Exam 1: NUR 2459/ NUR2459 (New 2023/ 2024 Update) | Mental and Behavioral Health Nursing Exam| 100% Correct | Questions and Verified Answers| Graded A -Rasmussen
Exam 1: NUR 2459/ NUR2459 (New 2023/
2024 Update) | Mental and Behavioral Health
Nursing Exam| 100% Correct | Questions
and Verified Answers| Graded A -Rasmussen
QUESTION
Allowing the client to introduce the topic. Nurse: “What would you like to talk about?”
Answer:
Giving broad openings
QUESTION
Question is restated to the client. Client: “What should I do about the problem?” Nurse: “What
do you think you should do?”
Answer:
Reflecting
QUESTION
Taking notice of a single idea or word. Nurse: “Let’s look at that more closely.”
Answer:
Focusing
QUESTION
“That was Dr. Jones, not a CIA agent.” ( Used with all hallucinations)
Answer:
Presenting reality
QUESTION
The nurse is persistent in questioning.
Answer:
Probing
QUESTION
Refusing medication/agitated patients. What can you do for safety?
Answer:
Keep self safe, try to get them to talk with you about what is going on.
QUESTION
What to know in regards to restraints?
Answer:
You can restrain for safety and then get order from provider later.
QUESTION
Respecting patient’s decisions to refuse certain treatments
Answer:
Ethical Principle of Autonomy
QUESTION
What is the criteria for involuntary mental health admission?
Answer:
he client enters against her/his will for an indefinite period. This is based on the client’s need for
psychiatric treatment, the risk of harm to self or others, and the inability to provide self-care
QUESTION
What are professional boundaries?
Answer:
Nurses must be consistently conscientious in avoiding any circumstance in which they might
achieve personal gains. Concerns regarding the nurse boundaries with the client include selfdisclosure, and gift giving and receiving. Always remember you are the nurse, and this
relationship is a unique, professional one, with you as the nursing care provider. Also, in mental
health, touch is generally avoided. This approach is often inappropriate with clients with a
mental health disorder. It can be misinterpreted as affection or aggression.
QUESTION
Best approach for anxious/pacing patients? What can you do to help calm them?
Answer:
Attempt to talk with the patient. Perhaps walk with them while they’re pacing.
QUESTION
HIPPA Privacy Rule
Answer:
Law that regulates the use and disclosure of patients’ protected health information (PHI).
QUESTION
When can HIPPA be broken?
Answer:
Warn other’s if the patient may be reporting harm to others
QUESTION
Patients rights
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what are some psychiatric historical events that have occurred in the early psychiatric era?
18th century- state asylums created, 600,000 residents were in them, 1st school or psychiatric nursing was created in 1882, deinstitutionalization, shift in role of the nurse from custodial care to professional care.
explain what early use of phenothiazine was for in early psych nursing.
it was discovered to help control psychotic behaviors and improve/ clear thinking.
what were the two nursing interventions associated with somatic therapy in early psych nursing?
insulin therapy
ECT therapy
explain significance of insulin therapy in the early psych era.
insulin was administered until the client was comatose, this could kill the patient because the blood sugar could drop below normal levels, but it helped relive psych symptoms.
explain significance of early ECT therapy.
an electrical stimulus was given to the brain with the result of a grand-map seizure. now we can control the shock given and give medications to sedate the client and stimulate the seizure and for proper monitoring throughout the procedure.
explain what deinstitutionalization is.
there was a massive discharge of psychiatric patients from mental hospitals back to their original communities.
what is significant about the impact of deinstitutionalization?
many of the psych patients who needed services were forced onto the streets, potentially leading them to more harm and crime.
3 main reasons deinstitutionalization was initiated.
the belief that treatment in the hospitals was inhumane
hope that medications would offer a cure
lack of funding at the state and federal level
what is the order of maslows hierarchy of needs bottom to top?
physiological needs-safety need- love and belong needs- self esteem- self actualization
what is important to know about maslows hierarchy of needs?
motivation is continuous quest for self actualization, can reverse levels based on life circumstances, lower level needs must be met first before advancement to higher level psychological needs.
examples of psychotherapy
behavioral therapy, cognitive therapy, didactical behavior therapy
based on a verbal therapist to client interaction
examples of open environment therapies
family, group and milieu therapy
examples of Brian stimulation techniques
ECT, trans-cranial magnetic stimulation, vagus nerve stimulation
explain what behavioral therapy is.
aims to modify maladaptive behavior patterns.
based that a behavior is learned and has consequences and abnormal behavior results from an attempt to avoid painful feelings and reduce anxiety.
what is the nurses role with behavioral therapy?
Role of the nurse: to use the nursing process to assist the client with behavior modification. This can be through 1 on 1 groups, different ways like classical and operant conditioning
explain what cognitive therapy is.
focuses on individual client thoughts and behaviors to solve current problems.
Based on changing the way one thinks.
what is the role of the nurse with cognitive therapy?
the nurse will plan psychoeducation, use of the therapeutic relationship and counseling interventions. They also reevaluate to determine if intervention was successful with the therapy.
explain what cognitive behavioral therapy is (CBT)
uses both cognitive and behavioral approaches to assist a client with anxiety management.
explain what family therapy is
therapy based on family dynamics and improving family functioning by learning the ways for dealing with mental illness in the family, improving understanding among family members, maximizing positive interaction with family members.
explain what milieu therapy is
creates an environment that is supportive and therapeutic and safe to benefit clients and promote coping within a safe place.
explain what group therapy is
therapy focused on helping individuals develop more functional and satisfying reactions within a group setting with common feelings, experiences and thoughts that lead to positive behavior changes from interaction and feedback.
explain what ECT is used today
the induction of a grand-mal seizure through the application of electrical currents to the brain during anesthesia.
Electrodes are placed bilaterally and an appropriate dose of electrical current is sent through the brain to enhance the effects of certain neurotransmitters.
what types of disorders can ECT help with?
Used as a last resort in depression, mania, schizophrenia, and psychosis when medication and treatment has failed.
side effects from ECT
confusion and memory loss, headache
what is the role of the nurse during ECT?
often during the pre-op and post-op phases. Complete assessment should be completed before the client goes back to the procedure, including medication reconciliation and a signed consent form. places the IV, gives pre procedure medications, takes vitals before and after procedure. after procedure : placing the patient on the side, orient the client, describe what happened, allow the patient to have therapeutic communication based on their feelings, assisting them as needed until fully awake.
what will actually happen during the ECT procedure?
When in the treatment room, the nurse will help position the patient while the CRNA gives the patient a short acting anesthetic and medication to induce the seizure.a bp cuff, pulse ox and oxygen may be given as needed and a bite block and electrodes to monitor EKG.once asleep, the provider will decide how much electricity the client will get and will shock the client and monitor for any changes, the CRNA will wake the patient up when finished, all people in the room will monitor for adverse reactions.
medications that may be given during ECT
atropine sulfate, succinylcholine, sedative medication and medication to help client relax.
what is trans-cranial magnetic stimulation?
a noninvasive therapy that uses magnetic pulsations to stimulate the cerebral cortex of the brain for those with depression who have not been responsive to medications.
What is vagus nerve stimulation?
provides electrical stimulation through the vagus nerve of the brain through a surgically implanted device to increase neurotransmitter levels to treat depression resistant to other methods of treatment and medication.
which system is responsible for how the body changes with stress?
fight or flight system- everyone will react differently
explain what stress is.
maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that are incongruent with the local and cultural norms, and interfere with the individual, social, occupational and physical functioning.
which two defense mechanisms are always healthy?
alturism and sublimation
Role of psychiatric nurse
maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that are incongruent with the local and cultural norms, and interfere with the individual, social, occupational and physical functioning.
explain the role of EEG and EKG with ECT
This allows for cardiac monitoring, and also observation of brain activity (seizure activity in the brain).
what is the role of the stranger
first interaction with the nurse and treating the patient with respect.
what is the role of the resource person
will give answers in a way the patient can understand based on their healthcare information.
what is the role of the teacher
the nurse identifies learning needs and information related to the patients healthcare.
what is the role of the leader
encourages both the nurse and the patient to have a democratic relationship and be active in the plan of care.
what is the role of the surrogate
the patient may see the nurse as a mother figure, sibling, or another nurse in the past where the situation may generate feelings similar to ones felt in the past.
what is the role of the technical expert
understands technical devices and clinical interventions needed for the best interest of the patient.
what is the role of the counselor
the nurse uses interpersonal techniques to assist patients in adapting with changes in life experiences and to help them understand what they are going through in the present situation.
which of the roles of nurse are most apparent in psychiatric nursing and why
Counselor- They must have skills developed to provide helpful individual, group, or family therapy. The staff nurse should have general knowledge of basic counseling techniques and to have a therapeutic or helping relationshi
explain altruism
dealing with anxiety by reaching out for others
example of altruism
It is very cold and a man takes off his jacket and gives it to someone who cannot afford a coat.
explain compensation
covering up a real or perceived weakness by emphasizing a trait one considered more desirable
example of compensation
Someone who is too small to make the wrestling team becomes a talented member of the debating team.
explain denial
refusing to acknowledge the existence of a real situation or feelings associated.
example of denial
A woman who drinks alcohol daily, refuses to acknowledge she has a problem.
explain displacement
shifting feelings related to an object, person, or situation to another less threatening object, person or situation.
example of displacement
A man is angry with his boss and when he comes home, he yells at his children.
explain projection
attributing one’s unacceptable thoughts and feelings onto another who does not have them
example of projection
A woman has feelings for someone other than her husband, but blames him for being unfaithful.
Explain identification
conscious or unconscious assumption of the characteristics of another individual or group
Example of identification
The student nurse imitates the nurturing actions of the instructor.
explain intellectualization
separation of emotions and logical facts when analyzing or coping with a situation or event.
example of intellectualization
A wife is moving far away from her family because of her husband’s job transfer. She explains to her family all the advantages of the move.
explain rationalization
creating reasonable and unacceptable explanations for unacceptable behavior
example of rationalization
A boy justifies cheating in a card game because he said everyone cheats.
explain reaction formation
preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors.
example of reaction formation
A girl is angry with someone, but expresses exaggerated friendliness when she sees her.
explain regression
sudden use of childlike or earlier developmental behaviors that do not correlate with age or developmental stage.
example of regression
An adult throws a temper tantrum when she doesn’t get her way.
explain repression
unconsciously putting unacceptable feelings, ideas and thoughts out of awareness. No memory.
example of repression
A trauma victim is unable to remember anything about his accident.
explain suppression
voluntary denying or putting away stressful feelings
example of suppression
A student states, “I’ll worry about that exam tomorrow.”
explain conversion
responding to stress through the unconscious development of physical manifestations of illnesses.
example of conversion
A girl is unable to speak just before she is to try out for chorus.
explain splitting
demonstrating an inability to reconcile negative and positive attributes of self to others.
example of splitting
Someone says she has the best friend ever, until her friend is not able to attend her party. Then she says she never wants to see her again.
explain sublimation
dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression
example of sublimation
A mother whose child has cystic fibrosis, develops a support group for other parents with children diagnosed with the illness.
explain undoing
performing an act to make up for prior behavior.
example of undoing
A man argues with his wife and the next day brings her flowers.
explain what the therapeutic use of self means and the role of the nurse
The ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention.
The nurse must possess self-awareness and self understanding based on the belief of the human condition.
The nurse must understand the ability to effectively help others in time of need is influenced strongly by the internal values one has.
conditions essential for a therapeutic relationship to be established
rapport,
trust,
respect, genuineness, empathy
explain what rapport is
implies special feelings on the part of both the patient and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude
explain what trust is
one must feel confident in that person’s presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested. demonstrated through nursing interventions that convey a sense of warmth and caring to the patient.
explain what respect is
believe in the dignity and worth of an individual regardless of his or her unacceptable behavior
explain what genuineness is
nurse’s ability to be open, honest, and “real” in interactions with the patient. To be real is to be aware of what one is experiencing internally and to allow the quality of this inner experience to be apparent in the therapeutic relationshi
explain what empathy is
conveys an objective awareness and understanding of the feelings, emotions, and behaviors of others, including trying to envision what it must be like to be in the position of the client and the clients family.
explain the therapeutic nurse patient relationship
pre orientation, orientation, working, termination
explain what happens during pre orientation phase
involves preparation for the first encounter with the patient.
The nurse obtains information from the chart, significant others, or other team members.
They also may examine one’s feelings, fears, and anxieties about working with a specific patient and how they may affect the ability to care for the patient. no bias
explain the orientation phase
involves the nurse and the patient becoming acquainted. Introductions.
Creates environment with trust, identifies strengths and limitations and assess and create goals, discuss the termination phase.
explain the working phase
the therapeutic work of the relationship is accomplished, and interventions take place. maintain trust and rapport, problem solving, overcoming resistance saviors, advancing to reaching ones goals.
explain transference
when the patient unconsciously displaces to the nurse feelings formed to a person from his or her past from feelings or personality that remind the patient of another person, but also be dependency on the nurse based on unreal patient expectations.
explain countertransference
the nurse’s behavioral and emotional responses in which the nurse transfers feelings about past experiences to the patient that can interfere with the relationship
explain termination phase
occurs when the goals are reached, the client is discharged, or the shift ends.
Can be difficult for all parties involved and therapeutic conclusions must be developed and feeling of sadness and loss may occur.
explain therapeutic communication
caregiver verbal and nonverbal techniques that focus on the care receivers needs and that advance the promotion of healing and change. It fosters the exploration of feelings and understanding of behavioral motivation. Nonjudgemental, discourages defensiveness, and promotes trust.
explain non therapeutic communication
barriers to open communication between the nurse and patient that lead to anxiety, non healing, judgment, and defensiveness. No trust and rapport.
what is verbal communication?
communication by word or sound.
Nurses must be cautious about the word choices or sounds they make, as some works or phrases may not be therapeutic or healing.
what is non verbal communication?
communication that expresses one’s attitudes and feelings with body language, physical appearance, movement, posture, touch, facial expressions, eye contact, and vocal cutes.
explain what active listening is
occurs nonverbally and is important to have a desire to hear and understand what the patient is saying.
explain the acronym SOLER and active listening
S- sit squarely facing the patient
O- observe a open posture with legs and arms not crossed.
L- lean forward to the patient and allow them to see your interest in what they are saying
E- eye contact should be established to show interest
R- relaxing will show that you are comfortable and have full interest in the patient
explain nonverbal techniques that are therapeutic
appearance is nice and groomed appropriately, body movement is minimal per conversation and posture is upright with an open figure, no touch, facial expression is pleasant, eye contact is maintained, vocal cues are followed and tone of voice is neutral
explain nonverbal techniques that are non therapeutic
appearance is disheveled, body language is very negative (arms crossed, should shrugging), mood does not equal affect, posture is too relaxed or slouched, touch is used, eye rolling or looking at the clock, door or not the patient, vocal cues seem very conscientious and forceful
explain using silence
encourages the patient to organize thoughts and time to think. Can also provide the nurse with information about patient concerns.
explain accepting
conveys an attitude of reception and regard.
explain giving recognition
acknowledging awareness rather than complementing that reflects judgement.
explain offering self
willingness to spend time with the patient and show interest unconditionally to increase self worth.
explain broad openings
allows patients to direct focus on interaction and emphasizes the importance of patients’ role in the communication process.
explain offering general leads
offers the patient encouragement to continue with minimal nursing input.
explain placing the event in time or sequence
allows the patient to identify the sequence of events and when they occurred to organize thoughts.
explain making observations
allows patients to develop awareness of how they are perceived by others and prompts exploration of issues.
explain encouraging description of perceptions
allows for development of awareness or understanding based on their perceptions and reality.
explain encouraging comparison
asking the patient to compare similarities and differences in ideas or relationships helps the patient recognize recurring experiences and things they can change.
explain restating
repeating the main idea of what the patient said helps to let the patient know there is either understanding or a need for more clarity.
explain reflecting
questions and feelings are referred back to the patient so that the patient is empowered to actively engage in problem solving techniques.
explain focusing
taking notice of a single idea or word and exploring it even more. Hard with those who have anxiety.
explain exploring
when an issue or theme is relevant, the nurse may instruct the patient to explore it further and understand awareness about the event or feelings.
explain seeking clarification
striving to achieve understanding of vague statements can help for understanding.
explain presenting reality
when there is a misperception of reality, the nurse will express their perception of the situation without changing the patients.
explain voicing doubt
expressing uncertainty as to the reality of the patient’s perceptions during delusional thinking.
explain verbalizing the implied
putting into words what the patient has implied or said indirectly.
explain translating words into feelings
the nurse will symbolize what has been said to find the underlying feelings.
explain formulating a plan of action
encouraging identification of a behavior change will allow for better coping skills.
explain material boundaries
can be seen, like a fence that borders land.
explain social boundaries
hese are established within a culture and define how individuals are expected to behave in social situations.
explain personal boundaries
these are boundaries that individuals define for themselves.
explain physical/distance boundaries
how close individuals will allow others to enter their physical space.
explain emotional boundaries
how much individuals choose to disclose their most private and intimate sleeves to others.
explain professional boundaries
limit and outline expectations for appropriate professional relationships with patients. space between nurses power and patient vulnerability. Imbalance of power does exist because the nurse can see patient records. They must avoid conflict where a personal gain may be achieved within the relationship.
explain self disclosure
appropriate when the information could therapeutically benefit the patient. Not undertaken to meet the nurses needs.
explain gift giving
Nurses should not accept gifts but also use professional judgement based on the type of gift and patient care and thought behind it. Refusal should be based on patient sensitivity.
explain touch
Touching is required to do the therapeutic procedures and care, but caring touch in times where they have no need to do so is inappropriate. Touch should be appropriate, therapeutic, and welcomed. Many need to avoid it based on the situation and culture.
explain friendship/romantic association
all relationships should be professional. If unable to do this, one should withdraw from the relationship. Romantic relationships should not occur.
complications if boundaries are breeched
threatens the integrity of the nurse patient relationship, can cause boundary violations. Potential for the nurse to be fired or to lose their license.
signs that boundaries may be breeched
favoriting patients, keeping secrets, changing dress for working, swapping assignments, giving special attention to one client over another, spending free time with patients, thinking about patients when away from work, shoring personal concerns with patient, receive gifts or have contact with the patient after discharge
explain giving false reassurance
conveys the outcome is already known and minimizes the patient’s feelings and concerns and prevents further expression of feeling “everything will be okay”, “you will be better soon”
explain rejecting
refusing to consider or showing contempt for patients ideas or behavior may cause patients to discontinue the relationship.
explain approving/ disapproving or agreeing/disagreeing
indication accord or opposition based on good or right behaviors and bad or wrong behaviors that prevents modification without admitting error, or to please the nurse . Creates defensiveness.
explain giving advice
telling the patient what to do or how to behave implies the nurse knows what is best and discourages patient independence. “you should do this because it will help you”
explain probing
persistent questioning and the push for answers the patient does not wish causes the patient to feel used and valued for what information the nurse is only seeking, consistently talking about a traumatic childhood event by bringing up things about the clients childhood
explain defending
minimizes or completely ignores the patients concerns and encourages taking sides.
explain requesting an explanation
involves asking the client why they have certain behaviors or thoughts and that they must defend their feelings. “why do you feel depressed”
explain indicating there is a external source of power
attributing the thoughts to an outside source encourages the patient to project blame for their thoughts on others rather than accepting their own responsibility.
explain minimizing feelings
encourages a lack of empathy and understanding based on their concerns being irrelevant and not important.
explain stereotyping
using meaningless expressions to encourage a similar response from the patient
explain using denial
denying a problem exists blocks discussion with the patient and avoids getting help in areas they need it,
explain interpreting
attempts to tell the patient the meaning of his or her experience.
explain introducing an unrelated topic
changing the topic indicates the nurse does not want to discuss the topic the patient wants to discuss.
explain how to use the nursing process with psychiatric disorders
assessment- collecting information about past medical history, assessing physical and emotional state
diagnosis: medically will be through the DSM5 but can use NANDA as well for nursing dx’s
palling: independently and individualized with multiple disciplines involved.
planning/ implementation: the nurse plans intervention with the client and are then acted out
evaluation: did the client meet the goals or do we need to change things.
explain the parts of the mental status exam
appearance, motor activity, speech patterns, attitude, emotions, affect, thought processes, cognitive ability
explain what appearance means in relation to the mental status exam
-Grooming
-Personal hygiene
-Posture
-Level of eye contact
-Evidence of scars or other distinguishing skin marks
explain what motor acitvity means in relation to the mental status exam
-Tremors
-Tics
-Mannerisms
-Hyperactivity
-Restless or agitated
-Aggressive
-Echopraxia-mimicking the movements of others
-Psychomotor retardation-extremely slow movements
explain what speech patterns means in relation to the mental status exam
-Slowness or rapid speech
-Pressure of speech (frenzied)
-Volume
-Aphasia (difficulty in forming/thinking of specific words)
explain what attitude means in relation to the mental status exam
-Cooperative/uncooperative
-Friendly/hostile
-Uninterested/apathetic
-Guarded/suspicious
explain what emotions means in relation to the mental status exam
Mood
-Depressed
-Irritable
-Anxious
-Elated
-Euphoric
-Fearful
-Guilty
-Labile (mood swings)
explain what affect means in relation to the mental status exam
the behavioral expression of emotion
-Constricted or blunted (minimal emotional expression)
-Flat (absence of emotional expression)
-Appropriate
-Inappropriate
explain what thought processes means in relation to the mental status exam
-Form of thought
-Content of thought (hallucinations/delusions)
explain what cognitive ability means in relation to the mental status exam
-Level of alertness
Clear-minded/attentive
-Orientation
Time
Place
Person
Situation
-Memory
Recent
Remote
Confabulation (create content for memory gaps)
What is the mini mental status exam?
Brief screening tool to assess cognition and change over time
explain shaping
reinforcements are given for increasingly closer approximations for the desired response. Ex: teachers may reward an autistic child for doing things to form words, rewarding one step at a time.
explain modeling
learning new behaviors by imitating the behavior of others. Ex: role models, children imitating the behaviors of their older siblings or parents, observing television- can lead to maladaptive behaviors.
Explain Premack Principle
a frequently occurring response can serve as positive reinforcement to response 2 that occurs less frequently, Applied when response 1 to only occur after response 2 has been performed. Ex: a parent allows the child to go to the beach with her friend after all her chores are done for the day. The fun stuff response.
explain extinction
gradual decrease in frequency or disappearance of a response when positive reinforcement is withheld. Ex: tantrums with kids- the behaviors continue when the parent is close to them but they stop when they walk away form the child.
explain contingency contracting
a contract is drawn up among all parties involved and the desired behavior change and reinforcers and stated explicitly and the negative consequences will be taken if terms of the contract are broken. Specific to how the reinforcers or punishment stands.
explain token economy
“Treasure Box”, reinforcers for desired behaviors are presented in the form of tokens which consist of items the client likes. Tokens are awarded for desired behaviors and are exchanged for privileges or things the client likes. The hope is the desired behavior will stick even after the removal of the token system.
explain time out
aversive stimulus or punishment where the client is removed from the unacceptable environment with the unacceptable behavior and is isolated.
explain reciprocal inhibition
decreases or eliminates a behavior by introducing a more adaptive behavior, but one that is incompatible with the unacceptable behavior. Ex: relaxation for phobias.
explain overt stimulation
aversion therapy that produces unpleasant consequences for undesirable behaviors. Ex: disulfiram given for ETOH abuse. It causes N/V. Instead of pleasure, the patient gets punished with the medication.
explain covert stimulation
version therapy that relies on the individuals imagined unpleasant symptoms or negative consequences that is under the clients control and can be used whenever and wherever if required. A negative image is visualized and the image can induce the negative feelings.
explain systemic denensitization
a technique for assisting individuals to overcome their fear of a phobic stimulus. It is systemic in that there is a hierarchy of events that cause anxiety and then are taken one step at a time as the patient progresses. Paired with relaxation activities.
explain flooding
the individual gets stimulated all at one with undesirable stimuli until it no longer causes anxiety.
what are the goals of cognitive therapy?
Monitor negative automatic thoughts.
Recognize the connections between cognition, affect, and behavior.
Examine the evidence for and against distorted automatic thoughts.
Substitute more realistic interpretations for biased cognitions.
Learn to identify and alter dysfunctional beliefs that predispose to distortions.
Explain principles of cognitive therapy
based on an everlasting formulation of the patient and their problems in cognitive terms.requires a sound therapeutic alliance.emphasizes collaboration and active participation.goal oriented and problem focused.initially emphasized the present.educative, aims to teach the patient to be their own therapist, and emphasizes relapse prevention.aims to be time limited. structured, eaches patients to identify, evaluate, and respond to their dysfunctional thoughts and beliefs.uses a variety of techniques to change thinking, mood and behaviors.
explain automatic thoughts
thoses that occur in response to a situation quickly and without analysis. Negative and not logical.
explain arbitrary influence
an individual automatically comes to a conclusion without facts or evidence to support.
explain overgeneralization
sweeping, all or nothing conclusions.
explain dichotomous thinking
views situations in a good-bad way.
explain selective abstraction
a conclusion based on only a selected portion of the evidence that is negative and what is viewed as a failure.
explain magnification
exaggerating the negative significance.
explain minimization
under valuaing the positive significance of an event.
explain catastrophic thinking
always thinking that the worst will occur without considering the positive outcomes.
explain personalization
the person takes complete responsibility for the situation without considering the situations behind it.
explain socratic dialogue
the therapist questions the client to elaborate the who what where why how of the situation and describe feelings associated.
explain guided relaxation
aimed at reducing autonomic responses to anxiety. Deep breathing, imagery, meditation. Controls awareness over breathing, anxiety, and thoughts
explain behavioral rehearsal
role play allows the client to practice new ways to approach situations and try out scenarios in real life. Can also be used with thoughts with cognitive rehearsal.
explain questioning the evidence
they view the thought as a hypothesis and they question the facts with cognition.
explain examining options and alternatives
helps a client see a broader range of possibilities.
explain Decatastrophizing
the client examines the validity of a negative thought and develops a plan of action.
explain reattribution
aims to reverse negative attribution by self blame or placing the blame on others.
explain DRDT
used to help clients identify and modify automatic thoughts in a 3 column thought record and rate the thoughts they have and explain more rational approaches.
explain what ethics is
is the branch of philosophy that addresses methods to determine if one’s actions are right or wrong.
explain what bioethics is
applies to these same principles when referring to concepts in medicine, nursing and allied health.
what are the ethical principles of nursing?
· Autonomy
· Beneficence
· Non-maleficence
· Justice
· Veracity
·Fidelity
explain autonomy
right to self determination and to make their own independent choices about their medical and psychiatric care. Incapable individuals with serious mental health disorders may need someone appointed to make those decisions.
explain beneficence
the duty to promote the good of others. Nurses should act in their clients best interests and have good interests that will serve the client the best care in a good way, with sensitivity to wishes, beliefs, and feelings.
explain nonmalefience
oing no harm to clients. A big part of this patient safety when it comes to psychiatric disorders, as nurses we want to make sure everyone is safe while receiving care.
explain justice
giving fair treatment to all patients regardless of condition, past, race, gender, etc . All care resources should be given equally to all, and the nurse should favor all clients equally.
explain veracity
the duty to be honest and truthful. The nurse should never deceive or mislead patients.
explain fidelity
keepings one’s promise. the nurse should never break a promise if one is made
explain moral behaviors
conduct that results from serious critical thinking about how individuals treat others
explain values
personal beliefs about what is important or desirable.
what is utilitarianism?
actions are right to the degree that they promote happiness and are wrong as they produce the reverse of happiness.
what is kantianism?
not the consequences that make an action right or wrong but the motivation on which the action is based that is the morally decisive factor. Action bound by a sense of duty, and decisions are made in respect to the moral law.
what is christian ethics?
focused on the life and teachings of Jesus Christ based on forgiveness, love, and honesty. Golden rule. Right and wrong center around love for God and treating others with respect.
what is natural law theory?
based on st thomas aquinas and advances the idea about right vs. wrong being based on human nature.
what is ethical egoism?
exposes what is right and good and what is best for the individual making a decision.
what is the right to humane treatment?
must have a clean, safe environment and be given care under any circumstances, and will be given care that does not harm the client or in unrealistic
what is the right to refuse treatment or medication?
the patient can refuse it unless it is required to prevent death or cause serious harm to a person or themselves. must consider the client and situation before forcing any medications in the psych area. Can also be an involuntary or court mandated force to help with treatment.
what is the right to the least restrictive treatment?
no sedation, restraints, or seclusion unless they actively need it to prevent the harm of themselves and others. least restrictive hospitalization to the most based on treatment and care. no confining against will.
explain what an ethical dilemma is?
a situation requiring the nurse to make a choice between 2 equally unfavorable alternatives based on moral rightness. No clear reason often.
what things should the nurse think about when dealing with an ethical dilemma?
-gathering subjective and objective data
-consider personal values about the situation
-identify the conflict
-explore benefits and consequences of alternatives
- act on the decision made
-evaluate the situation
-assess needs of all parties involved, but remember it is the patients right to determine their course of action (in most situations)
What are statutory laws?
enacted by a legislative body- nurse practice acts.
what are common laws?
from decisions in previous cases that arise from court decisions. Per state.
what are civil laws?
protects the private and property rights of individuals and businesses
what is a tort?
iolation of civil law where an individual has been wronged. Malpractice and negligence.
what are contracts?
one party asserts the other in failure to fulfil obligations.
what are criminal laws?
provides protection from conduct deemed injurious to the public. punishment for those involved with conduct, like theft of hospital supplies.
what are client specific rights in mental health?
-informed consent
-right to refuse meds/ tx
-right to least restrictive tx
are not valid when the client is at risk of harming self or others
what is the role of HIPAA?
protect a person’s private health information. IN psych, individuals have the rights to their medical records, have corrections made, and decide who they can share them with.
Explain the two breeches of HIPAA that can occur in psych nursing
duty to warn others that a patient is dangerous to others, child abuse or elder abuse that should be immediately reported to authorities
explain what a voluntary admission is
The client or client’s guardian chooses admission to a mental facility.
A voluntarily admitted client may request release at any time.
explain what a temporary emergency admission is
The client is admitted for emergent mental health care due to the inability to make decisions regarding care.
After the admission is initiated by a healthcare provider, the client is evaluated by another healthcare provider.
This temporary admission varies by client’s needs and state laws.
explain what a involuntary admission is
The client enters against her/his will for an indefinite period time.
This is based on the client’s need for psychiatric treatment, the risk of harm to self or others, and the inability to provide self-care.
Physicians(generally) certify the client’s condition meets the above criteria.
The client can request a legal review.
explain competent/incompetent client in regards to involuntary admissions
can be competent or incompetent.if competent- the client can make decisions regarding refusal of treatment/meds. if incompetent- by the court, someone will sign the consent for the client.
how long is an involuntary admission lasting?
60 days
least restrictive restraint measures include:
-verbal intervention
-diversion or redirection
-providing a calm, quiet environment
-offering medication (chemical restraint is less restrictive than mechanical restraint)
we should never use restraints or seclusion for:
-punishment
-convenience of staff
-clients who are physically or mentally unstable
if a restraint or seclusion is used, we should do the following:
have the provider prescribe it in writing, see the patient face to face, have a order rewritten every 24 hrs, assess frequently every 30 mins safety, behavior, food, fluids, toiling, vitals, pain, skin assessment.
how long should restraints be applied to someone 18 years or older?
4 hrs
how long should restraints be applied to someone 9-17 years old ?
2 hrs
how long should restraints be applied to someone 8 years or younger?
1 hr
explain what a crisis is
psychological disequilibrium in a person who experiences a situation that constitutes a problem that cannot be escaped or solved with usual problem solving techniques.
what does the client need while they are in a crisis that the nurse can help with?
In this type situation, guidance and support must be provided to help mobilize resources needed to resolve the crisis and restore equilibrium.
phase 1 of the crisis development stage is:
The individual is exposed to a precipitating stressor.
phase 2 of the crisis development stage is:
When previous techniques to handle the stressor are not effective,the individual begins to feel a great deal of discomfort.
phase 3 of the crisis development stage is:
Resources, both internal and external are called upon to resolve the problem but fail,and the individual becomes more anxious.
phase 4 of the crisis development stage is:
Anxiety reaches a panic level. Cognitive functions are disordered, emotions are labile and behavior may reflect unrealistic thoughts and actions.
what can we do if there is a emergency and a patient needs restraints or seclusion quickly?
In an emergency, the nurse can use seclusion or restraint without first obtaining an order, but must obtain the written order within a certain amount of time.
*The nurse must be aware of state, federal, and facility policies that govern the use of seclusion and restraints.
explain the purpose of crisis intervention
is designed to provide rapid assistance to the client
what is the initial intervention when giving interventions to one in a crisis situation?
assess the client’s potential for suicide or homicide.
what are some of the other interventions we can do for a client needing crisis interventions?
-Identify the problem and direct intervention for resolution
-Take an active, directive role with the client
-Help the client set realistic goals
-Provide for client safety
-Attend to physical needs first
Use reality-oriented approach
-Remain with the individual
-Show unconditional acceptance
-Practice active listening
-Discourage lengthy explanations
-Set firm limits
-Clarify the problem with the individual through a problem-solving process
-Discuss alternative strategies
-Identify external support
what is the role of the nurse when a disaster occurs?
an event that overwhelms local resources and threatens the function and safety of the community. Can cause destruction and leave victims with a sense of anxiety and damaged sense of safety.
The nurse can provide interventions that not only help the patient but help the community to address needs.
what are protective factors for a client in crisis?
Resilient temperament
Social competency
Skills in problem solving, coping, conflict resolution.
Positive expectation, optimism for the future, identification of future goals.
Connectedness to family, school, community.
Presence and involvement of caring people.
Integration in social networks.
Culture and religious beliefs that discourage suicide
Access to social services and clinical healthcare.
Support with ongoing disorders
Restricted access to suicidal methods.
explain culture
a particular society’s entire way of living, encompassing shared patterns of belief, feeling, and knowledge that guide people’s conduct are passed down from generation to generation
explain ethnicity
groups of people who identify with each other because of a shared cultural, national, or ancestral heritage.
explain spirituality
the human concept that gives meaning and sense of purpose to an individual’s life. Religion is a set of beliefs, values, and rights adopted by a group of people. This is one way in which an individual’s spirituality is expressed.
what should the nurse be when taking care of patients with different cultural background?
culturally competent- have knowledge and acceptance to care for all clients in whatever culture they believe in
explain the spiritual needs
emphasize a meaning and sense of purpose in life.
faith
hope
love
forgiveness
meaning and purpose
explain religion
a set of beliefs, values, rites and rituals that a group of people follow from a certain leader.
define common religions that may be seen healthcare
Christianity
Jewish
Islam
Jehovah Witness
Mormons
Hindu
what things should we do to assess ones spirituality and culture?
asses their spiritual background, ask if they believe in a higher power, ask if they go to church, ask if they would prefer certain gentrified staff, ask about food preferences or dietary restrictions, ask about fasting and blood provisions, and about any ritualistic movements they would like to perform.
common nursing dx for culture and spirituality are:
RIsk for spiritual distress
Risk for impaired religiosity
Readiness for enhanced spiritual well being
__ is the branch of philosophy that addresses methods to determine if one’s actions are right or wrong.
Ethics
__ applies to these same principles when referring to concepts in medicine, nursing and allied health.
Bioethics
______ are the fundamental guidelines that influence decision making.
Ethical Principles
The right of patients to make decisions about their medical care.
Autonomy
Do what is best for your patient.
Beneficence
Do no harm.
Non-maleficence
Provide fairness in care and resources.
Justice
Tell the truth.
Veracity
Keep your promises. Loyalty.
Fidelity
True or False:
Clients who have a diagnosis of a mental health disorder have the same civil rights as any other citizen.
True
True or False:
Mental health patient have the right to humane treatment
True
True or False:
Mental health patients have the right to due process of law (ability to press legal charges against another)
True
True or False:
Harmless mentally ill individuals cannot be confined against their will if they are able to remain safe outside of the hospital setting.
True
True or False:
Mental health patients have the right to informed consent and the right to refuse treatment (unless immediate intervention is required to prevent death or serious harm to the client or another person).
True
True or False:
Mental health patients have the right to refuse medication unless the client exhibits behavior that is dangerous to self and others.
True
An involuntary admission is limited to _ days.
60
The Health Insurance Portability and Accountability Act (HIPAA)- applies to individuals and institutions in healthcare. An exception occurs when:
protection of a third party is needed
Seclusion and/or restraints are never used for:
punishment
Time limits for restraints: 18 & older __ hours.
4
Time limits for restraints: 9-17 years old __ hours.
2
Time limits for restraints: 8 years old or younger __ hours.
1
__ is a particular society’s way of living, patterns of belief, feeling and knowledge that guide people’s conduct and are passed down from generation to generation.
Culture
____ is the human concept that gives meaning and sense of purpose to an individual’s life. Religion is a set of beliefs, values, and rights adopted by a group of people. This is one way in which an individual’s spirituality is expressed.
Spirituality
A __ is psychological disequilibrium in a person who experiences a situation that constitutes a problem that cannot be escaped or solved with usual problem solving techniques.
crisis
This role of the nurse in a crisis:
Provide guidance and support
Mobilize resources needed
Restore equilibrium
Phase 1 in the development of a crisis:
The individual is exposed to a precipitating stressor.
Phase 2 in the development of a crisis:
Previous techniques to handle the stressor are not effective
Individual begins to feel a great deal of discomfort
Phase 3 in the development of a crisis:
Resources, internal & external are called upon to resolve the problem but fail, and the individual becomes more anxious.
Phase 4 in the development of a crisis:
Anxiety reaches a panic level.
Cognitive functions are disordered
Emotions are labile
Behavior may reflect unrealistic thoughts and actions
The initial task for a nurse during a crisis is to
Provide a sense of safety by assessing the client’s potential for suicide or homicide.
Nursing interventions during a crisis include
Attend to physical needs first
Identify the problem/direct intervention for resolution
Take an active, directive role with the client
Help the client set realistic goals
Provide for client safety
Phases of the therapeutic nurse patient relationship
Pre-Interaction
Orientation
Working
Termination
What happens during the Pre-Interaction phase?
Obtaining information about the client
Examining one’s own feelings
What happens during the orientation (introductory) phase?
Discuss confidentiality
establish boundaries/expectations
identify patient needs
set goals
What happens during the working phase?
Perform ongoing assessments
Assist patient with problem solving and behavior changes
Evaluate coping strategies used in the past
Introduce patient to others on the unit
Revise goals/plan as needed
Support use of new coping skills
This occurs when the client unconsciously displaces or transfers to the nurse feelings formed toward another person from his/her past. These can be positive or negative feelings.
Transference
This refers to the nurse’s behavioral and emotional response to the client. The nurse is to recognize the occurrence of this phenomenon and remain professional at all times.
Countertransference
What happens during the termination phase?
Summarize goals/achievements
allow patient to share feelings about termination of relationship
discuss ways for patient to incorporate new healthy behaviors into their life
Examples of nonverbal techniques:
Appearance
Body Movement/Posture
Touch (not often appropriate in mental health setting)
Facial expression
Eye behavior
Vocal cues
Silence
This gives the client the opportunity to collect and organize thoughts.
Accepting
Convey an attitude of acceptance. Nurse: ‘Yes, I understand what you said.”
Giving recognition
acknowledge awareness- “I see you made your bed.”
Offering self
Making oneself available. Nurse: “I will stay with you.”
Giving broad openings
Allowing the client to introduce the topic. Nurse: “What would you like to talk about?”
Offering general leads
Offering the client encouragement to continue. Nurse: “I see. Go on.”
Placing event in time/sequence
Clarifies the relationship of events so the nurse and client can view them in perspective. Nurse: “Was this before or after…”
Making observation
verbalizing what is observed. Nurse: ” you seem tense today.”
Encourage comparison
Asking the client to verbalized what is perceived. Nurse: “What is happening now?”
Restating
repeating the main idea of what the client said. Client: “I can’t do it.” Nurse: “You think you will fail?’
Reflecting
Question is restated to the client. Client: “What should I do about the problem?” Nurse: “What do you think you should do?”
Focusing
Taking notice of a single idea or word. Nurse: “Let’s look at that more closely.”
Exploring
Delving further into a subject, idea, or situation. Nurse: “Please explain that to me.”
Seeking clarification/validation
Striving to understand what is being said. Nurse: “I’m not sure I understand.”
Verbalizing the implied
Putting into words what the client has implied.-Client: “I am wasting time by being here.” Nurse: “You feel you are not getting help?”
Attempting to translate words into feelings
When words are expressed indirectly and the nurse tries to express the symbolic meaning of what was said. Client: “I am in a deep hole.” Nurse: “You feel helpless?”
Formulate a plan of action
When the client has a plan in mind to deal with a stressful event/situation. Nurse: “What could you do about…”
Encouraging description of perception (hallucinations)
Presenting reality (hallucinations)
Voicing doubt (delusions)
Giving reassurance
“Everything is going to be fine.”
Rejecting
“That’s not possible.”
Approving/disapproving
“I think that is a great idea.” “I don’t think that is such a great idea.”
Agreeing/disagreeing
“That’s right.” “That’s wrong.”
Giving advice
“I think you should……”
Probing
Nurse is persistent in questioning.
Defending
“We are all here to help you.”
Requesting an explanation (why?)
Asking the client to defend his/her thoughts.
Indicating the existence of an external source of power
“What made you act like that?”
Belittling feelings expressed
Client: “I have nothing to live for.” Nurse: “Everyone gets down in the dumps sometimes.”
Making stereotyped comments
“Hang in there.”
Using denial
Client: “I’m a nobody.” Nurse: “Of course, you are a somebody.”
Interpreting
“What you really mean is……”
Introducing an unrelated topic
The nurse changes the subject.
The Mini-mental status exam (MMSE) evaluates
cognitive abilities
Nursing interventions that began with assistance in somatic therapy
Insulin therapy
Electroconvulsive therapy
Electrical stimulus to the brain with the result being a grand mal seizure is called
ECT
Insulin administered until the client was comatose is called
Insulin therapy
The discharge of patients from “state mental hospitals” back to their original community, referred to as deinstitutionalization occurred in
1960
Deinstitutionalization (1960’s) – was initiated for 3 main reasons:
The belief that treatment in the hospitals was inhumane
Hope that medications would offer a cure
Lack of funding at the state and federal level
Maslow’s hierarchy of needs (1970)
self-actualization
self-esteem
love and belonging
safety
physiological needs
Which of Maslow’s hierarchy of needs (1970) are psychological?
love and belonging
self-esteem – respect of others
self-actualization (highest level)
What Nonpharmacological therapies have found to be effective in the treatment process?
Psychotherapy
Therapies with others or in a more open environment
Brain Stimulation
What are the types of psychotherapy?
(These involve a more verbal therapist-to- client Interaction.)
Behavioral therapy
Cognitive therapy
Dialectical- behavioral therapy
What are the types of therapies with others or in a more open environment?
Family therapy
Milieu therapy-(therapeutic community)
Group therapy
What are the types of brain Stimulation Therapies?
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation (TMS)
Vagus nerve stimulation-
The ____ syndrome creates body changes to deal with stress.
fight or flight
___ is defined by Townsend (2019) as maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings and behaviors that are incongruent with the local and cultural norms, and interfere with the individual, social, occupational and physical functioning.
Stress
True or False:
We are generally aware of the physiological changes in the body in dealing with stress.
True
True or False:
We have mechanisms we use to protect our psychological status.
True
There are 2 defense mechanisms that are always healthy, they are:
Altruism
sublimation
Defense Mechanisms example:
It is very cold and a man takes off his jacket and gives it to someone who cannot afford coat.
Altruism
Defense Mechanisms example:
Someone who is too small to make the wrestling team becomes a talented member of the debating team.
Compensation
Defense Mechanisms example:
A women who drinks alcohol daily, refuses to acknowledge she has a problem.
Denial
Defense Mechanisms example:
A man is angry with his boss and when he comes home, he yells at his children.
Displacement
Defense Mechanisms example:
A woman has feelings for someone other than her husband, but blames him for being unfaithful.
Projection
Defense Mechanisms example:
The student nurse imitates the nurturing actions of the instructor.
Identification
Defense Mechanisms example:
A wife is moving far away from her family because of her husband’s job transfer. She explains to her family all the advantages of the move.
Intellectualization
Defense Mechanisms example:
A boy justifies cheating in a card game because he said everyone cheats.
Rationalization
Defense Mechanisms example:
A girl is angry with someone, but expresses exaggerated friendliness when she sees her.
Reaction formation
Defense Mechanisms example:
An adult throws a temper tantrum when she doesn’t get her way.
Regression
Defense Mechanisms example:
A little boy starts sucking his thumb on his way home from his first day at school.
Repression
Defense Mechanisms example:
A student states, “I’ll worry about that exam tomorrow.”
Suppression
Defense Mechanisms example:
A girl is unable to speak just before she is to try out for chorus.
Conversion
Defense Mechanisms example:
Someone says she has the best friend ever, until her friend is not able to attend her party. Then she says she never wants to see her again.
Splitting
Defense Mechanisms example:
A mother whose child has cystic fibrosis, develops a support group for other parents with children diagnosed with the illness.
Sublimation
Defense Mechanisms example:
A man argues with his wife and the next day brings her flowers.
Undoing
What does the nurse teach the client prior to ECT today?
Side effects may be headache and recent memory loss that is temporary and confusion.
How is the client monitored during ECT today?
ECG
EEG
Is a written (informed) consent necessary before ECT?
Yes, if the client is being treated voluntarily.
What conditions/symptoms are best treated with ECT?
Depression
Drug resistant clients who are psychotic
Schizophrenia with catatonia
Depression associated with bipolar disorder