Nursing, 8th Edition by Margaret Jordan Halter
Chapter 01: Mental Health and Mental Illness
MULTIPLE CHOICE
1. A staff nurse completes orientation to a psychiatric unit. This nurse may
expect an advanced practice nurse to perform which additional intervention?
a. Conduct mental health
assessments.
b. Prescribe psychotropic
medication.
c. Establish therapeutic
relationships.
d. Individualize nursing care plans.
ANS: B
In most states, prescriptive privileges are granted to master’s-prepared nurse
practitioners and clinical nurse specialists 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.
PTS: 1 DIF: Cognitive Level: Understand
(Comprehension) REF: Page 1-23 TOP: Nursing
Process: Implementation MSC: Client Needs: Safe, Effective
Care Environment
2. A nursing student expresses concerns that mental health nurses “lose all
their clinical nursing skills.” Select the best response by the mental health nurse.
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. “That’s a misconception. Psychiatric nurses frequently use high technology
monitoring equipment and manage complex intravenous therapies.”
d “Psychiatric nurses do not have to deal with as much pain and suffering as medical–
. surgical
nurses do. That appeals to me.”
ANS: 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. Nurse–patient ratios and workloads in psychiatric
settings have increased, just like other specialties. Psychiatric nursing involves clinical
practice, not just documentation. Psychosocial pain and suffering are as real as
physical pain and suffering.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Pages 1-2, 21 TOP: Nursing Process:
Implementation MSC: Client Needs: Safe, Effective Care Environment
3. When a new bill introduced in Congress reduces funding for care of persons
diagnosed with mental illness, a group of nurses write letters to their elected
,representatives in opposition to the legislation. Which role have the nurses fulfilled?
,a. Recovery
b. Attending
c. Advocacy
d. Evidence-based
practice
ANS: C
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.
PTS: 1 DIF: Cognitive Level: Understand
(Comprehension) REF: Page 1-26 TOP: Nursing
Process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
4. 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.”
ANS: C
The correct response demonstrates the best evidence of a healthy recognition of the
importance of relationships. Mental health includes rational thinking, communication
skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier
in life may be healthy,but the correct response shows a higher level of mental health.
The other incorrect responses show blaming and avoidance.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 1-2, 3, 32 (Figure 1-1) TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial Integrity
5. Which assessment finding most clearly indicates that a patient may be
experiencing a mental illness? The patient
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between “as if” and “for real.”
d. perceives difficulty making a decision about whether to change
jobs.
ANS: B
The correct response describes a mood alteration, which reflects mental illness. The
distractersdescribe behaviors that are mentally healthy or within the usual scope of
human experience.
PTS: 1 DIF: Cognitive Level: Apply (Application)
,REF: Pages 1-2 to 4 TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial Integrity
6. Which finding best indicates that the goal “Demonstrate mentally
healthybehavior” was achieved for an adult patient? The patient
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of
own life.
ANS: A
The correct response describes an adaptive, healthy behavior. The distracters describe
maladaptive behaviors.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Pages 1-2 to 4 TOP: Nursing Process:
Evaluation MSC: Client Needs: Psychosocial Integrity
7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s
admission form. Which resource should the nurse consult to determine criteria used to
establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health
Problems (ICD-10)
b. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of
Practice
c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
d. A behavioral health reference manual
ANS: C
The DSM-V gives the criteria used to diagnose each mental disorder. It is the official
guideline for diagnosing psychiatric disorders. The distracters may not contain
diagnostic criteria for a psychiatric illness.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Pages 1-18, 19 TOP: Nursing Process:
Assessment MSC: Client Needs: Safe, Effective Care Environment
8. 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
.
ANS: B
The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the
official guideline for diagnosing psychiatric disorders. The other references are good
resources but do not define the diagnostic criteria.
,PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 1-18, 19 TOP: Nursing Process:
Implementation MSC: Client Needs: Safe, Effective Care Environment
9. Which 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.
ANS: D
Resilience is closely associated with the process of adapting and helps people facing
tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to
secure the resources they need to support their well-being. Repression and depression
are unhealthy. Living in a shelter for 2 years shows a failure to move forward after a
tragedy. See related audience response question.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Pages 1-5, 6 TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial Integrity
10. Complete this analogy. NANDA: clinical judgment: NIC:
a. patient
outcomes.
b. nursing actions.
c. diagnosis.
d. symptoms.
ANS: B
Analogies show parallel relationships. NANDA, the North American Nursing
Diagnosis Association, identifies diagnostic statements regarding human responses
to actual or potential health problems. These statements represent clinical
judgments. NIC (Nursing Interventions Classification) identifies actions provided by
nurses that enhance patient outcomes. Nursing care activities may be direct or
indirect.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
REF: Pages 1-21, 22 TOP: Nursing Process:
Evaluation MSC: Client Needs: Safe, Effective Care Environment
11. An adult says, “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 Mental
Illness Health
1 2 3 4 5
a. 1
b. 2
c. 3
d. 4
,e. 5
ANS: E
The adult is generally happy and has an adequate self-concept. The statement
indicates the adult is reality-oriented, works effectively, and has control over own
behavior. Mental health does not mean that a person is always happy.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Pages 1-2, 3, 32 (Figure 1-1) TOP: Nursing Process:
Assessment MSC: Client Needs: Psychosocial Integrity
12. Which disorder is an example of a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depressive
disorder
ANS: C
Culture-bound syndromes occur in specific sociocultural contexts and are easily
recognized by people in those cultures. A syndrome recognized in parts of Southeast
Asia is running amok, in which a person (usually a male) runs around engaging in
furious, almost indiscriminate violent behavior.
PTS: 1 DIF: Cognitive Level: Understand
(Comprehension) REF: Page 1-7 TOP: Nursing
Process: Assessment
MSC: Client Needs: Psychosocial Integrity
13. The DSM-V classifies:
a. deviant behaviors.
b. present disability or
distress.
c. people with mental
disorders.
d. mental disorders people
have.
ANS: D
The DSM-V 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.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Pages 1-18, 19 TOP: Nursing Process:
Implementation MSC: Client Needs: Safe, Effective Care Environment
14. A citizen at a community health fair asks the nurse, “What is the most prevalent
mental disorder in the United States?” Select the nurse’s correct response.
a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer’s
,disease
,ANS: D
The 12-month 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%. Dissociative fugue is a rare disorder.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Page 1-33 (Table 1-1) TOP: Nursing Process:
Implementation MSC: Client Needs: Health Promotion and Maintenance
15. In the majority culture of the United States, which individual has the greatest
risk to belabeled 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.
ANS: 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.
PTS: 1 DIF: Cognitive Level: Analyze
(Analysis) REF: Pages 1-3, 4 TOP: Nursing
Process: Assessment MSC: Client Needs: Psychosocial
Integrity
16. A patient’s relationships are intense and unstable. The patient initially idealizes
the significant other and then devalues him or her, resulting in frequent feelings of
emptiness. Thispatient will benefit from interventions to develop which aspect of
mental health?
a. Effectiveness in work
b. Communication
skills
c. Productive activities
d. Fulfilling
relationships
ANS: D
The information given centers on relationships with others that are described as intense
and unstable. The relationships of mentally healthy individuals are stable, satisfying,
and sociallyintegrated. Data are not present to describe work effectiveness,
communication skills, or activities.
PTS: 1 DIF: Cognitive Level: Understand
(Comprehension) REF: Page 1-32 (Figure 1-1)
TOP: Nursing Process: Planning MSC: Client Needs:
Psychosocial Integrity
17. 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.