Exam 1 Flashcards
(37 cards)
On review of the patient’s record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which client’s behavior?
A. Fearfulness regarding treatment measures
B. Anger and aggressiveness directed toward others
C. An understanding of the pathology and symptoms of the diagnosis
D. A willingness to participate in the planning of the care and treatment plan
D
A patient admitted voluntarily for the treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially?
A. Contact the client’s HCP.
B. Call the client’s family to arrange for transportations.
C. Attempt to persuade the client to stay for only a few more days.
D. Tell the client that leaving would likely result in an involuntary commitment.
A. AMA release
Step 1. Contact the physician because the pt needs to be seen before they can leave.
Step 2. Talk to patient about options and have conversation about goals. If you leave AMA, insurance may not cover your stay. Never try to persuade a patient!
A patient with a diagnosis of major depression who has attempted suicide says to the nurse, “I should have died! I’ve always been a failure. Nothing ever goes right for me.” Which response demonstrates therapeutic communication?
A. “You have everything to live for”
B. “Why do you see yourself as a failure?”
C. “Feeling like this is all part of being depressed”
D. “You’ve been feeling like a failure for a while?”
D. Restating.
Not A, because that is false reassurance
Not B, never ask why.
A client experiencing disturbed thought processes believes that his food has been poisoned. Which communication technique should the nurse use to encourage the client to eat?
A. Using open-ended questions and silence
B. Sharing personal preference regarding food choices
C. Documenting reasons why the client does not want to eat
D, Offering opinions about the necessity of adequate nutrition
A
Not B, that would be personal preference
Not C, that is not helping encourage them to eat
Not D, that is opinion
A client diagnoses with terminal cancer says to the nurse, “I’m going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I’m the one who’s dying.” Which response by the nurse is therapeutic?
A. “Have your shared your feelings with your family?”
B. “I think we should talk more about your anger with your family”
C. “You’re feeling angry that your family continues to hope for you to be cured?”
D. “You are probably very depressed, which is understandable with such a diagnosis”
C
Not A, that is a yes/no question and is telling pt what to do
Not B, your personal opinion does not matter
Not D, assuming/minimizing feelings
What type of therapeutic communication is this?
“I see you are crying.”
Making observations
What type of therapeutic communication is this?
“You feel like dying?”
Restating. Using the client’s own words brings attention to the words and allows them to expand
What type of therapeutic communication is this?
“Would you like to do an activity with me?” “Would you like to walk around the courtyard with me?”
Offering self
What type of therapeutic communication is this?
“I am hearing everything you’re saying. Let’s focus on you thinking about hurting yourself.”
Focusing.
What type of therapeutic communication is this?
Client: “I don’t do anything with my life, everyone would be better off if I wasn’t here”
Nurse: “Are you saying you feel worthless?”
Translating into feelings. Going from broad to specific emotion.
What type of therapeutic communication is this?
Client: “That cop is following me.”
Nurse: “That is Bill from security. He is not a cop.”
Presenting reality. This is good, straightforward correction.
List some examples of NON Therapeutic communication:
- offering personal opinions
- giving advice
- false reassurance
- minimizing feelings
- “why” questions
- offering value judgments
- giving approval/disapproval
Describe the defense mechanism of Reaction Formation
Unacceptable feelings or behaviors are controlled or kept out of awareness by overcompensating or demonstrating the opposite behavior of what is actually felt. (ATI)
Adaptive use: person trying to quit smoking repeatedly speaks to adolescents about the dangers of nicotine
Maladaptive use: a person who resents having to care for an aging parent becomes overprotective and restricts their freedoms
Describe the defense mechanism of Projection
Attributing one’s unacceptable thoughts and feelings onto another who does not have them
E.g. a married client who is attracted to another person accuses their partner of having an affair.
Describe the defense mechanism of Dissociation
A disruption in consciousness, memory, identity, or perception of the environment that results in compartmentalization of uncomfortable or unpleasant aspects of oneself.
Adaptive use: a parent blocks out the noise of their children in order to focus while driving in traffic
Maladaptive use: a person forget who they are following a sexual assault
Describe the defense mechanism of Regression
someone who regresses developmentally when upset. Think an adult screaming or having a tantrum
Define the meaning of beneficence and provide a nursing example
the quality of doing good; can be described as charity.
e.g. a nurse helps a newly admitted client who has a psychotic disorder to feel safe in the environment of the mental health facility
Define the meaning of autonomy and provide a nursing example
the client’s right to make their own decisions. However, the client must accept the consequences of those decisions. The client must also respect the decisions of others.
e.g. rather than giving advice to a client who has difficulty making a decision, a nurse helps the client to explore all alternatives and arrive at a choice.
Define the meaning of justice and provide a nursing example
fair and equal treatment for all
e.g. during a treatment team meeting, a nurse leads a discussion regarding whether or not two clients who broke the same facility rule were treated equally. Treating all client’s equally.
Define the meaning of fidelity and provide a nursing example
loyalty and faithfulness to the client and to one’s duty.
e.g. a client asks a nurse to be present when they talk to their guardian for the first time in a year. The nurse remains with the client during this interaction.
Define the meaning of veracity and provide a nursing example
honesty when dealing with a client
E.g. A client states, “you and that other staff member were talking about me, weren’t you?” The nurse truthfully replies, “We were discussing ways to help you relate to the other clients in a more positive way.”
What is milieu therapy?
Milieu therapy creates an environment that is supportive, therapeutic, and SAFE!!
Environment designed to promote healing experiences and provide a corrective setting to enhance a client’s coping abilities.
- correcting perceptions of stressors
- changing coping mechanisms
- improving interpersonal relationship skills
- learning effective stress management strategies
- one aspect is regular community meetings, which include both the clients and the nursing staff
What is the most effective safety intervention in Milieu therapy?
Monitoring!!!!
e.g. 1:1 staff member to client at all times
What are risk factors for depression/mood spectrum disorders?
Being a woman Stress Trauma Neglect/abuse Postpartum (PPD) Family hx Previous hx of depression Co-morbid medical and mental health disorders (anxiety disorders, psychotic disorders, SUD, eating disorders, personality disorders) Neurotransmitter deficiencies and imbalances
