Exam #1 Study Guide
Module 1: Introduction to Psychiatric Mental Health Nursing
Introduction to Psychiatric Mental Health Nursing and the Continuum of Care
 Describe the continuum of mental health
Well-being where someone feels adequate and high levels of functioning (don’t
experience impairment), whereas the other end of the spectrum where there is a
significant alteration in thinking, mood, behavior which results in chronic impairment of
disability
 Identify risk and protective factors for the development of mental health conditions
Risk factors: genetic and biological, social (family and peer groups) and economic
circumstances, environmental access like health care, cultural and religious beliefs
Protective factors: individual resiliency (secure resources they need to ensure wellbeing),
 Define the diathesis-stress model
Looks at ‘is it caused by nature or nurture?’ Suggests that both nature and nurture
results in mental health conditions.
 Identify the difference between a DSM-V diagnosis and a nursing diagnosis
DSM-V identifies disorders based on specific criteria for mental illnesses, diagnosed by
Dr’s, therapists, NP’s, but RNs cannot diagnose these. – Nursing diagnosis provide a
nurse with appropriate nursing interventions to address DSM-V diagnosis
 Describe the role of the registered nurse in the care of patients with mental health
conditions
Promote mental health through assessment, diagnosis and treatment using nursing
diagnosis to guide their treatment to actual or potential mental health problems.
Can be found inpatient hospitals, outpatient clinics, long term care facilities, prisons,
Coordination of care, health teaching and maintenance, and pharmacological therapies,
communicating what they’ve observed to other members of their team.
Mental Status Exam
 Identify the purpose of the Mental Status Exam
Structured assessment to identify cognitive and behavior functioning – identify
abnormalities that might impact their functioning
 Define the components of the mental status exam
Appearance – Behavior (psychomotor activity) – Attitude – Mood (self-reported) – Affect
– Speech – Thought process – Thought content – Perceptual disturbances
(hallucinations) – Orientation – Level of consciousness – Memory – Intelligence –
Reliability – Judgement – Insight  Apply the Mental Status Exam to a patient with a mental health condition
Module 2: The Nurse-Patient Relationship
Therapeutic Relationships
 Identify the difference between intimate, social, and therapeutic relationships
Social – friends, family members (enjoyment and mutual relationships, advice giving)
Therapeutic- focus is on exploring patient’s feelings and experiences (needs of the nurse
are not established in this relationship)
 Identify the role of boundaries in the nurse-patient relationship
To make it clear that the nature of the relationship is therapeutic and not social – protects
the patient
 Define transference and countertransference
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Transference= displaces feelings and behaviors about significant figures in their past
onto the nurse (can be positive and negative)
Countertransference= when the nurse displaces feelings related to significant figures in
past onto the patient
Identify the importance of self-reflection and therapeutic use of self in the nurse-patient
relationship
Using our unique strengths as individuals to promote patient well-being
Describe Peplau’s Model of the nurse-patient relationship
Professional nurse-patient relationship that consists of a nurse who has skills and
expertise and a patient that wants to alleviate suffering and they find solutions to
problems, explore different avenues to increase quality of life, or find an advocate.
Promotes autonomy and wellness
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Define the four phases of the nurse-patient relationship
Pre-orientation- before you meet the patient / chart review and talking to other staff
members
Orientation- when we’re talking to the patient, initiating interview / patient expresses
thoughts and feelings / establish rapport and identify ‘what are we trying to achieve?’
Working- continuation or expansion of orientation phase, further gather information from
patient, promoting and evaluating progress
Termination- when we are ending the relationship / saying goodbye is sometimes difficult
but remain boundaries / summaries goals and objectives
Identify the levels of psychiatric nursing care
Therapeutic Communication
 Identify the importance of therapeutic communication in the nurse-patient relationship
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Apply therapeutic communication techniques (open-ended questions, exploring,
focusing, clarifying, restating, reflecting, seeking consensual validation, verbalizing the
implied, close ended questions, projective questions, silence) to the care of a patient
with mental health conditions
Silence- reflection on nurse and patient and time for processing
Active listening- fully concentrating to understand and remember what the patient is
saying
Clarifying- allow nurse to request feedback on the message received to ensure they
understand
Paraphrasing- restating the content of the message in nurse’s words
Reflecting- makes patient aware of inner feelings
Restating- repeating patient’s words to ensure understands
Exploring- allows the nurse to examine important ideas, experiences more fully (expands
discussion)
Open ended questions- encourage patients to share info about experiences, perception
or responses to a situation
Close ended questions- used to elicit specific questions like yes or no
Projective questions- usually begin with ‘what if’ to help patients articulate, explore, and
identify thoughts and feelings
Miracle question- goal setting question to help patients see what the future could hold
Identify the role of active listening in the nurse-patient relationship
Eye contact, body language and space between patient and nurse, vocal quality in
soft/gentle tones
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Identify appropriate responses to patients experiencing psychosis
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Identify techniques to end a therapeutic interview
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Identify barriers to therapeutic communication
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Demonstrate empathy in the care of a patient with a mental health condition
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Identify the importance of culturally congruent (competent) therapeutic communication
Shows respect to our patients that might be of different cultures such as eye contact
Define the three phases of the clinical interview
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Module 3: The Nursing Process in Psychiatric Mental Health Nursing
 Define the six steps of the nursing process
Assessment= Consider age,
Diagnosis=
Outcomes=
Planning=
Implementation=
Evaluation=
 Identify priority nursing assessment of the care of a patient with mental health conditions
Module 4: Psychiatric Nursing Foundations, Therapeutic Environments and Treatment Settings
Psychiatric Nursing Foundations
 Define Erikson’s Theory of Development apply it to the role of the psychiatric mental
health nurse
Occurs in 8 predetermined stages – move through each of them in sequential manner
but it is possible to get stuck in one
 Define Peplau’s Interpersonal Theory and apply it to the role of the psychiatric mental
health nurse
Illness offers opportunities for learning, growth, and improved coping skills and
psychiatric nurse facilitates this growth (nurse’s interaction with the patient)
 Define Behavior Theory and apply it to the role of the psychiatric mental health nurse
(including biofeedback, cognitive behavioral therapy, and dialectical behavior therapy)
Conditioning which involves pairing a behavior with a condition that reinforces or
diminishes the behaviors occurrence
Biofeedback= used to control the body’s physiologic response to stress and anxiety
Cognitive behavior therapy= thoughts come before feelings and actions, thoughts are
based on our own perspectives (challenge negative thought patterns), treats rapid
responses based on irrational, automatic thoughts
Dialectical behavior therapy=
 Define Maslow’s hierarchy of needs and apply it to the role of the psychiatric mental
health nurse
Strongest needs for survival on lowest level moving towards self-actualization at the top,
emphasizes humans strengths / Nurse= look in patients for their own potential and
strengths to succeed / establish what is most important in nursing sequence
 Define Biological Therapy and apply it to the role of the psychiatric mental health nurse
Abnormal behavior is a result of a physical problem
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Define milieu therapy and apply it to the role of the psychiatric mental health nurse
Treatment Settings
 Identify the role of community mental health centers in the care of patients with mental
health conditions
 Community mental health centers= offer services regardless of insurance
 Identify the role of inpatient psychiatric hospitals in the care of patients with mental
health conditions
24/7 nursing care, stabilize and safety are primary goals
 Identify the difference between voluntary and involuntary admission
Voluntary=
Involuntary=
 Define levels of outpatient psychiatric care (ie intensive outpatient, partial hospitalization,
psychiatric home care, medical home, group home) and be able to identify which level of
outpatient care is most appropriate for a patient
Medical home= designed for individuals that need more support for needs to be met /
access to holistic care in the community
Psychiatric home care= lives in own home where they have an RN visit the patient to
meet needs with mental health or provide therapy
Intensive outpatient= M-F programs, structured activities like group therapy to ensure
patient is getting wrap around services but live at home / used for patients to prevent
them from inpatient services or patients just released from hospital
Group home=
Partial hospitalization=
Module 5: Introduction to Psychotropic Medications
 Define the role of the brainstem, hypothalamus, cerebellum and cerebrum
Brainstem= controls survival function like HR, breathing, sleeping, digestion
Hypothalamus= right above brain stem, part of the brain that drives hunger, thirst, sex,
and sleep/wake cycle
Cerebellum= just behind it, regulates voluntary movements for smooth manner and
balance, equilibrium
Cerebrum= mental activities like language and perception
 Identify the most common brain imaging techniques (ie CT scans, EEG, MRI, PET,
SPECT) 3.2
CT= looks at structure
EEG=
MRI= structure
PET= function of brain
SPECT= function of brain
 Identify the primary neurotransmitters involved in the development of mental health
conditions
Chemicals that translate messages in the brain
DopamineNorepinephrine
Serontonin
*Altered neurotransmitters are the cause of mental illness*
 Define the difference between “agonist” and “antagonist”
Agonist= mimic the effect of neurotransmitters naturally found in the human brain by
binding to and stimulating the receptor site
Antagonist= blocks the neurotransmitters and their actions
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Identify the indication, mechanism of action, side effects, and key safety considerations
of:
o Benzodiazepines- anti anxiety meds / promote GABA by binding / depress CNS
so can cause sedation / do not combine with other drugs like alcohol / Valium,
Klonopin, Xanax, Ativan
o Buspirone (buspar)- anti anxiety meds / reduces anxiety without sedative
properties because it cannot suppress CNS / partial agonist or a booster with
GABA / can take 4 weeks before results
o Short-acting sedative hypnotic sleep medications- used to treat insomnia / fast
onset and short half life / Ambien, despiril / fall risk, full 8 hours designated for
sleep or very tired or hangover effect the next day
o Antidepressants (SSRIs, SNRI, mirtazapine, bupropion, TCAs, MAOIs) – correct
deficiency in neurotransmitter serotonin, norepinephrine, and dopamine
o Lithium- mood stabilizer / treats bipolar disorder / stabilizes the electrical
conductivity in the neurons / body recognizies lithium as a salt / watch salt and
water intake, regular blood monitoring to ensure levels are therapeutic
o Anticonvulsants- used to treat bipolar / reduce the firing rate of certain neurons /
Depokot, triliptol / require blood monitoring to ensure levels are therapeutic so
compliance can be an issue
o First and second-generation antipsychotics1st gen= typical or conventional / block dopamine / only target positive symptoms
of schizophrenia / Halodol / remember: risk of EPS or extra pyramidal side effects
(abnormal, involuntary movements)
2nd gen= atypical / bind to dopamine receptors to lower levels / Decrease extra
pyramidal side effects / targets both positive and negative aspects of
schizophrenia / Seroquil, abilify,
o Stimulants and non-stimulants- used to treat ADHD
Stimulants= adderal, vivance, Ritalin / educate parents to take as prescribed or
locking up when not in use because they can be abused / inhibit growth so do
drug holidays
Non-stimulants= straterra,
o Cholinesterase inhibitors
Identify the role of the nurse in the administration of psychotropic medications
Module 6: Stress, Coping, and Crisis
Stress and Coping
 Define the stress response (including the physiologic components of stress)
 Identify the risks of prolonged stress
 Define the levels of anxiety (ie mild, moderate, severe, panic)
 Identify the importance of stress management and strategies to manage stress
 Apply the nursing process to the care of a patient experiencing stress
Crisis
 Define the types of crisis (ie situational crisis, subjective crisis, phase-of-life crisis,
adventitious crisis)
 Identify the phases of crisis
 Identify the goal of crisis intervention
 Apply the nursing process to the care of a patient experiencing a crisis
Module 7: Legal and Ethical Issues in Psychiatric Nursing
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Define the five ethical principles of beneficence, autonomy, justice, fidelity, and veracity
and be able to apply them to the care of patients with mental health conditions
Apply the Franciscan Values of dignity of the individual, responsible stewardship, peace
and justice, and reconciliation to the care of patients with mental health conditions
Identify the difference between voluntary and involuntary admission to a psychiatric
facility
Understand a patient’s right to treatment, right to refuse treatment, right to informed
consent and be able to apply these rights to the care of a patient with a mental health
condition
Identify a patient’s rights as it pertains to restraint and seclusion
Identify the nurse’s obligation to report abuse and neglect, act on questionable practices,
and maintain thorough documentation
Define the role of the forensic nurse, the sexual assault nurse examiner (SANE), the
corrections nurse, and the legal nurse consultant
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