testing

Third BASIC B.Sc. (Nursing) Examination, Summer – 2023

(Phase - III)

MENTAL HEALTH NURSING

Total Duration: 3 Hours Total Marks: 75

Instructions:

1) Use black ball point pen only.

2) Do not write anything on the blank portion of the question paper. If written anything, such type of act will be

considered as an attempt to resort to unfair means.

3) All questions are compulsory.

4) The number to the right indicates full marks.

5) Draw diagrams wherever necessary.

6) Distribution of syllabus in Question Paper is only meant to cover entire syllabus within the stipulated frame.

The Question paper pattem is a mere guideline. Questions can be asked from any paper's syllabus into any

question paper. Students cannot claim that the Question is out of syllabus. As it is only for the placement

sake, the distribution has been done.

7) Use a common answerbook for all sections.

SECTION - A

1. Short Answer Questions (any five out of six) [5 x 5 = 25]

a) Etiology of mental illness

b) Management of Autism in children

c) Mental Health services in community.

d) Mini Mental status examination.

e) Therapeutic community

f) Techniques of therapeutic communication.

a) Etiology of Mental Illness

Mental illness may result from a combination of genetic, biological, psychological, and environmental

factors:

 Biological: Neurochemical imbalances, brain injuries, infections (e.g., encephalitis), or prenatal

exposure to toxins.

 Genetic: Family history increases risk (e.g., schizophrenia, bipolar disorder).

 Psychological: Childhood trauma, abuse, or neglect can contribute.

 Environmental: Stressful life events like loss, poverty, or social isolation.

 Substance use: Alcohol or drug abuse can trigger or worsen mental illness.

b) Management of Autism in Children

Autism Spectrum Disorder (ASD) management includes:

 Behavioral Therapy: Applied Behavior Analysis (ABA) to improve social and communication

skills.

 Speech Therapy: Enhances verbal and non-verbal communication.

 Occupational Therapy: Helps with daily living and sensory integration.

 Special Education Programs: Individualized education plans (IEPs).

 Medication: May be used for symptoms like irritability or hyperactivity (e.g., risperidone).

 Parental Support: Training and counseling to manage child’s needs.

c) Mental Health Services in Community

Community mental health services aim at prevention, early intervention, and rehabilitation.

 Primary Health Centers (PHCs): Integrate mental health into general health services.

 District Mental Health Programme (DMHP): Provides decentralized services.

 Outreach Clinics: Mobile mental health teams visit rural or underserved areas.

 Rehabilitation Centers: Provide vocational training and psychosocial support.

 NGOs and Support Groups: Promote awareness, advocacy, and support.

d) Mini Mental Status Examination (MMSE)

The MMSE is a 30-point tool used to assess cognitive function. It includes:

 Orientation: Time and place (10 points)

 Registration: Repeating named objects (3 points)

 Attention and Calculation: Serial 7s or spelling backward (5 points)

 Recall: Remembering previously mentioned items (3 points)

 Language: Naming, repetition, following commands, writing, and copying (9 points)

Used to screen for dementia, delirium, and cognitive impairment.

e) Therapeutic Community

A therapeutic community is a structured group setting where patients participate in decision-making and

treatment.

 Focus: Responsibility, self-discipline, and mutual respect.

 Team Approach: Involves staff and patients collaboratively.

 Activities: Group therapy, vocational tasks, community meetings.

 Benefits: Promotes independence, social skills, and recovery.

Used in psychiatric hospitals, rehab centers, and correctional facilities.

f) Techniques of Therapeutic Communication

Therapeutic communication helps build trust and promote healing in psychiatric nursing. Techniques

include:

 Active Listening: Paying full attention and showing interest.

 Open-Ended Questions: Encourages expression (e.g., “How do you feel?”)

 Clarification: Ensures understanding (e.g., “Can you explain more?”)

 Silence: Allows time to reflect and speak.

 Empathy: Understanding the patient’s feelings.

 Summarizing: Reviewing what has been said to validate feelings.

2. Long answer question (any 1 out of 2): [1 x 15 = 15]

a) Define mental retardation enumerate the causes of Mental Retardation.

Discuss the Nursing management of Child with profound mental retardation.

b) Define depression Explain the clinical manifestations in severe depression. Develop nursing can

plan for client with acute depression.

a) Mental Retardation

Definition:

Mental Retardation (now referred to as Intellectual Disability) is a condition characterized by significantly

subaverage intellectual functioning (IQ < 70) with deficits in adaptive behavior, appearing before the age of

18 years.

Causes of Mental Retardation:

1. Genetic causes:

o Down syndrome

o Fragile X syndrome

o Phenylketonuria (PKU)

2. Prenatal factors:

o Infections (e.g., rubella, syphilis)

o Exposure to alcohol/drugs

o Maternal malnutrition

o Radiation exposure

3. Perinatal factors:

o Birth asphyxia

o Prematurity

o Low birth weight

o Birth trauma

4. Postnatal factors:

o Infections (e.g., meningitis, encephalitis)

o Head injuries

o Severe malnutrition

o Environmental deprivation

Nursing Management of a Child with Profound Mental Retardation:

 Physical care:

o Assist with all activities of daily living (ADLs)

o Prevent complications (e.g., contractures, pressure ulcers)

o Monitor nutrition and ensure appropriate feeding methods

 Safety measures:

o Maintain a safe environment to prevent injury

o Use protective equipment if needed

 Communication:

o Use simple, non-verbal cues and repetition

o Observe non-verbal signs of discomfort or need

 Behavioral support:

o Provide structured routine

o Reinforce positive behavior

o Use reward-based reinforcement

 Family support:

o Educate caregivers on home care

o Provide emotional support and connect with support groups

 Multidisciplinary care:

o Coordinate with physiotherapists, occupational therapists, and speech therapists for holistic

care

b) Depression

Definition:

Depression is a mood disorder characterized by persistent feelings of sadness, hopelessness, and loss of

interest in daily activities for at least two weeks, affecting social and occupational functioning.

Clinical Manifestations in Severe Depression:

1. Mood symptoms:

o Persistent sadness, hopelessness

o Feelings of worthlessness or guilt

o Suicidal thoughts or attempts

2. Cognitive symptoms:

o Poor concentration

o Indecisiveness

o Negative thoughts

3. Behavioral symptoms:

o Social withdrawal

o Psychomotor retardation or agitation

o Decreased personal care

4. Physical symptoms:

o Sleep disturbances (insomnia or hypersomnia)

o Appetite and weight changes

o Fatigue, loss of energy

o Somatic complaints (headaches, body pain)

Nursing Care Plan for Client with Acute Depression:

Nursing

Diagnosis

Goals/Objectives

Interventions

Rationale

Evaluation

Risk for suicide

related to

hopelessness

Client will remain

safe and free from

self-harm

- Monitor for suicidal

ideation- Maintain close

observation- Remove

harmful objects

To prevent

suicide

attempts

Client remains

safe during

hospitalization

Disturbed sleep

pattern related

to depressive

symptoms

Client will report

improved sleep

within 5 days

- Promote sleep hygiene-

Minimize noise and light

at night- Administer

prescribed medication

Improves

sleep and

promotes

recovery

Client reports

improved sleep

Social isolation

related to lack of

interest and low

energy

Client will interact

with at least one staff

or peer daily

- Encourage participation

in group activities-

Engage in one-on-one

interaction- Provide

praise for efforts

Improves

social

interaction

and self-

esteem

Client initiates or

responds to

interaction

Ineffective

coping related to

low self-esteem

Client will verbalize

2 positive traits about

self

- Encourage expression

of feelings- Use

therapeutic

communication- Provide

positive reinforcement

Enhances

self-worth

and

confidence

Client

demonstrates

improved coping

SECTION - B

3. Short answer questions (Solve any 4 out of 5): [4×5=20]

a) Therapeutic impasses and its management.

b) Care of patient with suspicious behavior.

c) Mental health issues among adolescents.

d) Psycho somatic disorder.

e) Difference between delirium and dementia.

a) Therapeutic Impasses and Its Management

Therapeutic impasse refers to a situation in therapy where progress stalls due to barriers in the therapeutic

relationship or unresolved issues in the client or therapist.

Causes include:

 Resistance from the client

 Countertransference from the therapist

 Unclear goals or expectations

 Communication breakdown

Management:

 Open and honest discussion of the issues

 Supervision or consultation for the therapist

 Revisiting treatment goals

 Re-establishing rapport and trust

 Allowing the client to express concerns

Recognizing and addressing impasses early helps maintain the therapeutic alliance and ensures continued

progress.

b) Care of Patient with Suspicious Behavior

Patients with suspicious behavior (often seen in paranoia, schizophrenia) require special care:

 Maintain a non-threatening attitude: Approach calmly and avoid sudden movements.

 Avoid arguing: Do not challenge delusions directly.

 Build trust: Be consistent, honest, and maintain boundaries.

 Ensure safety: Remove potentially harmful objects, ensure a safe environment.

 Encourage expression: Allow the patient to talk about feelings without judgment.

 Medication compliance: Monitor and educate about the need for treatment.

 Observe non-verbal cues: Watch for signs of agitation or aggression.

Always prioritize the safety of the patient, staff, and others.

c) Mental Health Issues Among Adolescents

Adolescents face unique mental health challenges due to physical, emotional, and social changes.

Common issues include:

 Depression and anxiety

 Substance abuse

 Eating disorders (e.g., anorexia, bulimia)

 Suicidal thoughts or self-harm

 Body image issues and low self-esteem

Contributing factors:

 Academic pressure

 Family conflicts

 Peer pressure and bullying

 Social media influence

Interventions:

 Counseling and psychoeducation

 Family support and involvement

 Early identification and treatment

 Promoting healthy coping strategies and resilience

d) Psychosomatic Disorder

Psychosomatic disorders are physical illnesses that are thought to arise from emotional or mental stressors

rather than a specific organic cause.

Examples:

 Irritable bowel syndrome (IBS)

 Tension headaches

 Peptic ulcers

 Hypertension (stress-related)

Features:

 Real physical symptoms without identifiable pathology

 Symptoms often worsen with stress

 High emotional distress

Management:

 Stress reduction techniques (relaxation therapy, yoga)

 Psychotherapy (CBT)

 Medication for symptom relief

 Psychoeducation for patient and family

e) Difference Between Delirium and Dementia

Feature

Delirium

Dementia

Onset

Sudden (hours to days)

Gradual (months to years)

Course

Fluctuating

Progressive and chronic

Consciousness

Impaired (clouding of consciousness)

Usually clear until late stages

Attention

Poor

Relatively preserved early

Reversibility

Often reversible with treatment

Usually irreversible

Causes

Infections, drugs, metabolic disorders

Alzheimer’s, vascular, Lewy body, etc.

4. Long answer questions (any one out of two): [1 × 15 = 15]

a) Define crisis. Explain the types of crisis. Discuss the role of Nurse In crisis Intervention.

b) Define psychiatric nursing. [2]

List out the roles of psychiatric nurse. [5]

Explain the principles of psychiatric nursing In detail. [8]

Here’s a complete, exam-ready answer for Question 4: Long Answer (Choose any one) — structured to

match the mark distribution:

Option (a)

Define Crisis:

A crisis is a sudden disturbance in a person’s psychological equilibrium due to a stressful event or situation

that cannot be managed by usual coping mechanisms. It results in a state of emotional instability, confusion,

and distress.

Types of Crisis:

1. Situational Crisis:

o Arises from unexpected external events such as job loss, divorce, death of a loved one.

o Example: A man becomes depressed after losing his job.

2. Maturational Crisis (Developmental):

o Occurs during normal life transitions (e.g., adolescence, marriage, retirement).

o Example: A teenager struggling with identity and peer pressure.

3. Adventitious Crisis (Traumatic):

o Results from natural or man-made disasters (e.g., floods, earthquakes, assault).

o Example: PTSD after a terrorist attack.

4. Cultural Crisis:

o Arises from adjustment issues due to migration, racism, or cultural shock.

Role of Nurse in Crisis Intervention:

1. Assessment:

o Identify the cause and severity of the crisis.

o Assess the client’s physical, emotional, and mental state.

2. Establish Rapport:

o Build a trusting relationship with active listening and empathy.

o Provide a calm and nonjudgmental presence.

3. Ensure Safety:

o Protect the client from self-harm or harm to others.

o Remove harmful objects if needed.

4. Support Coping Strategies:

o Encourage expression of feelings.

o Help the patient recognize and use healthy coping skills.

5. Problem-Solving Assistance:

o Guide the client to explore options and make realistic plans.

6. Mobilize Support System:

o Involve family, friends, or support groups.

o Refer to community resources.

7. Follow-up Care:

o Monitor recovery and prevent recurrence.

o Provide psychoeducation and therapeutic support.

Option (b)

Define Psychiatric Nursing: [2 Marks]

Psychiatric nursing is a specialized area of nursing practice focused on the care of individuals with mental

health disorders. It involves assessment, diagnosis, treatment, and rehabilitation using therapeutic

communication and evidence-based interventions.

Roles of Psychiatric Nurse: [5 Marks]

1. Care Provider:

o Provides therapeutic care and medication administration.

2. Counselor:

o Helps clients understand and cope with mental health issues.

3. Educator:

o Teaches clients and families about illness, treatment, and coping.

4. Advocate:

o Protects client rights and ensures dignity and confidentiality.

5. Coordinator:

o Collaborates with multidisciplinary teams for holistic care.

6. Researcher:

o Participates in mental health research to improve practices.

7. Crisis Manager:

o Handles emergencies and provides crisis intervention.

Principles of Psychiatric Nursing: [8 Marks]

1. Acceptance:

o Accept the client as they are, without judgment.

2. Individuality:

o Treat each client as a unique person with specific needs.

3. Therapeutic Communication:

o Use active listening, empathy, and clarity in communication.

4. Confidentiality:

o Maintain privacy and confidentiality of patient information.

5. Nonjudgmental Attitude:

o Avoid criticism or moralizing behavior.

6. Client Participation:

o Involve the client in decision-making and goal-setting.

7. Holistic Care:

o Address biological, psychological, and social aspects of health.

8. Consistency and Reliability:

o Be dependable to build trust and therapeutic alliance.