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NUR 256 Exam 1 (Mental Health)
VERIFIED QUESTIONS AND ANSWERS
Offering Self (therapeutic)
making oneself available
example of offering self
"I'll sit with you awhile."
"I'll stay here with you."
"I'm interested in what you think."
Giving Broad Openings (therapeutic)
Clarifies that the lead is to be taken by the patient. However, the nurse discourages pleasantries and small talk.
Example of giving broad openings
"What would you like to talk about today?"
"Tell me what you are thinking."
Restating (therapeutic)
repeating the main idea expressed
Example of restating
Client: "I can't sleep. I stay awake all night."
Nurse: "You have difficulty sleeping."
Reflecting (therapeutic)
directs questions or feelings back to client so that they may be recognized and accepted
Example of reflecting
Client "What do you think I should do about my wife 's drinking problem?
Nurse: "What do you think you should do?"
Client: "My sister won't help a bit toward my mother's care. I have to do it all."
Nurse: You feel angry when she doesn't help.
seeking clarification
Helps patients clarify their own thoughts and maximize mutual understanding between nurse and patient.
Seeking clarification example
"I am not sure I follow you."
Asking "why" questions
Implies criticism; often has the effect of making the patient feel defensive.
Asking "why" questions example
"Why did you stop taking your medication?"
Giving approval, agreeing
Implies the patient is doing the right thing-and that not doing it is wrong. May lead the patient to focus on pleasing the nurse or clinician; denies the patient the opportunity to change his or her mind or decision.
Giving approval, agreeing example
"I'm proud of you for applying for that job."
"I agree with your decision."
Disapproving, disagreeing
can make a person defensive
Disapproving, disagreeing example
"You really should have shown up for the medication group."
"I disagree with that."
Transference
when the patient transfers feelings onto the nurse
"You remind me of my mother"
Countertransference
when the nurse transfers feelings onto the patient - can lead to over involvement with the patient
Pre-orientation phase
before you meet with client (reading the chart)
Orientation phase
meeting the patient/interview (pt agrees to be interviewed)
Working phase
identify, explore, EDUCATE the pt
termination phase
Discharge (continue to educate aftercare issues)
Maslow's
Physiological needs are most important; ABCs, water, shelter, food, heart rate, rhythm, strength of contraction
Teamwork and collaboration (QSEN)
nurses and interprofessional teams need to maintain open communication, respect, and shared decision making
Safety (QSEN)
the care provided should not add further injury
When a patient refuses meds, what should be documented?
date, time. HCP notified, why refused
You should only document ____?
Subjective information - what the patient says
Tardive dyskinesia symptoms
involuntary movements of the facial muscles, tongue, and limbs; grimacing, tongue protrusion, lip smacking, lip puckering (all permanent)
What medication causes tardive dyskinesia?
Haldol (1st generation antipsychotics)
What food should you avoid with MAOIs?
fermented cheese/meats, wines, anything chocolate, tyramine
TRUE or FALSE: You can take other antidepressants with MAOIs?
False - do not take any other antidepressants with MAOIs.
What should you do before or after taking am MAOI or other antidepressant?
Wash out period - stop meds & wait 2 weeks then start next medication
Lithium levels
0.5-1.
If lithium level is above 1.5, the pt is considered _____?
toxic
If lithium level is below 0.5, pt is considered ____?
Generation 2 Antipsychotics reversible side effects
Sexual dysfunction, weight gain, sedation, orthostatic hypotension
Generation 2 Antipsychotics irreversible side effects
poverty of speech
Pts always have the right to visit with ____?
Clergy
What are adolescents mostly concerned with?
Confidentiality
TRUE OR FALSE: With adolescents we must temper with what is told to the team because nurses are mandated reporters.
TRUE
Do patients have the right to refuse meds?
Yes but it can be overridden by HCP if patient is deemed incompetent
Who determines who has access to medical records?
The patient
Some rights can be removed based on ____?
care needs - like privacy (1:1)
Erikson's developmental stage: Infancy (0-1 1/2 y.o.)
Trust vs mistrust
Erikson's developmental stage: Early childhood (1 1/2 - 3 y.o.)
autonomy vs shame and doubt
Erikson's developmental stage: Preschool (3-6 y.o.)
initiative vs guilt
Erikson's developmental stage: School age (6-12 y.o.)
industry vs inferiority
Damages
Duty
Causes
Damages
actual damages (loss of earnings, medical expenses, property damage) & pain and suffering
Duty
When the nurse represents themselves as being capable of caring for a psychiatric pt
Cause
Actual cause (cause in fact) or legal cause (proximate cause)
Voluntary admission
pt agrees to admission, can sign themselves out if not a harm to self or others w/ HCP approval, can request discharge
Involuntary admission
pt may not agree to admission, unable to sign self out, length of stay may be extended depending upon need, may be court ordered
What should you watched for when a patient is from a different culture?
Nonverbal cues
If a patient speaks another language, should you use family or an interpreter for translation?
Interpreter
Negligence
failure to take proper care in doing something
Assault
intentional threat; verbal
Battery
actual harm; offensive touching
invasion of privacy
breaking of confidence; taking pictures without permission
anything that could potentially be used to harm oneself or another (sharp objects, razors, weapons, meds)
Contraband searches are always done?
At admissions
What is searched during contraband searches?
Pt's body - no cavity searches
clothing
Mental illness cues
pt is hallucinating, be paranoid, becoming aggressive for no obvious reason
If a pt states "I have more money than Elon Musk", could they be mentally ill?
Yes
TRUE OR FALSE: A patient is considered mentally ill if they brag about not sleeping for days.
TRUE
If we (nurses) are told, suspect or see abuse, we must report it?
Yes, we are mandated reporters
Breach of duty
failure to meet the standard of care
Wehn a pt refuses meds, if you can
Tell HCP why they refused
Can a pt refused meds if they have back up meds in IM form?
No
When do pts have back up meds in IM form?
When they're incompetent & involuntary
Restraints are never ____?
A PRN order
Should restraint orders be written each time that they're needed?
YES & the PCP must come evaluate ptWhat are last option orders?
