NUR326 Mental Health

What is Beneficence?

quality of doing good ex: nurse helps a newly admitted client with a psychotic disorder to feel safe in the environment

A nurse is discussing burnout among nurses with a colleague. Which of the following is a strategy to reduce burnout? a. self-scheduling work shifts b. keeping to oneself at work c. working extra shifts during staff shortages d. skipping shared governance meetings

A, more control over work-life balance helps reduce burnout BC increase burnout D is a chance to share staffing concerns

A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority? a. coordinate holistic care with social services b. identify the client's perception of their mental health status c. include the client's family in the interview d. teach the client about their current mental health disorder

B ACD, appropriate if the client wishes but there is another priority

A nurse is caring for a client who is in mechanical restraints. Which of the following statements should the nurse include in the documentation? (SATA) a. "client ate most of their breakfast" b. "client was offered 8oz of water every hr" c. "client shouted obscenities at assistive personnel" d. "client received chlorpromazine 15 mg by mouth at 1000" e. "client acted out after lunch"

BCD, only objective data should be documented "a" would be correct if it stated "client ate 70% of their breakfast"

A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary information to the client? (SATA) a. reassure the client that everything will be okay b. discuss prior use of coping mechanisms with the client c. ignore the client's anxiety so that they will not be embarrassed d. demonstrate a calm manner while using simple and clear directions e. gather information from the client using closed-ended questions

BD False reassurance and ignoring the problem is bad. Open ended questions are better, they urge the client to express feelings and identify the source of the anxiety

What are manifestations of someone at the excelling level on the mental health continuum?

Being motivated toward a goal achievement, energetic, positivity, high performance, joyfulness

Identify the standardized assessment tool the nurse should use to assess the older adult client's severity of depression

Geriatric Depression Scale

What are examples of genetic determinants of mental health?

intellectual disability, gender, race, and age (things you cannot change)

What is Fidelity?

loyalty and faithfulness to the client and one's duty ex: a client asks a nurse to be present when they talk to their guardian for the first time in a year, nurse stays with the client during this interaction

A charge nurse in conducting a class on therapeutic communication with a group of newly licensed nurses. Which of the following aspects of communication should the nurse identify as a component of verbal communication? a. personal space b. posture c. eye contact d. intonation

D

What are manifestations of someone in the crisis level on the mental health continuum?

absenteeism, high anxiety, very poor sleep, weight loss, and very low mood along with exhaustion

What is Veracity?

honesty when dealing with a client ex: a client states "you and the other staff member were talking about me weren't you?", the nurse truthfully replies "we were discussing ways to help you relate to the other clients in a more positive way"

What are manifestations of someone at the surviving level on the mental health continuum?

social isolation/withdrawing from society, nervousness, sadness, trouble sleeping, and irritability

A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (SATA) a. educational groups b. medication dispensing programs c. individual counseling programs d. detoxification programs e. family therapy

ABCE Detox programs are provided in a partial hospitalization program

A nurse is reviewing the medical records of multiple clients t a community mental health facility. Which of the following events is an example of a client experiencing a maturational crisis? a. rape b. marriage c. severe physical illness d. job loss

B, a maturational crisis is a naturally occurring event during the lifespan A: adventitious crisis, not a part of every day life C: situational crisis D: situational crisis

A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (AST) group? a. a client in an acute care mental health facility who has failed several times while running down the hallway b. a client who lives at home and keeps "forgetting" to come in for a scheduled monthly antipsychotic injection for schizophrenia c. a client in a day treatment program who reports increasing anxiety during group therapy d. a client in a weekly grief support group who reports still missing a deceased partner who has been dead for three months

B, an ACT group works with clients who are nonadherent with traditional therapy

A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (SATA) a. lithium carbonate b. paroxetine c. risperidone d. haloperidol e. lorazepam

BE, SSRIs and benzos may be prescribed for someone experiencing a crisis

What is Justice?

fair and equal treatment for all ex: two clients who break the same facility rule are treated equally

What are manifestations of someone at the thriving level on the mental health continuum?

fostering social relationships, performing, positivity, eating well, and calmness

Identify the assessment/communication techniques the nurse should use when assessing the older adult client

1. private, quiet space to accommodate for impaired vision/hearing 2. ask what they preferred to be called 3. stand/sit at their level 4. use touch to communicate caring as appropriate 5. include questions relating to: difficulty sleeping, incontinence, falls/other injuries, depression, dizziness, loss of energy 6. include family and significant others as appropriate 7. obtain detailed med history 8. following interview, summarize and ask for feedback from client

Identify what factors the nurse should assess to determine if role and life changes are contributing to the client's depression

1. whether recent role transitions were expected or unexpected 2. client's knowledge and use of positive coping behaviors 3. participation in community resources 4. client's knowledge and use of stress reduction techniques 5. ability to maintain housing or employment

A nurse is caring for a client who reports that they are having a hard time completing their ADLs due to feeling anxious. The client also reports feeling tired, difficulty sleeping, and having a poor appetite. The nurse should anticipate they would fall in which end of the mental health continuum? a. The client would fall closer towards the mental illness end or struggling b. The client would fall closer towards the mental health end or thriving c. The client would not clearly fall on the mental health continuum as they do not have a mental illness diagnosis d. The client should be evaluated by the provider before their observance on the mental health continuum is noted, as currently they would fall in the middle

A, the mental health continuum is a range of responses a person displays in response to life events. The ends vary between positive and negative responses, often viewed as mental health versus mental illness. They do not have to be diagnosed with a mental illness to be on the continuum, nor do they have to be evaluated by the provider first.

A nurse is discussing ethical principles with another nurse. Which of the following should the nurse include as an examples of the principle of nonmaleficence? a. a nurse evaluates the clint's desire for autonomy while considering the personal safety of other clients on the unit b. a nurse encourages the client to determine which therapeutic activity they would like to participate in c. a nurse plans to spend equal amounts of time with each client assigned to their care d. a nurse makes a referral to speech therapy for a client who is experiencing dysphagia

A, the principle of nonmaleficence involves doing no harm. by weighing the risks and benefits of the client's desire for autonomy while considering the safety of the other clients on the unit, the nurse is practicing nonmaleficence B is principle of autonomy C is principle of justice D is principle of beneficence

A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." The nurse should identify that the client is using which of the following defense mechanisms? a. reaction formation b. denial c. displacement d. sublimation

B Reaction formation is overcompensating or demonstrating the opposite behavior of what is felt. Displacement is shifting feelings related to an object/person/situation to another less threatening object/person/situation. Sublimation is dealing with unacceptable feelings/impulses by unconsciously substituting acceptable forms of expression.

A nurse is preparing a poster presentation on the priorities of Health People 2030. Which of the following priority goals should the nurse include? a. the practice of trephination for the treatment of mental illness b. Prevention practices related to cyber-bullying c. increasing institutionalization of clients who have severe mental health disorders d. limit screening of mental illness to those individuals who display manifestations

B, cyber-bullying is a stressor that can result in mental health disorders. By implementing practices targeted at prevention of cyber-bullying, the priority goal of prevention of mental health disorders is met The goals of Healthy People 2030 include prevention and screening along with assessment and treatment of individuals who have mental health disorders; this includes increasing screening for mental health issues during primary care visits

A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following actions indicates transference behavior? a. the client asks the nurse if they will go out to dinner together b. the client accuses the nurse of being controlling just like an ex-partner c. the client reminds the nurse of a friend who died from substance toxicity d. the client becomes angry and threatens to engage in self harm

B, transference is when a client views the nurse as having characteristics of another person A indicates the needs to discuss boundaries, not transference C indicates countertransference D indicates the need for a safety intervention, not transference

A nurse is providing preoperative teaching for a client who was informed of the need for emergency surgery. The client has a respiratory rate 30/min, and says, "This is difficult to comprehend. I feel shaky and nervous." The nurse should identify that the client is experiencing which of the following levels of anxiety? a. mild b. moderate c. severe d. panic

B. moderate anxiety decreases problem-solving and may hamper the client's ability to understand information. Vital signs may increase somewhat, and the client is visibly anxious Mild: the clients ability to understand information may actually increase Severe: restlessness, decreased perception, and an inability to take direction Panic: person is completely distracted, unable to function, and may lose touch with reality

A nurse is discussing different factors of the determinants of mental health during a staff meeting. Which of the following factors should the nurse include in the discussion? (SATA) a. receiving paid maternity leave b. unsafe drinking water c. exposure to an adverse childhood event d. a playground in the neighborhood e. national policy addressing cyber-bullying

BCDE, the five categories are life-course, households, community, local services, and country level factors

A nurse is planning a peer group discussion about the DSM-5. which of the following information is appropriate to include in the discussion? (SATA) a. the DSM-5 includes client education handouts for mental health disorders b. the DSM-5 establishes diagnostic criteria for individual mental health disorders c. the DSM-5 indicates recommended pharmacological treatment for mental health disorders d. the DSM-5assists nurses in planning care for client's who have mental health disorders e. the DSM-5 indicates expected assessment findings of mental health disorders

BDE It does not do A or C

A charge nurse is presenting on the topic of mental health diagnoses during a unit meeting. The charge nurse should identify that the DSM-5 TR classification is used in conjunction or paired with what other classification system? a. Nursing Intervention Classifications b. Maslow's hierarchy of needs c. International Classification of Disease d. Erikson's Stages of Psychosocial Development

C

A nurse is caring for a newly admitted client who expresses concern that their insurance will not cover their care. The nurse should identify that which of the following is a US congressional act that requires providers to inform their clients of the cost for treatment and whether their insurance will cover it? a. Health Insurance Portability and Accountability Act b. Affordable Care Act of 2010 c. No Surprises Act d. Nurse Practice Act

C

A nurse on a pediatric mental health unit is discussing the importance of setting boundaries with another nurse. Which of the following statements by the nurse explains why setting boundaries is important? a. "Setting boundaries will cause the children to try and leave the unit" b. "Children will automatically rebel against all boundaries set on the unit, so you must let them know the consequences" c. "Setting boundaries increases a child's sense of security through knowing the consequences of behaviors" d. "Children are not able to understand boundaries or consequences of their behavior"

C, setting boundaries increases a child's sense of security, reduces misunderstanding, establishes expected behaviors, and provides an understanding of consequences

A nurse tells a client that they will return in 30 min with their medication. The nurse returns 30 min later with the client's medication. Which of the following ethical principles is the nurse demonstrating? a. beneficence b. autonomy c. veracity d. justice

C, veracity = truthful and honoring commitments

A charge nurse is discussing the characteristics of a nurse-client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? (SATA) a. the needs of both participants are met b. an emotional commitment exists between the participants c. it is goal-directed d. behavioral change is encouraged e. a termination date is established

CDE A is wrong because relationship should focus on needs of client B is wrong because the nurse should not get emotionally involved

A nurse in an acute mental health facility is communicating with a client. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? a. offering general leads b. summarizing c. focusing d. restating

D

A nurse is talking with the caregiver of a child who has demonestrated recent changes in behavior and mood. When the caregiver of the child asks the nurse for reassureance about their child's condition, which of the following responses should the nurse make? a. "I thinking your child is getting better. What have you noticed?" b. "I'm sure everything will be okay. I just takes time to heal." c. "I'm not sure what's wrong. Have you asked the doctor about your concerns?" d. "I understand you're concerned. Lets discuss what concerns you specifically."

D remember: no one cares what you think!

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? a. a client' verbal threat of suicide is attention-seeking behavior b. interventions are ineffective for clients who really want to commit suicide c. using the term suicide increases the client's risk for a suicide attempt d. a no-suicide contract decreases the client's risk for suicide

D, a contract promotes and maintains trust between the nurse and client (however it should not be used as a replacement for other suicide prevention strategies) ABC: just no

A nurse is reviewing the concept of bias with a newly licensed nurse. Which of the following scenarios should the nurse use to demonstrate biased treatment? a. a client is not permitted to attend the group therapy activity due to wanting to harm another peer in the group b. a client is not permitted to attend the group therapy activity due to having a family therapy session during the same time c. a client is not permitted to attend the group therapy activity due to having thoughts of harming themselves with "anything they can find" d. a client is not permitted to attend the group therapy activity because they practice the Buddhist faith

D, bias is when treatment of a client is verified in the form of stereotyping, prejudice, or discrimination.

A nurse is caring for a client who has schizophrenia and has recently been diagnosed with a terminal illness. The client's interprofessional team should recommend which of the following for the client? a. urgent care b. dementia care c. experimental therapy d. hospice care

D, hospice care focuses on the care, comfort, and quality of life for a person who has a terminal illness and is approaching end of life

A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? a. assign the client to a private room b. document the client's behavior every hour c. allow the client to keep perfume in her room d. ensure that the client swallows medication

D, prevents the client from possibly hoarding meds to overdose A: its better to not give them a private room B: document behavior q15min C: no

A nurse is reviewing the chart of a client who has paranoid schizophrenia. The nurse should identify that the DSM-5 TR distinguishes the different types of schizophrenia based on which of the following criteria? a. current medication history b. when the manifestations started c. family history of mental illness d. the client's full history

D, the DSM-5 TR criteria can be broken down based on the client's manifestations obtained during the complete health history

A newly licensed nurse is reviewing the American Nurses Association's core professional values of nursing. Which of the following actions by the nurse demonstrates the value of empowerment? a. the nurse becomes a trainer for the new equipment for other nurses on the unit b. the nurse schedules care around the client's religious practices of daily prayer c. the nurse supports the autonomy of a client who refuses chemotherapy, even though their family wants it d. the nurse provides resources to the client who wants to create a living will before they have surgery

D, the value of empowerment involves the use of decision making to solve problems for the client.

What are the levels on the mental health continuum?

Excelling, Thriving, Surviving, Struggling, Crisis

What are examples of social determinants of mental health?

physical abuse, job stress, education, job opportunities, social support systems, housing conditions, family dynamics (conditions based on people around you, ATI says these cannot be changed)

What is Autonomy?

the client's right to make their own decisions; client must accept the consequences of those decisions and must respect the decisions of others ex: a nurse helps a client explore all alternatives and arrive at a choice

A nurse is caring for a client who states "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? a. client's educational and economic background b. lethality of the method and availability of means c. quality of the client's social support d. client's insight into the reasons for the decision

B, priority is to find out: how lethal the method is, how available the method is, and how detailed the plan is

A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission? a. a client who has schizophrenia with delusions of grandeur b. a client who has manifestations of depression and attempted suicide a year ago c. a client who has borderline personality disorder and assaulted a homeless man with a metal rod d. a client who has bipolar disorder and paces quickly around the room while talking to themselves

C a client who is a current danger to self or others is a candidate for a temporary emergency admission

A nurse in an acute mental health facility is assisting with discharge planning for a client who has a severe mental illness and requires supervision. The client's partner works all day but is home by late afternoon. Which of the following strategies should the nurse suggest for follow up care? a. receiving daily care from a home health aide b. having a weekly visit from a nurse case worker c. attending a partial hospitalization program d. visiting a community mental health center on a daily basis

C, a partial hospitalization program can provide treatment during the day while allowing the client to spend nights at home, as long as a responsible family member is present ABD will not provide enough supervision for this client

A is nurse caring for a client who has anorexia nervosa. Which of the following examples demonstrates the nurse's use of interpersonal communication? a. the nurse discusses the client's weight loss during a health care team meeting b. the nurse examines their own personal feelings about clients who have anorexia nervosa c. the nurse asks the client about personal body image perception d. the nurse presents an educational session about anorexia nervosa to a large group of adolescents

C, interpersonal communication is between nurse and one other person (often the client) A is small-group communication B is intrapersonal communication D is public communication

A nurse in a mental health facility is caring for an adult client who has bipolar disorder. The client becomes violent and begins throwing objects at other clients. After calling for assistance, what actions should the nurse take next? (Before applying mechanical restraints)

1. tell the client calmly to sit down (verbal intervention is the least restrictive method when dealing with an aggressive patient) 2. provide the client with a decreased-stimulation environment and attempt diversion or redirection (these interventions are less restrictive than seclusion or restraint and the nurse should attempt these interventions prior to more restrictive actions) 3. offer the client a PRN med like diazepam (it can be necessary for the nurse to administer diazepam to calm the client and is considered less restrictive than mechanical restraints) 4. place the client in a monitored seclusion room (it can become necessary to place the client in seclusion if the client persists in the behavior after attempting less restrictive interventions)

A nurse is caring for a newly admitted client who states they are concerned about their privacy and rights while on the psychiatric unit. The nurse should explain to the client that they have which of the following rights? a. the right to refuse treatment b. the right for their information to be shared with their family at any time c. the right for their clinical notes to be shared with anyone at the facility d. the right for providers to solely decide their treatment options

A

A nurse is communicating with a client who was admitted for treatment of a substance use disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication? a. offering advice b. reflecting c. listening attentively d. giving information

A

A patient who is at a health clinic reports a sore throat and is exhibiting signs of depression. The nurse administers a basic screening for depression. What level of prevention is the nurse performing? a. secondary prevention b. tertiary prevention c. modified prevention d. primary prevention

A, Secondary prevention is aimed at early detection of problems, in this case, the identification of depression for early intervention. Primary prevention for mood disorders focuses on stress reduction and societal issues such as reducing poverty and racism. Tertiary prevention aims to reduce disability from a diagnosed condition; for mood disorders, this includes prevention of relapse and protection from harm. Modified prevention is not a recognized level of prevention, although prevention interventions may need to be adapted to meet specific individual situations.

A family member of a patient diagnosed with bipolar disorder asks what behaviors would indicate the beginnings of a manic phase. What is the best response by the nurse? a. "The person may have excess energy, talk a lot, feel restless, and spend too much money." b. "The person may experience decreased energy and interest in activities beginning in the winter months." c. "The person may have sudden spikes in blood pressure and crave foods that are sweet or salty." d. "The person may sleep more, have trouble completing hygiene needs, and have a poor appetite."

A, Signs that a person is cycling into a manic phase include sleeping and eating less and having increased energy and racing thoughts, increased impulsivity, and increased spending behaviors. Blood pressure may increase related to increased activity, but increased blood pressure and food cravings alone are not indicative of mania. Increased sleep and poor appetite and hygiene are indicative of depression. Decreased energy in winter seasons is indicative of seasonal affective disorder related to decreased sunlight.

A nurse decides to put a client who has psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? a. invasion of privacy b. false imprisonment c. assault d. battery

B, confining a client to a specific area for the convenience of the staff invasion of privacy is the sharing or obtaining of the client's confidential information without the client's consent. assault is making a threat to the client's person. battery involves causing intentional physical harm to clients

A nurse is working in a neighborhood where the population is culturally diverse. Which of the following actions should the nurse take to ensure the delivery of culturally competent care? a. reflect on their own culture b. read a book about the countries of the residents' ancestry c. talk to the residents of the neighborhood about their culture d. provide care that meets the residents' needs

C, ask don't assume

A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements should the nurse make? a. "You and a group of other clients will meet to discuss your treatment plans." b. "Community meetings have specific agenda that is established by staff." c. "You and the other clients will meet with staff to discuss common problems d. "Community meetings are an excellent opportunity to explore your personal mental health issues."

C, community meetings are an opportunity for clients to discuss common problems or issues affecting all members of the unit A and D happen during individual therapy B community meetings are structured so that they are client led with decisions made by the group as a whole, not the staff

A nurse is talking with a client who is at risk for suicide following their partner's death. Which of the following statements should the nurse make? a. "I feel very sorry for the loneliness you must be experiencing." b. "Suicide is not the appropriate way to cope with loss." c. "Losing someone close to you must be very upsetting." d. "I know how difficult it is to lose a loved one."

C, empathetic response that attempts to understand the client's feelings A is sympathetic rather than empathetic B implies judgement D focuses on nurse's experiences

A client tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always threatening me." Which of the following actions should the nurse take? a. keep the client's communications confidential, but talk to the client daily, using therapeutic communication to convince them to admit to hiding the knife b. keep the client's communication confidential, but watch the client and their roommate closely c. tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others d. report the incident to the health care team, but do not inform the client of the intention to do so

C, information presented is a serious safety issue and nurse shows veracity by telling the client truthfully what must be done

A nurse is discussing what to do about feelings of burnout with a group of nurses. Which of the following is the best strategy the nurse should implement? a. suggest that nurses who are experiencing burnout get treatment or quit their position b. reduce meetings for shared governance c. request an increase in pay d. meet with other nurses to create a plan to support each other

D

A nurse is reviewing the medical records of a group of clients. The nurse should identify that which of the following factors places a client at risk for mental illness? a. a family member wit ha diagnosis of diabetes b. a medical diagnosis of diabetes c. a history of using community support services d. a history of abuse

D

A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention? a. assist the client with systematic desensitization therapy b. teach the client appropriate coping mechanisms c. assess the client for comorbid health conditions d. monitor the client for adverse effects of medications

D A is a cognitive and behavioral intervention B is a counseling or health teaching intervention C is a health promotion and maintenance intervention

A nurse is sitting with a client who is extremely anxious until they fall asleep. The nurse should identify that this is an example of which of the following ethical principles? a. justice b. autonomy c. nonmaleficence d. beneficence

D, acting "for the good" of others A: caring for all clients equally B: client can make decisions about their care C: advocate for treatment modalities that result in least amount of harm which achieving a beneficial outcome

Describe concepts of mental health treatment

Goals of acute mental health treatment: a. prevention of the client harming self/others b. stabilizing mental health crises c. return of clients who are severely ill to some type of community care Interprofessional team members in acute care include: a. nurses b. mental health technicians c. psychologists d. psychiatrists e. other general health care providers f. social workers g. counselors h. occupational and other specialty therapists i. pharmacists

What are nursing interventions that apply to acute mental health care?

Who: the interprofessional team member's primary responsibility is planning and monitoring individualized treatment plans of clinical pathways of care When: plans for discharge to home or to a community facility begin from the time of admission How: nursing roles include overall management of the unit, including client activities and therapeutic milieu Ensuring safe administration and monitoring client meds Implementation of individual client treatment plans, including client teaching Documentation of the nursing process for each client, manage crises as they arise

Identify criteria for admitting a client to a mental health facility

a. clear risk of the client's danger to self/others b. failure to meet expected outcomes of a community-based treatment c. a dangerous decline in the mental health status of a client undergoing long-term treatment d. a client having a medical need in addition to a mental illness

Identify interventions to prevent client self-harm or harm by others.

a. prevent access to sharp/harmful objects b. restrict client access to restricted or locked areas c. monitor visitors d. restrict alcohol and illegal substance access and use e. restrict sexual activity among clients f. deter elopement from facility g. provide rapid de-escalation of disruptive and potentially violent behaviors h. be aware of facility policies and procedures for seclusion/restraints i. provide safe access to recreational areas, therapy, and meeting rooms

Identify responsibilities of the health care team to maintain a therapeutic milieu

a. promote independence for self-care and individual growth b. treat clients as individuals c. allow choices for clients within the daily routine and treatment plan d. apply rules of fair treatment for all clients e. model good social behavior f. work cooperatively as a team to provide care g. maintain boundaries with clients h. maintain a professional appearance and demeanor i. promote safe and satisfying peer interactions among clients j. promote feelings of self-worth and hope for the future

What are environmental determinants of mental health?

basic necessities (such as water), social inequality, pollutants, war, and natural disasters

What are manifestations of someone at the struggling level on the mental health continuum?

hopelessness, poor sleep, tiredness, depression, poor appetite, anxiety, and poor performance

A nurse is discussing responsibilities in milieu therapy with a group of newly hired nurses. Which of the following should the nurse include? (SATA) a. explain unit rules, including expectations and client rights b. provide orientation, including a tour of the unit, rules, and expectations c. select activities based on preferences of available staff d. ensure that culturally-sensitive care is provided e. use a trauma-informed approach to client care

ABDE C: the nurse should select activities that promote participation, recovery, and healing

A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse implement as a method of tertiary prevention? a. educating clients on health promotion techniques to reduce the risk of depression b. performing screenings for depression at community health programs c. establishing rehabilitations programs to decrease the effects of depression d. providing support groups for clients at risk for depression

C, rehab programs are an example of tertiary prevention. Tertiary prevention deals with prevention of further problems in clients already diagnosed with mental illness A is primary prevention B is secondary prevention D is primary prevention

A nurse is presenting information on mental health services over the last 50 years to a group of newly licensed nurses. in 1946, the National Mental Health Act was signed into law which resulted in which of the following? a. the establishment of the mental health court to determines soundness or fitness to stand trial b. the development of mental health centers throughout community settings c. the creation of the National Institute for Mental Health d. the coverage of mental health services for children and youth

C, the need for psychiatric services has increased over the years, specifically following WWII. The National Institute of Mental Health is a federal agency that researches mental illness and was a pioneers in assisting in the transformation of treatment and understanding of mental illnesses

A nurse is planning care for several clients who are attending community-based mental health programs. Which of the following clients should the nurse visit first? a. a client who received a burn on the arm while using a hot iron at home b. a client who requests a change of antipsychotic medication due to some new adverse effects c. a client who reports hearing a voice saying that life is not worth living anymore d. a client who tells the nurse about experiencing manifestations of severe anxiety before and during a job interview

C, this client is at greatest risk for self-harm and should be visited first

A charge nurse on a mental health unit is discussing the concept of client competency with a group of newly licensed nurses. Which of the following information should the charge nurse include? a. a client can be deemed legally competent via confirmation by two mental health providers b. a client is automatically deemed to be incompetent upon admission to the facility if they are experiencing psychosis c. a client who is deemed incompetent will be unable to make decisions for themselves d. a client is considered mentally competent until deemed incompetent by a judge in a legal hearing

D competency can only be determined by a judge in a court, if a client is incompetent then a legal surrogate or representative will make decisions on their behalf

A patient coming to the health clinic for a blood pressure check reports to the nurse that she just does not have the energy to go out much in winter but looks forward to gardening in summer. The nurse realizes that this patient is describing a major symptom of what condition? a. medication side effects b. antisocial personality c. anxiety d. seasonal affective disorder

D, Decreased exposure to sunlight in winter months can reduce the production of serotonin in the brain, leading to a type of depression termed seasonal affective disorder; this tends to resolve with the longer days and increased exposure to sun of spring and summer. There are not enough data to identify anxiety or signs linked to medication, which also tend to not resolve with seasons. Antisocial traits not only include isolation but also include behaviors of manipulation and lack of remorse in interpersonal relationships.

A nurse is explaining what "duty to warn" means to a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding? a. "If a client threatens to harm another person, health care providers have a responsibility to inform that person." b. "If a client threatens to harm themselves, there is a responsibility to report that client to their family." c. "If a client threatens to harm themselves, there is a responsibility to tell their medical provider." d. "If a client threatens to harm another person, there is a responsibility to inform the other person's family."

A, duty to warn when there is a treat from a client to another person to cause harm to them

A nurse is planning care for the termination phase of a nurse-client relationship. Which of the following actions should the nurse include in the plan of care? a. discussing ways to use new behaviors b. practicing new problem-solving skills c. developing goals d. establishing boundaries

A B happens during the working phase C happens during the orientation phase D happens during the orientation phase

AA nurse is caring for a client who speaks a different language than the nurse. The nurse is looking for resources to assist with providing educational instructions about the client's medication. Which of the following resources should the nurse use? a. US Department of Health and Human Services b. Healthy People 2020 c. Centers for Disease Control and Prevention d. The Mayo Clinic Website

A, US Dep of HHS has a set of culturally and linguistically appropriate services standards to assist in working with people who speak a limited amount of English Healthy People 2020 is an initiative that strives to set national health improvement goals and objectives to assist with these goals. CDC's purpose is to protect Americans from health and safety threats (illness or disease outbreak). The Mayo Clinic website provides educational info for clients on disease and info regarding their medical services

A charge nurse is discussing mental status examinations with a newly licensed nurse. which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (SATA) a. to assess cognitive ability, I should ask the client to count backward by sevens b. to assess affect, I should observe the client's facial expression c. to assess language ability, I should instruct the client to write a sentence d. to assess remote memory, I should have the client repeat a list of objects e. to assess the client's abstract thinking, I should ask the client to identify our most recent presidents

ABC D is assessing immediate memory E is assessing cognitive ability

A nurse is planning an in-service about client confidentiality for a group of newly hired nurses. Which of the following examples should the nurse include when discussing exceptions for maintaining client confidentiality (SATA) a. a client tells a nurse that they intend to kill a coworker b. a nurse is subpoenaed to testify in court about a client they cared for c. an older adult client reports their caregiver allows them to eat one meal per day d. a client tells a nurse that they stole a watch from a friend's house e. a client tells a nurse that they plan to hang themselves when they are discharged

ABCE D: crimes such as battery or murder are reportable, stealing is not

A nurse is facilitating a group discussion about mental health at a local community center. One of the group members states, "My family lost their home and now my child and I are living in a community shelter. It's all been so much to handle. I can't eat or sleep and it's affecting my ability to work." Which of the following factors should the nurse identify as indications this client is at increased risk for a mental health disorder? (SATA) a. dietary intake b. workload c. current living situation d. sleep habits e. parenthood

ACD, The nurse should identify multiple factors that can impact a client's mental health status. Adverse life events such as the loss of a home and living in a community shelter, along with the client's reported physiological effects such as having difficulty eating and sleeping, can increase the risk for the development of a mental health disorder. Although the client reported their ability to work has been negatively impacted, this is a result of the stressors they are currently experiencing rather than a risk factor for mental health disorders. The client reported the child remains with them and is living in the community shelter, but this is not an indication of the client's parenting skills and does not present as a risk factor for mental health disorders.

The nurse is caring for a patient newly diagnosed with major depressive disorder. What typical signs and symptoms would the nurse expect? (SATA) a. appetite changes b. increased fever c. poor eye contact d. slowed speech e. increased white blood cell count

ACD, Typical signs of depression include sleep disturbance; poor eye contact; loss of interest in events; guilt; decreased energy, speech, and concentration; appetite changes; and slowed motor movements. Increased fever and white blood cell count are indicative of infection, not depression.

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (SATA) a. my family will be better off if I'm dead b. the stress in my life is too much to handle c. I wish my life was over d. I don't feel like I can ever be happy again e. If I kill myself then my problems will go away

ACE, a statement is an overt comment about suicide if the client directly talks about their perception of an outcome of their death BD are cover comments, where the client identifies a problem but does not directly talk about suicide, there is a need to assess for suicidal ideation

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (SATA) a. conducting a suicide risk screening on all new clients b. creating a support group for family members of clients who completed suicide c. educating high school teens about suicide prevention d. initiating one-on-one observation for a client who has current suicidal ideation e. teaching middle-school educators about warning indicators of suicide

ACE, primary intervention includes screening and community education B is tertiary prevention D is secondary prevention

A nurse is planning a presentation regarding mental illness for a local health fair. Which of the following should the nurse include as a characteristic of mental illness? a. resilience following a loss of a job b. difficulty maintaining social relationships c. volunteering at a crisis center d. ending a friendship with an individual who demands participation in dangerous activities

B, mental illnesses are associated with distress/problems functioning in social, work, or family activities

A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? a. notify the nurse manager b. tell the nurse to stop discussing the behavior c. provide an in-service program about confidentiality d. complete an incident report

B, invasion of privacy because the information is being shared in a public place other answers are also correct but "b" must be done first

A nurse is discussing the DSM-5 TR with a newly licensed practical nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the DSM-5? a. "I would use the DSM-5 TR to diagnose clients who have mental health disorders." b. "The DSM-5 TR assists in planning nursing interventions for clints who have a mental health disorder." c. "I would use the DSM-5 TR as a guide instructing what specific criteria or questions should be asked for a suspected mental health diagnosis." d. "The DSM-5 TR tells how to treat a patient who has a mental health diagnosis."

B, nurses use the DSM-5 TR diagnostic info to assist with planning, implementing, and evaluating client care. This info can guide nursing interventions for specific needs. A and D are done by the provider, C would lead to biased answers

A patient has been prescribed a selective serotonin reuptake inhibitor (SSRI) antidepressant. After taking the new medication, the patient states, "This medication isn't working. I don't feel any different." What is the best response by the nurse? a. "I will call your care provider, perhaps you need a different medication." b. "Don't worry, we can try taking it at a different time of day to help it work better." c. "It usually takes a few weeks for you to notice improvement from this medication." d. "Your life is much better now. You will feel better soon."

C, Seeing a response to antidepressants takes 3 to 6 weeks. No change in medication is indicated at this point of treatment, because there is no report of adverse effects from the medication. If nausea is present, taking the medication with food may help, but this is not reported by the patient, so a change in administration time is not needed. Telling a depressed patient that his or her life is better does not acknowledge the patient's feelings.

A nurse is providing teaching to a group of newly licensed nurses about stigma. Which of the following client scenarios should the nurse include as an example of self-stigma? a. a client refuses to go to their provider for manifestations of anxiety until they meet with their cultural leader, a shaman b. a client stops taking their medication for anxiety because they do not like how it makes them feel c. a client refuses to pick up their prescription for an antidepressant because they do not want the pharmacist to know they are on an antidepressant d. a client refuses a follow-up appointment for their anxiety because they are waiting until they can arrange their transportation

C, self-stigma is when an individual has a negative view of internalized shame regarding their mental illness, often due to the public stigma of mental illness. side note: another type of stigma is institutionalized stigma

A nurse is caring for a client who is newly admitted to the acute psychiatric unit for alcohol use disorder. The client reports growing up in an Amish community. Which of the following actions should the nurse take? a. inform the client that the nurse follows Judaism b. provide the client with a Bible c. assess for personal bias related to alcohol use disorder before interacting with the client d. ask the client where they grew up practicing Amish traditions

C, to ensure the nurse does not have any bias in their treatment of the client, the nurse should first understand what their own culture and biases are to not hinder client care A, no one cares B, don't assume D, the nurse should allow the client to provide details of the cultural or religious practices on their own terms

Identify nursing interventions that the nurse can use to assist the client who is experiencing severe anxiety

a. provide an environment that meets the physical and safety needs of the client. remain with the client b. provide a quiet environment with minimal stimulation c. use medications and restraint, but only after less restrictive interventions have failed to decrease anxiety to safer levels d. encourage gross motor activities, such as walking and other forms of exercise e. set limits by using firm, short, and simple statements. repetition may be necessary f. direct the client to acknowledge reality and focus on what is present in the environment