quiz 2 psych evolve
t is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? Refusal of treatment. To send and receive mail. To seek legal counsel. To access all personal possessions.
d A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.
The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A client and family members attend counseling sessions together at a neighborhood clinic Implementation of a more flexible work schedule for staff Improved reimbursement for services provided in the community A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.
d A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.
A client reports to the nurse that once he is released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? None, because no explicit threat has been made. Ask the client if he is threatening his wife. Call the client's wife and report the threat. Report the incident to the client's therapist.
e The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made.
The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles? Autonomy and beneficence Advocacy and confidentiality Veracity and fidelity Justice and humanism
a Autonomy refers to self-determination and beneficence refers to doing good. When a client is restrained or secluded, the need to do good and prevent harm outweighs the client's autonomy.
Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? Private insurance Medicare Medicaid Private pay
a Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.
Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)? A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately A 75-year-old patient with dementia who demands to be allowed to go back to his own home A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care
a A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately AMS discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.
therapeutic inpatient milieu will include which characteristic? It provides for the client's safety and comfort. Voluntarily admitted clients are generally allowed additional privileges. Rules and behavioral limits are flexibly enforced. Staff provide frequent and ongoing negative feedback to clients.
a Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu
According to current information what factor is associated with the most disabling mental disorders? a. Biological influences b. Psychological trauma c. Learned ways of behaving d. Faulty patterns of early nurturance
a Biological and genetic factors influence mental health. 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. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.
A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? a. "Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." b. "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." c. "I'd like you tell me more about your depression and your suicide attempt?" d. "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."
a By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy since they do not represent actions by the nurse that the patient is incapable of on their own.
When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true? They are assured the same as those for any other citizen. Their rights are altered to prevent use of poor judgment. Their rights are always ensured by appointment of a guardian. Their rights are limited to provision of humane treatment.
a Civil rights are not lost because of hospitalization for mental illness. None of the other statements are accurate when describing the rights of a hospitalized mentally ill client
The nurse responsible for the care of a client prescribed clonazepam should evaluate treatment as being successful when the client demonstrates which behavior? Less anxiety Normal appetite Improved physical balance Reduced auditory hallucinations
a Clonazepam is a benzodiazepine thought to enhance the effects of GABA. GABA is associated with the production of a calming emotional state. None of the other options are associated with clonazepam.
The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which client behavior? Laughing at a joke Apologizing for being sarcastic Writing down his telephone number Going to his room to "calm down"
a Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. While the other options demonstrate positive behaviors, none are directly associated with such a medication.
Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? Break-away closet bars to prevent hanging Bedroom and dining areas with locked windows to prevent jumping Double-locked doors to prevent escaping from the unit Platform beds to prevent crush injuries
a Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.
What is the function of a neuron? Conduction of electrical impulses Diffuses an impulse across a space Provides a space at an axon terminal Provides an attachment point of the cell surface
a Neurons are nerve cells that conduct electrical impulses. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface.
What term is used to identify the structures that respond to stimuli, conduct electrical impulses, and release neurotransmitters? Neurons Synapses Dendrites Receptors
a Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.
A 38-year-old patient diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the patient's question? "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." "Neurotransmitters are chemicals in the brain that are the reason you are depressed." "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."
a Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.
The nurse planning care for a mentally ill client bases interventions on which concept? a. Every client has a certain degree of resilience. b. It is a client right to be treated respectfully. c. Every client comes with experiences that contribute to their problem. d. There are universal fears that are shared by all mentally healthy individuals.
a Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged. Resilience is the ability and capacity for people to secure the resources they need to support their well-being. None of the remaining options describe concepts that are the foundation for the actual creation of individualized care plans.
In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? Nurses Social workers Clinical psychologists Chemical dependency counselors
a Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.
When treating mental illnesses with psychotropic drugs what is the focus of the treatment? Altering brain neurochemistry. Correcting brain anatomical defects. Regulating social behaviors. Activating the body's normal response to stress.
a Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.
When considering mental illness, recovery is best described to a client by which statement? Working, living, and participating in the community Never having to visit a mental health provider again Being able to understand the nature of the diagnosed illness A period of time when signs and symptoms are being managed
a Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.
Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5? It is a medical psychiatric assessment system. It is a compendium of treatment modalities. It offers a complete list of nursing diagnoses. It suggests common interventions for mental disorders.
a The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses. None of the other options are accurate descriptions.
When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate which sign/symptom? Impaired balance Abnormal eye movement Impaired social judgment Blood pressure irregularities
a The cerebellum is the organ primarily responsible for symptoms of equilibrium or imbalance and would not be a likely source of any of the other options.
When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? "That judge is going to really regret putting me in here." "All politicians need to be shot." "When I'm elected president, I'll make them all pay for doubting me." "The man out there who is laughing at me is going to die."
a The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.
The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? Arranging for the client to have a screening for prostate cancer Notifying the family that the client will require a wheelchair when discharged Providing the client with organizations that help defray the cost of prescribed drug Arranging for respite care when the client's family needs to attend an out-of-state affair
a The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.
Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? All rights remain intact. Only rights that do not involve decision making remain intact. The right to refuse treatment is no longer guaranteed. All rights are temporarily suspended.
a The hospitalized client is not a convicted criminal thus all civil rights remain intact.
The incoherent thought and speech patterns of the client diagnosed with schizophrenia are related to the brain's inability to perform which function? Regulate conscious mental activity. Retain and recall past experience. Regulate social behavior. Maintain homeostasis.
a When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.
Which function is classified as a circadian rhythm? Sex drive Sleep cycle Skeletal muscle contraction Maintenance of a focused stream of consciousness
b Circadian rhythms are biological rhythms that influence specific regulatory functions such as body temperature, sleeping and waking, and the secretion of certain hormones and neurotransmitters.
According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? SATA a. I've been really anxious for at least 2 years now. b. My anxiety has to be genetic; my mom was a terrible worrier too. c. My marriage is in trouble because I'm always so irritable. d. I've had a good physical and my health care provider says I'm in good health. e. Its hard falling asleep and even harder staying asleep; I'm restless all night.
a, c, d, e he DSM-V criteria for generalized anxiety disorder include excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months; sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) and irritability; the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; the disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Family history is not a recognized criterion for generalized anxiety disorder.
Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression? Select all that apply. Dopamine γ-aminobutyric acid (GABA) Serotonin Norepinephrine Acetylcholine
a,c,d Antidepressant medication targets serotonin and norepinephrine. While dopamine is implicated in schizophrenia (increase) and Parkinson's disease (decrease), it is also believed to be a factor in depression. GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer's disease as well as Huntington's disease and Parkinson's disease.
The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? Select all that apply. Daytime sleepiness Reports of heartburn A rapid heartbeat Sexual dysfunction A weight gain
a,d,e Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated with this medication.
When considering client rights, which client can be legally medicated against his or her wishes? The client has accepted the medication in the past. The client may cause imminent harm to himself or others. The client's primary provider orders the medication. The client's mental illness may relate to cognitive impairment.
b A patient may be medicated against his or her will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.
The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? Opportunity to act out fears and frustrations Providing a safe place to practice coping skills Meeting their physical as well as emotional needs Encouraging group communication about existing problems
b A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.
Which ethical principle refers to the individual's right to make his or her own decisions? Beneficence Autonomy Veracity Fidelity
b Autonomy refers to self-determination, or the right to make one's own decisions. None of the other options are directly related to the client's right to makes decisions.
What nursing action supports a client's right to autonomy? Spending time with an extremely anxious client Witnessing the informed consent for electroconvulsive therapy from a client Spending equal amount of one-on-one time with each client on the unit Attending an inservice on a newly approved medication
b Autonomy refers to self-determination. One way to exercise self-determination is to make decisions about one's care. Witnessing the client's informed consent demonstrates attention to the client's right to autonomy. None of the other options are associated with autonomy.
A client who presents no danger to himself or to others is forced to take medication against his will. This situation represents assault. battery. defamation. invasion of privacy.
b Battery is the harmful, nonconsensual touching of another person. Forceful administration of medication constitutes battery.
What is the primary advantage of using a case manager when considering the planning and implementation of client care? Increases collaborative practice. Enhances resource management. Increases client satisfaction with care. Promotes evidence-based psychiatric nursing.
b Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.
A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? "We will help you make decisions that will keep you safe." "I am going to help you shower, so you will not smell so bad." "Your pocket knife and nail clippers will be kept in the nurses' station." "You will be having a number of tests to help us learn about your condition."
b Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.
The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? Alert security to come to the unit for a show of strength Request that the client accompany the nurse to the client's room Inform the client that restraints will be used if the behavior continues Prepare to administer a prn chemical restraint to the client
b Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options
When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? The patients who are convicted criminals sentenced to home confinement. Care is provided to clients in unconventional settings. Care is provided by a preferred provider for a large HMO. The patients are provided for by a clinical specialist with the visiting nurse service.
b Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.
A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment? a."By becoming active in politics leading to a potential political career." b. "By educating the public on the effects that stigmatizing has on mental health clients." c. "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." d. "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."
b Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.
When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? Fostering research Maintaining a therapeutic milieu Providing sympathetic listening Providing constructive negative feedback
b Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.
How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? Ask the client whether he views himself as being depressed. Identify the client's culture's view regarding suicide. Explain that suicide is often regarded as a desperate act. Assess the client for other examples of depressive behaviors.
b One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor Contrast that viewpoint with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill. While the remaining options are appropriate interventions, they fail to address the possible cultural component of the client's behavior.
Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A depressed patient with a suicidal plan A patient being discharged from an inpatient alcohol rehabilitation unit A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs Jeff, who has mild depression symptoms and is starting outpatient therapy
b PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.
Which assessment should the nurse perform to evaluate the pharmacokinetic affect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? The status of the client's appetite The results of the liver function test The level of depression exhibited by the client The client's current sleeping patterns
b Pharmacokinetics refers to the movement of a drug through the body. Four basic processes of pharmacokinetics which determine the concentration of a drug at its sites of action are easily remembered with the acronym ADME: absorption, distribution, metabolism, and excretion. MAOIs can affect liver function and require monitoring. The other options are related to the medication's pharmacodynamic effects.
Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? a. "My mother made decisions about my husband's funeral when I just couldn't do that." b. "Losing my job was hard but my skills will help me get another one." c. "In spite of all the treatment, I know I'll never be really healthy." d. "My kids, happiness is worth any sacrifice I have to make."
b Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.
A 49-year-old patient diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this patient? Monitoring blood levels to avoid toxicity Monitoring for abnormal involuntary movements Observing for secondary mania Observing for memory changes
b Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.
A client tells the mental health nurse "I am terribly frightened! I hear whispering in my head that someone is going to kill me." Which criteria of mental health can the nurse assess as lacking? Self-control Rational thinking Learning and productivity Positive self-concept
b The ability to think rationally is lacking for this client. The client does not have an accurate picture of what is happening that is based on reliable cognitive thinking. The statement fails to meet the criteria for any of the other options.
Homeostasis is promoted by interaction between the brain and internal organs and is mediated by component of the nervous system? The central nervous system The autonomic nervous system The sympathetic nervous system The parasympathetic nervous system
b The function of the autonomic nervous system is to transmit messages between the brain and the internal organs. This linkage promotes the maintenance of homeostasis.
Which imaging technique can provide information about brain function? Computed tomography (CT) scan Positron emission tomography (PET) scan Magnetic resonance imaging (MRI) scan Skull radiograph
b The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.
Which severe mental illness is recognized across cultures? SATA a. Antisocial disorder b. Schizophrenia c. Anorexia nervosa d. Social phobia e. Bipolar disorder f. Borderline personality disorder
b, c Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.
Which organ secretes hormones that are a normal component of the body's general response to stress? Select all that apply. Thyroid gland Hypothalamus Pituitary gland Adrenal glands Parathyroid glands
b,c,d The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The organs secrete corticotropin-releasing hormone, corticotropin, and cortisol; all influence the function of nerve cells of the brain. None of the remaining options secrete hormones associated with general stress.
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question? 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 has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.
A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? a. "You will participate in unit activities and groups daily." b. "You will be given a schedule daily of the groups we would like you to attend." c. "You will attend a psychotherapy group that I lead that will help you care for yourself." d. "You will see your provider daily in a one-to-one session."
c Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.
Which right of the client has been violated if he is medicated without being asked for his permission? Right to dignity and respect Right to treatment Right to informed consent Right to refuse treatment
c Before being given medication, the client should be fully informed about the reason for, the expected outcomes of, and any side effects of the medication. The client has the right to refuse medication. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated.
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? a. Experimental b. Descriptive c. Clinical d. Analytic
c Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms. None of the other options accurately identify the field that is associated with clinical practice.
After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? Confidentiality is now reserved to the immediate family. Only HIV status continues to be protected and privileged. Nothing may be disclosed that would have been kept confidential before death. The nurse must confer with the next of kin before divulging confidential, sensitive information.
c Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive. None of the other statements are accurate.
Which scenarios describe a HIPAA violation associated with a nurse's behavior? An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.
c Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.
What term is used to identify the quantitative study of the distribution of mental disorders in human populations? 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 with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.
If a client is placed in seclusion and held there for 24 hours without a written order or examination by a physician, the client has experienced which illegal act? Battery Defamation of character False imprisonment Assault
c False imprisonment is the arbitrary holding of a client against his or her will. When seclusion is ordered, it is not invoked arbitrarily, but after other less restrictive measures have failed. If the client is secluded without the medical order, the measure cannot be proven as instituted for medically sound reasons. None of the other options relate directly to such seclusion.
If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle? Autonomy Veracity Fidelity Justice
c Fidelity refers to being "true" or faithful to one's obligations to the client. Client abandonment would be a violation of fidelity. None of the other options addressed abandonment.
Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work A 30-year-old accountant who has developed symptoms of depression A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road A 76-year-old retired librarian who is experiencing memory loss and some confusion at times
c Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.
A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism? Fluoxetine Bupropion Lithium Imipramine
c Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.
The mental health status of a particular client can best be assessed by considering which factor? The degree of conformity of the individual to society's norms The degree to which an individual is logical and rational Status placement on a continuum from health to illness Rate of demonstrated intellectual and emotional growth
c Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.
A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care? a. Justifying the use of certain psychotropic medication. b. Providing data essential for insurance reimbursement. c. Establishing a framework for selecting appropriate interventions. d. Completing the medical diagnostic statement.
c Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. While the nursing diagnosis may contribute to the other options, none describe the purpose of the nursing diagnosis.
What client assessment data demonstrates parity related to mental health care? The client is admitted for a 72-hour mental hygiene evaluation. Advance practice nurse can be certified as psychiatric nurse specialist. A client's mental health coverage is equal to his/her medical/surgical coverage. A client who has attempted suicide is hospitalized for a mental health evaluation.
c Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. None of the other options are associated with mental health insurance coverage.
Which criterion must be met to refer a client to a partial hospitalization program? The client is hospitalized at night in an inpatient setting. The client must be able to provide his or her own transportation daily. The client is able to return home each day. The clients are all recovering from an addiction.
c Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs
The psychiatric community health nurse engages in secondary prevention when implementing which intervention? Visiting a homeless shelter to provide mental health screenings for its clients Discussing the need for proper nutrition with a depressed new mother Providing stress reduction seminars at the local senior center Visiting the home of a client currently displaying manic behavior
c Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.
The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The nurse may correctly assume that the client has met the criteria for which type of admission? Outpatient Emergency Voluntarily Involuntarily
c Voluntary admission occurs when the client seeks treatment and is willing to be admitted and agrees to comply with hospital and unit rules. None of the other options meet all these criteria.
What assumption can be made about the client who has been admitted on an involuntary basis? Select all that apply. The client can be discharged from the unit on demand of next of kin. For the first 48 hours, the client can be given medication over objection. The client has failed to agree to fully participate in treatment and care planning. The client is a danger to self or others or unable to meet basic needs. The commitment was court ordered.
c, d, e Involuntary admission which is court ordered implies that the client did not consent to the admission. The usual reasons for admitting a client over his or her objection is if the client presents a clear danger to self or others or is unable to meet even basic needs independently. Neither of the remaining options is accurate assumption regarding an involuntary admission.
The nurse caring for a client prescribed an antidepressant medication that produces anticholinergic side effects should assess for which possible side effects? Select all that apply. Memory dysfunction Ejaculatory dysfunction Blurred vision Dry mouth Constipation
c,d,e Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention. None of the remaining options are associated with anticholinergic side effects.
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports what conclusion about this client? The client is demonstrating symptoms of bipolar disorder. The client is demonstrating socially deviant behavior. The client is engaging in egocentric behaviors. The client is not conforming with social norms.
d Behavior that deviates from socially accepted norms does not indicate a mental illness unless there is significant disturbance in mental functioning.
In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? Knowledge of both national and local political activism The ability to cross service systems An awareness of own cultural and personal values Creative problem-solving and intervention skills
d Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.
Which situation demonstrates the nurse functioning in the role of advocate? Providing one-to-one supervision for a client on suicide precautions Co-leading a medication education group for clients and families Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days
d In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues
What function is shared by advanced practice and general practice psychiatric nurses? Prescriptive authority Admitting privileges Offers consultation services Membership on a multidisciplinary team
d Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation
