mental health exam 2

What is “therapeutic communication”?

Patient-centered, professional, goal-directed communication that supports assessment, coping, and problem-solving.

Name four core therapeutic communication techniques.

Silence, active listening, clarifying (paraphrasing/restating), and open-ended/focused questions.

When does silence help vs. hinder?

Helps reflection and disclosure; overuse (especially with youth) can impede comfort and feedback.

What is active listening?

Focusing, responding, and remembering verbal and nonverbal content to enhance coping and problem-solving.

List Peplau’s phases of the nurse–patient relationship.

Preorientation, Orientation, Working, Termination.

Key task of the orientation phase?

Establish roles, purpose, parameters, and initial goals/contract.

Define genuineness.

Nurse’s realness/congruence—open, honest, and authentic.

Define empathy.

Accurately understanding the patient’s world and conveying that understanding.

Define positive regard.

Unconditional respect and valuing of the person while suspending judgment.

What are attending behaviors?

Eye contact (as culturally appropriate), open posture/lean, facial/vocal qualities, and verbal tracking.

Why be cautious interpreting eye contact?

Meanings vary by culture; direct eye contact can be respectful in some, disrespectful or aggressive in others.

Which factors can interfere with communication?

Personal (anxiety, bias), environmental (noise, lack of privacy), and relational (mistrust, power imbalance).

Name three nontherapeutic techniques to avoid.

Excessive questioning, “why” questions, approval/disapproval (also false reassurance, minimizing feelings).

Two techniques that enhance communication.

Clarifying (restating/paraphrasing) and open-ended questions.

What are cultural filters?

Built-in biases that shape what we notice or ignore during communication.

What makes a group “therapeutic”?

Therapeutic factors like instillation of hope, universality, and interpersonal learning support change.

Phases of group development?

Initial/Orientation, Working, Termination.

Purpose of task roles in groups?

Move the group’s work forward (e.g., initiate, give information, clarify).

Purpose of maintenance roles in groups?

Maintain group climate (e.g., encourage, harmonize, gatekeep).

One strategy for a silent group member.

Gentle invitations/go-rounds, explore anxiety, avoid rapid-fire questioning.

One strategy for a demoralizing/disruptive member.

Set clear norms, reflect impact, redirect to here-and-now; address privately if needed.

Which systems drive the acute stress response?

Sympathetic nervous system and HPA axis (CRH → ACTH → cortisol).

Two long-term effects of chronic cortisol exposure.

Immune suppression and cardiometabolic risk (e.g., weight gain, hypertension).

How do perception and personality affect stress?

They shape appraisal and coping style, influencing physiologic and psychological impact.

How does social support affect stress?

Buffers stress, improves coping, and reduces negative health effects.

What does the Recent Life Changes Questionnaire (RLCQ) estimate?

Cumulative life-event stress load to flag risk; use with coping/support assessment.

Name three first-line nonpharmacologic stress interventions.

Relaxation/breathing or PMR, mindfulness/cognitive reframing, sleep hygiene/exercise.

Two additional stress-management supports.

Time management and strengthening social connections.

Define serious mental illness (SMI) impact on daily life.

Impairs ADLs, health maintenance, employment/education, relationships, and overall quality of life.

Common problems associated with SMI.

Stigma, homelessness, substance use, trauma/victimization, limited access to care, poor physical health.

Nurse’s role in SMI care.

Recovery-oriented care: case management, medication education, safety planning, health promotion, family psychoeducation, advocacy.

First priorities in an SMI care plan.

Safety, medication adherence/symptom management, community linkage, relapse prevention.

Major domains of integrative care.

Natural products; mind–body approaches (e.g., meditation, yoga); other modalities (e.g., massage, energy therapies).

Two counseling priorities for CAM use.

Evidence of benefit/limits and safety (quality, interactions, proper use and disclosure to providers).

Name two interaction cautions with CAM.

Serotonergic combinations and anticoagulant/antiplatelet effects with certain herbs/supplements.

Two broad contributors to neurodevelopmental disorders.

Biological (genetic/neurodevelopmental) and environmental/psychosocial factors (including ACEs).

Define resilience in children/adolescents.

Capacity to adapt/recover; supported by nurturing adult ties and good caregiver–child fit.

Two essentials in child assessment.

Combine caregiver input with observation/therapeutic play; watch for developmental regression.

Two essentials in adolescent assessment.

Clarify confidentiality/its limits and perform structured risk screening (e.g., HEADSSS).

Two nonpharmacologic modalities for youth.

Psychoeducation/family work and behavioral interventions; add school supports and play-based therapies as indicated.

Three anchor neurodevelopmental diagnoses and core features.

ASD (social/behavioral deficits), ADHD (inattention/hyperactivity-impulsivity), intellectual disability (intellectual/adaptive deficits).

What defines schizophrenia spectrum disorders?

Disorders with psychosis—altered cognition, perception, and reality testing (including schizophrenia).

Examples of positive symptoms.

Delusions, hallucinations, disorganized speech/behavior.

Examples of negative symptoms.

Affective flattening, avolition, alogia, anhedonia.

Two cognitive deficits seen in schizophrenia.

Impaired attention and executive functioning.

Nursing approach for hallucinations.

Present reality (“I don’t hear it”), reduce stimulation, and coach coping strategies.

Nursing approach for delusions.

Do not argue content; focus on feelings/safety, gently clarify, keep to reality-based topics.

Nursing approach for disorganized thinking/speech.

Do not pretend to understand; summarize/paraphrase; use brief, concrete language.

Distinguish FGAs vs. SGAs.

FGAs: strong D2 block—good for positive symptoms, higher EPS/TD; SGAs: D2/5-HT2A—fewer EPS, higher metabolic risk.

One high-yield SGA risk to monitor.

Metabolic syndrome (weight gain, hyperglycemia, dyslipidemia).

Clozapine’s two unique points.

Effective for treatment-resistant schizophrenia; requires ANC monitoring due to neutropenia risk.

Phases of schizophrenia care across illness course.

Acute (safety/stabilization), Stabilization (optimize treatment/skills), Maintenance (relapse prevention/community functioning).