When interviewing an adolescent patient the nurse can expect the patient to be most concerned about the issue of?

QuestionAnswerTraits of Mental Health Ability to Think rationally Communicate appropriately Learn Grow emotionally Be resilient Have a healthy self-esteem The traits that contribute to mental health is the ability to: Accurate appraisal of reality Love and experience joy Have the capacity to deal with conflicting emotions Live without undue fear, guilt, or anxiety Take responsibility for one’s own actions Control one’s own behavior Think clearly and rationally Problem solve Use good judgment Reason logically Reach insightful conclusions Be creative Learn Relate to others Communicate appropriately Form relationships Have close, loving, adaptive relationships Experience empathy toward others Manage interpersonal conflict constructively Be resilient An important characteristic of mental health either in recovery or the maintenance of mental health is resilience. It is considered the process of how individuals adapt and handle severe stress, loss, trauma, or tragedies. Mental Illness Considered clinically significant when marked by Patient’s distress Disability or Risk of disability or Loss of freedom Is culturally defined mental illness has been defined as a psychological syndrome or observing clinically significant behavior. This behavior is indicated by the patient’s distress, disability, risk of disability, or loss of freedom. The factor to remember is that mental illness is how illness is how the individual responds to marked distress in not being able to handle the tasks of everyday living. Diathesis-Stress Model Diathesis biological predisposition Stress environmental stress or trauma Most accepted explanation for mental illness National Alliance on Mental Illness (NAMI) This was a nationwide advocacy group formed by people with mental illness and their families in 1979 This brought about a consumer movement to allow the consumer to have more involvement in their own treatment and be part of their own recovery Decade of the Brain This occurred in 1990 and was designated by George H. W. Bush. It was established to enhance and stimulate neuroscience and brain research. Great strides were made due to this research. To see the specific advances and progress that was made, you can f New Freedom Commission on Mental Health This was released in 2003 attempting to revamp mental health care. It encouraged early diagnosis and treatment, right along with new expectations for principals of recovery and increased assistance in facilitating people to find work and housing Mental Health Parity Act There is no mandate for employers to provide mental health coverage This was signed into law in 1996 to equalize the mental health care coverage of an insurer to the same level as the medical/surgical coverage. In 2008, the Wellstone-Domenici Parity Act Mental disorders are considered a manifestation of a Behavioral Psychological or Biological what is used to classify diagnostic categories for psychiatric disorders. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR The DSM-IV-TR is a manual for what? the classification of mental health disorders. This classification explains the behavior, the psychological aspects, and the biological aspects of each mental disorder. The DSM-IV-TR describes the mental disorders and not the people that have the disord Axis I: Mental disorder that is the focus of treatment entails 16 major categories of mental health disorders. Axis II: Personality disorders and mental retardation Axis III General medical disorder relevant to the mental disorder in axis I Axis IV: Psychosocial and environmental problems issues that can affect the diagnoses, treatment, and prognosis of the individual with the mental disorder . Some of these issues could be homelessness, unemployed, lack of family support or lack of education. Axis V: Global Assessment of Functioning (GAF) which is a scale from 1-100 determining the person’s best function score of the preceding year. This score is considered the level of psychosocial, social, and occupational functioning. what is ICD-10 International Classification of Disease Clinical descriptions of mental and behavior disorders Divided into 10 disease classifications The 10 disease classifications are: Organic – includes symptomatic mental health disorders Mental and behavior disorders due to psychoactive substance use Schizophrenia, schizotypal, and delusional disorders Mood or affective disorders Neurotic, stress-related, and somatoform disorders Levels of awareness Conscious Preconscious Unconscious Personality structure Id Ego Superego Id Pleasure principle Reflex action Primary process Ego Problem solver Reality tester Superego Moral component Sullivan's Interpersonal Theory -Purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety Foundation for Hildegard Peplau's theory Participant observer Mutuality Respect for the patient Unconditional acceptance Empathy Hildegard Peplau The art of nursing Provide care, compassion, and advocacy Enhance comfort and well-being The science of nursing -Application of knowledge to Understand a broad range of human problems and psychosocial phenomena Intervene in relieving patients' suffering and promote growth Rational-Emotive Behavior Therapy (Ellis) Aims to eradicate irrational beliefs Recognize thoughts that are not accurate Cognitive-Behavioral Therapy (Beck) Test distorted beliefs and change way of thinking; reduce symptoms Culture Groups with shared beliefs, values, and practices Influences their thinking and behavior Deviance from cultural expectations can be defined as illness by other members of the group Western Tradition - Values Autonomy Independence Self-reliance Eastern Tradition Family basis for identity Body-mind-spirit one entity Disease caused by fluctuations in opposing forces Time is circular and recurring Born into a fate; duty to comply Indigenous Culture Place significance on place of humans in natural world Basis of identity is the tribe Person an entity only in relation to others Disease – lack of harmony of individual with environment Ethnocentric Tendencies Nurses influenced by their own professional and ethnic cultures Ethnocentrism Assuming one’s own beliefs, values, and practices are the best, preferred, or only way Populations at Risk of Mental Illness and Inadequate Care Immigrants Refugees Cultural “minorities” Cultural Competence for Psychiatric Mental Health Nurses - Five constructs Five constructs 1. Cultural awareness 2. Cultural knowledge 3. Cultural encounters 4. Cultural skill 5. Cultural desire Cultural knowledge Learn by attending cultural events and programs Forge friendships with diverse cultural groups Learn by studying Learning cultural differences helps nurse Establish rapport Ask culturally relevant questions Avoid cultural insensitivity Cultural encounters Deter nurses from stereotyping Help nurses gain confidence in cross-cultural interactions Help nurses avoid or reduce cultural pain Cultural skill Ability to perform a cultural assessment in a sensitive way Use professional medical interpreter to ensure meaningful communication Use culturally sensitive assessment tools Goal A mutually agreeable therapeutic plan Culturally acceptable Capable o Cultural desire Genuine concern for client's welfare Willingness to listen until client's viewpoint understood Patience, consideration, and empathy Ethical dilemma Conflict between two or more courses of action, each with favorable and unfavorable consequences Ethics The study of philosophical beliefs about what is considered right or wrong in a society Bioethics Used in relation to ethical dilemmas surrounding health care Beneficence The duty to promote good Autonomy: Respecting the rights of others to make their own decisions - this is respecting the rights of others to make their own decisions. Justice: Distribute resources or care equally -this is the distribute resources or care equally regardless of any personal attributes. Fidelity nonmaleficence): Maintaining loyalty and commitment; doing no wrong to a patient Veracity: One's duty to always communicate truthfully In 1963, President John F. Kennedy signed into law the Community Mental Health Centers Act which stated that people with mental illnesses were to be treated in their own communities. It’s goal was to make sure that mental health services were made available to individuals. A person’s civil rights include: The right to vote. The right to civil service ranking. The right to receive, forfeit, or deny a driver’s license. The right to make purchases and enter into contractual relationships The right to press charges against another person. The right to huma . The Fifth Amendment has dictated that a person requires due process protections in the civil commitment procedure to have their life, liberty, or property denied. Under the Fourteenth Amendment of the Constitution, there is an explicit statement that the state cannot deny citizens of life, liberty, or property with due process. If a citizen is denied any of these rights, that citizen is allowed to challenge the state on constitutional grounds, thus causing the state to support their commitment proces The Writ of habeas corpus is a a formal written order for a person to be freed from commitment. It is a document that is presented to challenge an unlawful detention by the government The Least restrictive alternative doctrine states that the least restrictive means are to be used in order to achieve a specific purpose. An informal admission is a a type of voluntary admission in which there is no formal or written application to be admitted. This is an admission that is sought by the patient and is much like any general hospital admission. A voluntary admission is the type of admission just as in the informal admission is sought by the patient or guardian. There is a written application to be admitted. The patient does have the right to ask for and receive a discharge. In this type of admission, many states require the patient to ha A temporary admission is used for those individuals that are confused or demented and can’t make decisions for themselves or are so ill they need an emergency admission. This type of admission is originated by a physician then is established by a psychiatrist that is employed by An involuntary admission is one one in which the patient is admitted to a facility without the patient’s consent. This type of admission is necessary for the patient that is in need of psychiatric care because of being a danger to self or others, or is unable to meet his or her own bas An involuntary admission-The patient does have the right for his/her his/her close family to be notified of the patient’s hospitalization, a right to legal council and the right to go before a judge to determine if the patient is to remain in the facility or be released from the facility. This type of admission are not al Which individual with mental illness may need involuntary hospitalization? A person with alcoholism who has been sober for 6 months but begins drinking again. An individual with schizophrenia who stops taking prescribed antipsychotic drugs. An individu The answer is option C. An individual with bipolar disorder, manic phase, who has not eaten in 4 days. The rational for this answer is that when an individual has not eaten in four days, they are displaying the inability to meet his/her basic needs. Th Patients’ Rights Under the Law Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment and psychiatric advance directives Rights regarding restraint and seclusion Right to confidentiality An unconditional release is the release is the discharge of a patient from the hospital which could be court ordered or administrative ordered by the facility’s officials and there are no conditions placed on the patient after the discharge. A release against medical advice or an AMA is is the discharge in which the patient and treatment team disagree about the continued need for hospitalization. As long as the patient isn’t an involuntary admission or the patient is not meeting the criteria of the voluntary admission warrants a change Patients’ Rights Under the Law Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment and psychiatric advance directives Rights regarding restraint and seclusion Right to confidentiality . Patients must be informed of: The nature of their problem or condition. The native and purpose of a proposed treatment. The risks and benefits of that treatment. The alternative treatment options. The probability that the proposed treatment will be successful. The risks of not co Behavioral restraint and seclusion can be authorized as an intervention under the following circumstances: When the particular behavior is physically harmful to the patient or a third party. When alternative or less restrictive measures are ineffective to protect the patient and others. When a decrease in sensory overstimulation is necessary, this is for sec In using seclusion and restraint, it is permitted under the following conditions: By the written order of the physician. When orders are confined to specific time-limited periods. When the patient’s condition is reviewed and documented regularly. When the original order is extended after review and reauthorization and specifies the The right to confidentiality – confidentiality is the the ethical responsibility of a health care professional that prohibits the disclosure of privileged information without the patient’s informed consent. The Health Insurance Portability and Accountability Act or HIPAA was enacted in in 1996 that established national standards for the protection of electronic medical records of the patients Exceptions to the rule - Patient Confidentiality Duty to warn and protect third parties Child and elder abuse reporting statutes In 1974 the California Supreme Court decided in the case of Tarasoff vs. Regents of University of California This duty to protect includes: Assessing and predicting the patient’s danger of violence toward another. Identifying the specific persons being threatened. Taking appropriate action to protect the identified victims. Failure to report a potential threat is seen as negligence Tort A civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendantThe injury can occur to person, property, or reputation.) Intentional tort Willful or intentional acts that violate another person’s rights or property Battery Assault False imprisonment Invasion of privacy Defamation of character (slander or libel) intentional torts:Battery – which is the harmful or offensive touching of another person. intentional torts:False imprisonment this may be a misdemeanor or tort brought against health care providers who illegally hold people in confinement. intentional torts:Invasion of privacy Invasion of privacy – this is breaking a person’s confidences or taking photographs without specific permission of the individual in a healthcare setting. This includes using the camera or video on one’s cell phone. Defamation of character (intentional torts:) this includes slander or verbal, which is talking about patients in public and libel which is releasing written information that the patient has shared to the health care provider. intentional torts:Assault – Assault – which is an intentional threat designed to make the victim fearful; produces reasonable apprehension of harm. intentional torts: Confinement Confinement includes restraint within a limited area and restraint within an institution. An unintentional tort this is the unintended act against another person that results I injury or harm to that person. This can occur through: Negligence which is an act, or failure to act, that breaches the duty of due care and results in or is responsible for another person’s injuries. Malpractice which is an act or omission to act that breaches the duty of due care and results in or is responsible for a person’s injuries. There are five elements that are required in order to prove negligence which are: Duty Breach of duty Cause in fact Proximate cause Damages Five Elements to Prove Negligence:Duty this includes the care of the psychiatric patient, to understand the theory and medications used in psychiatric care. Those nurses that are mental health nurse specialists possess superior knowledge and skill and are held to an even higher standard of ca Five Elements to Prove Negligence:Breach of duty this is any conduct that exposes the patient to an unreasonable risk of harm, through either commission or omission of acts by the nurse. This can also be considered when a nurse that is not qualified in a specific specialty and works in that area and ex Five Elements to Prove Negligence:Cause in fact this is evaluated by asking the question: “Except for what the nurse did, would this injury have occurred?” Proximate cause – which is legal cause and is evaluated by determining whether there were any intervening actions or persons that were the causes Five Elements to Prove Negligence:Damages this is actual damages such as loss of earnings, as well as pain and suffering. This damage could be incident or consequential. This could be an incidence such as the nurse giving the wrong medication which results in a temporary problem that the damage Five Elements to Prove Negligence:Foreseeability of harm this evaluates the likelihood of the outcome under the circumstances. If the average reasonable person can foresee that injury can occur as a result of an action. In this instance, the injury is foreseeable. Admissions reserved for Suicidal Homicidal or Extremely disabled in need of short-term acute care Funding Psychiatric Mental Health Care Private pay insurance Managed care plans Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Managed behavioral health care organizations (MBHOs) Medicaid Medicare (ACT) Assertive Community Treatment Principles to consider when planning care Safe Compatible and appropriate Realistic and individualized Evidence-based Walter Cannon Fight-or-flight response Fight-or-flight response Body prepares for situation that individual perceives as threat to survival New research indicates that men and women have different neural responses to stress Hans Selye General Adaptation Syndrome (GAS) Three stages Alarm or acute stress stage Resistance or adaptation stage Exhaustion stage diathesis-stress model in which diathesis represents biological predisposition, and stress represents envionmental stress or trauma the most accepted explanation for mental illness? diathesis stres model NAMI natinal alliance on mental illness 1979 who was the decade of the brain 1990 President George H.W. Bush - to make legislators and the general public aware of the advances that had been made in neuroscience and brain research incidence refers to the number of new cases of menal disorders in a healthy population within a given period of time prevalence describes the total of number of cases new and existing in a given population the main personality disorders are? obsessive compulsive, narcissistic, histrionic, paranoid, borderline, dependent, schizoid, anxious/avoidant, schizotypal and antisocial. mental health and mental illness are not either or propositions but but end points on a continuum resilience is a personal characteristic that helps to promite adaptation to stressful circumstances. this is a trait that can be promoted and improved to strengthen responses to stress comorbid conditions are those those disorders that occur at the same time as another condition. for example a person with schizophrenia may also have comorbid diabetes, depression and hypertension talk therapy or cathartic method getting things off our chest what are the levels of awareness conscious(perceptions, memories, thoughts, fantasies and feelings), pre conscious and unconscious (repressed memories, passions, and unacceptable urges id source of all drives, instincts, reflexes, needs, genetic inheritance, capacity to respond as well as all the wishes that motivate us. the id cannot tolerate frustration and seeks to discharge tension ego develops because the needs, wishes and demands of the id cannot be satisfactorily met through primary processes and reflex action super ego represents the moral component of personality. the super ego consists of the conscience. the super ego represents the ideal rather than the real; it seeks perfection as opposed to seeking pleasure or engaging reason. the ego develops defense or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings they al operate on an unconscius level and we are not aware of their operation, and they deny falsify or distort reality to make it less threatening. One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand the root causes of client suffering. According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as the part of the mind will have problems with: Correct all material that the person is aware of at any one time. The nurse explains to a depressed client who was abused physical as a child that his id is: the source of his instincts to save himself from hurting himself. As a result of Harry Stack Sullivan, the nurse in virtually all residential and day hospital settings is involved in providing clients with: A psychotherapeutic environment The nurse is working with a severely depressed client who has very low self-esteem and is distrustful of unit staff. The client is facing role transition from wife to wife and mother. The nurse's priority is to: establish trust with the client. The nurse uses Maslow's model of needs to direct the identification of an anxious client' priority intervention to be: assessing the client for her strengths upon which a nurse-client relationship can be based. The nurse is working with a patient who lacks the ability to problem solve and seeks ways to self-satisfy without regard for others. The nurse understands that which system of the patient’s personality is most pronounced? Id Which behavior, seen in a 30-year-old patient, would alert the nurse to the fact that the patient is not in his appropriate developmental stage according to Erikson? . Says “I’m still trying to find myself.” A patient has difficulty sitting still and listening to others during group therapy. The therapist plans to use operant conditioning as a form of behavioral modification to assist the patient. Which action would the nurse expect to see in group therap The patient will receive a token from the therapist for each session in which she sits still and listens. The nurse is planning care for a patient with anxiety who will be admitted to the unit shortly. Which nursing action is most important? Identify a room where the patient will have comfortable surroundings, and order a balanced meal plan How do Freud’s concepts of the conscious, preconscious, and unconscious affect your understanding of patients’ behaviors? When we begin to take conscious and unconscious influences into consideration, we can potentially help a patient identify the “root” causes of their anguish. Freud was the first to identify the importance of counseling sessions characterized by attentive Do you believe that Erikson’s psychosocial stages represent a sound basis for identifying disruptions in stages of development in your patients? Support your position with a clinical example. Erickson’s stages of development extended throughout the lifespan, which is more complex than Freud’s theory. As the text points out, analysis of behavior patterns using Erikson’s framework can identify age-appropriate or arrested development of normal in What are the implications of Sullivan’s focus on the importance of interpersonal relationships for your interactions with patients? According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety. He would expound on the interpersonal theory to include a therapeutic component. Sullivan’s theory is the foundatio Peplau believed that nurses must exercise self-awareness within the nurse-patient relationship. Describe situations in your student experience in which this self-awareness played a vital role in your relationship(s) with patient(s). I have found myself in a situation where the patient was being very hostile to the nursing staff and to me. I felt myself becoming angry at the patient, as if it were a personal attack. Consciously telling myself that the patient’s behaviors weren’t perso Identify someone you believe to be self-actualized. What characteristics does this person have that support your assessment? Last year we honored a nurse who had been in the profession for 40 years. Even though she was officially retired, she was still on call as a contingency nurse and would work to suit her schedule. The characteristics she demonstrated to me that supported h How do/will you make use of Maslow’s hierarchy of needs in your nursing practice? The most important thing about Maslow’s hierarchy of needs is that our patients’ physiological needs must be met first, before any of the “higher”-level needs. That is not to say love and belonging or self-actualization aren’t important, but basic physiol What do you think about the behaviorist point of view that a change in behavior results in a change in thinking? Can you give an example of this in your own life? This thought process is based on the belief that maladaptive behaviors (or behaviors in general) can be changed without insight into the underlying cause. The text uses an example of using modeling. Student nurses are often frightened when it comes to cal Which of the therapies described in this chapter do you think are/will be the most helpful to you in your nursing practice? Explain your choice. I tend to favor cognitive therapy because it forces the patient to look at faulty thinking and allows for an opportunity to correct misinterpretations. Those misinterpretations can lead us to make “mountains out of molehills.” I also have subscribed to Ab An experienced nurse is monitoring a new nurse. Which action of the new nurse would cause the experienced nurse to intervene? Asking a patient to justify her behaviors The nurse is planning care for a patient with anxiety who will be admitted to the unit shortly. Which nursing action is most important? Identify a room where the patient will have comfortable surroundings, and order a balanced meal plan A patient has difficulty sitting still and listening to others during group therapy. The therapist plans to use operant conditioning as a form of behavioral modification to assist the patient. Which action would the nurse expect to see in group therap The patient will receive a token from the therapist for each session in which she sits still and listens. . Which behavior, seen in a 30-year-old patient, would alert the nurse to the fact that the patient is not in his appropriate developmental stage according to Erikson? Says “I’m still trying to find myself.” You are a community mental health nurse meeting with a patient who has just been discharged from the hospital where he had received his first episode of psychiatric care. Which of the following activities would you expect to undertake in your role as Take a ride on the local bus system with the patient to help him learn routes and schedules A nurse providing in-home mental health care enjoys working with Mr. Jones, an elderly man suffering from depression since the loss of his wife and a recent below-knee amputation that has left him homebound. A fondness develops between the two, with t Continue to decline the gifts while helping him find other ways to express his feelings. Mr. Johnson has been hospitalized twice in 5 years with a severe, chronic psychiatric disorder. He responds well to inpatient and community treatment and is usually stable, but he also has a history of becoming socially withdrawn and failing to provid Partial hospitalization program Mrs. Smith, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications? Help Mrs. Smith to understand her illness and share in decisions about her care. In order to be most affective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess: creative problem solving and intervention skills. The Advanced Practice Psychiatric Nurse is asked to explain what a psychosocial rehabilitation program is. The nurse responds best when sharing: "Referrals from inpatient and intensive out patient facilities are provided with long termcare that focuses on desired goals." A client is being discharged after a short hospitalization. He will receive continuing care from a community mental health nurse who will visit his home. Unlike in the hospital where the goal is the stabilization of the client and driven by the psychiatri negotiated by both client and staff and focused on long term functioning In 1963 the Community Mental Health Centers Act was signed with the primary purpose of: Providing mental health care on an outpatient basis in order to maintain the client as a member of an established community When preparing an education program focused on the history of the community mental health movement in the United States, the nurse includes the fact that: The shift from care in psychiatric hospitals to community mental health centers to the community began in the 1960s. In order to be most affective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess: creative problem solving and intervention skills. The psychiatric community health nurse engages in primary prevention when: Providing stress reduction seminars at the local senior center In 1963 the Community Mental Health Centers Act was signed with the primary purpose of: Providing mental health care on an outpatient basis in order to maintain the client as a member of an established community A community mental health nurse whose culture is Hispanic is assigned to a mobile mental health care unit in a locale where the majority culture is Vietnamese. A measure that will help the nurse plan and implement culturally sensitive care for clients is arranging for the services of an interpreter and cultural consultant. An example of deinstitutionalization would include: Discharging a stabilized psychotic client to a transitional half way house The community mental health nurse recognizes that the mental ill population will require: frequent assessment for physical illness both acute and chronic in mature A community mental health nurse is responsible for medication management for clients. Which general approach can be anticipated to yield the best results? Empowering clients to be responsible for medication compliance Which idea held by the nurse would best promote the provision of culturally competent care? Western biomedicine is one several established healing systems. Which idea held by the nurse would best promote the provision of culturally competent care? Western biomedicine is one several established healing systems. When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects imbalance. Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? Religious ritual The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports appeasement of spirits. The nurse assesses the wellness beliefs and values of a client from another culture best when asking: "What do you think is making you ill?" Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? "What usually helps people who have the same type of illness you have?" Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to power and control. The psychiatric nurse planning and implementing care for culturally diverse clients should understand holistic theory. A nurse is adequately representing the stated bioethical principle when valuing: autonomy by respecting a client's right to decide to refuse cancer treatment. Which statement about right to treatment in public psychiatric hospitals is accurate? Hospitalization without treatment violates the client's rights. What ethical principle is supported when a physician obtains informed consent for electroconvulsive therapy from a depressed client? Autonomy A psychiatric technician reports to the charge nurse that a client is going to sue for negligence because she intervened to prevent him from striking another client. The charge nurse shares with the psychiatric technician that negligence: is an act or failure to act in a way that a responsible employee would act. The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between the ethical principles of autonomy and beneficence. What assumption can be made about the client who has been admitted on an involuntary basis? The client is a danger to self or others or unable to meet basic needs. When the nurse reads the medical record and learns that a client has agreed to receive treatment and abide by hospital rule, the correct assumption is that the client was admitted: voluntarily. ID: 45475169 A client is released from involuntary commitment by the judge, who orders that a caseworker supervise him for the next 6 months. This is an example of conditional discharge. A client who is to be discharged the next day tells the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? Report the incident to the client's therapist and document If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client would have the right to bring suit against the hospital for false imprisonment. Which statement reflects a principle the psychiatric nurse follows in planning actions to reach agreed-on client outcomes? Individuals have the right to autonomy to make decisions that affect them. Interviewer anxiety during an assessment interview is most likely to stem from the client's perception of the interviewer's ability to help the client. A factor that will interfere most with obtaining data in an initial assessment interview of an older adult is client's physical and cognitive deficients. A nurse is interviewing a new client who is angry and highly suspicious. When the nurse asks about a client's sexual orientation, the client becomes highly distressed and threatens to walk out of the interview. The nurse should say "I can see that this topic makes you uncomfortable. We can defer discussion of it today A nurse is about to interview a client whose glasses and hearing aid were placed in safe keeping when she was admitted. Before beginning the interview, the nursing intervention that will best facilitate data collection is to assist the client in putting on glasses and hearing aid What is the common behavior shared by both client and the nurse at the beginning of the initial assessment interview? Anxiety When interviewing an adolescent client, the nurse can expect the client to be most concerned about the issue of confidentiality. The nurse best assesses the client's spiritual life by asking "What role does religion play in your life?" The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. The priority outcome would be that the client will refrain from attempting suicide. Which nursing diagnosis for a psychiatric client is correctly structured and worded? Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" The primary difference between a social and a therapeutic relationship is the type of responsibility involved. A client states "Nurse X always seems as though she is hiding behind her uniform." The nurse hearing this would assess Nurse X as not seeming genuine to the client. The pre-orientation phase of the nurse-client relationship in characterized by a focus on: The nurse's self-analysis of strengths, limitations, and feelings The orientation phase of the nurse-client relationship focuses on: the nurse and client identifying client needs Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of transference. The outcome of the nurse's expressions of sympathy instead of empathy towards the client often leads to decreased client communication. The use of empathy and support begins in the stage of the nurse-client relationship termed the orientation stage. A client is complaining about her mother-in-law's intrusiveness. The nurse responds "I know how you feel. My mother-in-law is nosy, too." The nurse is most likely experiencing countertransference. The nurse notes that she is finding it difficult to provide structure and set limits for a client. She finds herself thinking "What harm will it do if I cut him a little slack?" The nurse should evaluate her feelings and actions to assess for boundary blurring. Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? Biofeedback A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. This technique is called cognitive reframing. What tool might be useful in assessing the amount of stress a client has experienced in the past year? Life Changing Event Questionnaire A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes biofeedback Meditation is successful in promoting stress reduction because it quiets the sympathetic nervous system Self-help groups are useful for reducing an individual's stress because they provide the individual with the stress mediator identified as social support. What would a client experience during a progressive relaxation session? Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed. An advantage of the Miller and Rahe updated life event and social readjustment scale is that it assesses stress threshold and potential for future illness. The physiologic basis for the success of guided imagery is β-endorphin release raises the pain threshold. Guided imagery stimulates release of â-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. The individual initially thinks "I'll never get through this huge assignment," but then amends the thought to "I can get through the assignment by breaking it into small portions and doing them one by one." This thought process is an example of: cognitive reframing. The nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? Constricted pupils If it is determined that a patient will benefit from guided imagery, what teaching should the nurse provide? Envision an image of a place that is peaceful. A patient is going to undergo biofeedback. Which patient statement requires further teaching by the nurse? “I will feel a small shock of electricity if I tell a lie.” A patient has told the nurse that she knows she is going to lose her job, which scares her because she needs to work to pay her bills. Which nursing response reflects the positive stress response of problem solving? “What are your plans to find a new job?” The nurse is caring for four patients. Which patient would be at highest risk for psychosocial compromise? The patient who has experienced: the death of a spouse. Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? The nurse spends time sitting with a withdrawn patient. A male patient frequently inquires about the female student nurse’s boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? She points out to the patient that he is making social inquiries and explores this behavior. Mary, a patient in the psychiatric unit, had a very rejecting and abusive father and a difficult childhood, but from age 10 on was raised by a very warm and supportive grandmother who recently passed away. Mary frequently comments on how hard her nurs Jane is experiencing countertransference in response to Mary’s meeting Jane’s needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics. A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship? Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. A patient with depression presents with her family in the emergency room. The family feels the patient should be admitted because “she might hurt herself.” An assessment indicates moderate depression with no risk factors for suicide other than the dep Arrange for an emergency outpatient counseling appointment the next day An advanced practice nurse wishes to initiate treatment with an antipsychotic medication which, although very likely to benefit the patient, in a small percentage of patients may cause a dangerous side effect. The nurse explains the purpose, expected Petition the court to appoint a guardian to substitute for the patient’s being unable to comprehend the proposed treatment A patient incidentally shares with you that he has difficulty controlling his anger when around children because their play irritates him, leading to resentment and fantasies about attacking them. He has a history of impulsiveness and assault, escalat Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger towards children and the resultant risk that his babysitting would present. A patient with depression presents with her family in the emergency room. The family feels the patient should be admitted because “she might hurt herself.” An assessment indicates moderate depression with no risk factors for suicide other than the dep Arrange for an emergency outpatient counseling appointment the next day. An advanced practice nurse wishes to initiate treatment with an antipsychotic medication which, although very likely to benefit the patient, in a small percentage of patients may cause a dangerous side effect. The nurse explains the purpose, expected Petition the court to appoint a guardian to substitute for the patient’s being unable to comprehend the proposed treatment. A patient incidentally shares with you that he has difficulty controlling his anger when around children because their play irritates him, leading to resentment and fantasies about attacking them. He has a history of impulsiveness and assault, escalat Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger towards children and the resultant risk that his babysitting would present. Which patient behavior would alert the nurse to the potential for somatization? Presents with concerns involving back pain, dizziness, and fatigue. The nurse is caring for a patient who states that he has “ghost sickness.” Which is the appropriate nursing response? “How does ‘ghost sickness’ make you feel?” Which nursing actions demonstrate cultural competence? Planning mealtime around the patient’s prayer schedule,Researching foods that a lacto-ovo-vegetarian patient will eat, Providing time for a patient’s spiritual healer to visit The nurse is planning care for a patient of the Latin-American culture. Which goal is appropriate? Patient will visit with spiritual healer once weekly A nurse is caring for a patient of another culture. Which nursing action is appropriate? Ask the patient if family should be included in the decision-making process. You are a community mental health nurse meeting with a patient who has just been discharged from the hospital where he had received his first episode of psychiatric care. Which of the following activities would you expect to undertake in your role as Take a ride on the local bus system with the patient to help him learn routes and schedules . A nurse providing in-home mental health care enjoys working with Mr. Jones, an elderly man suffering from depression since the loss of his wife and a recent below-knee amputation that has left him homebound. A fondness develops between the two, with Continue to decline the gifts while helping him find other ways to express his feelings Mr. Johnson has been hospitalized twice in 5 years with a severe, chronic psychiatric disorder. He responds well to inpatient and community treatment and is usually stable, but he also has a history of becoming socially withdrawn and failing to provid Partial hospitalization program Mrs. Smith, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications? Help Mrs. Smith to understand her illness and share in decisions about her care.

What is the primary goal of data collection during the psychiatric interview?

Which patient source for data collection is considered primary during a psychiatric nursing assessment?

Which of the following is the principle that is the basis of nursing outcome planning?

Which criterion is not essential when the nurse plans nursing interventions designed to meet a specific goal?