Mental Health Final Exam Answer Key

74 1. The definition of mental health is standardized and universally accepted a) True b) False Rationale: There is no single universal definition of mental health, which has many components and is influenced by myriad factors 2. Which statement best reflects the current state of mental health and mental illness? a) Mental health-care costs exceed the costs for cancer care b) Most adults and children receive adequate mental health care c) Community resources for the homeless with mental illness are adequate d) Deinstitutionalization has reduced the revolving-door effect Rationale: The economic burden of mental illness exceeds that for all types of cancer care. Only 1 in 4 adults and 1 in 5 children receive the necessary mental health care. Community resources for homeless clients with mental illness are inadequate 3. Community-based programs are preferable for treating many people with mental illness a) True b) False Rationale: Although there are flaws in the system, community-based programs have positive aspects that make them preferable for treating many people with mental illness 4. The National League for Nursing required schools to include a psychiatric nursing experience before the first nursing school included a psychiatric nursing course in its curriculum a) True b) False Rationale: Johns Hopkins was the first school of nursing to include a course in psychiatric nursing in its curriculum; this was done in 1913. It was not until 1950 that the National League for Nursing required schools to include an experience in psychiatric nursing 75 Ch. 2 PowerPoint Questions 1. The cerebellum consists of four lobes a) True b) False Rationale: The cerebrum consists of four lobes. The cerebellum is located below the cerebrum 2. Single photon emission computed tomography is considered the best type of brain imaging technique to diagnose disease a) True b) False Rationale: Single photon emission computed tomography (SPECT) is not considered the major type of brain imaging used to diagnose disease. In fact, many of the changes in the brain are not currently detectable with any of the current techniques 3. Which of the following drugs would be classified as a conventional antipsychotic? a) Clozapine b) Risperidone c) Fluphenazine d) Aripiprazole Rationale: Fluphenazine is classified as a conventional antipsychotic. Clozapine and risperidone are considered second-generation antipsychotics. Aripiprazole is considered a third-generation antipsychotic 4. A client who takes an SSRI with an MAOI is at risk for a hypertensive crisis a) True b) False Rationale: A client who takes an SSRI with an MAOI is at risk for serotonin syndrome. Hypertensive crisis occurs if the client is taking MAOI and ingests foods containing tyramine 5. Which of the following drugs would the nurse expect to administer to a client with ADHD? a) Disulfiram b) Methylphenidate c) Buspirone d) Lithium Rationale: Methylphenidate is a stimulant used to treat ADHD. Disulfiram is used to treat alcoholism. Buspirone is used to treat depression. Lithium is used to treat bipolar disorder 76 Ch. 3 PowerPoint Questions 1. Freud identified three stages of psychosexual development a) True b) False Rationale: Freud identified five stages of psychosexual development: oral, anal, phallic/oedipal, latency, and genital 2. Abraham Maslow was the first theorist to focus on the client’s role a) True b) False Rationale: Carl Rogers was the first to focus on the client’s role in his client-centered therapy 3. Which of the following includes the concept of automatic thoughts? a) Cognitive therapy b) Rational emotive therapy c) Logotherapy d) Gestalt therapy Rationale: Rational emotive therapy focuses on 11 irrational beliefs and automatic thoughts. Cognitive therapy focuses on immediate through processing. Logotherapy involves therapy as a search for life with meaning. Gestalt therapy emphasizes self-awareness 4. Self-help groups tend to have an informal or no definitive leader a) True b) False Rationale: Support groups and self-help groups tend to have an informal leader or no leader at all. Therapy and education groups typically have a formal leader 77 Ch. 4 PowerPoint Questions 1. Board and care homes are an example of a partial hospitalization program a) True b) False Rationale: A board and care home is an example of a residential treatment setting. A day treatment program is an example of a partial hospitalization program 2. In the clubhouse model, the relationship between clients is most important a) True b) False Rationale: With the clubhouse model, the physician–client relationship is the most important 3. Which of the following disciplines most likely would be included as part of the interdisciplinary team? a) Physician’s assistant b) Physical therapist c) Pharmacist d) Dietician Rationale: The pharmacist would be a member of the interdisciplinary team when medication, management of side effects, and/or interactions with nonpsychiatric medications are complex Ch. 5 PowerPoint Questions 1. A nurse displays empathy by showing feelings of concern and compassion a) True b) False Rationale: Empathy is putting oneself into the client’s shoes. Sympathy is showing feelings of concern and compassion 2. A social relationship involves superficial communication for the purposes of friendship or task accomplishment 78 a) True b) False Rationale: A social relationship occurs for friendship, socialization, companionship, or task achievement. It involves superficial communication with shifting roles 3. During the working phase of a nurse–client relationship, which of the following would occur? a) Expectations are clarified. b) Nurse–client contracts are established. c) Feelings of loss are addressed. d) Client’s feelings are examined Rationale: During the working phase, the client identifies issues or concerns and his or her feelings and responses are examined. Expectations are clarified and contracts are established during the orientation phase. Feelings of loss are addressed during the termination phase Ch. 6 PowerPoint Questions 1. A distance of 2 feet between the nurse and patient is adequate for promoting comfortable therapeutic communication a) True b) False Rationale: For effective therapeutic communication, a distance of 3 to 6 feet between the nurse and patient would be most appropriate 2. Nonverbal communication is often less accurate than verbal communication a) True b) False Rationale: Nonverbal communication is often more accurate than verbal communication when the two are incongruent. People can readily change what they say, but are less likely to be able to control nonverbal communication 3. Which of the following would be a nontherapeutic communication technique? a) Reassuring b) Reflecting c) Focusing d) Exploring 79 Rationale: Reassuring is a nontherapeutic technique because it attempts to dispel the patient’s feelings. Reflecting, focusing, and exploring are examples of therapeutic communication techniques 4. Assertive communication focuses on identifying negative feelings a) True b) False Rationale: Assertive communication focuses on the expression of positive and negative feelings or ideas in an open, honest, direct manner PowerPoint/Panopto Questions Exam 2 1. Cultural factors include hardiness and resilience a) True b) False Rationale: Cultural factors include the patient’s beliefs about health and illness. Hardiness and resilience are individual factors 2. When interviewing a patient, the nurse should select an area that is quiet and isolated from others a) True b) False Rationale: The nurse should interview a patient in an environment that is comfortable, private, and safe for both the patient and nurse. The nurse should not choose an isolated location 3. Which of the following would the nurse include when assessing a patient’s self-concept? a) Roles b) Support systems c) Personal qualities d) Abstract thinking Rationale: Assessment of the patient’s self-concept includes information about the patient’s personal view of self, a description of physical self, and his or her personal qualities or attributes. Roles and support systems are addressed when assessing the patient’s roles and relationships. Abstract thinking is addressed when assessing the patient’s sensorium and intellectual processes 4. Personality tests measure a person’s cognitive abilities a) True b) False 80 Rationale: Personality tests reflect the patient’s personality in areas such as self-concept, impulse control, reality testing, and major defenses. Intelligence tests evaluate the patient’s cognitive abilities and intellectual functioning 5. Mental health patients who are hospitalized voluntarily give up their right to leave the hospital a) True b) False Rationale: Mental health patients who are hospitalized voluntarily retain all the civil rights afforded to any person, including the right to leave the hospital. However, patients hospitalized involuntarily give up this right 6. A nurse is required to maintain patient confidentiality unless the patient threatens a specifically identified individual or group a) True b) False Rationale: In cases where a patient threatens an identifiable third party, the nurse has a duty to warn that third party 7. Which of the following would be considered an unintentional tort? a) Malpractice b) Assault c) Battery d) False imprisonment Rationale: Malpractice is an unintentional tort. Assault, battery, and false imprisonment are intentional torts 8. The greatest good for the greatest number reflects the deontologic ethical theory a) True b) False Rationale: Deontologic theory bases decisions on whether an action is morally right or wrong, without regard for the consequences. Utilitarianism bases decisions on the “greatest good for the greatest number 9. Anxiety and fear are considered to be two different things a) True b) False 81 Rationale: Anxiety is different from fear. Anxiety is a vague feeling of dread or apprehension. Fear is a feeling of being afraid or threatened by an identifiable stimulus representing danger 10. Which of the following would a nurse expect to assess in a patient with a panic disorder? a) Rational thinking b) Blaming of others c) Automatisms d) Organized thoughts Rationale: A patient with panic disorder would demonstrate automatisms, irrational thinking, self-blame, and disorganized thoughts 11. Phobias result from a past negative experience a) True b) False Rationale: Phobias usually do not result from past negative experiences. In fact, the person may never have had contact with the object of the phobia 12. The best way to help a patient with OCD is to avoid talking about the obsessive–compulsive behaviors as the patient feels ashamed of the behaviors a) True b) False Rationale: Although a patient with OCD is typically ashamed and embarrassed by the behaviors, it is important to offer encouragement, support, and compassion; to be clear that you believe he/she can change; and to develop and follow a written schedule with specified time and activities. In order to accomplish these tasks, you will need to talk with the patient about the behaviors 13. Which of the following would be most appropriate for the treatment of mania associated with bipolar disorder? a) Lithium b) Fluoxetine c) Citalopram d) Venlafaxine Rationale: Lithium is an antimanic agent, which would be most appropriate for treating a manic patient with bipolar disorder. Fluoxetine, citalopram, and venlafaxine are antidepressants 82 14. Ch. 17, Slide 30 (Panopto): “Client A” comes to a doctor appointment. Their speech is rapid and loud. The client is easily distracted and states they have not slept for two days. Is the client manic or depressed? Answer: Manic Rationale: The client hasn’t slept; Manic = “high, high, high” opposed to depression which is “low, low, low” 15. Ch. 17, Slide 30 (Panopto): “Client B” reports to a doctor visit and states “I have been irritable at work for the past three days. No one can understand me and I have been having trouble sleeping at night. But I am getting so much done.” What might this client be experiencing? Answer: Hypomania Rationale: ADLs aren’t affected, no sign of psychotic behavior 16. Priority Question (Panopto): During a home visit, the nurse finds that an older adult client has amassed a large quantity of newspapers and magazines. When the nurse offers to remove some of the newspapers, the client becomes anxious. What disorder does the nurse suspect? a) Body dysmorphic disorder (BDD) b) Hoarding c) Body identity integrity disorder (BIID) d) Oniomania Rationale: It’s hoarding 17. Knowledge-Based Question (Panopto): The nurse is caring for a client who has been diagnosed with OCD. The nurse is preparing a plan of care. Which is a safety priority for the nurse to observe? a) Antisocial behavior and demeanors b) Eating, drinking, and elimination c) Demeanor with other clients d) Daily routines Rationale: Think Maslow’s Hierarchy of Needs 18. Scenario-Based Question (Panopto): The nurse is interviewing the parents of a child who is exhibiting OCD. The nurse would anticipate the parent would report the occurrence of which situation with the child? (intact intellectual functioning) a) Failing classes due to lack of concentration 83 b) Spending excessive amount of time in the child’s room c) Frequently staring off into space d) Appearing jittery and nervous all the time Rationale: Think about the parents’ perspective regarding certain “cues” and behaviors at the child’s age that you would pay more attention to (Erikson’s stages of development; imaginative play) PowerPoint Questions Exam 3 1. The honeymoon phase of violence often occurs before the first episode of violence (T/F) a) True b) False Rationale: The honeymoon phase occurs after an episode of violence in which the abuser expresses regret and then apologizes and promises it will never happen again 2. Adults who were abused as children are more likely to abuse their own children (T/F) a) True b) False Rationale: The tendency for adults to raise children in the same way they were raised perpetrates the cycle of family violence. Adults who were victims of abuse as children frequently abuse their own children 3. Which of the following statements about rape is most accurate? a) It is a highly reported crime b) Most rapes are premeditated c) Rape requires ejaculation d) Provocative dress invites rap 84 Rationale: Most rapes are premeditated. Rape, an underreported crime, requires only slight penetration of the vulva. Full erection or ejaculation is not necessary. Provocative dress leading to rape is a myth 4. Persons who witness a traumatic event are likely to develop posttraumatic stress disorder (PTSD) (T/F) a) True b) False Rationale: Not all people, nor even most people, who witness a traumatic event will develop posttraumatic stress disorder (PTSD). Those most likely to develop PTSD are those who were directly involved in the event, not just merely witness to the event; those who experienced physical injury or loss of a loved one; those with a lack of social supports; or previous psychiatric history/repeated trauma 5. Which person is most likely to experience a dissociative disorder? a) A survivor of a car accident b) A survivor of childhood sexual abuse c) A survivor of a natural disaster d) A patient with a sudden, severe illness Rationale: Dissociative disorders are most prevalent among those persons with a history of childhood physical and/or sexual abuse. Dissociative disorders are relatively rare in the general population 6. It may require years for patients of trauma to achieve their outcomes (T/F) a) True b) False Rationale: Patients with trauma or stress-related disorders make gradual progress in their treatment. The effects of trauma and abuse can be far reaching and can last a lifetime 7. Positive symptoms of schizophrenia include a flat affect and social withdrawal (T/F) a) True b) False Rationale: Flat affect and social withdrawal are negative symptoms of schizophrenia 8. Which of the following would be considered a neurologic side effect of antipsychotic therapy? a) Blurred vision b) Agranulocytosis c) Sedation d) Tardive dyskinesia 85 Rationale: Tardive dyskinesia is a neurologic side effect of antipsychotic therapy; blurred vision, sedation, and agranulocytosis are Nonneurological side effects 9. The nurse should confront a patient’s delusions (T/F) a) True b) False Rationale: When a patient is experiencing delusions, the nurse should focus on the reality and not confront or reinforce the patient’s delusions 10. When discussing personality disorders, the term treatment resistant refers to a lack of response to medications prescribed (T/F) a) True b) False Rationale: Although a personality disorder is a psychiatric diagnosis, it is important to remember that it is not an illness with treatable symptoms in the way other mental disorders are. The term treatment resistant refers to the fact that it is difficult to change a person’s personality. Changes occur slowly and over time. It is true that there is no “magic pill” that will result in a change in someone’s personality for the better 11. Which of the following would a nurse expect to assess in a patient with antisocial personality disorder? a) Overwhelming empathy b) High self-esteem c) Manipulative behaviors d) Pervasive suspiciousness Rationale: A patient with antisocial personality disorder typically exhibits manipulative behaviors, lack of empathy, and low self-esteem; suspiciousness would be assessed in a patient with paranoid personality disorder 12. A patient with narcissistic personality disorder typically likes to be the center of attention (T/F) a) True b) False Rationale: Being the center of attention is a finding typically associated with a patient with a histrionic personality disorder 86 13. A person who abuses hallucinogens will experience a withdrawal syndrome on cessation of use (T/F) a) True b) False Rationale: There is no withdrawal syndrome associated with hallucinogen use 14. The typical age of onset for anorexia is which of the following? a) 10 to 14 years b) 14 to 18 years c) 18 to 22 years d) 22 years and older Rationale: Most commonly, anorexia begins between the ages of 14 and 18 years 15. A patient with a somatic symptom illness is able to voluntarily control the symptoms (T/F) a) True b) False Rationale: The symptoms of somatic symptom illness are not under the client’s voluntary control. Clients truly experience the symptoms they report. They are not “making it up” or fabricating symptoms. While psychologically or perhaps even subconsciously, clients need or want attention, it is not purposeful, attention-seeking, or overtly manipulative behavior 16. A patient with a factitious disorder develops symptoms primarily for attention (T/F) a) True b) False Rationale: Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention Ch. 11 PowerPoint Questions 1. Hostility and aggression are terms that can be used interchangeably (T/F) a) True b) False 87 Rationale: Hostility and aggression are two different terms. Hostility means verbal aggression. Physical aggression involves attack on or injury to another person or destruction of property 2. A patient with a history of violent or aggressive behavior is more likely to exhibit similar behavior in the future (T/F) a) True b) False Rationale: A history of violent or aggressive behavior is one of the best predictors of future aggression 3. During which phase does staff debriefing occur? a) Escalation phase b) Crisis phase c) Recovery phase d) Postcrisis phase Rationale: Staff debriefing occurs during the recovery phase to allow for discussion of the event, how it was handled, what worked well or needed improvement, and how the situation could have been defused more effectively Ch. 22 PowerPoint Questions 1. Which of the following would be considered an autism spectrum disorder? a) Expressive language disorder b) Learning disorder c) Rett’s disorder d) Intellectual disability Rationale: Autism spectrum disorders include autism, Rett’s disorder, childhood disintegrative disorder, and Asperger’s disorder. Expressive language disorder is a type of communication disorder. Learning disorders and intellectual disability are separate classifications of disorders 2. Atomoxetine is a stimulant agent used to treat ADHD (T/F) a) True 88 b) False Rationale: Atomoxetine is not classified as a stimulant. It is a nonstimulant agent, an antidepressant, and more specifically a selective norepinephrine reuptake inhibitor 3. Which of the following would the nurse most likely assess in a child with ADHD? a) High self-esteem b) Aggression toward animals c) Impulsiveness d) Limited gestures to communicate Rationale: A child with ADHD will often exhibit impulsiveness. Self-esteem is not a key indicator of ADHD. Children with conduct disorder exhibit aggression toward animals. Children with autism spectrum disorders exhibit limited gestures 4. A treatment option for ADHD includes educational interventions (T/F) a) True b) False Rationale: Treatment options for ADHD include educational interventions to support the child at school in learning, as well as behavioral and psychosocial interventions. Medications also play a role Ch. 23 PowerPoint Questions 1. Which of the following is considered a characteristic of intermittent explosive disorder? a) Episodes of anger lasting greater than 30 minutes b) No feeling of guilt or remorse after episode c) Injury to self, others, or property d) Comorbidity of an autistic disorder Rationale: Intermittent explosive disorder includes repeated episodes of violent behavior that include physical injury to others, property, or self. Episodes last less than 30 minutes, and typically the person experiences guilt/remorse but is unable to refrain from future outbursts. Autistic disorders are not an associate comorbidity 89 2. Anticonvulsant mood-stabilizing medications are frequently used to treat oppositional defiant disorder (T/F) a) True b) False Rationale: Oppositional defiant disorder treatment typically involves behavioral interventions/behavior therapy. Anticonvulsant mood stabilizers are used in treating intermittent explosive disorder 3. Which of the following would the nurse most likely assess in a child with a conduct disorder? a) High self-esteem b) Aggression toward animals c) Disorientation d) Lack of rational thinking Rationale: A child with conduct disorder will often exhibit aggression toward people or animals. These children have low self-esteem; are oriented; and are capable of logical, rational thinking Ch. 24 PowerPoint Questions 1. There is usually an identifiable cause for the development of delirium (T/F) a) True b) False Rationale: Delirium is usually due to an identifiable physiologic, metabolic, or cerebral disturbance or disease or caused from drug intoxication or withdrawal 2. A patient makes up answers to fill in memory gaps. The nurse identifies this as which of the following? a) Echolalia b) Palilalia 90 c) Aphasia d) Confabulation Rationale: Confabulation is the making up of answers to fill in gaps in the memory. Echolalia is echoing or repeating what is heard; palilalia is repeating words or sounds over and over. Aphasia refers to a deterioration in language function Anorexia Nervosa Onset: usually between ages 14 and 18 Denial early on; depression and lability with progression; isolation; medical complications (see Table 20.2) Treatment: often difficult; patient resistant, uninterested, denies problem Medical management 1. Weight restoration/nutritional rehabilitation 2. Rehydration/correction of electrolyte imbalances Psychopharmacology: amitriptyline, cyproheptadine, olanzapine, fluoxetine Psychotherapy 1. Family therapy 2. Individual therapy 3. Cognitive–behavioral therapy Bulimia Nervosa Onset: late adolescence, early adulthood (average age of 18 to 19 years) Often begins during or after dieting episode Possible restrictive eating between binges; secretive storage/hiding of food Treatment 1. Cognitive–behavioral therapy 2. Psychopharmacology: antidepressants Eating Disorders and Nursing Process: Assessment History: model child, no trouble, dependable (anorexia); eager to please and conform, avoid conflict (bulimia) General appearance, mood: slow, lethargic, emaciation (anorexia); not unusual (bulimia) Mood, affect: labile Thought process, content: preoccupation with food or dieting Sensorium, intellectual processes Judgment, insight Self-concept: low self-esteem Roles, relationships Physiologic/self-care considerations 91 Risk Factors for Eating Disorders (Table 20.1) Disorder Biologic Risk Factors Developmental Risk Factors Family Risk Factors Sociocultural Risk Factors Issues of developing Cultural ideal of being autonomy and having Family lacks emotional thin; media focus on control over self and Anorexia Obesity; dieting at an support; parental beauty, thinness, environment; early age maltreatment; cannot fitness; preoccupation nervosa developing a unique deal with conflict with achieving the identity; dissatisfaction ideal body with body image Chaotic family with Obesity; early dieting; Self-perceptions of being loose boundaries; possible serotonin and overweight, fat, parental Bulimia norepinephrine unattractive, and Same as above; weightmaltreatment disturbances; undesirable; related teasing nervosa including possible chromosome 1 dissatisfaction with physical or sexual susceptibility body image abuse Key Points Anorexia nervosa is a life-threatening eating disorder characterized by body weight less than below minimum expectations, an intense fear of being fat, a severely distorted body image, and refusal to eat or binge eating and purging Bulimia nervosa is an eating disorder that involves recurrent episodes of binge eating and compensatory behaviors such as purging, using laxatives and diuretics, or exercising excessively Of clients with eating disorders, 90% are females. Anorexia begins between the ages of 14 and 18 years, and bulimia begins around age 18 or 19 Severely malnourished clients with anorexia nervosa may require intensive medical treatment to restore homeostasis before psychiatric treatment can begin Family therapy is effective for clients with anorexia; CBT is most effective for clients with bulimia