Assessment and Diagnostic Processes PMHNP D344 Questions with 100% corrrect answers + rationales

Which statement best describes the relationship between theory and research?

Theory may guide research through a deductive process or generate research through an inductive process.

3 multiple choice options

The science of nursing includes paradigms. Which statement best describes a paradigm?

A paradigm is a worldview or widely accepted value system.

According to Pehlivan and Guner (2016), why are theories used in the mental health field?

To assess the client's current situation and take necessary initiatives

Orem's Theory

known as self-care deficit theory which focuses on the patient's self care needs

Parse's Theory

To focus on man as a living unity and qualitative participation with health experience

Erikson's Theory

A psychoanalytic theory in which eight stages of psychosocial development unfold throughout the human life span. Each stage consists of a unique developmental task that confronts individuals with a crisis that must be faced.

Peplau's theory

centers on the interpersonal process in nursing

Three phases

Social cognitive theory

Bandura's theory of personality that emphasizes both cognition and learning by watching others as sources of individual differences in personality

cognitive behavioral therapy

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

Psychoanalytic theory

A theory developed by Freud that attempts to explain personality, motivation, and mental disorders by focusing on unconscious determinants of behavior

developmental theory

Developmental theories explain normal human growth and development over time. Many developmental theories are presented in terms of stages based on the assumption that normal development proceeds longitudinally from the beginning to the ending stage.

empathic linkage

Empathic linkage refers to the nonverbal transmission of feelings such as anxiety, anger, and disgust from the client to the PMHNP.

Psychodynamic theory mnemonic

Old Age Parrots Love Grapes

Old Age Parrots Love Grapes

Oral 0-1 Yr

Anal 1-3 Yr

Phallic 3-5/6 Yr

Latency 5/6-Puberty

Genital Puberty to Adulthood

According to research what makes humans happy and healthy?

Good relationships

Widely accepted definition of theory

An organized set of concepts that explains a phenomenon or set of phenomena

psychodynamic theories

theories that posit that conscious and unconscious processes influence one's thoughts and behaviors.

Interpersonal theories

Stress importance of human relationships, instincts and drives are less important. Harry Stack Sullivan. Health or illness of one's personality is related to how he interacts with those around him.

humanistic theories

Based on the theory that all human beings have the potential for goodness. This therapy focuses on learning about oneself and accept oneself.

Hildegard Peplau is considered the first nurse theorist who addressed psychiatric and mental health nursing. Which theorist influenced her seminal work on the nurse-client relationship?

Harry Stack Sullivan

3 multiple choice options

Describe the Transtheoretical Model of behavior change.

Otherwise known as the stages of change model. This model has six stages that a person will go through when attempting a change in one's life.

1. Precontemplation

2. Contemplation

3. Determination

4. Action

5. Relapse

6. Maintenance.

Which stage of the TTM is an individual who is researching weight loss programs in the community?

Preparation

3 multiple choice options

Motivational Interviewing

Model for collaborating with a client about the path forward through the stages of change towards a valued goal

Health Belief Model

A theory of health behaviors; the model predicts that whether a person practices a particular health habit can be understood by knowing the degree to which the person perceives a personal health threat and the perception that a particular health practice will be effective in reducing that threat.

True or false: The beliefs of both the client and practitioner have an impact on the efficacy of the treatment.

True

What are six constructs of the health belief model

1. Perceived susceptibility

2. Perceived severity

3. Perceived benefits

4. Perceived barriers

5. Cues to action

6. Self-efficacy

According to Carl Rogers, which qualities are included in the term facilitating conditions?

Accurate empathy, congruence or transparency, and unconditional positive regard

Carl Rogers: Accurate empathy

Empathic understanding, sensitively tracking the moment-to-moment feelings.

Carl Rogers: Congruence/Transparency

Transparency, the therapist must not put up a facade of any kind, or attempt to deceive clients about what the therapist is feeling.

Carl Rogers: Unconditional Positive Regard

Constant unwavering acceptance support, love, and good will towards the client with no conditions attached.

In regards to presenting clients with the Heinz Dilemma, Kohlberg was mostly interested in what?

The reasoning behind their answer of yes or no.

Gilligan's Theory

Argued that men tend to base their moral choices on abstract principles of law and justice and women based moral decisions on principles of compassion and caring

Gilligan: Conventional Care

Caring for another's needs above one's own.

Three elements of the biopsychosocial model according to George Engel

Psychological, sociological, and biological

What is a core concept of the transtheoretical model (TTM) of behavior change?

Stages of Change

A client has started walking a half-mile every day and eats a reduced carbohydrate diet to help lose 20 pounds. He has lost 3 pounds thus far. According to the transtheoretical model (TTM) of behavior change, which stage of change is the client in?

Action

What is the major premise of the health belief model

Individuals make healthy choices based on their own perceived risk, and their trust in the solution, and perceived benefits/barriers to a behavior

Lawrence Kohlberg's Theory of Moral Development

His theory is similar to Piaget's theory, but he focuses on one aspect of cognition - Moral Reasoning.

How people come to judge situations as right or wrong using three stages of development

1st Preconventional level of moral development.

2nd Conventional level of moral development.

3rd Postconventional level of moral development.

Preconventional morality

first level of Kohlberg's stages of moral development in which the child's behavior is governed by the consequences of the behavior

Conventional morality

second level of Kohlberg's stages of moral development in which the child's behavior is governed by conforming to the society's norms of behavior

Postconventional morality

third level of Kohlberg's stages of moral development in which the person's behavior is governed by moral principles that have been decided on by the individual and that may be in disagreement with accepted social norms

Carol Gilligan criticism of Kohlberg

moral development studies to follow up Kohlberg. She studied girls and women and found that they did not score as high on his six stage scale because they focused more on relationships rather than laws and principles. Their reasoning was merely different, not better or worse

Difference between Carol Gilligan and Kohlberg's theories

Gilligan's positions cannot be ranked in a developmental sequence.

Which percentage of adults are thought to be experiencing a severe mental illness?

4.55%

Which state had the highest prevalence of substance use disorder in 2021?

Colorado

Which percentage of all lifetime mental illness begins by age 14?

50%

What is the most common mental illness worldwide and one of the main causes of disability.

Depression

How many adverse events are included on the standard version of the Adverse Life Events Scale?

16

Prevalence of disease

total number of existing cases with respect to the entire population

incidence of the disease

the number of new cases of a disease in a given area or population during a given period of time

What is the percentage of individuals reporting serious thoughts of suicide in 2021?

4.34%

What is a major factor in reducing impact of adverse childhood experiences

Having a warm, loving, and actively engaged caregiver.

changes that occur early in brain development secondary to adverse childhood experiences are more likely __________.

to be enduring and passed on to future generations

Life Events Checklist

A brief, 17 item, self-report measure designed to screen for potentially traumatic events in a respondents lifetime.

Positive psychology

the scientific study of optimal human functioning; aims to discover and promote strengths and virtues that enable individuals and communities to thrive

Transference

Attitudes and beliefs that are held towards the practitioner based on the psychological similarities between them and previous person they were in relationship with.

Countertransference

Attitudes and beliefs the practioner holds towards a client based on their psychological similarity to a previous relationship.

Negative transference

Example: displacement of one's negative feelings towards one's parents onto the therapist

Positive transference

Phenomenon that occurs during therapy, in which the patient redirects toward the therapist unconscious feelings of love and affection retained from experiences with authority figures (usually the parents) in early childhood.

How should incidences of transference and countertransference be handled in a therapeutic alliance.

Transference and countertransference can provide useful clinical information about therapeutic relationships, leading to increased empathy.

What are the four examples of mature defense mechanisms

Suppression: Emotions remain conscious but are suppressed.

Altruism: Suppressing the emotion by doing kind things for others.

Sublimation: Transmitting the emotion into a productive and socially redeeming endeavor. Reading a book on rejection.

Humor: Expressing the emotion in indirect and humorous ways.

Give some examples of neurotic defense mechanisms.

Denial: Denying the emotion exists at all.

Repression: Stuffing the emotion out of conscious awareness. (Usually surfaces in unpredictable ways, headache)

Reaction Formation: Forgetting the negative emotion by transforming it into it's opposite.

Displacement: Shifting the emotion from it's original source to something or someone else.

Rationalization: Inventing a convincing but usually false reason why you are not bothered.

Give examples of immature defense mechanisms

Passive aggressiveness: Expressing anger indirectly and passively.

Acting out: Expressing the emotion in actions rather than keeping it in awareness.

Dissociation: Dissociating instead of feeling the pain.

Projection: Disavowing the feelings/anger and attributing it to the other person.

Splitting (Idealization/Devaluation): Attributing total malice and ill intent to the other person.

Give examples of psychotic defenses

-Denial of external reality

-Distortion of external reality

What are the goals of the initial psychiatric interview

The goals of the initial psychiatric interview include establishing a traditional biomedical diagnosis, understanding the biopsychosocial dimensions of the person, and building rapport.

According to Carlat, which element of the psychiatric interview is the most important?

History of present illness

What are the four tasks of the diagnostic interview according to carlat?

1. Build a therapeutic alliance

2. Obtain the psychiatric database

3. Interview for Diagnosis

4. Negotiate a treatment plan and communicate it to patient

What does obtaining the psychiatric database refer to?

Obtaining history of present illness, medical history, social and developmental history, family medical history, psychiatric history

MIDAS

Medications: What medications are taken

Illnesses: Current illnesses and conditions

Doctor: Who is the primary care doctor

Allergies: Allergies to medications or other things

Surgeries: Surgical history

Diagnostic overshadowing

phenomenon in which a person's physical symptoms are attributed to their mental illness

What are key elements of the psychiatric interview

According to Carlat (2017), what is the next step after a short list of potential diagnoses is generated?

Ask screening questions

SIGECAPS

acronymn for depression symptoms - sleep, interest, guilt, energy, concentration, appetite, psychomotor agitation, suicide

What are the seven major adult diagnostic categories of the DSM 5-TR

-Depression and Mood Disorders

-Psychotic Disorders

-Somatic Disorders

-Anxiety Disorders

-Cognitive Disorders

-Substance Use Disorders

-Personality Disorders

Mnemonic for seven major adult diagnostic categories of the DSM 5-TR

Depressed Patients Sound Anxious, So Claim Psychiatrists

GAF scale

The Global Assessment of Functioning (GAF) scale is a numeric scale (0 - 100) used in mental health to rate the social, occupational and psychological functioning of adults. (DSM-IV)

Case formulation

Bridges the gap between simple diagnosis which is a flat 2 dimensional criteria, and joining that with a creative, evidence based, treatment approach catered to the uniqueness of every patient.

Process by which we link the diagnosis to etiological underpinnings and future prognosis.

Standards of practice

Standards of practice include a set of behaviors for which a PMHNP is always accountable.

What are some characteristics of clients who may benefit from engaging in psychoanalytic therapies?

-Neurotic-To-Healthy Personality Organization

-Rely on primarily mature defenses with potentially some primitive defenses.

-Have a sense of who they are

-In touch with reality

-Have achieved object constancy

-Seek help without being forced

Difference between ego dystonic and ego syntonic.

Ego Dystonic refers to emotions, thoughts, and feelings that feel alien or unwelcome to themselves. (Such as anxiety, disturbing thoughts, or mental illness). These

Ego Syntonic refers to abnormal emotions, thoughts, and feelings but the patient feels they are compatible with who they are. (feel justified in having paranoia/acting out)

ego dystonic

the individual sees the illness as something thrust upon her that is intrusive and bothersome

ego syntonic

the individual perceives her behavior as correct, normal, or in harmony with her goals

Supportive psychotherapy

Treatment that involves offering encouragement, support, and hope to patients facing difficult life transitions and crisis.

First wave behavioral therapy (radical behaviorism)

Change comes about by two dynamics that is underneath all behavior: attraction and aversion in response to stimulus. People do more of what they find pleasant and less of what they find unpleasant. Reward and punishment.

Second wave behavioral therapy

Simply put, second wave overlays first wave by including cognition, emotion, and subjective experience to inform the therapeutic process. Change a behavior leading to change in the thoughts AND a change in the thoughts which changes the behavior

Third wave behavioral therapy

Contemporary behavioral therapies that shift from a sole emphasis on behavioral change to incorporate acceptance, emotion, and mindfulness.

Cognitive Therapy

An approach that emphasizes the importance of thoughts and beliefs on behaviors. This approach aims to call attention to these thoughts and empower the client to respond to them more effectively.

Cognitive Model

Situation -> Automatic thoughts and Images -> Reaction -> Emotional/Behavioral/Physiological

humanistic-existential approach

Approach that focuses on individuals capacity for self-awareness, individual freedom, personal growth, and the search for the meaning of life.

Humanistic: Self-actualization, personal responsibility

Existential philosophy: Freedom, choice, and search for meaning.

Psychoanalytic Therapy

-Emphasizes the past

-focuses on expression of emotion, identification of patterns in actions, thoughts, feelings, experiences, and relationships.

-Explores intrapsychic issues: wishes, dreams, fantasies

-Emphasizes transference and the working alliance.

7 key concepts

unconscious, developmental perspective, transference, countertransference, resistance, psychic determinism, and unique subjectivity.

cognitive therapy

a treatment method designed to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or self-destructive

Four Steps of Motivational Interviewing

-Establishing an alliance with the client and a sense of working together (engaging)

-Clarifying the goals or target for change (focusing)

-Conversating about eliciting the client's own motivation for change (evoking)

-Shaping a plan for putting the change in place

behavioral therapy

focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors, and using rewards or other consequences to make the changes

dialectical behavior therapy

-Used for borderline personality disorder, mood disorders, substance use, eating disorders, and PTSD.

-Combines principles of acceptance and change to help individuals develop skills for managing intense emotions.

-Dialectical philosophy brings two contradictory concepts into balance. Finding balance between acceptance and change. Accepting themselves while also moving towards positive changes.

existential therapy

-Focuses on the meaning and purpose of life, responsibility, suffering, freedom, death.

humanistic therapy

Emphasis on inherent capacity for growth, self-actualization and fulfillment.

interpersonal therapy

-Looks at interpersonal relationships, identifying significant life events, conflicts, losses, and social roles.

-

EDMR

eye movement desensitization and reprocessing - a therapy using rapid eye movement during desensitization techniques for PTSD

Family Therapy

Types of Boundaries