Nurb 4130 Exam 1
CHAPTER 1
1. ANA – Scope and Standards of Practice: assessment, diagnosis, outcomes, planning,
implementation, evaluation ???
2. ANA, APNA, ISPN – Psychiatric-Mental Nursing Scope and Standards of Practice (pg. 17):
defines the focus of psychiatric mental health nursing as “promoting mental health group
through the assessment, diagnosis, and treatment of human responses to mental health
problems and psychiatric disorders”; uses the same nursing process
3. Advanced practice nurse (pg. 19): the APRN-PMH is a licensed RN with a MSN or DNP and
may function autonomously and is eligible for special privileges.
a. Interventions
i. All of basic level
ii. Medication prescription and treatment – prescription of psychotropic meds, with
appropriate use of diagnostic tests; hospital admitting privileges
iii. Psychotherapy – individual, couple, group, or family therapy, using EBP
therapeutic frameworks and the nurse patient relationship
iv. Consultation – sharing of clinical expertise with nurses or those in other
disciplines to enhance their treatment of patients or address system issues
4. Attributes of mental health Figure 1-1 (pg. 3):
a. Accurate appraisal of reality
b. Ability to love and experience joy
c. Capacity to deal with conflicting emotions
d. Ability to live without (undue) fear, guilt, or anxiety
e. Ability to take responsibility for one’s own actions
f. Ability to control one’s own behavior
g. Think clearly
i. Problem solve
ii. Use good judgment
iii. Reason logically
iv. Reach insightful conclusions
v. Be creative
h. Relate to others
i. Form relationships
ii. Have close, loving, adaptive relationships
iii. Experience empathy toward others
iv. Manage interpersonal conflict constructively
i. Attain self-defined spirituality
j. Negotiate each developmental task
k. Ability to work and be productive
l. Maintain a healthy self-concept and self-value
m. Ability to play and laugh
Page 1 of 28
, 5. Basic level RN (pg. 18): professionals who have completed a nursing program, passed state
licensure exam, and is qualified to work in most any general or specialty area; work in various
supervised settings and perform multiple roles such as staff nurse, case manager, and home
care nurse
a. Interventions
i. Coordination of care – coordinates implementation of the nursing care plan and
documents care
ii. Health teaching and health maintenance – community screenings, parenting
classes, stress management
iii. Milieu therapy – provides, structures, and maintains a safe and therapeutic
environment in collaboration with patients, families, and other clinicians
iv. Pharmacological, biological, and integrative therapies – applies current
knowledge to assessing patient’s response to medication, provides medication
teaching, and communicates observations to other healthcare team members
6. Biologically based mental illnesses (pg. 7): Mental health disorders listed in the DSM-IV-TR
7. Clinical epidemiology (pg. 11): broad field that addresses what happens after people with
illnesses are seen by providers of clinical care and includes:
a. Studies of the natural history of an illness
b. Studies of diagnostic screening tests
c. Observational and experimental studies of interventions used to treat people with the
illness or symptoms
Example: epidemiological studies demonstrate that depression is a significant risk factor for
death in people with cardiovascular disease and premature death in people with breast cancer.
8. Comorbid condition (pg. 11): more than one mental disorder at a time
Diathesis-stress model: Biological predisposition vs. environmental (psychosocial) stress
Current model used in which diathesis represents biological predisposition, and stress
represents environmental stress or trauma. It is the most accepted explanation for mental
illness. This nature+nurture argument asserts that most psychiatric disorders result from a
combination of genetic vulnerability and negative environmental stressors.
DSM-IV-TR
A classification of mental disorders that includes descriptions of diagnostic categories. The
DSM-IV-TR is the most widely accepted system of classifying abnormal behaviors used in
the United States today
DSM-IV-TR – Multiaxial system, Table 1-2
Axis I: clinical disorders or other conditions that may be a focus of clinical attention (ex.
Major depressive disorder)
Axis II: personality disorders or mental retardation (ex. Dependent personality disorder)
Page 2 of 28
, Axis III: general medical conditions (ex. Diabetes)
Axis IV: psychosocial and environmental problems (ex. Divorce 3 months previously)
Axis V: global assessment of functioning (ex. 31 years old and unable to work or respond
to family and friends)
Electronic health care
The provision of health care through methods which are not face-to-face but rather through
an electronic medium
Epidemiology
The quantitative study of the distribution of mental disorders in human populations
Evidence-based practice (EBP)
A method of care that integrates the latest and best available research
Fundamental components of recovery process – p. 8
1. Self directed: consumers lead, control, exercise choice over, and determine their own
path of recovery
2. Individual and person centered: recovery is based on unique strengths and
resiliencies, as well as needs, preferences, experiences (including past trauma), and
cultural backgrounds
3. Empowering: consumers have the authority to choose from a range of options,
participate in all decisions that will affect their lives, and be educated and supported in so
doing
4. Holistic: recovery encompasses an individual’s whole life, including mind, body, spirit,
and community
5. Nonlinear: recovery is based on continual growth, occasional setbacks, and learning
from experience
6. Strength-based: recovery is focused on valuing and building on the multiple capacities,
resiliencies, talents, coping abilities, and inherent worth of individuals
7. Peer supported: consumers encourage and engage each other in recovery and provide
a sense of belonging, supportive relationships, valued roles, and community
8. Respect: community, systems, and societal acceptance and appreciation of consumers-
including protecting their rights and eliminating discrimination and stigma- are crucial in
achieving recovery
9. Responsibility: consumers have a personal responsibility for their own self-care and
recovery, for understanding and giving meaning to their experiences, and for identifying
coping strategies and healing processes to promote their own wellness
10. Hope: recovery provides the essential motivating message of a better future: that
people can and do overcome the barriers and obstacles that confront them. Hope is the
catalyst of the recovery process
Page 3 of 28
CHAPTER 1
1. ANA – Scope and Standards of Practice: assessment, diagnosis, outcomes, planning,
implementation, evaluation ???
2. ANA, APNA, ISPN – Psychiatric-Mental Nursing Scope and Standards of Practice (pg. 17):
defines the focus of psychiatric mental health nursing as “promoting mental health group
through the assessment, diagnosis, and treatment of human responses to mental health
problems and psychiatric disorders”; uses the same nursing process
3. Advanced practice nurse (pg. 19): the APRN-PMH is a licensed RN with a MSN or DNP and
may function autonomously and is eligible for special privileges.
a. Interventions
i. All of basic level
ii. Medication prescription and treatment – prescription of psychotropic meds, with
appropriate use of diagnostic tests; hospital admitting privileges
iii. Psychotherapy – individual, couple, group, or family therapy, using EBP
therapeutic frameworks and the nurse patient relationship
iv. Consultation – sharing of clinical expertise with nurses or those in other
disciplines to enhance their treatment of patients or address system issues
4. Attributes of mental health Figure 1-1 (pg. 3):
a. Accurate appraisal of reality
b. Ability to love and experience joy
c. Capacity to deal with conflicting emotions
d. Ability to live without (undue) fear, guilt, or anxiety
e. Ability to take responsibility for one’s own actions
f. Ability to control one’s own behavior
g. Think clearly
i. Problem solve
ii. Use good judgment
iii. Reason logically
iv. Reach insightful conclusions
v. Be creative
h. Relate to others
i. Form relationships
ii. Have close, loving, adaptive relationships
iii. Experience empathy toward others
iv. Manage interpersonal conflict constructively
i. Attain self-defined spirituality
j. Negotiate each developmental task
k. Ability to work and be productive
l. Maintain a healthy self-concept and self-value
m. Ability to play and laugh
Page 1 of 28
, 5. Basic level RN (pg. 18): professionals who have completed a nursing program, passed state
licensure exam, and is qualified to work in most any general or specialty area; work in various
supervised settings and perform multiple roles such as staff nurse, case manager, and home
care nurse
a. Interventions
i. Coordination of care – coordinates implementation of the nursing care plan and
documents care
ii. Health teaching and health maintenance – community screenings, parenting
classes, stress management
iii. Milieu therapy – provides, structures, and maintains a safe and therapeutic
environment in collaboration with patients, families, and other clinicians
iv. Pharmacological, biological, and integrative therapies – applies current
knowledge to assessing patient’s response to medication, provides medication
teaching, and communicates observations to other healthcare team members
6. Biologically based mental illnesses (pg. 7): Mental health disorders listed in the DSM-IV-TR
7. Clinical epidemiology (pg. 11): broad field that addresses what happens after people with
illnesses are seen by providers of clinical care and includes:
a. Studies of the natural history of an illness
b. Studies of diagnostic screening tests
c. Observational and experimental studies of interventions used to treat people with the
illness or symptoms
Example: epidemiological studies demonstrate that depression is a significant risk factor for
death in people with cardiovascular disease and premature death in people with breast cancer.
8. Comorbid condition (pg. 11): more than one mental disorder at a time
Diathesis-stress model: Biological predisposition vs. environmental (psychosocial) stress
Current model used in which diathesis represents biological predisposition, and stress
represents environmental stress or trauma. It is the most accepted explanation for mental
illness. This nature+nurture argument asserts that most psychiatric disorders result from a
combination of genetic vulnerability and negative environmental stressors.
DSM-IV-TR
A classification of mental disorders that includes descriptions of diagnostic categories. The
DSM-IV-TR is the most widely accepted system of classifying abnormal behaviors used in
the United States today
DSM-IV-TR – Multiaxial system, Table 1-2
Axis I: clinical disorders or other conditions that may be a focus of clinical attention (ex.
Major depressive disorder)
Axis II: personality disorders or mental retardation (ex. Dependent personality disorder)
Page 2 of 28
, Axis III: general medical conditions (ex. Diabetes)
Axis IV: psychosocial and environmental problems (ex. Divorce 3 months previously)
Axis V: global assessment of functioning (ex. 31 years old and unable to work or respond
to family and friends)
Electronic health care
The provision of health care through methods which are not face-to-face but rather through
an electronic medium
Epidemiology
The quantitative study of the distribution of mental disorders in human populations
Evidence-based practice (EBP)
A method of care that integrates the latest and best available research
Fundamental components of recovery process – p. 8
1. Self directed: consumers lead, control, exercise choice over, and determine their own
path of recovery
2. Individual and person centered: recovery is based on unique strengths and
resiliencies, as well as needs, preferences, experiences (including past trauma), and
cultural backgrounds
3. Empowering: consumers have the authority to choose from a range of options,
participate in all decisions that will affect their lives, and be educated and supported in so
doing
4. Holistic: recovery encompasses an individual’s whole life, including mind, body, spirit,
and community
5. Nonlinear: recovery is based on continual growth, occasional setbacks, and learning
from experience
6. Strength-based: recovery is focused on valuing and building on the multiple capacities,
resiliencies, talents, coping abilities, and inherent worth of individuals
7. Peer supported: consumers encourage and engage each other in recovery and provide
a sense of belonging, supportive relationships, valued roles, and community
8. Respect: community, systems, and societal acceptance and appreciation of consumers-
including protecting their rights and eliminating discrimination and stigma- are crucial in
achieving recovery
9. Responsibility: consumers have a personal responsibility for their own self-care and
recovery, for understanding and giving meaning to their experiences, and for identifying
coping strategies and healing processes to promote their own wellness
10. Hope: recovery provides the essential motivating message of a better future: that
people can and do overcome the barriers and obstacles that confront them. Hope is the
catalyst of the recovery process
Page 3 of 28
