Mental Health Ch. 2
A cognitive therapist would help a patient restructure the thought "I am stupid!" to 1 "What I did was stupid" 2 "I am not as smart as others" 3 "Things usually go wrong for me" 4 "Things like this should not happen to anyone"
1 Cognitive therapists help patients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.
A nurse talks with a patient engaged in an arts and crafts activity. The patient says, "I've never been artistic. I shouldn't even come to these silly groups." The patient also attends cognitive behavioral therapy (CBT) sessions two times a week. Which comment by the nurse would be supportive of the CBT? 1 "I noticed that you made interesting color combinations and encouraged others." 2 "What activities do you think you would enjoy more than arts and crafts?" 3 "You should try harder to finish projects that you start. You give up too easily." 4 "These are simply recreational activities. Talk to your therapist about your reactions." 00:00:10 Question Answer Confidence ButtonsJust a guessPretty sureNailed it
1 The patient's comment suggests distorted thinking and overgeneralization. The nurse can contribute to the CBT by recognizing positive aspects of the patient's participation in the activity.
Which need is the highest priority for a seriously and persistently ill patient living in the community? 1 Access to medication 2 Socialization and diversion 3 Independent decision making 4 Engaging in meaningful work
1 Access to medication After basic life necessities have been met, maintenance of the medication regimen is critical to preventing relapse and recurrence of the patient's illness. If the patient does not have access to medication, he or she will be unable to be compliant.
Which statement regarding patients' rights after being voluntarily admitted to a behavioral health unit is true? 1 All rights remain intact. 2 Only rights that do not involve decision making remain intact. 3 The right to refuse treatment is no longer guaranteed. 4 All rights are temporarily suspended.
1 All rights remain intact.
Which symptomology has priority for admission to an inpatient behavioral health unit? 1 Severe anxiety and feeling as though one is suffocating 2 Profound grieving over the recent death of one's identical twin 3 Hearing voices that proclaim one to be "the exalted ruler of the universe" 4 History of seizures and an elevated lithium level
4 History of seizures and an elevated lithium level The patient needs modification of a psychotropic medication regimen. This modification requires careful titration and observation that would be difficult to provide on an outpatient basis. Lithium toxicity can result in death.
The following table identifies various theorists while summarizing the impact their theories have on mental health nursing. Which theorist has influenced the mental health nurse to ask the patient, "What do you believe triggers you to abuse alcohol?" 1 Carl Rogers 2 Jean Piaget 3 Albert Bandura 4 Viktor Frankl
1 Carl Rogers Rogers's contributions included the concept of empathetic understanding, which is the ability to apprehend the feelings and experiences of the patient as if these things were happening to you. This is accomplished best by asking the appropriate questions. He also proposed the importance of unconditional acceptance that in this case allows the nurse to ask the question regarding the client's behaviors in a therapeutic manner. This focus is not associated with Jean Piaget, Albert Bandura, or Viktor Frankl.
The major difference between the psychiatric nursing assessment performed for a patient who is hospitalized and for a patient who will be treated in the community is 1 For the latter, the general assessment must be expanded 2 For the latter, the nursing focus is primarily on the mental status examination 3 For the former, the general assessment must be reimbursement-based 4 For the former, the nursing focus is limited to the patient's willingness to accept treatment
1 For the latter, the general assessment must be expanded General assessment of patients in the community is expanded to include community living challenges and resources, the patient's ability to cope with the demands of living in the community, and the patient's willingness to accept community support.
A nurse is assessing a patient who is impulsive and lacks control regarding basic desires. Which system of personality should the nurse consider for this patient? 1 Id 2 Ego 3 Superego 4 Transference
1 Id A patient who lacks control about basic desires has a personality that defines the id. The id works on basic instincts, and its focus is to fulfill the needs. The ego is a problem solver, appreciates reality, and logically plans to fulfill desires. The superego appreciates the ideal and seeks perfection more than being real. Transference is not a system of personality. It is the set of feelings that the patient has for the health care worker, which were earlier experienced for someone else.
According to Erikson's Theory of Ego Development, which psychosocial stage of development is a healthy preschool child likely to demonstrate? 1 Initiative vs. guilt 2 Trust vs. mistrust 3 Intimacy vs. isolation 4 Industry vs. inferiority
1 Initiative vs. guilt Erikson proposed eight stages of development. The psychosocial crisis of initiative vs. guilt might be demonstrated in a preschool-aged child. In this stage, the child is able to initiate his or her own activities and derive a sense of purpose. The psychosocial crisis of trust vs. mistrust is observed in infancy. The psychosocial crisis of intimacy vs. isolation is observed in early adulthood. The psychosocial crisis of industry vs. inferiority is observed in school-aged children.
The nurse finds that a patient who has depression reports side effects from the drugs prescribed and is not compliant with taking the medication as intended. How can the nurse ensure and encourage the patient's compliance with the medication regimen? Select all that apply. 1 Educate the patient that the side effects are short term 2 Teach the patient how the medication works and the ill effects of discontinuing it 3 Inform the health care provider about the patient being noncompliant 4 Counsel the patient to take over-the-counter medications for symptom relief 5 Teach the patient ways to cope with depression other than taking medications
1,2 The patient should be educated properly about the importance of the medication, how it works, and the side effects. This helps to promote patient compliance. Educating the patient about the ill effects of prematurely discontinuing the medication helps in the patient's adherence with the treatment. Patients should be educated that the medication will benefit them and that the side effects are short-term. Informing the health care provider would not help in promoting the patient's adherence to treatment. The nurse should never give up on helping a patient, even if he or she is not compliant. The nurse should encourage other ways for the patient to cope with depression but not in substitution of the prescribed drug regimen.
Interpersonal psychotherapy identifies several different problem types. Which psychosocial dilemma represents one of these classic areas? Select all that apply. 1 The inability to accept the death of a child 2 Multiple incidences of spousal infidelity 3 Depression that is a result of a forced retirement 4 Loss of employment caused by anger management issues 5 Ritualistic behaviors resulting from obsessive compulsive tendencies
1,2,3,4 In interpersonal psychotherapy, four types of problem areas have been identified: grief, such as complicated bereavement following the death or loss of a loved one; role disputes resulting in conflicts with significant others, including work relationships; role transition issues caused by problematic change in life status or social or vocational roles such as retirement; and interpersonal deficit resulting in the inability to initiate or sustain close relationships. Behaviors resulting from psychiatric illnesses are not one of these problem areas.
Which of the following interventions demonstrates that the nurse understands the principles of therapeutic milieu management? Select all that apply. 1 Assigning a staff member to keep constant watch of a suicidal patient. 2 Providing a reference to a woman's shelter for a patient who is in an abusive relationship. 3 Alerting the local child protection agency concerning possible adolescent sexual abuse. 4 Closely monitoring the interactions between a cognitively impaired patient and other patients. 5 Allowing patients to decide what foods will be served at unit parties.
1,2,3,4 Milieu therapy is a basic intervention in nursing practice. Common examples include providing a safe environment for the suicidal patient or a patient with a cognitive disorder, referring abused women to safe houses, and advocating for children suspected of being abused in their home environments. Encouraging patients to take part in unit decisions is not a factor in therapeutic milieu management but rather a factor in individual therapies.
Which statement is true regarding the treatment plan chosen for a chronically ill mental health patient admitted for acute care treatment? Select all that apply. 1 Appropriate discharge planning should be emphasized immediately. 2 Acute care stay is planned to last as long as is economically possible. 3 There is an expectation that the patient will re-assume personal responsibility as expressed. 4 Interventions are included to facilitate resolution of acute symptomology. 5 Transition is coordinated between institutional and community services.
1,3,4,5 The treatment plan or clinical pathway chosen for the patient should reflect this discharge planning emphasis as early as the day of admission. The patient is expected to begin to progress toward a resolution of acute symptoms, to assume personal responsibility, and to improve interpersonal functioning. Patients with prolonged mental illness benefit most from a seamless transition to community services. The primary factor determining length of acute care stay is patient need, not economics.
What activities is a nurse working in a psychiatric inpatient unit supposed to perform? Select all that apply. 1 Provide round-the-clock supervision 2 Establish a long-term therapeutic relationship 3 Monitor nutrition and self-care with assistance 4 Assist patients in self-assessment 5 Offer structured socialization activities
1,3,5 A psychiatric nurse working in an inpatient unit has different interventions to perform compared to a nurse who works in an outpatient setting. The nurse is responsible for patient safety and therefore should provide round-the-clock supervision. The nurse should monitor the nutrition and self-care activities of patients to determine their functional ability. The inpatient setting offers structured socialization activities for improving patients' health and well-being. In an inpatient setting, the nurse forms short-term therapeutic relationships rather than long-term relationships. A long-term therapeutic relationship is a characteristic feature of outpatient psychiatric care units. The psychiatric nurse in an inpatient unit assesses patients; in an outpatient setting, the nurse helps patients with self-assessment.
A nurse is learning about the various theories related to psychiatric nursing. Which functions does the nurse consider as important for learning these therapies? Select all that apply. 1 Improving the patient's symptoms 2 Increasing the patient's dependence 3 Improving the patient's coping skills 4 Helping the patient ignore the problem 5 Helping the patient realize the situation
1,3,5 Learning about psychological theories can help in improving patient symptoms by focusing on goal-centered psychological therapy. Psychological theories provide an understanding that can be used in improving the patient's coping skills during therapy sessions. With the knowledge of theories, it becomes easy to help the patient realize the existing situation in his or life. Increasing the patient's dependence is not the aim of learning psychological theories; the nursing objective is to make the patient independent. Ignoring the existing problem is not a solution; instead theories help the patient to realize the situation and cope with it.
Which statement by an 86-year-old patient reflects successful resolution of the expected psychosocial crisis? 1 "I enjoy being retired and having time to myself. Sometimes I go two or three weeks without seeing anyone." 2 "After my spouse died five years ago, my siblings and I have become closer. That gives me a sense of contentment." 3 "I worked all my life to take care of my family but my kids never come to see me. That's okay because I like being alone." 4 "I had chemotherapy for colon cancer three years ago. Since then, I do not have much energy so I quit going to activities at the senior center."
2 According to Erikson, integrity vs. despair is the psychosocial crisis of this developmental group. Successful completion of this task leads to a sense of integrity and fulfillment. This patient has maintained meaningful relationships with others, despite the loss of a spouse. Going two or three weeks without seeing anyone, never having one's children come to visit, and not going to outside activities indicate despair, represented by social isolation.
Sullivan's term "security operations" and Freud's term "defense mechanisms" both reflect actions that serve to accomplish what? 1 The increase of self-esteem 2 The reduction of anxiety 3 The increase of self-awareness 4 The reduction of cognitive distortions
2 Both Sullivan and Freud coined terms to mean actions that individuals do as an attempt to reduce anxiety. The terms do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.
The nurse is talking with a patient to find if there is any unresolved psychosocial crisis present. Based on Erikson's stages of psychosocial development, which statement indicates that the patient has had an unsuccessful resolution of the psychosocial crisis of autonomy vs. shame and doubt? 1 "I do not trust this health care provider. I am not going to take the medicines prescribed." 2 "Why should I take these medicines if this treatment is not going to help me?" 3 "I am not as expressive as others. I don't think I would be able to speak up to you." 4 "I am sure that I would be able to manage on my own and take care of myself."
2 The successful resolution of the psychosocial stage of autonomy vs. shame and doubt is indicated when a patient has a sense of self-control, adequacy, and willpower. If there is unsuccessful resolution of this crisis, the patient would have severe feelings of self-doubt. The statement that the treatment is not going to help the patient indicates that the patient has severe feelings of self-doubt. The statement that the patient does not trust the doctor indicates that there is unsuccessful resolution of the trust vs. mistrust crisis. The statement that the patient is not as expressive as others indicates that the patient has a feeling of inferiority. This statement is indicative of the failure of resolving the industry vs. inferiority crisis. The statement that the patient is sure to be able to take care of self indicates that the patient is strong-willed and has a good sense of self-control. This statement of the patient indicates successful resolution of the psychosocial crisis of autonomy vs. shame and doubt.
Using Maslow's model of needs, the nurse providing care for an anxious patient identifies the priority intervention to be 1 Assessing the patient's success at fulfilling appropriate developmental level tasks 2 Assessing the patient for strengths upon which a nurse-patient relationship can be based 3 Planning one-on-one time with the patient to assist in identifying the fears behind anxiety 4 Evaluating the patient's ability to learn and retain essential information regarding condition
2 The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the patient's strengths is key to successful nurse-patient relationships. The second value lies in establishing what is most important in the sequencing of nursing actions in the nurse-patient relationship.
The nurse is speaking to the mother of a student. The mother complains, "My child has performed very badly on exams. My child is quite intelligent, but somehow doesn't seem to enjoy studying." Based on B. F. Skinner's theory of operant conditioning, what advice should the nurse give the mother to help her resolve this problem? 1 "Spend some time with the child and help him or her take extra practice tests at home." 2 "Give the child a chocolate each time the child scores well on the test." 3 "Hire a home tutor who can create an interest in the child's mind towards study." 4 "Design the study room in such a way that it creates a favorable environment for study."
2 "Give the child a chocolate each time the child scores well on the test." According to B. F. Skinner's theory of operant conditioning, voluntary behaviors are learned through consequences of the behavior. In this case, the child doesn't score well in the tests because of lack of interest in studies. As per operant conditioning theory, rewarding the child for scoring well in the test would positively reinforce the child to study well and score better. Though, spending time with the child and taking extra tests at home would be helpful in improving academic performance, this intervention is not based on theory of operant conditioning. Appointing a home tutor who makes studying enjoyable or creating a conducive environment for study are interventions to improve the academic performance. Both of these are based on John B. Watson's behaviorism theory, according to which controlling the environment could mold behavior.
A patient was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. Personal hygiene is poor, and responses to questions are bizarre and inappropriate. The patient's constitutional rights are violated when the nurse states: 1 "We will help you make decisions that will keep you safe." 2 "I am going to help you shower, so you will not smell so bad." 3 "Your pocket knife and nail clippers will be kept in the nurses' station." 4 "You will be having a number of tests to help us learn about your condition."
2 "I am going to help you shower, so you will not smell so bad." Every patient has the right to be treated with dignity. This statement is demeaning.
A nurse is managing a patient suffering from depression. Which short-term therapy should the nurse apply to reduce the patient's psychiatric symptoms? 1 Erikson's ego theory 2 Psychodynamic therapy 3 Interpersonal psychotherapy 4 Freud's psychoanalytical theory
3 Interpersonal psychotherapy is effective short-term therapy that helps in reducing psychiatric symptoms by improving interpersonal relationships, which can be the main cause for depression. Erikson's ego theory gives a developmental model that is more useful for assessment to identify age-appropriate normal skills. Psychodynamic therapy is more suitable for relatively healthy people and is usually considered long-term with a number of sessions. Freud's psychoanalytical theory presents a human developmental process throughout childhood and its relation to human personality.
A nurse is assessing a patient who has destructive tendencies. Which stage of Freud's psychosexual stages of development should the nurse analyze for this behavior? 1 Oral 2 Anal 3 Phallic 4 Latency
2 Anal According to Freud's psychosexual stages of development, there are five stages of psychosexual development. Each stage has a different focus for deriving pleasure. In anal stage the source of satisfaction is the anal region through the activity of expulsion and retention of feces. A fixation at anal stage may result in behaviors related to anal expulsive features, like destructive tendencies. In oral stage the mouth is the source of satisfaction through activities like sucking, chewing, and biting. Fixation at oral stage may cause sarcasm or dependence and habits like smoking. In phallic stage the source of satisfaction is genitals through masturbation. Fixation at phallic stage may result in reckless behavior or inability to love. The latency stage is characterized by development of ego. Fixation at latency stage can result in difficulty in social skills and feelings of inferiority.
Using Maslow's model of needs, the nurse providing care for an anxious patient identifies the priority intervention to be 1 Assessing the patient's success at fulfilling appropriate developmental level tasks 2 Assessing the patient for strengths upon which a nurse-patient relationship can be based 3 Planning one-on-one time with the patient to assist in identifying the fears behind anxiety 4 Evaluating the patient's ability to learn and retain essential information regarding condition
2 Assessing the patient for strengths upon which a nurse-patient relationship can be based The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the patient's strengths is key to successful nurse-patient relationships. The second value lies in establishing what is most important in the sequencing of nursing actions in the nurse-patient relationship.
Which of the following is considered a primary behavioral theorist? 1 Freud 2 Skinner 3 Sullivan 4 Peplau
2 Skinner B.F. Skinner (1904--1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.
A nurse is assessing a group of individuals for psychodynamic therapy. Which type of candidates should the nurse choose? Select all that apply. 1 Patients with mild depression 2 Relatively healthy individuals 3 Patients motivated for change 4 Patients who are psychologically minded 5 Patients with borderline personality disorder
2,3,4 Relatively healthy individuals are the best candidates, as psychodynamic therapy is more concerned about "here-and-now" issues. Psychodynamic therapy requires well-functioning individuals, and patients motivated for change can be suitable. Patients who are psychologically minded are relatively healthy with clear area of difficulty and care suitable for psychodynamic therapy. Patients with mild depression are not suitable for psychodynamic therapy, as it requires relatively healthy individuals. Patients with borderline personality disorder are not suitable for psychodynamic therapy, as it requires relatively healthy individuals.
A nurse is learning about common cognitive distortions. Which distortions related to drawing conclusions should the nurse evaluate? Select all that apply. 1 Labeling 2 Mind reading 3 Fortune-telling 4 Overgeneralization 5 Emotional reasoning
2,3,5
Which statements concerning Erikson's developmental model are true? Select all that apply. 1 This model is an essential component of the patient's evaluation process. 2 Analysis of this model allows for identification of arrested development. 3 This model focuses on the recognition of interpersonal skills. 4 The role of defense mechanisms is evaluated using this model. 5 Correct identification of the developmental stage supports effective care planning.
2,3,5 Erikson's developmental model is an essential component of patient assessment. Analysis of behavior patterns using Erikson's framework can identify age-appropriate or arrested development of normal interpersonal skills. A developmental framework helps the nurse know what types of interventions are most likely to be effective. Treatment approaches and interventions can be tailored to the patient's developmental level. Evaluation of the patient's progress does not involve this model. The use of defense mechanisms is associated with Freud, not Erikson.
A nurse is learning about common cognitive distortions. Which distortions related to drawing conclusions should the nurse evaluate? Select all that apply. 1 Labeling 2 Mind reading 3 Fortune-telling 4 Overgeneralization 5 Emotional reasoning
2,3,5 Mind reading occurs when others' negative thoughts, motives, and responses interfere and the patient jumps to conclusions. Fortune-telling is when a patient anticipates a negative outcome as an established fact and draws conclusion. Emotional reasoning is when a patient draws conclusions based on an emotional state. Labeling is a kind of generalization that leads to forming harsh labels for oneself or others. Overgeneralization is to apply a bad occurrence and believe that it will always be the case.
An experienced nurse is teaching a group of novice nurses about the implications of cognitive behavioral therapy in nursing. Which factors should the nurse include when teaching? Select all that apply. 1 Encouraging ventilation of emotions through unconstructive thoughts 2 Recognizing interplay between negative thinking 3 Encouraging one's thinking of overgeneralization 4 Helping the patient identify negative thought patterns 5 Understanding one's response in difficult situations
2,4.5
An important difference between the developmental theories of Freud and Erikson is 1 Freud considers the entire life span from birth to old age 2 Freud focuses to a greater extent on cognitive development. 3 Erikson viewed individual growth in terms of social setting 4 Erikson focuses on the development of individual moral thinking
3 Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages.
A patient who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda reacts to every nursing intervention with sarcasm. When asking advice, the nurse manager's most helpful response is 1 "You are dealing with a very difficult and resistant patient; just keep with your plan." 2 "If you haven't been able to establish patient trust by now, ask for a change of assignment." 3 "Remember that sarcasm represents the oral-stage fixation of development." 4 "You are attempting to work with a patient who likes to keep others off-balance."
3 "Remember that sarcasm represents the oral-stage fixation of development. "According to Freud's psychosexual stages of development, this patient is exhibiting the oral (0--1 year) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence, the use of sarcasm, and the development of orally focused habits (e.g., smoking, nail biting).
Which patient has met the criteria for involuntary admission? 1 A college student who has developed symptoms of anxiety and is missing classes and work 2 An accountant who has developed symptoms of depression 3 A kindergarten teacher who was found confused and wandering about on a busy road 4 A retired librarian who is experiencing memory loss and some confusion at times
3 A kindergarten teacher who was found confused and wandering about on a busy road Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). An anxious college student, a depressed accountant, and a confused, retired librarian can all be managed at this point in the community setting and do not meet criteria (risk of harm to self or others) for admission.
The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to 1 Establish trust 2 Gain autonomy 3 Achieve identity 4 Develop a sense of industry
3 Achieve identity According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood.
According to Freud, the nurse recognizes that a patient experiencing dysfunction of the conscious as part of the mind will have problems with 1 Only recent memory 2 Both recent and long-term memory 3 All material that the person is aware of at any one time 4 Only material that should be retrieved easily
3 All material that the person is aware of at any one time Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time.
Sullivan viewed anxiety as 1 Emotional experience felt after the age of 5 years 2 A sign of guilt in adults 3 Any painful feeling or emotion arising from social insecurity 4 Adults trying to go beyond experiences of guilt and pain
3 Any painful feeling or emotion arising from social insecurity According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.
An important difference between the developmental theories of Freud and Erikson is 1 Freud considers the entire life span from birth to old age 2 Freud focuses to a greater extent on cognitive development. 3 Erikson viewed individual growth in terms of social setting 4 Erikson focuses on the development of individual moral thinking
3 Erikson viewed individual growth in terms of social setting Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages.
A nurse is assessing a young boy who is unwilling to drive on the road following a minor road accident. Which cognitive distortion is applicable to this patient? 1 Labeling 2 Mental filter 3 Overgeneralization 4 All-or-nothing thinking
3 Overgeneralization
According to Freud's theory, which stage of psychosexual development would be expected in a healthy 5-year-old child? 1 Oral 2 Anal 3 Phallic 4 Latency
3 Phallic
Which nursing activity demonstrates the role of a professional psychiatric nurse as identified by Hildegard Peplau? 1 Managing the milieu 2 Caring for the patient's physiological needs 3 Providing counseling 4 Documenting patient behaviors
3 Providing counseling Hildegard Peplau identified the role of counselor or psychotherapist as the heart of psychiatric nursing and a role unique to this nursing specialty. Managing the milieu, attending to the patient's physiological needs, and documenting patient behaviors and responses are responsibilities of all professional nurses and are not unique to the role of a psychiatric nurse.
In 1963 the Community Mental Health Centers Act was signed with the primary purpose of 1 Having mental health care services funded by the federal government while provided by state government 2 Providing mental health care to the uninsured in an economical reasonable manner 3 Providing mental health care on an outpatient basis to maintain the patient as a member of an established community 4 Assuring all Americans of the mental health care services they need or desire
3 Providing mental health care on an outpatient basis to maintain the patient as a member of an established community Community mental health centers were created as a result of the 1963 Community Mental Health Centers Act for the purpose of providing mental health services while maintaining the patient in his or her own community.
A chronically ill patient was readmitted when symptoms of the illness exacerbated. The patient lives alone and has few outside activities. To best prepare the patient for discharge, the nurse will focus on 1 Improving patient-family relationships 2 Placing the patient in a sheltered workshop 3 Psychoeducation to promote medication compliance 4 Involving the patient in daily visits to a psychosocial club
3 Psychoeducation to promote medication compliance To prepare patients for discharge, nurses should focus on precipitants of the crisis that led to hospital admission.
A patient's family called for help when the patient, suffering from bipolar disorder, had a manic episode. A team consisting of a psychiatrist, a social worker, and a psychiatric nurse arrived at the location and stabilized the patient's condition. What kind of care setting was used in response to this emergency? 1 Comprehensive emergency service model 2 Hospital-based consultant model 3 Mobile crisis team model 4 Crisis stabilization and observation unit
3 The mobile crisis team model serves patients in emergency conditions wherever they may be located. Psychiatric evaluations are performed in the community in which the crisis occurs, with the goal of stabilizing the patient without a visit to an emergency department. The team may comprise psychiatrists, social workers, psychiatric nurses, advanced practice nurses, and counselors, depending on the crisis at hand. The comprehensive emergency service model works with a full-service emergency department in a hospital or other medical facility. Specialty staff and a multidisciplinary workforce operate in a dedicated space with a focus on triage and stabilization of psychiatric emergencies. The hospital-based consultant model works on the same concept as the comprehensive emergency service model but does not include a dedicated space or special workforce. The patients are stabilized by clinicians and discharged or transferred to psychiatric care for further treatment. The crisis stabilization/observation unit is not a model for emergency care.
A nurse is learning about Freud's psychoanalytical theory. Which level of awareness would the nurse evaluate for patients suffering from emotions related to trauma? 1 Ego 2 Conscious 3 Unconscious 4 Preconscious
3 Unconscious The unconscious level includes memories and urges that are socially unacceptable or trauma-related emotions, which are placed deep inside as the patient finds it painful to cope with them. The ego is the problem solver, which can differentiate between subjective and objective reality. The conscious level includes all memories and perceptions that the patient is aware of at a given time. The preconscious level includes memories and emotions that can be retrieved with conscious effort.
A 5-year-old child has this nursing diagnosis: Ineffective coping related to distress regarding impending divorce of parents as evident by disrespectful behavior toward adults and frequent temper tantrums. Select the best initial outcome for this child's plan of care. Within one week, the child will: 1 show respect for authority figures. 2 engage in cooperative play with other children. 3 describe feelings about pending family changes. 4 identify which parent he or she wants to live with after the divorce.
3 describe feelings about pending family changes. According to Erikson, initiative vs. guilt is the psychosocial crisis of this developmental group. The aggression suggests the child fears the conflict and is at risk for a sense of inadequacy or guilt. The first step is for the child to share feelings about the pending family changes; later, outcomes will be targeted more toward the tantrums and disrespect. While cooperative play with other children is desirable, it does not address the etiology of the child's problem. This child is too young to select a custodial parent.
The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are handled best by 1 Giving the child what he or she is asking for 2 Scolding the child when he or she displays tantrum behaviors 3 Spanking the child at the onset of the tantrum behaviors 4 Ignoring the tantrum and giving attention when the child acts appropriately
4 Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction.
An experienced nurse helps a teenage patient to learn about the harmful effects of tobacco use to promote deaddiction. Which theory would a novice nurse analyze in this practice of mental health nursing? 1 Humanism 2 Existentialism 3 Moral development 4 Social learning
4 Social learning theory promotes concepts of self-efficacy and includes cognitive functioning related to environmental factors. Carl Rogers's theory of humanism encourages you to view each patient as unique and to show positive regard. Albert Ellis presented the theory of existentialism, which encourages the patient to live in the present. The theory of moral development, presented by Lawrence Kohlberg, teaches you to evaluate moral decisions.
Which would NOT be considered a crisis on a psychiatric unit? 1 Mr. R reports chest pain after eating a spicy lunch. 2 Ms. T cannot speak and is holding her hands up to her neck. 3 Mr. S demonstrates anger that escalates to physical assault. 4 Mr. U reports hearing voices telling him to hit others.
4 rises on a psychiatric unit can be either medical in nature or behavioral. Medical crises include shock, cardiopulmonary arrest, hemorrhage, and status epilepticus, whereas behavioral crises include actual or potential violence against self, others, or the environment. Hearing voices urging one to hit others is not considered a crisis, but rather a potential crisis that was averted.
It is not always guaranteed that all patients who are admitted voluntarily to a behavioral health unit will have the right to 1 Refuse treatment 2 Send and receive mail 3 Seek legal counsel 4 Access all personal possessions
4 Access all personal possessions A patient has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication usually are removed from the patient's possession and kept in a locked area to be used by the patient under supervision or returned at discharge.
Which therapy is most likely to be effective in treating patients with eating disorders? 1 Behavior therapy 2 Interpersonal therapy 3 Psychodynamic therapy 4 Cognitive-behavioral therapy
4 Cognitive-behavioral therapy Cognitive-behavioral therapy is a short-term therapy that can be used for treating persons diagnosed with eating disorders. It evaluates and helps to modify dysfunctional thoughts and behaviors. Behavior therapy is best used to treat posttraumatic stress disorder, obsessive-compulsive disorder, and panic disorder. Interpersonal therapy can be used to treat depression. Psychodynamic therapy can be used to treat personality disorder, anxiety, and depression.
Which patient problem would be suited most to the use of interpersonal therapy? 1 Disturbed sensory perception 2 Impaired social interaction 3 Medication noncompliance 4 Dysfunctional grieving
4 Dysfunctional grieving Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.
A depressed patient tells the nurse "I have never been able to have a successful relationship. I am not able to trust anybody. Is there a problem with me?" This type of behavior suggests an issue in what area? 1 Grief 2 Role disputes 3 Role transitions 4 Interpersonal deficit
4 Interpersonal deficit According to interpersonal psychotherapy, there are four types of problems. They are grief, role disputes, role transition, and interpersonal deficit. Interpersonal deficit refers to the problems where an individual is unable to initiate or sustain close relationships. In this case, the patient has problems with developing trust and having close relationships. This is an example of interpersonal deficit. Grief refers to the problems occurring during the process of bereavement following death or loss of a loved one. Role disputes refer to the problems arising due to conflicts with an important person in an individual's life. Role transitions refer to the problematic situations due to changes in life status, social, and vocational role.
Which of the following statements is true of the biological model? 1 It is the oldest and most reliable model for explaining mental illness. 2 It does not explain every symptom of mental illness. 3 It is the most popular theory among leading psychiatrists. 4 It does not recognize any other influences.
4 It does not recognize any other influences. In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these also have been proven to play a part in mental health and mental illness. Being the oldest and most reliable model for explaining mental illness, not explaining every symptom of mental illness, and being the most popular theory among leading psychiatrists are untrue.
The nurse is speaking to a patient who recently got divorced and is very depressed. The patient blames him or herself for the failure of the marriage and feels incapable of getting involved in a future relationship. According to Freud's psychoanalytic theory, what can the nurse interpret from this behavior? 1 The patient's id, ego, and superego are well-balanced. 2 The patient's id is more powerful than superego and ego. 3 The patient's ego is more dominant than id and superego. 4 The patient's superego is more powerful than ego and id.
4 The patient's superego is more powerful than ego and id. The patient blames him or herself for the failure of the marriage, which implies that the patient is extremely self-critical. The feeling of being incapable of getting involved in a relationship in the future indicates that the patient has an inferiority complex. According to Freud's psychoanalytic theory, behavior such as self-criticism and inferiority indicate that the superego is more powerful than the ego and id. In every behavior of an individual, either the id, ego or superego is dominant over the other two. The three personalities are never balanced. If the id is too powerful, the person will lack control over impulses. If the ego dominates over the id and superego, then the patient behaves like a mature and well-adjusted individual.
