Class 13 Mental Health

You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy? a. "Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed." b. "Dr. Raye, during her admissions interview Kiley stated that she has had three other suicide attempts in the past." c. "Kiley, can you tell me more about your depression and your suicide attempt?" d. "Kiley, I will take you on a tour of the unit and orient you to the rules."

a. "Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed." 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.

A cognitive therapist would help a client restructure the thought "I am stupid!" to 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."

a. "What I did was stupid." 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.

You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient? a. Rapid, pressured speech b. Grandiose thoughts c. Lack of sleep d. Hyperactive behavior

c. Lack of sleep Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.

The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to a. establish trust. b. gain autonomy. c. achieve identity. d. develop a sense of industry.

c. achieve identity. 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.

According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with a. only recent memory. b. both recent and long-term memory. c. all material that the person is aware of at any one time. d. only material that should be easily retrieved.

c. all material that the person is aware of at any one time. Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time.

Sullivan viewed anxiety as a. emotional experience felt after the age of 5 years. b. a sign of guilt in adults. c. any painful feeling or emotion arising from social insecurity. d. adults trying to go beyond experiences of guilt and pain.

c. any painful feeling or emotion arising from social insecurity. 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.

Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? a. experimental b. descriptive c. clinical d. analytic

c. clinical 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.

The quantitative study of the distribution of mental disorders in human populations is called a. mortality. b. prevalence. c. epidemiology. d. clinical epidemiology.

c. epidemiology. 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.

The mental health status of a particular client can best be assessed by considering a. the degree of conformity of the individual to society's norms. b. the degree to which an individual is logical and rational. c. placement on a continuum from health to illness. d. the rate of intellectual and emotional growth.

c. placement on a continuum from health to illness. Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.

A nursing diagnosis for a client with a psychiatric disorder serves the purpose of a. justifying the use of certain psychotropic medication. b. providing data essential for insurance reimbursement. c. providing a framework for selecting appropriate interventions. d. completing the medical diagnostic statement.

c. providing a framework for selecting appropriate interventions. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.

Using the total environment, including the people, setting, and emotional climate, as therapy is called _____________ therapy.

Milieu Milieu therapy uses the environment, including people, setting, emotional climate, and structure, for healing.

Which of the following is considered a primary behavioral theorist? a. Freud b. Skinner c. Sullivan d. Peplau

b. Skinner 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.

The premise underlying behavioral therapy is 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. 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.

Which statement best describes the 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. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.

Which statement best clarifies the difference between the art and the science of nursing? a. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. b. The art is the way in which knowledge is applied, and the science is the technological aspects of caregiving. c. The art is the applied technology of practice, and the science is the problem-solving and teaching aspects of caregiving. d. The art is the assessing and planning phases of the nursing process, and the science lies in implementing and evaluating.

a. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. This statement reflects the larger thinking of the profession.

Current information suggests that the most disabling mental disorders are the result of a. biological influences. b. psychological trauma. c. learned ways of behaving. d. faulty patterns of early nurturance.

a. biological influences. 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.

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by: a. cultural and ethnic factors. b. occupation and status. c. birth order. d. sexual preference.

a. cultural and ethnic factors. The DSM-5 states there is evidence to suggest that mental illness is influenced by cultural and ethnic factors. The DSM-5 does not state that there is evidence that occupation, birth order, or sexual preference affect mental illness.

The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially the nurse's priority is to a. establish trust with the client. b. teach the client effective mothering skills. c. identify positive traits the client possesses. d. focus on preparing for a speedy discharge.

a. establish trust with the client. 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.

The nurse planning care for a mentally ill client bases interventions on the concept that the client a. has areas of strength on which to build. b. has right that must be respected. c. comes with experiences that contribute to their problem. d. share fears that are similar to those of all mentally healthy individuals.

a. has areas of strength on which to build. 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.

Maslow's theory of humanistic psychology has provided nursing with a framework for a. holistic assessment. b. determining moral development. c. identifying the potential for success in therapy. d. conducting nurse-client interpersonal interactions.

a. holistic assessment. Central to Maslow's theory is the assumption that human beings are active rather than passive participants in life, striving for self-actualization. Maslow (1968) focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs (see Figure 2-5 in the text). Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This picture is broader and more holistic. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships.

A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client a. is displaying deviant behavior. b. cannot accurately appraise reality. c. is seriously and persistently mentally ill. d. should be considered for group home placement.

a. is displaying deviant behavior. This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.

One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand a. the root causes of client suffering. b. the client's immature behavior. c. the client's interpersonal interactions. d. the client's psychological ability to reason.

a. the root causes of client suffering. Freud's theory of the unconscious is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can develop and begin to think about the root causes of client suffering.

A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking? a. Control over behavior b. Appraisal of reality c. Effectiveness in work d. Healthy self-concept

b. Appraisal of reality The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.

Which statement about diagnosis of a mental disorder is true? a. The symptoms of each disorder are common among all cultures. b. Culture may cause variations in symptoms for each clinical disorder. c. All mental disorders listed in the DSM-5 are seen in all other cultures. d. Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.

b. Culture may cause variations in symptoms for each clinical disorder. Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five axes system was abandoned in this edition of the DSM-5.

Role-playing is associated with which type of therapy? a. Psychoanalysis b. Modeling c. Operant conditioning d. Systematic desensitization

b. Modeling 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.

Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be a. assessing the client's success at fulfilling her appropriate developmental level tasks. b. assessing the client for her strengths upon which a nurse-client relationship can be based. c. planning one-on-one time with the client to assist in identifying the fears behind her anxiety. d. evaluating the client's ability to learn and retain essential information regarding her condition.

b. assessing the client for her strengths upon which a nurse-client relationship can be based. 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 using a. the superego b. defense mechanisms. c. security operations. d. suppression.

b. defense mechanisms. The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings.

In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to a. ask the client whether he views himself as being depressed. b. identify his culture's view regarding suicide. c. explain to him that suicide is often regarded as a desperate act. d. assess the client for other examples of depressive behaviors.

b. identify his culture's view regarding suicide. 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, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.

Sullivan's term security operations and Freud's term of defense mechanisms both reflect actions that serve to: a. increase self-esteem. b. reduce anxiety. c. increase self-awareness. d. reduce cognitive distortions.

b. reduce anxiety. 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 nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by: a. becoming active in politics leading to a potential political career. b. reducing the stigma of mental illness and advocating for equality in treatment. c. encouraging 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. reducing the stigma of mental illness and advocating for equality in treatment. 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.

One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is: a. dependence. b. resilience. c. pessimism. d. altruism.

b. resilience. Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as being dependent 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.

Lucas states, "I will always be alone because nobody could love me." This is most likely an example of: a. emotional consequence. b. schema. c. actualization. d. aversion.

b. schema. 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.

These severe mental illnesses are recognized across cultures: a. antisocial and borderline personality disorders. b. schizophrenia and bipolar disorder. c. bulimia and anorexia nervosa. d. amok and social phobia.

b. schizophrenia and bipolar disorder. Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.

When asked, the nurse explains that a client's id is a. the control over the emotional frustration he feels over the loss of his job. b. the source of his instincts to save himself from hurting himself. c. not in place since he was abused after the age of 5 months. d. able to differentiate his believed experiences and reality.

b. the source of his instincts to save himself from hurting himself. 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.

A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is a. "You are dealing with a very difficult and resistant client; just keep with your plan." b. "If you haven't been able to establish client trust by now, ask for a change of assignment." c. "Remember that sarcasm represents the oral-stage fixation of development." d. "You are attempting to work with a client who likes to keep others off-balance."

c. "Remember that sarcasm represents the oral-stage fixation of development." According to Freud's psychosexual stages of development, this client is exhibiting the oral (0-1 year) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence; the use of sarcasm; and the development of orally focused habits (e.g., smoking, nail biting).

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?" The nurse responds best by answering: a. "Don't be afraid; it means I'm here to help, not hurt, you." b. "Psychiatric mental health nurses care for people with mental illnesses." c. "We have the specialized skills needed to care for those with mental illnesses." d. "The nurses who work in mental health facilities have that title."

c. "We have the specialized skills needed to care for those with mental illnesses." 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.

You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a licensed Registered Nurse. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement? 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." d. "You will see your provider daily in a one-to-one session."

c. "You will attend a psychotherapy group that I lead." Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.

Which of the following best 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 medical/surgical coverage. d. A client who has attempted sucide is hospitalized for a mental health evaluation.

c. A client's mental health coverage is equal to his medical/surgical coverage. 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.

An important difference between the developmental theories of Freud and Erikson is a. Freud considers the entire life span from birth to old age. b. Freud focuses to a greater extent on cognitive development. c. Erikson viewed individual growth in terms of social setting. d. Erikson focuses on the development of individual moral thinking.

c. Erikson viewed individual growth in terms of social setting. Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages.

Which client problem would be most suited to the use of interpersonal therapy? a. Disturbed sensory perception b. Impaired social interaction c. Medication noncompliance d. Dysfunctional grieving

d. Dysfunctional grieving Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.

You and Jack are two of the nurses working on the psychiatric unit. Jack mentions to you that the biological model for mental illness is the one he embraces, and states "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model? a. The biological model is the oldest and most reliable model for explaining mental illness. b. The biological model does not explain every symptom 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 the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

d. In believing only 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 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.

A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy? a. Psychodynamic b. Cognitive c. Behavioral d. Interpersonal.

d. Interpersonal. Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.

As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with a. security operations. b. psychoanalysis. c. analysis of behavior patterns. d. a psychotherapeutic environment.

d. a psychotherapeutic environment. Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings.

The prevalence rate over a 12-month period for major depressive disorder is a. lower than the prevalence rate for panic disorders. b. greater than the prevalence rate for psychotic disorders. c. equal to the prevalence rate for psychotic disorders. d. greater than the prevalence rate for generalized anxiety.

d. greater than the prevalence rate for generalized anxiety. Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.

The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by a. giving the child what he is asking for. b. scolding the child when he 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.

d. ignoring the tantrum and giving attention when the child acts appropriately. 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.

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 that he is a. demonstrating symptoms of bipolar disorder. b. socially deviant. c. egocentric. d. not demonstrating any definitive signs of mental illness.

d. not demonstrating any definitive signs of mental illness. One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams "irrational" dreams at night, and "irrational" emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.