01 Ch 1 Foundations of Psychiatric Mental Health Nursing
A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's best response?
"Mental health is marked by productivity, fulfilling relationships, and adaptability." Mental health means the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health provides the capacity for rational thinking, communication, learning, emotional growth, resilience, and self-esteem.
Deinstitutionalization has reduced the number of public hospital beds by what percentage?
80% Although deinstitutionalization has reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%.
Which is a result of deinstitutionalization?
A "revolving door" of repetitive hospital admissions One result of deinstitutionalization is the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.
A psychiatric-mental health nurse is preparing a presentation about the historical evolution of current psychiatric-mental health treatment. When describing the impact of Sigmund Freud's work on care, which information would the nurse most likely include? Select all that apply.
A disturbance in personality development as an underlying issue Use of psychoanalysis to address the underlying injury Sigmund Freud believed the primary causes of mental illnesses were psychological and a result of disturbed personality development and faulty parenting. He developed a personality theory based on unconscious motivations for behavior, or drives. Psychoanalysis, which was long-term and costly, focused on repairing the trauma of the original psychological injury. Medication therapy was not associated with Freud.
In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend?
A lack of suitable housing for persons with mental illness In 1970, the deinstitutionalization of clients from state mental hospitals to community living was considered a positive move; however, insufficient federal funding resulted in an increase in the number of homeless, mentally ill people.
Which individual has experienced the consequences of deinstitutionalization?
A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure The process of deinstitutionalization involves moving chronically mentally ill clients from state psychiatric hospitals back to their homes or to community-supervised facilities.
The nurse knows the written instructions for healthcare when a person is incapacitated is called
Advance directive Advance care directives are written instructions for health care when individuals are incapacitated. For people who are gravely disabled ; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require advance care directives and/or may require appointment of a conservator or legal guardian.
Chlorpromazine is a drug in which classification?
Antipsychotic Thorazine is a first generation antipsychotic medication.
When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which is more applicable to the Middle Ages?
Belief in demonic possession and exorcism was common. While some of these answers are true of both ancient Greece and the Middle Ages, belief in demonic possession and exorcism was more common in the Middle Ages.
The major goal of the Community Mental Health Act of 1963 was what?
Build mental health centers that would provide mental health care within the local community. The 1963 Community Mental Health Act was designed to provide community-centered mental health care.
The psychiatric mental health nurse is planning the care of a client. What action best addresses the client's needs in the social domain?
Collaborating with the client's family to organize support Family support exists within the social domain. Feelings and thoughts are within the psychological domain and medications have a biologic effect.
Which activity is a function solely of the advanced practice psychiatric-mental health nurse?
Conducting individual psychotherapy The advanced practice psychiatric-mental health nurse may provide psychotherapy (individual, group, family). Examples include all common forms of brief or long-term therapy. The therapist role that the APRN-PMH assumes is formal and structured and often involves contracts (verbal, written, or both) with clients.
In early Christian times, what was thought to cause mental illness?
Demonic control During early Christian times (1-1000), primitive beliefs and superstitions were strong. All diseases were blamed on demons and the mentally ill were viewed as possessed, or under demonic control.
The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are?
Descriptions of the responsibilities for which nurses are accountable Standards of practice are authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They do not have the same standing as laws, and they are not future goals but are instead current standards.
When reviewing the evolution of mental health care in the United States, a psychiatric-mental health nurse reads about the creation of state hospitals for mental health care. The nurse would attribute this concept of care as the idea supported by:
Dorothea Dix. Dorothea Dix was a vigorous crusader for the humane treatment of clients with mental illness and was responsible for much of the reform of the mental health care system in the 19th century. Her solution was the creation of state hospitals. Horace Mann is credited with the mandate that states assume financial responsibility for the care of people with mental illnesses. Clifford Beers was an advocate for the human treatment of individuals with mental illness. Sigmund Freud developed a personality theory for mental illness based on unconscious motivations for behavior.
Which skill is in the psychiatric-mental health registered nurse's scope of practice?
Evaluating the effectiveness of psychiatric medications Skills and practices of the psychiatric-mental health registered nurse may include assessing and recording behavior, administering and evaluating the effectiveness of medications, communicating with other team members, and being in charge of the psychiatric milieu.
Which is a difference between counseling and psychotherapy?
Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. The psychiatric nurse uses counseling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling. Transference and countertransference are significant obstacles in both modes, and neither intervention is appropriate during acute psychotic episodes.
When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual?
Hildegard Peplau Hildegard Peplau conceptualized nursing practice as independent of physicians and emphasized the use of self as a nursing tool. Florence Nightingale identified the need to view clients holistically, was sensitive to human emotions, and recommended interactions that today would be classified as therapeutic communication. Dorothea Dix crusaded for the humane treatment of clients with mental illness. Sigmund Freud developed a personal theory based on unconscious motivations for behavior.
Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship?
Hildegard Peplau Hildegard Peplau wrote a publication introducing the concepts of interpersonal relations and the therapeutic relationship within psychiatric-mental health nursing practice.
Which provides the best definition for mental illness?
Inability to function in a manner that manages both external and internal stressors effectively Mental illness is best defined as a syndrome characterized by symptoms and/or impairment in functioning. Not all mental illnesses are characterized by cognitive impairment or altered sensory perceptions. Genetic and environmental factors are not the only known causes of mental illness.
Which is a true statement regarding Medicaid?
It covers individuals and families with low incomes. Medicaid covers individuals and families with low incomes. Medicare covers people 65 years of age and older, those with permanent kidney failure, and those with certain disabilities.
Which is an inaccurate depiction of self-awareness?
It involves changing one's values or beliefs. The goal of self-awareness is to know oneself so that one's values, attitudes, and beliefs are not projected to the client, interfering with nursing care. Self-awareness does not mean having to change one's values or beliefs, unless one desires to do so.
Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy?
Lack of parity. Parity refers to the various inequities inherent in any health care system. Many health plans cover the costs of psychotropic drugs at far lower rates than they do for other medications. Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services. Medication noncompliance occurs when clients do not take their medications as prescribed.
Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function?
Milieu therapy A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management.
The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure?
Pepla In 1952, Peplau published the landmark work, Interpersonal Relations in Nursing. It introduced psychiatric and mental health nursing practice to the concepts of interpersonal relations and the importance of the therapeutic relationship. The nurse-client relationship supported a holistic perspective on client care.
The nurse is busy preparing a client for a procedure. The nurse may obtain a clients' signature on a form, but obtaining informed consent for the procedure is the responsibility of the
Physician To provide informed consent for care, the patient must be given adequate information upon which to base decisions and actively participate in the decision-making process. Informed consent is not an option but is mandated by state law. Clients receiving mental health care retain all civil rights afforded to all people except the right to leave the hospital in the case of involuntary commitment. They have the right to refuse treatment, to send and to receive sealed mail, and to have or refuse visitor. Any restrictions must be made for a verifiable, documented reason.
Which sets professional standards of care?
Professional nursing organizations States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.
Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice?
Promoting symptom management Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.
Which is a clinical activity of only the advanced practice registered nurse?
Psychotherapy Clinical activities of the advanced practice registered nurse include psychotherapy, community interventions, and clinical supervision. Milieu therapy, crisis intervention, and triage are clinical activities of the psychiatric-mental health registered nurse
Which mental health service is an advanced-level function?
Psychotherapy\ Psychotherapy is an advanced-level function. Milieu therapy, counseling, and self-care activities are basic level functions.
The following events are important in the development of psychiatric-mental health nursing practice. Which event occurred first?
Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey In 1920, the first psychiatric nursing text was published. In 1954, the first graduate program in psychiatric nursing was established. In 1967, the ANA published the Standards of Psychiatric-Mental Health Nursing. In 1985, the Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice was published.
What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care?
Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. The American Nurses Association (ANA) develops standards of care as authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable, thus identifying the nurse's scope of practice. They are not legally binding unless they are incorporated into the state nurse practice act or state board rules and regulations. When legal problems or lawsuits arise, these professional standards are used to determine safe and acceptable practice and to assess the quality of care in the court of law. Neither identifying advanced level functions or safety delegation principles are directly associated with the ANAs nursing standards.
A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client?
Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse-client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship. The behavior should not be ignored or minimized but rather addressed in a professional, matter-of-fact manner so that the client understands the limits being placed on such behaviors.
Which is a criterion for mental health?
Satisfaction with personal relationships and self People in a state of emotional, physical, and social well-being fulfill life responsibilities, function effectively in daily life, and are satisfied with their interpersonal relationships and themselves. None of the remaining options fully satisfy the criteria for a healthy mental status.
Dorothea Dix's solution to gain humane treatment for the mentally ill population included what?
State hospitals Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century. Her solution was state hospitals.
During the moral treatment period, clients were routinely placed into which environment?
asylums In the moral treatment period (1790-1900), moral treatment and the use of kindness, compassion, and a pleasant environment was adopted. Clients were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Community mental health centers, by and large, ignored the legions of people with serious mental illnesses and instead focused on the treatment of those with alcoholism and drug addiction. Clients were not placed in psychosocial rehabilitation centers or group homes during the moral treatment period.
A nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. Which practice would most likely be included as being used during this time?
asylums In the moral treatment period (1790-1900), the use of kindness, compassion, and a pleasant environment was adopted. Individuals with mental disorders were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Blood letting, exorcisms and incarceration were not practices associated with the moral treatment period.
A psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. When explaining how these programs work, the nurse would emphasize which concept?
collaboration In today's environment, the traditional medical model, which is viewed as autocratic and paternalistic, is being replaced by a collaborative model whereby mental health professionals work in partnership with consumers to help rebuild their lives. Consumer advocacy efforts have led to the implementation of recovery philosophy and practices
One of the primary reforms accomplished by Dorothea Lynde Dix was the ...
establishment or enlargement of state hospitals. One of the primary reforms accomplished by Dorothea Lynde Dix was the establishment or enlargement of state hospitals to treat the mentally ill. She also was instrumental in the establishment of mental hospitals in England, Canada, and Europe in the 19th century.
