Mental Health Evolve Chapter 1
A psychiatric mental health advanced practice registered nurse (PMH-APRN) works with patients in a community mental health center. Which actions differentiate this nurse's practice from the basic practice level? Select all that apply. 1 Preparing a nursing plan of care. 2 Conducting a family therapy session. 3 Leading an exercise group in an outpatient program. 4 Prescribing medication to manage a severe mental illness. 5 Conducting a psychoeducational session about medication side effects.
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A nurse is caring for a patient whose area of residence was affected by a flood. To check the resilience of the patient, the nurse uses the Resilience Factor test. Which score on this test indicates the need to teach calming skills? 1 A score below 6 2 A score above 13 3 A score between 6 and 13 4 A score between 5 and 13
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To what is resilience most closely related? 1 Adaptation 2 Spirituality 3 Self-confidence 4 Self-actualization
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A patient says to the nurse, "Once in a while I have some anxiety about my job but otherwise, life is good." Where is this patient on the mental health-mental illness continuum? 1 Resilience 2 Well-being 3 Mental illness 4 Emotional concerns
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What characteristic of mental health allows people to adapt to tragedies, trauma, and loss? 1 Altruism 2 Resilience 3 Pessimism 4 Dependence
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A nurse works in a psychiatry clinic. In which age group is the nurse likely to find dementia and Alzheimer disease? 1 Old age 2 Childhood 3 Middle age 4 Adolescence
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Which severe mental illnesses are recognized across cultures? 1 Amok and social phobia 2 Bulimia and anorexia nervosa 3 Schizophrenia and bipolar disorder 4 Antisocial and borderline personality disorders
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Which statement best describes the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5? 1 It is a compendium of treatment modalities. 2 It offers a complete list of nursing diagnoses. 3 It is a medical psychiatric assessment system. 4 It suggests common interventions for mental disorders.
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Which statement most clearly shows a holistic view of mental illness? 1 "Mental illness is the result of the moral deterioration of our society." 2 "People are not as tough as they once were, which has led to an epidemic of mental illness." 3 "Mental illness is difficult to define because different cultures vary regarding what is healthy." 4 "The main reason for so much mental illness is that families no longer spend enough time together."
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The nurse has explained deep breathing to a patient who has weak coping skills. The nurse is evaluating the patient's performance of deep breathing exercises to reduce stress. Which action by the patient indicates effective learning? 1 Relaxing the neck muscles 2 Contracting the chest muscles 3 Inhaling slowly through the mouth 4 Inhaling deeply using the chest muscles
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The nurse is caring for a Southeast Asian patient who has been diagnosed with Amok. What outcome does the nurse expect while preparing the treatment plan for the patient? 1 The patient stops exhibiting violent behavior. 2 The patient has an elevated mood and affect. 3 The patient eats adequate food on a regular basis. 4 The patient stops exposing himself or herself to severe cold weather.
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The nurse understands that which term is used to describe new cases of mental disorders in a healthy population within a given period of time? 1 Incidence 2 Prevalence 3 Comorbidity 4 Epidemiology
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The nurse understands which information can be obtained from the Diagnostic and Statistical Manual (DSM)? 1 Classification of mental health disorders 2 An explanation of the mental health continuum 3 Treatment intervention options for people with illnesses 4 Diagnoses for mental health disorders based on international models
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Which is the most significant dysfunction in a patient with Alzheimer disease? 1 Impaired cognitive abilities 2 Impaired emotional control 3 Impaired behavioral control 4 Impaired sensory perception
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Which of the following roles would not be within the scope of practice for a basic level registered nurse (RN)? 1Leading a psychotherapy group session 2 Conducting a home mental health assessment 3 Facilitating the administration of psychotropic medications 4 Arranging for a patient to receive medical treatment off the unit
1 Basic level RNs cannot perform psychotherapy. Administration of psychotropic medications, arrangements for patients, and conducting a mental health assessment are all appropriate expectations of this level of mental health nursing
A nurse who is aware of the future challenges to the role of the psychiatric mental health nurse will encourage which of the following? Select all that apply. 1 Working toward certification as an advanced psychiatric mental health nurse 2 Attending a seminar on meeting the needs of the patient diagnosed with advanced dementia 3 Being aware of the culturally focused needs represented in the area's current patient population 4 Volunteering to help establish a website that provides online screening for depression and anxiety 5 Working with a community group whose goal is to secure funding for a community-based mental health clinic
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Which of the following interventions are considered to be within the scope of practice for a basic psychiatric mental health nurse? Select all that apply. 1 Coordinating the care of a patient diagnosed with acute depression. 2 Establishing rules for an acute care unit that treats depressed patients. 3 Providing information materials concerning depression to the patient's family members. 4 Reporting to the patient's interdisciplinary team behaviors that suggest the depression is worsening. 5 Evaluating the effectiveness of the patient's medication therapy based on his or her reported state of mind.
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Which interventions relate directly to the phenomena of concern that is central to the practice of psychiatric mental health nursing? Select all that apply. 1 Monitoring the patient for signs of psychic behavior. 2 Discussing treatment options with the family of a severely psychotic patient. 3 Providing depression screening for college students as a part of orientation week. 4 Developing a friendship-based nurse-patient relationship with a patient who has no involved family. 5 Discussing end-of-life issues with a chronically mentally ill patient diagnosed with terminal cancer.
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A nurse working in a psychiatric unit plans to apply milieu therapy on a patient. Which intervention should the nurse include in the therapy? 1 Coordinate the implementation of the nursing care plan and documents 2 Apply current knowledge to assess the patient's response to medication 3 Provide and maintain a safe and therapeutic environment in collaboration with others 4 Give anticipatory guidance to prevent or reduce mental illness and enhance mental health
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Which personal attributes are considered by the World Health Organization (WHO) when defining mental health as a state of well-being? Select all that apply. 1 Expressing happiness and hope 2 Being free of mental and emotional stressors 3 Possesses healthy stress management techniques 4 Demonstrating average or above average intelligence 5 Capable of understanding and implementing new concepts
1 3 5 The WHO defines mental health as a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking; communication skills, learning, emotional growth, resilience, and self-esteem are some of the attributes of mentally healthy people. A person's mental health is not dependent upon the total lack of stress but rather the ability to cope with it in a healthy manner. Intelligence is not generally a factor unless it negatively impacts the individual's ability to achieve the other stated attributes.
The nurse is assessing a patient of Asian origin who has recently immigrated to the United States. The nurse finds that the patient's behavior is different from that of the other patients. What are the likely reasons for this? Select all that apply. 1 The patient most likely belongs to a different culture. 2 The patient is most likely suffering from a mental illness. 3 The patient does not understand what abnormal behavior is. 4 The patient is too stressed by getting adjusted to the new place. 5 The patient is unaware of societal expectations in the United States.
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According to earlier psychological theory, mental illness was caused by a faulty psychological process that could be corrected by increasing personal insight and understanding. What challenged this theory? 1 Invention of insulin shock therapy 2 Invention of psychosurgery techniques 3 Identifying the effects of chlorpromazine (Thorazine) 4 Identification of specific agents causing mental illness
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On reviewing the care plan prepared by the staff nurse for a patient with depression, the head nurse finds that six domains of the Nursing Outcomes Classification (NOC) have been included in the expected outcome list. The six domains include functional health, physiologic health, psychosocial health, perceived health, family health, and community health. The nurse has failed to address one other NOC domain. Interventions based on which other NOC domain is the nurse expected to add to the care plan? 1 The patient identifies the cause of depression. 2 The patient describes the schedule and dosages of the medications. 3 The patient demonstrates positive interaction with the family members. 4 The patient demonstrates different measures to maintain personal hygiene.
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How can a nurse who is active in state and national legislation affect the climate for mental health 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 advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions. 4 By encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons.
2 By encouraging laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. 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.
An adolescent patient tells the nurse, "My mom scolded me yesterday, and I was crying for three hours. I have never cried like this before. Does this mean I have a psychiatric illness?" What is the appropriate response from the nurse? 1 "You should consult a psychologist." 2 "You just had an emotional outburst." 3 "You should have responded in a firm manner." 4 "You should try to stay away from any stressors."
2 Crying after a feud with a loved one is a normal emotional response to a negative situation. The nurse cannot say that the patient shows abnormal behavior. The nurse should reassure the patient, saying that the patient's behavior was a normal emotional outburst. The patient does not need to consult a psychologist. Telling the patient that he or she should have responded in a firm manner indicates that the nurse believes that the patient showed an inappropriate behavior. Asking the patient to try to stay away from stressors is not an appropriate response because one has to learn to cope with stressors. Getting upset for being scolded by parents is normal, and the nurse should not advise the patient to stay away from parents for this.
A nurse works in a pediatric care unit. Which mental disorders are more likely to begin in childhood? Select all that apply. 1 Agoraphobia 2 Hydrophobia 3 Social phobia 4 Posttraumatic stress disorder (PTSD) 5 Obsessive-compulsive disorder (OCD)
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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 Maternal mortality rate 2 Diagnostic screening test 3 Birth rates and death rates 4 Natural history of the disease 5 Interventions used to treat the illness
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The nurse is providing care for a patient who has schizophrenia. The nurse demonstrates the QSEN competency of quality improvement by performing which activities? Select all that apply. 1 Respecting the patient's cultural preferences 2 Monitoring the patient's psychiatric nursing outcomes 3 Applying new technologies to help track the patient's auditory hallucinations 4 Testing changes that are made to how quickly the patient receives certain services 5 Using current research findings about schizophrenia when providing care to the patient
2, 4 The QSEN competency of quality improvement involves monitoring the outcomes of the care provided. Nurses should also be care designers and test the changes that are made to see what outcomes they will have. Providing culturally sensitive care is part of patient-centered care. Using current research findings when providing care is part of evidence-based practice. Applying new technologies to help track patient status, such as auditory hallucinations, is part of informatics.
The nurse is speaking to a Japanese patient who attempted suicide. On assessment the nurse finds that the patient does not show any signs of mental illness or depression. What does the nurse keep in mind about this patient? 1 The patient is trying to get attention 2 The patient may have an underlying health issue 3 Cultural factors affect how people view the act of suicide 4 The patient should be prescribed antidepressants to prevent suicide
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The nurse provides care to a patient with a Likert score of 1. What must the nurse consider about this patient? 1 The patient is low-risk. 2 The patient is allowed to have visitors. 3 The patient does not have favorable nursing outcomes. 4 The patient cannot provide self-care.
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A group of nurses take 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
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A nurse wants to find a description of the diagnostic criteria for addictive disorders. Which resource would have the most complete information? 1 The Future of Nursing: Leading Change, Advancing Health 2 Nursing Diagnoses Definitions and Classifications 2015-2017 (10th edition) 3 Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) 4 International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
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What is the prevalence rate over a 12-month period for major depressive disorder? 1 Lower than the prevalence rate for panic disorders 2 Equal to the prevalence rate for psychotic disorders 3 Greater than the prevalence rate for generalized anxiety 4 Greater than the prevalence rate for psychotic disorders
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A nurse plans and implements effective care based on current valid research. Which term applies? 1 Competence 2 Holistic practice 3 Advanced practice 4 Evidence-based practice
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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?" What is the nurse's best response? 1 "Don't be afraid; it means I'm here to help, not hurt, you." 2 "The nurses who work in mental health facilities have that title." 3 "Psychiatric mental health nurses care for people with mental illnesses." 4 "We have the specialized skills needed to care for those with mental illnesses."
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The nurse assesses a 64-year-old patient of Japanese descent who recently attempted suicide. During the assessment, the patient explains to the nurse that the attempt was not an act of mental illness but rather done out of honor for his family. The patient asks why a mental health assessment is necessary. Which is the best response by the nurse? 1 "There is no honor in committing suicide." 2 "Japanese culture must take life and death very seriously." 3 "Attempting suicide is a sign of mental illness no matter how you look at it." 4 "American culture sees suicide attempts differently than does Japanese culture
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The nurse assesses a patient who reports insomnia and weight loss related to an inability to cope with ending a three-year relationship. The patient tells the nurse, "I'm barely able to concentrate at work, and I'm afraid my performance is going downhill." What does the nurse infer about this patient? 1 The patient has a mental illness. 2 The patient is reporting normal symptoms. 3 The patient has good mental health and well-being. 4 The patient is showing signs of a mental health problem.
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The nurse is providing care to a patient diagnosed with depression and Crohn disease. As part of the patient's treatment plan, the nurse works with a nutritionist to come up with a list of foods the patient should eat and avoid based on the patient's comorbidity. Which QSEN competency is the nurse most demonstrating? 1 Informatics 2 Patient-centered care 3 Evidence-based practice 4 Teamwork and collaboration
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The nurse is providing care to a young adult patient who claims to have mental illness because of "feeling stressed at work." What does the nurse tell the patient to correct the patient's understanding of mental illness? 1 "Work stress does not cause mental illness." 2 "Nearly everyone in the United States has some sort of mental illness." 3 "People with mental illnesses do not know they have a mental illness." 4 "Mental illness has to do with a significant dysfunction, not just stress."
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What differentiates the Psychiatric-Mental Health Registered Nurse (RN-PMH) from the Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH)? 1 Only the APRN-PMH is responsible for milieu management. 2 The RN-PMH has less experience working with the mentally ill. 3 Only the RN-PMH provides medication education to the patient. 4 The APRN-PMH exercises a greater degree of autonomy when providing care.
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The nurse is studying the reports of two patients who show signs of depression. One patient (Patient A) is depressed because his pet dog has passed away, and the other patient (Patient B) is depressed at losing a spouse and material possessions in a natural disaster. What does this indicate about biological vulnerability and depression? 1 Patient A may respond better to the treatment provided. 2 Patient B may respond better to the treatment provided. 3 Patient A may be more vulnerable to developing severe depression. 4 Patient B may be more vulnerable to developing severe depression
4 The reports indicate that Patient B has faced a worse situation than Patient A. According to the diathesis-stress model, the depression in Patient A is likely because of biological vulnerability and less due to the impact of the situation. Losing a pet is not a very traumatic event and not a cause of depression. Therefore, depression in Patient A is likely due to biological vulnerability triggered by the loss of a pet. On the other hand, Patient B suffers from depression mainly because of an environmental stressor; biological vulnerability has a limited role here. Based on the information provided, the nurse cannot tell which patient would respond better to therapy.
The nurse is educating a patient with depression about the mental health continuum. Which statement made by the patient indicates the need for additional teaching? 1 "Most people are on some point of the mental health continuum." 2 "Mental health is an important point of the mental health continuum." 3 "People can shift along various points of the mental health continuum." 4 "People in the mental health category of the continuum do not experience stress."
4 The statement about people in the mental health category of the mental health continuum not experiencing stress is incorrect and indicates to the nurse that further patient education is required. People can be in the mental health category of the continuum and still experience stress and discomfort. Mental health is an important point of the mental health continuum, even though it is characterized by well-being. Most people fall somewhere along the mental health continuum, even if they have good mental health. People can shift to various points of the mental health continuum and are not stuck in one category forever. These shifts can occur gradually or suddenly.
A patient has been admitted to begin recovery for chronic alcohol abuse. The nurse has implemented the following interventions. Which intervention addresses the guiding principle of recovery that stresses the need for individual and person-centered care? 1 Patient offered and accepted the role as peer-support representative for the unit 2 Patient asked to select one of three different Alcoholics Anonymous (AA) meeting locations 3 Patient is asked to identify which if any family members are to be involved in therapy sessions for support system members 4 Patient will work on identifying four successful coping mechanisms that have impacted the patient's sobriety successfully in the past
4 Guiding principles of recovery include that the recovery will be individual- and person-centered and based on the unique strengths and resiliencies, as well as needs, preferences, experiences (including past trauma), and cultural background of the patient. Identifying coping mechanisms that have been successful in the past will help tailor treatment to the patient's strengths and resiliencies. Selecting an AA meeting is related to the recovery principle of autonomy. Identifying family members for inclusion in appropriate therapy sessions relates to the recovery principle of respect, assuring confidentiality and providing appropriate support. Finally, accepting a leadership role in the unit relates to the recovery principle of being peer-supported as well as providing peer support.
