Chapter 56 Mental Health Function, Assessment, and Therapeutic Measures

Answers CHAPTER 56 MENTAL HEALTH FUNCTION, ASSESSMENT, AND THERAPEUTIC MEASURES AUDIO CASE STUDY Bonnie: Ego Defense Mechanisms and Therapeutic Communication Techniques 1. Bonnie is using displacement (transference). Other ego defense mechanisms are denial, repression, rationalization, compensation, reaction formation, regression, projection, restitution, conversion reaction, and avoidance. 2. Restitution. 3. Exploration: “Can you tell me what happened?” Observation: “You sound upset.” General lead: “Go on, honey.” Reflecting: “So what do you think you should do?” And silence. VOCABULARY 1. Coping 2. cognitive 3. Psychopharmacology 4. Electroconvulsive 5. milieu 6. insight 7. Orientation 8. affect DEFENSE MECHANISMS 1. Denial 2. Rationalization 3. Reaction formation 4. Compensation 5. Repression 6. Displacement or transference 7. Projection 8. Restitution 9. Avoidance 10. Conversion reaction CRITICAL THINKING 1. Dirty hair and clothing, poor personal hygiene, and morbid obesity are not normal. A good way to open up communication related to the subject is to ask if she would like you or an assistant to help her with a bath. If her state of cleanliness is bothersome to her, she will most likely welcome the help and maybe even share information as to why she has been unable to bathe. On the other hand, if she refuses help or says she doesn’t need a bath, further assessment of her ability to care for herself is warranted. 2. It should become fairly obvious whether Mrs. Jewel knows where she is and whether she is oriented to person and time during routine data collection. If you have any doubts, ask specific questions such as “Where are you? Why are you here? Who is this sitting over here? [Point to a family member if one is in the room.] What year is it? Who is the president of the United States?” (or other questions to which most people should know the answers). 3. During routine data collection, listen carefully to Mrs. Jewel’s responses. Document any irrational or inconsistent responses. 4. For recent memory, ask about what she ate for breakfast or about a news event in the last week that everyone should have heard about. For remote memory, ask questions about her younger years, such as where she lived, the name of her grade school, or the year she got married. 5. There is no special questioning needed to determine communication ability. Simply pay attention to her responses to routine questions. Document unusually fast or slow speech, stuttering, inappropriate volume, or difficulty getting ideas across. 6. Affect is the outward expression of emotion. If this expression does not match what Mrs. Jewel is telling you or if it is inconsistent with her situation, her affect is inappropriate. For example, it would be unusual to be laughing about being in the hospital. 1 2 Chapter 56 Answers 7. Asking her to explain a proverb (such as “A stitch in time saves nine”) will help determine if she has good judgment. In addition, you might ask her what she would do under certain circumstances, such as if her blood sugar was low. Keep in mind that her response might reflect both judgment and knowledge. 8. Perception is the way a person experiences reality. Pay attention to her responses to your questions. For example, if she stopped taking medication for her diabetes because some voices in her head told her to do so, her perception is faulty. Normal responses are based on reality. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (4) is correct. Close friends and relationships are a sign of mental health. (1, 2, 3) may all be considered healthy behaviors. 2. (2) is correct. Blaming is a type of projection. (1, 3, 4) do not necessarily involve blaming others. 3. (4) is correct. The worker has displaced anger at the boss onto spouse and children. (1, 2, 3) do not involve transferring responses to others. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 4. (2) is correct. The patient may be disoriented following electroconvulsive therapy. Maintaining safety is a primary goal during this time. (1) is incorrect. Restraints are inappropriate. (3) is incorrect. The patient should not be discharged until he or she is oriented and safety is ensured. (4) is incorrect. Oxygen is not standard treatment after electroconvulsive therapy. 5. (4) is correct. A stressor must be defined by the patient. (1, 2, 3) are incorrect. Although surgery, divorce, and loss of a job would seem stressful to most people, it is important to allow the patient to identify for herself or himself what is stressful. 6. (2) is correct. Magnetic resonance imaging is used to rule out physiological problems. (1, 4) are incorrect. Magnetic resonance imaging does not measure neurotransmitters or electrical activity. (3) is incorrect. Magnetic resonance imaging is a diagnostic test, not a treatment. 7. (1) is correct. Helping the patient identify stressors is most helpful. (2) does not help the patient work through the problem. (3) is incorrect. It is impossible to eliminate stress. (4) is incorrect. Giving advice is not appropriate. 8. (3) is correct because it reflects the question back to the patient. (1) is incorrect. Giving approval is not therapeutic. (2) is incorrect. Asking “Why?” may be threatening. (4) may discourage a potentially good decision. 9. (3) is correct. Regression is the return to an earlier time in life when a patient experienced less stress; it is commonly seen in patients while hospitalized. (1) is incorrect. Conversion reaction is anxiety channeled into a physical symptom. (2) is incorrect. A drug reaction would not be a common explanation for the behavior. (4) is incorrect. Repression is an unconscious “forgetting.” 10. (4) is correct. It presents reality and addresses the patient’s feelings. (1) may be threatening, (2) is not true, and (3) is not therapeutic.