER-✔✔✅-Misinterpretation of true stimuli -I.E. a curtain in a dark room is mistaken for a person What are Hallucinations? - CORRECT ANSWER-✔✔✅-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 These hallucinations may indicate a medical illness , substance intoxication or withdrawal? - CORRECT ANSWER-✔✔✅-Visual -Gustatory (taste) -Olfactory (smell) -Tactile What are Hypnagogic and Hypnopompic Hallucinations? - CORRECT ANSWER-✔✔✅False sensory perceptions that occur while falling asleep and while awakening from sleep

Ways to test Cognition and Abstraction? - CORRECT ANSWER-✔✔✅-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 DSM-5 Axis 1? - CORRECT ANSWER-✔✔✅Clinical disorders -does not include personality disorders or mental retardation DSM-5 Axis 2? - CORRECT ANSWER-✔✔✅Personality Disorders and Mental Retardation DSM-5 Axis 3? - CORRECT ANSWER-✔✔✅General Medical Conditions (medical issues that causes the mental disorder) DSM-5 Axis 4 - CORRECT ANSWER-✔✔✅Psychosocial and environmental problems DSM-5 Axis 5 - CORRECT ANSWER-✔✔✅Global Assessment of Functioning (GAF) What is GAF? - CORRECT ANSWER-✔✔✅-Scoring system that is used to assess how well an individual is functioning in their daily lives -Scores range from 0 to 100 GAF Scoring System? - CORRECT ANSWER-✔✔✅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 What is Freud's Psychosexual stages of development? - CORRECT ANSWER-✔✔✅-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 Relation between Freud's theory and mental disorders? - CORRECT ANSWER-✔✔✅-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 Psychosexual stage: Oral? - CORRECT ANSWER-✔✔✅-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 Psychosexual stage: Anal? - CORRECT ANSWER-✔✔✅-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) Psychosocial stage: Phallic - CORRECT ANSWER-✔✔✅-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 Psychosocial stage: Latency? - CORRECT ANSWER-✔✔✅-6 to 12 yrs -sexual urges remain represses -children interact and play mostly with same sex peers Psychsexual stage: Genital? - CORRECT ANSWER-✔✔✅-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 Freud's ID? - CORRECT ANSWER-✔✔✅-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) Freud's Ego? - CORRECT ANSWER-✔✔✅-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 Freud's Superego? - CORRECT ANSWER-✔✔✅-emerges around age 5 -holds the moral standards and ideals -provides guidelines for making judgements -has 2 parts (conscience and ego ideal) Erikson's Stage of Development: Infancy? - CORRECT ANSWER-✔✔✅-birth to 18 months conflict: trust vs mistrust -important events: feeding -outcome: hope Erikson's Stage of Development: Early childhood? - CORRECT ANSWER-✔✔✅-2 to 3 years -conflict: autonomy vs shame and doubt -important events: toilet training -outcome: will Erikson's Stage of Development: Preschool - CORRECT ANSWER-✔✔✅-3 to 5 years -conflict: initiative vs guilt -important events: exploration -outcome: purpose Erikson's Stage of Development: School Age? - CORRECT ANSWER-✔✔✅-6 to 11 years -conflict: industry vs inferiority -important event: school -outcome: confidence

Erikson's Stage of Development: Adolescence? - CORRECT ANSWER-✔✔✅-12 to 18 years -conflict: identity vs role confusion -important events: social relationships -outcome: fidelity Erikson's Stage of Development: Young Adult? - CORRECT ANSWER-✔✔✅-19 to 40 years -conflict: intimacy vs isolation -important events: relationships -outcome: love Erikson's Stage of Development: Middle Adult? - CORRECT ANSWER-✔✔✅-40 to 65 years -conflict: generativity vs stagnation -important events: work and parenthood -outcome: care Erikson's Stage of Development: Maturity? - CORRECT ANSWER-✔✔✅-65 to death -conflict: ego integrity vs despair -important events: reflection on life -outcome: wisdom Function of the frontal lobe? - CORRECT ANSWER-✔✔✅-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 Function of Parietal lobe? - CORRECT ANSWER-✔✔✅-coordination of sensation and motor behavior (coordination of language functions) -spatial orientation (knowing where your body is, physical sensation)

-recognition of people and objects Function of temporal lobe? - CORRECT ANSWER-✔✔✅-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 Function of Occipital lobe? - CORRECT ANSWER-✔✔✅-vision and visual memory -impairment can cause visual defects, blindness and visual hallucinations What is case formulation? - CORRECT ANSWER-✔✔✅-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 5 Broad Categories of Case Formulation? - CORRECT ANSWER-✔✔✅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 What are the Biopsychosocial Assessment Domains? - CORRECT ANSWER-✔✔✅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 What psychosocial factors influence depression? - CORRECT ANSWER-✔✔✅-Family history of psychiatric illness -Early loss of a nurturing relationship -Stressful life events -Low social support Important things to communicate to the patient during an initial psychiatric assessment? - CORRECT ANSWER-✔✔✅-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 Key points to Open Ended Questions? - CORRECT ANSWER-✔✔✅-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

Key points to Closed Ended Questions? - CORRECT ANSWER-✔✔✅-focuses on one particular problem -gathers specific information -limited responses (yes or no) Definition of Transference? - CORRECT ANSWER-✔✔✅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 Definition of Counter Transference? - CORRECT ANSWER-✔✔✅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 How can perceptual differences affect the interview? - CORRECT ANSWER-✔✔✅-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 What is autonomy? - CORRECT ANSWER-✔✔✅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. What is therapeutic use of touch? - CORRECT ANSWER-✔✔✅-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 Descriptors of lack of eye contact during the interview? - CORRECT ANSWER-✔✔✅-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. How is a SOAPIER note different from a SOAP? - CORRECT ANSWER-✔✔✅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 Phases of the therapeutic patient/nurse relationship? - CORRECT ANSWER-✔✔✅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 The PMHNPs role in relationship building, maintaining and terminating? - CORRECT ANSWER- ✔✔✅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 What are the psychiatric symptoms measurement scales? - CORRECT ANSWER-✔✔✅-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) What is the Holmes and Rahe Stress Scale? - CORRECT ANSWER-✔✔✅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