Chap 2 Questions
A psychiatric nurse addresses Axis I of the DSM-IV-TR as the focus of care but also considers the presence of other long-term, nonmedical disorders that may affect treatment. To which axis should the nurse refer for this information? a. II b. III c. IV d. V
ANS: A Axis II refers to personality disorders and mental retardation. Together, Axis I and Axis II constitute the classification of abnormal behavior diagnosed in the individual. Axis III indicates any relevant general medical conditions. Axis IV reports psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis. Axis V is the GAF score.
A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide? a. "It is more respectful to refer to the patient by name than by diagnosis." b. "Thank you for informing me about that. I will document the behavior." c. "It is not unusual for schizophrenics to do that. It's just part of their illness." d. "You have a difficult job. I am glad you are so accepting of our patients' behavior."
ANS: A Diagnoses classify the disorders that people have, not the person. For this reason, it is important to avoid use of expressions such as "a schizophrenic" or "an alcoholic." The nurse has a responsibility to educate the coworker.
Most cultures label behavior as mental illness on the basis of which of the following criteria? A. Incomprehensibility and cultural relativity B. Strength of character and ethics C. Goal directedness and high energy D. Creativity and good coping skills
ANS: A Incomprehensibility and cultural relativity are most often the criteria used to define whether something is labeled mental illness. The other identified behaviors would be more associated with health than illness.
A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents? A. Reactions to stress are relative rather than absolute; individual responses to stress vary. B. It is abnormal for identical twins to react differently to similar stressors. C. Identical twins should share the same temperament and respond similarly to stress. D. Environmental influences weigh more heavily than genetic influences on reactions to stress.
ANS: A Responses to stress are variable among individuals and may be influenced by perception, past experience, and environmental factors in addition to genetic factors.
A mental health technician asks the nurse, "How do psychiatrists determine which diagnosis to give a patient?" Which of these responses by the nurse would be most accurate? A. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). B. Hospital policy dictates how psychiatrists diagnose mental disorders. C. Psychiatrists assess the patient and identify diagnoses based on the patient's unhealthy responses and contributing factors. D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from.
ANS: A The DSM-5 is an organized manual describing mental disorders and the criteria that determine whether a given diagnosis is appropriate. It is published by the American Psychiatric Association (APA). It intends to facilitate accurate and reliable medical diagnosis and treatment. Item C describes nursing rather than medical diagnosis.
A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient's insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. DSM-IV-TR b. Nursing Diagnosis Manual c. A psychiatric nursing textbook d. A behavioral health reference manual
ANS: A The DSM-IV-TR gives the criteria used to diagnose each mental disorder. The Nursing Diagnosis Manual focuses on nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manual may not contain diagnostic criteria.
A mentally ill person's current global assessment of functioning (GAF) score is 10. Select the nurse's highest priority related to this patient's care. a. Safety b. Hygiene c. Nutrition d. Socialization
ANS: A This low GAF score indicates a consistent risk for self-harm exists; therefore the nurse's highest priority is safety.
A 40-year-old adult living with parents states, "I'm happy but I don't socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them." A nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior
ANS: A The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept
How is the DSM-5 useful in the practice of psychiatric nursing? Select all that apply. A. It informs the nurse of accurate and reliable medical diagnosis. B. It represents progress toward a more holistic view of mind-body. C. It provides a framework for interdisciplinary communication. D. It provides a template for nursing care plans. E. It provides a framework for communication with the client.
ANS: A, B, C The DSM-5 is useful in the practice of psychiatric nursing because it facilitates comprehensive evaluation of the client. In addition, it encourages a holistic view and provides a framework for interdisciplinary communication.
Which of the following are cultural aspects of mental illness? Select all that apply. A. Local or cultural norms define pathological behavior. B. The higher the social class the greater the recognition of mental illness behaviors. C. Psychiatrists typically see patients when the family can no longer deny the illness. D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion.
ANS: A, B, C The fewer ties that a group has with mainstream society, the greater the likelihood of a negative response by society to mental illness. Coercive treatments and involuntary hospitalizations are more common in this population.
A patient asks a nurse, "The pamphlet I read about depression says psychosocial factors influence depression. What does that mean?" Which examples could the nurse cite to support the information? Select all that apply. a. Having a hostile family b. Having an over- or under-involved family c. Having two first-degree relatives with bipolar disorder d. Experiencing the sudden death of a parent or loved one e. Feeling strong guilt over having an abortion when one's religion forbids it f. Experiencing symptom remission when treated with an antidepressant medication
ANS: A,B,D,E Family influence is considered a psychosocial factor affecting a patient's mental health. A hostile under- or over-involved family is critical of the patient and contributes to low self esteem. Religious influences are considered psychosocial in nature. Life experiences, especially crises and losses, are considered psychosocial influences on mental health. Having two first-degree relatives with bipolar disorder would be considered a factor that influences the individual's risk for mental disorder, but it is a genetic, not psychosocial, factor. Treatment with a biological agent such as an antidepressant medication is an example of a biological influence.
A patient is admitted to the psychiatric hospital for assessment and evaluation. Which assessment finding best indicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can perform tasks attempted within the limits of own abilities. d. reports occasional problems with insomnia.
ANS: B A patient who reports having a consistently negative mood is describing a mood alteration. The incorrect options describe mentally healthy behaviors and common problems that do not indicate mental illness
A nurse is educating a patient about the difference between mental health and mental illness. Which statement by the patient reflects an accurate understanding of mental health? A. Mental health is the absence of any stressors. B. Mental health is successful adaptation to stressors in the internal and external environment. C. Mental health is incongruence between thoughts, feelings, and behavior D. Mental health is a diagnostic category in the DSM-5.
ANS: B Several definitions of mental health exist, but this definition highlights concepts of successful adaptation to stressors, including thoughts, feelings, and behaviors that are age-appropriate and congruent with cultural and societal norms.
Which should the nurse recognize as a DSM-5 disorder? A. Obesity B. Generalized anxiety disorder C. Hypertension D. Grief
ANS: B The DSM-5 identifies several disorders that are related to anxiety, including generalized anxiety disorder, somatic symptom disorder, and dissociative disorders.
At what point should the nurse determine that a client is at risk for developing a mental disorder? A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates significant distress D. When the client uses defense mechanisms as ego protection
ANS: B The nurse should determine that the client is at risk for mental disorder when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental disorder, there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usually associated with significant distress or disability in social, occupational, or other important activities. The client's ability to communicate distress would be considered a positive attribute.
A nurse finds a new patient uncommunicative about recent life events. The nurse suspects marital and economic problems. The social worker's assessment is not available. The most effective action the nurse can take is to: a. ask the patient who shares a room with him or her. b. consult Axis IV of the DSM-IV-TR in the medical record. c. focus questions on the topics of marital and economic issues. d. delay discussion of these topics until the social worker's assessment is available
ANS: B The physician's admission note identifies psychosocial and environmental problems on Axis IV pertinent to the patient's situation, providing another source of information for the nurse. Asking the patient who shares a room with him or her violates patient privacy rights. Persistent questioning may cause the patient to withdraw. Delaying the discussion until the social worker's assessment is available is not an effective solution.
Which statement reflects a student nurse's accurate understanding of the concepts of mental health and mental illness? A. "The concepts are rigid and religiously based." B. "The concepts are multidimensional and culturally defined." C. "The concepts are universal and unchanging." D. "The concepts are unidimensional and fixed."
ANS: B The student nurse should understand that mental health and mental illness are multidimensional and culturally defined. It is important for nurses to be aware of cultural norms when evaluating a client's mental state.
A patient in the emergency department reports, "I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me." Which aspects of mental health have the greatest immediate concern to a nurse? Select all that apply. a. Happiness 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 patient's appraisal of and control over behavior. The patient's appraisal of reality is inaccurate, and auditory hallucinations are evident, as well as delusions of persecution and grandeur. In addition, the patient's control over behavior is tenuous, as evidenced by the plan to "stab" anyone who seems threatening. A healthy self-concept is lacking. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.
A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of: a. the degree of conformity of the individual to society's norms. b. the degree to which an individual is logical and rational. c. a continuum from mentally healthy to unhealthy. d. the rate of intellectual and emotional growth.
ANS: C Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to society's norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness.
Which scenario meets the criteria for "normal" behavior? a. An 8 yr old child's only verbalization is "No no no." b. A 16 yr old girl usually sleeps 3-4 hrs per night. c. A 43 yr old man cries privately for 1 month after the death of his wife. d. A 64 yr old woman has difficulty remembering the names of her grandchildren.
ANS: C People who are normal may also experience dysfunction during their lives. The death of a spouse is a difficult experience, so crying is expected.
A mentally ill gunman opens fire in a crowded movie theater, killing 6 people and injuring others. Which comment about this event most clearly shows the stigma of mental illness? a. "Gun control laws are inadequate in our country." b. "it's frightening to feel that it is not safe to go to a movie theater." c. "All these people with mental illness are violent and should be locked up." d. "These events happen because American families no longer go to church together."
ANS: C Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear and misinformation contribute to stigma.
During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? A. "It's just a routine part of our assessment. All clients are asked these same questions." B. "Why are you concerned about these types of questions?" C. "Psychological factors, like excessive stress, have been found to affect medical conditions." D. "We can skip these questions, if you like. It isn't imperative that we complete this section."
ANS: C The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip either physiological or psychosocial questions, as this would lead to an inaccurate assessment.
The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will: a. describe feelings associated with loss and stress. b. meet own needs without considering the rights of others. c. identify healthy coping behaviors in response to stressful events. d. allow others to assume responsibility for major areas of own life.
ANS: C The patient's ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors.
The nurse presents a class about mental health and mental illness to a group of 4th graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response. a. "There are many reasons why mental illness occurs." b. "The cause of mental illness in complicated and very hard to understand." c. "Sometimes a person's brain doesn't work correctly because something bad happens or they inherit a brain problem." d. "Most mental illnesses result from genetically transmitted abnormalities in cerebral structures; however, some are a consequence of traumatic life experiences."
ANS: C a. This doesn't answer the child's question. b. This doesn't answer the child's question. c. This answers the child's question in a way the child can understand. It provides accurate info and uses terminology the child can understand. d. This answer doesn't use terminology a child can understand.
A nurse explains multi-axial diagnoses to a psychiatric technician. Which information is accurate? a. It is a template for treatment planning. b. Nursing and medical diagnoses are included. c. Assessments of several aspects of functioning are included. d. It incorporates the framework of a specific biopsychosocial theory
ANS: C The use of five axes requires an assessment beyond the diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision) (DSM-IV-TR) is not a template for treatment planning and does not use a specific biopsychosocial theory. Nursing diagnoses are not included in multiaxial diagnoses.
Which statements most clearly reflect the stigma of mental illness? Select all that apply. a. "Many mental illnesses are hereditary." b. "Mental illness can be evidence of a brain disorder." c. "People claim mental illness so they can get disability checks." d. "If people with mental illness went to church, they would be fine." e. "Mental illness is a result of the breakdown of the American family."
ANS: C,D,E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.
Which belief by a nurse supports the highest degree of 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 constant from culture to culture. d. Some symptoms of mental disorders reflect a person's cultural patterns
ANS: D A nurse who understands that a patient's symptoms are influenced 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. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.
The spouse of a patient with schizophrenia says, "I don't understand why childhood experiences have anything to do with this disabling illness." Select the nurse's response that will best help the spouse understand this condition. a. "Psychological stress is actually at the root of most mental disorders." b. "We now know that all mental illnesses are the result of genetic factors." c. "It must be frustrating for you that your spouse is sick so much of the time." d. "Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important."
ANS: D Many of the most prevalent and disabling mental disorders have been found to have strong biological influences. Helping the spouse understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse's level of knowledge about the cause of the patient's condition. Not all mental illnesses are the result of genetic factors. Psychologic stress is not at the root of most mental disorders
A patient tells a nurse, "I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems." Select the nurse's best response. a. "Comparing yourself with others has no real advantages." b. "Why do you blame yourself for having a psychiatric illness?" c. "Mental illness affects 50% of the adult population in any given year." d. "It sounds like you are concerned that others don't experience the same challenges as you."
ANS: D Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing.
An adult experienced a spinal cord injury resulting in quadriplegia 3 yrs ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? a. "I often pray for a miracle that will heal my paralysis so I will be whole again." b. "I don't know what i did to deserve this fate or whether I am tough enough to endure it." c. "My accident was a twist of fate. I suppose there are worse things than being paralyzed." d. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life."
ANS: D Resiliency is the ability to recover from of adjust successfully to trauma/change. A successful transition through a crisis builds resiliency for the next difficult trial. In the correct response, the person demonstrates acceptance of the paralysis and a focus on her abilities and assets.
A patient's history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient's needs are not met. Which aspect of mental health is a problem? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships
ANS: D The information provided centers on relationships with others, which 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.
A critical care nurse asks a psychiatric nurse about the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. Select the psychiatric nurse's best response. a. "No functional difference exists between the two diagnoses. Both serve to identify a human deviance." b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables." c. "The DSM-IV-TR diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-IV-TR diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."
ANS: D The medical diagnosis is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both the DSM-IV-TR and a nursing diagnosis consider culture. The DSM-IV-TR is multiaxial. Nursing diagnoses also consider potential problems.
A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? A. The client's behaviors demonstrate mental illness in the form of depression. B. The client's behaviors are extensive, which indicates the presence of mental illness. C. The client's behaviors are not congruent with cultural norms. D. The client's behaviors demonstrate no functional impairment, indicating no mental illness.
ANS: D The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the client's distress does not indicate a mental illness.
Which documentation of diagnosis would a nurse expect for a person with mental illness? a. I Rheumatoid arthritis II 100 III Posttraumatic stress disorder IV Arrested for shoplifting 2 months earlier V None b. I Mental retardation II Histrionic personality disorder III 75 IV Hypertension V Home destroyed by tornado last year c. I Schizophrenia, paranoid II Death of spouse last year III 40 IV None V Alcohol abuse d. I Generalized anxiety disorder II Avoidant personality disorder III Fibromyalgia IV Declared bankruptcy 6 months ago V 60
ANS: D The option beginning with a diagnosis of generalized anxiety disorder places a clinical disorder on Axis I, a personality disorder on Axis II, a medical problem on Axis III, a psychosocial problem on Axis IV, and global assessment of functioning (GAF) on Axis V. The other options misplace and incorrectly order the clinical data
A participant at a community education conference asks, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response. a. "Why do you ask?" b. "Schizophrenia" c. "Affective disorders" d. "Anxiety disorders"
ANS: D The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymia, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.
In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy person who gives $20 bills to needy individuals in the community c. Person with an optimistic viewpoint about life and getting his or her own needs met d. Person who attends a charismatic church and describes hearing God's voice
ANS: D Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-IV-TR diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill.
A nurse wants to find a description of diagnostic criteria for a person with schizophrenia. Which resource should the nurse consult? a. U.S. Department of Health and Human Services b. Journal of the American Psychiatric Association c. North American Nursing Diagnosis Association (NANDA) International d. DSM-IV-TR
ANS: D The DSM-IV-TR identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful information but are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder.
A newly admitted patient is profoundly depressed, mute, and motionless. The patient has refused to bathe and eat for a week. Which score would be expected on the patient's global assessment of functioning? a. 100 b. 80 c. 50 d. 10
ANS: D The patient is unable to maintain personal hygiene, oral intake, or verbal communication. The patient is dangerous to self because of the potential for starvation. A GAF score of 100 indicates high-level functioning. A score of 80 or 50 suggests higher functional abilities than the patient presently displays.