• The nursing process is a six-step problem-solving approach to patient care to help secure safety and quality care for patients. • The Institute of Medicine (IOM) and QSEN faculty have established mandates to prepare future nurses with the knowledge, skills, and attitudes (KSAs) necessary for achieving quality and safety as they engage in the six competencies of nursing: patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics. • The primary source of assessment is the patient. Secondary sources of information include the family, neighbors, friends, police, and other members of the health team. • The assessment interview includes gathering objective data (mental or emotional status) and subjective data (psychosocial assessment). A number of tools are provided in this textbook for the evaluation of cultural, spiritual/ religious, and mental status. • Medical examination, history, and systems review complete a comprehensive assessment. • An important part of planning patient-centered care is to understand how spiritual/ religious beliefs play a part in a person's life and how they deal with stress. • Caregivers should also have an awareness of the person's cultural background and social attachments, and how these issues affect the way a person experiences healing in his or her culture. • Assessment tools and standardized rating scales may be used to evaluate and monitor a patient's progress. Emphasis needs to be placed on further evaluation of progress and sharing of this information with other members of the health care team. • Self-assessment is an important part of the assessment process. There are a number of ways that novice interviewers can gain valuable feedback, support, and supervision. • Determination of the nursing diagnosis (NANDA-I) defines the practice of nursing, improves communication between staff members, and assists in accountability for care. • A nursing diagnosis consists of (1) an unmet need or problem, (2) an etiology or probable cause, and (3) supporting data. • Outcomes are variable, measurable, and stated in terms that reflect a patient's actual state. NOC provides 330 standardized outcomes. Planning involves determining desired outcomes. • Behavioral goals support outcomes. Short- and long-term outcomes are measurable, indicate the desired patient behavior( s), include a set time for achievement, and are short and specific. • Planning nursing actions (NIC or other sources) to achieve the stated outcomes include the use of the following specific principles: the plan should be (1) safe, (2) evidence based whenever possible, (3) realistic, and (4) compatible with other therapies. NIC provides nurses with standardized nursing interventions that areapplicable for use in all settings • Practice in psychiatric nursing encompasses basic-level interventions: coordination of care; health teaching and health promotion; milieu therapy; and pharmacological, biological, and integrative therapies. • Advanced practice interventions are carried out by a nurse who is educated at the master's level or higher. Nurses certified for advanced practice psychiatric mental health nursing may be additionally prepared to practice psychotherapy, prescribe certain medications, and perform consulting work. • The evaluation of care is a continual process of determining to what extent the outcome criteria have been achieved. The plan of care may be revised on the basis of the evaluation. • Documentation of patient progress through evaluation of outcome criteria is crucial. The patient's record is a legal document and should accurately reflect the patient's condition, medications, treatment, tests, responses, and any untoward incidents. • Simply documenting a patient's noncompliance/ nonadherence to medical treatment no longer protects nurses, doctors, other health care professionals, and/ or institutions from lawsuits when further harm to the patient presents itself. Careful documentation of what has been done to help the individual understand the instructions, understand the reasons behind the medical advice, and follow-up on compliance issues should be included. 1 The nurse received the change-of-shift report on a 74-year-old woman admitted for depression. She has aphasia from a recent stroke and communicates minimally by using pencil and paper. Her college-age grandson moved in with her to help with meals and household chores and a home health aide provides daily assistance with ADLs and medications. For the past week, she has refused to bathe, eats poorly, and has stopped writing. Which of the following statements best demonstrates that the nurse has the ability to plan holistic care for this client? 1. The client's psychobiologic health, rehabilitation, self-care potential, and discharge arrangements are interrelated. 1 The psychiatric-mental health nurse understands that the philosophy underlying humanistic practice means which of the following? 1. Nurses must develop interests related to human beings, wherever they live and whatever their status or culture, in order to work for change within social and political systems. 2 A nurse on a medical unit overhears a discussion about the failure of psychobiologic interventions for clients with mental disorders. Which statement could be made to counteract that supposition? 1. "There is a current moratorium on development of new drugs to correct biochemical imbalances in the brain." 4 Which of the following statements best reflects the nurse's comprehensive understanding of medical-psychobiologic theories? 1. Psychobiologic explanations of mental disorders do little to decrease the stigma associated with mental illness. 1
Which of the following statements made by the nursing student best summarizes the medical-psychobiologic position on mental disorders? 1. Factors related to mental disorders can include excesses or deficiencies of brain neurotransmitters as well as alterations in biologic rhythms, including the sleep-wake cycle and genetic predispositions. 3 When meeting with a client for the first time, the psychiatric-mental health nurse applying psychobiological principles is most likely to make which of the following statements? 1. "Your abnormal behavior is directly related to living in an unsupportive environment." 1
In comparing the major features of psychiatric theories, the nurse correctly concludes that: 1. Medical-psychobiologic and psychoanalytic theories focus on the individual client. 2 Sullivan's interpersonal theory focusing on the client's relationships with others and modes of interacting with others is most similar to the theory developed by: 1. Emil Kraepelin. 4 The
nurse who applies a conceptual framework that integrates the biologic and social sciences with the physical sciences in assessing clients is using: 1 A holistic view of the mind-body relationship is best demonstrated by which of the nurse's comments to a student nurse? 1. "My view
is that clients have physical problems that have emotional consequences and psychological issues that cause physical problems." 4 Which statement indicates that the nurse understands the developmental-interpersonal perspective of the self-system? 1. "A person's sense of security is primarily derived from doing well in school." 2 Which statement indicates the psychiatricmental health nurse understands the basic principles of symbolic interactionism in working with clients? 1. Clients with mental disorders are unlikely to understand the personal meaning of their experiences. 2. I try to avoid interventions that ignore the personal meaning of experiences to my clients. 3. Clients with altered brain chemistry need frequent reassurance that they should not worry about their condition. 4. After my first year of working in mental health, I was able to develop standardized interventions for clients with the same diagnoses. 2 Concepts of interactionism are evidenced in which of the following statements the nurse makes to the parent of an adolescent hospitalized for an overdose of cocaine and Valium? 1. Peer pressure is usually responsible for these accidental overdoses. 2. All behavior has meaning, so we will focus on trying to understand the meaning of the drug use as well as the occurrence of overdose. 3. Use of Valium probably means your child accidentally overdosed by trying to treat the effects of cocaine. 4. Adolescence is such a painful time. Rehabilitation programs give kids a chance to get away from their everyday pressures. 3 A grieving widow tells a psychiatricmental health nurse, I feel so tired and alone. The nurse who incorporates an understanding of symbolic interactionism in practice would not suggest which of the following to the client? 1. You had a terrible loss. Feeling tired and alone must be very difficult for you. 2. I would like to hear more about how you are feeling now. 3. Try to get plenty of rest. Most people who suffer losses like yours need more sleep than usual to cope effectively. 4. You seem sad. Can I sit with you for a while? 1 The nurse received the change-of-shift report on a 74-year-old woman admitted for depression. She has aphasia from a recent stroke and communicates minimally by using pencil and paper. Her college-age grandson moved in with her to help with meals and household chores and a home health aide provides daily assistance with ADLs and medications. For the past week, she has refused to bathe, eats poorly, and has stopped writing. Which of the following statements best demonstrates that the nurse has the ability to plan holistic care for this client? 1. The clients psychobiologic health, rehabilitation, self-care potential, and discharge arrangements are interrelated. 2. Reliance on the grandson and home health aide have decreased her feelings of self-worth and caused this episode of depression. 3. The clients quality of life and prognosis are primarily related to her aphasia and inability to communicate. 4. Sudden life changes, such as a stroke, usually lead to depression in older clients. 4 Which statement best describes a holistic-interactional approach to nursing care for clients with mental disorders? 1. Clients with psychotic symptoms rarely indicate an interest in creative activities. 2. Medication is the only treatment required to manage affective symptoms for clients with mood disorders. 3. Developing comfortable relationships with clinicians is the major factor in maintaining mental health. 4. I always try to understand the complex relationship between a clients psychobiologic health and expressions of self-esteem. 3 When planning care for clients on the mental health unit, the nurse using principles of humanism would consider which of the following? 1. Clinical interventions are most effective when they focus on the current actions, feelings, and concerns of clients. 2. Clients rely on providers to develop solutions for their problems. 3. Emotional stress has a relationship to physical symptoms. 4. The mind-body relationship focuses on biological explanations of illness. 1 The psychiatricmental health nurse understands that the philosophy underlying humanistic practice means which of the following? 1. Nurses must develop interests related to human beings, wherever they live and whatever their status or culture, in order to work for change within social and political systems. 2. The nurse must be cautious about empowering clients as they may make poor choices that impede their progress. 3. The model for intervention and change requires that the nurse feel comfortable confronting clients when they resist treatment goals. 4. Client and family education about the mental disorder and its treatment must be provided only when clients are stable enough to accept their illness. 2 A nurse educator is teaching a group of students about humanism. The educator knows that humanism is a philosophy of service to benefit humanity through applying which of the following concepts? 1. Science is the core consideration of humanistic philosophy. 2. Caring practices and compassion must be approached holistically. 3. Limitations of life in todays world have little effect on planning effective interventions. 4. Mental health clients must rely on clinicians for difficult decision-making and care. 4 Which statement made by a nurse indicates an understanding of the basic premises of psychobiology? 1. All mental disorders can now be fully classified and cured with biological interventions. 2. By focusing on the biologic sciences, we will diminish the art of psychiatricmental health nursing. 3. Because of the advances in psychobiology, the role of psychiatricmental health nurses focuses primarily on medication monitoring. 4. Genetics, immunology, biorhythms, brain structure, and brain biochemistry all influence mental disorders. 2 A nurse on a medical unit overhears a discussion about the failure of psychobiologic interventions for clients with mental disorders. Which statement could be made to counteract that supposition? 1. There is a current moratorium on development of new drugs to correct biochemical imbalances in the brain. 2. Contemporary research findings indicate that the field of psychobiology and effective interventions is growing rapidly. 3. There are subjective reports that exposure to bright light and white noise provides effective treatment for mental disorders. 4. Restriction of nutrients and non-nutrients is no longer believed to affect behavior. 4 Which of the following statements best reflects the nurses comprehensive understanding of medicalpsychobiologic theories? 1. Psychobiologic explanations of mental disorders do little to decrease the stigma associated with mental illness. 2. Individuals suffering from emotional disturbances have complex personalities that require changes in their motivation and willingness to comply with treatment. 3. Mental disorders rarely respond to physical or somatic treatments. 4. Mental disorders have characteristic structural, biochemical, and mental symptoms that can be diagnosed, run a characteristic course, and have a particular prognosis for recovery. 1 Which of the following statements made by the nursing student best summarizes the medicalpsychobiologic position on mental disorders? 1. Factors related to mental disorders can include excesses or deficiencies of brain neurotransmitters as well as alterations in biologic rhythms, including the sleepwake cycle and genetic predispositions. 2. Mental illnesses with an organic cause have an unpredictable course and poor prognosis. 3. Mental disorders rarely respond to physical or somatic treatments without careful monitoring of progress by clinicians in medical settings. 4. Biological interventions such as hormones, diet, and medications must be changed frequently as they are only effective for short periods of time. 3 When meeting with a client for the first time, the psychiatricmental health nurse applying psychobiological principles is most likely to make which of the following statements? 1. Your abnormal behavior is directly related to living in an unsupportive environment. 2. You have a brain lesion and can expect to be hospitalized many times over the course of your life. 3. We are thoroughly assessing your symptoms because an accurate diagnosis is the basis of your treatment. 4. It is fairly certain that your children will feel stigmatized by their peers. 1 In comparing the major features of psychiatric theories, the nurse correctly concludes that: 1. Medicalpsychobiologic and psychoanalytic theories focus on the individual client. 2. Socialinterpersonal and medicalpsychobiologic theories seek to change behavior through pharmacology. 3. Socialinterpersonal and medicalpsychobiologic theories are in direct opposition to the other. 4. Cognitive behavioral and psychoanalytic theories share the premise that behavior stems from the unconscious and requires the client to develop insight. 2 Sullivans interpersonal theory focusing on the clients relationships with others and modes of interacting with others is most similar to the theory developed by: 1. Emil Kraepelin. 2. Karl Menninger. 3. B. F. Skinner. 4. Sigmund Freud. 4 The nurse who applies a conceptual framework that integrates the biologic and social sciences with the physical sciences in assessing clients is using: 1. Ericksons eight stages of development. 2. The medical model. 3. Social interactionism. 4. General systems theory. 4 When providing orientation to a group of students, the psychiatricmental health nurse describes use of an eclectic clinical approach with newly admitted clients with a diagnosis of schizophrenia. Which of the following statements most accurately reflects the therapeutic value of an eclectic approach? 1. There is limited scientific evidence about treatment for schizophrenia, so a variety of medications and interventions must be tried over time. 2. Nurses do not need a philosophy of care to direct their practice. 3. It is difficult to determine a final plan of care for new clients with psychotic disorders. 4. Strategies from one or a combination of psychiatric theories are used to determine interventions and evaluation criteria for working with each client. 1 A holistic view of the mindbody relationship is best demonstrated by which of the nurses comments to a student nurse? 1. My view is that clients have physical problems that have emotional consequences and psychological issues that cause physical problems. 2. Psychiatric clients often blame their problems on the side effects of the medications. 3. Clients come and go so quickly, we cant always complete a thorough physical exam. 4. We might as well be working on a medical unit. We focus mostly on medication management now. 3 The nursing student is studying the psychoanalytic theory. The student knows that which one of the following statements is not consistent with the psychoanalytic theory? 1. The structural model of the mind contends that the id, ego, and superego have specific interrelated functions. 2. Psychic determinism means that no behavior is accidental. 3. Psychoanalysis deals with the conscious mind. 4. Psychoanalytic therapy focuses on a dynamic view of mental phenomena rather than on the classification of illness. 2 The nurse educator knows the approach that helps a client develop insight is aligned with which of the following theories? 1. Cognitive behavioral theory 2. Psychoanalytic theory 3. Socialinterpersonal theories 4. Medicalpsychobiologic theory 4 Which statement indicates that the nurse understands the developmentalinterpersonal perspective of the self-system? 1. A persons sense of security is primarily derived from doing well in school. 2. Security is only achieved when a child discovers his or her autonomy. 3. Feelings of self-worth are established during infancy. 4. Childhood experiences influence the way people view and understand themselves. 2 In explaining cognitive behavioral theory to a student, the nurse would not describe the concept of: 1. Reinforcement. 2. Psychic determinism. 3. Conditioned response. 4. Shaping. 4 A nursing student is preparing a presentation on Eriksons developmental theory. The student wants to include in the presentation that Eriksons eight developmental stages are most closely aligned with: 1. Cognitive behaviorist concepts. 2. Maslows theory of self-actualization and hierarchy of needs. 3. Freuds psychosexual stages. 4. Sullivans stages of interpersonal development. 4 Nursing roles associated with shifts in the delivery of psychiatric services to social and community settings would not include: 1. Leading community support groups for couples receiving genetic counseling. 2. Providing case management as part of an interdisciplinary team. 3. Participating as a member of a community board for social planning activities. 4. Providing individual therapy in a private practice setting. 2 The humanistic perspective on mental disorders implies that psychiatricmental health nurses function in expanded roles. Which statement does not reflect this perspective? 1. Psychiatricmental health nurses are prepared to work for change within social and political systems. 2. Psychiatricmental health nursing focuses on the client and does not deal with social or political consequences. 3. Psychiatricmental health nurses develop philosophic and ethical frameworks to guide and evaluate the political outcomes of therapeutic intervention. 4. Psychiatricmental health nursing is involved in social goals that advance health holistically. 3 The heart of the psychiatricmental health nurses therapeutic and caring role is characterized by: 1. Bringing unconscious childhood traumas into awareness. 2. Focusing on basic life issues of eating, sleeping, grooming, and hygiene as they relate to mental functioning. 3. Using the nurseclient relationship to support the client in exploring new definitions and actions for life situations. 4. Providing educational information about the clients mental illness. 4 The psychiatricmental health nurses scope of practice includes: 1. Developing a comfortable relationship with the client. 2. Establishing a routine for clients to manage basic life issues of eating, sleeping, grooming, and hygiene. 3. Identifying client reasons for failure to comply with recommended treatments. 4. Exploring the meaning of life experiences such as birth and death, losses, life course changes, and human rights. 4 A middle-aged parent goes to the emergency room for symptoms of dizziness, headache, and suicidal ideation. The nurse assesses the patient for substance use, employment, child-rearing stressors, relationships with coworkers, recurring physical symptoms, and marital problems. The nurse is: 1. Failing to focus on the seriousness of the primary presenting problem. 2. Establishing rapport that will decrease the likelihood of suicide. 3. Doing more than the nurses share of the interdisciplinary assessment. 4. Formulating a holisticinteractional assessment needed to interpret clinical data. 3 The psychiatricmental health nurse is asked to prepare an educational conference for unlicensed staff working in a day treatment program for hyperactive children with borderline intelligence. Using fundamental concepts of cognitive behaviorist theory, which of the following conference exercises would the nurse include? 1. Have a contest to choose the best staff-designed time-out room where children can comfortably spend significant periods alone. 2. Include sessions for staff to practice talking with parents about the benefits of having their child transferred to an institutional setting where he or she would have access to highly trained experts. 3. Ask staff to work in teams to develop a token economy program that uses a prescribed daily routine and reinforcers for the children. 4. Show a brief movie that demonstrates the simplicity of using behavior modification. 1 The psychiatricmental health nurse is asked to consult with an emergency room nurse about a client who has been refusing to cooperate with lab work for over four hours. The client appears frightened, answers questions reluctantly, and has no family present. Which response of the psychiatricmental health nurse demonstrates a humanisticinteractional approach to the situation? 1. Have you asked if the client wants to have a friend or family member to be here? 2. Have you offered medication for anxiety? 3. Give the client some time alone to decide whether or not to accept treatment. 4. I would ask for a full psychiatric evaluation before discharge. |
Which consideration is the most accurate when applying the principles of mental health Quizlet
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