Chapter 25: Populations Affected by Mental Illness

Mr. T has been admitted to the mental health floor for evaluation. You, the nurse, note that he has displayed hallucinations, disorganized thinking and speech, and bizarre behavior. He has a flat affect, lack of energy, and poor attention. You know that these are symptoms of what disorder? 1. Schizophrenia 2. Depression 3. Anxiety 4. Panic disorder

1. Schizophrenia Rationale: Diagnostic criteria for schizophrenia are two or more of (each present for a significant portion of a 1-month period): delusions, hallucinations, disorganized speech (e.g., frequent derailment or incoherence), grossly disorganized or catatonic behavior, or negative symptoms (e.g., affective flattening, alogia, avolition).

Tony, age 16 years, comes to see you, the school nurse, with complaints of abdominal pain. You note that Tony exhibits signs and symptoms of depression, states he wishes he did not wake up today, and exhibits signs of anxiety. You would: 1. Refer him immediately for evaluation. 2. See him back in your office next week. 3. Refer him next month for evaluation. 4. Do nothing; this is normal in a 16-year-old boy.

1. Refer him immediately for evaluation. Rationale: It should be noted that suicide is the third leading cause of death among persons 15 to 24 years of age. Thus, it is important that all community health nurses become familiar with assessing for suicide warning signs and accessing appropriate resources. Whenever individuals exhibit suicide warning signs, nurses should refer the person to a mental health clinic or provider as soon as possible.

Match each condition with the expected symptoms. Symptoms include loss of control over a substance, the continued use despite injury, and obsession with obtaining more. a. Schizophrenia b. Bipolar disorder c. Post traumatic stress syndrome d. Substance use disorder

d. Substance use disorder Substance Use Disorder: A condition where a client cannot stop using a substance though it may be harmful to them if continued. They also can lose control or the ability to stop using the substance. This condition can appear in other mental health disorders to medicate their conditions. For example, alcoholism can be a coping mechanism used by a person with depressive disorder.​

Ms. L is being treated for depression. Which statement by her indicates a need for further education? 1. "My medication will cure me of my depression." 2. "A side effect of my medication (Prozac) may be gastrointestinal upset." 3. "I need to keep my follow-up appointment for medication management." 4. "I should not stop taking my medication without checking with my doctor first."

1. "My medication will cure me of my depression." Rationale: Psychotherapeutic medications do not cure mental illness; rather, they act by controlling symptoms. The other statements are correct.

Mr. B has been diagnosed with a severe mental illness. He tells the nurse that his family says his disorder is his own fault and is because of his laziness. Which reply by the nurse is accurate? 1. "Lazy people are more prone to mental illness." 2. "Mental illness is a disease with biopsychosocial causes that are not the patient's fault." 3. "Most people are unsupportive of family members with mental illness." 4. "It would really help your situation if you got over the stigma associated with mental illness."

2. "Mental illness is a disease with biopsychosocial causes that are not the patient's fault." Rationale: Mental illness is a medical condition that is caused by biopsychosocial attributions that are not the patient's fault nor caused by the patient's behavior.

Ms. W, 18 years old, presents at a community clinic describing vague symptoms. She explains that she recently dropped out of high school and is having trouble keeping a job. She notes that she has difficulty concentrating and has used drugs (i.e., marijuana and alcohol) when riding motorcycles with friends. When conducting the initial assessment, the RN should include questions and tools that would screen for: 1. Depression. 2. Attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD). 3. Posttraumatic stress disorder. 4. Obsessive-compulsive disorder.

2. Attention-deficit disorder/attention-deficit hyperactivity disorder (ADD/ADHD). Rationale: The reported symptoms best fit ADD/ADHD, although the young woman should also be screened for depression and substance abuse, which can accompany ADD/ADHD.

Mr. S was recently hospitalized for a stroke. While in the hospital, he was also diagnosed with diabetes. As his nurse, you know he is at risk for 1. Panic disorder. 2. Depression. 3. schizophrenia. 4. Bipolar disorder.

2. Depression Rationale: Depression is often a complication of serious physical disorders such as heart attack, stroke, diabetes, and cancer. The other options are usually not complications of other physical disorders.

Mr. H is a patient in the primary care center where you work as a staff nurse. He tells you that he is currently participating in a type of therapy that helps patients change behaviors. You know that Mr. H is describing which type of therapy? 1. Individual therapy 2. Couple therapy 3. Behavioral therapy 4. Family therapy

3. Behavioral therapy Rationale: Behavioral therapy uses learning principles to change thought patterns and behaviors systematically; it is used to encourage the individual to learn specific skills to obtain rewards and satisfaction. Individual therapy focuses on the client's current life and relationships within the family, social, and work environments. Couple therapy is used to develop the relationship and minimize problems through understanding how individual conflicts are expressed in the couple's interactions. Family therapy involves problem-solving sessions with members of a family.

You work in a community clinic that specializes in pediatric mental health. Joy, age 12 years, has been diagnosed with depression. You know a major risk factor for depression in childhood is: 1. Family history of diabetes. 2. Family history of abuse. 3. Family history of depression. 4. Family history of poverty.

3. Family history of depression. Rationale: A family history of depression is a major risk factor for childhood depression. Other associated factors that may increase the risk of depression in children and adolescents include a history of verbal, physical, or sexual abuse; frequent separation from or loss of a loved one; poverty; mental retardation; attention-deficit/hyperactivity disorder; hyperactivity; and chronic illness.

Mental illnesses adversely affect achievement of social justice. Which statement related to marginalization of some populations because of mental illness is false? 1. About half of all inmates in jails and prisons have mental health problems. 2. Mental illnesses can lead to employment difficulties, which adversely affects access to health insurance, thereby limiting treatment options. 3. Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups. 4. Both natural and human-made disasters can adversely affect mental health; those with limited resources appear to be more directly impacted, and the effects persist longer.

3. Most mental illnesses are caused by genetic factors; therefore, problems associated with them persist across generations and among certain racial and ethnic groups. Rationale: Although genetic factors most likely contribute to some mental illnesses and in some individuals there is little information linking a specific gene to a specific disorder. Rather, the major psychiatric disorders are complex, and mental illnesses appear to result from a very complex interaction among neurochemical and metabolic changes and environmental and situational factors. The other statements are all true.

You are working in a mental health facility as a nurse. You are involved with patients who have varied diagnoses. One of your patient's family members asks what biological problem causes all of these people to have mental illness. You respond that most experts believe: 1. Brain structure is the problem. 2. Neurotransmitters are the problem. 3. Genetics are the problem. 4. Many factors cause the problem.

4. Many factors cause the problem. Rationale: Information from studies to date is insufficient to establish a definitive biological cause for mental illness. Scholars have concluded that mental disorders are multifactorial, complex physiological phenomena.

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: A: absolutely honest about what will be reported and what the family can expect. B: authoritarian in approaching the problem. C: cautious in reporting unconfirmed reports of violence. D: sincere in concern for the victims

A: absolutely honest about what will be reported and what the family can expect. The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: A: child abuse. B: depression. C: intimate partner abuse. D: parent's resentment of the preteen.

A: child abuse. To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.

The community health nurse performs an assessment of violence by observing which of the following community characteristics? (Select all that apply.) A: Presence of social support networks B: Crime rates C: Levels of unemployment D: Presence of physical disabilities in individuals E: Presence of family violence

B: Crime rates C: Levels of unemployment Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings. Although abuse cannot be predicted with certainty, several factors influence the onset and support the continuation of abusive patterns. Assessing for violence in a community context is completed by observing community characteristics inclusive of crime rates, unemployment levels, lack of neighborhood resource and support systems, and a lack of community cohesiveness. Individual factors include the presence of physical disability and familial factors are those related to violence and other family factors.

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? A: Emotional abuse B: Emotional neglect C: Physical abuse D: Physical neglect

B: Emotional neglect Neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: A: confront the daughter when she arrives to pick the father up. B: discuss the findings with the caregivers to determine the cause of the injuries. C: educate the staff about indications of elder abuse. D: make a referral to the primary care provider for follow-up.

B: discuss the findings with the caregivers to determine the cause of the injuries. Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients' skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries so that proper plans for interventions can be made.

Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: A: community deterioration. B: health care costs. C: juvenile delinquency. D: population density.

B: health care costs. Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: A: fleeing to a shelter. B: homicide. C: possessive behavior. D: spontaneous abortion

B: homicide. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences. As a woman tries to leave the abusive relationship, the risk for homicide increases, creating a catch-22 scenario. A nurse encountering evidence of severe abuse needs to consider the safety of the woman and her children as the priority.

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: A: child neglect. B: family secrets. C: father-daughter incest. D: impaired family functioning.

C: father-daughter incest. Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: A: advocate for government programs to treat survivors. B: demonstrate the provider's commitment to address the need for services. C: increase awareness of community resources to address violence and abuse. D: increase the number of individuals identified as perpetrators.

C: increase awareness of community resources to address violence and abuse. Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.

A client tells the nurse that he believes his situation is intolerable and is observed isolating socially. Which nursing diagnosis should be considered? a. Hopelessness b. Deficient knowledge c. Chronic low self-esteem d. Compromised family coping

a. Hopelessness The defining characteristics are present for the nursing diagnosis of hopelessness. The characteristics of the other options are not presented in the statement or behavior of the client.

While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms? a. It is high risk, or a hard method. b. It is low risk, or a soft method. c. It was not an actual suicide attempt because the client was intoxicated. d. Considering the results, it is a nonlethal means.

a. It is high risk, or a hard method. Higher risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A: competition. B: unemployment. C: survivor guilt. D: work-related stress.

D: work-related stress. Productive and paid work is an expectation in mainstream American society. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.

Match each condition with the expected symptoms. Symptoms include verbal or auditory hallucinations, paranoia, insomnia, and psychosis. a. Schizophrenia b. Bipolar disorder c. Post traumatic stress syndrome d. Substance use disorder

a. Schizophrenia Schizophrenia: A condition causing a loss of touch with reality. This condition is often associated with verbal or auditory hallucinations, paranoia, insomnia, and psychosis. Sometimes the hallucinations can lead to behavior that seems rational to the client but is not to those observing the behavior.​

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? a. Constant 24-hour, one-to-one observation at arm's length b. One-to-one observation while client is awake c. Every 15-minute observation around the clock d. Seclusion with 15-minute observation

a. Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch since the client is unable to commit to seeking help to resist suicidal ideations.

Match each example with one of the challenges associated with mental illness. Last time Ali was in a mental health unit, she was assaulted by another patient. a. Facility inadequacy b. Lack of resources c. Comorbidity d. Stigma of mental illness​

a. Facility inadequacy Psychiatric technicians and security are frequently available in a mental health unit. Therefore, an assault on one patient by another should not occur, especially in adequately staffed facilities.​

Indicate if the client's mental health was most impacted by biological, genetic, or social factors. "My mom had major depressive disorder, and now I do too." a. Genetic b. Social c. Biological

a. Genetic Genetic factors: Certain mental illnesses occur in relatives and may put the client at higher risk of similar conditions. Having a relative with a mental illness DOES NOT mean the rest of the family may experience it. However, it DOES mean that there may be a higher likelihood of having the same condition.​

Unit practice requires inspection of all items being brought onto the unit by visitors. How can this be most effectively done? a. Having a staff member sit at the door and check packages as visitors enter. b. Having a staff member make frequent rounds during visiting hours to inspect gifts. c. Asking all visitors to report to the nurse's station before visiting a client. d. Asking clients to give staff any unsafe item that might have been left by a visitor.

a. Having a staff member sit at the door and check packages as visitors enter. A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety. None of the other options provide a measure of control before clients and visitors meet. Self-reporting by the visitors is not reliable.

Which resources are available through the Substance Abuse and Mental Health Services Administration (SAMHSA)? Select all that apply. a. Supportive employment programs b. Cognitive behavioral intervention for trauma in schools programs c. Assertive community treatment (ACT) team models d. Community case management programs e. Mobile crisis units f. Crisis housing programs g. Crisis intervention team (CIT) models h. Psychotropic medication management programs

a. Supportive employment programs b. Cognitive behavioral intervention for trauma in schools programs c. Assertive community treatment (ACT) team models d. Community case management programs e. Mobile crisis units f. Crisis housing programs g. Crisis intervention team (CIT) models h. Psychotropic medication management programs The Substance Abuse and Mental Health Services Administration (SAMHSA) is a branch of the Department of Health and Human Services tasked with identifying and treating mental illness. Many services are available through this government agency to treat mental health, reduce symptoms, and improve social and occupational functioning. Programs available through this agency include crisis housing programs, supportive employment programs, assertive community treatment (ACT) team models, crisis intervention team (CIT) models, psychotropic medication management programs, community case management programs, mobile crisis units, and cognitive behavioral intervention for trauma in schools programs.​

Which statement is the definition of mental illness? a. A condition causing auditory or visual hallucinations b. A condition that may disrupt activities of daily function c. A condition that causes an improvement in the activities of daily function d. A condition caused by a traumatic brain injury

b. A condition that may disrupt activities of daily function Mental illness is a condition that may disrupt activities of daily function. Schizophrenia is associated with auditory or visual hallucinations and is one type of mental illness. Traumatic brain injury can lead to mental illness, but it can also cause other symptoms and problems.​

Which is the greatest protective factor against the risk of suicide? a. One or more previous suicide attempts b. A sense of responsibility to family c. Fear of dying d. A cultural belief that suicide is a shameful resolution for a dilemma

b. A sense of responsibility to family Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor. Previous attempts are a high risk factor. None of the remaining options have the impact that support has on preventing suicide.

Match each condition with the expected symptoms. Symptoms include significant mood swings causing erratic behavior and severe depression. a. Schizophrenia b. Bipolar disorder c. Post traumatic stress syndrome d. Substance use disorder

b. Bipolar disorder Bipolar Disorder: A condition associated with significant mood swings causing erratic behavior and severe depression. Psychosis can lead to the need for immediate mental health care. In addition, these clients are at higher risk of suicidal ideation related to severe depressive swings.​

A patient had a distorted thought pattern, which led to very uncomfortable feelings and inappropriate behaviors. Which of the following types of therapy would most likely be successful? a. Behavioral therapy b. Cognitive-behavioral therapy c. Family therapy d. Group therapy

b. Cognitive-behavioral therapy Cognitive-behavioral therapy may be used in individual, family, couples, or group therapy. The goal is to identify and correct distorted thought patterns that can lead to troublesome feelings and behaviors. In comparison, behavioral therapy uses learning principles to change thought patterns and behaviors systematically; it is used to encourage the individual to learn specific skills to obtain satisfaction. Family therapy involves problem-solving sessions with members of the family. Group therapy involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of which feeling? a. Anger b. Disbelief c. Confusion d. Sympathy

b. Disbelief Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life." The statement doesn't demonstrate any of the other options as significantly.

A nurse suspects that a client is depressed. Which of the following symptoms is most likely being exhibited by the client? (Select all that apply.) a. Paranoia b. Fatigue c. Irritability d. Difficulty concentrating e. Hallucinations f. Impulsivity

b. Fatigue c. Irritability d. Difficulty concentrating Symptoms of depression include the following: persistent sad, anxious, or "empty" feelings; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; irritability, restlessness; loss of interest in activities or hobbies once pleasurable, including sex; fatigue and decreased energy; difficulty concentrating, remembering details, and making decisions; insomnia, early-morning wakefulness, or excessive sleeping; overeating or appetite loss; thoughts of suicide, suicide attempts; aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

What are the most important characteristics for staff members who work with suicidal clients? a. Organization b. Problem-solving skills c. Warm, consistent interaction d. Effective interview and counseling skills

c. Warm, consistent interaction Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency since they support the nurse-client relationship. While helpful, none of the other options have the impact of a effective nurse-client relationship.

Which of the following are the causes of mental illness? (Select all that apply.) a. Excessive amounts of brain serotonin, dopamine, and γ-aminobutyric acid b. Genetic inheritance combined with neurochemical and metabolic changes c. Living through a severe disaster, whether manmade or natural d. Physiological abnormalities in the brain structure e. Posttraumatic stress syndrome (PTSD) f. Social isolation, rejection, and/or stress

b. Genetic inheritance combined with neurochemical and metabolic changes c. Living through a severe disaster, whether manmade or natural d. Physiological abnormalities in the brain structure e. Posttraumatic stress syndrome (PTSD) f. Social isolation, rejection, and/or stress Genetic expressions, combined with neurochemical and metabolic changes and environmental insults, may result in the display of mental disorder characteristics. Evidence indicates that structural brain abnormalities can be related to some mental illnesses, such as schizophrenia, depression, and Alzheimer disease. Natural and manmade disasters, such as hurricanes, floods, violence, terrorism, war, and the global economic crisis are profound stress-inducing events that can lead to mental illness. Researchers reported high levels of PTSD among survivors.

Which of the following provides the best description of severe mental illness (SMI)? a. Having been clearly diagnosed with at least two mental health disorders within the past year b. Having a diagnosable mental disorder with moderate functional behavior in a specific area of lifestyle at any time during the past year c. Being unable to function in society due to a mental illness d. Being convicted of several impulsive crimes during the past year

b. Having a diagnosable mental disorder with moderate functional behavior in a specific area of lifestyle at any time during the past year SMI occurs in adults who currently or at any time during the past yearhave a diagnosable mental, behavioral, or emotional disorder with moderate, severe, or extreme functional behavior in specific areas of lifestyle. These mental health disorders afflicting persons who are 18 years of age or older present emotional or behavioral functioning that is so impaired as to interfere substantially with their capacity to remain in the community without supportive treatment or services of a long-term or indefinite duration.

What is the focus of the SAFE-T assessment tool? (Select all that apply.) a. Facilitate hospitalization. b. Identify level of suicidal risk. c. Development of client focused treatment. d. Introduce antidepressant medication therapy e. Stress collaboration with the client

b. Identify level of suicidal risk. c. Development of client focused treatment. e. Stress collaboration with the client The Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is an assessment tool that allows the clinician to benchmark relative risk (high, moderate, low) and to develop a treatment plan, in consultation with the patient, to reduce current risk. The tool does not provide for specific interventions.

Match each example with one of the challenges associated with mental illness. Josiah is unable to get counselling services because there is no funding available. a. Facility inadequacy b. Lack of resources c. Comorbidity d. Stigma of mental illness​

b. Lack of resources Josiah cannot get counseling services because there is a lack of resources available to him as a client with a mental health condition. Many times, city and state governments decide on these funding levels. Because counseling services may not be considered necessary by some lawmakers, there is a lack of resources.​

Which represent barriers to mental health treatment in ethnic populations? Select all that apply. a. Less stigma about mental health among minority populations b. Language barriers c. Trust in the health care system d. Lack of diversity among health care providers ​e. Lack of cultural understanding by health care providers f. Increased government assistance

b. Language barriers d. Lack of diversity among health care providers ​e. Lack of cultural understanding by health care providers

Which of the following best explains why having parity in insurance coverage does not always help persons with depression? a. Many persons find that the medications do not relieve symptoms. b. Most depressed persons do not seek treatment. c. Most depression is situational, and having insurance does not change the situation. d. Psychotherapists will not accept the low reimbursement offered by insurance plans.

b. Most depressed persons do not seek treatment. Although effective treatments and medications exist, most people (almost two thirds) with depressive illness do not seek help. Parity in insurance coverage helps for depressed persons who are encountering situational depression to receive services and promotes care being provided by a variety of providers.

In a veteran, which condition may be the primary cause of mental health issues? a. Major depressive disorder b. Post-traumatic stress syndrome c. Attention deficit disorder d. Substance use disorder

b. Post-traumatic stress syndrome The primary cause of a mental health issue in a veteran may be post-traumatic stress syndrome (PTSS), leading to substance use disorder or major depressive disorder.​

Which of the following statements is true regarding culture and protective factors against suicide? a. Asian Americans have the highest rates of suicide. b. Religion and the importance of family are protective factors for Hispanic Americans. c. Older women have the highest risk for suicide among African Americans. d. American Indians and Pacific Islanders have the lowest rates of suicide.

b. Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

An assessment tool that is useful to nurses in rating suicide risk is the a. AIMS scale. b. SAFE-T. c. CAGE questionnaire. d. Mini-Mental Status Examination.

b. SAFE-T. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The SAFE-T is short and easy to use and is focused on the risk for self-injury. That is not the focus of the other options.

Indicate if the client's mental health was most impacted by biological, genetic, or social factors. "I was sexually assaulted at a young age, and now I have nightmares and insomnia." a. Genetic b. Social c. Biological

b. Social Social factors: Mental illness is seen frequently in clients who experience abuse, sexual assault, or other traumatic events. In addition, poor nutrition, parenting behaviors, or low socioeconomic status can aggravate someone who may be more susceptible to a mental illness based on biological or genetic factors. Finally, those with mental illness may be more likely to commit crimes due to poor judgment, rage, fear, anxiety, or social circumstances.​

A family was very pleased with how well their child was doing now that he was on medication. They congratulated the nurse on getting their child help and said they were so impressed that the nurse was able to cure him. Which of the following would be the most appropriate response by the nurse? a. Congratulate them on being so supportive to their child through this ordeal. b. Stress that the medication is controlling the symptoms and their child will continue to need their support. c. Thank them for their recognition of the role you—and all nurses—play in promoting health. d. Verbalize your observations of how well their child is doing.

b. Stress that the medication is controlling the symptoms and their child will continue to need their support. Psychotherapeutic medications do not cure mental illness; they act by controlling symptoms. Thus, it is important for the nurse to stress to the family that the medication is controlling the symptoms and the child needs their continued support. Both of these factors are important for the long-term success and treatment of the child.

A patient with severe panic attacks refuses to come to the mental health clinic to get help even after being assured there is no charge for the initial assessment. Which of the following provides the best explanation for this behavior? a. People know that the treatment is to confront your fears in small doses, and the very idea is overwhelming and frightening. b. Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. c. The recurring symptoms such as tachycardia, chest pain, nausea, and sweating are seen as symptoms of a physical illness, not a mental illness. d. They are too depressed to take action.

b. Such persons have anticipatory anxiety, so they try to avoid situations that may lead to a panic attack, such as leaving their house. As the avoidance behavior intensifies, the client begins to withdraw further to avoid being in places or situations from which escape may be difficult. Individuals with agoraphobia frequently progress to the point where they cannot leave their homes without experiencing anxiety.

Which of the following events occurred in 1965? a. State mental hospitals were created. b. The mentally ill were deinstitutionalized. c. Electroconvulsive therapy was discovered to help depression. d. Community mental health centers for outpatient care were established.

b. The mentally ill were deinstitutionalized. Deinstitutionalization is the release of institutionalized people, especially mental health patients, from an institution for placement and care in the community and was initiated in 1965. From 1955 to 1980, the number of mentally ill patients in state facilities fell from 559,000 to 154,000 because patients moved back out into communities. The Community Mental Health Centers Act of 1964 provided federal support for mental health services. The act supported measures to implement facilities to care for those who were mentally retarded and to construct community mental health centers. The creation of state mental hospitals and the discovery of electroconvulsive therapy occurred before 1965.

Which of the following best describes how brain imaging scans are being used? a. To deliver electroconvulsive therapy to high-risk individuals b. To help detect and diagnose medical disorders and illnesses c. To help determine treatment options for mental disorders d. To help determine the effects of psychotherapy

b. To help detect and diagnose medical disorders and illnesses Brain imaging scans, also called neuroimaging scans, are being used more and more to help detect and diagnose a number of medical disorders and illnesses. Currently, the main use of brain scans for mental disorders is in research studies to learn more about the disorders. These researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain. Brain scans alone cannot be used to diagnose a mental disorder, such as autism, anxiety, depression, schizophrenia, or bipolar disorder (NIMH, 2010). Brain neuroimaging helps researchers study healthy brain development, effects of mental illnesses, or effects of mental health treatments on the brain.

Which legislative act acknowledged mental illness as a disease? a. Affordable Care Act in 2010 b. U.S. Surgeon General's Report on Mental Health in 1999 c. Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 ​d. Community Mental Health Centers Act (CMHCA) in 1963 ​

b. U.S. Surgeon General's Report on Mental Health in 1999 The U.S. Surgeon General's Report on Mental Health in 1999 acknowledged mental illness as a disease.​ The Community Mental Health Centers Act (CMHCA) in 1963 encouraged the deinstitutionalization of people with mental health conditions. The Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 introduced insurance coverage for mental health and substance use conditions. The Affordable Care Act in 2010 extended federal protection to 62 million Americans with mental health issues.​

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? (Select all that apply.) a. How long the client has been suicidal b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan e. Has the client been suicidal in the past

b. Whether the plan has specific details c. Whether the method is one that could cause death d. Whether the client has the means to implement the plan Lethality refers to how deadly a plan is. The length of time a client has been suicidal or a history suicidal thoughts have nothing to do with the lethality of the plan. While the remaining options present important about the seriousness of the plan.

A student nurse on the psychiatric unit expresses being uncomfortable about discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern? a. "I'm glad you are thinking that way. They may not have thought of suicide before, and we don't want to introduce that." b. "You are right; however, because of professional liability, we have to ask that question." c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." d. "If I were you, I'd ask the health provider to talk to the patient about that subject."

c. "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

Which of the following females would be at greatest risk for developing anorexia nervosa? a. A young woman who had been badly hurt in a car accident and is now living with her grandparents but managing to retain her high school Grade Point Average (GPA) b. A young woman who is a fantastic athlete but acts out and does what she feels is best, regardless of what others think c. A "good girl," obedient to her parents' wishes, who always agrees with peers in her clique and strives to do everything perfectly d. A student under a lot of stress from family events at home but who has good coping skills and recognizes that she is coping with major life changes

c. A "good girl," obedient to her parents' wishes, who always agrees with peers in her clique and strives to do everything perfectly Risk factors for eating disorders are perfectionism, low self-esteem, stress, poor coping skills, sexual/physical abuse, poor self-image, dependency on others' opinions and deference to others' wishes, and being emotionally reserved. Based on these descriptors and the typical characteristics of a person who has anorexia, the "good girl" demonstrates the greatest risk.

Which of the following females would be at greatest risk for developing bulimia nervosa? a. A 13-year-old who is constantly snacking on food from her backpack all day b. A 14-year-old student who is known as a nerd c. A 15-year-old cheerleader who wants to be a professional ballerina d. An 11-year-old student with the highest Grade Point Average (GPA) in the school

c. A 15-year-old cheerleader who wants to be a professional ballerina Bulimia nervosa typically begins in adolescence or during the early 20s, usually in conjunction with a diet. High school and college students, as well as members of certain professions that emphasize weight and/or appearance (e.g., dancers, flight attendants, cheerleaders, athletes, actors, models), are at a high risk. Based on these descriptors and the typical characteristics of a person who has bulimia, the 15-year-old cheerleader demonstrates the greatest risk.

Indicate if the client's mental health was most impacted by biological, genetic, or social factors. "I have hyperthyroidism and was diagnosed with panic attacks." a. Genetic b. Social c. Biological

c. Biological Biological factors: Many physical problems can mimic mental illness. Therefore, if someone experiences symptoms associated with mental illness, a medical evaluation is needed to determine other possible causes. Frequently seen conditions include hyperthyroidism, hypothyroidism, visual or auditory deficits, medication side effects or adverse effects, brain lesions, or other potential hormone imbalances. Additional biological factors include traumatic brain injury.​

Indicate if the client's mental health was most impacted by biological, genetic, or social factors. "These steroids are causing me to be depressed." a. Genetic b. Social c. Biological

c. Biological Biological factors: Many physical problems can mimic mental illness. Therefore, if someone experiences symptoms associated with mental illness, a medical evaluation is needed to determine other possible causes. Frequently seen conditions include hyperthyroidism, hypothyroidism, visual or auditory deficits, medication side effects or adverse effects, brain lesions, or other potential hormone imbalances. Additional biological factors include traumatic brain injury.​

Which of the following best summarizes the symptoms of a person with bipolar disorder? a. Chronic, unrealistic, and exaggerated worry about life b. Ongoing hallucinations and delusions c. Changes in mood from depression to mania d. A persistent abnormally elevated or irritable mood

c. Changes in mood from depression to mania Bipolar disorder refers to a group of mood disorders that present with changes in mood from depression to mania. The depressed phase is manifested by symptoms seen in major depressive disorder. The manic phase is characterized by a persistent abnormally elevated or irritable mood, impaired judgment, flight of ideas, pressured speech, grandiosity, distractibility, excessive involvement in goal-directed activities, few hours sleeping, and impulsivity. These symptoms may co-occur with psychotic features, such as hallucinations and delusions. Generalized anxiety disorder is characterized by chronic, unrealistic, and exaggerated worry and tension about one or more life circumstances lasting 6 months or longer.

Which approach is the most common model currently used for the treatment of mental illness? a. Hospitalization b. Institutionalization c. Community-based treatment d. Deinstitutionalization

c. Community-based treatment Currently, community-based treatment is the basis for care of clients with mental illness. Hospitalization is used in urgent or emergent circumstances when clients are a danger to themselves or others. Institutionalization was used in the 1960s and before. Deinstitutionalization occurred after the Community Mental Health Centers Act (CMHCA) became law in 1963.​

Match each example with one of the challenges associated with mental illness. Andrea is on risperidone. At a recent medical appointment, she had a fasting blood sugar of 130. a. Facility inadequacy b. Lack of resources c. Comorbidity d. Stigma of mental illness​

c. Comorbidity Andrea may have diabetes mellitus type 2, a comorbid condition, which is common in someone taking psychiatric medications.​

Which of the following mental illnesses is most frequently diagnosed among adults in the United States? a. Acute stress disorder b. Bipolar disorder c. Depression d. Schizophrenia

c. Depression Depression is the most frequently diagnosed and one of the most disabling mental illnesses in the United States. Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. Acute stress disorder, bipolar disorder, and schizophrenia are not diagnosed as frequently as depression.

A nurse is working in a community setting caring for persons with mental health problems and their families. Which of the following is the most important and critical task for this nurse? a. Be an advocate by writing letters to legislators demanding more resources for care for the mentally ill b. Encourage all those involved to fight the community's tendency to stigmatize the mentally ill and their families c. Establish supportive interpersonal relationships with all those involved d. Lobby for increased funding for care of the mentally ill

c. Establish supportive interpersonal relationships with all those involved Perhaps the most critical impact made by the nurse in a community setting is through the establishment of interpersonal relationships with clients. Establishing supportive relationships is the first step in the role of the community mental health nurse as coach for mental and physical health promotion. After a supportive relationship has been established, the nurse will be more knowledgeable about the needs of the population and will be a better advocate and lobbyist for the population.

Which of the following behaviors best represent the definition of mental health? (Select all that apply.) a. Currently enjoys receiving unemployment benefits b. Frequent dates, although most relationships are short term c. Happily married and successful parent of three children d. Just promoted with more responsibilities and increased salary e. Lives alone in a small apartment f. Set up a memorial fund for research after death of a family member

c. Happily married and successful parent of three children d. Just promoted with more responsibilities and increased salary f. Set up a memorial fund for research after death of a family member In 1999, the Surgeon General's Report on Mental Health defined mental health as a state of successful performance of mental function that results in productive activities, fulfilling relationships with others, and an ability to adapt to change and cope with adversity. The correct behaviors represent the ability to maintain employment and relationships, and to adapt to change, including adversity. The incorrect responses demonstrate behaviors that do not support mental health - enjoyment in receiving unemployment benefits, short-term relationships, and living alone.

A person with obsessive-compulsive disorder (OCD) knows the ritual is senseless, but is unable to stop. Which of the following best explains why he does not quit doing the ritual? a. As rituals become habit, others will worry about the person if he or she suddenly stops engaging in the ritual behavior. b. Engaging in rituals allows the individual to feel in control. c. If the compulsion is resisted, anxiety increases. d. Rituals, even if nonsensical, are comforting and reassuring.

c. If the compulsion is resisted, anxiety increases. The person with OCD feels compelled to engage in some ritual to avoid a persistent frightening thought, idea, image, or event. Obsessions are recurrent thoughts, emotions, or impulses that cannot be dismissed. Compulsions are the rituals or behaviors that are repeatedly performed to prevent, neutralize, or dispel the dreaded obsession. When the individual tries to resist the compulsion, anxiety increases.

Which of the following best describes how people with mental illness are viewed by the general public? a. Individuals in need of assistance b. Criminals who need to be institutionalized c. Lazy, weak, and immoral d. Contributing members of society

c. Lazy, weak, and immoral Throughout history, the symptoms of mental illness have been perceived as permanent, dangerous, frightening, and shameful. People with a diagnosis of mental illness have been described as lazy, idle, weak, immoral, irrational, and, too often, criminal.

Which suicide prevention intervention that has the greatest impact on a client's safety? a. Educating visitors about potentially dangerous gifts. b. Restricting the client from potentially dangerous areas of the unit. c. One-on-one observation by the staff. d. Removal of personal items that might prove harmful.

c. One-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm. While the remaining options provide some protection, none have the impact of constant supervision.

Match each condition with the expected symptoms. Symptoms include recurrent nightmares, insomnia, severe anxiety, and depression that continues after an event. a. Schizophrenia b. Bipolar disorder c. Post traumatic stress syndrome d. Substance use disorder

c. Post traumatic stress syndrome Post Traumatic Stress Syndrome (PTSS): A condition caused by experiencing a traumatic event. Symptoms include recurrent nightmares, insomnia, severe anxiety, and depression. There is a potential risk for substance use as a way of treating the pain associated with this.​

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. Which is the most appropriate short-term goal for this diagnosis? a. Will reclaim any prized possessions that were given away. b. Be able to name three personal strengths. c. Seek help when feeling self-destructive. d. Consistently participate in a self-help group.

c. Seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal presented for Risk for self-directed violence since it focuses on client safety.

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? a. γ-Amino-butyric acid b. Dopamine c. Serotonin d. Acetylcholine

c. Serotonin Low serotonin levels have been noted among individuals who have committed suicide. None of the other options are as directly related in the physiology of depression.

Which of the following was required by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008? a. That alcoholism be recognized as a disease and treatment be given in residential facilities b. That drug addiction be accepted as a mental health diagnosis and addicts be treated rather than jailed when caught c. That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness d. That community clinics must treat clients for mental illness just as they treat prisoners who have a physical illness

c. That health insurance must cover treatment for mental illness on the same terms and conditions as physical illness In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted. The law requires health insurance to cover treatment for mental illness on the same terms and conditions as physical illness. This law does not require that alcoholism be recognized as a disease, that drug addiction be accepted as a mental health diagnosis, or that community clinics must treat clients for mental illness.

Which of the following would be most upsetting for American families when their loved one, after serving in Iraq or some other battlefield, returns home? a. Many families, especially those with children, do not want guns in the house. b. Reabsorbing them into the family structure is challenging and difficult. c. The suicide rate is twice as high as among nonveteran adults. d. They must use the Veterans Affairs medical system for medical care.

c. The suicide rate is twice as high as among nonveteran adults. Male veterans in communities are twice as likely to die by suicide as their civilian counterparts. There is nothing to support that these veterans will have guns in their homes. The veterans will be able to use the Veteran Affairs system for medical care and there may be challenges with their return home, but that should not be as upsetting as the risk for suicide for their loved one.

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." How should the nurse respond to the client's concern? a. "I understand" and allow the client to close the door. b. Keep the door open, but step to the side out of the client's view. c. Leave the client's room and wait outside in the hall. d. "For your safety I can be no more than an arm's length away."

d. "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate. The correct statement reinforces the basic need for client safety. The other options fail to provide for the degree of client safety required.

Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment? a. "I know a lot of people care about me and want me to get better." b. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I think things will be better soon."

d. "I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

A nurse is picking up her child from nursery school when the day care teacher says to her, "One of the boys we care for does not seem able to sit still and listen, but is always running around and getting into things. His parents are not worried. His mother said her brother was the same way when he was a kid. Since you are a nurse, do you have any ideas on how I can calm him down?" Which of the following would be the most appropriate response by the nurse? a. "I'm not a pediatric nurse; I really don't know what to tell you." b. "I'm sorry you're concerned, but being impulsive and very physically active is quite normal for 3- to 4-year-old children." c. "Tell the parents he has to see the doctor as he's not doing well in nursery school." d. "Why not suggest that it's time for him to have a complete assessment and suggest the physician call you for an update on how he is doing in nursery school?"

d. "Why not suggest that it's time for him to have a complete assessment and suggest the physician call you for an update on how he is doing in nursery school?" The three major characteristics of attention-deficit hyperactivity disorder/attention-deficit disorder (ADHD/ADD) are inattention, hyperactivity, and impulsivity. Although parents may notice symptoms and signs, it is often teachers who recognize the behaviors consistent with ADHD/ADD and suggest referral for assessment and treatment. Suggesting a referral is the most appropriate response for the nurse because of the symptoms that have been reported.

Which statement factually describes the act of suicide? a. More women than men commit suicide. b. The Jewish culture has the lowest suicide rate. c. Suicide is the leading cause of death in the United States. d. A client diagnosed with schizophrenia is at great risk for attempting suicide.

d. A client diagnosed with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 8 times more likely to attempt suicide than is the general public. Suicide is the tenth leading cause of death in the United States. Protestants and the Jewish culture have a higher rate of suicide than do Catholics. More women attempt suicide, but more men are successful.

When working with a client who may have made a covert reference to suicide, the nurse should base the response on what statement? a. Being careful not to mention the idea of suicide. b. Listening carefully to see whether the client mentions suicide more overtly. c. Asking about the possibility of suicidal thoughts in a covert way. d. Asking the client directly if they are thinking of attempting suicide.

d. Asking the client directly if they are thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. None of the other options should direct this discussion.

Which of the following was the primary recommendation of the New Freedom Commission on Mental Health report for the mental health service delivery system? a. Advised the president to drastically increase funding for mental health b. Increased scholarships and grants to health care professionals willing to specialize in care of the mentally ill c. Suggested the federal government take over responsibility for mental health care for all citizens d. Called for a shift from a fragmented nonsystem to an integrated comprehensive approach to care delivery

d. Called for a shift from a fragmented nonsystem to an integrated comprehensive approach to care delivery The commission acknowledged that mental illness comprises the only type of illness that defies a comprehensive delivery approach. This is due to the way the state and local governments organize, manage, and carry out distinct treatment systems, making comprehensive care impossible in the larger health care system. Thus, the commission called for a shift in the fragmented system to an integrated comprehensive approach to mental health care delivery. The commission did not suggest a drastic increase in funding or scholarships or suggest that the federal government take over responsibility for mental health care for all citizens.

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? a. Plastic plate b. Cloth napkin c. Styrofoam cup d. Metal utensils

d. Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays since metal utensils can be used to cause physical harm. None of the other options carry that same degree of risk.

Match each example with one of the challenges associated with mental illness. Edward notices that when he applies for a job, no one will hire him even though he is taking his medications. a. Facility inadequacy b. Lack of resources c. Comorbidity d. Stigma of mental illness​

d. Stigma of mental illness​ Edward is unable to get a position because he is taking medication for his disorder. Unfortunately, with some of these disorders, clients feel obligated to tell their employer. However, then the stigma of mental illness can prevent someone from getting selected for a position.​

A student said she wanted to discuss an issue with the nurse but that it was confidential. Therefore, she asks the nurse to promise as a professional to keep this a secret. She then shares that her roommate is very depressed; her older sister committed suicide, and she is planning on killing herself if she does not pass her final examinations. Which of the following actions should be taken by the nurse? a. As a professional who made a promise, the nurse teaches the student how to recognize if her roommate is getting ready to actually do it and the phone number of the suicide hot line. b. As secrecy was promised, the nurse can only encourage the student to encourage her roommate to seek help. c. The nurse should give the student brochures and information plus the suicide hotline phone number to share with her roommate. d. The nurse should stress that one cannot keep a secret when someone's life is at stake and immediately go to assess the roommate.

d. The nurse should stress that one cannot keep a secret when someone's life is at stake and immediately go to assess the roommate. Suicide is preventable. Most people want to live but sometimes cannot see any other alternative. Now that the nurse knows the roommate is talking about suicide, the nurse cannot agree to keep the secret but must intervene and seek immediate help.

A college student visits the student health center and tells the nurse that his roommate is talking about killing himself, has given some of his possessions away, and he believes the roommate has a gun. Which of the following actions should be taken by the nurse? a. Ask the student why he is telling this story; what does he expect the nurse to do? b. Call the police immediately, and have the student tell them the story. c. Call the roommate, and set up an appointment for him to come to the student health center to discuss how things are going in his life right now. d. Call the roommate, ask if he is thinking of killing himself, and, if so, how is he thinking of doing that? e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive.

e. Immediately locate the roommate, talk to him, and, if the story is confirmed, stay with him until emergency services arrive. Whenever an individual exhibits suicide warning signs, nurses should refer the person to a mental health clinic or provider as soon as possible. This may involve taking emergency action by calling the local emergency services number in the community and staying with the person until help arrives.

Which statement best describes a mental illness requiring further follow-up? a. A person has similar symptoms to friends who have a mental illness. b. Mild symptoms are experienced for a few days. c. A person suspects they have mental illness. d. Mental illness has been diagnosed, but no symptoms are experienced at e. this time. f. Symptoms significantly impact functions of daily life.

f. Symptoms significantly impact functions of daily life. Further follow-up is needed when someone's symptoms significantly impact the functions of daily life. People who suspect mental illness or have friends with similar symptoms can seek further evaluation, but this is not urgent if the symptoms do not impact daily life. Typically, symptoms lasting 3 to 6 months require treatment.​