Mental Health Test 1

Question 1

Discuss how the DSM-IV-TR is used in the mental health setting.

Answer 1

The Diagnostic and Statistical Manual of Mental Disorders is used as a diagnostic tool to identify mental health diagnoses.

It is used by mental health professionals for clients who have mental health disorders using a multiaxial system.

A nursing diagnosis specifically describes the client’s actual or potential reaction to a health problem that the nurse is licensed and skilled to treat.

Question 2

Define and give an example of: flat affect, mood, blocking, insight, judgment

Answer 2

mood: a client’s mood provides information about how an emotion
affect: an objective expression of mood.

flat affect: means lack of facial expression

blocking: a person stops speaking suddenly and without explanation in the middle of a sentence (schizophrenia)
insight: objective assessment of the client’s perception of the illness
judgment: based on the client’s answer to a hypothetical question

Question 3

Describe and give an example of: flight of ideas, delusion, hallucination, poor insight.

Answer 3

flight of ideas: accelerated thinking and speaking. These people typically think they are “God”.

delusion: characterized by persistent, non bizarre delusions involving situations that may occur in real life. They might think they are being followed, poisoned, infected etc.
hallucinations: hearing, seeing, feeling things that are not there

poor insight: mentally ill person. thought process does not commensurate with reality.

Question 4

Compare and contrast rational, concrete, and abstract thinking

Answer 4

rational thinking: the epistemic sense is the art of arriving at true beliefs. (rational that the earth revolves around the sun.)

concrete: opposite of abstract. focused on facts
abstract: ability to think about objects, principles, and ideas that are not physically present

Question 5

During a mental status examination, describe how to assess a client’s orientation

Answer 5

year/date/month/season

where are we?
state/country/town/hospital

Question 6

Discuss “violation of confidentiality”, slander, limit setting, and false imprisonment. Give an example of each

Answer 6

false imprisonment: confinement to a specific area when it is convenient to staff

slander: malicious verbal statements that are false or injurious. (gossip)

limit setting: boundaries must be established

violation of confidentiality: HIPAA. (do not talk about patients in an elevator with a CNA)

Question 7

Discuss when restraints can be used

Answer 7

set up for safety.
never used for staff convenience, client punishment.

order must be rewritten every 24 hours

Question 8

Discuss the criteria for emergency involuntary commitment and give an example

Answer 8

client enters the mental health facility against her will for an indefinite period of time. commitment based on clients need to psychiatric tx, the risk of harm to self or others, or the inability to provide self care.

emergency involuntary: client is hospitalized to prevent harm to self or others. temporary up to 10 days. imposed by PCP, mental health providers or police officers.

Question 9

Discuss the nursing care for the client in full leather restraints

Answer 9

Assess client’s safety

Ensure the restraint is easy to release in case of an emergency situation

Ensure the restraint is attached to a non moving part of the bed

Ensure client’s physical needs and comfort measures are met

Check circulation every 15 minutes

Remove restraints every 2 hours

Document patient’s status

Question 10

Discuss the use of emergency physical restraints for aggressive or combative clients

Answer 10

Seclusion rooms and restraints should be set up for safety and used only after all less-restrictive measures have been exhausted.

Be sure to document:

• the start/stop time -date
• reason for restraint -type used
• sign verbal order within 24 hours.

Restraints may be used in an emergency situation if the client is a harm to self or others.

Question 11

Explain the use of silence in therapeutic communication

Answer 11

Silence allows time for meaningful reflection. Being silent gives the patient an opportunity to consider his thoughts, fostering therapeutic relationship.

Question 12

List five barriers to effective communication with a client

Answer 12

Offering personal opinions

Giving advice

Giving false reassurance

Minimizing feelings

Changing the topic

Asking “why” questions

Offering value judgments

Excessive questioning

Responding approvingly or disapprovingly

Question 13

Define and give examples of at least 5 defense mechanisms

Answer 13

Suppression- voluntarily denying unpleasant thoughts and feelings. Ex- A person who has lost his job states he will worry about paying his bills next week

Undoing- performing an act to make up for prior behavior. Ex- An adolescent completes his chores without being prompted after having an argument with his parent

Dissociation- temporarily blocking memories and perceptions from consciousness. Ex- An adolescent witnesses a shooting and is unable to recall any details of the event

Splitting- demonstrating an inability to reconcile negative and positive attributes of self or others. Ex- A client tells a nurse that she is the only one who cares about her, yet the following day, the same client refuses to talk to the nurse

Projection- blaming others for unacceptable thoughts and feelings. Ex- A young adult blames his substance use disorder on his parents refusal to buy him a new car

Question 14

What are self-defeating measures

Answer 14

A self-defeating behavior is any behavior that normally ends up with a result that is something the person doing the behavior doesn’t want to happen.

Question 15

Define and give examples of displacement, denial, introjection, projection, and compensation

Answer 15

Projection- blaming others for unacceptable thoughts and feelings. Ex- A young adult blames his substance use disorder on his parents refusal to buy him a new car

displacement- shifting feelings related to an object, person or situation to another less threatening object, person or situation. Ex- A person who is angry about losing his job destroys his child’s toy.

Denial- pretending the truth is not reality to manage the anxiety of acknowledging what is real. Ex- A parent who is informed that his son was killed in combat tells everyone he is coming home for the holidays.

Introjection- Introjection is the opposite of projection. Projection occurs when a person projects feelings or characteristics onto another person. Introjection, which is common among children and parents,occurs whena person internalizes the beliefs of other people. A child might take on elements of parents’ personalities or beliefs by adopting their political ideology, concept of right and wrong, or ideas about sex. When people introject, they identify with a person or object so strongly that they cannot separate that person or object from themselves.

Compensation- compensation is a strategy whereby one covers up, consciously or unconsciously, weaknesses, frustrations, desires, or feelings of inadequacy or incompetence in one life area through the gratification or (drive towards) excellence in another area.

Question 16

Define and give examples of rationalization, repression, sublimation, and suppression

Answer 16

Suppression- voluntarily denying unpleasant thoughts and feelings. Ex- A person who has lost his job states he will worry about paying his bills next week

Rationalization- creating reasonable and acceptable explanations for unacceptable behavior. Ex- A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog

Repression- putting unacceptable ideas, thoughts and emotions out of conscious awareness. Ex- A person who has a fear of the dentist’s drill continually forgets his dentist’s appointment

Sublimation- dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression. Ex- A person who has feelings of anger and hostility toward his work supervisor sublimates those feelings by working out vigorously at the gym during his lunch period.

Question 17

List and define three (3) different therapeutic communication techniques

Answer 17

Active listening- the nurse is able to hear, observe and understand what the client communicates and to provide feedback.

Touch- If appropriate, touch communicates caring and can provide comfort to the client

Open ended questions- this technique facilitates sponatenous responses and interactive discussion

Question 18

List three (3) signs/symptoms of anxiety

Answer 18

Restlessness, irritability, impatience and apprehension.

Question 19

List three (3) interventions for a client having severe anxiety

Answer 19

S/s include- confusion, feelings of impending doom, hyperventilation, tachycardia, withdrawal, loud and rapid speech and aimless activity.

Interventions include-
Provide an environment that meets the physical and safety needs of the client. Remain with the client

Provide a quiet environment with minimal stimulation

Use meds and restraint, but only after less restrictive interventions have failed to decrease anxiety to safer levels

Encourage gross motor activities such as walking

Set limits by using firm, short and simple statements. Repetition may be necessary

Direct the client to acknowledge reality and focus on what is present in the environment

Question 20

Define “therapeutic communication.”

Answer 20

Purposeful use of communication to build and maintain helping relationships with clients, families and significant others.

Essential components include time, active listening, caring non judgmental attitude, honesty, trust and empathy.

Therapeutic communication is client centered, not social and is purposeful, planned and goal directed. The nurse must recognize and respond to both verbal and nonverbal communications.

Question 21

Give two (2) examples of a therapeutic response.

Answer 21

“Tell me more”

“How does your mastectomy make you feel like less of a woman?”

“I notice that you’re pacing. How are you feeling?”

“Tell me how you feel about your recent car accident?”

Question 22

Discuss the nurse’s most important role in caring for a client with a mental health disorder.

Answer 22

To establish trust and rapport. It’s extremely important that the nurse establish trust and rapport.

The nurse shouldn’t offer advice. Instead, she should help the client develop the coping mechanisms necessary to solve his own problems.

Setting limits is also important but not as important as developing trust and rapport.

Question 23

Discuss the phases of the nurse-client relationship.

Answer 23

Orientation-

• Discuss goals with the client
• Discuss confidentiality
• Explore the client’s ideas, issues and needs
• Explore the meaning of testing behaviors
• Build trust by establishing expectations and boundaries

Working-

• Perform ongoing data collection to plan and monitor therapeutic responses
• Facilitate the client’s expression of needs and issues
• Encourage the client to problem solve
• Foster positive behavioral change
• Monitor and document client’s problems and goals and contribute to replanning as necessary

Termination-

• Provide opportunity for the client to discuss thoughts and feelings about termination and loss
• Summarize goals and achievements
• Review memories of work in the session
• Express own feelings about sessions to validate the experience with the client
• Discuss ways for the client to incorporate new healthy behaviors into life
• Maintain limits of final termination

Question 24

Give an example of the psychiatric nurse’s role in primary prevention.

Answer 24

The psychiatric nurse participates in primary, secondary, and tertiary prevention activities. Primary prevention includes providing sexual education classes for adolescents, and education programs that promote mental health and prevent future psychiatric episodes. For ex- the nurse leads a group for parents of toddlers, discussing normal toddler behavior and ways to promote health development.

Question 25

Describe how you would care for a client from a different cultural background than your own.

Answer 25

• respect the religious/spiritual practices of the client
• death rituals vary among cultures, nurse must be prepared
• recognize the way a client reacts to and displays pain varies by culture
• use an alternative pain scale
• explore religious beliefs that may influence pain

Question 26

Discuss transference and counter-transference. Give an example.

Answer 26

transference: when a client views a member of the health care team as having characteristics of another person who has been significant to the client’s personal life.
countertransference: occurs when he healthcare team member displaces characteristics of people in her past onto the client.

Question 27

Axis I

Answer 27

all mental health dx except those found in Axis II

Question 28

Axis II

Answer 28

any personality disorder dx and mental retardation

Question 29

Axis III

Answer 29

any general medical dx (asthma, DM)

Question 30

Axis IV

Answer 30

pertinent psychosocial problems and problems concerning the client’s living conditions

Question 31

Axis V

Answer 31

global assessment of functioning rates the client’s level of functioning, present and past year, in the areas of:

work performance
social abilities
psychological ability:

80-100 normal or near normal

60-80 moderate

40 and below serious disability