Chapter 01 Mental Health and Mental Illness

Chapter 01: Mental Health and Mental Illness MULTIPLE CHOICE 1.A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a . b Prescribe psychotropic medication. . c Establish therapeutic relationships. . d Individualize nursing care plans. . ANS: B In most states, prescriptive privileges are granted to masterÕs-prepared nurse practitioners and clinical nurse specialists who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning. 2 A nursing student expresses concerns that mental health nurse Òloses all their clinical nursing skills.Ó Select the best response by the mental health nurse. a ÒPsychiatric nurses practice in safer environments than other specialties. . Nurse-to-patient ratios must be better because of the nature of the patientsÕ problems.Ó b ÒPsychiatric nurses use complex communication skills as well as . critical thinking to solve multidimensional problems. I am challenged by those situations.Ó c ÒThatÕs a misconception. Psychiatric nurses frequently use high technology . monitoring equipment and manage complex intravenous therapies.Ó d ÒPsychiatric nurses do not have to deal with as much pain and suffering as . medicalÐsurgical nurses do. That appeals to me.Ó ANS: B The practice of psychiatric nursing requires a different set of skills than medicalÐ surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reßecting the holistic perspective these nurses must have. NurseÐpatient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering. 3- When a new bill introduced in Congress reduces funding for care of persons diagnosed with mental illness, a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulÞlled? a Recovery . b Attending . c Advocacy . d Evidence-based practice . ANS: C An advocate defends or asserts anotherÕs cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. 4- A family has a long history of conßicted relationships among the members. Which family memberÕs comment best reßects a mentally healthy perspective? a ÒIÕve made mistakes but everyone else in this family has also.Ó . b ÒI remember joy and mutual respect from our early years together.Ó . c ÒI will make some changes in my behavior for the good of the family.Ó . d ÒItÕs best for me to move away from my family. Things will never change.Ó . ANS: C The correct response demonstrates the best evidence of a healthy recognition of the importance of relationships. Mental health includes rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may be healthy, but the correct response shows a higher level of mental health. The other incorrect responses show blaming and avoidance. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 1-2, 3, 32 (Figure 1-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. Which assessment Þnding most clearly indicates that a patient may be experiencing a mental illness? The patient a reports occasional sleeplessness and anxiety. . b reports a consistently sad, discouraged, and hopeless mood. . c is able to describe the difference between Òas ifÓ and Òfor real.Ó . d perceives difÞculty making a decision about whether to change jobs. . ANS: B The correct response describes a mood alteration, which reßects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-2 to 4 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 6 Which Þnding best indicates that the goal ÒDemonstrate mentally healthy behaviorÓ was achieved for an adult patient? The patient a sees self as capable of achieving ideals and meeting demands. . b behaves without considering the consequences of personal actions. . c aggressively meets own needs without considering the rights of others. . d seeks help from others when assuming responsibility for major areas of own . life. ANS: A The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors. 7. A nurse encounters an unfamiliar psychiatric disorder on a new patientÕs admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a International Statistical ClassiÞcation of Diseases and Related Health . Problems (ICD-10) b The ANAÕs Psychiatric-Mental Health Nursing Scope and Standards of . Practice c Diagnostic and Statistical Manual of Mental Disorders (DSM-V) . ANS: C The DSM-V gives the criteria used to diagnose each mental disorder. It is the ofÞcial guideline for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a psychiatric illness. 8.A nurse wants to Þnd a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a Nursing Outcomes ClassiÞcation (NOC) . b DSM-V . c The ANAÕs Psychiatric-Mental Health Nursing Scope and Standards of . Practice d ICD-10 . ANS: B The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the ofÞcial guideline for diagnosing psychiatric disorders. The other references are good resources but do not deÞne the diagnostic criteria. 9. a . b . c . d . Which individual is demonstrating the highest level of resilience? One who is able to repress stressors. becomes depressed after the death of a spouse. lives in a shelter for 2 years after the home is destroyed by Þre. takes a temporary job to maintain Þnancial stability after loss of a permanent job. ANS: D Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and depression are unhealthy. Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-5, 6 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity Complete this analogy. NANDA: clinical judgment: NIC: _________________ patient outcomes. b nursing actions. 10. . c diagnosis. . d symptoms. . ANS: B Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identiÞes diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions ClassiÞcation) identiÞes actions provided by nurses that enhance patient outcomes. Nursing care activities may be direct or indirect. 12. a . b . c . d . Which disorder is an example of a culture-bound syndrome? Epilepsy Schizophrenia Running amok Major depressive disorder ANS: C Culture-bound syndromes occur in speciÞc sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-7 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 13. The DSM-V classiÞes: a deviant behaviors. . b present disability or distress. . c people with mental disorders. . d mental disorders people have. . ANS: D The DSM-V classiÞes disorders people have rather than people themselves. The terminology of the tool reßects this distinction by referring to individuals with a disorder rather than as a ÒschizophrenicÓ or Òalcoholic,Ó for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 1-18, 19 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 14. A citizen at a community health fair asks the nurse, ÒWhat is the most prevalent mental disorder in the United States?Ó Select the nurseÕs correct response. a Schizophrenia . b Bipolar disorder . c Dissociative fugue . d AlzheimerÕs disease . ANS: D The 12-month prevalence for AlzheimerÕs disease is 10% for persons older than 65% and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder. In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who a describes hearing GodÕs voice speaking. 15. . b is usually pessimistic but strives to meet personal goals. . c is wealthy and gives away $20 bills to needy individuals. . d always has an optimistic viewpoint about life and having own needs met. . ANS: A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difÞcult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill. A patientÕs relationships are intense and unstable. The patient initially idealizes the signiÞcant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will beneÞt from interventions to develop which aspect of mental health? 16. a Effectiveness in work . b Communication skills . c Productive activities . d FulÞlling relationships . ANS: D The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-32 (Figure 1-1) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 17. Which belief will best support a nurseÕs efforts to provide patient advocacy during a multidisciplinary patient care planning session? a All mental illnesses are culturally determined. . b Schizophrenia and bipolar disorder are cross-cultural disorders. . c Symptoms of mental disorders are unchanged from culture to culture. . d Assessment Þndings in mental illness reßect a personÕs cultural patterns. . ANS: D Symptoms must be understood in terms of a personÕs cultural background. A nurse who understands that a patientÕs symptoms are inßuenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-27 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 18. A nurse is part of a multidisciplinary team working with groups of depressed patients. One group of patients receives supportive interventions and antidepressant medication. The other group receives only medication. The team measures outcomes for each group. Which type of study is evident? a Incidence . b Prevalence . c Comorbidity . d Clinical epidemiology . ANS: D Clinical epidemiology is a broad Þeld that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. See related audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-17 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment The spouse of a patient diagnosed with schizophrenia says, ÒI donÕt understand how events from childhood have anything to do with this disabling illness.Ó Which response by the nurse will best help the spouse understand the cause of this disorder? a ÒPsychological stress is the basis of most mental disorders.Ó 19. . b ÒThis illness results from developmental factors rather than stress.Ó . c ÒResearch shows that this condition more likely has a biological basis.Ó . d ÒIt must be frustrating for you that your spouse is sick so much of the time.Ó . ANS: C Many of the most prevalent and disabling mental disorders have strong biological inßuences. Genetics are only one part of biological factors. Empathy does not address increasing the spouseÕs level of knowledge about the cause of the disorder. The other distracters are not established facts. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-5, 6 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity A category 5 tornado occurred in a community of 400 people. Many homes and businesses were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a Prevalence 20. . b Comorbidity . c Incidence . d Parity . ANS: C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a speciÞc period of time, regardless of when they became ill. Parity refers to equivalence, and legislation required insurers that provide mental health coverage to offer annual and lifetime beneÞts at the same level provided for medicalÐsurgical coverage. Comorbidity refers to having more than one mental disorder at a time. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-16 TOP: Nursing Process: Planning/Outcomes IdentiÞcation MSC: Client Needs: Safe, Effective Care Environment Which component of treatment of mental illness is speciÞcally recognized by Quality and Safety Education for Nurses (QSEN)? a All genomes are unique. 21. . b Care is centered on the patient. . c Healthy development is vital to mental health. . d Recovery occurs on a continuum from illness to health. . ANS: B The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Select the best response for the nurse to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis. a ÒThere is no functional difference between the two. Both identify human . disorders.Ó b ÒThe DSM-V diagnosis disregards culture, whereas the nursing diagnosis . takes culture into account.Ó c ÒThe DSM-V diagnosis describes causes of disorders whereas a nursing . diagnosis does not explore etiology.Ó d ÒThe DSM-V diagnosis guides medical treatment, whereas the nursing . diagnosis offers a framework for identifying interventions for issues a patient is experiencing.Ó ANS: D The medical diagnosis is concerned with the patientÕs disease state, causes, and cures, whereas the nursing diagnosis focuses on the patientÕs response to stress and possible caring interventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also consider potential problems. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 1-21 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse? a Coordination of care 23. . b Health teaching . c Milieu therapy . d Psychotherapy . ANS: D Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a basic level registered nurseÕs scope of practice. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 1-23, 35 (Table 1-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment Which Þndings are signs of a person who is mentally healthy? (Select all that apply.) a Says, ÒI have some weaknesses, but I feel IÕm important to my family . and friends.Ó b Adheres strictly to religious beliefs of parents and family of origin. 2. . c Spends all holidays alone watching old movies on television. . d Considers past experiences when deciding about the future. . e Experiences feelings of conßict related to changing jobs. . ANS: A, D, E Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. A patient in the emergency department says, ÒVoices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat.Ó Which aspects of the patientÕs mental health have the greatest and most immediate concern to the nurse? (Select all that apply.) a Happiness 3. . b Appraisal of reality . c Control over behavior . d Effectiveness in work . e Healthy self-concept . ANS: B, C, E The aspects of mental health of greatest concern are the patientÕs appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patientÕs control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-3, 4 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity