Psychiatric/Mental Health (Exam One) Flashcards
________________ behavior promotes a feeling of personal power and self-confidence.
Assertive behavior
What type of behavior empowers individuals by promoting self-esteem and promotes clear and direct expression of ones needs and rights without impinging on the rights of others?
Assertive behavior
What characteristic is considered basic to assertive behavior?
Honesty
List indirect forms of communication.
- Hinting
- “Beating around the bush”
What type of communication is considered assertive, but conveys honesty with clarity and candor?
Direct communication
List the ten basic assertive human rights.
- Treated with respect
- Express feelings, opinions, and beliefs
- Say ‘no’ without feeling guilty
- Make and accept responsibility for mistakes
- To be listened to and taken seriously
- Change your mind
- Ask for what you want
- Put yourself first, sometimes
- Refuse justification for your feelings/actions
By accepting the ten basic ‘assertive rights’, an individual also accepts what?
The responsibilities that accompany these rights
__________ and ______________ are reciprocal entities.
Rights and responsibilities
List the four common response patterns.
- Nonassertive
- Assertive
- Aggressive
- Passive-aggressive
Describe the nonassertive (passive) response pattern.
Individual seeks to please others at the expense of their basic human rights
Individuals who demonstrate this type of response pattern often feel uncomfortable in interpersonal interactions and harbor anger and resentment.
Nonassertive (passive)
Describe the assertive response pattern.
Individual who stands up for their own rights while protecting the rights of others
Individuals who demonstrate this type of response pattern are considered self-confident and experience satisfactory and pleasurable relationships with others.
Assertive
Describe the aggressive response pattern.
Individual will defend their own basic rights by violating the basic rights of others
Individuals who demonstrate this type of response pattern often express their feelings dishonestly and inappropriately.
Aggressive
What type of behavior hinders interpersonal relationships?
Aggressive behavior
An individual who responds to others by appearing passive and accepting of demands while behaving in ways that suggest anger and resentment is considered what type of response pattern?
Passive-aggressive
Individuals who demonstrate this type of response pattern are considered dishonest, manipulative, and sly, and often undermine others by behaving in a manner that expresses the opposite of what they are feeling.
Passive-aggressive
List an example of passive-aggressive behavior.
Individual agree’s to work an extra shift but does not complete any of the necessary work during the shift and clocks out leaving all of the work to be done by the next employee
Which response pattern is associated with extremely low self-confidence?
Passive-aggressive
Two patients disagree on what movie to watch during free activity time. One patient says to the other, “I would like to watch the comedy instead of the murder mystery.” The nurse recognizes this as which form of communication response pattern? A. Nonassertive B. Assertive C. Aggressive D. Passive-Aggressive
B. Assertive
What type of eye contact is considered appropriate?
Intermittent eye contact
Assertive responses are considered most effective when they are what?
- Spontaneous
- Immediate
What type of statements are considered a key component of assertive communication?
“I” statements
A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include?
A. Eye contact should be steady and continuous
B. Invasion of intimate space can be interpreted as assertive behavior
C. While interacting, individuals should turn slightly away from the other person
D. The facial expression is congruent with the verbal message
D. The facial expression is congruent with the verbal message
___ ____________ allow an individual to take ownership for his or her feelings rather than saying they are caused by another person.
“I” statements
Describe the responding as a broken record technique.
Persistently repeating in a calm voice what is wanted
The following conversation is an example of what type of technique?
Telephone salesperson: I want to help you save money by adding an extended warranty to your vehicle.
Assertive response: I don’t want to add an extended warranty to my vehicle.
Telephone salesperson: I can’t believe you don’t want to save money!
Assertive response: I don’t want to add an extended warranty to my vehicle.
Responding as a broken record
Describe the characteristics of the agreeing assertively technique.
- Accepting negative aspects about oneself
- Admitting when an error has been made
The following conversation is an example of what type of technique?
Ms. Jones: You sure let that meeting get out of hand. What a waste of time.
Ms. Smith: Yes, I didn’t do a very good job of conducting the meeting today.
Agreeing assertively
Describe the inquiring assertively technique.
Seeking additional information about critical statements
The following conversation is an example of what type of technique?
Male board member: You made a real fool of yourself at the board meeting last night.
Female board member: Oh, really? Just what about my behavior offended you?
Male board member: You were so damned pushy!
Female board member: Were you offended that I spoke up for my beliefs, or was it because my beliefs are in direct opposition to yours?
Inquiring assertively
Who developed the thought-stopping technique?
Joseph Wolpe
What technique is intended to eliminate intrusive, unwanted thoughts?
Thought-stopping technique
Assertive communication is part of a larger set of competencies referred to as __________ ___________.
Emotional intelligence
List the four competencies included in emotional intelligence.
- Self-awareness
- Social awareness
- Self-management
- Relationship management
______________ describes an individuals thoughts and beliefs about themselves.
Self-concept
________________ describes how individuals feel about themselves.
Self-esteem
List the three components of self-concept.
- Physical self or body image
- Personal identity
- Self-esteem
The subjective perception of one’s physical appearance based on self-evaluation and reactions and feedback from others in known as what?
Body image
________________ is the degree of regard or respect that individuals have for themselves and is a measure of worth that they place on their abilities and judgements.
Self-esteem
A patient with a new ileostomy tells the nurse, “I’m disgusting. This ileostomy makes me so ugly.” Which correctly written nursing diagnosis would be appropriately assigned to address this patient’s problem?
A. Situational low self-esteem related to disturbed body image evidenced by client statement “I’m disgusting”
B. Risk for complicated grieving related to loss of normal GI function evidenced by expressions of anger
C. Disturbed thought processes related to ileostomy evidenced by altered body image
D. Anxiety related to cancer of the colon evidenced by ileostomy
A. Situational low self-esteem related to disturbed body image evidenced by client statement “I’m disgusting”
List factors that are consistently correlated with higher self-esteem.
- Emotional stability
- Extroversion
- Conscientiousness
- High sense of mastery
- Low risk taking
- Being healthy
Describe internal locus of control.
Person contributes success’ or failures to their own efforts
Describe external locus of control.
- Feel helpless
- Feel they are not in control of their own success’ or failures
After his wife left him, the husband, diagnosed with depression, is admitted to a psychiatric unit. He states that he was proud of receiving job commendations that led to a promotion. Which condition that would affect self-esteem has contributed to the patient’s depression?
A. The lack of power
B. The lack of significance
C. The lack of virtue
D. The lack of competence
B. The lack of significance
A mother berates her child for breaking a cup and says, “You are bad and so destructive.” This statement discourages the development of positive self-esteem by not meeting which parenting focus as described by Warren?
A. A sense of competence
B. Unconditional love
C. A sense of survival
D. Realistic goals
B. Unconditional love
According to Erikson, when an individual fails to achieve the tasks associated with a development their emotional growth is _________.
Inhibited
How many stages of psychosocial development did Erikson describe?
8
Erikson’s developmental stage, Trust versus Mistrust, occurs during what age range?
Birth to 18 months
According to Erikson, the developmental stage that occurs between birth and 18 months of age is known as what?
Trust versus Mistrust
Erikson’s developmental stage, Autonomy versus Shame and Doubt, occurs during what age range?
18 months to 3 years
According to Erikson, the developmental stage that occurs between 18 months and 3 years of age is known as what?
Autonomy versus Shame and Doubt
Erikson’s developmental stage, Initiative versus Guilt, occurs during what age range?
3 years to 6 years
According to Erikson, the developmental stage that occurs between 3 years and 6 years of age is known as what?
Initiative versus Guilt
Erikson’s developmental stage, Industry versus Inferiority, occurs during what age range?
6 years to 12 years
According to Erikson, the developmental stage that occurs between 6 years and 12 years of age is known as what?
Industry versus Inferiority
Erikson’s developmental stage, Identity versus Role Confusion, occurs during what age range?
12 years to 20 years
According to Erikson, the developmental stage that occurs between 12 years and 20 years of age is known as what?
Identity versus Role Confusion
Erikson’s developmental stage, Intimacy versus Isolation, occurs during what age range?
20 years to 30 years
According to Erikson, the developmental stage that occurs between 20 years and 30 years of age is known as what?
Intimacy versus Isolation
Erikson’s developmental stage, Generativity versus Stagnation, occurs during what age range?
30 years to 65 years
According to Erikson, the developmental stage that occurs between 30 years and 65 years of age is known as what?
Generativity versus Stagnation
Erikson’s developmental stage, Ego Integrity versus Despair, occurs during what age range?
65 years and older
According to Erikson, the developmental stage that occurs at 65 years of age and older is known as what?
Ego Integrity versus Despair
Are Erikson’s stages of development determined according to age or task development?
Age
How would a nurse promote self-esteem and prevent a 42 year old patient from falling into the stagnation stage of development?
Recommend volunteer work
According to Erikson, what factors are the most detrimental to the self-esteem, or are most likely to cause low self-esteem, of a person between the ages of 12 and 20 years old?
- Absent parental support
- Overly harsh discipline
- Inconsistent discipline
- Absent discipline
Self-confidence is gained at this stage through learning, competing, performing successfully, and receiving recognition from significant others, peers, and acquaintances? (List the name and age range of the specific stage of development)
- Industry versus Inferiority
- 6 to 12 years
Which stage of development will occur when love in the home has been deprived or distorted throughout the younger years, causing severe impairment in self-esteem? (List the name and age range of the specific stage of development)
- Intimacy versus Isolation
- 20 to 30 years
List an example of the isolation stage of development. At what age does this stage of development occur?
- 20 to 30 years old
- Patient has been financially supported all of his life by his parent(s)/caregiver(s)
Describe focal stimuli.
Immediate concern that causes threat to one’s self-esteem
An individual being fired from their job is an example of what type of stimuli?
Focal stimuli
Describe contextual stimuli.
Environment contributes to what is happening
An individual who is preoccupied over their divorce and how it will affect their children is an example of what type of stimuli?
Contextual stimuli
Describe residual stimuli.
Previous experiences influence maladaptive behavior
An individual raised in an environment being constantly ridiculed who grows up to feel like they will never be able to be successful is an example of what type of stimuli?
Residual stimuli
List priority nursing intervention(s) for a patient with chronic low self-esteem.
- Assess negative self-talk
- Promote positive self-talk
The word ____________ is used to denote the personal space, both physical and psychological, that individuals identify as their own.
Boundary
Healthy ____________ are a measure of self-esteem, communicate self-respect, and an expectation to be treated well in interpersonal relationships.
Boundaries
List the three types of boundaries.
- Rigid
- Flexible
- Enmeshed
__________ boundaries occur when people have a very narrow perspective.
HINT: Cats
Rigid
___________ boundaries occur when people are able to let go of their boundaries as appropriate.
HINT: Dogs are flexible
Flexible
______________ boundaries occur when two people’s boundaries are so blended together that neither can be sure where one stops and the other begins.
Enmeshed
List the characteristics of an individual with rigid boundaries.
- Non-trusting
- Difficulty communicating
- Physically/emotionally withdrawn
Give an example of enmeshed boundaries.
An adult child is financially supported by his/her parents
Unhealthy boundaries occur within what types of families?
- Unhealthy
- Dysfunctional
- Troubled
How is self-esteem fostered in the older adult population, such as those in a long-term care facility?
Providing choices about their care
A law school graduate failing the bar examination and a 15-year-old high school girl not being selected for the cheerleading squad are examples of which of the following?
A. Focal stimuli
B. Contextual stimuli
C. Residual stimuli
D. Spatial stimuli
A. Focal stimuli
Jessica told Andrea a secret that Eva had told her. This is an example of which of the following?
A. Too flexible a boundary
B. A boundary violation
C. Too rigid a boundary
D. An enmeshed boundary
B. A boundary violation
___________ is a normal, healthy emotion that serves as a warning signal and alerts us to potential threat or trauma.
Anger
What is the result of anger being turned inward on oneself?
- Depression
- Low self-esteem
___________ is a negative function or destructive use of anger.
Aggression
List physical maladaptive expressions of anger.
- Sleepiness
- Nausea/vomiting
- Pain
- Headaches
List the physiological changes associated with anger.
- Increased heart rate
- Increased blood pressure
- Increased adrenaline
- Increased noradrenaline
Is the expression of anger considered an innate behavior or a learned behavior? Is it considered a primary emotion?
- Learned behavior
- No it is a secondary behavior
Does anger cause physiological arousal or psychological arousal?
Physiological arousal
A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. What is an accurate description of this display of emotion?
A. Anger is a primary emotion that is automatically experienced
B. Anger is a psychological arousal
C. Expression of anger can come under personal control
D. Expression of anger and aggression are closely related
C. Expression of anger can come under personal control
What is considered the negative function or use of anger?
Aggression
_______ ____________ is one of the strongest forms of learning.
Role modeling
Whether role modeling is positive or negative depends on what?
The behavior of the model
Describe operant conditioning.
Occurs when a specific behavior is positively or negatively reinforced
A __________ ___________ is a response to the specific behavior that is pleasurable or produces the desired result.
Positive reinforcement
A ________ ____________ is a response to the specific behavior that prevents an undesirable result from occurring.
Negative reinforcement
Anger and aggression can be learned through ___________ ____________.
Operant conditioning
After repeated requests for a patient to unpack and get settled on the psychiatric unit, the patient states, “I have no intention of unpacking and staying on this unit.” To avoid a confrontation, the nurse unpacks the patient’s belongings. Which nursing behavior is exemplified?
A. Positive role modeling
B. Negative operant conditioning
C. Assertiveness
D. Aggressiveness
B. Negative operant conditioning
Which hormone has been identified as playing a key role in aggressive behavior?
Testosterone
List the three environmental factors that have been shown to increase risk for aggression.
- Crowding of people
- Uncomfortable temperatures
- Noise
List the three best predictors, or red flags, of violent behavior.
- Alcohol intake/substance abuse
- History of child abuse
- History of violent criminal activity/arrests
List the early signs of anger.
- Restlessness
- Anxiety
- Irritability
- Pacing
- Rapid breathing
- Perspiration
- Loud voice
T/F: Accidents that lead to unintentional harm or destruction are not considered aggression.
True
What is considered the key factor in managing aggressive or violent behavior?
Prevention
List the three factors that have been identified as important considerations in assessing for potential violence.
- History of violence
- Client diagnosis
- Current behavior
Assaultive behavior is highly correlated with which specific diagnoses? (SATA)
A. Substance use disorder B. Dementia C. Schizophrenia D. Anorexia nervosa E. Major depression F. Bipolar disorder
A, B, C, E, F
List the different types of behavior or actions the nurse should display when a patient is manifesting or exhibiting signs of prodromal syndrome.
- Show expectation of patient to maintain control over their behavior
- Enforce a healthier behavior
- Avoid challenging the patients behavior
List the physical signs and symptoms of prodromal syndrome.
- Rigid posture
- Clenched fists/jaw
- Grim/defiant affect
- Rapid talking
- Raised voice
- Arguing
- Agitation
- Pacing
- Pounding
- Slamming
An angry patient states to the nurse, “You red-headed skinny witch. You can’t tell me what to do.” Which appropriate intervention would the nurse implement during this outburst?
A. Reprimand the patient for poor judgment and derogatory remarks
B. Respond to angry expressions with matching verbalizations
C. Offer support by the use of empathy and therapeutic touch
D. Ignore initial derogatory remarks
D. Ignore initial derogatory remarks
How would the nurse determine if a patient is making progress in their inability to control inappropriate expressions of anger?
- Patient acknowledges they have a problem expressing their anger appropriately
- Patient is able to identify when they are becoming angry
When should restraints be utilized on a patient?
Patient is a danger to themselves or others
When should restraints be removed from a patient?
As soon as the patient is no longer a threat to themselves or others regardless of the order
When should a physician physically assess a patient who has been placed in restraints?
Within one hour of the restraints being applied
How long can a patient be placed in restraints if they are 18 years of age or older?
Up to 4 hours
How long can a patient be placed in restraints if they are between the ages of 9 and 17 years old?
Up to 2 hours
How long can a patient be placed in restraints if they are under the age of 9 years old?
Up to 1 hour
How often must a patient be monitored if they are placed in restraints or seclusion?
-Every 15 minutes
