Ch 1: Foundations of Psychiatric Mental Health Nursing
A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's best response?
"Mental health is marked by productivity, fulfilling relationships, and adaptability."
Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy?
lack of parity rationale: Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services
During the 1800s, Pinel believed that the cure for mental illness was ...
moral treatment rationale: During the 1800s, the cure for mental illness was believed to be moral treatment, defined as kindness, compassion, and a pleasant environment. Philippe Pinel was one of the first physicians who began using moral treatment in France.
The nurse recognizes that public education is needed to erode stigma to prevent what?
discrimination
How should the nurse best explain the purpose of the DSM-5 to the client recently diagnosed with bipolar disorder?
"It is used to assist in identifying the underlying causes of your disorder."
When discussing instutionalization, which issue would most likely be considered a major problem associated with large state institutions? Select all that apply.
-Attendants were accused of torturing female residents - Clients were isolated from family and community - Clients were not given proper nutrition or clothed properly
A nurse can accurately identify which personal characteristics that contribute to mental health? Select all that apply.
-Sense of responsibility for one's own actions -Personal self-awareness -Relatively worry free -Generally happy with life
What percentage of adults requiring mental health services get the care they need?
25%
Deinstitutionalization has reduced the number of public hospital beds by what percentage?
80%
A psychiatric-mental health nurse is preparing a presentation about the historical evolution of current psychiatric-mental health treatment. When describing the impact of Sigmund Freud's work on care, which information would the nurse most likely include? Select all that apply.
A disturbance in personality development as an underlying issue Use of psychoanalysis to address the underlying injury
Chlorpromazine(Throazine) is a drug in which classification?
Antipsychotic- 1st gen
In the early Christian period, who treated clients thought to be possessed by demons causing their mental illness?
Clergymen
The nursing instructor asks the student to perform an assessment of a mentally ill client. What should the student do when executing this task?
Collect comprehensive data
Which activity is a function solely of the advanced practice psychiatric-mental health nurse?
Conducting individual psychotherapy
The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are?
Descriptions of the responsibilities for which nurses are accountable
Who was responsible for much of the reform of the mental health care system in the 19th century?
Dorothy Dix: promoted asylum and proper nutrition, warm clothes and shelter
Freud's personality theory was based on what?
Drives rationale: theory based on unconscious motivations for behavior, or drives. His personality theory was not based on social attributes, symbols, or impaired functioning.
A nurse is reading a journal article about the evolution of psychiatric-mental health nursing. Which individual would the nurse identify as being the first to address the education of psychiatric nursing?
Effie Taylor
What is the primary benefit of the DSM-5 to the student nurse's practice with the mentally ill population?
Encourages the building of a knowledge base about the nature of psychiatric illnesses.
How can a nurse best assure the management of personal long-term self-reflection that is associated with professional interaction with clients?
Engage in regular discussions with a formal clinical supervisor
Which skill is in the psychiatric-mental health registered nurse's scope of practice?
Evaluating the effectiveness of psychiatric medications
Which is a difference between counseling and psychotherapy?
Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role.
Which provides the best definition for mental illness?
Inability to function in a manner that manages both external and internal stressors effectively
Which is the most influencing factor that complicates the treatment of people with mental illness in the Unites States?
Insurers' reimbursement decisions rationale: A goal of behavioral health managed care has been to reduce hospital admissions, which are the most expensive part of psychiatric care. Unfortunately, some managed care "gatekeepers" have denied or restricted access to needed services and therefore have added to the discouragement, distress, and even despair of clients and their families.
What are the standards of professional performance that a nurse should implement when caring for a mentally ill client? Select all that apply.
Integration of research Collegial interaction Collaboration with clients and their families
A psychiatric-mental health nurse is working a booth at a local community college job fair. One of the participants comes to the booth and asks the nurse about the different types of conditions for which psychiatric-mental health nurses provide care. Which condition would the nurse most likely include in the response? (Select all that apply.)
Issues involving self-mutilation Self-esteem issues related to loss of a limb Problems associated with family or group isolation Substance use disorders
Which is a true statement regarding Medicaid?
It covers individuals and families with low incomes. rationale: Medicaid covers individuals and families with low incomes. Medicare covers people 65 years of age and older, those with permanent kidney failure, and those with certain disabilities.
Which is an inaccurate depiction of self-awareness?
It involves changing one's values or beliefs.
A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care?
It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client.
A nurse is reviewing the historical trends impacting the practice of psychiatric-mental health nursing practice. The nurse demonstrate understanding of the information by identifying which individual as being resonsible for opening the first training school for nurses in 1882?
Linda Richards the first trained nurse in the United States, opened the Boston City Hospital Training School for Nurses in 1882 at McLean Hospital, a psychiatric facility.
A client refuses to interact with a student nurse during a clinical session. Which would be the most helpful in the immediate situation? Select all that apply.
Listen to the client Show genuine interest in the client's situation
A nurse is conducting a review class for a group of psychiatric-mental health nurses about the changes in psychiatric care that have occurred through the years related to legislation and policy initiatives. The nurse determines that the teaching was successful when the group identifies that supporters of the Community Mental Health Centers Construction Act (1963) believed that institutionalization was contributing to what?
Mental Illness
Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?
Milieu therapy Ratioanle: A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management.
The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure?
Peplau rationale: In 1952, Peplau published Interpersonal Relations in Nursing. It introduced psychiatric and mental health nursing practice to the concepts of interpersonal relations and the importance of the therapeutic relationship. The nurse-client relationship supported a holistic perspective on client care.
Which sets professional standards of care?
Professional nursing organizations rationale: States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.
During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of which?
Psychopharmacology rationale: Psychopharmacology revolutionized the treatment of mental illness and led to an increased number of clients discharged into the community, and the eventual focus on the brain became a key to understanding psychiatric disorders.
The following events are important in the development of psychiatric-mental health nursing practice. Which event occurred first?
Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey rationale: In 1920, the first psychiatric nursing text was published. In 1954, the first graduate program in psychiatric nursing was established. In 1967, the ANA published the Standards of Psychiatric-Mental Health Nursing. In 1985, the Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice was published.
A psychiatric-mental health nurse is asked to be a guest speaker at a community fund-raising event for mental health services. Which would the nurse emphasize as the primary focus of the current consumer movement and mental health services?
Recovery from mental illness as a realistic goal
What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care?
Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice.
A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client?
Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client.
Which is a criterion for mental health?
Satisfaction with personal relationships and self ** can't always treat the disorder, but better manage it
A nurse can accurately identify which personal characteristics that contribute to mental health? Select all that apply.
Sense of responsibility for one's own actions Personal self-awareness Relatively worry free Generally happy with life
A client with mental illness has come to an outpatient mental health clinical for a counselling session with the community mental health nurse. Which areas should be the focus of counselling for this client? Select all that apply.
Stress management Behavior modification Communication skills
Which is the greatest barrier to an individual's ability to obtain the most effective and safest psychiatric medication?
These medications are often not covered by the managed care system because they are expensive.
What are the individual factors a nurse has to be aware of that may influence the mental health of a client with schizophrenia? Select all that apply.
Vitality Self-esteem Biological makeup
Which is a result of deinstitutionalization?
a "revolving door" effect of admissions rationale: the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.
The nurse knows the written instructions for healthcare when a person is incapacitated is called
advanced directive rationale: Advance care directives are written instructions for health care when individuals are incapacitated. For people who are gravely disabled ; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require advance care directives and/or may require appointment of a conservator or legal guardian.
A nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. Which practice would most likely be included as being used during this time?
asylums rationale: In the moral treatment period (1790-1900), the use of kindness, compassion, and a pleasant environment was adopted. Individuals with mental disorders were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Blood letting, exorcisms and incarceration were not practices associated with the moral treatment period.
A psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. When explaining how these programs work, the nurse would emphasize which concept?
collaboration rationale: In today's environment, the traditional medical model, which is viewed as autocratic and paternalistic, is being replaced by a collaborative model whereby mental health professionals work in partnership with consumers to help rebuild their lives. Consumer advocacy efforts have led to the implementation of recovery philosophy and practices.
In terms of causing disability among people aged 15 to 44 years of age in North America, where does mental illness rank?
first!!!!
Which mental health service is an advanced-level function?
psychotherapy
A psychiatric-mental health registered nurse is studying the impact of factors like safety, effectiveness, and cost on the practice and delivery of nursing services. What is this process called?
resource utilization
Define deinstitutionalization?
shift from institutional care to community facilities - serves smaller groups - less restrictive treatment ex: A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure
A psychiatric-mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders, as identified in Healthy People 2020. Which type of program would be least appropriate?
single substance treatment programs
Dorothea Dix's SOLUTION to gain humane treatment for the mentally ill population included what?
state hospitals rationale: Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century. Her SOLUTION was state hospitals.