Exam 1: NSG221/ NSG 221 (Latest 2024/ 2025 Update) Mental Health | Guide with Questions and Verified Answers| 100% Correct- Herzing
Exam 1: NSG221/ NSG 221 (Latest 2024/
2025 Update) Mental Health | Guide with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Freud’s 3 Levels of Awareness
Answer:
Conscious refers to the perceptions, thoughts, and emotions that exist in the person’s awareness,
such as being aware of happy feelings or thinking about a loved one.
Preconscious thoughts and emotions are not currently in the person’s awareness, but he or she
can recall them with some effort—for example, an adult remembering what he or she did,
thought, or felt as a child.
The unconscious is the realm of thoughts and feelings that motivates a person even though he or
she is totally unaware of them.
Q: Ego Defense Mechanism Definition:
Answer:
Freud believed that the self, or ego, uses ego defense mechanisms, which are methods of
attempting to protect the self and cope with basic drives or emotionally painful thoughts,
feelings, or events
Q: Examples of Ego Defense Mechanisms
Answer:
Compensation, Conversion, Denial, Displacement, Dissociation, Fixation, Identification,
Intellectualization, Introjection (accepting another’s believes as one’s own), Projection
(unconscious blaming inclinations on external object), Rationalization, Reaction Formation
(think opposite), Regression (moving back a developmental stage to feel safe), Repression,
Resistance, Sublimation (Substituting a socially acceptable activity for an impulse that is
unacceptable), Substitution, Suppression, Undoing
Q: Freud’s Stages of Psychosexual Developement: Oral
Answer:
birth to 18 months, Major site of tension and gratification is the mouth, lips, and tongue; includes
biting and sucking activities. Id is present at birth. Ego develops gradually from rudimentary
structure present at birth.
Q: Freud’s Stages of Psychosexual Developement: Anal
Answer:
18-36 months, Anus and surrounding areas are major source of interest, voluntary sphincter
control acquired.
Q: Freud’s Stages of Psychosexual Developement: Phallic/Oedipal
Answer:
3-5 years, Genital is the focus of interest, stimulation, and excitement. Penis is organ of interest
for both sexes. Masturbation is common. Penis envy (wish to possess penis) is seen in girls;
oedipal complex (wish to marry opposite-sex parent and be rid of same-sex parent) is seen in
boys and girls.
Q: Freud’s Stages of Psychosexual Developement: Latency
Answer:
5-11/13 years Resolution of oedipal complex. Sexual drive channeled into socially appropriate
activities such as school work and sports. Formation of the superego. Final stage of psychosexual
development.
Q: Freud’s Stages of Psychosexual Developement: Genital
Answer:
11-13 years Begins with puberty and the biologic capacity for orgasm; involves the capacity for
true intimacy.
Q: Transference Definition
Answer:
occurs when the client displaces onto the therapist attitudes and feelings that the client originally
experienced in other relationships. Transference patterns are automatic and unconscious in the
therapeutic relationship.
Q: Countertransference Definition
Answer:
occurs when the therapist displaces onto the client attitudes or feelings from his or her past. For
example, a female nurse who has teenage children and who is experiencing extreme frustration
with an adolescent client may respond by adopting a parental or chastising tone. The nurse is
countertransfering her own attitudes and feelings toward her children onto the client.
Q: Psychoanalysis in Freud’s Theories
Answer:
Focuses on discovering the causes of the client’s unconscious and repressed thoughts, feelings,
and conflicts believed to cause anxiety and on helping the client gain insight into and resolve
these conflicts and anxieties. The analytic therapist uses the techniques of free association, dream
analysis, and interpretation of behavior. Psychoanalysis is still practiced today but on a limited
basis
Q: Four Phases of Peplau Theory
Answer:
Orientation
Identification
Exploitation
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Mental Health Definition A state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability
Mental Health Influencing Factors: Individual Include a person’s biologic makeup, autonomy and independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities
Mental Health Influencing Factors: Interpersonal Include effective communication, ability to help others, intimacy, and a balance of separateness and connectedness
Mental Health Influencing Factors: Social/Cultural Include a sense of community, access to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world
Mental Illness Definition Disorders that affect mood, behavior, and thinking, such as depression, schizophrenia, anxiety disorders, and addictive disorders.
Mental Illness Influencing Factors: Individual Include biologic makeup, intolerable or unrealistic worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of disharmony in life, and a loss of meaning in one’s life
Mental Illness Influencing Factors: Interpersonal Include ineffective communication, excessive dependency on or withdrawal from relationships, no sense of belonging, inadequate social support, and loss of emotional control
Mental Illness Influencing Factors: Social/Cultural Include lack of resources, violence, homelessness, poverty, an unwarranted negative view of the world, and discrimination such as stigma, racism, classism, ageism, and sexism
Frontal Lobe Function Controls the organization of thought, body movement, memories, emotions, and moral behavior. The integration of all this information regulates arousal, focuses attention, and enables problem-solving and decision-making. Abnormalities in the frontal lobes are associated with schizophrenia, ADHD, and dementia
Parietal Lobe Function Interprets sensations of taste and touch and assist in spatial orientation
Temporal Lobe Function Center for the senses of smell and hearing and for memory and emotional expression
Occipital Lobe Function Assist in coordinating language generation and visual interpretation, such as depth perception
What system in the brain affects mental health? Limbic System (Hippocampus, Amygdala, Cingulate Gyrus)
Dopamine Physiological Effect Controls complex movements, motivation, cognition; regulates emotional response
Norepinephrine Physiological Effect Causes changes in attention, learning, and memory, sleep and wakefulness, mood
Serotonin Physiological Effect Control food intake, sleep and wakefulness, temperature regulation, pain control, sexual behaviors, regulation of emotions
Components of Personality According to Freud: ID Innate desires, pleasure-seeking behavior, aggression, and sexual impulses. The ID seeks instant gratification, causes impulsive unthinking behavior, and has no regard for rules or social convention.
Components of Personality According to Freud: SUPEREGO Moral and ethical concepts, values, and parental and social expectations. It is in direct opposition to the ID.
Components of Personality According to Freud: EGO Mature and adaptive behavior that allows a person to function successfully in the world.
Freud’s Stages of Psychosexual Developement: Oral Birth-18 months: Major site of tension and gratification is the mouth, lips, and tongue. Includes biting and sucking activities. Id is present at birth. Ego develops gradually from rudimentary structure present at birth.
Freud’s Stages of Psychosexual Developement: Anal 18-36 months: Anus and surrounding areas are major source of interest. Voluntary sphincter control acquired.
Freud’s Stages of Psychosexual Developement: Phallic/Oedipal 3-5 years: Genital is the focus of interest, stimulation, and excitement. Penis is organ of interest for both sexes. Masturbation is common. Penis envy (wish to possess penis) is seen in girls; oedipal complex (wish to marry opposite-sex parent and be rid of same-sex parent) is seen in boys and girls.
Freud’s Stages of Psychosexual Developement: Latency 5-11/13 years: Resolution of oedipal complex. Sexual drive channeled into socially appropriate activities such as school work and sports. Formation of the superego. Final stage of psychosexual development.
Freud’s Stages of Psychosexual Developement: Genital 11-13 years: Begins with puberty and the biologic capacity for orgasm; involves the capacity for true intimacy.
Erikson’s: Trust vs. Mistrust Infant: Hope, viewing the world as safe and reliable; relationships as nurturing, stable, and dependable
Erikson’s: Autonomy vs. Shame and Doubt Toddler: Will, achieving a sense of control and free will
Erikson’s: Initiative vs. Guilt Preschool: Purpose, beginning development of a conscience; learning to manage conflict and anxiety
Erikson’s: Industry vs. Inferiority School age: Competence, emerging confidence in own abilities; taking pleasure in accomplishments
Erikson’s: Identity vs. Role Confusion Adolescence: Fidelity, formulating a sense of self and belonging
Erikson’s: Intimacy vs. Isolation Young adult: Love, forming adult, loving relationships, and meaningful attachments to others
Erikson’s: Generativity vs. Stagnation Middle age: Care, being creative and productive; establishing the next generation
Erikson’s: Ego Integrity vs. Despair Maturity: Wisdom, accepting responsibility for oneself and life
Piaget: Sensorimotor Stage Birth to 2 years: The child develops a sense of self as separate from the environment and the concept of object permanence, that is, tangible objects do not cease to exist just because they are out of sight. He or she begins to form mental images.
Piaget: Preoperational Stage 2 to 6 years: The child develops the ability to express self with language, understands the meaning of symbolic gestures, and begins to classify objects.
Piaget: Concrete Operations Stage 6 to 12 years: The child begins to apply logic to thinking, understands spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is still concrete.
Piaget: Formal Operations Stage 12 to 15 years and beyond: The child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.
Peplau’s 4 Stages 1) The orientation phase is directed by the nurse and involves engaging the client in treatment, providing explanations and information, and answering questions.2) The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.3) In the exploitation phase, the client makes full use of the services offered.4) In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.
RN Role Functions -Stranger: offering the client the same acceptance and courtesy that the nurse would to any stranger.-Resource person: providing specific answers to questions within a larger context-Teacher: helping the client learn either formally or informally-Leader: offering direction to the client or group-Surrogate: serving as a substitute for another, such as a parent or sibling-Counselor: promoting experiences leading to health for the client, such as expression of feelings
What is classical conditioning? Ivan Pavlov: a learning process that occurs when two stimuli are repeatedly paired: a response which is at first elicited by the second stimulus is eventually elicited by the first stimulus alone.
What is operant conditioning? B.F. Skinner: people learn their behaviors from their history or past experiences, particularly those experiences that were repeatedly reinforced
Maslow’s Hierarchy of Needs 1) Physiologic needs: food, water, sleep, shelter, sexual expression, and freedom from pain2) Safety and security: protection, security, and freedom from harm or threatened deprivation3) Love and belonging needs: enduring intimacy, friendship, and acceptance4) Esteem needs: the need for self-respect and esteem from others5) Self-actualization: the need for beauty, truth, and justice.
Existential Therapy: Rational Emotive Therapy “Therapist: Albert EllisA cognitive therapy using confrontation of “”irrational beliefs”” that prevent the individual from accepting responsibility for self and behavior”
Existential Therapy: Logotherapy Therapist: Viktor E. FranklA therapy designed to help individuals assume personal responsibility (the search for meaning [logos] in life is a central theme)
Existential Therapy: Gestalt Therapy Therapist: Frederick S. PerlsA therapy focusing on the identification of feelings in the here and now, which leads to self-acceptance
Existential Therapy: Reality Therapy Therapist: William GlasserTherapeutic focus is need for identity through responsible behavior; individuals are challenged to examine ways in which their behavior thwarts their attempts to achieve life goals
Many existential therapists use cognitive therapy. What is it? It focuses on immediate thought processing—how a person perceives or interprets their experience and determines how they feels and behave.
T/F: You should stop taking your psychopharmacological medication once you feel better False – Don’t stop taking your medication even if your symptoms improve
Major adverse drug reactions for psychopharmacological medications Suicidal tendencies, serotonin syndrome, EPS, increased portal hypertension (MAOIs-avoid foods with tyramine (aged food, wine, meats, cheeses))
Neurotransmitter target for antipsychotics Decreases dopamine
Neurotransmitter target for anti-anxiety medications Increases norepinephrine and GABA
Neurotransmitter target for antidepressants Increases norepinephrine and serotonin
What is involuntary hospitalization/civil commitment? Curtails the client’s right to freedom (the ability to leave the hospital when he or she wishes). All other client rights remain intact. Clients hospitalized against their will under these conditions are committed to a facility for psychiatric care until they no longer pose a danger to themselves or to anyone else.
Confidentiality Exception Mental health clinicians may have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege.
Maturational Crises Definition Sometimes called developmental crises: are predictable events in the normal course of life, such as leaving home for the first time, getting married, having a baby, and beginning a career.
Situational Crises Definition Unanticipated or sudden events that threaten the individual’s integrity, such as the death of a loved one, loss of a job, and physical or emotional illness in the individual or family member.
Adventitious Crises Definition Sometimes called social crises: include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.
Tort Definition A wrongful act that results in injury, loss, or damage. Torts may be either unintentional or intentional.
Negligence Definition An unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances
Malpractice Definition A type of negligence that refers specifically to professionals such as nurses and physicians.
Intentional Tort: Assault Any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority.
Intentional Tort: Battery Involves harmful or unwarranted contact with a client; actual harm or injury may or may not have occurred
Intentional Tort: False Imprisionment The unjustifiable detention of a client, such as the inappropriate use of restraint or seclusion.
Standards of Care Definition Nurses are expected to meet standards of care, meaning the care they provide to clients meets set expectations and is what any nurse in a similar situation would do.
Utilitarianism “A theory that bases decisions on “”the greatest good for the greatest number.”” Decisions based on utilitarianism consider which action would produce the greatest benefit for the most people.”
Deontology A theory that says decisions should be based on whether an action is morally right with no regard for the result or consequences. Principles used as guides for decision-making in deontology include autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity
What is Individual Psychotherapy? A method of bringing about change in a person by exploring his or her feelings, attitudes, thinking, and behavior. It involves a one-to-one relationship between the therapist and the client.
What is group therapy? Clients participate in sessions with a group of people. The members share a common purpose and are expected to contribute to the group to benefit others and receive benefit from others in return.
What are support groups? Organized to help members who share a common problem cope with it. Support groups often provide a safe place for group members to express their feelings of frustration, boredom, or unhappiness and also to discuss common problems and potential solutions.
What are education groups? Provide information to members on a specific issue—for instance, stress management, medication management, or assertiveness training
RN role in group therapies 1) The group leader has expertise in the subject area and may be a nurse, therapist, or other health professional.2) The group leader explores members’ thoughts and feelings and creates an atmosphere of acceptance so that members feel comfortable expressing themselves.
Principles of Discharge – Interventions to Prevent Relapse Interventions include symptom education, service continuity, and establishment of daily structure. Clients and families who can recognize signs of impending relapse and seek help, participate in outpatient appointments and services, and have a daily plan of activities and responsibilities are least likely to require rehospitalization.
What is Bridging Staff? Refers to an overlap between hospital and community care; hospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider
Goals of Psychiatric Rehabilitation -Recovery from mental illness-Personal growth-Quality of life-Community reintegration-Empowerment-Increased independence-Decreased hospital admissions-Improved social functioning-Improved vocational functioning-Continuous treatment-Increased involvement in treatment decisions-Improved physical health-Recovered sense of self
Characteristics of Later Recovery -Accepting illness-Managing symptoms effectively-Being actively engaged in the community-Having meaningful social contact-Coping with family relationships-Valuing self and others
Community Support Services or Community Support Programs Psychiatric rehabilitation involves providing services to people with severe and persistent mental illness to help them to live in the community.
What is Positive Regard? The nurse who appreciates the client as a unique worthwhile human being can respect the client regardless of his or her behavior, background, or lifestyle. This unconditional nonjudgmental attitude is known as positive regard and implies respect. Calling the client by name, spending time with the client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to the client. The nurse also conveys positive regard by considering the client’s ideas and preferences when planning care.
Working Phase of Therapeutic Relationship Usually divided into two subphases. 1) During problem identification, the client identifies the issues or concerns causing problems. 2) During exploitation, the nurse guides the client to examine feelings and responses and develop better coping skills and a more positive self-image; this encourages behavior change and develops independence.
What are professional boundaries? Inappropriate Boundaries: If a client is attracted to a nurse or vice versa, it is up to the nurse to maintain professional boundaries. Accepting gifts or giving a client one’s home address or phone number would be considered a breach of ethical conduct. Nurses must continually assess themselves and ensure they keep their feelings in check and focus on the clients’ interests and needs.
What is Active Listening? Refraining from other internal mental activities and concentrating exclusively on what the client says
Therapeutic Communication Strategies Touch, silence, active listening, clarifying techniques, asking questions, restating
What are overt cues in relation to suicide ideation? “Clear, direct statements of intent, such as “”I want to die.”” The message is clear that the client is thinking of suicide or self-harm”
What are covert cues in relation to suicide ideation? “Vague or indirect messages that need interpretation and exploration—for example, if a client says, “”Nothing can help me.”” The nurse is unsure, but it sounds as if the client might be saying he or she feels so hopeless and helpless that he or she plans to commit suicide. The nurse can explore this covert cue to clarify the client’s intent and to protect the client.”
Elements of Nonverbal Communication Personal spaceAppearanceEye contactPostureFacial expression Body LanguageSilence
What is a Mental Status Exam? The nurse collects objective data by observing the patient and the patient’s behavior. This includes not only how the patient communicates and responds to questions but also physical presentation.
Indicators of abuse -Injuries not consistent with the story of their cause-Sexual activity and STIs in a child younger than age 14 years-Failure to seek timely medical care-Multiple hospital or clinic visits for injuries-Multiple previous fractures, including those that result from twisting, blows, bending or tension-Burns, noting those that are symmetric, of uniform depth, and sharply demarcated-Bruises and fractures in multiple stages of healing-Bruises on the head, face, ears, and soft parts of the body (e.g., cheeks, neck, buttocks, thighs, calves)-Patterned bruises (e.g., handprint caused by slapping; linear marks caused by blows with belts, cords, or sticks; imprints caused by a household item, such as a wooden spoon or flyswatter)-Bite and scratch marks-Defensive posturing injuries-Head trauma from blows and falls, loose or missing teeth, and abdominal trauma from being punched in the stomach
Indicators of Abuse in Older Adults -Frailty, cognitive impairment-Psychiatric disorder, depression, anxiety-Alcohol abuse-Decreased social network-Shared living arrangements-External stressors on family-Vague excuses for missing activities, therapy-Untrimmed, dirty nails-Inadequate or absent assistive devices-History of family violence-Unexplained injuries-Explanation not consistent with findings-Recurrent UTIs or other infections-Poor hygiene, poor oral hygiene, dirty clothes-Weight loss/lack of interest in meals-Recurrent or worsening pressure ulcers, dehydration
What is cultural competence? Being sensitive to issues related to culture, race, gender, sexual orientation, social class, economic situation, and other factors.