Mental Health Final Exam Outline Grade
A+
Chapter 1 (2 questions)
Defense Mechanisms
Defense Mechanism Example
Compensation “I may not know how to cook, but I can sure do the dishes!”
A process of psychologically counterbalancing perceived
weakness by emphasizing strength in other areas.
Denial A functioning alcoholic denies they have a drinking problem
The refusal to accept reality or fact, acting as if a painful but points out how well they function in their job &
event, thought or feeling did not exist. Characteristic of early relationships
childhood development.
Displacement Man gets angry at boss but can’t express it b/c he will get
The redirecting of thoughts, feelings, & impulses directed at fired so instead he comes home & kicks the dog and starts
one person or object, but taken out upon another person argument with wife.
object.
Identification A teenage boy who required lengthy rehabilitation after an
An attempt to increase self-worth by acquiring certain accident decides to become a physical therapist as a result of
attributes & characteristics of an individual one admires. his experiences.
Intellectualization
Intellectualization A person has just been given a terminal medical diagnosis,
The overemphasis of thoughts feelings and impulses directed instead of expressing their sadness & grief, focuses instead on
at one person or object, but taken out upon another person or the details of all possible fruitless medical procedures
object
Introjection Children integrate their parents’ value system into the
Integrating the beliefs and values of another individual into process of conscience formation. A child says to friend, “Don’t
one’s own ego structure cheat. It’s wrong.”
Projection Sue feels a strong sexual attraction to her track coach and tells
Attributing feelings or impulses unacceptable to one’s self to her friend, “He’s coming on to me!”
another person
Rationalization A woman who starts dating a mean she really likes and thinks
Putting something into a different light or offering a different the world of is suddenly dumped by the man for no reason.
explanation for one’s perceptions or behaviors in the face of a She renames the situation in her mind with “I suspected he
changing reality. was a loser all along”.
Reaction formation A woman who is very angry at her boss & would like to quit
The converting of unwanted or dangerous thoughts, feelings her job instead is overly kind & generous toward her boss &
or impulses into their opposites. express a desire to keep working there forever. She is
incapable of expressing the negative emotions of anger &
unhappiness with her job, and instead becomes overly kind to
publicly demonstrate her lack of anger and unhappiness.
Regression An adolescent who is overwhelmed with fear, anger, and
The reversion to an earlier stage of development in the face of growing sexual impulses might become clingy and start
unacceptable thought or impulses. exhibiting earlier childhood behaviors he has long since
overcome, such as bedwetting. An adult may regress when
under great deal of stress, refusing to leave their bed and
engage in normal, everyday activities.
Sublimation A person has sexual impulses they would like not to act upon,
The channeling of unacceptable impulses, thoughts and they may instead focus on rigorous exercise
emotions into more acceptable ones.
Suppression Scarlett O’Hara says, “I don’t want to think about that now. I’ll
The voluntary blocking from one’s awareness of unpleasant think about that tomorrow.”
feelings and experiences
Undoing Joe is nervous about his new job and yells at his wife. On his
Symbolically negating or canceling out an experience that one way home he stops and buys her some flowers.
finds intolerable
, Physical Responses to Stress
Hans Selye defined stress as “the state manifested by a specific syndrome which consists of all the nonspecifically induced
changes within a biologic system.”
“Fight-or-flight” syndrome
Selye’s General Adaptation Syndrome
Alarm reaction stage
Stage of resistance
Stage of exhaustion
The Fight-or-Flight Syndrome
Immediate response
Sustained response
Sustained physical responses to stress promote susceptibility to many diseases of adaptation
Psychological Responses
Anxiety and grief have been described as two major, primary psychological response patterns to stress.
A variety of thoughts, feelings, and behaviors are associated with each of these response patterns.
Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s
functioning.
Anxiety
-A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
-Extremely common in our society
-Mild anxiety is adaptive and can provide motivation for survival
Peplau’s Four Levels of Anxiety:
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
Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of
physiological disorders, e.g., migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.
Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving, e.g., anxiety disorders and
somatoform disorders.
Extended periods of functioning at the panic level of anxiety may result in psychotic behavior.
Examples of psychotic disorders include schizophrenia, schizoaffective disorders, and delusional disorders.
Behavioral Adaptation Responses to Anxiety
At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking,
sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.
At the mild to moderate level, the ego calls on defense mechanisms for protection
Grief
• The subjective state of emotional, physical, and social Elisabeth Kübler-Ross
responses to the loss of a valued entity. -5 Stages of Grief
• The loss may be real or perceived. 1. Denial
2. Anger
Anticipatory grief: the experiencing of the grief process 3. Bargaining
before the actual loss occurs. 4. Depression
Resolution: length of the grief process is entirely individual. 5. Acceptance
It can last from a few weeks to years. It is influenced by a
number of factors.
,• The experience of guilt for having had a “love-hate” relationship with the lost entity. Guilt often lengthens the grieving
process.
• Anticipatory grieving is thought to shorten the grief response when the loss actually occurs.
• The length of the grief response is often extended when an individual has experienced a number of recent losses and when
he or she is unable to complete one grieving process before another one begins.
• Resolution of the grief response is 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.
Maladaptive Grief Responses:
- Prolonged response
- Delayed/inhibited response
- Distorted response
Create a therapeutic environment (Milieu)
Health education, promotion & maintenance
Promotion of self-care
Cognitive and behavioral therapies
Nursing Interventions Medication education, administration, and monitoring
Documenting:
GAF: Global assessment of findings
0 10 100
Inadequate info Danger Superior function
Chapter 5 (3 questions)
Core Concepts
Ethics a branch of philosophy that deals with distinguishing right
from wrong
Bioethics term applied to ethics when they refer to concepts within the
scope of medicine, nursing, and allied health
Moral behavior conduct that results from serious critical thinking about how
individuals ought to treat others
Values personal beliefs about what is important and desirable
Values clarification a process of self-exploration by which people identify and
rank their own personal values
a valid, legally recognized claim or entitlement, encompassing
Right both freedom from government interference or
discriminatory treatment and entitlement to a benefit or
service
Absolute right when there is no restriction whatsoever on the individual’s
entitlement
Legal right a right on which the society has agreed and formalized into
law
Ethical dilemmas are situations that require individuals to
Ethical Dilemmas make a choice between two equally unfavorable alternatives.
Taking no action is considered an action taken.
Ethical Issues in Psychiatric/Mental Health Nursing
The right to refuse medication
The right to the least restrictive treatment alternative
Legal Considerations
The Nurse Practice Act defines the legal parameters of professional and practical nursing
Types of laws:
Statutory law
Common law
Classifications Within Statutory and Common Law
Civil law: protects the private and property rights of Criminal law: provides protection from conduct deemed
individuals and businesses injurious to the public welfare
- Torts, Contracts
, Legal Issues in Psychiatric/Mental Health Nursing
Confidentiality and Right to Privacy
HIPAA
Doctrine of privileged communication
Exception: A duty to warn
Informed Consent
Restraints and Seclusion
False imprisonment
Commitment issues
Voluntary admissions
Involuntary commitments
Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client
Nursing liability
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander
Invasion of privacy
Assault and battery
False imprisonment
Chapter 7 (7 questions)
The Therapeutic Nurse-Client Relationship
Therapeutic nurse-client relationships can occur only when each views the other as a unique human being. When this
occurs, both participants have needs met by the relationship.
Therapeutic relationships are goal-oriented and directed at learning and growth promotion.
Goals are often achieved through use of the problem-solving model
Identify the client’s problem.
Promote discussion of desired changes.
Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively.
Discuss alternative strategies for creating changes the client desires to make.
Weigh benefits and consequences of each alternative.
Help client select an alternative.
Encourage client to implement the change.
Provide positive feedback for client’s attempts to create change.
Help client evaluate outcomes of the change and make modifications as required.
Definition: ability to use one’s personality consciously and in full
awareness in an attempt to establish relatedness and to structure
nursing interventions.
Therapeutic Use of Self
Nurses must possess self-awareness, self-understanding, and a
philosophical belief about life, death, and the overall human
condition.
Phases of a Therapeutic Nurse-Client Relationship
Pre-interaction phase
Obtain information about the client from chart, significant others, or other health team members
Examine one’s own feelings, fears, and anxieties about working with a particular client
Orientation (introductory) phase
A+
Chapter 1 (2 questions)
Defense Mechanisms
Defense Mechanism Example
Compensation “I may not know how to cook, but I can sure do the dishes!”
A process of psychologically counterbalancing perceived
weakness by emphasizing strength in other areas.
Denial A functioning alcoholic denies they have a drinking problem
The refusal to accept reality or fact, acting as if a painful but points out how well they function in their job &
event, thought or feeling did not exist. Characteristic of early relationships
childhood development.
Displacement Man gets angry at boss but can’t express it b/c he will get
The redirecting of thoughts, feelings, & impulses directed at fired so instead he comes home & kicks the dog and starts
one person or object, but taken out upon another person argument with wife.
object.
Identification A teenage boy who required lengthy rehabilitation after an
An attempt to increase self-worth by acquiring certain accident decides to become a physical therapist as a result of
attributes & characteristics of an individual one admires. his experiences.
Intellectualization
Intellectualization A person has just been given a terminal medical diagnosis,
The overemphasis of thoughts feelings and impulses directed instead of expressing their sadness & grief, focuses instead on
at one person or object, but taken out upon another person or the details of all possible fruitless medical procedures
object
Introjection Children integrate their parents’ value system into the
Integrating the beliefs and values of another individual into process of conscience formation. A child says to friend, “Don’t
one’s own ego structure cheat. It’s wrong.”
Projection Sue feels a strong sexual attraction to her track coach and tells
Attributing feelings or impulses unacceptable to one’s self to her friend, “He’s coming on to me!”
another person
Rationalization A woman who starts dating a mean she really likes and thinks
Putting something into a different light or offering a different the world of is suddenly dumped by the man for no reason.
explanation for one’s perceptions or behaviors in the face of a She renames the situation in her mind with “I suspected he
changing reality. was a loser all along”.
Reaction formation A woman who is very angry at her boss & would like to quit
The converting of unwanted or dangerous thoughts, feelings her job instead is overly kind & generous toward her boss &
or impulses into their opposites. express a desire to keep working there forever. She is
incapable of expressing the negative emotions of anger &
unhappiness with her job, and instead becomes overly kind to
publicly demonstrate her lack of anger and unhappiness.
Regression An adolescent who is overwhelmed with fear, anger, and
The reversion to an earlier stage of development in the face of growing sexual impulses might become clingy and start
unacceptable thought or impulses. exhibiting earlier childhood behaviors he has long since
overcome, such as bedwetting. An adult may regress when
under great deal of stress, refusing to leave their bed and
engage in normal, everyday activities.
Sublimation A person has sexual impulses they would like not to act upon,
The channeling of unacceptable impulses, thoughts and they may instead focus on rigorous exercise
emotions into more acceptable ones.
Suppression Scarlett O’Hara says, “I don’t want to think about that now. I’ll
The voluntary blocking from one’s awareness of unpleasant think about that tomorrow.”
feelings and experiences
Undoing Joe is nervous about his new job and yells at his wife. On his
Symbolically negating or canceling out an experience that one way home he stops and buys her some flowers.
finds intolerable
, Physical Responses to Stress
Hans Selye defined stress as “the state manifested by a specific syndrome which consists of all the nonspecifically induced
changes within a biologic system.”
“Fight-or-flight” syndrome
Selye’s General Adaptation Syndrome
Alarm reaction stage
Stage of resistance
Stage of exhaustion
The Fight-or-Flight Syndrome
Immediate response
Sustained response
Sustained physical responses to stress promote susceptibility to many diseases of adaptation
Psychological Responses
Anxiety and grief have been described as two major, primary psychological response patterns to stress.
A variety of thoughts, feelings, and behaviors are associated with each of these response patterns.
Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s
functioning.
Anxiety
-A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
-Extremely common in our society
-Mild anxiety is adaptive and can provide motivation for survival
Peplau’s Four Levels of Anxiety:
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
Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of
physiological disorders, e.g., migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.
Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving, e.g., anxiety disorders and
somatoform disorders.
Extended periods of functioning at the panic level of anxiety may result in psychotic behavior.
Examples of psychotic disorders include schizophrenia, schizoaffective disorders, and delusional disorders.
Behavioral Adaptation Responses to Anxiety
At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking,
sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.
At the mild to moderate level, the ego calls on defense mechanisms for protection
Grief
• The subjective state of emotional, physical, and social Elisabeth Kübler-Ross
responses to the loss of a valued entity. -5 Stages of Grief
• The loss may be real or perceived. 1. Denial
2. Anger
Anticipatory grief: the experiencing of the grief process 3. Bargaining
before the actual loss occurs. 4. Depression
Resolution: length of the grief process is entirely individual. 5. Acceptance
It can last from a few weeks to years. It is influenced by a
number of factors.
,• The experience of guilt for having had a “love-hate” relationship with the lost entity. Guilt often lengthens the grieving
process.
• Anticipatory grieving is thought to shorten the grief response when the loss actually occurs.
• The length of the grief response is often extended when an individual has experienced a number of recent losses and when
he or she is unable to complete one grieving process before another one begins.
• Resolution of the grief response is 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.
Maladaptive Grief Responses:
- Prolonged response
- Delayed/inhibited response
- Distorted response
Create a therapeutic environment (Milieu)
Health education, promotion & maintenance
Promotion of self-care
Cognitive and behavioral therapies
Nursing Interventions Medication education, administration, and monitoring
Documenting:
GAF: Global assessment of findings
0 10 100
Inadequate info Danger Superior function
Chapter 5 (3 questions)
Core Concepts
Ethics a branch of philosophy that deals with distinguishing right
from wrong
Bioethics term applied to ethics when they refer to concepts within the
scope of medicine, nursing, and allied health
Moral behavior conduct that results from serious critical thinking about how
individuals ought to treat others
Values personal beliefs about what is important and desirable
Values clarification a process of self-exploration by which people identify and
rank their own personal values
a valid, legally recognized claim or entitlement, encompassing
Right both freedom from government interference or
discriminatory treatment and entitlement to a benefit or
service
Absolute right when there is no restriction whatsoever on the individual’s
entitlement
Legal right a right on which the society has agreed and formalized into
law
Ethical dilemmas are situations that require individuals to
Ethical Dilemmas make a choice between two equally unfavorable alternatives.
Taking no action is considered an action taken.
Ethical Issues in Psychiatric/Mental Health Nursing
The right to refuse medication
The right to the least restrictive treatment alternative
Legal Considerations
The Nurse Practice Act defines the legal parameters of professional and practical nursing
Types of laws:
Statutory law
Common law
Classifications Within Statutory and Common Law
Civil law: protects the private and property rights of Criminal law: provides protection from conduct deemed
individuals and businesses injurious to the public welfare
- Torts, Contracts
, Legal Issues in Psychiatric/Mental Health Nursing
Confidentiality and Right to Privacy
HIPAA
Doctrine of privileged communication
Exception: A duty to warn
Informed Consent
Restraints and Seclusion
False imprisonment
Commitment issues
Voluntary admissions
Involuntary commitments
Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client
Nursing liability
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander
Invasion of privacy
Assault and battery
False imprisonment
Chapter 7 (7 questions)
The Therapeutic Nurse-Client Relationship
Therapeutic nurse-client relationships can occur only when each views the other as a unique human being. When this
occurs, both participants have needs met by the relationship.
Therapeutic relationships are goal-oriented and directed at learning and growth promotion.
Goals are often achieved through use of the problem-solving model
Identify the client’s problem.
Promote discussion of desired changes.
Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively.
Discuss alternative strategies for creating changes the client desires to make.
Weigh benefits and consequences of each alternative.
Help client select an alternative.
Encourage client to implement the change.
Provide positive feedback for client’s attempts to create change.
Help client evaluate outcomes of the change and make modifications as required.
Definition: ability to use one’s personality consciously and in full
awareness in an attempt to establish relatedness and to structure
nursing interventions.
Therapeutic Use of Self
Nurses must possess self-awareness, self-understanding, and a
philosophical belief about life, death, and the overall human
condition.
Phases of a Therapeutic Nurse-Client Relationship
Pre-interaction phase
Obtain information about the client from chart, significant others, or other health team members
Examine one’s own feelings, fears, and anxieties about working with a particular client
Orientation (introductory) phase
