Wks 1 Mental Health

Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient: a. sees self as approaching ideals and capable of meeting demands. b. seeks others to assume responsibility for major areas of own life. c. behaves without considering the consequences of personal actions. d. aggressively meets own needs without considering the rights of others.

A

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A) Private insurance B) Medicare C) Medicaid D) Private pay

A Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.

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

A patient diagnosed with major depression has lost 20 pounds in one month, has chronic low self-esteem, and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention has the highest priority? a. Implement suicide precautions. b. Offer high-calorie snacks and fluids frequently. c. Assist the patient to identify three personal strengths. d. Observe patient for therapeutic effects of antidepressant medication.

ANS: A Implementing suicide precautions is the only option related to patient safety. The other options, related to nutrition, self-esteem, and medication therapy, are important but are not priorities.

When a nurse assesses an older adult patient, answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: a. "Are you having difficulty hearing when I speak?" b. "How can I make this assessment interview easier for you?" c. "I notice you are frowning. Are you feeling annoyed with me?" d. "You're having trouble focusing on what I'm saying. What is distracting you?"

ANS: A The patient's behaviors may indicate difficulty hearing. Identifying any physical need the patient may have at the onset of the interview and making accommodations are important considerations. By asking if the patient is annoyed, the nurse is jumping to conclusions. Asking how to make the interview easier for the patient may not elicit a concrete answer. Asking about distractions is a way of asking about auditory hallucinations, which is not appropriate because the nurse has observed that the patient seems to be listening intently.

Select all that apply. A nurse performing an assessment interview for a patient with a substance use disorder decides to use a standardized rating scale. Which scales are appropriate? a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) c. Abnormal Involuntary Movement Scale (AIMS) d. Cognitive Capacity Screening Examination (CCSE) e. Recovery Attitude and Treatment Evaluator (RAATE)

ANS: A, B, E Standardized scales are useful for obtaining data about substance use disorders. The ASI, B-DAST, and RAATE are scales related to substance abuse. AIMS assesses involuntary movements associated with anti-psychotic medications. The CCSE assesses cognitive function.

A nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?"Which aspect of the mental status examination is the nurse assessing? a. Behavior b. Cognition c. Affect and mood d. Perceptual disturbances

ANS: B Assessing cognition involves determining a patient's judgment and decision making. In this case, the nurse would expect a response of "Call my doctor" if the patient's cognition and judgment are intact. If the patient responds, "I would stop eating" or "I would just wait and see what happened," the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.

Before assessing a new patient, a nurse is told by another health care worker, "I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge." The nurse's responsibility is to: a. document the other worker's assessment of the patient. b. assess the patient based on data collected from all sources. c. validate the worker's impression by contacting the patient's significant other. d. discuss the worker's impression with the patient during the assessment interview.

ANS: B Assessment should include data obtained from both the primary and reliable secondary sources. The nurse, bearing in mind the possible effects of counter-transference, should evaluate biased assessments by others as objectively as possible.

A patient presents to the emergency department with mixed psychiatric symptoms. The admission nurse suspects the symptoms may be the result of a medical problem. Lab results show elevated BUN (blood urea nitrogen) and creatinine. What is the nurse's next best action? a. Report the findings to the health care provider. b. Assess the patient for a history of renal problems. c. Assess the patient's family history for cardiac problems. d. Arrange for the patient's hospitalization on the psychiatric unit.

ANS: B Elevated BUN (blood urea nitrogen) and creatinine suggest renal problems. Renal dysfunction can often imitate psychiatric disorders. The nurse should further assess the patient's history for renal problems and then share the findings with the health care provider.

Which entry in the medical record best meets the requirement for problem-oriented charting? a. "A: Pacing and muttering to self. P: Sensory perceptual alteration related to internal auditory stimulation. I: Given fluphenazine HCL (Prolixin) 2.5 mg po at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV." b. "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg po. I: Haloperidol (Haldol) 2 mg po given at 0900. E: Returned to lounge at 0930 and quietly watched TV." c. "Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg po and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV." d. "Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg po administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'"

ANS: B Problem-oriented documentation uses the first letter of key words to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation. The distracters offer examples of PIE charting, focus documentation, and narrative documentation.

"QSEN" refers to: a. Qualitative Standardized Excellence in Nursing b. Quality and Safety Education for Nurses c. Quantitative Effectiveness in Nursing d. Quick Standards Essential for Nurses

ANS: B QSEN represents national initiatives centered on patient safety and quality. The primary goal of QSEN is to prepare future nurses with the knowledge, skills, and attitudes to increase the quality, care, and safety in the health care setting in which they work.

A nurse wants to assess an adult patient's recent memory. Which question would best yield the desired information? a. "Where did you go to elementary school?" b. "What did you have for breakfast this morning?" c. "Can you name the current president of the United States?" d. "A few minutes ago, I told you my name. Can you remember it?"

ANS: B The patient's recall of a meal provides evidence of recent memory. Two incorrect responses are useful to assess immediate and remote memory. The other distracter assesses the patient's fund of knowledge.

After formulating the nursing diagnoses for a new patient, what is a nurse's next action? a. Designing interventions to include in the plan of care b. Determining the goals and outcome criteria c. Implementing the nursing plan of care d. Completing the spiritual assessment

ANS: B The third step of the nursing process is planning and outcome identification. Outcomes cannot be determined until the nursing assessment is complete and nursing diagnoses have been formulated.

A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? a. Perform mental health assessment interviews. b. Prescribe psychotropic medication. c. Establish therapeutic relationships. d. Individualize nursing care plans.

ANS: B Prescriptive privileges are granted to master's-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level performs mental health assessments, establishes relationships, and provides individualized care planning. Note that this question was also offered for Chapter 1.

Select all that apply.A patient is very suspicious and states, "The FBI has me under surveillance." Which strategies should a nurse use when gathering initial assessment data about this patient? a. Tell the patient that medication will help this type of thinking. b. Ask the patient, "Tell me about the problem as you see it." c. Seek information about when the problem began.d. Tell the patient, "Your ideas are not realistic." e. Reassure the patient, "You are safe here."

ANS: B, C, E During the assessment interview, the nurse should listen attentively and accept the patient's statements in a nonjudgmental way. Because the patient is suspicious and fearful, reassuring safety may be helpful, although trust is unlikely so early in the relationship. Saying that medication will help or telling the patient that the ideas are not realistic will undermine development of trust between the nurse and patient.

Nursing behaviors associated with the implementation phase of nursing process are concerned with: a. participating in mutual identification of patient outcomes. b. gathering accurate and sufficient patient-centered data. c. comparing patient responses and expected outcomes. d. carrying out interventions and coordinating care.

ANS: D Nursing behaviors relating to implementation include using available resources, performing interventions, finding alternatives when necessary, and coordinating care with other team members.

Select all that apply. A nurse assessed a patient who reluctantly participated in activities, answered questions with minimal responses, and rarely made eye contact. What information should be included when documenting the assessment? a. The patient was uncooperative b. The patient's subjective responses c. Only data obtained from the patient's verbal responses d. A description of the patient's behavior during the interview e. Analysis of why the patient was unresponsive during the interview

ANS: B, D Both content and process of the interview should be documented. Providing only the patient's verbal responses would create a skewed picture of the patient. Writing that the patient was uncooperative is subjectively worded. An objective description of patient behavior would be preferable. Analysis of the reasons for the patient's behavior would be speculation, which is inappropriate.

Select all that apply.What information is conveyed by nursing diagnoses? a. Medical judgments about the disorder b. Unmet patient needs currently present c. Goals and outcomes for the plan of care d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventions

ANS: B, D, E Nursing diagnoses focus on phenomena of concern to nurses rather than on medical diagnoses.

A patient states, "I'm not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up." Which nursing intervention should have the highest priority? a. Self-esteem-building activities b. Anxiety self-control measures c. Sleep enhancement activities d. Suicide precautions

ANS: D The nurse would place a priority on monitoring and reinforcing suicide self-restraint because it relates directly and immediately to patient safety. Patient safety is always a priority concern. The nurse should monitor and reinforce all patient attempts to control anxiety, improve sleep patterns, and develop self-esteem, while giving priority attention to suicide self-restraint.

When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in: a. counseling. b. health teaching. c. milieu management. d. psychobiological intervention.

ANS: C Milieu management provides a therapeutic environment in which the patient can feel comfortable and safe while engaging in activities that meet the patient's physical and mental health needs. Counseling refers to activities designed to promote problem solving and enhanced coping and includes interviewing, crisis intervention, stress management, and conflict resolution. Health teaching involves identifying health education needs and giving information about these needs. Psychobiological interventions involve medication administration and monitoring response to medications.

A newly admitted patient diagnosed with major depression has gained 20 pounds over a few months and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis. a. Imbalanced nutrition: more than body requirements b. Chronic low self-esteem c. Risk for suicide d. Hopelessness

ANS: C Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but these problems do not affect patient safety as urgently as would a suicide attempt.

Select the best outcome for a patient with the nursing diagnosis: Impaired social interaction related to sociocultural dissonance as evidenced by stating, "Although I'd like to, I don't join in because I don't speak the language very well." Patient will: a. show improved use of language. b. demonstrate improved social skills. c. become more independent in decision making. d. select and participate in one group activity per day.

ANS: D The outcome describes social involvement on the part of the patient. Neither cooperation nor independence has been an issue. The patient has already expressed a desire to interact with others. Outcomes must be measurable. Two of the distracters are not measurable.

The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within 7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. The nurse will document the outcome as: a. consistently demonstrated. b. often demonstrated. c. sometimes demonstrated. d. never demonstrated.

ANS: D Although the patient is sleeping 6 hours daily, the total is not one uninterrupted session at night. Therefore, the outcome must be evaluated as never demonstrated. See relationship to audience response question.

At what point in an assessment interview would a nurse ask, "How does your faith help you in stressful situations?" During the assessment of: a. childhood growth and development b. substance use and abuse c. educational background d. coping strategies

ANS: D When discussing coping strategies, the nurse might ask what the patient does when upset, what usually relieves stress, and to whom the patient goes to talk about problems. The question regarding whether the patient's faith helps deal with stress fits well here. It would be out of place if introduced during exploration of the other topics.

A nurse documents: "Patient is mute despite repeated efforts to elicit speech. Makes no eye contact. Inattentive to staff. Gazes off to the side or looks upward rather than at speaker." Which nursing diagnosis should be considered? a. Defensive coping b. Decisional conflict c. Risk for other-directed violence d. Impaired verbal communication

ANS: D The defining characteristics are more related to the nursing diagnosis of impaired verbal communication than to the other nursing diagnoses.

A nurse prepares to assess a new patient who moved to the United States from Central America three years ago. After introductions, what is the nurse's next comment? a. "How did you get to the United States?" b. "Would you like for a family member to help you talk with me?" c. "An interpreter is available. Would you like for me to make a request for these services?" d. "Are you comfortable conversing in English, or would you prefer to have a translator present?"

ANS: D The nurse should determine whether a translator is needed by first assessing the patient for language barriers. Accuracy of the assessment depends on the ability to communicate in a language that is familiar to the patient. Family members are not always reliable translators. An interpreter may change the patient's responses; a translator is a better resource.

Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? a. "I can always trust my family." b. "It seems like I always have bad luck." c. "You never know who will turn against you." d. "I hear evil voices that tell me to do bad things."

ANS: D The statement regarding evil voices tells the nurse that the patient is experiencing auditory hallucinations and may create risks for violence. The other statements are vague and do not clearly identify the patient's chief symptom.

A nurse assesses an older adult patient brought to the emergency department by a family member. The patient was wandering outside saying, "I can't find my way home." The patient is confused and unable to answer questions. Select the nurse's best action. a. Record the patient's answers to questions on the nursing assessment form. b. Ask an advanced practice nurse to perform the assessment interview. c. Call for a mental health advocate to maintain the patient's rights. d. Obtain important information from the family member.

ANS: D When the patient (primary source) is unable to provide information, secondary sources should be used, in this case, the family member. Later, more data may be obtained from other information sources familiar with the patient. An advanced practice nurse is not needed for this assessment; it is within the scope of practice of the staff nurse. Calling a mental health advocate is unnecessary. See relationship to audience response question.

A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? a. "I've made mistakes but everyone else in this family has also." b. "I remember joy and mutual respect from our early years together." c. "I will make some changes in my behavior for the good of the family." d. "It's best for me to move away from my family. Things will never change."

C

Which individual diagnosed with a mental illness may need involuntary hospitalization? An individual a. who has a panic attack after her child gets lost in a shopping mall. b. with visions of demons emerging from cemetery plots throughout the community. c. who takes 38 acetaminophen tablets after the person's stock portfolio becomes worthless. d. diagnosed with major depression who stops taking prescribed antidepressant medication.

C Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary hospitalization also protects other individuals in society. An overdose of acetaminophen indicates dangerousness to self. The behaviors described in the other options are not sufficient to require involuntary hospitalization.

Which criterion must be met to refer a client to a partial hospitalization program? A) The client is hospitalized at night in an inpatient setting. B) The client must be able to provide his or her own transportation daily. C) The client is able to return home each day. D) The clients are all recovering from an addiction.

C Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.

Which disorder is an example of a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depressive disorder

C Running amok

In which situations would a nurse have the duty to intervene and report? (Select all that apply.) a. A peer has difficulty writing measurable outcomes. b. A health care provider gives a telephone order for medication. c. A peer tries to provide patient care in an alcohol-impaired state. d. A team member violates relationship boundaries with a patient. e. A patient refuses medication prescribed by a licensed health care provider.

C, D Both keyed answers are events that jeopardize patient safety. The distracters describe situations that may be resolved with education or that are acceptable practices.

Which actions violate the civil rights of a psychiatric patient? The nurse (Select all that apply) a. performs mouth checks after overhearing a patient say, "I've been spitting out my medication." b. begins suicide precautions before a patient is assessed by the health care provider. c. opens and reads a letter a patient left at the nurse's station to be mailed. d. places a patient's expensive watch in the hospital business office safe. e. restrains a patient who uses profanity when speaking to the nurse.

C, E The patient has the right to send and receive mail without interference. Restraint is not indicated because a patient uses profanity

After leaving work, a nurse realizes documentation of administration of a prn medication was omitted. This off-duty nurse phones the nurse on duty and says, "Please document administration of the medication for me. My password is alpha1." The nurse receiving the call should a. fulfill the request promptly. b. document the caller's password. c. refer the matter to the charge nurse to resolve. d. report the request to the patient's health care provider.

C. Fraudulent documentation may be grounds for discipline by the state board of nursing. Referring the matter to the charge nurse will allow observance of hospital policy while ensuring that documentation occurs. Notifying the health care provider would be unnecessary when the charge nurse can resolve the problem. Nurses should not provide passwords to others.

Which statement about diagnosis of a mental disorder is true?

Culture may cause variations in symptoms for each clinical disorder.

A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker's assessment is not yet available. Select the nurse's best action. a. Focus assessment questions on these two topics. b. Ask another patient who shares a room with this patient. c. Avoid seeking information on these topics at this time. d. Refer to axis IV of the DSM-IV-TR in the medical record.

D The admitting physician would use axis IV to record psychosocial and environmental problems pertinent to the patient's situation, providing another source of information for the nurse. Persistent questioning may cause the patient to withdraw. The other distracters demonstrate violation of the patient's privacy rights and are not an effective solution.

A nurse participating in a community health fair is asked, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response. a. Schizophrenia b. "Why do you ask?" c. Bipolar disorder d. Alzheimer's disease

D The prevalence for Alzheimer's disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. It is important for the nurse to provide information rather than probe the reason for the person's question.

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A) A client and family members attend counseling sessions together at a neighborhood clinic B) Implementation of a more flexible work schedule for staff C) Improved reimbursement for services provided in the community D) A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

D. A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.

A newly admitted acutely psychotic patient is a private patient of the medical director and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care? a. Medical director b. Hospital c. Profession d. Patient

D. Although the nurse is accountable to the health care provider, the agency, the patient, and the profession, the duty of care is owed to the patient. This duty reflects both legal and ethical standards of nursing practice.

What is the legal significance of a nurse's action when a patient verbally refuses medication and the nurse gives the medication over the patient's objection? The nurse a. has been negligent. b. committed malpractice. c. fulfilled the standard of care. d. can be charged with battery.

D. Battery is an intentional tort in which one individual violates the rights of another through touching without consent. Forcing a patient to take medication after the medication was refused constitutes battery. The charge of battery can be brought against the nurse. The medication may not necessarily harm the patient-- harm is a component of malpractice.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A) Knowledge of both national and local political activism B) The ability to cross service systems C) An awareness of own cultural and personal values D) Creative problem-solving and intervention skills

D. Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.

Which statement best describes the DSM-5?

It is a medical psychiatric assessment system.

3. Which nursing interventions best demonstrate an understanding of the Quality and Safety Education in Nursing (QSEN) competences? Select all that apply. a. Asking the patient what he or she expects from the treatment he or she is receiving b. Seeking recertification for cardiopulmonary resuscitation (CPR) c. Accessing the internet to monitor social media related to opinions on healthcare d. Consulting with a dietician to discuss a patient's cultural food preferences and restrictions e. Reviewing the literature regarding the best way to monitor the patient for a fluid imbalance

a. Asking the patient what he or she expects from the treatment he or she is receiving b. Seeking recertification for cardiopulmonary resuscitation (CPR) d. Consulting with a dietician to discuss a patient's cultural food preferences and restrictions e. Reviewing the literature regarding the best way to monitor the patient for a fluid imbalance

10. Amadi is a 40-year-old African national being treated in a psychiatric outpatient setting due to a court order. Amadi's medical record is limited in scope, so where can Renata, his registered nurse, obtain more data on Amadi's condition within legal parameters? Select all that apply. a. Emergency department records b. Police records related to the offense resulting in the court order for treatment c. Calling his family in Africa for details about Amadi's mental health d. Past medical records in the current facility

a. Emergency department records b. Police records related to the offense resulting in the court order for treatment d. Past medical records in the current facility

1. What is the purpose of the Health Insurance Portability and Accountability Act (HIPAA)? Select all that apply. a. Ensuring that an individual's health information is protected b. Providing third-party players with access to patient's medical records c. Facilitating the movement of a patient's medical information to the interested parties d. Guaranteeing that all those in need of healthcare coverage have options to obtain it e. Allowing healthcare providers to obtain personal health to provide high-quality healthcare.

a. Ensuring that an individual's health information is protected e. Allowing healthcare providers to obtain personal health to provide high-quality healthcare.

8. A nurse identified a nursing diagnosis of self-mutilation for a female diagnosed with borderline personality disorder. The patient has multiple self-inflicted cuts on her forearms and inner thighs. What is the most important patient outcome for this nursing diagnosis? a. Identify triggers to self-mutilation b. Demonstrate a decrease in frequency and intensity of cutting c. Describe strategies in increase socialization on the unit d. Describe two strategies to increase self-care

a. Identify triggers to self-mutilation

7. During an interview with a non-English-speaking middle-aged woman recently diagnosed with major depression, the patient's husband states, "She is happy now and doing very well." The patient, however, sits motionless, looking at the floor, and wringing her hands. A professional interpreter would provide better information due to the fact that a family member in the interpreter role may: Select all that apply. a. Be too close to accurately capture the meaning of the patient's mood. b. Censor the patient's thoughts or words. c. Avoid interpretation. d. Leave out unsavory details.

b. Censor the patient's thoughts or words.

9. Medical records are considered legal documents. Proper documentation needs to reflect patient condition along with changes. It should also be based on professional standards designated by the state board of nursing, regulatory agencies, and reimbursement requirements. Proper documentation can be enhanced by: a. Only using objective data b. Using the nursing process as a guide c. Using language the specific patient can understand d. Avoiding legal jargon

b. Using the nursing process as a guide

2. Which intervention demonstrates a nurse's understanding of the initial action associated with the assessment of a patient's spiritual beliefs? a. Offering to pray with the patient b. Providing a consult with the facility's chaplain c. Asking the patient what role spirituality plays in his or her daily life d. Arranging for care to be provided with respect to religious practices

c. Asking the patient what role spirituality plays in his or her daily life

4. Which disadvantage is inherent to the problem-oriented charting system (SOAPIE)? a. Does not support a universal organizational system b. Commonly allows for the inclusion of subjective information c. Documentation is not listed in chronological order d. Does not support the nursing process as a format

c. Documentation is not listed in chronological order

6. A 13-year-old boy is undergoing a mental health assessment. The nurse practitioner assures him that his medical records are protected and private. The nurse recognizes that this promise cannot be kept when the youth divulges: a. "I lost my virginity last year." b. "I am angry with my parents most of the time." c. "I have thoughts of being in love with boys." d. "My parents do not know that I hit my grandpa."

d. "My parents do not know that I hit my grandpa."

5. Which standardized rating scale will the nurse specifically include in the assessment of a newly admitted patient diagnosed with major depressive disorder? a. Mini-Mental State Examination (MMSE) b. Body Attitude Test c. Global Assessment of Functioning Scale (GAF) d. Beck Inventory

d. Beck Inventory

The mental health status of a particular client can best be assessed by considering ...

placement on a continuum from health to illness

A nurse is concerned that an agency's policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice? a. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care. b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care. c. Faced with substandard policies, a nurse has a responsibility to inform the supervisor and discontinue patient care immediately. d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.

A. Nurses are professionally bound to uphold standards of practice regardless of lesser standards established by a health care agency or a state. Conversely, if the agency standards are higher than standards of practice, the agency standards must be upheld. The Courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.

In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain a. a signed consent by the patient for release of information stating specific information to be released. b. a verbal consent for information release from the patient and the patient's guardian or next of kin. c. permission from members of the health care team who participate in treatment planning. d. approval from the attending psychiatrist to authorize the release of information.

A. Nurses have an obligation to protect patients' privacy and confidentiality. Clinical information should not be released without the patient's signed consent for the release.

An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." Which response by the nurse is appropriate? a. "That isn't true. What you tell us is private and held in strict confidence. Your parents have no right to know." b. "Yes, your parents may find out what you say, but it is important that they know about your problems." c. "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." d. "It sounds as though you are not really ready to work on your problems and make changes."

ANS: C Adolescents are very concerned with confidentiality. The patient has a right to know that most information will be held in confidence but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse. The incorrect responses are not true, will not inspire the confidence of the patient, or are confrontational.

A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, "Encourage patient to attend one psychoeducational group daily"? a. Assessment b. Analysis c. Implementation d. Evaluation

ANS: C Interventions are the nursing prescriptions to achieve the outcomes. Interventions should be specific.

Select the most appropriate label to complete this nursing diagnosis: ___________ related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening. a. Deficient knowledge b. Ineffective coping c. Social isolation d. Powerlessness

ANS: C Nursing diagnoses are selected based on the etiological factors and assessment findings, or evidence. In this instance, the evidence shows social isolation that is caused by shyness and poorly developed social skills.

The desired outcome for a patient experiencing insomnia is, "Patient will sleep for a minimum of 5 hours nightly within 7 days." At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse's next action? a. Continue the current plan without changes. b. Remove this nursing diagnosis from the plan of care. c. Write a new nursing diagnosis that better reflects the problem. d. Examine interventions for possible revision of the target date.

ANS: D Sleeping a total of 5 hours at night remains a reasonable outcome. Extending the period for attaining the outcome may be appropriate. Examining interventions might result in planning an activity during the afternoon rather than permitting a nap. Continuing the current plan without changes is inappropriate. Removing this nursing diagnosis from the plan of care would be correct when the outcome was met and the problem resolved. Writing a new nursing diagnosis is inappropriate because no other nursing diagnosis relates to the problem.

The nurse records this entry in a patient's progress notes: Patient escorted to unit by ER nurse at 2130. Patient's clothing was dirty. In interview room, patient sat with hands over face, sobbing softly. Did not acknowledge nurse or reply to questions. After several minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, "Let me out of here." Verbal intervention unsuccessful. Order for stat dose 2 mg haloperidol PO obtained; medication administered at 2150. By 2215, patient stopped shouting and returned to sit wordlessly in chair. Patient placed on one-to-one observation. How should this documentation be evaluated? a. Uses unapproved abbreviations b. Contains subjective material c. Too brief to be of value d. Excessively wordy e. Meets standards

ANS: E This narrative note describes patient appearance, behavior, and conversation. It mentions that less-restrictive measures were attempted before administering medication and documents patient response to medication. This note would probably meet standards. A complete nursing assessment would be in order as soon as the patient is able to participate. Subjective material is absent from the note. Abbreviations are acceptable.

What is the primary advantage of using a case manager when considering the planning and implementation of client care? A) Increases collaborative practice. B) Enhances resource management. C) Increases client satisfaction with care. D) Promotes evidence-based psychiatric nursing.

B Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.

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 & bipolar disorder

An aide in a psychiatric hospital says to the nurse, "We don't have time every day to help each patient complete a menu selection. Let's tell dietary to prepare popular choices and send them to our unit." Select the nurse's best response. a. "Thanks for the suggestion, but that idea may not work because so many patients take MAOI (monoamine oxidase inhibitor) antidepressants." b. "Thanks for the idea, but it's important to treat patients as individuals. Giving choices is one way we can respect patients' individuality." c. "Thank you for the suggestion, but the patients' bill of rights requires us to allow patients to select their own diet." d. "Thank you. That is a very good idea. It will make meal preparation easier for the dietary department."

B. The nurse's response to the aide should recognize patients' rights to be treated with dignity and respect as well as promote autonomy. This response also shows respect for the aide and fulfills the nurse's obligation to provide supervision of unlicensed personnel. The incorrect responses have flawed rationale or do not respect patients as individuals.

Which individual is demonstrating the highest level of resilience? One who a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for 2 years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job.

D Resilience is closely associated with the process of adapting and helps people facing tragedy, loss, trauma and severe stress.

The Diagnostic and Statistical Manual of Mental Disorders classifies: a. deviant behaviors. b. people with mental disorders. c. present disability or distress. d. mental disorders people have.

D The DSM-IV-TR classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

A patient is depressed, mute, and motionless. According to family members, the patient has refused to bathe or eat for a week. The patient's global assessment of functioning score is: a. 100 b. 50 c. 25 d. 10

D The patient is unable to maintain personal hygiene, oral intake, or verbal communication. The patient is a danger to self because of not eating. The distracters represent higher levels of functioning.

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? A) Arranging for the client to have a screening for prostate cancer B) Notifying the family that the client will require a wheelchair when discharged C) Providing the client with organizations that help defray the cost of prescribed drug D) Arranging for respite care when the client's family needs to attend an out-of-state affair

A The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.

A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice

A An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.

A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource? a. Diagnostic and Statistical Manual of Mental Disorders b. A nursing diagnosis handbook c. A psychiatric nursing textbook d. A behavioral health reference manual

A The DSM-IV-TR gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness.

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? A) Nurses B) Social workers C) Clinical psychologists D) Chemical dependency counselors

A Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.

When considering mental illness, recovery is best described to a client by which statement? A) Working, living, and participating in the community B) Never having to visit a mental health provider again C) Being able to understand the nature of the diagnosed illness D) A period of time when signs and symptoms are being managed

A Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.

A 40-year-old who lives with parents and works at an unchallenging job says, "I'm as happy as anyone else, even though I don't socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas." The nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior.

A The patient sees self as needing multiple explanations of new tasks at work and allows the parents to make decisions, even though she is 40 years old. These behaviors indicate a poorly developed self-concept.

In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing God's voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.

A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.

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

An experienced nurse says to a new graduate, "When you've practiced as long as I have, you'll instantly know how to take care of psychotic patients." Which information should the new graduate consider when analyzing this comment? You may select more than one answer. a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurse's practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients' needs guides effective psychiatric nurses.

A & B Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.

Which of the following best demonstrates party related to mental health care?

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

A patient asks the nurse, "I read an article online about psychosocial factors that influence depression. What are psychosocial factors?" Examples a nurse could cite to support the premise that a patient's depression may be influenced by psychosocial factors include: (Select all that apply) a. having a hostile and over involved family. b. having two first-degree relatives with bipolar disorder. c. feeling strong guilt over having an abortion when one's religion forbids it. d. experiencing the death of a parent a month before the onset of depression. e. experiencing symptom remission when treated with antidepressant medication.

A, C, & D Family influence is a psychosocial factor affecting a patient's mental health. A hostile, overinvolved family is critical of the patient and contributes to low self-esteem. Genetic factors influence an individual's risk for mental disorder but are not psychosocial factors. Religious influences are psychosocial in nature. Life experiences, especially crises and losses, are psychosocial influences on mental health. Treatment with a biological agent, such as antidepressant medication, is an example of a biological influence.

Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, "I have some weaknesses, but I feel I'm important to my family and friends." b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.

A, D & E Mental health is a state of well being in which each individual is able to realize his or her own potential, cope with the normal stress of life, work productively and make a contribution to the community.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A) Break-away closet bars to prevent hanging B) Bedroom and dining areas with locked windows to prevent jumping C) Double-locked doors to prevent escaping from the unit D) Platform beds to prevent crush injuries

A. Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.

Which action by a psychiatric nurse best applies the ethical principle of autonomy? a. Exploring alternative solutions with the patient, who then makes a choice. b. Suggesting that two patients who were fighting be restricted to the unit. c. Intervening when a self-mutilating patient attempts to harm self. d. Staying with a patient demonstrating a high level of anxiety.

A. Autonomy is the right to self-determination, that is, to make one's own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.

A therapeutic inpatient milieu will include which characteristic? A) It provides for the client's safety and comfort. B) Voluntarily admitted clients are generally allowed additional privileges. C) Rules and behavioral limits are flexibly enforced. D) Staff provide frequent and ongoing negative feedback to clients.

A. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.

A patient in alcohol rehabilitation reveals to the nurse, "I feel terrible guilt for sexually abusing my 6-year-old before I was admitted." Select the nurse's most important action. a. Anonymously report the abuse by phone to the local child protection agency. b. Reply, "I'm glad you feel comfortable talking to me about it." c. File a written report with the agency's ethics committee. d. Respect nurse-patient relationship confidentiality.

A. Laws regarding child abuse reporting discovered by a professional during the suspected abuser's alcohol or drug treatment differ by state. Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility.

A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" Select the nurse's best response. a. "Less restrictive settings are available now to care for individuals with mental illness." b. "There are fewer persons with mental illness, so less hospital beds are needed." c. "Most people with mental illness are still in psychiatric institutions." d. "Psychiatric institutions violated patients' rights."

A. The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. The distracters are incorrect and part of the stigma of mental illness.

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? A) All rights remain intact. B) Only rights that do not involve decision making remain intact. C) The right to refuse treatment is no longer guaranteed. D) All rights are temporarily suspended.

A. The hospitalized client is not a convicted criminal thus all civil rights remain intact.

Insurance will not pay for continued private hospitalization of a mentally ill patient. The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred. Select the nurse's most helpful reply. a. "By law, treatment must be provided. Hospitalization without treatment violates patients' rights." b. "All patients in public hospitals have the right to choose both a primary therapist and a primary nurse." c. "You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety." d. "Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable."

A. The right to medical and psychiatric treatment is conferred on all patients hospitalized in public mental hospitals under federal law.

A college student said, "Most of the time I'm happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it." Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5

E The student is happy and has an adequate self-concept. The student is reality oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is happy all the time.

Which comment most clearly shows a speaker views mental illness with stigma? a. "Some mental illnesses are inherited." b. "Most people with mental illness are unmotivated." c. "Severe environmental stress sometimes causes mental illness." d. "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted."

B Stigma refers to stereotypical, negative beliefs. With respect to mental health and mental illness, stigma often leads to discrimination and uncaring attitudes. Mental illness has multiple causes, including stress, changes in brain structure or function, and genetic transmission.

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?

Appraisal of reality

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. DSM-V c. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10

B

Complete this analogy. NANDA : clinical judgment :: NIC : _________________ a. patient outcomes b. nursing actions c. diagnosis d. symptoms

B

Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health.

B

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A) Opportunity to act out fears and frustrations B) Providing a safe place to practice coping skills C) Meeting their physical as well as emotional needs D) Encouraging group communication about existing problems

B A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.

The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information? a. II b. III c. IV d. V

B Axis III indicates any relevant general medical conditions. Axis II refers to personality disorders and mental retardation. Together they constitute the classification of abnormal behavior diagnosed in the individual. Axis IV reports psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis. Axis V is the global assessment of functioning.

A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Prevalence b. Clinical epidemiology c. Descriptive epidemiology d. Experimental epidemiology

B Clinical epidemiology is a broad field that addresses what happens to people with illnesses seen by providers of clinical care. This study is concerned with the effectiveness of various interventions. Prevalence refers to numbers of new cases. Descriptive epidemiology provides estimates of the rates of disorders in a general population and its subgroups. Experimental epidemiology tests presumed assumptions between a risk factor and a disorder.

Which finding best indicates that a patient has a mental illness? The patient: a.responds to rules, routines, and customs of a group. b. reports mood is consistently sad, discouraged, and hopeless. c. performs tasks attempted within the limits set by own abilities. d. is able to see the difference between the "as if" and the "for real."

B The correct response describes a mood alteration, which further reflects mental illness. The distracters describe mentally healthy behaviors.

Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems." b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations." c. "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate." d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."

B The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering is as real as physical.

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

A patient in the emergency department says, "The voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspect(s) of mental health should be of greatest immediate concern to the nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e.Healthy self-concept

B, C, E The aspects of mental health of greatest concern are the patient's appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patient's control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.

Select the example of a tort. a. The plan of care for a patient is not completed within 24 hours of the patient's admission. b. A nurse gives a prn dose of an antipsychotic drug to an agitated patient because the unit is short-staffed. c. An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others. d. A patient's admission status changed from involuntary to voluntary after the patient's hallucinations subside.

B. A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient-- thus, false imprisonment is a possible charge.

An adolescent hospitalized after a violent physical outburst tells the nurse, "I'm going to kill my father, but you can't tell anyone." Select the nurse's best response. a. "You are right. Federal law requires me to keep clinical information private." b. "I am obligated to share that information with the treatment team." c. "Those kinds of thoughts will make your hospitalization longer." d. "You should share this thought with your psychiatrist."

B. Breach of nurse-patient confidentiality does not pose a legal dilemma for nurses in these circumstances because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should also know that the team has a duty to warn the father of the risk for harm.

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? A) "We will help you make decisions that will keep you safe." B) "I am going to help you shower, so you will not smell so bad." C) "Your pocket knife and nail clippers will be kept in the nurses' station." D) "You will be having a number of tests to help us learn about your condition."

B. Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.

Which nursing intervention demonstrates false imprisonment? a. A confused and combative patient says, "I'm getting out of here, and no one can stop me." The nurse restrains this patient without a health care provider's order and then promptly obtains an order. b. A patient has been irritating and attention seeking much of the day. A nurse escorts the patient down the hall saying, "Stay in your room, or you'll be put in seclusion." c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit. d. An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving.

B. False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. If a patient is not competent (confused), then the nurse should act with beneficence. Patients admitted involuntarily should not be allowed to leave without permission of the treatment team.

A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist a. released information without proper authorization. b. demonstrated the duty to warn and protect. c. violated the patient's confidentiality. d. avoided charges of malpractice.

B. It is the health care professional's duty to warn or notify an intended victim after a threat of harm has been made. Informing a potential victim of a threat is a legal responsibility of the health care professional. It is not a violation of confidentiality.

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A) The patients who are convicted criminals sentenced to home confinement. B) Care is provided to clients in unconventional settings. C) Care is provided by a preferred provider for a large HMO. D) The patients are provided for by a clinical specialist with the visiting nurse service.

B. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? A) Fostering research B) Maintaining a therapeutic milieu C) Providing sympathetic listening D) Providing constructive negative feedback

B. Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A) A depressed patient with a suicidal plan B) A patient being discharged from an inpatient alcohol rehabilitation unit C) A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs D) Jeff, who has mild depression symptoms and is starting outpatient therapy

B. PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.

A nurse prepares to administer a scheduled intramuscular injection of an antipsychotic medication to an outpatient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, "Stop! I don't want to take that medicine anymore. I hate the side effects." Select the nurse's best action. a. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary. b. Stop the medication administration procedure and say to the patient, "Tell me more about the side effects you've been having." c. Proceed with the injection but explain to the patient that there are medications that will help reduce the unpleasant side effects. d. Say to the patient, "Since I've already drawn the medication in the syringe, I'm required to give it, but let's talk to the doctor about delaying next month's dose."

B. Patients diagnosed with mental illness retain their civil rights unless there is clear, cogent, and convincing evidence of dangerousness. The patient in this situation presents no evidence of dangerousness. The nurse, as an advocate and educator, should seek more information about the patient's decision and not force the medication.

Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion a. reinforces the autonomy of the two patients. b. violates the civil rights of both patients. c. represents the intentional tort of battery. d. correctly places emphasis on safety.

B. Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient's autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.

A patient experiencing psychosis asks a psychiatric technician, "What's the matter with me?" The technician replies, "Nothing is wrong with you. You just need to use some self-control." The nurse who overheard the exchange should take action based on a. the technician's unauthorized disclosure of confidential clinical information. b. violation of the patient's right to be treated with dignity and respect. c. the nurse's obligation to report caregiver negligence. d. the patient's right to social interaction.

B. Patients have the right to be treated with dignity and respect. The technician's comment disregards the seriousness of the patient's illness. The Code of Ethics for Nurses requires intervention. Patient emotional abuse has been demonstrated, not negligence. An interaction with the technician is not an aspect of social interaction.

Which action by a nurse constitutes a breach of a patient's right to privacy? a. Documenting the patient's daily behavior during hospitalization b. Releasing information to the patient's employer without consent c. Discussing the patient's history with other staff during care planning d. Asking family to share information about a patient's pre-hospitalization behavior

B. Release of information without patient authorization violates the patient's right to privacy. The other options are acceptable nursing practices. See relationship to audience response question.

A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should a. review the directive with the patient to ensure it is current. b. ensure that the directive is respected in treatment planning. c. consider the directive only if there is a cardiac or respiratory arrest. d. encourage the patient to revise the directive in light of the current health problem.

B. The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply

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 mental illnesses."

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

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. The ICD-10 b. Nursing Outcomes Classification c. Diagnostic and Statistical Manual of Mental Disorders d. The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice

C The DSM-IV-TR details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria.

A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it: a. focuses on plans for treatment. b. includes nursing and medical diagnoses. c. classifies problems in multiple areas of functioning. d. uses the framework of a specific biopsychosocial theory.

C The use of five axes requires assessment beyond diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. The DSM-IV-TR does not include treatment plans or nursing diagnoses. It does not use specific biopsychosocial theories

A category 5 tornado occurred in a community of 400 people. Many homes and businesses were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence b. Comorbidity c. Incidence d. Parity

C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time.

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A) A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B) A 30-year-old accountant who has developed symptoms of depression C) A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road D) A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.

A voluntarily hospitalized patient tells the nurse, "Get me the forms for discharge. I want to leave now." Select the nurse's best response. a. "I will get the forms for you right now and bring them to your room." b. "Since you signed your consent for treatment, you may leave if you desire." c. "I will get them for you, but let's talk about your decision to leave treatment." d. "I cannot give you those forms without your health care provider's permission."

C. A voluntarily admitted patient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient's wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. Facilitating discharge without consent is not in the patient's best interests before exploring the reason for the request.

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A) Visiting a homeless shelter to provide mental health screenings for its clients B) Discussing the need for proper nutrition with a depressed new mother C) Providing stress reduction seminars at the local senior center D) Visiting the home of a client currently displaying manic behavior

C. Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.

A new antidepressant is prescribed for an elderly patient diagnosed with major depressive disorder, but the dose is more than the usual geriatric dose. The nurse should a. consult a reliable drug reference. b. teach the patient about possible side effects and adverse effects. c. withhold the medication and confer with the health care provider. d. encourage the patient to increase oral fluids to reduce drug concentration.

C. The dose of antidepressants for elderly patients is often less than the usual adult dose. The nurse should withhold the medication and consult the health care provider who wrote the order. The nurse's duty is to practice according to professional standards as well as intervene and protect the patient.

Select the best response for the nurse to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology." d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing."

D

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A) Refusal of treatment. B) To send and receive mail. C) To seek legal counsel. D) To access all personal possessions.

D A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.

Which situation demonstrates the nurse functioning in the role of advocate? A) Providing one-to-one supervision for a client on suicide precautions B) Co-leading a medication education group for clients and families C) Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation D) Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

D In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.

A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions? a. Conduct mental health assessments b. Establish therapeutic relationships c. Individualize nursing care plans d. Prescribe psychotropic medication

D Prescriptive privileges are granted to masters-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning

Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse? a. Coordination of care b. Health teaching c. Milieu therapy d. Psychotherapy

D Psychotherapy is part of the scope of practice of an advanced practice nurse.

Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a person's cultural patterns.

D A nurse who understands that a patient's symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.

An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse: a. always asks me which type of juice I want to help me swallow my medication." b. explained my treatment plan to me and asked for my ideas about how to make it better." c. told me that if I take all the medicines the doctor prescribes, then I will get discharged soon." d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."

D Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice.

What function is shared by advanced practice and general practice psychiatric nurses? A) Prescriptive authority B) Admitting privileges C) Offers consultation services D) Membership on a multidisciplinary team

D Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.

Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."

D The medical diagnosis is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both tools consider culture. The DSM-IV-TR is multiaxial. Nursing diagnoses also consider potential problems.

The spouse of a patient with schizophrenia says, "I don't understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness." Which response by the nurse will best help the spouse understand this disorder? a. "This illness is the result of genetic factors." b. "Psychological stress is at the root of most mental disorders." c. "It must be frustrating for you that your spouse is sick so much of the time." d. "New findings show that this condition more likely has biological rather than psychological origins."

D Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouse's level of knowledge about the cause of the disorder. The other distracters are not established facts.

Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting? a. I Acute renal failure II 75 III Bipolar disorder I, mixed IV Loss of disability benefits 2 months ago V None b. I Schizophrenia, paranoid type II Death of spouse last year III 60 IV None V Diabetes, type 2 c. I Polysubstance dependence II Narcissistic Personality Disorder III 90 IV Hyperlipidemia V Charges pending for assault d. I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80

D The DSM-IV-TR profiles psychiatric diagnoses on five axes. Each axis defines a specific aspect of the diagnosis. Axis I identifies major clinical disorders. Axis II details personality and developmental disorders. Axis III identifies general medical conditions. Axis IV details psychosocial and environmental problems. Axis V rates the Global Assessment of Functioning

A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships

D The information given centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

A patient experiencing psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation. a. Patient struck another patient who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two patients away from each other for 24 hours. b. Seclusion ordered by physician at 1415 after command hallucinations told the patient to hit another patient. Careful monitoring of patient maintained during period of seclusion. c. Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Patient calmer and apologized for outburst. d. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, "I'll punch anyone who gets near me," and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

D. Documentation must be specific and detail the key aspects of care. It should demonstrate implementation of the least restrictive alternative. Justification for why a patient was secluded should be recorded, along with interventions attempted in an effort to avoid seclusion. Documentation should include a description of behavior and verbalizations, interventions tried and their outcomes, and the name of the health care provider ordering the use of seclusion.

Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who a. is noncompliant with the treatment regimen. b. fraudulently files for bankruptcy. c. sold and distributed illegal drugs. d. threatens to harm self and others.

D. Involuntary hospitalization protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization

Which documentation of a patient's behavior best demonstrates a nurse's observations? a. Isolates self from others. Frequently fell asleep during group. Vital signs stable. b. Calmer-- more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. d. Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

D. The documentation states specific observations of the patient's appearance and the exact statements made. The other options are vague or subjective statements and can be interpreted in different ways.

A family member of a patient with delusions of persecution asks the nurse, "Are there any circumstances under which the treatment team is justified in violating a patient's right to confidentiality?" The nurse should reply that confidentiality may be breached a. under no circumstances. b. at the discretion of the psychiatrist. c. when questions are asked by law enforcement. d. if the patient threatens the life of another person.

D. The duty to warn a person whose life has been threatened by a psychiatric patient overrides the patient's right to confidentiality. The right to confidentiality is not suspended at the discretion of the therapist or for legal investigations.

In a team meeting a nurse says, "I'm concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision." Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justice

D. The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make one's own decisions. Fidelity is the observance of loyalty and commitment to the patient.

Which individual diagnosed with mental illness may need emergency or involuntary admission? The individual who a. resumes using heroin while still taking naltrexone (ReVia). b. reports hearing angels playing harps during thunderstorms. c. does not keep an outpatient appointment with the mental health nurse. d. throws a heavy plate at a waiter at the direction of command hallucinations.

D. Throwing a heavy plate is likely to harm the waiter and is evidence of dangerousness to others. This behavior meets the criteria for emergency or involuntary hospitalization for mental illness. The behaviors in the other options evidence mental illness but not dangerousness. See related audience response question.

The quantitative study of the distribution of mental disorders in human populations is called

epidemiology

The prevalence rate over a 12-month period for major depressive disorder is...

greater than the prevalence rate for generalized anxiety

The nurse planning care for a mentally ill client bases interventions on the concept that the client ....

has areas of strength on which to build

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 .....

not demonstrating any definitive signs of mental illness

A nursing diagnosis for a client with a psychiatric disorder serves the purpose of....

providing a framework for selecting appropriate interventions