Psychology Chapter 5: Behaviors and Expressions

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Questions and Answers

A client is observed to be drumming their fingers and twisting their hair repeatedly. This behavior is most likely indicative of:

  • Psychomotor retardation
  • Automatisms (correct)
  • Waxy flexibility
  • Blunted affect

A client is talking about the recent death of their pet, laughing and smiling while doing so. This demonstrates an inconsistency between:

  • Speech quantity and quality
  • Automatisms and waxy flexibility
  • Thought process and thought content
  • Mood and affect (correct)

Which of the following is NOT a common observation in assessing general appearance and motor behavior?

  • Hygiene and grooming
  • Speech patterns (correct)
  • Facial expressions and tremors
  • Eye contact and posture

A client is talking nonstop and seems unable to move from one topic to another. This is known as:

<p>Perseveration (B)</p> Signup and view all the answers

A client who displays a full range of emotional expressions is demonstrating:

<p>Broad affect (D)</p> Signup and view all the answers

Which of the following is NOT considered a component of assessing mood and affect?

<p>Speech patterns and content (A)</p> Signup and view all the answers

A client with a consistently serious or somber facial expression is said to have:

<p>Restricted affect (C)</p> Signup and view all the answers

A nurse asking a client to rate their mood on a scale of 1 to 10, with 1 being least depressed and 10 being most depressed, is trying to assess:

<p>Mood intensity (C)</p> Signup and view all the answers

Which of the following is NOT a misconception about mental health treatment?

<p>Seeking professional help is a sign of individual weakness (D)</p> Signup and view all the answers

A client who frequently uses invented words that only they understand is displaying:

<p>Neologisms (A)</p> Signup and view all the answers

A client exhibits a fixed, false belief that is not based in reality. This is known as:

<p>Delusion (D)</p> Signup and view all the answers

Which of the following is NOT a key term associated with a client's thought process?

<p>Waxy Flexibility (A)</p> Signup and view all the answers

A client who displays rapid changes in mood is said to have:

<p>Labile Affect (C)</p> Signup and view all the answers

What does the term 'affect' refer to in a psychosocial assessment?

<p>The client's outward expression of emotions (A)</p> Signup and view all the answers

A client who exhibits 'thought blocking' is likely to:

<p>Stop abruptly in the middle of a sentence or thought (D)</p> Signup and view all the answers

The term 'automatisms' describes which behavior?

<p>Repetitive, seemingly purposeless behaviors often indicative of anxiety (C)</p> Signup and view all the answers

Which of these behaviors would be considered 'psychomotor retardation'?

<p>Overall slowed movements and slow cognitive processing (C)</p> Signup and view all the answers

A client who demonstrates the ability to understand their situation and accept responsibility for it is said to have:

<p>Insight (A)</p> Signup and view all the answers

Which term refers to a client's enduring emotional state?

<p>Mood (B)</p> Signup and view all the answers

In the context of a psychological assessment, what does 'orientation' refer to?

<p>The initial stage of the nurse-client relationship (A)</p> Signup and view all the answers

Why is it important for nurses to use nonjudgmental language when asking about sensitive information?

<p>All of the above. (D)</p> Signup and view all the answers

A client describes a unique word they created that only has meaning to them. This is considered a:

<p>Neologism (C)</p> Signup and view all the answers

Which of the following terms describes a client's inaccurate interpretation that general events are directed at them?

<p>Ideas of reference (C)</p> Signup and view all the answers

Which of the following questions is most likely to elicit honest and accurate information about a client's parenting practices?

<p>Can you tell me about the disciplinary methods you use with your child? (B)</p> Signup and view all the answers

What is the purpose of a psychosocial assessment in psychiatric-mental health nursing?

<p>To develop a comprehensive understanding of the client's emotional state, mental capacity, and behavioral function. (C)</p> Signup and view all the answers

Which of the following is NOT a component of the psychosocial assessment framework discussed in the text?

<p>Physical Examination (A)</p> Signup and view all the answers

Why is it important for nurses to consider the client's cultural and spiritual beliefs during a psychosocial assessment?

<p>All of the above. (D)</p> Signup and view all the answers

Which of the following is LEAST likely to be a factor influencing a psychosocial assessment?

<p>The client's family history (C)</p> Signup and view all the answers

What is the purpose of using an organizing framework for a psychosocial assessment?

<p>All of the above. (D)</p> Signup and view all the answers

In the text, what is the main idea of a psychosocial assessment?

<p>It's a tool to understand the client's thoughts, emotions and behaviours. (C)</p> Signup and view all the answers

Which of the following is NOT a factor included in the history component of the psychosocial assessment?

<p>Previous medical history (B)</p> Signup and view all the answers

The text highlights that assessment is the first crucial step in caring for a client. What is the next essential step after this?

<p>Organize and analyze collected data (C)</p> Signup and view all the answers

What is the significance of a family history of alcoholism, bipolar disorder, or suicide in a client's psychosocial assessment?

<p>It increases the client's risk for developing these problems. (B)</p> Signup and view all the answers

What is the primary developmental task for an adolescent?

<p>All of the above. (D)</p> Signup and view all the answers

Why is it important for nurses to avoid stereotyping clients based on their appearance or physical characteristics?

<p>All of the above. (D)</p> Signup and view all the answers

Which of the following should the nurse ask the client to gain insight into their beliefs about health and illness?

<p>What are your beliefs about the cause of your current health problems? (D)</p> Signup and view all the answers

What is the most important thing for the nurse to prioritize when beginning a psychosocial assessment?

<p>Establishing a trusting working relationship with the client. (B)</p> Signup and view all the answers

What are some examples of unusual movements or mannerisms that the nurse might observe during the general assessment?

<p>All of the above. (D)</p> Signup and view all the answers

Which of the following is NOT an example of a concern related to self-concept?

<p>Difficulty with relationships. (B)</p> Signup and view all the answers

What is the difference between judgment and insight in a psychosocial assessment?

<p>Judgment refers to problem-solving abilities, while insight involves understanding one's own role in a situation. (A)</p> Signup and view all the answers

What is the importance of assessing the client's ability to perform the activities of daily living (ADLs) as part of a psychosocial assessment?

<p>All of the above. (D)</p> Signup and view all the answers

What type of thinking is characterized by the client eventually answering a question but only after giving excessive unnecessary detail?

<p>Circumstantial thinking (A)</p> Signup and view all the answers

Which of the following is a delusional belief that others are taking the client's thoughts away?

<p>Thought withdrawal (B)</p> Signup and view all the answers

What is the purpose of data analysis in a psychosocial assessment?

<p>To identify patterns and themes to understand the client's strengths and needs. (D)</p> Signup and view all the answers

Which of the following is NOT a type of personality test?

<p>Beck Depression Inventory (BDI) (D)</p> Signup and view all the answers

Which of the following statements accurately describes the concept of 'reassessment' in client care?

<p>Reassessment is a dynamic process used to evaluate the effectiveness of treatment. (C)</p> Signup and view all the answers

Which of the following statements is true about the use of intelligence tests in mental health care?

<p>Intelligence tests can provide valuable information regarding cognitive abilities and intellectual functioning. (A)</p> Signup and view all the answers

What is the purpose of asking a client directly about suicidal ideation?

<p>To assess the client's risk for self-harm and develop a safety plan. (B)</p> Signup and view all the answers

Which of the following is a common criticism of both intelligence tests and personality tests?

<p>They are often culturally biased and may not accurately reflect individuals from diverse backgrounds. (A)</p> Signup and view all the answers

What type of thinking involves a disorganized flow of unconnected words with no meaning to the listener?

<p>Word salad (B)</p> Signup and view all the answers

When analyzing data from a psychosocial assessment, what should the nurse look for to identify the client's needs and problems?

<p>Patterns or themes that emerge from the data collected. (D)</p> Signup and view all the answers

What is the primary purpose of developing a plan of care?

<p>To guide the provision of care and ensure continuity of treatment. (A)</p> Signup and view all the answers

Which of the following is NOT an element of the nursing process or clinical judgment model as described in the text?

<p>Diagnosis (A)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the assessment process in nursing?

<p>Assessment is an ongoing process, repeated throughout the client's care. (B)</p> Signup and view all the answers

What is the main purpose of 'objective personality tests' compared to 'projective personality tests'?

<p>To measure personality traits and disorders in a standardized way. (C)</p> Signup and view all the answers

Which of the following is an example of a projective personality test?

<p>Thematic Apperception Test (TAT) (C)</p> Signup and view all the answers

What is the primary goal of a multidisciplinary treatment plan?

<p>To clarify the roles and responsibilities of different disciplines involved in the client's care. (D)</p> Signup and view all the answers

What is essential for a nurse to avoid when conducting a psychosocial assessment?

<p>Allowing personal beliefs to interfere (B)</p> Signup and view all the answers

Which component is NOT part of a thorough psychosocial assessment?

<p>Family medical history (D)</p> Signup and view all the answers

Why is self-awareness important for a nurse during the psychosocial assessment?

<p>To conduct an objective assessment (A)</p> Signup and view all the answers

What should a nurse do if a client is reluctant to discuss their relationships during an assessment?

<p>Encourage the client to share at their own pace (C)</p> Signup and view all the answers

How can a nurse demonstrate cultural competence during a psychosocial assessment?

<p>By asking about cultural beliefs and practices (C)</p> Signup and view all the answers

What feeling might a nurse experience when working with a client who has been physically abusive?

<p>Increased anxiety about the assessment (D)</p> Signup and view all the answers

What is one major factor that can influence the psychosocial assessment process?

<p>Client's ability to participate and give feedback (C)</p> Signup and view all the answers

Which area might be impaired due to a client's illiteracy during a psychosocial assessment?

<p>Intellectual functioning (A)</p> Signup and view all the answers

What approach should a nurse take to avoid making inaccurate assumptions about a client's psychosocial functioning?

<p>Conduct a thorough cultural assessment (B)</p> Signup and view all the answers

What is a priority for the nurse when assessing a client for suicidal ideation?

<p>Asking clearly and directly (A)</p> Signup and view all the answers

What is the main purpose of the Mental Status Examination?

<p>To assess cognitive abilities (B)</p> Signup and view all the answers

How does the DSM-5-TR assist mental health professionals?

<p>It offers a standardized classification system for mental disorders (A)</p> Signup and view all the answers

Which of the following is NOT a component evaluated in the Mental Status Examination?

<p>Self-reported mood state (A)</p> Signup and view all the answers

What is the significance of self-awareness for nurses in psychosocial assessments?

<p>It helps them recognize their biases that could affect client assessments (D)</p> Signup and view all the answers

Which projective measure involves describing perceptions of ink blots?

<p>Rorschach Test (C)</p> Signup and view all the answers

What is the role of the ICU psychological assessment tools?

<p>To account for psychiatric problems following critical illness (A)</p> Signup and view all the answers

What should a nurse do when assessing clients for suicidal thoughts?

<p>Ask directly and clearly about suicidal ideations (D)</p> Signup and view all the answers

Which of the following statements accurately reflects the significance of culturally aware assessments?

<p>Cultural context can influence the relevance of assessment scores (C)</p> Signup and view all the answers

Which assessment tool focuses on storytelling in response to pictures?

<p>Thematic Apperception Test (TAT) (D)</p> Signup and view all the answers

Why is it important to address sensitive topics during psychosocial assessments?

<p>They provide essential information for comprehensive assessments (D)</p> Signup and view all the answers

What type of completion does the Sentence Completion Test involve?

<p>Filling in the blanks of prompts (A)</p> Signup and view all the answers

What is the role of judgment in the psychosocial assessment process?

<p>It should be avoided to keep the assessment objective (D)</p> Signup and view all the answers

Which cognitive function is often assessed to screen for dementia?

<p>Memory recall and recognition (D)</p> Signup and view all the answers

What may indicate impaired cognition when using the Mental Status Examination?

<p>Struggling with short-term recall tasks (A)</p> Signup and view all the answers

What should the nurse do if a client is anxious, tired, or in pain during a psychosocial assessment?

<p>Delay the assessment until the client's symptoms are addressed. (B)</p> Signup and view all the answers

Why might a client be reluctant to provide information during a psychosocial assessment?

<p>They may have had negative previous experiences with healthcare. (D)</p> Signup and view all the answers

When conducting a psychosocial assessment, what is the primary concern for the nurse regarding the client's ability to understand?

<p>Whether the client is able to read and speak the nurse's language. (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of an ideal environment for a psychosocial interview?

<p>Isolated and secluded. (A)</p> Signup and view all the answers

What is the primary advantage of using open-ended questions in a psychosocial assessment?

<p>They allow the client to express their perception of their situation. (A)</p> Signup and view all the answers

Which of the following statements about obtaining input from family or friends during a psychosocial assessment is TRUE?

<p>The nurse should ensure the family is comfortable sharing information in the client's presence. (A)</p> Signup and view all the answers

Why is it important to use focused or closed-ended questions in a psychosocial assessment?

<p>To ensure the client doesn't feel overwhelmed by open-ended questions. (D)</p> Signup and view all the answers

Which of the following is an example of a focused or closed-ended question that could be used in a psychosocial assessment?

<p>How often do you feel anxious? (A)</p> Signup and view all the answers

Which of the following is NOT a reason why a nurse may need to rely on observations and secondary sources for information during a psychosocial assessment?

<p>If the client is unwilling to provide sensitive information. (D)</p> Signup and view all the answers

What is the primary goal of a psychosocial assessment?

<p>To provide a comprehensive picture of the client's well-being. (D)</p> Signup and view all the answers

Why might a client provide superficial information or omit important information during a psychosocial assessment?

<p>The client may feel rushed or pressured. (A)</p> Signup and view all the answers

How can a nurse establish a trusting relationship with a client who is reluctant to participate in a psychosocial assessment?

<p>Being patient and empathetic towards the client's feelings. (C)</p> Signup and view all the answers

Why is it important for a nurse to be aware of their own feelings and responses during a psychosocial assessment?

<p>To avoid projecting their own biases onto the client. (B)</p> Signup and view all the answers

What is the most appropriate course of action for a nurse to take if they suspect abuse during a psychosocial assessment?

<p>Discreetly report the suspicion to the appropriate authorities. (B)</p> Signup and view all the answers

Which of the following actions is most likely to negatively impact the client's willingness to participate in a psychosocial assessment?

<p>Asking the client to provide information that they may find uncomfortable. (D)</p> Signup and view all the answers

Which of the following is LEAST likely to be affected by a client's ability to understand the psychosocial assessment?

<p>The nurse's ability to build rapport. (A)</p> Signup and view all the answers

Flashcards

Abstract Thinking

Ability to make associations or interpretations about a situation.

Affect

The outward expression of the client’s emotional state.

Automatisms

Repeated, purposeless behaviors often indicative of anxiety.

Blunted Affect

Showing little or slow-to-respond facial expression.

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Circumstantial Thinking

Client answers a question after giving excessive detail.

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Concrete Thinking

Client gives literal translations; abstraction is diminished.

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Delusion

A fixed, false belief not based in reality.

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Flat Affect

Showing no facial expression.

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Flight of Ideas

Excessive rate of speech with fragmented ideas.

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Hallucinations

False sensory perceptions that do not exist.

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Insight

Ability to understand one’s situation and accept responsibility.

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Labile

Rapidly changing or fluctuating emotions.

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Mood

Client’s pervasive and enduring emotional state.

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Self-concept

How one views oneself in terms of worth and dignity.

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Thought Blocking

Stopping abruptly in the middle of a thought.

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Psychosocial Assessment

A process to evaluate a client’s mental and emotional well-being and its impact on health.

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Client's Health Status

A client's physical and mental health can affect their participation in assessments.

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Client's Previous Experiences

Past interactions with healthcare can affect a client's willingness to engage.

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Communication Barriers

Differences in language or hearing can lead to misunderstandings.

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Nurse's Attitude

The nurse's demeanor can influence the depth of information shared by the client.

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Comfortable Environment

Conducting assessments in a safe, private setting encourages client openness.

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Input from Family

Gathering perceptions from friends or family can provide insights into the client's condition.

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Open-Ended Questions

Questions that allow clients to respond freely and express their thoughts.

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Closed-Ended Questions

Specific questions that require short, direct answers.

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Assessment Challenges

Client anxiety or discomfort can hinder accurate assessments.

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Sensitive Topics

Certain subjects may require a trusting atmosphere for discussion.

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Attention Span

A client's ability to focus on assessment questions can vary due to mental state.

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Clarifying Questions

Follow-up queries that help clients organize their thoughts and clarify misunderstandings.

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Phrasing Questions

The manner in which questions are asked can shape client responses.

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Assessment Privacy

Conducting interviews without distractions can protect client confidentiality.

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Psychomotor Retardation

Overall slowed movements observed in a client.

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Waxy Flexibility

Maintenance of posture or position, even if uncomfortable.

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Labile Mood

Rapidly changing emotions, such as crying then laughing.

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Restricted Affect

Displaying one type of expression, usually serious or somber.

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Inappropriate Affect

Facial expression that doesn't match the situation.

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Thought Process

How the client thinks, inferred from their speech patterns.

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Thought Content

What the client actually expresses verbally.

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Neologisms

Invented words that have meaning only for the client.

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Perseveration

Client is stuck on one topic, unable to move on.

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Ideas of Reference

Inaccurate interpretation that general events are personally directed to the individual.

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Loose Associations

Disorganized thinking that connects ideas with little relation.

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Tangential Thinking

Wandering off topic, failing to get to the requested information.

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Thought Broadcasting

Delusional belief that others can hear the client's thoughts.

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Thought Insertion

Belief that others are placing thoughts into the client's mind.

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Thought Withdrawal

Belief that others are stealing the client's thoughts.

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Word Salad

Flow of unconnected words that lacks meaning to the listener.

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Assessment of Suicide

Determining if a client has thoughts of self-harm or suicide.

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Data Analysis

Analyzing collected data to identify clients' strengths and needs.

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Psychological Tests

Tools used to evaluate cognitive abilities and personality traits.

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Intelligence Tests

Evaluate cognitive abilities and intellectual functioning.

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Personality Tests

Assess individual traits, defenses, and self-concept.

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Self-Awareness in Nursing

Understanding one’s own beliefs and feelings to improve client interactions.

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Cultural Competence

The ability to understand and respect a client's cultural background during assessment.

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Assessment Components

Key areas to evaluate include history, mood, relationships, and intellectual process.

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Influence of Physical Health

Client's health status can affect psychosocial evaluation and communication.

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Professional and Nonjudgmental Attitude

Maintaining objectivity during client assessments, free of personal bias.

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Assessment of Illiterate Clients

Evaluating the intellectual functioning of clients who cannot read or write.

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Suicidal Ideation Inquiry

Directly asking clients about thoughts of self-harm or suicide for their safety.

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Assessment of Relationships

Understanding a client's connections with family and others during assessment.

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Assessing Sexuality and Self-Harm

Focus areas in psychosocial assessments that are sensitive and challenging.

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Cultural Considerations

Factors related to a client’s culture that affect test relevance.

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DSM-5-TR

The diagnostic manual for psychiatric disorders used by professionals.

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Mental Status Examination

Assessment focusing on cognitive abilities of the client.

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Cognitive Deficit

When a client accurately completes fewer tasks on assessments.

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Mini-Mental State Exam (MMSE)

A common tool to screen for cognitive impairment.

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Rorschach Test

A personality test using ink blots to assess thoughts.

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Thematic Apperception Test (TAT)

A test where clients create stories based on images.

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Sentence Completion Test

Clients finish sentences to reveal thoughts and feelings.

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Discussing Suicide

Openly asking clients about suicidal thoughts during assessments.

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Client Biases

Preconceptions nurses may have about clients' beliefs or behaviors.

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Judgments in Assessment

Assessments should be free from personal judgments.

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Common Cognitive Items

Tasks like naming objects or following commands in assessments.

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Psychological Distress in ICU

Psychiatric issues can arise post intensive care experiences.

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Nonjudgmental tone

Using neutral language and tone to encourage open dialogue.

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Sensitive information

Personal topics that may cause discomfort, like drug use or abuse.

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Building trust

Establishing a safe environment for open communication.

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Organizing framework

Structure used for systematic assessment.

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History in assessment

Client’s background important for understanding current issues.

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Developmental stage

Client's age and maturity influencing their functioning.

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Judgment and insight

Ability to interpret experiences and self-awareness.

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Roles and relationships

Client's current roles in life and their satisfaction.

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Physiological assessments

Evaluation of physical health and self-care practices.

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Mood and affect

Client's emotional expression and physical demeanor.

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Communication techniques

Methods to effectively convey messages and gather information.

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Study Notes

Psychosocial Assessment Key Terms

  • Affect: The outward expression of a client's emotional state
  • Automatisms: Repeated, seemingly purposeless behaviors, often anxiety-related (e.g., drumming fingers)
  • Blunted Affect: Minimal or delayed facial expression; few observable expressions
  • Broad Affect: Displaying a full range of emotional expressions
  • Circumstantial Thinking: Eventually answering a question but with excessive, unnecessary detail
  • Concrete Thinking: Literal interpretations; lacking abstract thought
  • Delusion: A fixed, false belief not rooted in reality
  • Flat Affect: Absence of facial expression
  • Flight of Ideas: Rapid, fragmented, unrelated thoughts; racing thoughts
  • Hallucinations: False sensory perceptions or experiences
  • Ideas of Reference: Misinterpreting general events as personally directed
  • Inappropriate Affect: Facial expression incongruent with mood or situation
  • Insight: Understanding one's situation and accepting personal responsibility
  • Judgment: Ability to interpret surroundings and adapt behavior
  • Labile: Rapidly changing mood or emotions
  • Loose Associations: Disorganized thinking, jumping from one idea to another
  • Mood: Pervasive, enduring emotional state
  • Neologisms: Invented words with meaning only to the client
  • Orientation: Initial nurse-client interaction where the client identifies problems
  • Psychomotor Retardation: Overall slowed movements and verbal interaction
  • Restricted Affect: Displaying one type of emotional expression, often serious
  • Self-Concept: How one views their personal worth
  • Tangential Thinking: Wandering off topic without providing requested information
  • Thought Blocking: Abruptly stopping a sentence or train of thought
  • Thought Broadcasting: Delusion that others can hear one's thoughts
  • Thought Content: What the client says
  • Thought Insertion: Delusion that others are placing thoughts into one's head
  • Thought Process: How a client thinks
  • Thought Withdrawal: Delusion that others are taking one's thoughts
  • Waxy Flexibility: Maintaining posture or position despite discomfort

Psychosocial Assessment Factors

  • Client Participation: Essential for a thorough assessment; consider client's ability and willingness to participate
  • Client Health Status: Anxiety, fatigue, or pain may affect the assessment
  • Client Experiences/Misconceptions: Past experiences with healthcare can affect how clients answer questions and communicate
  • Client's Ability to Understand: Language barriers and cognitive impairments should be considered
  • Nurse's Attitude: Non-judgmental, matter-of-fact approach crucial; avoid rushing/pressuring the client

Psychosocial Assessment Process

  • Environment: Comfortable, private, and safe environment is essential
  • Family/Friend Input: Can provide valuable insights, but prioritize client privacy, especially regarding abuse
  • Questioning: Open-ended questions to start, followed by direct questions if needed; avoid confusing multiple questions
  • Nonjudgmental Language: Avoid judgmental language when discussing sensitive topics

Components of Psychosocial Assessment

  • History: Includes background, age, developmental stage, culture, spirituality, health beliefs
  • General Appearance/Motor Behavior: Hygiene, dress, posture, eye contact, unusual movements or mannerisms
  • Mood and Affect: Outward expressions and consistency of mood and affect
  • Thought Process/Content: Clarity, relationships between ideas; assess for delusions, hallucinations, disorganized thinking
  • Sensorium/Intellectual Processes: Orientation, confusion, memory, concentration, abstract thinking
  • Judgment/Insight: Ability to interpret surroundings and adapt behavior; understanding one's situation
  • Self-Concept: Personal view of self and personal attributes
  • Roles/Relationships: Current roles, satisfaction with roles, significant relationships
  • Physiological/Self-Care Concerns: Eating habits, sleep patterns, health problems, medication compliance, activities of daily living

Data Analysis

  • Overall Assessment: Analyze the entire assessment, not isolated information
  • Cues to Action: Look for patterns/themes and identify strengths/needs
  • Identifying Problems/Risks: Consider congruence of information; client perception might differ from others
  • Communicating Needs: Describe client needs clearly for other health team members
  • Ongoing Process: Assessment is a dynamic, ongoing process

Self-Awareness in Assessment

  • Crucial for Accuracy: Be aware of personal feelings, biases, and values to avoid interference
  • Avoiding Judgments: Don't let personal beliefs influence client treatment
  • Specific Concerns: Sexuality, self-harm, and suicidality discussions often uncomfortable for beginning nurses; address discomfort and demonstrate acceptance

Cultural Competence in Assessment

  • Important for all Clients: Recognize and respect diverse cultural beliefs and values
  • Cultural Assessment: Be sensitive to cultural nuances regarding family roles, eye contact, and health practices

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