PMHNP-NonPharmacologic/Therapy (ANCC 3Ed, Chapter 7)Questions And Answers Latest Update 20, Exams of Nursing

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PMHNP-NonPharmacologic/Therapy

(ANCC 3Ed, Chapter 7)Questions And

Answers Latest Update 2023.

What circumstances justify breaking client confidentiality? - Correct answer When there is 1)increased potential for self-harm or harm to others;

2. abuse of children, older adults, or people with disabilities;
3. when the therapist determines that the patient needs hospitalization; and
4. when patients request that their information be released to a third party. What is psychoanalytic therapy? - Correct answer Individual therapy approach (Freud): promotes change by developing greater insight and awareness of maladaptive defenses. What is cognitive therapy? - Correct answer Individual therapy approach (Beck): Anxiety or maladaptive responses are caused by a person's expectations, perceptions, and interpretations of an external event, not the event itself. Goal is to change a patient's irrational beliefs, faulty conceptions, and negative cognitive distortions. What is behavioral therapy? - Correct answer Individual therapy approach (Lazarus): Change maladaptive behaviors through active behavior techniques e.g. exposure, relaxation, problem-solving, and role-playing What is dialectical behavior therapy? - Correct answer DBT (Marsha Linehan):

CBT variant with focus on emotional regulation, tolerance for distress, self-management skills, interpersonal effectiveness, and mindfulness, with an emphasis on treating therapy-interfering behaviors What is existential therapy? - Correct answer (Viktor Frankl): a philosphical approach in which reflection on life and self-confrontation is encouraged. Emphasizes accepting freedom and making responsible choices, to live authentically, focus on the present and on personal responsiblity. What is humanistic (person-centered) therapy? - Correct answer (Carl Rogers): a form of individual therapy focused on self-directed growth & self-actualization. What is interpersonal therapy? - Correct answer (Klerman and Weissman): an evidence-based, time-limited, present-oriented therapy focusing on interpersonal issues that are creating distress. Effective in adults and adolescents to treat depression, bipolar, substance use, and eating disorders to treat interpersonal distress. What is EMDR? - Correct answer (Shapiro): a form of behavioral therapy. Eye Movement Desensitization and Reprocessing uses bilateral stimulation to achieve adaptive resolution. Most common use is in PTSD. 3 phases: desensitzation, installation, and body scan. What are benefits of group therapy over individual therapy? - Correct answer Group therapy increases insight about oneself, increases social skills, is cost-effective, develops sense of community. Who developed the theoretical perspective on group work? - Correct answer Irvin Yalom

Name the 6 phases of group work. - Correct answer PREGROUP phase FORMING phase STORMING phase NORMING phase PERFORMING phase ADJOURNING (termination) phase What happens in the first phase of group therapy? - Correct answer In the pregroup phase, the leader considers direction and framework of the group including purpose, goals, membership criteria, size, pregroup interview, informed consent, and termination parameters. What happens in the second phase of group therapy? - Correct answer In the Forming phase, members are concerned about self-disclosure & rejection. The group establishes trust & rapport, and develops boundaries. What happens in the third phase of group therapy? - Correct answer In the third phase (Storming), members are resistant & may use testing behaviors. Issues related to inclusion, control, and affection. Leader must allow positive and negative feelings, assist group to understand the underlying conflict, examine nonproductive behaviors. What happens in the fourth phase of group therapy? - Correct answer In the fourth phase (Norming), resistance to group is overcome with open & spontaneous communication & group norms established. What happens in the fifth phase of group therapy? - Correct answer In the fifth phase (Performing or Work phase), the group work becomes more focused with creative problem-solving & goal-directed group energy.

What is the sixth phase of group therapy? - Correct answer The sixth phase is the Adjourning (termination) phase: preparation is made to end the group, with expression of and discussion of feeling, what has been learned, what issues need to be worked on. List the 10 curative factors that differentiate group therapy from individual therapy. - Correct answer 1. Instillation of hope (hope for creating different life. Members at different levels of growth & can gain hope that change is possible).

2. Universality (discovery that others have similar problems, thought, feelings and they are not alone).
3. Altruism (from sharing oneself with another and helping another).
4. Increased development of socialization skills ("natural laboratory" to learn new social skills and correct maladaptive social behaviors).
5. Imitative behaviors (increase skills by imitating other's behaviors).
6. Interpersonal learning (increases adaptive interpersonal relationships by interacting with others).
7. Group cohesiveness (attraction to group & members and sense of belonging).
8. Catharsis (open expression of previously repressed feelings).
9. Existential factors (dealing with the meaning of existence).
10. Corrective refocusing (re-experiencing family conflict in group, allowing for recognition and changing of problem behaviors) What is a family system? - Correct answer A SYSTEM is any unit structured on feedback (e.g. the family). FAMILY SYSTEM: process by which all family members operate together. Operates based on a set of rules that may be overt or covert. Family systems theory is based on the idea that one cannot understand any family member (part) without understanding how all family members operate together (system). What does CIRCULAR CAUSALITY mean in the context of Family Systems? - Correct answer CIRCULAR CAUSALITY: ongoing feedback loop; a series of actions an reactions that maintain a problem. Individuals and emotional problems are best

understood within the context of relationships and through assessing interactions within and entire family. What do BOUNDARIES mean in the context of Family Systems? Describe 3 types of boundaries and the effect on the family system. - Correct answer BOUNDARIES: barriers that protect & enhance the functional integrity of families, individuals, subsystems. May be physical or psychogical. Types:

1. CLEARLY DEFINED boundaries - maintain indivdual's separateness while emphasizing belongingness.
2. RIGID or INFLEXIBLE boundaries - may lead to distant relationships and to disengagement;
3. DIFFUSE boundaries - blurred or indisctinct boundaries, leading to enmeshment What is FAMILY HOMEOSTASIS? - Correct answer Family homeostasis: the tendency of families to resist change and maintain a steady state. What is MORPHOGENESIS in the context of family systems? - Correct answer Morphogenesis: a family's tendency to adapt to change when changes are necessary What is MORPHOSTASIS in the context of family systems? - Correct answer Morphostasis: a family's tendency to remain stable in the midst of change Who developed Family Systems Therapy and what are the theoretical underpinnings? - Correct answer Murray Bowen Explain Family Systems Therapy - Correct answer The underlying belief is that an individual's problematic behavior serves a function or purpose for the family, or is a symptom of dysfunctional patterns in the family. The focus is on chronic anxiety within families. The treatment goal to increase the family member's awareness of their function with the family and increase levels of self-differentiation (level at which on's sense of self-worth is not dependent on external relationships, circumstances, or occurrences).

What are the five theoretical constructs in Bowen's Family Systems Therapy? - Correct answer TRIANGLES: dyads that form triads to decrease stress; the lower the level of family adaptation, the more likely a triangle with develop (e.g. mother and child against father) NUCLEAR FAMILY EMOTIONAL SYSTEM: level of differentiation of the parents usually equal to the level of differentiation for the entire family MULTITRANSMISSION PROCESS: Dysfunction present over several generations FAMILY PROJECTION PROCESS: Parents transmitting their own level of differentiation on the most susceptible child EMOTIONAL CUTOFFS: Attempting to breat contact with the family of origin SIBLING POSITION: Influences interactions and personality characteristics. Who developed Structural Family Therapy and what are the theoretical underpinnings?

• Correct answer Salvador Minuchin - emphasis on how, when, and to whom family members related in order to understand and then change the family's structure. The individual's symptoms are rooted in the context of family transaction patterns. The symptom is a function of the health of the whole family and is maintained by structural problems in the system. What are the theoretical constructs in Minuchin's Structural Family Therapy? - Correct answer The main treatment goal is to produce a structural change in the family organization to more effectively manage probles - changing transactional patterns and family structure. FAMILY STRUCTURE: invisible set of functional demands that organize the way members inteact with each other, made up of subsystems (e.g. marital, parental, sibling), coalitions, and boundaries STRUCTURAL MAPPING (genogram): mapping relationships using symptoble to represent overinvolvement, conflict, coalitions, and so forth HIERARCHIES: distribution of power

Who developed Experiential Therapy and what are the theoretical underpinnings? - Correct answer (Virginia Satir) behavior is determined by personal experience and not by external reality. The focus is on being authentic, on freedom of choice, human validations, and experiencing the moment to develop authenic, nurturing comunication sand increased self-worth of each family member, overall goal is growth rather than symptom reduction alone. No specific techniques. Who developed Strategic Therapy and what are the theoretical underpinnings? - Correct answer Jay Haley - problem-focused and more symptom-focused than structural therapy. Symptoms reflect problems in the hierarchal structure, and are a way to communicate metaphorically within a family; treatment goal is to help family members behave in ways that change the sequence of interactions that maintain the problem behavior. What are the theoretical constructs in Haley's Strategic Family Therapy? - Correct answer STRAIGHTFORWARD DIRECTIVES: Tasks designed in expectation of the family member's compliance PARADOXICAL DIRECTIVES: A negative task assigned when family members are resistant to change and the member is expected to be noncompliant (use with caution) REFRAMING BELIEF SYSTEMS: Relabeling problematic behaviors to have more positive meaning (e.g. jeaulousy reframed to caring) Who developed Solution-focused Therapy and what are the theoretical underpinnings? - Correct answer deShazer, O'Hanlon, and Berg: focus is to rework solutions that worked previously for the present situation; goal is effective resolution of problems through cognitive problem-solving and use of personal resources and strengths. What are three techniques used in Solution-focused Therapy? - Correct answer MIRACLE QUESTIONS: If a miracle were to happen tonight while you were asleep, and

tomorrow morning you woke to find the problem no longer existed, what would be different? How would you know the miracle took place? How would others know? EXCEPTION-FINDING QUESTIONS: directing indivduals to a time in their life when the problem did not exist, which helps them move towards solutions by assiting them in searching for any exceptions to the pattern. "what there a time when the problem did not occur?" SCALING QUESTIONS: "on a scale of 1-10, with 10 being very anxious and depressed, how would you rate how you are feeling now?" Useful for highlighting small increments of change. What are CAMS? - Correct answer COMPLEMENTARY (or integrative) therapies - used in addition to traditional medical practices. ALTERNATIVE therapies - used in place of traditional medical practices. Includes MIND-BODY interventions (guided imagery, meditation, yoga, biofeedback), BIOLOGICALLY BASED therapies (herbals, vitamins, supplements, aromatherapy), MANIPULATIVE and BODY-BASED therapies (accupresssure/puncture, massage, reflexology) 1998 - NIH established Natl Center for Complementary & Alternative Medicine List the uses and interactions for Omega-3 fatty acids - Correct answer USES: ADHD, dyslexia, cognitive impairment, demntia, CVD, asthma, lupus, RA INTERACTIONS: warfarin (potentiates anticoagulant effect) List the uses and potential adverse effects for Sam-E - Correct answer USES: depression, OA, liver disease ADVERSE EFFECTS: hypomania, hyperacive muscle movements, possible serotonin syndrome List the uses and interactions for tryptohan - Correct answer USES: depression, obesity, insomnia, headaches, fibromyalgia INTERACTIONS: increased risk of serotonin syndrome with use of SSRIs, MAOIs, and St. John's Wort

List the uses and interactions for Vitamin E - Correct answer USES: enhancing immune system and protecting cells against free radical efeects; used for neurologic disorders, diabetes, PMS INTERACTIONS: warfarin (potentiates anticoagulant effect), antiplatelet drugs, and statins (increasing additive effect and risk of rhabdomyolysis List the uses and interactions for melatonin - Correct answer USES: insomnia, jet lag, shift work, cancer; sets timing of circadian rhythms and regulates seasonal responses INTERACTIONS: aspirin, NSAIDs, beta blockers, corticosteroids, valerian, kava kava, alcohol. Can inhibit ovulation in large doses List the uses and interactions for fish oil - Correct answer USES: bipolar disorder, hypertension, lowering triglycerides, decreasing bloot clotting INTERACTIONS: warfarin, aspirin, NSAIDs, garlic, ginkgo. May alter glucose metabolism Discuss herbal use in pregnancy and lactation - Correct answer Most herbals are secreted in breast milk and are contraindicated during lactation and should be avoided during pregnancy Describe cognitive & behavioral techniques to use with a depressed patient with catastrophic thinking (and all-or-nothing distortions). - Correct answer Identify the negative thoughts & distortions (core beliefs) with a thought record. Use thought-stopping and cognitive restructuring to change the negative thoughts to result in a behavioral and emotional change.