NURS 465: Exam 1

Question 1

Introductory Statement

Answer 1

made at the beginning of a conversation/ meeting with a patient and includes: name, position/credentials, role/function in relation to the patient and approximate time to spend with patient

Question 2

Closed questions & statements

Answer 2

Can be answered with yes or no statements, one-word answers
Ex: “Did you do your homework?”
Does not use who, what, when, where, and how in the question

Question 3

Open-ended questions & statements

Answer 3

Can’t be answered with yes/no/one word
Questions start with who, what, when, where and how
Ex: “What’s the reason for not studying?
Exceptions: “could, would” can be used as open ended

Question 4

General leads

Answer 4

Generic/ basic open questions to help open conversations

Ex: “How are you? Tell me about yourself”

Question 5

Focusing questions and statements

Answer 5

Done in response to a patient listing several things they may be worried about, or having several problems or feelings
Ex: “Which of the things you mentioned worry you the most?”
“Tell me more about feeling depressed”

Question 6

Clarification questions & statements

Answer 6

Type of open-ended question/statement used in clarifying the patient’s emotions
Ex: “What do you mean when you say…”
“I don’t quite understand what that means to you”

Question 7

Emotional metaphor

Answer 7

Metaphor used to convey feelings

Ex: “stressed out, on my last limb”

Question 8

Mixed feelings

Answer 8

Used in emotional metaphors; these particular emotions and depth of the emotions is not clear
Ex: upset, torn, confused, unsure

Question 9

Clarifying questions

Answer 9

Appropriate response to emotional metaphors and mixed feelings to get a better understanding of what is being said by patient

Question 10

Restatement

Answer 10

Simple and brief, repeat of the exact words of the patient’s last statement

Question 11

Minimal encouragement

Answer 11

Brief verbal utterance

Ex: “Oh.. Mmm. I see”

Question 12

Paraphrasing

Answer 12

Saying in your own words, and without changing the means, what you hear the patient is saying.
Effective paraphrasing: personalization (patient’s name); most important key words of the patient; distilled, shortened and clarified version of the patient’s statement, which catches the essence of what was said

Question 13

Reflection of Feelings (ROF)

Answer 13

Reflecting back to the patient an unspoken emotion (feeling)
Complete reflective statement: includes and connects a feeling and a content issue and in some instances, a behavior
2nd type: simple statement or reflection by the nurse about a patient’s affect, or nonverbal communication which suggests an unspoken feeling

Question 14

Check-out

Answer 14

Closed question that is asked following a paraphrase, reflection, or summarization
Less formal: change voice to a questioning tone at the end of a paraphrase, ROF, summary statement

Question 15

Expression of empathy (empathic statement)

Answer 15

Short statement to express that you identify with the patient’s situation

Question 16

Simple observation statement

Answer 16

Making a statement of a simple observation that the nurse has made of the patient’s current behavior, not feelings

Question 17

Summarizing

Answer 17

Concise, tying together, or review of important thoughts, feelings and behaviors expressed by the patient during the interview
- summarize q2–30 min in the conversation

Question 18

Circular questioning

Answer 18

Interventive questioning
Used when working with families or groups
Focus on the impact that the illness/injury has had on the functioning of the family system

Question 19

Self-disclosure

Answer 19

Sharing something about the nurse with the patient that will help the patient toward specific health promotion goals
Must be used sparingly with the patient specific health promotion goals in mind and must be brief

Question 20

Keeping self-disclosure “therapeutic” involves the following?

Answer 20

1. Adhering to the goal of helping the patient open up to you and assist with “reality testing”
2. Keeping disclosure brief
3. Not implying that your own experience are the same as the patient’s experiences

Question 21

Reframing

Answer 21

Presenting the patient situation, or what the patient has said from a different perspective

Question 22

Normalizing

Answer 22

Help with reality testing

Telling patients and families that what they are going through is normal

Question 23

Concepts of the nurse-patient relationship

Answer 23

Establish that the nurse is safe, confidential, reliable and consistent
Relationship with clear boundaries

Question 24

Establish boundaries

Answer 24

Physical boundaries; the contract, personal space

Question 25

Transference

Answer 25

Patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient’s past
- intensified in relationships of authority

Question 26

Countertransference

Answer 26

Nurse displaces feelings related to the people in nurse’s past onto patient

• patient’s transference to nurse results in countertransference in nurse
• Common sign of countertransference in nurse is over-identification with the patient

Question 27

Peplau’s model of nurse-patient relationship

Answer 27

Orientation phase
Working phase
Termination phase

Question 28

Orientation phase

Answer 28

Establishing rapport
Parameters of the relationship
Formal or informal contract
Confidentiality
Terms of termination

Question 29

Working phase

Answer 29

Maintain relationship
Gather further data
Promote patient’s problem-solving skills, self-esteem and use of language
Facilitate behavioral change
Overcome resistant behaviors
Evaluate problems and goals (redefine them as necessary)
Promote practice and expression of alternative adaptive behaviors

Question 30

Termination phase

Answer 30

Summarize goals and objective achieved
Discuss ways for patient to incorporate new coping strategies learned
Review situations of relationship
Exchange memories

Question 31

Communication Process

Answer 31

Stimulus for information, comfort or advice

1. Sender - initiates contact
2. Message - sent or expressed
3. Variety of media - hearing, visual, touch, small
4. Feedback received

Question 32

Process recording

Answer 32

Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse
Useful tool for identifying communication patterns

Question 33

MH-4

Answer 33

Filled out by MD after pt is brought to the hospital, through the ER. 48 hr emergency commitment

Question 34

MH-5

Answer 34

Voluntary admission form signed by adult on admission

Question 35

MH-5a

Answer 35

Voluntary admission form signed by minor done at the hospital. Family court sends an officer to sign the pt in once the pt is in the hospital

Question 36

MH-6

Answer 36

Petition for involuntary commitment. MD completes form after 48 hr time period on the MH-4 and pt continues to show signs of dangerousness to self or others and is in need of tx for mental disorder. Max confinement is 90 days

Question 37

Ethics

Answer 37

Study of philosophical beliefs about what is considered right or wrong in a society

Question 38

Bioethics

Answer 38

Used in relation to ethical dilemmas surrounding health care

Question 39

Ethical dilemma

Answer 39

Conflict between >2 courses of action, each with favorable and unfavorable consequences

Question 40

5 principles of bioethics

Answer 40

Beneficence
Autonomy
Justice
Fidelity/ nonmaleficence
Veracity

Question 41

Informal admission

Answer 41

Sought by Pt

MH-5

Question 42

Voluntary admission

Answer 42

Sought by pt or guardian

MH-5/ MH-5a

Question 43

Temporary admission

Answer 43

Person confused or demented
So ill, he/she needs emergency admission
MH-4

Question 44

Involuntary admission

Answer 44

Without patient’s consent

MH-6

Question 45

Long-term involuntary admission

Answer 45

Medical certification, judicial review, administrative action
MH-6

Question 46

Conditional release

Answer 46

Required outpatient treatment for a specified period to determine the pt’s adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into the community

Question 47

Unconditional release

Answer 47

termination of a patient-institution relationship

Question 48

Release against medical advice (AMA)

Answer 48

Disagreement between mental health care providers and the pt whether hospital stay is necessary.

Question 49

Patients’ rights under the law

Answer 49

Right to treatment
Right to refuse treatment
Right to informed consent
Right surrounding involuntary commitment and psychiatric advance directive
Rights regarding restraint and seclusion
Right to confidentiality

Question 50

Patient Confidentiality

Answer 50

HIPAA
Confidentiality after death
Confidentiality of professional communications
Confidentiality and HIV status
Exceptions to the rule
- Duty to warn and protect third parties
- Child and elder abuse reporting statuses

Question 51

Tort

Answer 51

Civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (defendant)

Question 52

Intentional tort

Answer 52

Willful or intentional acts that violate another person’s rights or property
- assault, battery, false imprisonment, invasion of privacy, defamation of character (slander/libel)

Question 53

Unintentional tort

Answer 53

Unintended acts against another that produce injury or harm

- negligence, malpractice

Question 54

Documentation of care

Answer 54

A record’s usefulness is determined by evaluating - when the record is read later - how accurately and completely it portrays the patient’s behavioral status at the time it was written

Question 55

When doing MSE for children and adolescents, consider:

Answer 55

Consider developmental level; Involves the family; Observational ; Use tools such as toys, play, stories, drawing; Reporting of neglect or abuse

Question 56

When doing MSE for geriatrics, consider:

Answer 56

Changes in social roles in retirement; Brian changes; Decline of senses; Memory loss; Poly-pharmacy; High risk for suicide

Question 57

Mental Status Exam (MSE)

Answer 57

Evaluation for medical, psychiatric and neurological disorders
Nurse’s observation of patient’s behavior described in an objective manner
Evaluation of the patient’s current state

Question 58

MSE: General appearance and behavior

Answer 58

Grooming, level of hygiene, clothing.
Unusual physical characteristics/movements.
Attitude. Ability to interact with interviewer.
Psychomotor activity. Agitation/retardation.
Degree of eye contact.

Question 59

MSE: Affect

Answer 59

Affect—External range of expression—
quality, range, and appropriateness.
flat—absence of all or most affect
blunted/restricted—moderately reduced range
labile—multiple abrupt changes in affect
full/wide-range—generally appropriate

Question 60

MSE: Mood

Answer 60

Mood—Internal emotional tone—

dysphoric, euphoric, angry, anxious, euthymic

Question 61

MSE: Thought Process

Answer 61

Thought Process—quality, quantity of speech. Tone, fluency
Pressured speech. Rapid speech (manic)
Poverty of speech. Minimal response, yes/no.
Blocking. Sudden cessation, often in middle of statement.
Flight of Ideas. thoughts jump idea to idea
Loosening of association. Illogical shifting—unrelated topics.
Tangentiality. wanders from the original point
Circumstantiality. digression, eventually reaches the point
Echolalia. Echoing of words and phrases.
Neologisms. Invention of new words
Clanging. rhyming, punning.
Preservation. Repetiton of phrases or words
Ideas of reference. tv talking directly to them.

Question 62

MSE: Thought Content

Answer 62

Thought Content—perceptual disturbances
Hallucinations. auditory, visual, tactile, gustatory, olfactory.
Delusions. Persecutory, erotomanic, grandiose, somatic
Derealization. Feelings of unrealness—outer environment
Depersonalization. Observing self from outside the body
Suicidal/Homocidal Ideation—intent, plan

Question 63

MSE: Cognitive Evaluation

Answer 63

Level of consiousness
Orientation. Person, place, date
attention and concentration. WORLD
short-term memory. Recall 3 objects after 5 minutes
fund of knowledge. Name past 5 presidents, 5 lg cities.
Calculations. Serial seven subtraction, simple math
Abstraction. Proverb interpretation, similarities

Question 64

MSE: Insight

Answer 64

Able to show understanding of current problems/implication

Question 65

MSE: Judgment

Answer 65

Ability to make sound decisions regarding daily activities

Best evaluation by pt’s hx of decision making, not hypothetical questions