Psychiartic Nursing Certification Review Guide For The .
Psychiatric NursingCertification Review Guidefor the Generalist andAdvanced PracticePsychiatric and Mental Health NurseThird EditionVictoria Mosack, PhD, RN, APNP, BCAssistant ProfessorSchool of NursingWichita State UniversityWichita, Kansas
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ContentsPreface viiAcknowledgmentsixChapter 1Test Taking Strategies and Techniques1Strategy #1 Know Yourself 1Strategy #2 Develop Your Thinking Skills 1Strategy #3 Know the Content 3Strategy #4 Become Test-Wise 6Strategy #5 Apply Basic Rules of TestTaking 7Strategy #6 Psych Yourself Up: Taking a Testis Stressful 8Summary 9Bibliography 9Interdisciplinary Treatment & theHealthcare Team 16Client Advocacy 17Case Management 17Psychiatric Liaison Nursing 18Milieu 18Principles of Prescriptive AuthorityMental Health Education 21Family Therapy 21Group Dynamics & Group ProcessTheory 22Ethical Considerations 23Questions 25Answers 32Bibliography 33Chapter 2Essentials of Psychiatric Nursing Care 11Chapter 3Major Theoretical Frameworks forPsychiatric Nursing 35Mental Health 11Change 11The Nursing Process 12Nurse–Client Relationship 12Communication 13Cultural & Ethnic Factors 15Theory 35Evidence-Based Practice (EBP) 35Research 36Nursing Theoretical Models 37Nursing Theories 37Personality Theories 3919iii
ivContentsTheories of Growth and DevelopmentSocial/Interpersonal Theories 43Existential/Humanistic Theories 43Behavioral Theories 45Cognitive Theories 45Theories of Communication 46Theories of Group Behavior andTherapy 47Family Theories 48Neurobiological Theories 49Miscellaneous Theories 51Questions 52Answers 60Bibliography 6142Chapter 4Substance-Related Mental Disorders 63Anxiety Disorders 83Somatoform Disorders 95Factitious Disorders 98Dissociative Disorders 99Adjustment Disorder 104Questions 105Answers 111Bibliography 111Chapter 6Schizophrenia and Other PsychoticDisorders 115Overview of Disorders 115Information Common to Schizophreniaand Other Psychotic Disorders 118Questions 129Answers 134Bibliography 134137Mood Disorders—Overview 137Depressive Disorders 139Bipolar Disorders 140Mood Disorder Due to . . . (Indicate GeneralMedical Condition) 141Substance-Induced Mood Disorder 141Suicide 141Etiology of Mood Disorders 142Diagnostic Studies/Tests 143Screening Instruments 143Interventions 144Questions 156Answers 164Bibliography 164Chapter 8Behavioral Syndromes and Disorders ofAdult Personality 165Substance-Related Disorders 63Questions 76Answers 80Bibliography 80Chapter 5Anxiety and Stress-Related DisordersChapter 7Mood Disorders83Eating Disorders 165Sexual and Gender Identity Disorders 168Sexual Dysfunctions 170Sleep Disorders 171Impulse Control Disorders 173Personality Disorders—Coded on Axis II ofthe DSM-IV-TR Multiaxial ClassificationSystem 174Questions 179Answers 184Bibliography 184Chapter 9Cognitive Mental Disorders andGeropsychiatric Nursing 187Cognitive Disorders 187Geropsychiatric Nursing 196Questions 197Answers 202Bibliography 202
ContentsChapter 10Behavioral and Emotional Disorders ofChildhood and Adolescence 205Child and Adolescent Psychiatric andMental Health Nursing 205Mental Disorders Diagnosed in Children &Adolescents 208Other Disorders of Infancy, Childhood, orAdolescence 227Treatment Modalities for Mental Disordersin Childhood and Adolescence 231Questions 240Answers 249Bibliography 249Chapter 11The Larger Mental Health EnvironmentMental Healthcare Delivery System 253Managed Care—An Internal Force ofChange within the Mental HealthDelivery System 257Reimbursement for Mental HealthServices 257Types of Healthcare Insurance Plans 257External Forces Interacting with the MentalHealth System 258Leadership and Management 261Questions 270Answers 276Bibliography 276Index279v
PrefaceThis is the third edition of a book developed especiallyfor nurses preparing to take certification examinationsoffered by the American Nurses Credentialing Center(ANCC). Major revisions were needed in a number ofareas to accommodate changes in the field of psychiatric and mental health nursing and to incorporatemore recent references as well as evidence-based practice guidelines that may have become available sincethe previous revision was published.The book is inclusive in that it contains both basicand advanced content, and may be used by nursesseeking certification as generalists as well as nursesseeking certification in advanced practice psychiatricand mental health nursing. It is assumed that the readerof this review guide has completed a course of study inpsychiatric and mental health nursing. The PsychiatricNursing Certification Review Guide for the Generalistand Advanced Practice Psychiatric and Mental Health(PMH) Nurse is not intended to be a basic learning tool.The purpose of the book is twofold. It will assist individuals engaged in self-study preparation for certification examinations, and may be used as a referenceguide in the practice setting. Many nurses preparingfor certification examinations find that reviewing anextensive body of scientific knowledge requires a verydifficult search of many sources that must be synthesized to provide a review base for the examination. Thepurpose of this publication is to provide a succinct, yetcomprehensive review of the core material.The book has been organized to provide the reviewerwith test taking strategies and techniques. This isfollowed by chapters on the Essentials of PsychiatricNursing Care, Major Theoretical Frameworks for Psychiatric Nursing, Substance-Related Mental Disorders,Anxiety and Stress-Related Disorders, Schizophreniaand Other Psychotic Disorders, Mood Disorders,Behavioral Syndromes and Disorders of Adult Personality, Cognitive Mental Disorders and GeropsychiatricNursing, Behavioral and Emotional Disorders of Childhood and Adolescence, and The Larger Mental HealthEnvironment.Following each chapter are test questions, whichare intended to serve as an introduction to the testingarena. In addition, a bibliography is included for thosewho desire a more in-depth discussion of the subjectmatter in each chapter. These references can serve asadditional instructional material for the reader.Certification is a process that is gaining recognitionboth within and outside the profession. For the professional, it is a means of gaining special recognition asa certified psychiatric nurse, which not only demonstrates a level of competency, but may also enhanceprofessional opportunities and advancement. Forthe consumer, it means that a certified nurse has metcertain predetermined standards set by the profession.vii
AcknowledgmentsFront/EndMatterTitleThe author of the third edition would like to expressappreciation to the authors of the first and secondeditions of this review guide. The contributions of theseauthors provided a sound foundation upon which thepresent revision was built.Chapter 1. Test Taking Strategies: Clare Houseman,PhD, RN, CS and Nancy A. Dickenson Hazard, MSN,RN, CPNP, FAANChapter 2. The Essentials of Psychiatric Nursing Care:Clare Houseman, PhD, RN, CSChapter 3. Major Theoretical Frameworks for Psychiatric Nursing: Clare Houseman, PhD, RN, CS andJoan Donovan, PhD, RN, CSChapter 6. Schizophrenia and Other Psychotic Disorders: Mary Ann Camaan, MN, RN, CS and Mary FultzSpencer, MN, RN, CSChapter 7. Mood Disorders: Mary D. Moller, DNP, ARNP,APRN, PMHCNS-BC, CPRP, FAANChapter 8. Behavioral Syndromes and Disorders ofAdult Personality: Richardean Benjamin-Coleman,PhD, MPH, RN, CSChapter 9. Cognitive Mental Disorders andGeropsychiatric Nursing: Jane Bryant Neese, PhD,RN, CS, Anita Thompson-Heisterman, MSN, RN, CS,and Ivo L. Abraham, PhD, RN, CS, FAANChapter 4. Substance-Related Mental Disorders: ThereseK. Killeen, PhD, RN, CSChapter 10. Behavioral and Emotional Disorders ofChildhood and Adolescence: Michele L. Zimmerman,MA, RN, CSChapter 5. Anxiety and Stress-Related Disorders: KarmaCastleberry, PhD, RN, CSChapter 11. The Larger Mental Health Environment:Janice V. R. Belcher, PhD, RN, CSix
1Test Taking Strategiesand TechniquesWe all respond to testing situations in different ways.What separates the successful test taker from the unsuccessful one is knowing how to prepare for and take atest. Preparing yourself to be a successful test taker is asimportant as studying for the test. Each person needsto assess and develop their own test taking strategiesand skills. The primary goal of this chapter is to assistpotential examinees in knowing how to study for andtake a test. STRATEGY #1 Know YourselfWhen faced with an examination, do you feel threatened, experience butterflies or sweaty palms, havetrouble keeping your mind focused on studying or onthe test questions? These common symptoms of testanxiety plague many of us, but can be used advantageously if understood and handled correctly (Divine &Kylen, 1979). Over the years of test taking, each of ushas developed certain testing behaviors, some of whichare beneficial, while others present obstacles to successful test taking. You can take control of the test taking situation by identifying the undesirable behaviors,maintaining the desirable ones, and developing skillsto improve test performance.of thinking as well as the techniques to enhance thethought process.Everyone has a personal learning style, but we allmust proceed through the same process to think.Thinking occurs on two levels––the lower level ofmemory and comprehension and the higher level of application and analysis (ABP, 1989). Memory is the ability to recall facts. Without adequate retrieval of facts,progression through the higher levels of thinking cannot occur easily. Comprehension is the ability to understand memorized facts. To be effective, comprehensionskills must allow the person to translate recalled information from one context to another. Application, or theprocess of using information to know why it occurs, isa higher form of learning. Effective application relieson the use of understood memorized facts to verify intended action. Analysis is the ability to use abstract orlogical forms of thought to show relationships and todistinguish the cause and effect between the variablesin a situation.As applied to testing situations, the thought process from memory to analysis occurs quite quickly.Some examination items are designed to test memoryand comprehension, while others test applicationand analysis. An example of a memory question is asfollows: STRATEGY #2 Develop YourThinking SkillsClients’ initial response to learning that they have aterminal illness is generally:Understanding Thought ProcessesA.B.C.D.In order to improve your thinking skills and subsequenttest performance, it is best to understand the typesDepressionBargainingDenialAnger1
2Chapter 1 Test Taking Strategies and TechniquesTo answer this question correctly, the individual hasto retrieve a memorized fact. Understanding the fact,knowing why it is important, or analyzing what shouldbe done in this situation is not needed. An example of aquestion that tests comprehension is as follows:Shortly after having been informed that she is in theterminal stages of breast cancer, Mrs. Jones begins totalk about her plans to travel with her husband whenhe retires in two years. The nurse should know that:a.b.c.d.The diagnosis could be wrong and Mrs. Jones maynot be dying.Mrs. Jones is probably responding to the news byusing the defense mechanism of denial.Mrs. Jones is clearly delusional.Mrs. Jones is not responding in the way most clients would.In order to answer this question correctly, an individual must retrieve the fact that denial is often the firstresponse to learning about a terminal illness and thatMrs. Jones’ behavior is indicative of denial.In a higher level of thinking examination question,individuals must be able to recall a fact, understandthat fact in the context of the question and apply thisunderstanding to explaining why one answer is correctafter analyzing the answer choices as they relate to thesituation (Sides & Cailles, 1989). An example of an application analysis question is as follows:Mr. Smith has just learned that he has an inoperablebrain tumor. His comment when the nurse speaks tohim later is “This can’t possibly be true. Mistakes aremade in hospitals all the time. They might have mixedup my test results.” The nurse’s most appropriate response would be to:a.b.c.D.Refer Mr. Smith for a psychiatric consultation.Neither agree nor disagree with Mr. Smith’scomment.Confront Mr. Smith with his denial.Agree with Mr. Smith that mistakes can happenand tell him you will see about getting repeattests.To answer this question correctly, the individual mustrecall the fact that denial is often the initial response tolearning about a terminal illness; understand that Mr.Smith’s response in this case is evidence of the normaluse of denial; apply this knowledge to each option, understanding why it may or may not be correct; and analyze each option for what action is most appropriate forthis situation. Application/analysis questions requirethe examinee to use logical rationale, which demonstrates the ability to analyze a relationship, based ona well-defined principle or fact. Problem-solving ability becomes important as the examinee must thinkthrough each question option, deciding its relevanceand importance to the situation of the question.Building Your Thinking SkillsEffective memorization is the cornerstone to learningand building thinking skills (Olney, 1989). We have allexperienced “memory power outages” at some time,due in part to trying to memorize too much, too fast,too ineffectively. Developing skills to improve memorization is important to increasing the effectiveness ofyour thinking and subsequent test performance.Technique #1Quantity is NOT quality, so concentrate on learning important content. For example, it is important to knowthe various pharmacologic agents appropriate for themanagement of chronic obstructive pulmonary disease(COPD), not the specific dosages for each medication.Technique #2Memory from repetition, or saying something over andover again to remember it usually fades. Developingmemory skills that trigger retrieval of needed facts ismore useful. Such skills are as follows:AcronymsThese are mental crutches that facilitate recall. Someare already established such as PERRL (pupils equal,round, reactive to light), or PAT (paroxysmal atrialtachycardia). Developing your own acronyms can beparticularly useful since they are your own word association arrangements in a singular word. Nonsense wordsor funny, unusual ones are often more useful since theyattract your attention.AcrosticsThis mental tool arranges words into catchy phrases.The first letter of each word stands for something thatis recalled as the phrase is said. Your own acrostics aremost valuable in triggering recall of learned information since they are your individual situation associations. An example of an acrostic is as follows:Kissing Patty Produces Affection stands for thefour types of nonverbal messages: Kinesics, Paralanguage, Proxemics and Appearance.ABCsThis technique facilitates information retrieval by usingthe alphabet as a crutch. Each letter stands for a symptom, which when put together creates a picture of theclinical presentation of the disease. For example, thecharacteristics of the disease and symptoms of osteoarthritis using the ABC technique are as follows:a)b)c)d)e)f)Aching or painBeing stiff on awakeningCrepitusDeterioration of articular cartilageEnlargements of distal interphalangeal jointsFormation of new bone at joint surface
Strategy #3 Know the Contentg) Granulation inflammatory tissueh) Heberden’s nodesOne letterRecall is enhanced by emphasizing a single letter. Themajor symptoms of schizophrenia are often remembered as follows: Affect (flat) Autism Auditory hallucinationsImagingThis technique can be used in two ways. The first isto develop a nickname for a clinical problem thatwhen said produces a mental picture. For example,“a wan, wheezy pursed lip” might be used to visualize a patient with pulmonary emphysema who is thin,emaciated, experiencing dyspnea, w
and mental health nursing. It is assumed that the reader of this review guide has completed a course of study in psychiatric and mental health nursing. The Psychiatric Nursing Certification Review Guide for the Generalist and Advanced Practice Psychiatric and Mental Health
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OF ARCHAEOLOGICAL ILLUSTRATORS & SURVEYORS LSS OCCASIONAL PAPER No. 3 AAI&S TECHNICAL PAPER No. 9 1988. THE ILLUSTRATION OF LITHIC ARTEFACTS: A GUIDE TO DRAWING STONE TOOLS FOR SPECIALIST REPORTS by Hazel Martingell and Alan Saville ASSOCIATION OF ARCHAEOLOGICAL ILLUSTRATORS & SURVEYORS THE LITHIC STUDIES SOCIETY NORTHAMPTON 1988 ISBN 0 9513246 0 8 ISSN 0950-9208. 1 Introduction This booklet .
