Mental Health Ch. 1
Current information suggests that the most disabling mental disorders are the result of biological influences. psychological trauma. learned ways of behaving. faulty patterns of early nurturance.
biological influences. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders.
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? experimental descriptive clinical analytic
clinical Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms.
The quantitative study of the distribution of mental disorders in human populations is called mortality. prevalence. epidemiology. clinical epidemiology.
epidemiology. Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care.
The prevalence rate over a 12-month period for major depressive disorder is lower than the prevalence rate for panic disorders. greater than the prevalence rate for psychotic disorders. equal to the prevalence rate for psychotic disorders. greater than the prevalence rate for generalized anxiety.
greater than the prevalence rate for generalized anxiety. Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for generalized anxiety is 3.1%.
The nurse planning care for a mentally ill client bases interventions on the concept that the client has areas of strength on which to build. has right that must be respected. comes with experiences that contribute to their problem. share fears that are similar to those of all mentally healthy individuals.
has areas of strength on which to build. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged.
In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to ask the client whether he views himself as being depressed. identify his culture's view regarding suicide. explain to him that suicide is often regarded as a desperate act. assess the client for other examples of depressive behaviors.
identify his culture's view regarding suicide. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor, and Middle Eastern "suicide bombers" are considered holy warriors or martyrs. Contrast these viewpoints with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill.
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 is displaying deviant behavior. cannot accurately appraise reality. is seriously and persistently mentally ill. should be considered for group home placement.
is displaying deviant behavior. This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.
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 demonstrating symptoms of bipolar disorder. socially deviant. Incorrect egocentric. not demonstrating any definitive signs of mental illness.
not demonstrating any definitive signs of mental illness One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams "irrational" dreams at night, and "irrational" emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.
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 demonstrating symptoms of bipolar disorder. socially deviant. egocentric. not demonstrating any definitive signs of mental illness.
not demonstrating any definitive signs of mental illness. One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams "irrational" dreams at night, and "irrational" emotions are universal human experiences and are essential to a fulfilling life. Some people who show extremely abnormal behavior and are characterized as mentally ill are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.
The mental health status of a particular client can best be assessed by considering the degree of conformity of the individual to society's norms. the degree to which an individual is logical and rational. placement on a continuum from health to illness. the rate of intellectual and emotional growth.
placement on a continuum from health to illness. Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful.
A nursing diagnosis for a client with a psychiatric disorder serves the purpose of justifying the use of certain psychotropic medication. providing data essential for insurance reimbursement. providing a framework for selecting appropriate interventions. completing the medical diagnostic statement.
providing a framework for selecting appropriate interventions. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing
These severe mental illnesses are recognized across cultures: antisocial and borderline personality disorders. schizophrenia and bipolar disorder. bulimia and anorexia nervosa. amok and social phobia.
schizophrenia and bipolar disorder. Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally.
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: "Don't be afraid; it means I'm here to help, not hurt, you." "Psychiatric mental health nurses care for people with mental illnesses." "We have the specialized skills needed to care for those with mental illnesses." "The nurses who work in mental health facilities have that title."
"We have the specialized skills needed to care for those with mental illnesses." A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia.
A nurse is caring for a patient who is agitated. Which medication should the nurse anticipate to be ordered to calm the patient? 1 Chlorpromazine (Thorazine) 2 Ibuprofen (Advil, Motrin) 3 Acetaminophen (Tylenol) 4 clonazepam (Klonopin)
1 Chlorpromazine (Thorazine) has a calming effect on the agitated person, and discovery of this effect in 1952 changed the psychological focus on treating mental illnesses in the United States. Ibuprofen and acetaminophen may have an analgesic effect, but will not calm an agitated person. Clonazepam (Klonopin) is an anti-seizure medication that is sometime used for patients with mental disorders, though it causes heavy sedation rather than just a calming effect.
Resilience is related most closely to: 1 adaptation 2 spirituality 3 self-confidence
1 Resilience is associated closely with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. Resilience refers to an ability and capacity to secure resources needed to support one's well-being. Spirituality relates to one's search for the meaning of life, a relationship with a higher being, and adherence to transcendent values. Self-confidence is the result of intact self-image and self-esteem. Self-actualization is part of Maslow's hierarchy of needs.
The nurse is addressing a group of people in the Save the Children campaign. The nurse states that the donations will motivate the children and also have a physiological impact on the children's brains. Which physiological impact is the nursing speaking about? 1 The effect of the destructive chemicals that increase stress is inhibited 2 The production of the destructive chemicals that increase stress is inhibited Incorrect3 Activation of chemicals blocking the receptor sites of the stress-related chemicals
1 The effect of the destructive chemicals that increase stress is inhibited Research has proved that social support motivates an individual by causing the release of oxytocin, which alleviates the destructive stress-related chemicals. Oxytocin diminishes the effect of the stress-related chemicals; however, it does not inhibit the production of these chemicals. Oxytocin is not a receptor-blocking agent. It does not inhibit the action of the chemicals by blocking the receptor site of the chemicals either directly or indirectly.
A nurse is caring for a patient in a psychiatric unit. The nurse plans to use the advanced level of interventions for the patient. Which interventions should the nurse include in the plan of care? Select all that apply. 1 Consultation 2 Psychotherapy 3 Milieu therapy 4 Heath teaching 5 Medication prescription
1,2,3,4,5 Advanced practice interventions include consultation, psychotherapy, and medication prescription and treatment; however, advanced level care plans will also include basic-level interventions (coordination of care, health teaching and health maintenance, milieu therapy, and pharmacological, biological, and integrative therapies). Consultation means sharing of clinical expertise with nurses or those in other disciplines to enhance their treatment of patients. Psychotherapy means individual, couple, group, or family therapy. Medication prescription involves the prescription of psychotropic medications. Milieu therapy is associated with providing and maintaining a safe and therapeutic environment in collaboration with patients, families, and other health care clinicians. Health teaching is patient education provided on topics like self-care, nutrition, and stress management.
A community health nurse is performing a clinical epidemiology study of a mental disorder in a population. Which tool should the nurse use in the study? Select all that apply. 1 Natural history of the disease 2 Diagnostic screening test 3 Maternal mortality rate 4 Birth rates and death rates 5 Interventions used to treat the illness
1,2,5 Clinical epidemiology involves the study of the natural history of the disease, which includes the etiology, pathology, and pathogenesis of the disease. It also involves the study of diagnostic screening tests to diagnose the mental disorders. A study of interventions used to treat the illness is also included when performing a clinical epidemiological study. The study of epidemics or epidemiology involves the study of maternal mortality rate, birth rate, and death rate.
Which statements will help a nurse effectively understand the concept of resilience as it affects the mental health of a patient facing a traumatic loss? Select all that apply. 1 Resilience is associated with an individual's ability to adapt to unpleasant situations. 2 A resilient individual has an increased tolerance for normal stressors. 3 Being able to seek out appropriate support is a characteristic of the resilient individual. 4 The resilient individual has the advantage of increased oxytocin release. 5 Resilience is believed to be a coping mechanism that we are born with and is not learned.
1,3,4 A characteristic of mental health, increasingly being promoted and essential to the recovery process, is resilience. Resilience is associated closely with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being that allow them to excel. This social support actually brings about chemical changes in the body through the release of oxytocin, which mutes the destructive stress-related chemicals. The resilient individual is one who learns to adapt to stressors; it is not related to an increased tolerance for stress.
Which federal legislative acts serve to help assure equality in benefits for both medical/surgical and mental health needs to all insured Americans? Select all that apply. 1 Mental Health Parity Act of 1996 2 The Health Insurance Portability and Accountability Act of 1996 3 The Wellstone-Domenici Parity Act of 2008 4 Patient Protection and Affordable Care Act of 2010 5 Health Care and Education Reconciliation Act of 2010
1,3,4 Parity simply refers to equivalence, and these legislative acts (Mental Health Parity Act, The Wellstone-Domenici Parity Act, and the Patient Protection and Affordable Care Act) help require insurers (including Medicare and Medicaid) to provide mental health coverage (both annual and lifetime benefits) at the same level provided for medical/surgical coverage. The Health Insurance Portability and Accountability Act and the Health Care and Education Reconciliation Act are not related to assuring parity regarding mental health and medical/surgical benefits.
How can a nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment positively affect the climate for treatment? 1 By becoming active in politics leading to a potential political career. 2 By reducing the stigma of mental illness and advocating for equality in treatment. 3 By encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. 4 By advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions
2 Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. Encouraging laws regarding the involuntary long-term commitment process and advocating for reduced mental health insurance benefits are undesirable outcomes.
What was the primary impact that the development and use of psychotropic drugs had on nursing's role in the care of patients with mental health disorders? 1 The availability of mental health therapies as an outpatient service Correct2 The expansion of the role assumed by professionally trained nurses 3 Nurses were needed to fill the gap created by a lack of medical personnel. Incorrect4 More nurses were required to address the needs of the now treatable mental health patients
2 With the influx of mental health patients who were now treatable, the role of the professional nurse was expanded to assist in meeting their needs for care management, treatment implementation, and evaluation of care in both inpatient and outpatient settings. Although availability of outpatient mental health therapies increased with the introduction of psychotic medications, that development affected delivery of the services more directly than it did the role of the professional nurse in the care of psychiatric patients. Nursing is a health care profession that is unique and has never attempted to fill the role of the medical health care professional. Although the expansion of services and the number of treatable patients increased with the development of psychotropic medications, the professional nurse's role was affected by more than simply a need for increased numbers of nurses.
A nurse is caring for a patient who complains of restlessness and inability to concentrate. The patient also has difficulty falling asleep. There is no history of any trauma or physical injury. What is the most common mental disorder that involves such behavior? 1 Obsessive-compulsive disorder 2 Anxiety disorder 3 Bipolar disorder 4 Posttraumatic stress disorder (PTSD)
2 Anxiety disorder The patient is suffering from anxiety disorder, which manifests as restlessness, sleep disturbances, and extreme anxiety in any circumstances. Obsessive-compulsive disorder is a disorder in which a patient has an overwhelming urge to perform rituals, but is not necessarily marked with sleep disturbances. Bipolar disorder is a mood disorder, whereas PTSD is characterized by stress and uneasiness following a history of trauma.
What are the functions of a registered nurse (RN) in a psychiatric facility? Select all that apply. 1 Prescribing drugs for patients with mental illness 2 Planning nursing interventions for patients 3 Teaching stress management techniques to caregivers 4 Explaining drug prescriptions and regimens 5 Providing individual or group psychotherapy
2,3,4 The functions of the RN in a psychiatric facility include planning nursing interventions, teaching stress management to patients and caregivers, and explaining the drug regimens to patients and the caregivers. These activities require nursing judgment and the implementation of the nursing process. Prescribing drugs and providing psychotherapy is beyond the scope of work of the RN. However, an advanced practice registered nurse in psychiatric mental health (APRN-PMH) is eligible to perform these duties.
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A patient with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering: 1 "Don't be afraid; it means I'm here to help, not hurt, you." 2 "Psychiatric mental health nurses care for people with mental illnesses." 3 "We have the specialized skills needed to care for those with mental illnesses." 4 "The nurses who work in mental health facilities have that title."
3 A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. Telling the patient not to be afraid, that a psychiatric mental health nurse cares for people with mental illnesses, or that this is the title for those working in mental health facilities either do not effectively answer the patient's question or assume that the question is the result of the patient's paranoia.
Select the statement that best describes successful treatment for mental disorders in the United States. 1 Treatment outcomes were most successful when they focused on biological interventions. 2 Treatment for mental disorders has improved greatly in the 21st century and is reflected in the reduction of mental disorders. 3 Statistics for the prevalence of mental disorders in the United States remain static. 4 The combination of medications, interactive therapies, and biologic therapies have been most successful in reducing prevalence of mental disorders.f
3 Despite advances in biological and psychological research and treatment options, statistics reflect the prevalence of mental disorders in the United States has remained static.
During crisis management in an earthquake-hit area, a nurse comes across a woman who has lost her family in the earthquake. However, she is still helping the team to recover other dead bodies from the debris. What characteristic does the woman exhibit in this case? 1 Panic 2 Anxiety 3 Resilience 4 Depression
3 Resilience Resilience means an ability to recover from a difficult situation quickly. A resilient person is able to adapt to the loss and does not become a victim of negative emotions. Panic, anxiety, and depression take away the power to think and make a proper decision. These characteristics may interfere with coping and increase stress.
Which statement describes the incidence and prevalence of a chronic illness like schizophrenia? 1 The prevalence and incidence of schizophrenia are equally low. 2 The prevalence and incidence of schizophrenia are equally high. 3 The prevalence of schizophrenia is high, and the incidence is low. 4 The prevalence of schizophrenia is low, and the incidence is high.
3 The prevalence of schizophrenia is high, and the incidence is low. The prevalence rate of an illness describes the total number of new and existing cases in a given population during a specific period of time, regardless of when they became ill. The incidence rate of an illness describes the number of new cases of an illness in a healthy population within a given period of time. For chronic illnesses such as schizophrenia, the total number of existing cases (prevalence) is always higher than the total number of new cases (incidence). The prevalence and incidence rates are not equally high or low; the prevalence rate always exceeds the incidence rate. For a disease like the common cold, which is cured easily, the incidence rate is higher than the prevalence rate.
Which basic intervention should the psychiatric mental health nurse plan to provide for a patient diagnosed with a mood disorder? 1 Sharing clinical expertise to enhance patient treatment 2 Performing individual or group psychotherapy for the patient 3 Using appropriate diagnostic tests to monitor patient condition 4 Conducting stress management and health maintenance classes
4 Conducting stress management and health maintenance classes is the basic intervention that should be performed by the psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management classes are examples of health maintenance classes. Consulting nurses from other disciplines to share clinical expertise and enhance patient treatment is an advanced practice psychiatric mental health nursing intervention. Performing individual and group psychotherapy and performing diagnostic tests like blood pressure, etc., are also advanced practice psychiatric mental health nursing interventions.
What must the psychiatric nurse do first to become a political advocate for the mentally ill? 1 Be willing to learn the legislative and regulatory processes at both the federal and state levels. 2 Recognize the need to work in partnership with the American Medical Association. 3 Be willing to put aside differences and unite for a common mental health cause. 4 Recognize the value of his or her understanding of the needs of the mentally ill.
4 Recognize the value of his or her understanding of the needs of the mentally ill. The collective experience and knowledge possessed by psychiatric nurses are invaluable to understanding and advocating for the mentally ill. Psychiatric nurses must recognize that value and then move towards being political advocates for the mentally ill in our nation. While it is necessary to become politically effective, learning legislative and regulatory processes is not the first task to be addressed. Professional nursing has as a mandate to act as a patients' advocate. This role is not viewed as a joint venture with any other health care profession or agency. Although a factor in becoming politically effective, recognizing the need to work in partnership with the American Medical Association is not the first task to be addressed.
Which of the following best demonstrates parity related to mental health care? The client is admitted for a 72-hour mental hygiene evaluation. Advance practice nurse can be certified as psychiatric nurse specialist. A client's mental health coverage is equal to his medical/surgical coverage. A client who has attempted sucide is hospitalized for a mental health evaluation.
A client's mental health coverage is equal to his medical/surgical coverage. Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage.
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? Control over behavior Appraisal of reality Effectiveness in work Healthy self-concept
Appraisal of reality The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.
Which statement about diagnosis of a mental disorder is true? The symptoms of each disorder are common among all cultures. Culture may cause variations in symptoms for each clinical disorder. All mental disorders listed in the DSM-5 are seen in all other cultures. Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system.
Culture may cause variations in symptoms for each clinical disorder. Every society has its own view of health and illness and the types of behavior categorized as mental illness. Culture also influences the symptoms of a particular disorder. For example, individuals of certain cultures are more likely to express depression through somatic symptoms than through affect and feeling tone. The five axes system was abandoned in this edition of the DSM-5.
Which statement best describes the DSM-5? It is a medical psychiatric assessment system. It is a compendium of treatment modalities. It offers a complete list of nursing diagnoses. It suggests common interventions for mental disorders.
It is a medical psychiatric assessment system. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses.
A group of nurses takes action to ensure that consumers have the authority to choose from various health care options, participate in their health care decisions, and provide education and support. Which component of the recovery process has been enhanced? 1 Hope 2 Respect 3 Empowerment 4 Responsibility
Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. It has multiple components. Empowered consumers have the authority to choose from a range of options, participate in all decisions that affect their lives, and are educated and supported to do so. Hope is the essential motivating message and catalyst of a better future, the belief that people can overcome barriers and obstacles that confront them. Respect is defined as the community, systems, and societal acceptance and appreciation of consumers, including protecting their rights and eliminating discrimination and stigma. Promoting responsibility occurs when consumers have a personal accountability for their own self-care and recovery, understanding and giving meaning to their experiences, and identifying strategies to promote their own wellness.