VARCAROLIS CH 1; MENTAL HEALTH & MENTAL ILLNESS A

VARCAROLIS CH 1; MENTAL HEALTH & MENTAL ILLNESS A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions? a. Conduct mental health assessments b. Establish therapeutic relationships c. Individualize nursing care plans d. Prescribe psychotropic medication - correct answer -D Prescriptive privileges are granted to masters-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems." b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations." c. "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate." d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me." - correct answer -B The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nursepatient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering is as real as physical. A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attendingc. Recovery d. Evidence-based practice - correct answer -A An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse: a. always asks me which type of juice I want to help me swallow my medication." b. explained my treatment plan to me and asked for my ideas about how to make it better." c. told me that if I take all the medicines the doctor prescribes, then I will get discharged soon." d. spends time listening to me talk about my problems. That helps me feel like I'm not alone." - correct answer -D Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice. Which finding best indicates that a patient has a mental illness? The patient: nds to rules, routines, and customs of a group. b. reports mood is consistently sad, discouraged, and hopeless. c. performs tasks attempted within the limits set by own abilities. d. is able to see the difference between the "as if" and the "for real." - correct answer -B The correct response describes a mood alteration, which further reflects mental illness. The distracters describe mentally healthy behaviors. Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient: a. sees self as approaching ideals and capable of meeting demands. b. seeks others to assume responsibility for major areas of own life. c. behaves without considering the consequences of personal actions. d. aggressively meets own needs without considering the rights of others. - correct answer -AA nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource? a. Diagnostic and Statistical Manual of Mental Disorders b. A nursing diagnosis handbook c. A psychiatric nursing textbook d. A behavioral health reference manual - correct answer -A The DSM-IV-TR gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness. Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting? a. I Acute renal failure II 75 III Bipolar disorder I, mixed IV Loss of disability benefits 2 months ago V None b. I Schizophrenia, paranoid type II Death of spouse last year III 60 IV None V Diabetes, type 2 c. I Polysubstance dependence II Narcissistic Personality Disorder III 90 IV Hyperlipidemia V Charges pending for assault d. I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80 - correct answer -D The DSM-IV-TR profiles psychiatric diagnoses on five axes. Each axis defines a specific aspect of the diagnosis. Axis I identifies major clinical disorders. Axis II details personality and developmental disorders. Axis III identifies general medical conditions. Axis IV details psychosocial and environmental problems. Axis V rates the Global Assessment of Functioning A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it: a. focuses on plans for treatment. b. includes nursing and medical diagnoses. c. classifies problems in multiple areas of functioning. d. uses the framework of a specific biopsychosocial theory. - correct answer -C The use of five axes requires assessment beyond diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. The DSM-IV-TR does not include treatment plans or nursing diagnoses. It does not use specific biopsychosocial theories A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. The ICD-10 b. Nursing Outcomes Classification c. Diagnostic and Statistical Manual of Mental Disorders d. The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice - correct answer -C The DSM-IV-TR details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria. Which comment most clearly shows a speaker views mental illness with stigma? a. "Some mental illnesses are inherited." b. "Most people with mental illness are unmotivated." c. "Severe environmental stress sometimes causes mental illness." d. "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted." - correct answer -B Stigma refers to stereotypical, negative beliefs. With respect to mental health and mental illness, stigma often leads to discrimination and uncaring attitudes. Mental illness has multiple causes, including stress, changes in brain structure or function, and genetic transmission. Complete this analogy. NANDA : clinical judgment :: NIC : _________________a. patient outcomes b. nursing actions c. diagnosis d. symptoms - correct answer -B A college student said, "Most of the time I'm happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it." Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5 - correct answer -E The student is happy and has an adequate self-concept. The student is reality oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is happy all the time. A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker's assessment is not yet available. Select the nurse's best action. a. Focus assessment questions on these two topics. b. Ask another patient who shares a room with this patient. c. Avoid seeking information on these topics at this time. d. Refer to axis IV of the DSM-IV-TR in the medical record. - correct answer -D The admitting physician would use axis IV to record psychosocial and environmental problems pertinent to the patient's situation, providing another source of information for the nurse. Persistent questioning may cause the patient to withdraw. The other distracters demonstrate violation of the patient's privacy rights and are not an effective solution. The Diagnostic and Statistical Manual of Mental Disorders classifies: a. deviant behaviors. b. people with mental disorders. c. present disability or distress. d. mental disorders people have. - correct answer -D The DSM-IV-TR classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.A nurse participating in a community health fair is asked, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response. a. Schizophrenia b. "Why do you ask?" c. Bipolar disorder d. Alzheimer's disease - correct answer -D The prevalence for Alzheimer's disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. It is important for the nurse to provide information rather than probe the reason for the person's question. In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing God's voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met. - correct answer -A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill. A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships - correct answer -D The information given centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities. A patient is depressed, mute, and motionless. According to family members, the patient has refused to bathe or eat for a week. The patient's global assessment of functioning score is: a. 100 b. 50c. 25 d. 10 - correct answer -D The patient is unable to maintain personal hygiene, oral intake, or verbal communication. The patient is a danger to self because of not eating. The distracters represent higher levels of functioning. Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a person's cultural patterns. - correct answer -D A nurse who understands that a patient's symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements. A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Prevalence b. Clinical epidemiology c. Descriptive epidemiology d. Experimental epidemiology - correct answer -B Clinical epidemiology is a broad field that addresses what happens to people with illnesses seen by providers of clinical care. This study is concerned with the effectiveness of various interventions. Prevalence refers to numbers of new cases. Descriptive epidemiology provides estimates of the rates of disorders in a general population and its subgroups. Experimental epidemiology tests presumed assumptions between a risk factor and a disorder. The spouse of a patient with schizophrenia says, "I don't understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness." Which response by the nurse will best help the spouse understand this disorder? a. "This illness is the result of genetic factors." b. "Psychological stress is at the root of most mental disorders." c. "It must be frustrating for you that your spouse is sick so much of the time."d. "New findings show that this condition more likely has biological rather than psychological origins." - correct answer -D Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouse's level of knowledge about the cause of the disorder. The other distracters are not established facts. A 40-year-old who lives with parents and works at an unchallenging job says, "I'm as happy as anyone else, even though I don't socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas." The nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior. - correct answer -A The patient sees self as needing multiple explanations of new tasks at work and allows the parents to make decisions, even though she is 40 years old. These behaviors indicate a poorly developed self-concept. The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information? a. II b. III c. IV d. V - correct answer -B Axis III indicates any relevant general medical conditions. Axis II refers to personality disorders and mental retardation. Together they constitute the classification of abnormal behavior diagnosed in the individual. Axis IV reports psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis. Axis V is the global assessment of functioning. Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account."c. "The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing." - correct answer -D The medical diagnosis is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both tools consider culture. The DSM-IV-TR is multiaxial. Nursing diagnoses also consider potential problems. An experienced nurse says to a new graduate, "When you've practiced as long as I have, you'll instantly know how to take care of psychotic patients." Which information should the new graduate consider when analyzing this comment? You may select more than one answer. a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurse's practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients' needs guides effective psychiatric nurses. - correct answer -A & B Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care. A patient asks the nurse, "I read an article online about psychosocial factors that influence depression. What are psychosocial factors?" Examples a nurse could cite to support the premise that a patient's depression may be influenced by psychosocial factors include: (Select all that apply) a. having a hostile and over involved family. b. having two first-degree relatives with bipolar disorder. c. feeling strong guilt over having an abortion when one's religion forbids it. d. experiencing the death of a parent a month before the onset of depression. e. experiencing symptom remission when treated with antidepressant medication. - correct answer - A, C, & DFamily influence is a psychosocial factor affecting a patient's mental health. A hostile, overinvolved family is critical of the patient and contributes to low self-esteem. Genetic factors influence an individual's risk for mental disorder but are not psychosocial factors. Religious influences are psychosocial in nature. Life experiences, especially crises and losses, are psychosocial influences on mental health. Treatment with a biological agent, such as antidepressant medication, is an example of a biological influence. A patient in the emergency department says, "The voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspect(s) of mental health should be of greatest immediate concern to the nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e.Healthy self-concept - correct answer -B, C, E The aspects of mental health of greatest concern are the patient's appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patient's control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern. A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? a. "I've made mistakes but everyone else in this family has also." b. "I remember joy and mutual respect from our early years together." c. "I will make some changes in my behavior for the good of the family." d. "It's best for me to move away from my family. Things will never change." - correct answer -C A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. DSM-V c. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10 - correct answer -BWhich individual is demonstrating the highest level of resilience? One who a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for 2 years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job. - correct answer -D Resilience is closely associated with the process of adapting and helps people facing tragedy, loss, trauma and severe stress. Which disorder is an example of a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depressive disorder - correct answer -C Running amok A category 5 tornado occurred in a community of 400 people. Many homes and businesses were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence b. Comorbidity c. Incidence d. Parity - correct answer -C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health. - correct answer -BSelect the best response for the nurse to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology." d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing." - correct answer -D Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse? a. Coordination of care b. Health teaching c. Milieu therapy d. Psychotherapy - correct answer -D Psychotherapy is part of the scope of practice of an advanced practice nurse. Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, "I have some weaknesses, but I feel I'm important to my family and friends." b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs. - correct answer -A, D & E Mental health is a state of well being in which each individual is able to realize his or her own potential, cope with the normal stress of life, work productively and make a contribution to the community. The mental health status of a particular client can best be assessed by considering ... - correct answer -placement on a continuum from health to illnessWhich of the following best demonstrates party related to mental health care? - correct answer -A client's mental health coverage is equal to his medical/surgical coverage A nursing diagnosis for a client with a psychiatric disorder serves the purpose of.... - correct answer - providing a framework for selecting appropriate interventions An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is ..... - correct answer -not demonstrating any definitive signs of mental illness In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to A. ask the client whether he views himself as being depressed. B. identify his culture's view regarding suicide. C. explain to him that suicide is often regarded as a desperate act. D. assess the client for other examples of depressive behaviors. - correct answer -B identify his culture's view regarding suicide The nurse planning care for a mentally ill client bases interventions on the concept that the client .... - correct answer -has areas of strength on which to build A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client A. is displaying deviant behavior. B. cannot accurately appraise reality. C. is seriously and persistently mentally ill. D. should be considered for group home placement. - correct answer -A is displaying deviant behavior A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking? - correct answer - Appraisal of realityWhich branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? A. experimental B. descriptive C. clinical D. analytic - correct answer -C Clinical These severe mental illnesses are recognized across cultures: A antisocial and borderline personality disorders. B schizophrenia and bipolar disorder. C bulimia and anorexia nervosa. D amok and social phobia. - correct answer -B schizophrenia & bipolar disorder The prevalence rate over a 12-month period for major depressive disorder is... - correct answer - greater than the prevalence rate for generalized anxiety Which statement about diagnosis of a mental disorder is true? - correct answer -Culture may cause variations in symptoms for each clinical disorder. A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering: A. "Don't be afraid; it means I'm here to help, not hurt, you." B. "Psychiatric mental health nurses care for people with mental illnesses." C. "We have the specialized skills needed to care for those with mental illnesses." D. "The nurses who work in mental health facilities have that title." - correct answer -C "We have the specialized skills needed to care for those mental illnesses." Current information suggests that the most disabling mental disorders are the result of: A) biological influences.B) psychological trauma. C) learned ways of behaving. D) faulty patterns of early nurturance. - correct answer -A biological influences Which statement best describes the DSM-5? - correct answer -It is a medical psychiatric assessment system. The quantitative study of the distribution of mental disorders in human populations is called - correct answer -epidemiolog