Chapter 1 Mental Health and Mental Illness

The interventions that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is: A. Advocacy B. Pyschotherapy C. Coordination of care D. Community-based care

B

Current information suggests that the most disabling mental disorders are the result of A. biological influences. B. psychological trauma. C. learned ways of behaving. D. faulty patterns of early nurturance.

A The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences.

A nurse assesses a patient suffering from an anxiety disorder and asks the patient to fill out a PROMIS tool questionnaire. The patient reports the following: always fearful, uneasy, nervous, and unable to focus on any topic outside of his or her anxiety; often tense and anxious; sometimes worried and sometimes feels like he or she needs help for anxiety. According to the PROMIS tool for anxiety, what would be the score for this?____points

34 In this case, the patient's score is 34. A score of 5 is given for each report of "always" including feeling fearful, uneasy, nervous, and unable to focus. A score of 4 is given for each report of "often" including feeling tense and anxious. A score of 3 is given for each instance of "sometimes" which included feeling worried and feeling the need for help for anxiety. For this patient, 5+5+5+5+ 4+4+ 3+3 gives a total score of 34 points.

A person has a high level of resilience. Which other characteristic would the nurse expect this person to have? A. Optimism B. Patriotism C. Aggressiveness D. Depressed effect

A

What phrase best describes the DSM-IV-TR? A. Is a multiaxial psychiatric assessment system B. Is a compendium of treatment modalities C. Offers a complete list of nursing diagnoses D. Suggests common interventions for mental disorders

A The DSM-IV-TR is a classification of mental disorders that includes descriptions of diagnostic categories and uses an axis system to provide a broad range of assessment.

When conducting epidemiological studies on mental disorders, in what order would a study be conducted? Arrange the steps of the study in the correct order. A. Perform quantitative study of distribution of mental disorders B. Identify the high-risk groups C. Identify the high-risk factors associated with illness D. Determine the etiology of mental disorders with studies

A, B, C, D Epidemiology is the study of distribution of mental illness in a population. In epidemiology studies, the epidemiologist performs the quantitative study of distribution of mental disorders. This is followed by identification of high-risk groups. The high-risk factors associated with illness are then identified, and lastly the etiology of mental disorders is identified.

When considering the mental health continuum, place the following patient statements regarding the patients' state of mental health in order from illness towards wellness. A. "I don't believe I will ever feel happy again." B. "I know I don't want to feel like this anymore." C. "I recognize the importance of taking my medication regularly." D. "I understand that I will have good days and bad days but I can handle that."

A, B, C, D Mental health and mental illness can be conceptualized as points along a mental health continuum. The patient's depression (illness) is described by the feeling that happiness will never be experienced again. The statement that first indicates movement toward wellness is that one shows self reflection as demonstrated by not wanting to continue feeling depressed anymore. Next is the recognition that improvement can occur if treatment is followed. The final point on the continuum to health is when the patient expresses insight into the problem and a sense that it can be managed.

A nurse who is aware of the future challenges to the role of the psychiatric mental health nurse will encourage which of the following? Select all that apply. A. Working toward certification as an advanced psychiatric mental health nurse B. Attending a seminar on meeting the needs of the patient diagnosed with advanced dementia C. Being aware of the culturally focused needs represented in the area's current patient population D. Volunteering to help establish a website that provides online screening for depression and anxiety E. Working with a community group whose goal is to secure funding for a community-based mental health clinic

A, B, C, D Significant trends that will affect the future of psychiatric nursing in the United States include educational challenges, an aging population, increasing cultural diversity, and expanding technology. While funding is important, it has not been identified as a challenge to the role of the psychiatric mental health nurse in the future.

What achievements were made in the field of neuroscience and brain research during the "Decade of the Brain"? Select all that apply. A. Identifying the roles of cytokines in brain disorders such as depression B. Mapping of the genes involved in neurological illnesses like Alzheimer's C. Pharmacological treatment of mental illnesses like schizophrenia and Parkinson's D. Refinement of neuroimaging techniques, such as magnetic resonance imaging (MRI) scans E. Discovery that the brain has a large number of neurotransmitters and a lower number of receptors

A, B, D There were many advances in brain research during the 1990s, which was referred to as the "Decade of the Brain." These included identifying the roles of cytokines in brain disorders like depression, mapping of the genes involved in neurological illnesses like Alzheimer's, and refining neuroimaging techniques like MRI and CT. Pharmacological treatment of diseases like schizophrenia and Parkinson's was developed relatively early (before 1900). During the Decade of the Brain, it was found that the brain had a lower number of neurotransmitters but a vast assortment of neurotransmitter receptors. This means that mental illnesses are multifactorial.

Which federal legislative acts serve to help assure equality in benefits for both medical/surgical and mental health needs to all insured Americans? Select all that apply. A. Mental Health Parity Act of 1996 B. The Health Insurance Portability and Accountability Act of 1996 C. The Wellstone-Domenici Parity Act of 2008 D. Patient Protection and Affordable Care Act of 2010 E. Health Care and Education Reconciliation Act of 2010

A, C, D Parity simply refers to equivalence, and these legislative acts (Mental Health Parity Act, The Wellstone-Domenici Parity Act, and the Patient Protection and Affordable Care Act) help require insurers (including Medicare and Medicaid) to provide mental health coverage (both annual and lifetime benefits) at the same level provided for medical/surgical coverage. The Health Insurance Portability and Accountability Act and the Health Care and Education Reconciliation Act are not related to assuring parity regarding mental health and medical/surgical benefits.

Which of the following interventions are considered basic level psychiatric nursing interventions and so considered within the scope of practice of a basic level psychiatric mental health nurse (PMHN)? Select all that apply. A. Coordinating the care of a patient diagnosed with acute depression. B. Evaluating the effectiveness of the patient's medication therapy based upon his or her reported state of mind. C. Reporting to the patient's interdisciplinary team behaviors that suggest the depression is worsening. D. Establishing rules for an acute care unit that treats depressed patients. E. Providing information materials concerning depression to the patient's family members.

A, C, D, E Psychiatric mental health nurses are registered nurses educated in nursing and licensed to practice in their individual states. Psychiatric nurses are qualified to practice at two levels, basic and advanced, depending on educational preparation. Coordination of care, health teaching and health maintenance, milieu management, and pharmacological, biological, and integrative therapies are all considered basic level interventions. It is the advanced practice mental health nursing professional who has gained diagnostic privileges, prescriptive authority, and permission to engage in psychotherapy.

N, a college student, comes to the mental health clinic with symptoms of feeling blue and having occasional difficulty sleeping. He is able to manage his course work with lowered grades but states he just doesn't get as much pleasure from life as he did several months ago. The nurse making his global assessment of functioning would probably assign the rating of A. 100. B. 70. C. 40. D. 10.

B A global assessment of functioning in the 70s indicates some mild symptoms are present or some difficulty in social, occupational, or school functioning is present but the individual is functioning well enough to have some meaningful interpersonal relationships.

Which statement about diagnosis of a mental disorder is true? A. The symptoms of each disorder are common among all cultures. B. Culture may cause variations in symptoms for each clinical disorder. C. All mental disorders listed in the DSM-IV-TR are seen in all other cultures. D. Global assessment of functioning is more diagnostic than symptoms noted.

B Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone.

What was the primary impact that the development and use of psychotropic drugs had on nursing's role in the care of patients with mental health disorders? A. The availability of mental health therapies as an outpatient service B. The expansion of the role assumed by professionally trained nurses C. Nurses were needed to fill the gap created by a lack of medical personnel. D. More nurses were required to address the needs of the now treatable mental health patients.

B With the influx of mental health patients who were now treatable, the role of the professional nurse was expanded to assist in meeting their needs for care management, treatment implementation, and evaluation of care in both inpatient and outpatient settings. Although availability of outpatient mental health therapies increased with the introduction of psychotic medications, that development affected delivery of the services more directly than it did the role of the professional nurse in the care of psychiatric patients. Nursing is a health care profession that is unique and has never attempted to fill the role of the medical health care professional. Although the expansion of services and the number of treatable patients increased with the development of psychotropic medications, the professional nurse's role was affected by more than simply a need for increased numbers of nurses.

Mental illnesses recognized across cultures include A. antisocial and borderline personality disorders. B. schizophrenia and bipolar disorder. C. bulimia and anorexia nervosa. D. amok and social phobia.

B Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.

A nurse works in a pediatric care unit. Which mental disorders are more likely to begin in childhood? Select all that apply. A. Agoraphobia B. Hydrophobia C. Social phobia D. Posttraumatic stress disorder (PTSD) E. Obsessive-compulsive disorder (OCD)

B, C, E The mental disorders that are likely to emerge in childhood involve hydrophobia, social phobia, and OCD. Hydrophobia is the fear of water. Social phobia is the fear of being judged by others or being embarrassed. OCD is a compulsive habit or thought. Agoraphobia begins in young adulthood, and PTSD can develop anytime throughout the lifecycle following a traumatic event.

The nurse is assessing a patient of Asian origin who has recently migrated to the United States. The nurse finds that the patient's behavior is different from that of the other patients. What are the likely reasons for this? Select all that apply. A. The patient is most likely suffering from a mental illness. B. The patient most likely belongs to a different culture. C. The patient does not understand what abnormal behavior is. D. The patient is unaware of societal expectations in the United States. E. The patient is too stressed by getting adjusted to the new place.

B, D The patient has recently migrated from Asia to the United States. This indicates that the patient is new to the United States and is not aware of its cultural norms. The patient would behave according to the social and cultural norms of his or her country of origin. The patient would take time to get accustomed to U.S. culture. Similarly, the patient is also unaware of the cultural and social norms of behavior in the United States. Based on the information that the patient behaves differently from the other patients, the nurse cannot conclude that the patient has a mental illness. The patient is aware of abnormal behavior but may not be aware of culturally acceptable behavior. The patient can get information from cultural books, programs, and local shops. The nurse does not find any signs of stress; therefore it is unlikely that the patient is stressed.

Epidemiological studies contribute to improvements in care for individuals with mental disorders by: A. Providing information about effective nursing techniques B. Identifying risk factors that contribute to the development of a specific disorder. C. Identifying who in the general population will develop a specific disorder. D. Identifying which individuals will respond favorably to a specific treatment.

C

Which of these mental health problems has the highest prevalence in the United States? A. Schizophrenia B. Alzheimer's disease C. Major depressive disorder D. Generalized anxiety disorder

C

Which statement about mental illness is true? A. Mental illness is a matter of individual nonconformity with societal norms. B. Mental illness is present when individual irrational and illogical behavior occurs. C. Mental illness changes with culture, time in history, political systems, and the groups defining it. D. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

C

Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis? A. There is no functional difference between the two; both serve to identify a human deviance. B. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. C. The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems. D. The DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying multidisciplinary interventions.

C

A nurse's identification badge includes the wording, 'Psychiatric Mental Health Nurse'. A client with a history of paranoia asks, "What does that title mean?" The nurse responds best when answering: A. "Don't be afraid, it means I'm here to help not hurt you." B. "Psychiatric Mental Health nurses care for people with mental illnesses." C. "We have the specialized skills needed to care for those with mental illnesses." D. "The nurses who work in mental health facilities have that title."

C A Psychiatric Mental Health Nurse possesses specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill.

According to psychological theory, mental illness is caused by a faulty psychological process that can be corrected by increasing personal insight and understanding. What challenged this theory? A. Invention of insulin shock therapy B. Invention of psychosurgery techniques C. Identifying the effects of chlorpromazine (Thorazine) D. Identification of specific agents causing mental illness

C Chlorpromazine (Thorazine) is known to have a calming effect on agitated patients. The finding indicates that psychiatric illness may respond to medications that alter the intercellular components. This implies that the mental illness is also caused by disruption of intercellular components. This theory rejected the earlier psychological theory which stated that mental illness is caused by a faulty psychological process that can be corrected by increasing personal insight and understanding. Insulin shock therapy and psychosurgery techniques (surgery on specific parts of the brain) are invasive techniques that were used to modify behavior. Germ theory stated that mental illness is caused by a specific agent that is identifiable and can be eliminated. This is an old theory of the cause of mental illness and was disproved, as a single agent causing mental illness was not identified.

Regarding individuals with mental disorders, distress refers to a painful symptom, and disability refers to A. the presence of deviant behavior. B. impairment in important areas of functioning. C. culturally appropriate responses to an event. D. a conflict between the individual and society.

C Disability refers to impairment in important areas of functioning or a significantly increased risk of death, pain, or an important loss of freedom.

The quantitative study of the distribution of mental disorders in human populations is called A. mortality. B. prevalence. C. epidemiology. D. clinical epidemiology.

C Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population who has a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.

A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be: A. Nursing Interventions Classification (NIC) B. Nursing Outcomes Classification (NOC) C. NANDA-I nursing diagnoses D. DSM-5

D

While caring for a client who is very ill with a mental disorder, the nurse wonders if the client has always been so regressed or if he has functioned at a higher level in the recent past. The best way to obtain this information would be to A. ask the client. B. ask the family. C. refer to the progress notes. D. look at axis V of the client's DSM-IV-TR sheet.

D Axis V is called the Global Assessment of Functioning and gives an indication of the client's best level of psychological, social, and occupational functioning during the preceding year.

Which basic intervention should the psychiatric mental health nurse plan to provide for a patient diagnosed with a mood disorder? A. Sharing clinical expertise to enhance patient treatment B. Performing individual or group psychotherapy for the patient C. Using appropriate diagnostic tests to monitor patient condition D. Conducting stress management and health maintenance classes

D Conducting stress management and health maintenance classes is the basic intervention that should be performed by the psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management classes are examples of health maintenance classes. Consulting nurses from other disciplines to share clinical expertise and enhance patient treatment is an advanced practice psychiatric mental health nursing intervention. Performing individual and group psychotherapy and performing diagnostic tests like blood pressure, etc., are also advanced practice psychiatric mental health nursing interventions.

The prevalence rate over a 12-month period for major depressive disorder is A. lower than the prevalence rate for panic disorders. B. greater than the prevalence rate for psychotic disorders. C. equal to the prevalence rate for psychotic disorders. D. greater than the prevalence rate for generalized anxiety.

D Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.