,
,
,
,11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual residents.
Ans: A, C
Feedback:
Clients were often far removed from the local community, family, and friends because
state institutions were usually in rural or remote settings. Choices B and D were not
major problems associated with large state instructions.
12. A significant change in the treatment of people with mental illness occurred in the 1950s
when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient's Bill of Rights was enacted.
D) psychotropic drugs became available for use.
Ans: D
Feedback:
The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and
ridiculing the mentally ill, who were seen as animals, less than human. Custodial care
was not often provided as persons who were considered harmless were allowed to
wander in the countryside or live in rural communities, and more dangerous lunatics
were imprisoned, chained, and starved. In early Christian times, primitive beliefs and
superstitions were strong. The mentally ill were viewed as evil or possessed. Priests
performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted
with offenders burned at the stake. It was not until the period of enlightenment when
persons who were mentally ill were offered asylum as a safe refuge or haven offering
protection at institutions.
Page 5
,14. The first training of nurses to work with persons with mental illness was in 1882 in
which state?
A) California
B) Illinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mental illness was in 1882 at
McLean Hospital in Belmont, Massachusetts.
15. What is meant by the term ìrevolving door effectî in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and persistent
mental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings
Ans: B
Feedback:
The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are
quickly discharged into the community where services are not adequate; without
adequate community services, clients become acutely ill and require rehospitalization.
The revolving door effect does not refer to flexible treatment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if utilized
appropriately could result in stabilization and less need for emergency department visits
and/or rehospitalization. The revolving door effect does not relate to the incidence of
severe mental illness.
Page 6
,16. Which of the following statements is true of treatment of people with mental illness in
the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community programs
and support.
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are declining.
Ans: C
Feedback:
Only one in four (25%) adults needing mental health care receives the needed services.
Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in
the current managed care environment. Money saved by states when state hospitals were
closed has not been transferred to community programs and support. Although people
with severe and persistent mental illness have shorter hospital stays, they are admitted to
hospitals more frequently. In some cities, emergency department visits for acutely
disturbed persons have increased by 400% to 500%.
17. Which of the following is the priority of the Healthy People 2020 objectives for mental
health?
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental illness
Ans: D
Feedback:
The objectives are to increase the number of people who are identified, diagnosed,
treated, and helped to live healthier lives. The objectives also strive to decrease rates of
suicide and homelessness, to increase employment among those with serious mental
illness, and to provide more services both for juveniles and for adults who are
incarcerated and have mental health problems. Answer choices A, B, and C are not
priorities of Healthy People 2020.
Page 7
,18. Which is a positive aspect of treating clients with mental illness in a community-based
care?
A) ìYou will not be allowed to go out with your friends while in the program.î
B) ìYou will have to have supervision when you want to go anywhere else in the
community.î
C) ìYou will be able to live in your own home while you still see a therapist
regularly.î
D) ìYou will have someone in your home at all times to ask questions if you have any
concerns.î
Ans: C
Feedback:
Clients can remain in their communities, maintain contact with family and friends, and
enjoy personal freedom that is not possible in an institution. Full-time home care is not
included in community-based programs.
19. One of the unforeseen effects of the movement toward community mental health
services is
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health services.
Ans: C
Feedback:
Although people with severe and persistent mental illness have shorter hospital stays,
they are admitted to hospitals more frequently. Although deinstitutionalization reduced
the number of public hospital beds by 80%, the number of admissions to those beds
correspondingly increased by 90%. The number of individuals with mental illness did
not change.
20. Which is included in Healthy People 2020 objectives?
A) To decrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, treated, and
helped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for mental illness
Ans: B
Feedback:
One of the Healthy People 2020 objectives is to increase the number of people who are
identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to
decrease the incidence of mental illness. At this time, the focus is on ensuring that
persons with mental illness are receiving needed treatment. It may not be possible or
desirable to provide mental health services only in the community.
Page 8
,21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a
community mental health center. Treatment most likely provided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilization.
Ans: A
Feedback:
Community mental health centers focus on rehabilitation, vocational needs, education,
and socialization, as well as on management of symptoms and medication. Daily
therapies, constant supervision, and stabilization require a more acute care inpatient
setting.
22. Which of the following is defined as an advanced-level function in the practice area of
psychiatric mental health nursing?
A) Case management
B) Counseling
C) Evaluation
D) Health teaching
Ans: C
Feedback:
Advanced-level functions are psychotherapy, prescriptive authority, consultation and
liaison, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-level functions in the practice area of
psychiatric mental health nursing.
23. Psychiatric nursing became a requirement in nursing education in which year?
A) 1930
B) 1940
C) 1950
D) 1960
Ans: C
Feedback:
It was not until 1950 that the National League for Nursing, which accredits nursing
programs, required schools to include an experience in psychiatric nursing.
Page 9
, 24. A new graduate nurse has accepted a staff position at an inpatient mental health facility.
The graduate nurse can expect to be responsible for basic-level functions, including
A) providing clinical supervision.
B) using effective communication skills.
C) adjusting client medications.
D) directing program development.
Ans: B
Feedback:
Basic-level functions include counseling, milieu therapy, self-care activities,
psychobiologic interventions, health teaching, case management, and health promotion
and maintenance. Advanced-level functions include psychotherapy, prescriptive
authority for drugs, consultation and liaison, evaluation, program development and
management, and clinical supervision.
25. Which one of the following is one of the American Nurses Association standards of
practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatricñmental health registered nurses.
B) All aspects of Standard 5: Implementation may be carried out by
psychiatricñmental health registered nurses.
C) Some aspects of Standard 5: Implementation may only be carried out by
psychiatricñmental health advanced practice nurses.
D) Psychiatricñmental health advanced practice nurses are the only ones who may
provide milieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmental health advanced practice registered
nurses in accordance with state and federal laws and regulations. Standards 5DñG are
advanced practice interventions and may be performed only by the psychiatricñmental
health advanced practice registered nurse. Psychiatricñmental health registered nurses
may provide milieu therapy according to Standard 5C. This is not restricted to
psychiatricñmental health advanced practice nurses.
Page 10
,
,
,11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual residents.
Ans: A, C
Feedback:
Clients were often far removed from the local community, family, and friends because
state institutions were usually in rural or remote settings. Choices B and D were not
major problems associated with large state instructions.
12. A significant change in the treatment of people with mental illness occurred in the 1950s
when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient's Bill of Rights was enacted.
D) psychotropic drugs became available for use.
Ans: D
Feedback:
The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and
ridiculing the mentally ill, who were seen as animals, less than human. Custodial care
was not often provided as persons who were considered harmless were allowed to
wander in the countryside or live in rural communities, and more dangerous lunatics
were imprisoned, chained, and starved. In early Christian times, primitive beliefs and
superstitions were strong. The mentally ill were viewed as evil or possessed. Priests
performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted
with offenders burned at the stake. It was not until the period of enlightenment when
persons who were mentally ill were offered asylum as a safe refuge or haven offering
protection at institutions.
Page 5
,14. The first training of nurses to work with persons with mental illness was in 1882 in
which state?
A) California
B) Illinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mental illness was in 1882 at
McLean Hospital in Belmont, Massachusetts.
15. What is meant by the term ìrevolving door effectî in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and persistent
mental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings
Ans: B
Feedback:
The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are
quickly discharged into the community where services are not adequate; without
adequate community services, clients become acutely ill and require rehospitalization.
The revolving door effect does not refer to flexible treatment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if utilized
appropriately could result in stabilization and less need for emergency department visits
and/or rehospitalization. The revolving door effect does not relate to the incidence of
severe mental illness.
Page 6
,16. Which of the following statements is true of treatment of people with mental illness in
the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community programs
and support.
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are declining.
Ans: C
Feedback:
Only one in four (25%) adults needing mental health care receives the needed services.
Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in
the current managed care environment. Money saved by states when state hospitals were
closed has not been transferred to community programs and support. Although people
with severe and persistent mental illness have shorter hospital stays, they are admitted to
hospitals more frequently. In some cities, emergency department visits for acutely
disturbed persons have increased by 400% to 500%.
17. Which of the following is the priority of the Healthy People 2020 objectives for mental
health?
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental illness
Ans: D
Feedback:
The objectives are to increase the number of people who are identified, diagnosed,
treated, and helped to live healthier lives. The objectives also strive to decrease rates of
suicide and homelessness, to increase employment among those with serious mental
illness, and to provide more services both for juveniles and for adults who are
incarcerated and have mental health problems. Answer choices A, B, and C are not
priorities of Healthy People 2020.
Page 7
,18. Which is a positive aspect of treating clients with mental illness in a community-based
care?
A) ìYou will not be allowed to go out with your friends while in the program.î
B) ìYou will have to have supervision when you want to go anywhere else in the
community.î
C) ìYou will be able to live in your own home while you still see a therapist
regularly.î
D) ìYou will have someone in your home at all times to ask questions if you have any
concerns.î
Ans: C
Feedback:
Clients can remain in their communities, maintain contact with family and friends, and
enjoy personal freedom that is not possible in an institution. Full-time home care is not
included in community-based programs.
19. One of the unforeseen effects of the movement toward community mental health
services is
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health services.
Ans: C
Feedback:
Although people with severe and persistent mental illness have shorter hospital stays,
they are admitted to hospitals more frequently. Although deinstitutionalization reduced
the number of public hospital beds by 80%, the number of admissions to those beds
correspondingly increased by 90%. The number of individuals with mental illness did
not change.
20. Which is included in Healthy People 2020 objectives?
A) To decrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, treated, and
helped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for mental illness
Ans: B
Feedback:
One of the Healthy People 2020 objectives is to increase the number of people who are
identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to
decrease the incidence of mental illness. At this time, the focus is on ensuring that
persons with mental illness are receiving needed treatment. It may not be possible or
desirable to provide mental health services only in the community.
Page 8
,21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a
community mental health center. Treatment most likely provided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilization.
Ans: A
Feedback:
Community mental health centers focus on rehabilitation, vocational needs, education,
and socialization, as well as on management of symptoms and medication. Daily
therapies, constant supervision, and stabilization require a more acute care inpatient
setting.
22. Which of the following is defined as an advanced-level function in the practice area of
psychiatric mental health nursing?
A) Case management
B) Counseling
C) Evaluation
D) Health teaching
Ans: C
Feedback:
Advanced-level functions are psychotherapy, prescriptive authority, consultation and
liaison, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-level functions in the practice area of
psychiatric mental health nursing.
23. Psychiatric nursing became a requirement in nursing education in which year?
A) 1930
B) 1940
C) 1950
D) 1960
Ans: C
Feedback:
It was not until 1950 that the National League for Nursing, which accredits nursing
programs, required schools to include an experience in psychiatric nursing.
Page 9
, 24. A new graduate nurse has accepted a staff position at an inpatient mental health facility.
The graduate nurse can expect to be responsible for basic-level functions, including
A) providing clinical supervision.
B) using effective communication skills.
C) adjusting client medications.
D) directing program development.
Ans: B
Feedback:
Basic-level functions include counseling, milieu therapy, self-care activities,
psychobiologic interventions, health teaching, case management, and health promotion
and maintenance. Advanced-level functions include psychotherapy, prescriptive
authority for drugs, consultation and liaison, evaluation, program development and
management, and clinical supervision.
25. Which one of the following is one of the American Nurses Association standards of
practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatricñmental health registered nurses.
B) All aspects of Standard 5: Implementation may be carried out by
psychiatricñmental health registered nurses.
C) Some aspects of Standard 5: Implementation may only be carried out by
psychiatricñmental health advanced practice nurses.
D) Psychiatricñmental health advanced practice nurses are the only ones who may
provide milieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmental health advanced practice registered
nurses in accordance with state and federal laws and regulations. Standards 5DñG are
advanced practice interventions and may be performed only by the psychiatricñmental
health advanced practice registered nurse. Psychiatricñmental health registered nurses
may provide milieu therapy according to Standard 5C. This is not restricted to
psychiatricñmental health advanced practice nurses.
Page 10
