Psychiatric Nursing Exam #1 Study Guide

Chapter 1
1. Define deviance.
Behavior outside the social norm of a specific group
2. Define crazy.
An informal, denigrating, and stigmatizing term for "mentally
ill" that carries with it unfounded and negative implications
3. What is a nervous breakdown?
A general, nonspecific term for an incapacitating but
otherwise unspecified type of mental disorder
4. What is a mental disorder?
A psychological group of symptoms, such as a pattern or a
syndrome, in which the individual experiences distress (a
painful symptom), disability (impairment in one or more
important areas of functioning), or a significantly increased
risk of suffering, pain, loss of freedom, or death
5. What is psychopathology?
The above signs and symptoms of mental disorder
6. What is the #1 psychiatric disorder?
Depression
7. What is a "broken brain" vs. a "flabby mental health"?
Neurological problems (dysfunctions) vs. Acts inappropriate
on purpose
8. Describe the Era of Magico—Religious Explanations.
(Time frame and focus.)
From preliterature cultures. Mental and physical suffering
attributed to forces outside the body. No distinctions made
between medicine, magic, and religion. They believe in
taboos, neglect of rites, loss of soul from body, foreign or
harmful substance in body, and witchcraft.
9. Describe the Era of Organic Explanations. (Time frame
and focus.)
In the 4th Century BCE, Hippocrates proposed a medical
concept to explain mental suffering. Proposed that
psychiatric illnesses were caused mainly by imbalances in
body humors, NOT demonology: blood (manic), black bile
(melancholy/depressed), yellow bile, and phlegm (ineffective
decision maker).
10. Describe the Era of Alienation.
 Middle Ages (400 CE - Renaissance). Madness seen as a
dramatic encounter with secret powers. Minds were thought
to be influenced by the moon (lunacy). Witch hunts. "Ships
of fools." Social abandonment.
11. Describe the Era of Confinement. (Time frame and
focus.)
Renaissance (1300-1600 CE). Seventeenth-century. Mad
persons = right to be fed but were morally constrained and
physically confined. Threatening institution complete with
stakes, irons and dungeons. No right to appeal. Mad persons
were publicly tortured.
12. Describe the Era of Moral Treatment. (Time frame and
focus.)
The 18th and early 19th centuries. Characterized by internal
contradictions. Unchained but tortured. The medical
treatment they received consisted of torture with special
paraphernalia. Mental disorders were believed to be
incurable, and mad persons were thought to be dangerous.
Illness couldn't be seen or explained and very feared.
13. During the Era of Moral Treatment, who led the
first person who led the movement that began to
release inmates from their chains, abolish
systematized brutality with chains and whips, feed
them nourishing foods, and treat them with kindness?
Philippe Pinel (1745-1826) in France and the Quakers in
England under William Tuke (1732-1822).
14. Who led the Moral treatment in the United states?
Benjamin Franklin and Benjamin Rush ("the father of
American Psychiatry", 1745-1813, a major follower of William
Cullen). Rush advocated bloodletting, the restraining chair,
the gyrating chair, and other devices that we now consider
inhumane.
15. What did Scotland's William Cullen (1710-1790)
believe?
Mental disorder was due to decay, either of the intellect of
the involuntary nervous system, that is, a matter of
disordered physiology.
16. Describe the Era of Psychoanalysis. (Time frame and
focus.)
 Late 19th and early 20th century. Insanity linked to faulty life
habits; treated with new forms of physical or somatic
therapies. Gradual assimilation into medicine. Treatments
varied. 1990's - decade of the brain.
17. Who is Sigmund Freud and what era did he form
background for his work based off its developments?
Sigmund Freud (1856-1939) is one of the most influential
figures in the history of psychiatry, and succeeded in
explaining human behavior in psychologic terms. Era of
Psychoanalysis.
18. Explain Contemporary Developments.
By the mid-20th century, psychiatric thinking was expanding
and moving toward and emphasis on the importance of the
social dimension. Drug treatment for mental illness was
being developed.
19. What was the primary innovation of the 1990s
called and what was it?
Biologic revolution: the collaboration of science and
technology to expand concepts of mental disorder proposed
by psychologic and behavioral theories.

Chapter 2
1. What is psychiatric-mental health nursing committed
to?
They are committed to promoting mental health through the
assessment, diagnosis, and treatment of human responses
to mental health problems and psychiatric disorders.
2. What are essential components of psychiatric-mental
health nursing?
Health and wellness promotion though identification of
mental health issues. Prevention of mental health problems.
Care of mental health problems. Treatment of persons with
psychiatric disorders.
3. Timeline of the history of psychiatric nursing: (SHE
SAID TIMELINE NOT IMPORTANT! So memorizing the
years is not important, but I would read over some of
the facts what is left of the timeline I have below– I
deleted over 75% of the timeline I had before and
only kept the facts I thought were most important.
Haha)
1836 – Theodore and Friedericke Fliedner founded the first
systematic school of nursing in Germany.
1860s – Emergence of the discipline of psychiatric nursing.
Florence Nightingale founds school at Saint Thomas
Hospital in London. Nightingale among the first to note that
the influence of nurses on their own clients transcends
physical care.
1870s – The first three American nursing schools, organized
in the pattern of Saint Thomas Hospital, were opened in New
York, Boston, and New Haven.
1880 – Linda Richards, "the first American psychiatric
nurse", opened/directed the first American school for
psychiatric nurses at the first Psychiatric Asylum (McLean
Psychiatric Asylum) in Waverly, Massachusetts.
1946 – Passage of National Mental Health Act (the
government's response to growing recognition of mental
illness as a national health problem) develops
psychotherapeutic roles for nurses. This established the
National Institute of Mental Health (NIMH).
1952 – Three important milestones in psychiatric nursing
occurred. First, Hildegard Peplau published Interpersonal
Relations in Nursing, the first systematic theoretic
framework in psychiatric nursing. Emphasized
psychodynamic concepts and counseling techniques.
Second, Gwen Tudor Will demonstrates nursing interventions
with sociopsychiatric base. Published in Psychiatry –
Research: study of intervention to disrupt pattern of
avoidance occurring among medical, nursing and patient.
Third, Frances Sleeper APA advocates psychiatric nurses as
psychotherapists.
1954 – Under Peplau's leadership, the first graduate
degree in psychiatric-mental health nursing was awarded by
Rutgers University. She has had greater impact on
psychiatric nursing than any other nursing theoretician to
date.
1969 – A psychiatric nurse had moved into private practice.
 1973 – Certification in psychiatric nursing becomes the
responsibility of the ANA. Standards of Psychiatric-Mental
Health Nursing published by ANA.
1980s – Period of Decline and Retrenchment.
1984 – ANA Council of Specialists in Psychiatric and Mental
Health Nursing develops a classification system for
Psychiatric Nursing Diagnosis (added to NANDA). Standards
of Child and Adolescents Psychiatric and Mental Health
Nursing and Standards of Addictions Nursing Practice
published by ANA.
4. When did psychiatric-mental health nursing first
begin?
The late 19h and 20th centuries.
5. What is the most significant piece of legislation
affecting the development of psychiatric-mental
health nursing?
The National Mental Health Act of 1946
6. Define advanced practice registered nurse in
psychiatric-mental health:
A licensed registered nurse who is educationally prepared as
a clinical nurse specialist or a nurse practitioner at the
master's or doctorate degree level in the specialty of
psychiatric-mental health nursing; CS = Certified Specialist.
7. What were the four phases of the nurse-client
relationship according to Peplau?
Orientation, Identification, Exploitation (or working), and
Resolution
8. Who is considered the "mother of psychiatric
nursing?
Hildegard Peplau
9. What is the difference between Basic Level of Practice
and Advanced Level of Practice?
Basic level Psychiatric-Mental Health Nurse (PMH) may have
received basic nursing preparation in a diploma, associate
degree, or baccalaureate program (RNs).
Advanced Practice Registered Nurse (APRN-PMH) is a
licensed registered nurse who is educationally prepared as a
clinical nurse specialist or a nurse practitioner at the
 master's or doctorate degree level in the specialty of
psychiatric-mental health nursing.
10. What are the 6 Psychiatric-Mental Health Nursing
Standards of Practice in relation to Basic Level and
Advanced Level of Practice?
Standard 1. Assessment The Psychiatric-Mental Health
Registered Nurse collects
comprehensive health data that
is pertinent to the patient's
health or situation.
Standard 2. Diagnosis The Psychiatric-Mental Health
Registered Nurse analyzes
the assessment data to
determine diagnosis or
problems, including level of risk.
Standard 3. Outcomes The Psychiatric-Mental Health
Identification Registered Nurse identified
expected outcomes for a plan
individualized to the patient or
to the situation.
Standard 4. Planning The Psychiatric-Mental Health
Registered Nurse develops a
plan that prescribes strategies
and alternatives to attain
expected outcomes.
Standard 5. The Psychiatric-Mental Health
Implementation Registered Nurse implements
the identified plan
Standard 5 A. The Psychiatric-Mental Health
Coordination of Care Registered Nurse coordinates
care of delivery
Standard 5 B. Health The Psychiatric-Mental Health
Teaching and Health Registered Nurse employs
Promotion strategies to promote health
and a safe environment
Standard 5 C. Milieu The Psychiatric-Mental Health
Therapy Registered Nurse provides,
structures, and maintains a safe
and therapeutic environment in
 collaboration with patients,
families, and other health care
clinicians.
Standard 5 D. The Psychiatric-Mental Health
Pharmacological, Registered Nurse
Biological, and Integrative incorporates knowledge of
Therapies pharmacological, biological, and
complementary interventions
with applied clinical skills to
restore the patient's health and
prevent further disability.
Standard 5 E. Prescriptive The Psychiatric-Mental Health
Authority and Treatment Advanced Practice
(APRN only) Registered Nurse uses
prescriptive authority,
procedures, referrals,
treatments, and therapies in
accordance with state and
federal laws and regulations.
Standard 5 F. The Psychiatric-Mental Health
Psychotherapy (APRN Advanced Practice
only) Registered Nurse conducts
individual, couples, group, and
family psychotherapy using
evidence-based
psychotherapeutic frameworks
and nurse-patient therapeutic
relationships.
Standard 5 G. The Psychiatric-Mental Health
Consultation (APRN only) Advanced Practice
Registered Nurse provides
consultation to influence the
identified plan, enhance the
abilities of other clinicians to
provide services for patients,
and effect change.
Standard 6. Evaluation The Psychiatric-Mental Health
Registered Nurse evaluates
progress toward attainment of
 expected outcomes.
11. What are the team members, their
education/preparation and roles for the mental health
team?
Team Education/Preparation Role
Member
Psychiatric- A registered nurse with Responsible for the
Mental specialized preparation nursing care of
Health Nurse in psychiatric-mental mental health
health nursing; level of clients; has major
expertise depends on responsibility for
education, which may the milieu.
include up to the
doctoral level.
Psychiatrist A medical physician Responsible for
whose specialty is diagnosis and
mental disorders; has treatment of
completed an approved persons with mental
psychiatric residency. disorders
Clinical A psychologist specially Performs
Psychologist educated and trained in psychotherapy;
mental health; plans and
certification requires implements
completion of an programs of
approved doctoral behavior
program and a clinical modifications;
internship. selects,
administers, and
interprets
psychological tests.
Psychiatric A graduate of a master's Helps clients and
Social program in social work their families cope
Worker with an emphasis in more effectively;
mental health; may have identifies
a doctoral degree. appropriate
community
resources; may
perform counseling
and psychotherapy.
Marriage and May be a member of any Provides
Family mental health discipline, psychotherapy
Therapist usually prepared at the usually focusing on
master's or doctoral couples or families
level
Occupational Prepared in occupational Uses manual and
Therapist therapy at the creative techniques
baccalaureate or to elicit desired
master's level with a interpersonal and
specialty in mental intrapsychic
health care responses; teaches
self-help activities,
helps clients
prepare to seek
employment.
Recreational May be prepared at Plans and guides
Therapist informal or formal levels recreational
in university physical activities to provide
education and health socialization,
education programs healthful recreation,
and desirable
interpersonal and
intrapsychic
experiences.
Creative Arts May be prepared at Uses art, music,
Therapist informal or formal levels dance, and
in colleges and literature to
universities facilitate
interpersonal
experiences and
increase social
responses and self-
esteem.
Psychosocial Most have either a high Teaches clients
Rehabillitatio school education or a practical, day-to-
n Worker bachelor's degree day skills for living
in the community
and provides case
management
 services.

Chapter 3
1. What is detached concern?
Ability to distance oneself in order to help others.
2. What does it mean to create a common ground with a
client?
Creating a mutually understood, negotiated reality.
3. True or False: Nurses who cannot cope with their own
feelings of depression can still be effective with
severely depressed clients.
False; They will not be effective.
4. What is self-awareness?
How well the people know themselves.
5. Feelings are like…
Icebergs; only the tips stick up into consciousness, and the
deeper parts are submerged.
6. What are the three major forms of beliefs and values?
Rational beliefs – beliefs that are supported by available
evidence.
Blind belief – belief in the absence of evidence.
Irrational beliefs – beliefs held despite available evidence to
the contrary.
7. What is dogmatic belief?
Opinions or beliefs held as if they were based on the highest
authority; includes both blind and irrational belief. Based on
personal experience.
8. What are the issues of blame and control?
Believing that people cause their own problems involves the
issue of blame. Believing that people are responsible for
solutions to their own problems involves the issue of control.
9. What are the four models of helping based on the
issues of blame and control?
Medical model: Believe that people are not responsible for
own problems nor responsible to solve them.
Compensatory Model: Believe that people are not to blame
for problems but should assist in solving them.
Enlightenment Model: Believe that people are responsible for
creating problems and need to rely on others for solution.
 Moral Model: Believe that people cause their own problems
and should be responsible for developing solutions to them.
10. What is an attitude? What is an opinion?
Attitude = a feeling over a period of time. An attitude linked
to an idea or belief becomes an opinion.
11. How are values demonstrated?
Through interests, preferences, decisions, and actions.
12. What is cognitive value? What is active values?
Cognitive = verbally subscribing to values but failing to act
on them. Active = Acting on verbalized values.
13. What is burnout?
A condition in which health care professionals lose their
concern and feeling for their clients and come to treat them
in detached or even dehumanized ways.
14. What is therapeutic alliance?
A conscious, growth-facilitating relationship between a
helping person (the psychiatric-mental health nurse) and the
client
15. What is assertive behavior?
Asking for what one wants or acting to get it in a way that
respects other people.
16. What is nonassertive behavior?
Timid holding back
17. What is aggressive behavior?
Inconsiderate, offensive aggression
18. What is passive behavior?
Don't want to say "no"
19. What are the three hallmarks of aggressive
behavior?
The major feeling is anger. The person says "no" even when
"yes" could, or should, be said. The aggressive person
believes that his or her feelings are more important than the
feelings of others.
20. What are 7 interpersonal qualities psychiatric
nurse should have?
Vision (to enhance people's quality of life). Accountability
(psychiatric clients are most defenseless – requires clinical
supervision). Advocacy (support of mentally ill and political
awareness). Spirituality. Empathy. Critical thinking (transfer
 knowledge into clinical practice). Self-disclosure (open to
personal feelings and experiences).
21. What is spirituality?
The search for meaning and purpose in life through
connection with others, nature, and/or a belief in a higher
power; at the core of each person's existence
22. What is empathy?
The ability to feel what others feel and respond to and
understand the experience of others on their terms.
23. What is critical thinking?
Purposeful, reasonable, reflective thinking that drives
problem solving and decision making and aims to make
judgments based on evidence.

Chapter 4
1. What is evidence-based practice?
The integration of individual clinical expertise with the best
available external clinical evidence from systematic
research.
2. Before evidence-based practice, practice was based
on what?
Traditions and customs. Trial and error. Clinical judgment.
Regulations.
3. What are the Levels of Evidence and Grades of
Recommendation?
Levels of Evidence Grades of
Studies are categorized Recommendation
based on the strength of the These are based on the JBI
evidence. The source of the grades of effectiveness.
evidence (type of study)
gives it a certain value,
graduated from Level I down
to Level IV.
Level I Grade A
Evidence obtained from a Effectiveness established to a
systematic review of all degree that merits
relevant randomized, application
controlled trials.
Level II Grade B
 Evidence obtained from at Effectiveness established to a
least one properly designed degree that suggests
randomized, controlled trial application
Level III a Grade C
Evidence obtained from well- Effectiveness established to a
designed pseudorandomized, degree that warrants
controlled trials (alternate consideration of applying the
allocation or some other findings.
method of assignment)
Level III b Grade D
Evidence obtained from Effectiveness established to a
comparative studies with limited degree.
concurrent controls and
allocation not randomized
(cohort studies), case control
studies, or interrupted time
series with a control group
Level III c Grade E
Evidence obtained from Effectiveness not established
comparative studies with
historical control, two or
more simple arm studies, or
interrupted time series with a
parallel control group.
Level IV
Evidence obtained from case
series, either posttest or
pretest and posttest

4. What are Best Practices?

Broad consensus statements about values, attitudes, skills,
knowledge, and approaches
5. What is Meta-analysis?
Analyzing the analysis of studies
6. What are clinical algorithms?
They show a logical progression of decisions and activities
that are designed to standardize quality care for a particular
clinical intervention.
7. What are critical pathways?
 They provide a means of accurate documentation and shift
the emphasis from depicting nursing as a series of tasks
(e.g. monitoring medication side effects, taking vital signs,
etc.) to interventions connected to a purpose or client
outcome.
8. What are Practice Guidelines?
Professional mandates for clinical practice
9. What is the Belmont Report?
An excellent resource for research basics, generated by the
National Commission for the Protection of Human Subjects of
Biomedical and Behavioral Research in 1979; short and
easily readable.
10. What are the three main principles on which research
is focused and what do they mean?
Respect for persons = includes the ethical consideration of
autonomy: the research subject is valued; the researcher
acknowledges boundaries; and there is respect for the
subject's body, family, culture, and community as well as
freedom from coercion.
Beneficence = means doing good. Researchers must inflict
no harm (nonmaleficence), prevent or remove harm, and
promote good for research subjects.
Justice = Focuses on how a person should be treated during
research, making sure we have provisions for what is fair,
given what is due or what is owed.
11. What did the Health Insurance Portability and
Accountability Act (HIPAA) of 1996 create?
Uniform standards for electronic health care transactions
(EDI) and provides for security protections for data that are
electronically stored and transmitted.
12. What is quantitative research vs. qualitative
research?
Quantitative research = Statistical analyses done on
numerical data such as test scores or ratings of
improvement or worsening of symptoms.
Qualitative research = data is interpreted in a way that
examines the qualities of the experience for the participants.
13. What are the 5 stages in the Transtheoretical Model
(TTM) of change formulated by Prochaska and
 DiClemente (1986) through which people progress
when behavior modifications are desired?
Precontemplation = The person has no intention to change
behavior in the foreseeable future.
Contemplation = The person is aware of the need for change
and is thinking about it but has not yet made the
commitment to take action.
Preparation = This stage combines the commitment to
change with the intention to initiate action. The person is on
the cusp of changed behavior. Some small change in the
direction of the overall goal may be made.
Action = Behavior, experiences, and environment are all
modified to support the change.
Maintenance = This stage involves the work necessary to
keep the desired change in place and stabilize the person in
the person in this new mode of behaving.
14. What are the 6 steps for change in the Model for
Evidence-Based Practice created by Rosswurm and
Larrabee (1999)?
Assessing the need for change. Linking the problem with
interventions and outcomes. Synthesizing the best evidence.
Designing the change in practice. Implementing and
evaluating the change in practice. Integrating and
maintaining the change in practice.
15. What is ethnography?
The study of human beings and their culture
16. What are randomized client trials?
Studies designed to test hypotheses using the traditional
experimental approach of randomly assigning subjects to
treatment and control groups and then comparing them on
identified and measureable outcomes in quantifiable terms.

Chapter 10
1. What does perception mean?
The experience of sensing, interpreting, and comprehending
the world in which one lives – it is a highly personal and
internal act; schizophrenic s have trouble with this
2. What are illusions?
 The eye and brain constantly being tricked into seeing things
that are not really what they seem
3. What is subculture?
Culture within the culture

4. What is a denotative meaning? What is a connotative

meaning?
Denotative = One that is in general use by most people who
share a common language
Connotative = Usually arises from a person's personal
experience
5. What are neologisms?
Private, unshared language (shared meaning? Text/Lecture
discrepancy)
6. Does verbal or nonverbal communication carry more
social meaning?
Nonverbal communication
7. What is a mixed message?
Inconsistency between the verbal and nonverbal
components
8. What is kinesics?
The study of body movement as a form of nonverbal
communication
9. What is the single most important source of
nonverbal communication?
Facial expressions
10. What can hand gestures communicate? What can
foot shuffling and fidgeting express?
Hand gestures = anxiety, indifference, and impatience,
among other things.
Foot shuffling/fidgeting = may express the desire to escape.
11. What are several common but unstated rules about
eye contact?
• Interaction is invited by staring at another person on the
other side of the room. If the other person returns the
gaze, the invitation to interact has been accepted.
Averting the eyes signals a rejection of the looker's
request.
 • A person's frank gaze is widely interpreted as positive
regard.
• Greater mutual eye contact occurs among friends.
• People who seek eye contact while speaking are usually
perceived as believable and earnest.
• If the usual short, intermittent gazes during a
conversation are replaced by gazes of longer duration, the
person looked at is likely to believe that the person gazing
considers the relationship between the two people to be
more important than the content of the conversation.
12. What is proxemics?
The study of space relationships maintained by people in
social interaction
13. What is territoriality?
Fixed and permanent territory that is somehow marked off
and defended from intrusion
14. What are the intimate, personal, social and public
distance ranges?
Intimate Distance = Close: 0" to 6" Far: 6" to 18"
Personal Distance = Close: 1 ½' to 2' Far: 2' to 4'
Social Distance = Close: 4' to 7' Far: 7' to 12'
Public Distance = 12' to 25' and beyond
15. True or False: People with schizophrenia can't
smell good smells and can't differ body language.
True.
16. True or False: Schizophrenics need 2x the space
others need (6 feet) of they become upset.
True.
17. What are cultural artifacts?
Clothes, cosmetics, perfume, glasses, wigs, hairpieces,
piercings, wedding bands, etc. They describe who we are
and what we're about.
18. What are 6 different ways in which verbal and
nonverbal systems interrelate?
• Nonverbal can repeat verbal – "The fish was huge" and
hands show size
• Nonverbal may contradict verbal – Sarcasm in voice can
contradict what is being said
 • " May add to or modify verbal – A man says he's a "little"
mad but tone shows a more profound anger
• " May accent or emphasize verbal cues – shrugging
shoulders when stating "I don't care"
• " May regulate – tell people when to speak, when to stop
• " May substitute for words – waving hello instead of
verbalizing it
19. If nonverbal communication contradicts verbal
communication, what should you go with?
Nonverbal communication
20. Differentiate between intrapersonal, interpersonal
and public communication.
Intrapersonal = occurs when people communicate within
themselves
Interpersonal = takes place in dyads (groups of two people)
and small groups.
Public = such as communication through the mass media or
giving a public speech.
21. What are the five phases in each person's
communication sequence?
Input = the person is motivated through some stimulus,
either external or internal, toward some goal that requires
engaging in a social interaction with another.
Covert Rehearsal = the person moves to make sense of the
input received and develops and organizes a message
before generating it.
Message Generation = the instrumental act of giving a
message is performed. A message generated by one person
serves as the input or the stimulus for another person.
Environmental Event = Once the second person completes
the covert rehearsal and generates a message, this message
becomes an environmental event or stimulus for the first
person.
Goal response = Response given from environmental event.
22. Explain the speech circuit in Wernicke's and
Broca's area.
There is a speech circuit in the brain between the auditory
cortex on the left, which passes to Wernicke's area in the
temporal cortex, and from there to Broca's area in the left
 frontal lobe via the arcuate fasciculus (a pathway composed
mainly of axons that synapse with other neurons).

23. What are the four formal criteria for successful

communication?
Efficiency = Simplicity, clarity, and correct timing.
Appropriateness = Messages are appropriate when they are
relevant to the situation at hand and when there is mutual fit
overall patterns and constituent parts.
Flexibility = People cannot always be sure how a message
will be received, because each person with whom they
communicate is unique and changing.
Feedback = The process by which performance is checked
and malfunctions corrected. It performs a regulatory function
in the communication process.
24. What is overload vs. underload?
Exceeding a tolerance level is called overload. Underload
occurs when delay or lack of information interferes with a
person's ability to comprehend the message of another.
25. What is tangential reply?
Disregards the content of the message and is directed
toward either and incidental aspect of the initial statement,
the type of language used, the emotions of the sender, or
another facet of the same topic.
26. What are the content levels and the relationship
levels of communication?
Content levels = the report aspect, in which information is
conveyed.
Relationship levels = communication about communication.
27. What is the difference between symmetric and
complementary relationships?
Symmetric = based on equality; the partners usually mirror
each other's behavior
Complementary = based on difference; maximize difference
between partners
28. What are the three sensory modalities that Bandler
and Grinder conclude how people take in, or access,
information?
Auditory, Visual, Kinesthetic
 29. Where does anxiety come from?
Unmet expectations
30. To determine whether a client's representational
system or sensory modality is auditory, visual or
kinesthetic, one must identify what things first?
Preferred predicates, eye-accessing cues, gross hand
movements, breathing pattern, speech pattern and voice
tones
31. What are guidelines for improving nonverbal
communication?
Relax. Use facial, hand, and body gestures judiciously. Get
feedback on your nonverbal communication. Practice.
32. Name 6 interpersonal principles and practices that
are essential to facilitating intimacy.
Respond with empathy, respect, genuineness, immediacy
and warm. Respect client's right to maintains distance.
33. What is the difference between empathy and
sympathy?
Empathy contains no elements of condolence, agreement, or
pity. When nurses sympathize rather than empathize, they
assume that there is a parallel between their feelings and
those of the client.
34. What are some blocks to mindful listening (active
listening)?
Rehearing, assuming, concern with self, judging, identifying
with own memories, getting off track, filtering out
35. What are common mistakes made in
communication?
Giving advice = Discounts ability for client to figure out
what's best for themselves
Minimizing feelings = Makes them think their feelings are
irrelevant or not as big of a deal
Deflecting = Using humor to avoid present situation
Interrogating = Feel more like a prisoner than a patient
Sparring = besting the client

Chapter 29
1. What is the therapeutic nurse-client relationship
("one-to-one" relationship)?
 One in which the nurse uses theoretical understandings,
personal attributes, and appropriate clinical techniques to
provide the opportunity for a corrective emotional
experience for clients.
2. What are the three distinct phases of a one-to-one
relationship? Explain each.
Orientation (beginning) phase: characterized by the
establishment of contact with the client. Clarify purpose of
relationship, role of nurse, and work of client. Address
confidentiality. Negotiate contract.
Working (middle) phase: characterized by the maintenance
and analysis of contact. Analysis of contact (how client
relates to others as manifested in nurse-patient
relationship). Explore response patterns. Analyze conflict
resolution. Facility assessment of growing and staying-put.
Forces that inhibit changes. Permit testing new behaviors.
Help cope with anxiety.
Termination (end) phase: characterized by the termination of
contact with the client. Occurs when client has relief from
presenting problem, achieve treatment goals, improve social
functioning, coping strategies, more effective defense
mechanisms, independent identity, resistance of client
(uncontrollable), and countertransference on part of nurse.
3. What are important termination tasks?
Help client evaluate contract and experience. Transfer
dependence to other support units. Participate in explicit
therapeutic good-bye.
4. What is the therapeutic alliance?
A conscious relationship between a facilitative person and a
client. It helps client change habitual response patters.
5. What are characteristics of the one-to-one
relationship?
Professional
Informal = spontaneous set of interactions
Formal = Planning, structure, consistency, expertise and
time.
Mutually defined – both enter voluntarily
Collaborative – goals, strategies, and outcomes evolve and
are met together
 Goal-directed – Initial goal is to solve an immediate problem,
and this serves as a basis for establishing more extensive
psychosocial goals.
Open – shared dignity
Negotiated – client is an active decision maker and is
personally accountable
Committed – based on the therapeutic contract between
nurse and client
6. What is resistance?
Refers to all the phenomena that interfere with and disrupt
the smooth flow of feelings, memories, and thoughts. Client
struggling against anxiety that goes with change, NOT
against the nurse. Most often occurs as the client begins to
address self-defeating thoughts, feelings and behaviors.
7. What are the five different forms in which resistance
is usually expressed?
Resistance to the recognition of feelings, fantasies, and
motives; to revealing feelings toward the nurse or therapist;
as a way of demonstrating self-sufficiency; as the client's
reluctance to change behavior outside the nurse-client
relationship; as a result of the failure of empathy on the part
of the nurse or therapist
8. What is acting out?
A particularly destructive form of resistance in which the
client puts into action (that is, "acts out") emotional conflicts
– externalizing an inner conflict. Rather than verbalizing
conflicts or feelings, the client displays inappropriate
behaviors.
9. What are important nursing interventions relating to
acting out?
Bring acting out to the attention of the client. Encourage the
client to talk about impulses rather than to act them out.
Encourage identification of feelings before putting them into
action. Increase frequency of contact. Look for evidence of
transference phenomena toward the nurse. With repeated
dangerous acting out, consider withdrawing from the
relationship unless the client sets limits on these behaviors
10. The nurse who manifests parental, erotic, sexual or
hostile nonverbal behaviors can also be acting out.
 This encourages acting out of the client. Examples
include:
• Placing hands on hips or pointing a finger while setting
limits on a client's behavior (parental)
• Patting a client on the shoulder and offering reassurance
(parental)
• Dressing suggestively (erotic)
• Blushing and giggling when a client makes a sexual
remark (sexual)
• Being sarcastic in response to a client's concern (hostile)
11. What is transference vs. countertransference?
*Both are normal but can inhibit the relationship.*
Transference = A set of feelings and thoughts about
significant others in the client's past and current life that is
transferred to the caregiver. Could be positive or negative.
Countertransference = the nurse's response to the client.
The nurse could develop powerful counterproductive
fantasies, feelings, and attitudes in response to the client's
transference or personality.
12. True or False: The caretaker role tends to involve
empathy rather than sympathy.
False; The caretaker role tends to involve sympathy rather
than empathy. Should be avoided in therapy though. Should
avoid the caretaker role in which you relieve the pain.
13. True or False: You should not take from or give gifts
to clients, and it is best to avoid unplanned physical
contact without therapeutic rationale.
True

Chapter 8
1. What is stress?
A demanding situation taxes a person's resources or coping
capabilities, causing a negative effect. A person-environment
interaction
2. What is a stressor?
The source of the stress, the demanding situation
3. The internal state the stress produces is one of:
Tension, anxiety or strain
4. What is conflict?
 Having opposing desires, feelings, or goals – often explains
such behaviors as hesitation, vacillation, blocking, and
fatigue.
5. What conflicts are the most likely to cause stress?
• Conflicts that involve social relations with significant
people
• Conflicts that involve ethical standards
• Conflicts that involve meeting unconscious needs
• Conflicts that involve the problem of everyday family
living
6. What are the 4 steps of how a conflict proceeds?
• The person holds two goals simultaneously.
• The person moves in relation to both of the goals using (a)
approach-avoidance movements or (b) avoidance-
avoidance movements
• The person shows hesitation, vacillation, blocking, or
fatigue.
• Resolution occurs either temporarily or permanently.
7. What is vacillation?
Moving first one way and then another
8. What is the fight-or-flight response? What are
symptoms?
Fight (aggression) or Flight (withdrawal). Adrenaline rush
response to excessive stress. Symptoms = ↑ HR, RR, BG, BP,
and diaphoresis. Pupil Dilation. Dry Mouth. (Panic attack)

9. What is Selye's Stress-Adaption Theory?

According to Selye, each person has a limited amount of
energy to use in dealing with stress. Selye defined stress as
the rate of wear and tear on the body. Stressors can be
physical, chemical, physiologic, developmental, or
emotional. Not necessarily harmful.
10. What symptoms did Selye observe that all sick
people have in common?
Loss of appetite, weight loss, felt/looked ill, anxious, fatigue,
aches and pains in muscles and joints. Actual body damage
= enlargement of the adrenal glands; shrinkage of the
thymus, spleen, and lymph nodes; and the appearance of
bleeding gastric ulcers.
11. What is the general adaption syndrome (GAS)?
Structural and chemical changes produced in the body that
can be objectively measured. It is called this because when
stress affects the whole person, the whole person must
adjust to the changes.
12. What are the 3 stages of GAS?
Alarm: "Fight or Flight" Immediate short-term responses to
crises
Resistance: Long-term metabolic adjustments occur
Exhaustion: Collapse of vital systems
13. True or false: All people receive stress in the same
way
False; Not all people receive stress in the same way
14. How did Lazarus view stress? (De Niro studied him a
lot in school! Possible test questions on him!)
Known for his transaction-based approach to understanding
stress. Stress is a process of complex interplay among the
perceived demands of the environment and the perceived
resources one has for meeting these demands. Perceived
threat—what the person appraises as taxing or exceeding
his or her resources and endangering his or her well-being—
is the central characteristic of stressful situations because it
threatens a person's most important goals and values.
15. What is cognitive appraisal?
Once a person has perceived a threat, the person evaluates
it by thinking about it.
16. How does the process of cognitive appraisal work?
Primary appraisal: The person assesses the potential for
benefit, harm, loss, threat or challenge in a situation.
Secondary appraisal: The person evaluates his or her coping
resources and options in the situation.
Coping: The person applies the coping resources and options
at his or her disposal.
Reappraisal: Person engages in ongoing reinterpretation of
the situation based on new info.
17. What is Psychoneuroimmunology (PNI)?
Interaction among the neurological, endocrine, and immune
systems and takes into account the nature of the influence
 of psychosocial factors on immune function and health
outcomes
18. Differentiate between self-healing personalities,
hardiness, and disease-prone personalities.
Self-healing: Emotionally stable people who bounce back
from stress. Enthusiastic, joyful, secure, energetic, alert, and
content. Likable, close warm relationships.
Hardiness: People with confidence in ability to control
circumstances and commitment to demands of life have
fewer illnesses.
Disease-prone: Display negative emotions. Suspicious of
others, anxious, angry or depressed. Activate sympathetic
nervous system, increase cortisol (increase weight and
stress) and suppresses immune system.
19. What is anxiety?
A state of varying degrees of uneasiness or discomfort. Often
described as a feeling of terror or dread; most uncomfortable
feeling a person can experience. Can be constructive or
destructive. Neurology = dysregulation in GABA
20. Differentiate between mild, moderate, severe anxiety
and Panic persons.
Mild: Helps one deal constructively with stress. A mildly
anxious person has a broad perceptual field because it
heightens the ability to take in stimuli. "Great educator" –
mild anxiety helps clients learn. The person feels relatively
safe and comfortable.
Moderate: Person remains alert, but the perceptual field
narrows. Person shuts out the events on the periphery while
focusing on central concerns (selective inattention). The
person sees, hears, and grasps less, but there is an element
of voluntary control. With direction, this person can focus on
what they have previously shut out.
Severe: Sensory reception is greatly reduced. Focus on small
or scattered details of an experience. Difficulty in problem
solving. Reduced ability to organize. New stimuli may be
overwhelming and cause anxiety levels to rise even higher.
The sympathetic nervous system is activated in severe
anxiety, causing an increase in HR, BP, RR, epinephrine
secretion, vasoconstriction, and Body temperature.
 Panic: Characterized by a completely disrupted perceptual
field. Disintegration of the personality experienced as
intense terror. Details may be enlarged, scattered, or
distorted. Logical thinking and effective decision-making
may be impossible. Unable to initiate or maintain goal-
directed action. Behavior may appear purposeless, and
communication may be unintelligible. Peplau believed that
all psychosis preceded by panic.
21. Would teaching be an effective nursing
intervention for a client with severe anxiety?
No, it would be pointless due to reasons listed above.
22. What are the two general reactions/behaviors to
threatening situations, such as illness and
hospitalization? Explain.
Task-oriented: When we feel competent to deal with stress
and the situation is not too threatening to our sense of self.
Geared toward problem solving.
Defense-oriented: When we feel inadequate to cope with
stress and the situation is extremely threatening to our
sense of self. Such behavior becomes harmful only when it is
the predominant means of coping with stress.
23. What are coping strategies?
A set of behaviors people under stress use in struggling to
improve their situations.
24. What are some ways people cope with stress?
Seek comfort = gentle touch, love, substances and food.
Self-discipline = Laugh off, stiff upper lip, bite the bullet, get
over it – don't want support
Intense expression of feelings = crying, swearing, and
laughing all tend to relieve tension.
Avoidance and Withdrawal = No sleep or a lot of sleep.
Talking it out = established/maintains contact with others
and allows for new ideas
Privately thinking it through = Become introspective about
it.
Working it off = Physical activity; focusing more on career
Self-healing practices = Yoga, meditation, massage,
visualization, and relaxation exercises
 Spirituality/Prayerfulness = Connection with others, nature,
and/or a Supreme Being.
Symbolic substitutes = confession, prayer, sacrifice, annual
income, physical appearance
Somatizing = "Organ Language" Going into physical s/s
(Palpitations, blushing, sweating, etc.)
25. A sense of coherence comes about when a person
has what 3 attributes?
Comprehensibility = the ability to understand the things that
happen in life (the cognitive or thinking aspect of coherence)
Manageability = having trust that things will work out well
because one has the resources to meet demands (the
behavioral or action aspect of coherence)
Meaningfulness = the motivation to invest time and energy
in life's challenges (the feeling aspect of coherence)
26. What are generalized resistance resources (GRRs)?
Give examples.
Factors in the person, group, or organization that help in
managing tensions
Physical/Biochemical GRRs: Physiologic characteristics
(genetic features & levels of immunity)
Artifactual/Material GRRs: Material goods and relative wealth
Cognitive GRRs: Intelligence and knowledge
Emotional GRRs: People who are self-aware
Valuative/Attitudinal GRRs: Products of a person's culture
and environment. Accurate appraisal and flexible approach
is in regards to attitudinal.
Interpersonal-Relational GRRs: Available social support
systems
Macrosociocultural GRRs: Institutional structures
(ceremonies/rites/etc.) that facilitate coping
27. What are defense mechanisms?
Using mental mechanisms to lessen anxiety and prevent
pain regardless of cost. Mostly unconscious, inflexible coping
pattern. Really self-deceptions.
28. Define 12 different types of defense mechanisms:
Denial: Blocking out painful or anxiety-inducing events or
feelings
 Displacement: Discharging pent-up feelings on people less
dangerous than those who initially aroused the emotion
Dissociation: Handling emotion conflicts, or internal or
external stressors, by a temporary alteration of
consciousness or identity
Fantasy: Symbolic satisfaction of wishes through nonrational
thought
Identification: Unconscious assumption of similarity between
oneself and another
Intellectualization: Separating an emotion from an idea or
though because the emotional reaction is too painful to be
acknowledged.
Introjection: Acceptance of another's values and opinions as
one's own
Projection: Attributing one's own unacceptable feelings and
thoughts to others
Rationalization: Falsification of experience through the
construction of logical or socially approved explanations of
behavior
Reaction formation: Unacceptable feelings disguised by
repression of the real feeling and by reinforcement of the
opposite feeling
Repression: Unconsciously keeping unacceptable feelings
out of awareness
Suppression: Consciously keeping unacceptable feelings and
thoughts out of awareness
29. What are characteristics of type A personality, and
what medical conditions correlate?
Highly competitive, urgent, impatient, hostile, and driving.
CV disorders (CAD, angina, pectoris, and myocardial
infarction)
30. What medical condition correlates with compulsive
personality?
Inflammatory bowel disorders
31. What are causes of peptic ulcer disease (PUD) and
emotions associated with it?
Stressful lifestyle of trying to be "getting ahead". Hostility,
irritability, hypersensitivity, and impaired coping ability.
32. Asthmatic people may feel:
 Helpless and vulnerable
33. People with Rheumatoid Arthritis (RA) are
described as:
Self-sacrificing, masochistic, inhibited, and perfectionistic
34. It is very common for emotional tension to result in
a:
Headache
35. In physical medicine, the feed-back loop has long
been accepted as the model for the functioning of:
Endocrine organs
36. What are psychophysiologic conditions associated
with skin disorders?
Itching (pruritus), excessive sweating (hidrosis), urticaria,
and atopic dermatitis

Chapter 5
1. What is symbolic interaction?
An approach to the study of human conduct based on three
philosophic premises:
• Humans act toward things (other people, events) based
on the meaning that the things have for them. Life
experiences may have different meaning for different
people. ALL behavior has meaning.
• The meaning of things in a person’s life is derived from
the social interactions that person has with others. We
learn meanings during our experience with others. Must
note social and cultural environment of each client.
• People handle and modify the meanings of the things they
encounter through an interpretive process. They come to
their own conclusions. Nurse must identify meanings
actions have for clients.
2. What is humanism?
A theory of life centered on human beings.
3. What is the Medical-Psychobiological Theory?
Mental illness viewed like any physical disease (due to
toxins, biochemical abnormality or genetic predisposition).
Can be summarized with the following attributes:
• The individual suffering from emotional disturbances is
sick and has an illness or defect
 • The illness can, at least presumably, be located in some
part of the body (usually the brain’s limbic system and the
central nervous system’s synapse receptor sites). Factors
related to mental disorders include excesses or
deficiencies of certain brain neurotransmitters; alterations
in the body’s biologic rhythms, including the sleep-wake
cycle; and genetic predisposition
• Illness has characteristic structural, biochemical, and
mental symptoms that can be
diagnosed/classified/labeled.
• Mental diseases run a characteristic course and have
particular prognosis for recovery.
• Mental disorders respond to physical or somatic
treatments, including drugs, chemicals, hormones, diet, or
surgery.
• Psychobiological explanations of mental disorders reduce
the stigma often associated with them, and can
discourage claims that mental disorders result from a lack
of willpower or moral character.
4. What is the Psychoanalytical Theory?
Credited to Freud, who believed all psychological and
emotional events, however obscure, are understandable. He
believed that childhood experiences caused adult neuroses.
5. What is Psychic determination?
No human behavior is accidental. Each psychic event is
determined by ones that preceded it. Accidents are caused
by wish of person, and dreams bear relationship to the rest
of the person’s life.
6. Role of the unconscious are seen through:
Slips of the tongue “Freudian slip”, comments made while
drunk, dreams, psychosis.
7. What is psychoanalysis?
A method for studying the unconscious. The basic logic
behind it is that 1.) The client underwent a traumatic
experience that stirred up intense and painful emotion. 2.)
The traumatic experience represented to the client some
ideas that incompatible with the dominant idea constituting
the ego. Thus, the client e experienced a neurotic conflict.
3.) The incompatible idea and the neurotic conflict
 associated with it force the ego to bring into action defense
mechanisms. 4.) Therapy is directed toward resolving the
conflict by uncovering its roots in the unconscious. If the
client is able to release the repressed feelings associated
with the conflict, the symptoms disappear.
8. Differentiate between id, ego and superego.
Id = completely unorganized reservoir of energy derived
from drives and instincts. Primitive drives, demand
immediate satisfaction. Operates on pleasure principle –
seek pleasure, avoid pain. A baby is all id.
Ego = controls action and perception, controls contact with
reality, and, through defense mechanisms, inhibits primary
instinctual drives. One of its fundamental functions is also
the capacity for developing mutually satisfying relationships
with others. Reality based.
Superego = Concerned with moral behavior. Frequently, the
superego allies itself with the ego against the id, imposing
demands in the form of conscience or guilt feelings.
9. What are the 2 types of drives?
Sexual and aggression
10. What are Freud’s psychosexual stages?
Stag Age Span Task Key Concept
e
Oral 0-18 Satisfaction and Oral activity gives
months anxiety pleasure and is a
management from source for learning.
oral activity.
Anal 18 months- Learning muscle Delayed gratification
3 years control for toilet and rule internalization.
training.
Phalli 3-6 years Gender Repression of attraction
c identification and to the opposite-sex
genital awareness. parent, leading to
same-sex identification.
Laten 6-12 years Repression of Oedipal conflict
cy sexuality. resolved with a shift to
other interests and
friends.
Genit 12 years- Channeling Reemerging sexuality
al young sexuality into to motivate behavior.
adult relationships with
members of the
opposite sex.
11. What is cognitive behavior theory?
Focuses on the present rather than the past. Began with
Pavolv's conditioned responses. Best research and most
effective out of all the therapies.
12. What is a conditioned response?
Famous experiment with a dog and a bell. The basic
principle of the conditioned response is 1.) A response is a
reaction to a stimulus 2.) If a new and different stimulus is
presented with or just before the original stimulating event,
the same response reaction can be obtained 3.) Eventually
the new stimulus can replace the original one, so that the
response occurs in reaction to the new stimulus alone.
13. What is reinforcement? What is positive vs. negative
reinforcement?
Behaviors are rewarded and persist.
Positive reinforcement: An event that increases the
probability that the response will recur—a reward for
behavior.
Negative reinforcement: An event that is likely to decrease
the possibility of recurrence because it penalizes the
behavior.
14. What is positive punishment vs. negative
punishment?
Positive punishment: Decrease the behavior by adding
aversive consequences
Negative punishment: Decrease the behavior by either
drawing a reinforcer or reward.
15. What is shaping?
The term for an intervention designed to change a person's
behavior and bring the person closer to the desired behavior
16. What is token economy?
Clients are rewarded for desired behavior by token
reinforcers, such as food, candy, and verbal approval.
17. What is interpersonal theory?
 The client's past and present relationships with others and
modes of interaction. Sullivan said that the patient's
relationships are the real focus of psychiatric inquiry.
18. What are self-systems?
"Self-dynamism". Provides tools that enable people to deal
with the tasks of avoiding anxiety and establishing security.
Result of reflected appraisals from significant others. (People
need approval from others to protect against anxiety.
19. What is Maslow’s Hierarchy of Needs?
An order, or hierarchy, of basic human needs. Lower level
needs must be met before higher level.
Self Actualization: Fulfillment of unique potential
Top
Esteem and Recognition: Self-esteem and the respect of
others; success at work; prestige
Love and Belonging: Giving and receiving affection;
companionship; and identification with a group
Safety: Avoiding harm; attaining security, order, and physical
safety
Physiologic: Biologic need for food, shelter, water, sleep,
oxygen, sexual expression Bottom
20. What are Erickson’s 8 Development Stages?
Age Stage of Task/Area of Concepts/Basic
Developm Resolution Attitudes
ent
Birth-18 Infancy Trust vs. Ability to trust others
months Mistrust and a sense of one's
own trustworthiness;
a sense of hope;
withdrawal and
estrangement
18 Early Autonomy vs. Self-control without
months-3 Childhood Shame and loss of self-esteem;
years Doubt ability to cooperate
and to express
oneself; compulsive
self-restraint or
compliance;
defiance, willfulness
3-5 years Late Initiative vs.Realistic sense of
Childhood Guilt purpose; some ability
to evaluate one's
own behavior; self-
denial and self-
restriction
6-12 School Age Industry vs. Realization of
years Inferiority competence,
perseverance; feeling
that one will never
be "any good,
withdrawal from
school and peers
12-20 Adolescents Identity vs. Coherent sense of
years Role Diffusion self; plans to
actualize one's
abilities; feelings of
confusion,
indecisiveness,
possibly antisocial
behavior
18-25 Young Intimacy vs. Capacity for love as
years adulthood Isolation mutual devotion;
commitment to work
and relationships;
impersonal
relationships,
prejudice
25-65 Adulthood Generativity Creativity,
years vs. Stagnation productivity, concern
for others; self-
indulgence,
impoverishment of
self
65 years Old Age Integrity vs. Acceptance of the
to death Despair worth and
uniqueness of one's
life; sense of loss,
contempt for others
 21. What is the General Systems Theory? What are
Menninger's 4 major issues?
When applied to living systems (people), provides a
conceptual framework for integrating the biologic and social
sciences with the physical sciences. System depends on
amount of stress and amount of coping. Menninger's work
addresses 4 major issues: 1.) Adjustment or individual-
environment interaction 2.) The organization of living
systems 3.) Psychologic regulation and control, known as
ego theory in psychoanalysis 4.) Motivation, which is often
called instinct and drive in psychoanalytic framework.
22. What are nursing roles in social-interpersonal
theories? What are implications for practice?
Case management, social psychiatry, community psychiatry,
psychoeducation, and milieu therapy
Implications = 1.) Approach clients in holistic ways
(increases the number of factors the nurse must assess). 2.)
Client include the client system. 3.) Intervention strategies
include primary prevention achieved through
psychoeducation, social change, and research. 4.) Therapy:
Helping troubled people gain a useful perspective on their
lifestyle and social environment rather than just controlling
symptoms.
23. Compare the major features of traditional
psychiatric theories:
Theory Assessm Problem Goal Dominant
ent Base Stateme Interventions
nt
Medical- Individual Disease Symptom Psychopharmac
psychobio client managem ology and other
logic symptom ent; cure biologic
s therapies
Psychoan Intrapsyc Conflict Insight Psychoanalysis
alytic hic;
unconscio
us
Cognitive Behavior Learning Behavior Behavior
behavioral Deficit change modification or
 conditioning
Social- Interactio Interperso Enhanced Group, family,
Interperso ns nal awareness and milieu
nal between dysfunctio and therapies
individual n quality of
and interperso
social nal
context interaction
s

Chapter 9
1. What is cultural competence?
Refers to the capacity of nurses or health service delivery
system to effectively understand and plan for the needs of a
culturally diverse client or group.
2. What is ethnicity?
Refer's to one's sense of identity, providing social belonging
and loyalty to a particular reference group within society.
3. What is ethnocentrism?
The belief that one's own culture values and behaviors are
superior and preferable to those of any other cultural group.
4. What is cultural sensitivity?
The process of increasing professional effectiveness through
understanding, respecting, and appreciating the importance
of cultural factors in the delivery of health services.
Acknowledging diversion = first step toward improving one's
cultural competencies and understanding.
5. What is the global burden of disease?
Represents comprehensive estimates of patterns of mortality
and disability from diseases and injuries. 5 of 10 leading
causes of disability are mental health (Unipolar depression,
alcohol use, bipolar disorder, schizophrenia, and obsessive
compulsive disorder).
6. What are 5 ways to improve cross-cultural
communication skills?
• Attending multicultural events
• Reading about different cultural groups
• Talking to members of the cultural group
 • Spending time in a particular ethnic community
• Learning another language
7. What is acculturation?
Degree to which a particular client or group from another
culture has adopted the values, attitudes, and behaviors of
mainstream U.S. culture.
8. What is culture brokering?
The act of bridging, linking, or mediating between groups of
people of different cultural systems to reduce conflict or
produce change
9. What is the nurse-as-culture-broker?
Serves as a bridge between the client and the providers in
the health care system by "stepping in," or intervening, to
facilitate the acquisition of effective health care
10. What does psychiatric epidemiology focus on?
What is the definition? What are benefits?
Human populations, not individual clients. The study of the
distribution and determinants of mental disorders (or other
health-related conditions or events) in human populations.
Determines causes for specific disorders, and identifies high
risk groups. Plans for current and future health needs, and
evaluates preventive and therapeutic measures.
11. What is a prevalence rate?
Total number of active cases, both old and new, present in a
population during a specific period of time.
12. What is incidence rate?
Measures the number of new cases of a disease or disorder
in a population over a specific period of time.
13. What is a risk factor?
A factor whose presence is associated with an increased
chance or probability of mental disorder (age, smoking, etc.)
14. What are the gender ratios, male to female, on the
following risk factors:
Alcoholism = 6:1
Depression = 1:2
Phobias = 1:2
15. What are age risk factors?
Most disorders = 25-44 years old
Alcoholism = Early 40s
 Drinking with driving/fighting = early 20s
16. How is ethnicity a risk factor for Depression and
Suicide?
Depression = Caucasian men > African-American men
African-American women > Caucasian women
Suicide = Caucasians of all ages > African-Americans
Naïve American youth increased risk
17. What are risk factors on marital status?
Single = psychiatric disorders such as schizophrenia
Depression = Highest in divorced/separated
Married women > non-married women
Married men < non-married men
18. What are risk factors on physical health status?
Psychiatric clients have an increase mortality rate
Medically hospitalized have an increased rate of psychiatric
disorders
Major depression – associated with many chronic medical
conditions; predictive of shortened life expectancy.
19. What are risk factors on positive family history?
Depression and schizophrenia
Genetic vulnerability to developing alcoholism
Dementia of the Alzheimer's type, bipolar, and anxiety
disorders are all being studied in correlation with family
history.
20. What seasons are individuals with schizophrenia
most likely to be born in?
Winter or Spring
21. True or False: Higher levels of stress associated with
particular events in one's social environment may be
associated with increased rates of mental disorders.
True
22. What are risk factors for physical environment?
Chemical exposure and homelessness = ↑ CNS
disturbances/mental disorders
23. What are lifestyle habits that should be incorporated
in nursing assessments?
Dietary patterns, use of alcohol and drugs, health and
healing process, religious and spiritual beliefs, use of time,
and migration patterns.
24. What are the stages of the natural history of
disorders? Explain each.
Stage of Susceptibility: Presence of risk factors that favor the
occurrence of disorder, but disorder not there
Stage of Presymptomatic Disorder: No apparent disorder, but
pathological changes have started to occur. The disorder has
begun but remains unrecognizable because it is
asymptomatic. If signs of the disorder are present, they may
be considered ordinary discomforts of daily living, like mild
depression.
Stage of Clinical Disorder: Recognizable signs and symptoms
of disorder
Stage of Disability: Run course and resolve completely,
either spontaneously or through therapy. However, some
leave residual impairment or short or long-term disability.
Chronic disability is the most significant.
25. What are culture bound syndromes. Give
examples.
Locality-specific patterns of experience—localized folk
diagnostic categories that explain repetitive and troubling
behaviors to specific societies.
Syndro Description
me
Amok A dissociative episode characterized by a period of
brooding followed by an outburst of violent,
aggressive, or homicidal behavior directed toward
objects or other people. May be found in Malaysia,
Laos, the Philippines, Polynesia, Papua New
Guinea, Puerto Rico, and among Navajo.
Falling- Occurring primarily in the southern US and in
out (or Caribbean groups, these episodes are
blacking characterized by a sudden collapse. Although the
out) person's eyes are open and the person can hear
and understand what is occurring, the person feels
powerless to move.
Ghost Various symptoms such as nightmares, weakness,
sickness feelings of impending doom, fainting,
hallucinations, loss of consciousness, and a sense
of suffocation, among others, along with a
 preoccupation with death are associated with the
deceased and sometimes with witchcraft.
Latah This syndrome is characterized by hypersensitivity
to sudden fright, with the automatic repetition by
imitation of the movements of another
(echopraxia), the parrot-like repetition of a word or
phrase just spoken by another (echolalia),
command obedience, and trance-like or
dissociative behavior. Originally of Malaysian or
Indonesian origin, this condition has also been
found in Siberian groups, Thailand, the Philippines,
and Japan.
Mal de This Spanish phrase means "evil eye." Common in
ojo other Mediterranean cultures, the evil eye can be a
curse instituted by an enemy. Children are
especially at risk; their symptoms include fitful
sleep, crying without apparent cause, diarrhea,
vomiting, and fever.
Nervois A term that means a distress of the nerves,
common among Latinos in North America and Latin
America. It includes a wide range of symptoms of
emotional and somatic disturbance and refers to a
general state of vulnerability to stressful life
experiences. Other ethnic groups (such as nevra
among the Greeks) have similar ideas about
"nerves."
Shenkui In China and Taiwan, this folk label describes
marked anxiety or panic symptoms accompanied
by somatic complaints, frequent dreams, and
sexual dysfunction (such as erectile dysfunction
and premature ejaculation). It is attributed to
excess semen loss through frequent intercourse,
masturbation, and nocturnal emission. Excessive
semen loss is feared because it represents the loss
of vital essence and can be seen as life
threatening.
Susto This folk illness is prevalent among some Latinos in
the US and among people in Mexico and Central
and South America. Also known as "loss souls," it is
 thought to be caused by a frightening event that
causes the soul to leave the body, resulting in
unhappiness and sickness including appetite
disturbances, feeling of sadness, lack of
motivation, troubled sleep, feelings of diminished
self-worth, headache, stomachache, and diarrhea.
26. What is comorbidity?
The occurrence of two or more psychiatric disorders over
and individual's life span.
27. What were some findings on the National
Comorbdity Survey (NCS) that are important to know?
Women = Higher rates of affective and anxiety disorders
Men = Higher rates of Substance Abuse and Antisocial
Personality disorders.
Most Disorders = ↓ with age and ↑socioeconomic status
Most common = depression and alcohol dependence
Nearly ½ of 1 of the mental disorders is lifelong
28. What are common health care-seeking patterns?
• Most persons with mental disorders don't seek
professional treatment.
• Comorbidity increases the likelihood that a person will
seek treatment.
• Most people seek treatment from primary care physicians,
who prescribe the majority of psychotropic medications.
• Individuals with chronic mental disorders comprise the
majority of those who seek treatment.
• Psychiatrists tent to treat individuals with severe
disorders, yet there is a undersupply of psychiatrists in
the US.
29. Who are the severely underserved groups in
relation to mental health services?
Substance abusers, older adults (especially if minority),
uninsured persons, and homeless persons.
30. What are the 3 main obstacles to improved mental
health/getting care?
1.) Scarcity of Resources. 2.) Inequities in the distribution
of resources. 3.) Inefficiencies in the use of resources