Mental Health Unit 1
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
Positron emission tomography (PET) scan Rationele The positron emission tomography scan provides information about function; the other imaging techniques provide information about structure.
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.
Regulate conscious mental activity. Rationele When the brain cannot regulate conscious mental activity, the individual's speech patterns demonstrate incoherence and lack of reality orientation.
Which nursing intervention demonstrates the theory behind operant conditioning? a. Rewarding the client with a token for avoiding an argument with another client b. Showing the client how to be assertive without being aggressive c. Demonstrating deep breathing techniques to a group of clients d. RExplaining to the client the consequences of not following unit rules
Rewarding the client with a token for avoiding an argument with another client Rationele Operant conditioning is the basis for behavior modification and uses positive reinforcement to increase desired behaviors. For example, when desired goals are achieved or behaviors are performed, patients might be rewarded with tokens. These tokens can be exchanged for food, small luxuries, or privileges. This reward system is known as a token economy. None of the remaining options demonstrate reward for positive behaviors, climate, and structure, for healing.
A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept? Emotional consequence Schema Actualization Aversion
Schema Rationele Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment.
Which severe mental illness is recognized across cultures?
Schizophrenia, Bipolar disorder
Which theorist is associated with behavioral therapy? Freud Skinner Sullivan Peplau
Skinner Rationele B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.
Which function is classified as a circadian rhythm? Sex drive Sleep cycle Skeletal muscle contraction Maintenance of a focused stream of consciousness
Sleep cycle Rationele 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.
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
The autonomic nervous system Rationele 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 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
The results of the liver function test Rationele 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.
Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met? a. "I really think I can succeed in school now." b. "I'm experiencing much less anxiety about school now." c. "Going back to school is hard and I'll need support." d. "I know that I'm not the only person who has a difficult time in school."
"I'm experiencing much less anxiety about school now." Rationele Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions
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? a. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." b. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." c. "Neurotransmitters are chemicals in the brain that are the reason you are depressed." d. "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."
"Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Rationele 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.
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?
"We have the specialized skills needed to care for those with mental illnesses." Rationele 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 cognitive therapist would help a client restructure the thought "I am stupid!" to which statement? a. "What I did was stupid." b. "I am not as smart as others." c. "Things usually go wrong for me." d. "Things like this should not happen to anyone."
"What I did was stupid." Rationele Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.
According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory? a. Recent memory b. Long-term memory c. All memories d. Painful memories
All memories Rationele Freud described the conscious part of the mind as containing all of the material that the person is aware of at any one time and so as dysfunction of the conscious mind involves all memories.
When treating mental illnesses with psychotropic drugs what is the focus of the treatment? a. Altering brain neurochemistry. b. Correcting brain anatomical defects. c. Regulating social behaviors. d. Activating the body's normal response to stress.
Altering brain neurochemistry. Rationele Psychotropic drugs act to increase or decrease neurotransmitter substances within the brain, thus altering brain neurochemistry.
According to current information what factor is associated with the most disabling mental disorders?
Biological influences Rationele 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
What term is used to identify the structures that respond to stimuli, conduct electrical impulses, and release neurotransmitters? Neurons Synapses Dendrites Receptors
Neurons Rationele Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events.
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)?
Clinical Rationele 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.
What is the function of a neuron? a. Conduction of electrical impulses b. Diffuses an impulse across a space c. Provides a space at an axon terminal d. Provides an attachment point of the cell surface
Conduction of electrical impulses Rationele 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.
A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care?
Establishing a framework for selecting appropriate interventions. Rationele 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.
The nurse planning care for a mentally ill client bases interventions on which concept?
Every client has a certain degree of resilience. Rationele 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.
The nurse providing anticipatory operant conditioning guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by which intervention? a. Giving the child what he/she is asking for b. Scolding the child when he/she displays tantrum behaviors c. Spanking the child at the onset of the tantrum behaviors d. Ignoring the tantrum and giving attention when the child acts appropriately
Ignoring the tantrum and giving attention when the child acts appropriately Rationele Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction.
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
Impaired balance Rationele 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.
A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement? a. The biological model is the oldest and most reliable model for explaining mental illness. b. The biological model has been proven to be successful in finding the cause of most symptoms of mental illness. c. The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. d. In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.
In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. Rationele In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.
The nurse is caring for an adult client who experienced severe physical abuse from the age of 2 through 12. What information should the nurse provide the client concerning the function of the "id" and the ability to function as an adult? a. It has control over the emotional frustration felt as an adult. b. It is the source of one's survival instincts. c. It is severely damaged by abuse experienced before the age of 5 years. d. It provides an individual with the ability to differentiate believed and real experiences.
It is the source of one's survival instincts. Rationele Freud delineated three major and distinct but interactive systems of the human personality. At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us. The id provides an individual with the instincts to survive the emotional trauma associated with physical abuse. None of the other statements accurately describes the id's role in adult functioning.
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"
Laughing at a joke Rationele 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.
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
Less anxiety Rationele 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.
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
Lithium Rationele Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.
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
Monitoring for abnormal involuntary movements Rationele 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 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. "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." Rationele 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
What is the premise underlying behavioral therapy? a. Behavior is learned and can be modified. b. Behavior is a product of unconscious drives. c. Motives must change before behavior changes. d. Behavior is determined by cognitions; change in cognitions produces new behavior.
a. Behavior is learned and can be modified. Rationele The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. None of the remaining options are true statements when considering behavioral therapy
According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? Select all that apply. 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. I've been really anxious for at least 2 years now. 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.
Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5? a. It is a medical psychiatric assessment system. b. It is a compendium of treatment modalities. c. It offers a complete list of nursing diagnoses. d. It suggests common interventions for mental disorders.
a. It is a medical psychiatric assessment system. Rationele The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses. None of the other options are accurate descriptions.
The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority? a. Making the client feel physically and emotionally safe b. Teaching the client effective coping skills c. Identifying the client's positive traits d. Focusing on preparing the client for a speedy discharge
a. Making the client feel physically and emotionally safe Rationele Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher level needs
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. "By educating the public on the effects that stigmatizing has on mental health clients." Rationele 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.
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. "Losing my job was hard but my skills will help me get another one." Rationele 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.
Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority? a. Assessing the client's ability to fulfill appropriate developmental level tasks b. Assessing the client for strengths upon which a nurse-client relationship can be based c. Planning one-on-one time to assist in identifying the fears trigger the client's anxiety d. Evaluating the client's ability to learn and retain essential information regarding their current condition
b. Assessing the client for strengths upon which a nurse-client relationship can be based Rationele The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.
Freud believed that individuals cope with anxiety by implementing which mechanism? a. The superego b. Defense mechanisms c. Security operations d.Cognitive distortions
b. Defense mechanisms Rationele The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings. None of the other options were proposed by Freud as a mechanism for dealing with anxiety.
How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? a. Ask the client whether he views himself as being depressed. b. Identify the client's culture's view regarding suicide. c. Explain that suicide is often regarded as a desperate act. d. Assess the client for other examples of depressive behaviors.
b. Identify the client's culture's view regarding suicide. Rationele 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.
Role-playing is associated with which type of psychotherapy? a. Psychoanalysis b. Modeling c. Operant conditioning d. Systematic desensitization
b. Modeling Rationele In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy. Demonstration of specific behaviors are not supported by any of the remaining options.
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? a. Self-control b. Rational thinking c. Learning and productivity d. Positive self-concept
b. Rational thinking Rationele 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.
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. "You will attend a psychotherapy group that I lead that will help you care for yourself." Rationele Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.
What client assessment data demonstrates parity related to mental health care? a. The client is admitted for a 72-hour mental hygiene evaluation. b. Advance practice nurse can be certified as psychiatric nurse specialist. c. A client's mental health coverage is equal to his/her medical/surgical coverage. d. A client who has attempted suicide is hospitalized for a mental health evaluation.
c. A client's mental health coverage is equal to his/her medical/surgical coverage. Rationele 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.
How does Harry Stack Sullivan's Interpersonal Theory view anxiety? a. An emotional experience felt after the age of 5 years. b. A sign of guilt in adults. c. A painful emotion arising from social insecurity. d. The result of trying to go beyond experiences of guilt and pain.
c. A painful emotion arising from social insecurity. Rationele According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.
The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience? a. Spending one-on-one time with staff to establish trust b. Providing them with the opportunity to select which unit activities they will participate in to gain autonomy c. Encouraging them to talk about their school plans to help achieve identity d. Assign them to help clean up the dayroom to develop a sense of industry
c. Encouraging them to talk about their school plans to help achieve identity Rationele According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. While appropriate activities none of the options are specifically identified with the developmental task for a 14-year-old.
The mental health status of a particular client can best be assessed by considering which factor? a. The degree of conformity of the individual to society's norms b. The degree to which an individual is logical and rational c. Status placement on a continuum from health to illness d. Rate of demonstrated intellectual and emotional growth
c. Status placement on a continuum from health to illness Rationele 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.
Diathesis-Stress Model
combination of genetic vulnerability and negative environmental stressors
Which client problem would be most suited to the use of interpersonal therapy? a. Disturbed sensory perception b. Impaired sensory perception c. Medication noncompliance d. Dysfunctional grieving
d. Dysfunctional grieving Rationele Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit
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? a. The client is demonstrating symptoms of bipolar disorder. b. The client is demonstrating socially deviant behavior. c. The client is engaging in egocentric behaviors. d. The client is not conforming with social norms.
d. The client is not conforming with social norms. Rationele Behavior that deviates from socially accepted norms does not indicate a mental illness unless there is significant disturbance in mental functioning.
Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression?
dopamine, seretonin, norepinephrine
What term is used to identify the quantitative study of the distribution of mental disorders in human populations?
epidemiology Rationele 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.
