Exam 2 mental health

What are the four phases of the nurse-client relationship?

Pre-interaction, Orientation, Working, and Termination.

What is the primary goal of the pre-interaction phase?

Self-awareness by reviewing the chart and identifying personal biases before meeting the client.

During which phase are confidentiality and professional boundaries discussed?

Orientation phase.

What is the primary goal of the orientation phase?

Establish trust, develop rapport, and set mutually agreed-upon goals.

During which phase does the nurse provide teaching and encourage problem-solving?

Working phase.

What occurs during the termination phase?

Review goals, discuss discharge plans, and allow the client to express feelings about ending the relationship.

What is transference?

The client unconsciously transfers feelings from a past relationship onto the nurse.

What is countertransference?

The nurse unconsciously transfers personal feelings onto the client.

How should a nurse respond to countertransference?

Recognize it, seek supervision, and request reassignment if necessary.

What does SOLER stand for?

Sit squarely, Open posture, Lean forward, Eye contact, and Relax.

When is SOLER most appropriately used?

During routine therapeutic communication to demonstrate active listening.

What does SURETY stand for?

Sit at an angle, Uncross arms and legs, Relax, Eye contact as appropriate, Touch cautiously, and trust Your intuition.

When should SURETY positioning be used?

With clients who are paranoid, aggressive, or potentially violent.

What is congruent communication?

When verbal statements match facial expressions and body language.

What is incongruent communication?

When verbal and nonverbal messages do not match.

Why is incongruent communication important to assess?

It may indicate hidden emotions or psychological distress.

What does OARS stand for?

Open-ended questions, Affirmations, Reflections, and Summaries.

Why are open-ended questions therapeutic?

They encourage clients to express thoughts and feelings in their own words.

What is reflection?

Restating or mirroring the client's feelings to encourage exploration.

What is clarification?

Asking the client to explain vague or confusing statements.

What is paraphrasing?

Restating the client's message in different words to verify understanding.

What is focusing?

Directing attention to an important topic introduced by the client.

What is offering self?

Being physically and emotionally present with the client to provide support.

What is therapeutic silence?

Allowing quiet time for the client to think and express feelings without interruption.

What is presenting reality?

Acknowledging the client's perception while calmly stating what the nurse perceives as reality.

How should the nurse respond to a client experiencing hallucinations?

"I understand you hear voices. I do not hear them. Can you tell me what they are saying?"

What is empathy?

Understanding and communicating the client's feelings from the client's perspective.

What is sympathy?

Feeling pity for the client and focusing on the nurse's emotions rather than the client's experience.

Which is therapeutic: empathy or sympathy?

Empathy.

Why are "why" questions considered nontherapeutic?

They often make clients feel defensive and judged.

Why is false reassurance nontherapeutic?

It minimizes the client's feelings and discourages expression.

Give an example of false reassurance.

"Everything will be okay."

Why is giving advice nontherapeutic?

It reduces client autonomy and problem-solving.

Why is changing the subject considered nontherapeutic?

It communicates that the client's concerns are unimportant.

Why is arguing with a client inappropriate?

It damages trust and the therapeutic relationship.

What type of listening is considered therapeutic?

Active listening.

What does active listening involve?

Paying attention to verbal and nonverbal communication, clarifying, and summarizing the client's message.

What are the four processes of motivational interviewing?

Engage, Focus, Evoke, and Plan.

Which process of motivational interviewing takes the most time?

Engage.

What does SMART goal setting stand for?

Specific, Measurable, Achievable, Realistic, and Time-bound.

What stage of change is characterized by denial of a problem?

Precontemplation.

What stage of change is characterized by ambivalence?

Contemplation.

What stage of change involves making small preparations for change?

Preparation.

What stage of change involves behavior change for less than six months?

Action.

What stage of change involves maintaining behavior change for more than six months?

Maintenance.

Can clients move backward in the stages of change?

Yes, progression through the stages of change is not always linear.

What is the best response when a client asks, "Should I stop taking my medication?"

"What are your thoughts about stopping your medication?"

What is the best therapeutic response to a grieving client who is crying?

Sit quietly with the client and offer your presence.

What is the priority communication technique when a client expresses suicidal thoughts?

Use empathy and ask directly about suicidal thoughts, plan, and intent.

What is the difference between anxiety and fear?

Anxiety is a vague response to an unknown or future threat, while fear is a response to a specific, present danger.

When does anxiety become a disorder?

When it occurs at inappropriate times, becomes more frequent or intense, lasts longer, or interferes with daily functioning.

Which anxiety level can improve learning and performance?

Mild anxiety.

What are common signs of mild anxiety?

Restlessness, irritability, nail biting, finger tapping, and increased alertness.

What is the hallmark sign of moderate anxiety?

Selective inattention.

What are common symptoms of moderate anxiety?

Difficulty concentrating, headache, GI upset, urinary urgency, tremors, increased heart rate, increased respirations, and sweating.

What nursing intervention is appropriate for moderate anxiety?

Provide a calm environment and redirect the client's attention.

What characterizes severe anxiety?

A greatly narrowed perceptual field with inability to problem solve or learn.

What is a hallmark symptom of severe anxiety?

A sense of impending doom.

What nursing intervention is most appropriate for severe anxiety?

Stay with the client, reduce stimuli, and use simple, direct instructions.

Which anxiety level may include hallucinations?

Panic.

What is the priority nursing intervention during a panic attack?

Stay with the client and maintain safety while reducing environmental stimuli.

Can clients learn during severe or panic anxiety?

No, learning is impaired during severe and panic anxiety.

What often follows a panic attack?

Physical and emotional exhaustion.

What are the three stages of General Adaptation Syndrome?

Alarm, Resistance, and Exhaustion.

What occurs during the alarm stage of GAS?

The fight-or-flight response is activated and cortisol is released.

What occurs during the resistance stage of GAS?

The body attempts to adapt while remaining alert.

What occurs during the exhaustion stage of GAS?

The body's resources are depleted, increasing the risk of illness and mental health disorders.

Which brain structure plays a major role in anxiety and fear?

The amygdala.

What is the HPA axis?

The hypothalamic-pituitary-adrenal axis that activates the body's stress response.

What is the diathesis-stress model?

The theory that anxiety disorders result from a combination of genetic vulnerability and environmental stress.

Name two modifiable risk factors for anxiety disorders.

Trauma, substance use, smoking, poor diet, or lack of exercise.

Name two nonmodifiable risk factors for anxiety disorders.

Genetics, family history, female sex, or personality traits.

What are Adverse Childhood Experiences (ACEs)?

Traumatic childhood events that increase the risk of anxiety and depression.

Do positive childhood experiences completely eliminate the effects of ACEs?

No, they provide protection but do not erase the effects.

What does transdiagnostic mean?

Anxiety symptoms occur across multiple psychiatric disorders.

How long must excessive worry be present to diagnose Generalized Anxiety Disorder?

At least six months.

What are the six symptoms associated with Generalized Anxiety Disorder?

Restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.

How many symptoms are required to diagnose GAD in adults?

Three or more.

How many symptoms are required to diagnose GAD in children?

One or more.

What is the defining feature of panic disorder?

Recurrent unexpected panic attacks with persistent worry or behavior changes afterward.

How quickly do panic attacks reach their peak intensity?

Within minutes.

Name four symptoms of a panic attack.

Palpitations, sweating, trembling, shortness of breath, chest pain, dizziness, nausea, chills, paresthesias, fear of dying, or fear of losing control.

What is social anxiety disorder?

Intense fear of being judged or embarrassed in social situations.

What is a specific phobia?

Intense fear of a specific object or situation that causes immediate anxiety.

What is agoraphobia?

Fear of situations where escape may be difficult or help unavailable.

What is separation anxiety disorder?

Developmentally inappropriate fear of being separated from an attachment figure.

What is selective mutism?

A child consistently fails to speak in certain social settings despite speaking normally in others.

What are obsessions?

Unwanted, intrusive thoughts, urges, or images that cause distress.

What are compulsions?

Repetitive behaviors or mental acts performed to reduce anxiety caused by obsessions.

Do clients with OCD usually recognize their thoughts and behaviors are unreasonable?

Yes, most clients have insight that their behaviors are irrational.

How much time must obsessions or compulsions consume to meet OCD criteria?

More than one hour per day or cause significant distress.

Give an example of an obsession.

Fear of contamination or germs.

Give an example of a compulsion.

Repeated handwashing or checking locks.

What is body dysmorphic disorder?

Preoccupation with perceived flaws in physical appearance.

What is hoarding disorder?

Persistent difficulty discarding possessions that results in excessive clutter.

What is trichotillomania?

Recurrent hair pulling that causes hair loss.

What is excoriation disorder?

Recurrent skin picking that causes skin lesions.

Are trichotillomania and excoriation considered self-harm behaviors?

No, they are obsessive-compulsive related disorders.

What are adaptive coping strategies for anxiety?

Exercise, mindfulness, therapy, relaxation techniques, humor, social support, and deep breathing.

What are maladaptive coping strategies?

Avoidance, withdrawal, alcohol misuse, and substance abuse.