Mental Health - Exam 1

Behavioral Strategies (horse/carrot/stick)

Classical conditioning Operant Conditioning Rewards & Punishment Role Modeling

To show that a person is voluntarily accepting treatment, what must the patient do? a. Be declared competent by a judge. b. Ensure their civil rights are enforced c. Obtain a second opinion d. Provide informed consent

ANS: D Informed consent is a term that means the patient has been provided with basic information regarding risks, benefits, and alternatives of treatment and is willing to accept treatment free of coercion. See page 97

According to Maslow's Hierarchy of Needs, which of the following problems needs to be addressed as the first priority in caring for an anxious patient receiving inpatient treatment? a. Lack of sleep b. Fear of job loss due to missing work c. Believing that God is distant and uncaring d. Refusal to go to group therapy

ANS: A According to Maslow, physiological problems are the priority needs, such as lack of sleep, and are more basic than belonging, esteem, security, or transcendence.

Which question is an example of what may be asked using the FICA assessment tool? a. "How can I assist you in using your beliefs to address your situation? b. "Does your ethnic group usually adhere to any particular religion?" c. "Would you like to know more about the influences of spirituality on coping?" d. "Have you ever learned about the five major religions of the world?"

ANS: A F - Faith and Belief "Is spirituality something important to you" or "Do you have spiritual beliefs that help you cope with stress/ difficult times?" If the patient responds "No," the health care provider might ask, "What gives your life meaning?" Sometimes patients respond with answers such as family, career, or nature. I - Importance "What importance does your spirituality have in our life? Has your spirituality influenced how you take care of yourself, your health? Does your spirituality influence you in your healthcare decision making? (e.g. advance directives, treatment, etc.) C - Community "Are you part of a spiritual community? Communities such as churches, temples, and mosques, or a group of like-minded friends, family, or yoga can serve as strong support systems for some patients. Can explore further: Is this of support to you and how? Is there a group of people you really love or who are important to you?" A - Address in Care "How would you like me, your healthcare provider, to address these issues in your healthcare?" (With the newer models including diagnosis of spiritual distress A also refers to the "Assessment and Plan" of patient spiritual distress or issues within a treatment or care plan.

A nurse says to a patient, "The social worker is bending over backwards to help you find a place to live after discharge." The patient responds, "No she's not. She's standing up straight." The nurse documents the patient's thinking as: a. Concrete b. Delusional c. Retrospective d. Illogical

ANS: A Lack of abstract thinking leads people to take idioms or analogies literally. This is called "concrete" thinking.

Under what circumstance can a nurse give medication to a patient against his or her will? a. The patient is harming themselves or others b. The patient is being held under an Order of Protective Custody c. The patient has signed an Advanced Directive d. The patient signed informed consent document

ANS: A Only in the case of an emergency (danger to self or others) or if a judge has ordered medications be administered (medication commitment hearing) can medications be forced on an individual refusing medications

A patient tells the nurse, "I made a huge mistake during my presentation at work. Everyone totally hates me and I will never be promoted at my job." Which cognitive distortion does this best illustrate? a. Overgeneralization b. Labeling c. Minimization d. Repression

ANS: A Overgeneralization occurs when someone used a bad outcome as evidence that nothing will ever go right again. Page 27

A nurse immediately orders a blood toxicology screen for illicit drug use for this patient prior to assessing the patient or receiving report. This is an example of which phenomena? a. Stereotyping b. Slander c. Attitudinal proficiency d. Cultural competence

ANS: A Stereotyping occurs when someone assumes or believes something about someone without verifying if it is true. A stereotype is an over-generalized belief about a particular category of people.

Which is an example of a violation of the Americans with Disabilities Act? a. A person is not given a raise because they have bipolar disorder b. A person is not permitted to call the authorities when treated unjustly in a hospital c. A person is fired from their job because they missed too many days of work during a depressive episode d. A person's insurance plan does not cover the cost of addictions treatment

ANS: A The ADA makes it unlawful for employers to discriminate on basis of disability. The fact that someone has a disability cannot exclude them from resources or opportunities that people without disabilities have. However, if a person is unable to perform their job, that is legal grounds for dismissal.

A community nurse working with Khmer refugees from Cambodia begins to understand their worldview, values and practices regarding treatment for epilepsy. The nurse is experiencing which phenomena? a. Enculturation b. Ethnocentrism c. Ethnic pharmacogenetics d. Cultural Distress

ANS: A The culture's worldview, beliefs, values, and practices are transmitted in a process of enculturation.

A nurse approaches a patient who is frantically pacing, breathing rapidly, holding his head in his hands, and saying, "Oh no, no, no" over and over again. The patient does not notice the nurse approach him. Once the nurse gets the patient's attention, the patient says, "I just got off of the phone with my brother who said that my dog ran away." Which comment by the nurse would be most therapeutic? a. Address the patient by name and say, "First, take a deep, slow breath." b. "I'm sure your dog will find his way home. Try not to worry about your dog." c. "Would you like to go to recreational therapy in 5 minutes?" d. "You cannot help your dog if you do not calm down. Now, I'll teach you about meditation."

ANS: A This patient is experiencing severe anxiety, so the perceptual field is reduced greatly. The person may be dazed and confused. Behavior is automatic and usually includes somatic symptoms (e.g., headache, nausea, dizziness, insomnia, trembling, hyperventilation, palpitations). Appropriate nursing interventions are to provide for safety and offer firm, short, and simple statements. Threats to calm down and false reassurance are not therapeutic and will be ineffective during this level of anxiety.

Which behavior is the best indicator that transference is influencing the nurse-patient relationship? a. A patient feels jealous and ignored like she did as a child when a nurse spends time with another patient. b. A nurse behaves emotionally cold and distant towards a patient who looks like the nurse's abusive grandfather. c. A patient thanks a nurse for the patience and empathy shown while the patient expressed feelings of grief and fear. d. A nurse gives report to another nurse stating that a patient is "needy, manipulative and attention-seeking."

ANS: A Transference occurs when a patient responds to a nurse (or any healthcare provider) based on past experiences. Counter-transference occurs when a nurse responds to a patient based on past experiences.

A patient asks, "I read somewhere that guided imagery can be useful in managing anxiety. What is imagery?" The nurse correctly responds with which comment? a. Imagery is the practice of focusing on pleasant images to replace negative ones. b. Imagery is addressing your physical appearance so that you promote a positive image of yourself and receive positive responses from others. c. Imagery is the use of virtual reality simulation technology to assist in addressing emotions related to a traumatic event. d. Imagery involves you looking at your reflection (image) in a mirror and verbally stating positive affirmations to yourself.

ANS: A With guided imagery, people are taught to focus on pleasant images to replace negative ones or stressful feelings. Using relaxation and imagining a peaceful scene can result a someone feeling more relaxed and focused. Page 166

Which immediate autonomic response indicates that the sympathetic nervous system has been activated? Select all that apply. a. Increased blood pressure b. Dilated pupils c. Increased libido d. Increased saliva production e. Decreased respiratory rate

ANS: A and B The flight or fight response stimulates immediate survival responses such as increased heart rate, respiratory rate, blood pressure, blood flow to muscles, pupil dilation.

Which of the following are potential cultural barriers to mental health services? (Select all that apply.) a. Patient's belief that mental illness is shameful b. Patient's use of slang language unfamiliar to the nurse c. High school programs to increase awareness of suicide risk d. Genetic variation between racial groups e. Nurse's lack of understanding of cultural somatization

ANS: A, B, D, and E Pages 81-84

A nurse refers a patient to a support group. The nurse explains the purposes of a support group are to: (Select all that apply) a. Encourage positive coping behaviors b. Decrease feelings of isolation c. Enhance social skills d. Avoid focusing on problems e. Provide crisis counseling

ANS: A, B, and C Pg. 616

According to ANA Psychiatric Nursing Standard of Care, a mental health RN could: (Select all that apply) a. Counsel a client to become more assertive. b. Prescribe an appropriate antidepressant. c. Conduct research to study factors influencing medication adherence. d. Coordinate a client's outpatient appointments as he transitions from inpatient treatment. e. Diagnose client with accurate mental illness and document on Axis I.

ANS: A, C, and D

Which of the following would be characteristic for someone with Hoarding Disorder? Select all that apply. a. The person demonstrates indecisiveness in various areas of life. b. The person experiences relief when unnecessary items are removed from the home. c. The accumulation of belongings keeps someone from leading a normal life. d. The person recognizes they have a problem when items at home are cluttered and unorganized. e. The person usually has symptoms of major depressive disorder.

ANS: A, C, and E Page 280 Someone with Hoarding Disorder accumulates belongings and finds getting rid of items very distressing and may not be aware that collecting stuff has consumed their lives. There is a very high comorbidity rate of depression and/or another anxiety disorder. Indecisiveness is very characteristic.

During a treatment team meeting on an inpatient psychiatric unit, the nurse is asked, "What intrusion symptoms of PTSD has the patient, Mr. M, demonstrated over the past two days?" The nurse correctly reports which symptom? a. Described feelings of guilt for surviving the trauma b. Reported nightmares last night about his trauma c. During visiting hours, wife says he seems emotionally distant and detached. d. Tearfulness during art therapy

ANS: B "Re-experiencing" PTSD symptoms are also sometimes called intrusion symptoms because they involve memories of the trauma, or associated feelings, thoughts, or sensory experiences, breaking into a PTSD sufferer's present experience. Some intrusion symptoms include: nightmares, intrusive thoughts, sensory feelings of the traumatic incident, flashbacks

A nurse working in a primary care physician's office conducts an intake assessment on a new patient who reports recent onset of sleeplessness, irritability, loss of appetite, and agitation. The most appropriate statement by the nurse is: a. "I will call a counselor to come speak to you about your emotions." b. "We will run some lab tests to rule out any physiological or biological factors." c. "Anxiety is a common problem that can be treated effectively." d. "There is minimal relationship between physical and emotional problems, so it is best if we focus on your physical symptoms."

ANS: B Don't read into a question ('but what if') Hints: sleeplessness, irritability, loss of appetite, and agitation. Think of Maslow's hierarchy and address the physical issues first.

A nurse manager of a children's diabetic outpatient clinic decides to implement a behavioral strategy to increase compliance with the client's maintaining current daily blood sugar and dietary intake logs. The nurse will: a. Use puppets to teach the importance of recording daily blood sugars and dietary intake. b. For each log entry, give a token that can be used to earn small prizes. c. Identify thoughts that the children have that make them not want to record values in the logs. d. Help children to imagine themselves filling out the logs.

ANS: B Giving them a reward for the correct behavior

Which is an example of subjective data obtained during a mental health examination? a. Patient is mute b. Patient is feeling depressed c. Patient is overweight d. Patient is wringing her hands

ANS: B Objective data refers to things the nurse observes about the patient by using the 5 senses. Subjective data is what the patient reports. The only way to know how a person is feeling is by asking them.

What is the best descriptor of the patient's perceptions? a. Unable to concentrate b. No hallucinations noted c. Responding to internal stimuli d. Patient demonstrates dissociation

ANS: B Perceptions are the patient's interpretations to internal stimuli (hallucinations or illusions). Since she is not hallucinating, the nurse would document that none were noted.

A person with depression is sitting alone in the day room, staring at the floor, with a sad affect. The nurse says, "You seem more depressed today than yesterday." The person replies, "Yes, I feel more sad today." Using a broad opening statement, the nurse will then say: a. "Group therapy starts in 10 minutes, and I think you will find it helpful." b. "Tell me more about what you're experiencing." c. "The staff is here to help you and we want the best for you." d. "How did your marital therapy session go yesterday?"

ANS: B See page 144 Broad opening clarifies that the lead is to be taken by the patient and allows the patient to choose the topic of the discussion." Other options include giving information, offering self, and exploring.

Which of the following is an example of tertiary prevention of mental illness? a. A nurse discusses signs and symptoms of depression that may potentially arise in someone who is being discharged after undergoing heart surgery. b. A person admits themselves to inpatient treatment because they feel suicidal. c. A parent takes their child to their pediatrician when the child complains of headache, poor attention span, and fear of going to school. d. After the death of a classmate, crisis counselors meet with students to address their grief reactions.

ANS: B Tertiary prevention treatment focuses on addressing severe symptoms and preventing severe or fatal outcomes, such as preventing suicide. Primary prevention reduces the chance of a potential problem arising, such as crisis counseling to prevent anxiety or depression related to grief. Secondary prevention helps people to get help early before things get bad; the disorder may be there, but secondary prevention delays or stops the progression (such as seeking help when symptoms arise or helping someone to identify early symptoms).

Which of the following is considered criteria for involuntary hospital commitments? Select all that apply. a. A patient has not been adherent to talking prescribed medication b. A patient has a mental illness c. A patient is a danger to someone else d. A patient has no insurance e. A patient is a danger to self

ANS: B, C, and E For someone to be involuntarily committed to a psychiatric facility, the following are considered: 1) the person has a mental illness, 2) the person is a danger to themselves 3) the person is a danger to someone else 3) the person is unable to take care of their basic needs 4) they cannot get help voluntarily. People have the right to stop their medications. Public resources make it possible for people to receive mental health treatment regardless of ability to pay.

A nurse working on a med-surg unti tells her co-worker, "I would never want to be a psychiatric nurse. I became a med-surg nurse because I don't want to deal with people's mental issues. Which responses by the co-worker are correct? Select all that apply. a. "It is likely that the patients you work with will have their mental illness under control since 85% of people who have mental illness get mental health treatment." b. "You may have patients with varying degrees of mental difficulties since people fluctuate along a mental health-mental illness continuum." c. "There is a good chance you will work with patients with a mental illness since about 15% of adults have a mental illness." d. "You will probably have a patient with schizophrenia at some point since it is the most commonly diagnosed mental illness." e. "You will likely have patients with co-morbid physical and mental illness since those with mental illness have higher prevalence of medical problems."

ANS: B, C, and E It is true that nurses in any specialty will encounter people with varying degrees of mental illness, especially since about 1 in 5 adults have had a mental illness and those with mental illnesses have higher prevalence of physical illnesses. Anxiety is the most frequently diagnosed mental illness. Unfortunately, only about 42% of people get mental health treatment.

A patient on a psychiatric inpatient unit tells the nurse, "I'm really sure my anxiety is sky-high because I think my husband is going to leave me. I can't seem to catch my breath and I'm having chest pains." What is the best response by the nurse? a. "I can see that you're anxious. Let's do some deep breathing exercises." b. "What did your husband say to make you think he is going to leave you?" c. Let's measure your oxygenation with a pulse oximeter and I will take your vital signs." d. "According to Erikson's Stages of Development, Trust vs Mistrust is a very important stage to master. It seems you are not able to trust your husband."

ANS: C

A patient on a psychiatric unit sits alone in the day area; no expression on his face; no eye contact; quiet mumbling; rocking back and forth. The nurse documents the patient's affect as: a. Isolative b. Incongruent c. Flat d. Incoherent mumbling

ANS: C

An inpatient psychiatric client says to the nurse, "Thank you for listening to me. I feel like I can finally trust someone with my darkest thoughts. Can I tell you something, but please promise that you will not tell anyone else." Which is the best nurse response? a. I'm glad you can trust me. I will not tell anyone what you tell me. b. Based on HIPPA regulations, I cannot tell your treatment team anything that you share with me. c. If anything you share impacts your safety or your treatment, I will let other members of your treatment team know. d. What I share with your treatment team depends on whether you are admitted voluntarily or involuntarily to this facility.

ANS: C

A nurse says to a patient, "If you interrupt me and ask the same question one more time, I'm going to put you in restraints." The nurse may be found guilty of which tort? a. Proximate Cause b. Battery c. Assault d. Slander

ANS: C Assault is the intentional threat designed to make another person fearful

Which nursing statement is the best example of the therapeutic communication technique of exploring? a. "So, what I understand you to be feeling is guilt over your company's bankruptcy." b. "You think today is Sunday? Actually, today is Wednesday and you have been in the hospital for 4 days." c. "Tell me more about how you felt when your kids left home to go to college." d. "You seem anxious when your wife comes to visit."

ANS: C Exploring prompts the patient to examine certain ides of events more fully.

On an inpatient psychiatric unit, some patients have private insurance and others have no insurance. All patients are offered the same meal choices and opportunities to attend group sessions. Thisterm-32 is an example of which ethical principle? a. Nommaleficence b. Egoism c. Justice d. Veracity

ANS: C No matter how much a hospital is getting paid for treating individual patients, they all receive the care and resources. This is an example of Justice "the duty to distribute resources or care equally, regardless of personal attributes".

A home health nurse visits a client to address maladaptive stress reactions due to the patient experiencing years of chronic stress. The client is pleasant and welcoming of the nurse. Which of the following would the nurse most likely assess? a. Profuse diaphoresis b. Diarrhea c. Autoimmune disease d. Nonadherence to medication

ANS: C The patient is not in a current state of moderate or severe anxiety, so the immediate signs of stress are not indicated (diaphoresis, diarrhea). There is no indication that chronic stress is related to medication nonadherence. Autoimmune diseases are results of long-term effects to the stress response.

Which medication will most likely be prescribed for someone with generalized anxiety disorder? a. Clozapine b. Oxcarbazepine c. Venlafaxine d. Phenelzine

ANS: C Venlafaxine is an SNRI which is usually prescribed (as are SSRI's) to treat people with anxiety disorders. Phenelzine is an MAOI. Oxcarbazepine is a mood stabilizer. Clozapine is an antipsychotic.

A client says to the nurse, "Since I lost my job last month, I have been feeling so useless and depressed. Sometimes I go shopping to numb the pain. I try to look for other jobs, but just feel defeated." What is the most therapeutic response by the nurse? a. "Did you enjoy your job?" b. "You should use job sites like Indeed or LinkedIn" c. "Shopping is a bad idea. Let's consider better options for how you can use your time." d. "It seems that losing your job has affected how you feel about yourself."

ANS: D

What patient comment indicates she has abstract thinking? a. "The kids make their own stuff, I don't bother really." b. "I'm just exhausted." c. "I'm not explaining myself very well." d. "I feel like my brain's not been switched off."

ANS: D Abstract thinking is the ability to apply general concepts and meanings to a specific example. It can also be done by finding similarities between different things. Humor is also a form of abstract thinking. Usually, a nurse would assess this by asking a patient their interpretation of an analogy or idiom such as "No use crying over spilled milk." In this case, the patient describes her brain as a "Switch" or some kind of electrical device.

A patient tells the nurse, "I'm anxious all the time since my home was burglarized and vandalized last week. I've always felt inferior to all my coworkers. I have no desire to write poetry anymore. I have superficial acquaintances, but don't feel like I have any meaningful relationships. According to the theory of Hierarch of Needs, which problem should be addressed first? a. Feeling inferior at work b. Lack of desire to write poetry c. Unfulfilled connectedness in relationships d. Anxiety stemming from recent home invasion

ANS: D According to Maslow's Hierarchy of needs, safety, security, and stability are more basic than self-esteem, self-actualization, or relationships. The home invasion affected the person's sense of security and is still making her feel unsafe, thus the anxiety.

A nurse providing medication teaching to someone recently prescribed alprazolam includes which correct information? a. Since this is a stimulant, you should not ingest caffeine. b. It may take 1-3 weeks before you feel the therapeutic effects c. You will need to have blood levels drawn periodically to assess your white blood cell count. d. This is for short-term use since dependence may occur.

ANS: D Alprazolam is a benzodiazepine (depressant) used to treat anxiety symptoms. They have a quick onset, but should be used short-term due to the potential for tolerance and dependence. Common side effects include sedation, ataxia, and decreased cognitive functioning.

According to behavioral theory, why would someone use methamphetamine to the point of disability? a. The patient believes they are "worthless and will never amount to anything" as they were told when younger by their father. b. The patient is genetically disposed to using drugs. c. The patient has a subconscious desire to escape their reality. d. The patient experiences euphoria with meth use which is rewarding.

ANS: D Behavioral approach is based on rewards and punishment that increase or decrease the likelihood of behaviors being repeated. Unfortunately, drugs make someone feel good which is an immediate "reward".

What can be the primary downside to the nurse making a statement to a patient such as, "I think you did a great job sharing about your depression in group today"? a. Other patients will think the nurse favors one patient over the others. b. The nurse is trying to manipulate the patient to talk more in group c. The patient will not talk as much in individual therapy settings. d. The patient may act to gain approval rather than based on his own convictions.

ANS: D Giving approval may influence others to say what they think others want to hear and may not do things based on their own motivation. See page 144

Which action best indicates the nurse is engaged in milieu management? a. A nurse documents that a patient is nonadherent to medications when the patient does not sign the consent forms for antidepressants. b. A nurse recommends inpatient treatment to a patient in the ED who reports drinking a bottle of vodka per day. c. A nurse write the nursing diagnosis "depressed mood R/T hopelessness" on a patient's treatment plan. d. A nurse teaches exercises during a physical exercise group to address the needs and abilities of patients on a psychiatric unit.

ANS: D Milieu therapy involves providing a secure and therapeutic environment that includes activities specifically designed to address patient needs. Activities such as documentation, planning, and referrals do not directly promote the therapeutic environment as much as providing an activity/therapy specifically designed for patient needs.

A patient states, "I'm not sure that my doctor prescribed the correct medication for my depression." Which would be the most therapeutic response? a. Would you like to talk to another patient who is taking the same medication? b. This medication has been prescribed to many people and you have a very good doctor. c. Why do you not want to take this medication? d. Tell me what is contributing to you feeling unsure.

ANS: D Responses that get to the underlying feeling or thought are often very therapeutic. "Why" questions are generally not encouraged as it can make someone feel defensive. Close ended questions that may not be as therapeutic as open-ended comments. Sharing other patient's medications may be a HIPPA violation.

A nurse needs to perform a glucose finger stick on a child recently diagnosed with juvenile diabetes. The child is very frightened and cries out loudly. To address the fear, the nurse asks the child to watch another child get a glucose stick who shows no reaction during the process. What type of behavior therapy does this represent? a. Negative punishment b. Flooding c. Classical Conditioning d. Modeling

ANS: D The nurse is trying to eliminate the fear in the child by providing a role model. The child has been asked to watch another child who does not react to the stimulus (glucose finger stick). This may help the child to learn to react in the same way as the other child while getting the finger stick.

Which action is reserved for nurses with an advanced degree? a. Coordination of care b. Interdisciplinary collaboration c. Milieu management d. Psychotherapy

ANS: D The psychiatric-mental health advanced practice registered nurse conducts individual, couple, group, and family psychotherapy

What is a definition of a patient's affect?

Affect describes someone's facial expression that conveys how they are feeling. For example, she looks sad and tearful and remains that way throughout the interview (not labile).