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125 Cards in this Set
- Front
- Back
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What is adaptation? |
Restoration of homeostasis to the internal environmental system. |
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What does adaptation include? |
Responses directed at stabilizing internal biological processes and psychological preservation of self identity and self esteem. |
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What is maladaptive? |
Responses perceived as negative or unhealthy and occur when the integrity of the individual is disrupted. |
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A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Miller and Rahe Recent Life Changes Questionnaire. How should the nurse evaluate this client data? A.The client is experiencing severe distress and is at risk for physical and psychological illness. B.A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness. C.Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D.The client may view these losses as challenges and perceive them asopportunities. |
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness. |
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What are the weaknesses in the Miller and Rahe Recent Life Changes Questionnaire Tool? |
Does not consider: * The individual's perception of the event * His or her coping strategies and available support systems at the time of the Life Change. |
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1.A 25-year-old man barely avoids a motor vehicle accident. His heart is pounding, his palms are sweaty, and his respirations are increased.This is an example of which stage of the general adaptation syndrome? A.Alarm reaction stage B.Stage of resistance C.Stage of exhaustion D.Stage of biological stress |
A.Alarm reaction stage |
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What is a secondary appraisal? |
The second stage of perception of a precipitating stress event. An assessment of skills, resources and knowledge that the person possesses to deal with the situation. |
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What is stress? |
A thing or event that triggers the adaptive physiological and psychological responses in an individual. The event is one that *creates changes in the life pattern of the individual * requires significant adjustment in lifestyle * taxes available personal resources |
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A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client’s appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging |
D. Challenging |
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What are the predisposing factors on how an individual responds to stress? |
* Genetic influences * Past experiences * Existing conditions |
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When are coping strategies considered maladaptive? |
When the conflict being experienced goes unresolved or intensifies. |
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What are some adaptive coping strategies? |
* Awareness * Relaxation * Meditation * Interpersonal communication with caring others * Problem solving * Pets * Music |
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What were early beliefs of mental illness? |
They were beliefs centered on mental illness as evil spirits, supernatural or magical powers that entered the body. |
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How do individuals experience stress? |
Both physically and psychologically. |
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What is mental health? |
Successful adaptation to stressors from the internal or external environment, shown by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms. |
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What is mental illness? |
Maladaptive responses to stressors from the internal or external environment, shown by thoughts,feelings, & behaviors that are incongruent with the local and cultural norms & interfere with the individual’s social, occupational, or physical functioning. |
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What are Peplau's four levels of anxiety with psychological adaptation to stress? |
* Mild - seldom a problem * Moderate - perceptual field diminishes * Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details * Panic - the most intense state |
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What is grief?
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State of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived. |
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What are Elisabeth Kubler-Ross's 5 stages of grief? |
* Denial * Anger * Bargaining * Depression * Acceptance |
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Which client statement should alert a nurse that a client may be responding maladaptively to stress? A.“I’ve found that avoiding contact with others helps me cope.” B.“I really enjoy journaling; it’s my private time.” C.“I signed up for a yoga class this week.” D.“I made an appointment to meet with a therapist.” |
A. I've found that avoiding contact with others helps me cope. |
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A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation? A.“I don’t like to talk about my relationship with my mother.” B .“My mother hates me.” C.“I have a very wonderful mother whom I love very much.” D.“My mom always loved my sister more than she loved me.” |
C. I have a very wonderful mother whom I love very much. |
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What are the maladaptive grief responses? |
* Prolonged response * Delayed/ inhibited response * Distorted response |
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How does guilt factor into the resolution of grief? |
Guilt can be for having had a love/ hate relationship with the lost entity. Guilt often lengthens the grieving process. |
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How does anticipatory grieving factor into the resolution of grief? |
It is thought to shorten the grief response when the loss actually occurs. |
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How does having a number of recent losses factor into the resolution of grief? |
Length of the grief response is often extended when an individual has experienced a number of recent losses. |
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When is resolution of the grief response thought to occur? |
When an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association. |
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A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client’s behaviors? A.The client’s behaviors demonstrate mental illness in the form of depression. B.Theclient’s behaviors are extensive which indicates the presence of mentalillness. C.Theclient’s behaviors are not congruent with cultural norms. D.Theclient’s behaviors demonstrate no functional impairment, indicating no mental illness. |
D. the Client's behaviors demonstrate no functional impairment, indicating no mental illness. |
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At what point should the nurse determine that a client is at risk for developing a mental illness?
A.When thoughts, feelings, and behaviors are not reflective of the DSM-V criteria B.When maladaptive responses to stress are coupled with interference in daily functioning C.When a client communicates significant distress D.When a client uses defense mechanisms as ego protection |
B.When maladaptive responses to stress are coupled with interference in daily functioning |
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What is communication? |
* Interpersonal communication is a transaction between the sender and the receiver. Both persons participate simultaneously. * In the transactional model, both participants perceive each other, listen to each other, and simultaneously engage in the process of creating meaning in a relationship. |
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What preexisting conditions can have an impact on communication? |
Both sender and receiver bring certain preexisting conditions to the exchange that influence both the intended message and the way in which it is interpreted. * Values, attitudes and beliefs * Culture or religion (such as personal space) * Social Status * Gender * Age or developmental level (know your audience) |
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Regarding the impact of preexisting conditions, what role does the environment in which the transaction takes place have? |
* Territoriality (my space - don't come in it) * Density (how many people are in an amount of space - can trigger aggression) * Distance (intimate, personal, social, public) |
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1.The unit manager needs to meet with a client who is exhibiting escalating hostility. Which would be the most appropriate location for the nurse to meet with this client? (Keep in mind - safety) A. The client’s room with the door shut B. A quiet corner of the dayroom C. The nurse’s station D. The unit’s treatment room |
B. A quiet corner of the day room helps to stay visible yet offers privacy |
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What are the components of nonverbal communication? |
* Physical appearance and dress * Body movement and posture * Touch * Facial Expressions * Eye behavior * Vocal Cues or paralanguage |
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In Therapeutic Communication techniques, what does silence do? |
Allows the client to take control of the discussion, if he or she so desires. |
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In Therapeutic Communication techniques, what does acceptance do? |
Conveys a positive regard |
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In Therapeutic Communication techniques, what does giving recognition do? |
Acknowledges, indicates awareness
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In Therapeutic Communication techniques, what does offering one's self do? |
Make one's self available for communication
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In Therapeutic Communication techniques, what does giving broad openings do? |
Allows the client to select the topic |
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In Therapeutic Communication techniques, what does offering general leads do? |
Encourages the client to continue. |
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In Therapeutic Communication techniques, what does placing the event in time or sequence do? |
Clarifies the relationship of events in time. "So I understand you were having a hard time last night". |
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In Therapeutic Communication techniques, what does making observations do? |
It verbalizes what is observed or perceived. |
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In Therapeutic Communication techniques, what does encouraging descriptions of perceptions do? |
It asks the client to verbalize what is being perceived. |
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In Therapeutic Communication techniques, what does encouraging comparisons do? |
It asks the client to compare similarities and differences in ideas, experiences, or interpersonal relationships |
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In Therapeutic Communication techniques, what does restating do? |
Letsthe client know whether an expressed statement has or has not been understood. (“If I understandyou correctly…”) |
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In Therapeutic Communication techniques, what does reflecting do? |
Directs questions or feelings back to client so that they may be recognized and accepted.(“That must be very difficult.”) |
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In Therapeutic Communication techniques, what does focusing do? |
Takes notice of a single idea or a single word. |
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In Therapeutic Communication techniques, what does exploring do? |
It is delving further into a subject, idea, experience, or relationship. |
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In Therapeutic Communication techniques, what does seeking clarification and validation do? |
It strives to explain what is vague and searches for mutual understanding. (“What isn’t worth it anymore?”) |
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In Therapeutic Communication techniques, what does presenting reality do? |
It clarifies misconceptions that client may be expressing. (“I don’t see what you see there. Can you describe it?”) |
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In Therapeutic Communication techniques, what does voicing doubt do? |
It expresses uncertainty as to the reality of client’s perception. |
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In Therapeutic Communication techniques, what does verbalizing the implied do? |
It is putting into words what client has only implied. |
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In Therapeutic Communication techniques, what does attempting to translate words into feelings do? |
It is putting into words the feelings the client has expressed only indirectly. |
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In Therapeutic Communication techniques, what does attempting to formulating a plan of action do? |
It strives to prevent anger or anxiety from escalating to an unmanageable level the next time the stressor occurs.(“How can we stop those hallucinations for you?”) (“What do you do at home for that?”) |
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As the move-out date to leave the shelter gets closer, a battered wife states, “I'm afraid to leave here. I'm afraid for my safety and the safety of my children.” Which nursing statement is most supportive? A. “This is a difficult transition. Let's formulate a plan to keep you all safe in the community.” B. “It’s the policy that clients can only live here 30 days. Maybe we can ask for more time.” C. “You've had a month to come up with a plan for keeping you and your family safe.” D. “Hopefully,your husband has been in counseling. I’m sure this will work out fine.” |
A. “This is a difficult transition. Let's formulate a plan to keep you all safe in the community.” |
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Why is giving reassurance a form of non-therapeutic communication technique? |
It may discourage the client from further expression of feelings if client believes the feelings will only be belittled. Don’t say “everything’s going to be okay”. |
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Why is rejecting a form of non-therapeutic communication technique? |
It is refusing to consider client’s ideas or behavior. |
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Why is giving approval or disapproval a form of non-therapeutic communication technique? |
It implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s behavior. |
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Why is agreeing or disagreeing a form of non-therapeutic communication technique? |
It implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or “wrong.” |
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Why is giving advice a form of non-therapeutic communication technique? |
It implies that the nurse knows what is best for the client and that the client is incapable of any self-direction. |
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Why is probing a form of non-therapeutic communication technique? |
It is pushing for answers to issues the client does not wish to discuss and causes the client to feel used and valued only for what is shared with the nurse. |
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Why is defending a form of non-therapeutic communication technique? |
It means to defend what the client has criticized implying that the client has no right to express ideas, opinions, or feelings. |
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Why is requesting an explanation a form of non-therapeutic communication technique? |
Asking “Why?” implies that the client must defend his or her behavior or feelings. |
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Why is Indicating the existence of an external source of power a form of non-therapeutic communication technique? |
It encourages the client to project blame for his or her thoughts or behaviors on others. |
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Why is belittling feelings expressed a form of non-therapeutic communication technique? |
It causes the client to feel insignificant or unimportant. |
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Why is making stereotyped comments, cliches, and trite expressions a form of non-therapeutic communication technique? |
They are meaningless in a nurse-client relationship. |
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Why is using denial a form of non-therapeutic communication technique? |
It blocks discussion with the client and avoids helping him or her identify and explore areas of difficulty. |
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Why is interpreting results a form of non-therapeutic communication technique? |
It is the therapist telling the client the meaning of his or her experience
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Why is introducing an unrelated topic a form of non-therapeutic communication technique? |
It causes the nurse to take over the direction of the discussion. |
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The nurse is performing an initial assessment on a newly admitted client who is oriented times four. Which of the following communication techniques would bestfacilitate obtaining accurate and complete client data? A. Closed-endedquestions B. Requesting an explanation C. Open-ended questions D. Interpreting |
C. Open-ended questions |
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What is active listening? |
To be attentive to what the client is saying, both verbally and nonverbally. |
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What are some nonverbal behaviors to facilitate skills for attentive listening? |
SOLER S - Sit squarely facing the client O - Observe and open posture L - Lean forward toward the client E - Establish eye contact R - Relax |
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What is transference? |
It occurs when the client unconsciously displaces (or transfers) to the nurse feelings formed towards a person from his or her past. |
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What is counter-transference? |
It refers to the nurse’s behavioral and emotional response to the client. These responses maybe related to unresolved feelings toward significant others from the nurse’s past, or they may be generated in response to transference feelings on the part of the client. |
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What are the different types of boundaries that may present a problem in therapeutic communication? |
* Time * Place/ space * Money/ gifts * Clothing * Language * Self- disclosure * Physical Contact |
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What are some signs of trouble brewing in therapeutic communication? |
* Feedback that YOUR behavior is intrusive * Difficulty/ problems setting limits * Relating to patients as if they were friends * Sexual feelings or advances toward patients |
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What are process recordings? |
Written reports of verbal interactions with clients, written by the nurse or student as a tool for improving communication techniques. |
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How is feedback most useful? |
* When it is descriptive rather than evaluative and focuses on the behavior rather than on the client * When it is specific rather than general * When it is directed toward behavior that the client has the capacity to modify * When it imparts information rather than offers advice * When it is well timed |
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What is milieu therapy? |
A therapeutic community. A setting where the client is expected to learn adaptive coping, interaction, and relationship skills that can be generalized to other aspects of his or her life. |
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What are the basic assumptions of milieu therapy? |
•The health in each individual is to be realized and encouraged to grow. •Every interaction is an opportunity for therapeutic intervention. •The client owns his or her own environment. •Each client owns his or her own behavior. •Peer pressure is a useful and powerful tool. •Inappropriate behaviors are dealt with as they occur. •Restrictions andpunishment are to be avoided. |
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What are conditions that promote a therapeutic community? |
•Basic physiological needs are fulfilled. •The physical facilities are conducive to achievement of the goals of therapy. •A democratic form of self-government exists. •Responsibilities are assigned according to client capabilities. •A structured program of social and work-related activities is scheduled as part of the treatment program. •Community and family are included in the program of therapy in an effort to facilitate discharge from treatment. |
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What is a program of therapeutic community? |
•Care is directed by an interdisciplinary team. •A comprehensive treatment plan is formulated by the team. •Team members of all disciplines sign the plan and meet regularly to update the plan as needed. •Disciplines may include psychiatry, psychology, nursing, social work, occupational therapy,recreational therapy, art therapy, music therapy, dietetics, and the chaplain’s service. |
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Which of the following bestdescribes the role of the psychiatric social worker as a member of theinterdisciplinary treatment team? A. Provides ongoingassessment of client’s mental and physical condition B. Functions under the supervision of the psychiatric nurse C. Serves as the leader of the treatment team D. Conducts individual, group, and family therapy |
D. Conducts individual, group, and family therapy |
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What is the role of the nurse in therapeutic communication? |
•Through use of the nursing process, nurses manage the therapeutic environment on a 24-hour basis. •Nurses have the responsibility for ensuring that the client’s physiological and psychological needs are met. •Nurses are also responsible for: – Medication administration – Development of a one-to-one relationship – Setting limits on unacceptable behavior – Client education |
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A client, diagnosed with borderline personality disorder, approaches the nursing station often with various requests. The nurse intervenes by stating, “You may approach the nurse’s station only once an hour.” Which nursing intervention has been employed? A. Providing reality orientation B. Ensuring physical need fulfillment C. Setting limits on behavior D. Providing client education |
C. Setting limits on behavior |
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What is primary appraisal? |
A judgement about the situation in one of the following ways: * irrelevant * benign - positive * stress appraisal |
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What is displacement? |
Feelings are transferred from one target to another that is considered less threatening or neutral. |
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What is undoing? |
A mechanism that is used to symbolically negate or cancel out a previous action or experience that one finds intolerable. |
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What's the difference between introjection and identification? |
Identification is conscious. Introjection they believe they ARE that person. |
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What is Isolation? |
The separation of a thought or memory from the feeling, tone or emotions associated with it. |
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What is denial? |
Refusal to acknowledge the existence of a real situation or the feelings associated with it. |
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What is introjection? |
The beliefs and values of another individual are internalized and symbolically become a part of the self, to the extent that the feeling of separateness or distinctness is lost. |
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What is identification? |
An attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires. |
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What is regression? |
A retreat to an earlier level of development and the comfort measures associated with that level of functioning. |
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What is compensation? |
Covering up a real or perceived weakness by emphasizing a trait one considers more desirable. |
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What is repression? |
The involuntary blocking of unpleasant feelings and experiences from one's awareness. |
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What is projection? |
Feelings or impulses unacceptable to one's self are attributed to another person. |
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What is suppression? |
The voluntary blocking of unpleasant feelings and experiences form one's awareness. It is conscious. |
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What is rationalization? |
Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors. |
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What are common characteristics of people with neuroses (a form of severe anxiety)? |
* They are aware that they are experiencing distress * They are aware that their behaviors are maladaptive * They are unaware of any possible psychological causes of the distress * They feel helpless to change their situation * They experience no loss of contact with reality |
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Which defense mechanism is this an example of? A handicapped boy who is unable to participate in sports compensates by becoming a great scholar |
Compensation |
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Which defense mechanism is this an example of? Individuals continue to smoke cigarettes even though they have been told of the health risks involved. |
Denial |
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Which defense mechanism is this an example of? A boy who is teased and hit by the class bully on the playground comes home after school and kicks his dog. |
Displacement |
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Which defense mechanism is this an example of? A teenage girl emulates the mannerisms and style of dress of a popular female rock star. |
Identification |
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Which defense mechanism is this an example of? A young psychology professor receives a letter from his fiancee breaking off their engagement. He shows no emotion when discussing this with his best friend. Instead he analyzes his fiancee's behavior and tries to reason why the relationship failed. |
Intellectualization |
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Which defense mechanism is this an example of? A psychiatric patient claims to be the son of God, drapes himself in a sheet and blanket, "performs miracles" on other patients and refuses to respond unless address as Jesus Christ. |
Introjection |
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Which defense mechanism is this an example of? A young woman describes being attacked and raped by a street gang. She displays an apathetic expression and no emotional tone. |
Isolation |
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Which defense mechanism is this an example of? A young soldier who has an extreme fear of participating in military combat tells his sergeant that the others in his unti are a "bunch of cowards". |
Projection |
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Which defense mechanism is this an example of? A young man is unable to afford the sports car he wants so desperately. He tells the salesperson, "I'd buy this car, but I'll be getting married soon. This is really not the car for a family man". |
Rationalization |
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Which defense mechanism is this an example of? A young soldier who has an extreme fear of participating in military combat volunteers for dangerous front line duty. |
Reaction formation |
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Which defense mechanism is this an example of? A person who is depressed may withdraw to his or her room, curl up in a fetal position on the bed and sleep for long periods of time. |
Regression |
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Which defense mechanism is this an example of? A woman cannot remember being sexually assaulted when she was 15 years old. |
Repression |
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Which defense mechanism is this an example of? A teenage boy with strong competitive and aggressive drives becomes the star football player on his high school team. |
Sublimation |
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Which defense mechanism is this an example of? Scarlett O'Hara says "I'll that about that tomorrow" |
Suppression |
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Which defense mechanism is this an example of? A man spills some salt on the table, then sprinkles some over his left shoulder to "prevent bad luck". |
Undoing |
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What are the disorders that are examples of psychoneurotic responses to anxiety as they appear in DSM-5? |
1. Anxiety disorders (phobias, panic disorders) 2. Somatic Symptom Disorders (physical symptoms with no pathology) 3. Dissociative disorders (dissociative amnesia, dissociative identity disorder) |
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What are the common characteristics of people with psychoses (a form of panic anxiety)? |
* They exhibit minimal distress (emotional tone is flat, bland or inappropriate) * They are unaware that their behavior is maladaptive * They are unaware of any psychological problems * They are exhibiting a flight from reality into a less stressful world or into one in which they are attempting to adapt. |
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What is bereavement overload? |
Accumulated grief, or numerous losses experienced in a relatively short time. |
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When is resolution of the process of mourning thought to have occurred? |
When an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association. |
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What is reaction formation? |
Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. |
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What is sublimation? |
Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive. |
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What is intellectualization? |
An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis. |
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What is a neurotransmitter? |
A chemical stored in the axon terminals of the presynaptic neurons. |
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What are receptor sites? |
The location situated on the cell membranes of the postsynaptic neurons where the neurotransmitter combines with it to generate an electrical impulse, creating an excitatory response, or not to create an electrical impulse, causing an inhibitory response. |
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What is re-uptake? |
The process for when the neurotransmitter is being stored for future use. |
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What are the major categories of neurotransmitters? |
* Cholinergics (acetylcholine) * Monoamines (norepinephrine) * Amino acids * Neuropeptides |
