Practice SAQs

Question 1

1. Draw a simple diagram that shows the various components in the process of communication
2. Write an example that shows an effective communication exchange in a healthcare setting.

Answer 1

1. SOURCE (ENCODER) sends a MESSAGE (either VERBAL or NON-VERBAL) —> RECEIVER (DECODER). FEEDBACK from the ENVIRONMENT is sent back to the source. The CHANNEL is either VISUAL, AUDITORY or KINAESTHETIC. The whole process is encompassed by INTERPERSONAL VARIABLES.
2. Conversation:
   “I’ve understood that you’ve quit smoking previously, please tell me about how you did this.”
   - answer
   “And what about the second time?”
   - answer
   “Would you feel open to trying a vape?”
   - “Can you please tell me what you know about vaping?”

Question 2

List at least eight ways in which people communicate non-verbally.

Answer 2

• Facial expression
• Posture/gait
• Sound
• Silence
• Gestures
• Mood
• Touch
• General physical appearance

Question 3

List six factors that influence communication. Give an example that explains one of these factors.

Answer 3

1. Eye contact: for example, in some cultures it is disrespectful to look directly into a person’s eyes. Thus, doing so would inhibit communication. Alternatively, eye contact can be a key way to ensure communication is being received.
2. Gender
3. Sociocultural differences
4. Developmental level (age and stage of development)
5. Physical, mental and emotional state
6. Space and territory (physical space between people is also important)

Question 4

List the five types of questions that can be used when interviewing a person. Give an example of a communication exchange that shows a sequence of questions and comments.

Answer 4

1. Open ended: “Tell me…” or “describe…”
2. Closed: direct yes/no answer; “Is it…” or “Are you…”
3. Validating: checking info; “So, I’ve heard/you’ve told me…is that correct/have I understood?”
4. Sequencing: more than 1 piece of info, want a response then another question; “If…then/when…” E.g. “You’ve been prepped for surgery… is there anything else you’d like to know?”
5. Directing: “Are you able to…” or “Could you” or “How did you…” or “please tell me what you have understood”
   Example:
   “So Tamara, you said that you’ve quit smoking previously, how did you do this?”
   “I used replacement…etc.”
   “And what about the second time?”
   “I quit cold turkey”
   “Would you feel open to trying an alternative method of quitting?”
   “I guess so. I just don’t want to gain weight”
   “Tell me a little bit more about that. What do you know about methods of quitting?”

Question 5

Name and identify critical time periods of prenatal brain development

Answer 5

critical period is 0-12 weeks in utero when the main systems are developing; face develops and fuses, billions of brain cells

1. Pre-embryonic stage: 0-2 weeks
2. Embryo in 3rd week: brain starts to develop; most vulnerable
3. 4th week: brain formation
4. 14th-30th week: brain cells continue to divide
5. Increase in SA of brain

Question 6

List four factors that influence the developing brain. Describe one of these in detail

Answer 6

1. Alcohol
2. Nutrition: inadequate maternal nutrition has been associated with developmental and growth issues, and potentially increases chances of chronic illness later in life.
3. Smoking
4. Maternal exercise/BMI

Question 7

What factors does the APGAR test examine?

Answer 7

Appearance
Pulse
Grimace
Activity
Respiration

Question 8

What are the newborn reflexes?

Answer 8

• Seeking reflex (newborns turn their mouth towards the nipple when their cheek is touched)
• Moro reflex
• Babinski plantar reflex
• Stepping reflex
• Grasp reflex
• Tonic neck (ATNR) reflex
• hand to mouth activity, sucking, swallowing, blinking, sneezing and yawning

Question 9

Compare and contrast Erikson, Freud and Piaget’s developmental theories for the infant from birth to 2 years’ age.

Answer 9

• Piaget: cognitive development; sensorimotor period; basic reflexes, multiple thoughts, starts to reason/anticipate; learning occurs as a result of the internal organisation of an event, forming a mental plan which is used for further plans as one grows/develops.
• Erikson: psychosocial; based on Freud but expanded to include cultural/social influences in addition to biological processes; trust vs mistrust (In this stage, infants require a great deal of attention and comfort from their parents, leading them to develop their first sense of trust [or mistrust]); autonomy vs shame and doubt (Toddlers and very young children are beginning to assert their independence and develop their unique personality, making tantrums and defiance common)
• Freud: effect of instinctual pleasure-seeking human drives on behaviour; sexuality as stimulus (libido); psychosexual; oral stage (0-18m: putting everything in their mouths) and anal stage (8m-4y): command/control over bladder and bowel & curiosity abt movement)

Question 10

List the trends of regular growth and development

Answer 10

1. Cephalocaudal development (from head to tail): head and brain first, then trunk, legs and feet
2. Proximoddistal development: gross motor movements to fine motor movements
3. Symmetric development of body: both sides of body developing equally

Question 11

What are the 4 major components of Freud’s theory?

Answer 11

1. Unconscious mind
2. Id: self-gratification, instinct
3. Ego: conscious, mediates bw desires of id and constraints of reality; intelligence, experiences, reality vs fantasy separation; allows infant to alter behaviour
4. Superego: represents conscious, develops from ego; learning praise vs punishment; internalisation of rules and values –> socially acceptable behaviour

Question 12

Explain Bowlby’s attachment theory

Answer 12

• infants are prewired to display attachment behaviour towards one or more of their caregivers
• attachment patterns that begin in infancy have a profound influence and find expression in a wide range of social behaviours throughout the life span
  E.g. If an attachment has not developed during this period, then the child will suffer from irreversible developmental consequences, such as reduced intelligence and increased aggression
  E.g. Harlow’s monkey experiments: isolated monkeys who were deprived of bonding displayed abnormal and harmful behaviour when returned to social setting of other monkeys after a period of time.

Question 13

Name four physical signs of Foetal Alcohol Syndrome (Spectrum Disorder) and explain the likely cognitive developmental effects that a child with this syndrome may experience.

Answer 13

1. Smaller head, smaller eyes, shorter upturned nose, thinner lips w less shape
2. trouble learning, solving problems and understanding consequences

Question 14

Name the first four stages of Erikson’s development theory. Use examples to explain the first developmental stage.

Answer 14

1. Trust versus mistrust (infancy)
   - Infant learns to rely on caregivers to meet basic needs of warmth, food and comfort, forming trust in others. Mistrust is the result of inconsistent, inadequate or unsafe care.
2. Autonomy versus shame and doubt (toddler)
   - toddler (1y-3y) learns from the environment and and gains independence through encouragement from caregivers to feed, dress and toilet self. If the caregivers are overprotective or have expectations that are too high, shame and doubt, as well as feelings of inadequacy, might develop in the child.
3. Initiative versus guilt (preschooler, 4y-6y)
   - Confidence gained as a toddler allows the preschooler to take the initiative in learning so that the child actively seeks out new experiences and explores the how and why of activities. If the child experiences restrictions or reprimands for seeking new experiences and learning, guilt results, and the child hesitates to attempt more challenging skills in motor or language development
4. Industry versus inferiority (school-aged children)
   - By focusing on the end result of achievements, the school-aged child gains pleasure from finishing projects and receiving recognition for their accomplishments. If the child is not accepted by peers or cannot meet parental expectations, a feeling of inferiority and lack of self-worth might develop.

Question 15

Using Erikson, Freud and Piaget’s theories, give examples for each one to explain the developmental challenges experienced by a ‘toddler’

Answer 15

• Erikson (autonomy vs shame and doubt): Feeding, dressing and toileting self.
• Freud (anal stage): toilet training, which requires delayed gratification as the child compromises between enjoyment of bowel function and limits set by social expectation
• Piaget (pre-operational stage): beginning the use of symbols through increased language skills and pictures to represent their world.

Question 16

Explain why, when and how you would use the concept of ‘positive reinforcement’ to modify a toddler’s behaviour.

Answer 16

• Positive reinforcement is rewarding desirable behaviour. It increases the occurrence of a response. he child is motivated by the desire to obtain a reward.
  E.g. Giving them a treat or praise them for desirable behaviour, such as cleaning up or playing nicely.

Question 17

According to Piaget’s cognitive developmental theory, four year olds are in the pre-operational stage. Explain and give an example of egocentric thinking that is typical of this development stage.

Answer 17

• beginning the use of symbols, through increased language skills and pictures, to represent their world
• Egocentrism: they’re the centre of their world; it’s hard to understand how others feel or how their behaviour affects others.
  E.g. Covering their eyes when playing hide and seek because they assume that if they can’t see the seeker, the seeker can’t see them.

Question 18

Explain how the water conservation test helps us to understand how a pre-schooler thinks.

Answer 18

• Intuitive rather than rational thinking: what they see is what represents reality. Irreversibility of thinking.
• I.e. Even though the glasses are the same volume, one is taller and since, for them, what you see is what you get, the taller is more.

Question 19

Explain the concept of the ecological transition that may be experienced by a five year old child as they begin primary school. Give six examples of how to prepare a child and their family to cope with this change.

Answer 19

• occurs when a person’s position in their ecological environment is altered as a result of a change in role, setting or both
• Examples
  1. Remind the child of previous transitions and successful change (e.g. starting preschool)
  2. Practice new routines
  3. Visit the school with your child to see their new classroom and meet their new teacher before school officially starts
  4. Point out the positive aspects of starting school. E.g. It will be fun and they can make new friends
  5. Introduce skills which increase independence, such as making lunch, doing chores and helping
  6. Encourage children to verbalise and express feelings; talk and listen

Question 20

Explain the differences between nociceptive and neuropathic pain.

Answer 20

• Nociceptive pain: pain arising from injury or pathology in somatic/visceral structures
• Neuropathic pain: pain arising from pathology to or changes within the peripheral or CNS; leads to abnormal sensation or pain in reaction to non-painful stimuli

Question 21

Describe the biomedical approach to managing the two main kinds of pain.

Answer 21

• Manages acute pain by identifying and treating the cause or providing pain relief until healing occurs.
• Mainly uses analgesics (mild pain), weak opioids (moderate) and strong opioids (severe)
• Limited effectiveness for neuropathic pain; varying success w antidepressants, surgery, injections, stimulation techniques and exercise
• Effective in acute pain, but increasingly less effective for chronic and ends up being main management rather than pain relief

Question 22

Explain the biopsychosocial model of pain. Using the example of a person suffering from chronic back pain, explain how you would use the model to help manage this kind of pain.

Answer 22

• examines biological, psychological, and social factors affecting an individual to examine how/why chronic disorders occur
• framework for diagnosing, understanding and treating chronic pain.
• Manage using functional restoration (a combination of CBT and intense physical therapy): interdisciplinary team focusing on reducing medication (opioid) intake and restoring function, by helping patients overcome the mental and physical obstacles that prevent their recovery. E.g. modifying how they physically perform tasks, helping them “make sense of their pain” from a multidimensional perspective, and adopting healthy lifestyle behaviours. Aims to build self-efficacy in the patient to break the cycle of pain-related distress and disability

Question 23

Discuss the nurse’s role in assessing, monitoring and psychologically supporting a person who is experiencing pain.

Answer 23

• Assessing: Complete pain assessment using objective measures (COLDSPA, pain scale, vital signs, etc.)
• Monitoring: Find out the patient’s pain expectations (what they can tolerate), checking response to interventions, and ensuring that their condition is improving/stable
• Supporting: Making sure they’re comfortable, being cultural safe

Question 24

Explain five steps used to conduct an effective Cognitive Behavioural Therapy (CBT) interview. Describe how CBT can be used to help manage chronic back pain.

Answer 24

1. Establish rapport. (Review case, use written records).
2. identify patient agenda.
3. Use a problem-focussed approach. (Identify physical symptoms and feelings).
4. Focus on a specific situation.
5. Summarise, give patient feedback and set homework for the next session.

• In CBT problems are seen as being linked to a bias or an exaggeration of a normal process.
• 5 systems model; the following interact and reinforce each other: Situation, thoughts, behaviour, physical reactions, and moods/feelings.
  It is believed that changing your thoughts about pain can change how your body responds to pain.
• CBT can be used in combination with medication and alternative or complementary therapies to help people cope with chronic pain conditions such as back pain. medical treatment (as above) with appropriate psychological and social
  support. First, your therapist helps you recognise the negative feelings and thoughts that occur when you have back pain (cognitive part). Then your therapist teaches you how to change those into helpful thoughts and healthy actions (behavioural part).

Question 25

Explain Elisabeth Kubler-Ross’ five stages of grief.

Answer 25

DON’T HAVE TO BE IN ORDER

• Denial: E.g. ‘I feel fine,’ ‘there’s been a mix up,’ or ‘the tests are someone else’s.’
• Anger: Misplaced feelings of anger and envy, project their feelings of anger onto somebody else. E.g. ‘Why me?’ ‘It isn’t fair,’ ‘How can this happen to me?’ ‘Who is to blame?’
• Bargaining: E.g. ‘I will give my life savings for a cure,’ or ‘if I change my diet or exercise more I’ll get better.’ May start to pray to a higher power or find faith
• Depression: allows a process which is the beginning of disconnection from love and affection and the move to acceptance; individuals may refuse to see visitors and spend their time crying, grieving or being silent. E.g. ‘what’s the point I will be dead soon anyway,’ or ‘I miss my loved ones there is no point going on’
• Acceptance: Individuals begin to come to terms w their mortality, or that of a loved one or other tragic event. Can also be a time when individuals try to make peace w relatives and friends as well as helping loved ones come to terms w their end of life. E.g. ‘it’s ok’ and ‘no one lives forever’

Question 26

You have been invited to give a talk to a community support group about how health professionals can support someone who is grieving. Use Kubler-Ross’s theory of grief to organise the 5 main points of your talk.

Answer 26

1. Denial: attempting to pretend that the loss does not exist as they are trying to absorb and understand what is happening.
   - Gives them the time to adjust to reality.
2. Anger: allow patient to talk and express feelings; engage them in exercise or activities.
3. Bargaining: feeling so desperate that they are willing to do almost anything to alleviate or minimize the pain
   - Be aware of poor coping mechanisms
4. Depression: the loss feels more present and unavoidable; increasing feelings of sadness and isolation
   - give patient the time they need; group discussion may help them express their feelings, but don’t force them to talk about it.
5. Acceptance: no longer resisting the reality of their situation, and not struggling to make it something different.
   - Provide them with support to help them work through this, as they can still be feeling sadness and regret in this stage.

Also: give them space, but let them know you are available and accessible when they are ready to talk.

Question 27

Name the steps of the clinical reasoning cycle and give an example of how the cycle can be applied to a nursing situation.

Answer 27

1. Consider the patient situation
2. Collect cues/info
3. Process info
4. Identify problems/issues
5. Establish goal/s
6. Take action
7. Evaluate outcomes
8. Reflect on process and new learning

Question 28

Explain why knowing your personality type can help you to develop reflection and self-awareness skills that relate to nursing practice

Answer 28

It helps with self-awareness by identifying strengths and weaknesses. Also aids in reflection by recognising what went well and what didn’t.

Question 29

How would damage to the brain affect personality? (Give three specific examples).

Answer 29

1. Lack of emotion: A person may lack emotional responses such as smiling, laughing, crying, anger, or enthusiasm, or their responses may be inappropriate
2. Self-centred attitude: The person may lack empathy.
3. Inappropriate sexual behaviour: A person may experience either increased or decreased interest in sex.

Question 30

Use the Transtheoretical model (TTM) to explain Tamara’s smoking behaviour. Suggest what needs to happen and the conditions required for Tamara to give up smoking.

Answer 30

Progress going down
Precontemplation 
Preparation           
Action                     --------->
Maintenance          --------->
Relapse going up

• Precontemplation: she was unaware of the problem with smoking, and had no intention to quit.
• Contemplation: she became aware during her education course that her smoking is a problem and wanted to stop, but had no plans yet
• Preparation: she was making plans and changing things she does in preparation
• Action: She stopped smoking
• Maintenance: she is continuing to not smoke. She may miss it sometimes but still does not smoke.

Conditions: have something, such as a vape, to hold in her hand while drinking; stay out of the smoking section when her friends smoke, and/or encourage them to support her by quitting too; suggest healthy snacking options; go out with others who don’t smoke so she’s not alone

Question 31

What is Kohlberg’s theory of moral development?

Answer 31

Recognised that a person’s moral development is influenced by cultural effects on one’s perceptions of justice in interpersonal relationships.
A child’s moral development begins from caregiver and child communications during the early childhood years, as the young child tries to please its parents.

Question 32

Strategies for helping people work through grief

Answer 32

• Help patient and family be aware of emotions they may encounter in the grief process
• Encourage patient and/or family to express their feelings
• Encourage healthy coping mechanisms such as exercising or gardening
• Identify changes in behaviour, communication, mood, eating and sleeping pattern
• Identify those with poor coping mechanisms. May need grief counselling or antidepressant treatment

Question 33

What is personality

Answer 33

a set of characteristics that people display over time and across situations, which distinguishes one individual from another

Question 34

how does children’s thinking changes in the pre-operational development stage

Answer 34

symbolic thinking - pretend play, using toys and props (medical doll) to represent people (themselves) and objects.
Intuitive rather than rational thinking - what they see is what represents reality (water conservation).
irreversibility of thinking - unable to reverse or ‘undue’ thinking - what they first see represents reality (difficult to change their minds).
egocentrism - they are the centre of their world, it is hard to understand how other people feel, or how their behaviour affects others.