CMN 548 Official Study Guide Test Questions and Answers
1. What are the four tasks of the diagnostic interview? P. 4
• Build a therapeutic alliance
• Obtain a psychiatric database
• Interview for diagnoses
• Negotiate a tmt plan and communicate it to your pt
What are the “rules�...
1 what are the four tasks of the diagnostic interview p 4 • build a therapeutic alliance • obtain a psychiatric database • interview for diagnoses • negotiate a tmt plan and communicate it to your
CMN 548 Official Study Guide test UNIT 2 STUGY GUIDE CARLAT READINGS Required Readings for this Unit: Chapters 1-13, 19-20 Chapter 1-13: 1. What are the four tasks of the diagnostic interview? P. 4 • Build a therapeutic alliance • Obtain a psychiatric database • Interview for diagnoses • Negotiate a tmt plan and communicate it to your pt 1 Complete the table below to create an overview of the phases of the diagnostic interview: p. 6 Phase Time Allotted Major Tasks Opening Phase 5-10 min Meet pt Learn about them Let them talk about self Body 30-40 min - Come up with initial diagnostic hypothesis Ch 20 - Map out interview strategy Hx of present illness Ch14 - Hx of depression, SI, subst abuse Ch 23,23,26 - Family hx - Asmt that pt meets DSM criteria Ch 20, 21, 24 - Social/development hx Ch 18 - Medical hx Ch 16 - Psychiatric ROS section III Closing Tasks 5-10 min - Discussion of assessment - Come up with negotiated agreement 1 Complete the table below which identifies strategies related to preparation for the diagnostic interview: p. 9-11 Strategy Rationale (how does facilitate the interview process) Arrive earlier than the patient Prep allows for reduced stress, sets up mellower interview Prevent interruptions ▪ Ask the clinic secretary to take messages for you. ▪ Ask the page operator to hold all but urgent pages. CMN 548 Official Study Guide test ▪ Put your pager on vibrate mode and only answer urgent pages. ▪ Sign your pages out to a colleague Don’t overbook patients Allows for time to evaluate and write up/dictate notes Leave time for notes Schedule enough time for charting -know how much you need 1 From the information on using paper tools effectively , complete the following table: Tool Purpose Advantages Disadvantages Long Form P11 Takes notes on it during interview process Ensures thorough data evaluation, saves time Pts may feel alienated when notes being completed in front of them Short Form P11 Used for rough notes Presents less of barrier between clinician and pt Less thorough evaluation Pocket Card Reminds clinicians what topics to cover Allows for max interaction btween clinician and pt Information not clearly spelled out, requires more memory from clinician Patient Questionnaire Given to pt before first appt Allows more time to focus on issues during appt Some pts may view questionnaire as a burden Patient Handouts Pts like receiving, a tool that often helps to increase pt compliance Increases pts sense of actively participation in tmt May provide too much info, pts may be overwhelmed with all the info provided. 1 What are the “rules” regarding the patients contacting the provider ? • Never give out personal phone number • If you give out phone specify times when you’re available to be called • If you have voice mail, have pts call there instead of personal phone • When on vacation, sign pts out to a clinician. 1 How should the provider handle missed appointments? Inform you at least 24 hrs in advance of any missed appointments or there will be a charge. Repeated missed sessions - figure out why pt is missing continued appts. Is it for legitimate reasons, or is pt acting out feelings of anxiety or hostility. CMN 548 Official Study Guide test If clinician just returned from vacation, pt may be acting out feelings of abandonment. 2. What are some strategies for “being warm, courteous, and emotionally sensitive”? • Empathic or sympathetic statements P.19 • Direct feelings questions P.19 • Reflective statements P.19 If you do not like pt, Ch 13. 1 What can the advanced practice nurse do to “actively defuse the strangeness of the clinical situation”? P.20 • Greet pt naturally • Get to know pt as a first patient • Educate the pt about the nature of the interview • Address your pts projections 1 What is the benefit in the advanced practice nurse allowing the patient to “give the opening word?” P.23 - gives pt feeling clinican is interested in listening, establishes rapport How long should this portion of the interview last? Allow pt 5 mins of free speech What is a good type of “opening question”? P.23 Open -ended questions that invite pt to tell story. What was it that brought you to the clinic today What brings you to see me today What sorts of things have been troubling you How can I be of help to you What can I do for you Solution -focused interviewing is exploring what the pts goals are for the interview. Instead of asking what brings you in? or what troubles you? Ask…what would make this a helpful visit? or… what would you like to see different from coming here? this approach may work well with reluctant patients. Miracle question: Imagine that tonight you go to bed like you normally would then imagine while youre asleep… a miracle happens…imagine that because of the miracle your problem (depression or whatever) goes away. What will your day be like tomorrow? - - - - - CMN 548 Official Study Guide test 10. How can the advanced practice nurse “project competence” during the psychiatric interview? Kinds of questions you ask Dressing professionally Adopting a general attitude of confidence Providing meaningful feedback at the end of the interview 11. Complete the table below to summarize strategies for approaching threatening topics: Strategy When to Use It When Not to Use It Examples Normalization For eliciting sensitive or embarrassing info. When the behavior is violent or sexual abusive See P.26 Symptom Expectation When you want the pt think you will not be offended by a +ve response… such as with drug use, suicidality. Use only when you suspect pt has engaged in the behavior. You wouldn’t ask a 70 yr old women being assessed for dementia “what kind of recreation drugs are you using?” See P.27 Symptom Exaggeration Often used with symptom expectation when attempting to clarify the severity of symptoms. Reserve for appropriate situations. If you don’t suspect a pt is drinking don’t ask them how many cases of beer they drink each day. See P.28 Reduction of Guilt When seeking to reduce a pts guilt about a specific behavior in order to discover what they have been doing. P.28 When obtaining a hx of domestic violence and other antisocial behavior. Using Familiar Language Pts more likely to admit to socially undesirable behavior if they feel clinician speaks the same language.. “standard” language vs “familiar” language P.29 - - - -
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