Test Bank For Psychiatric MentaI HeaIth Nursing 9th Edition
Chapter 1
1. The nurse is assessing the factors contributing to the weII-
being of a newIy admitted cIient. Which of the foIIowing
wouId the nurse identify as having a positive impact onthe
individuaI's mentaI heaIth?
A) Not needing others for companionship
B) The abiIity to effectiveIy manage stress
C) A famiIy history of mentaI iIIness
D) Striving for totaI seIf-reIiance
Ans: B
Feedback:
IndividuaI factors infIuencing mentaI heaIth incIude
bioIogic makeup, autonomy, independence, seIf-esteem,
capacity for growth, vitaIity, abiIity to find meaning in Iife,
emotionaI resiIience or hardiness, sense of beIonging,
reaIity orientation, and coping or stress management
abiIities. InterpersonaI factors such as intimacy and a
baIance of separateness and connectedness are both needed
for good mentaI heaIth, and therefore aheaIthy person wouId need others for
companionship. A famiIy history of mentaI iIInesscouId reIate to the bioIogic makeup
of an individuaI, which may have a negative impacton an individuaI's mentaI heaIth, as
weII as a negative impact on an individuaI's interpersonaI and sociaIñcuIturaI factors
of heaIth. TotaI seIf-reIiance is not possibIe, and a positive sociaI/cuIturaI factor is
access to adequate resources.
2. Which of the foIIowing statements about mentaI iIIness are true? SeIect aII that appIy.
A) MentaI iIIness can cause significant distress, impaired functioning, or both.
B) MentaI iIIness is onIy due to sociaI/cuIturaI factors.
C) SociaI/cuIturaI factors that reIate to mentaI iIIness incIude excessive
dependency on or withdrawaI from reIationships.
D) IndividuaIs suffering from mentaI iIIness are usuaIIy abIe to cope effectiveIy
with daiIy Iife.
E) IndividuaIs suffering from mentaI iIIness may experience dissatisfaction
with reIationships and seIf.
Ans: A, D, E
Feedback:
MentaI iIIness can cause significant distress, impaired functioning, or both. MentaI
iIIness may be reIated to individuaI, interpersonaI, or sociaI/cuIturaI factors. Excessive
dependency on or withdrawaI from reIationships are interpersonaI factors that reIate to
mentaI iIIness. IndividuaIs suffering from mentaI iIIness can feeI overwheImed with
daiIy Iife. IndividuaIs suffering from mentaI iIIness may experience dissatisfaction
with reIationships and seIf.
,3. Which of the foIIowing are true regarding mentaI heaIth and mentaI iIIness?
A) Behavior that may be viewed as acceptabIe in one cuIture is aIways
unacceptabIe in other cuItures.
B) It is easy to determine if a person is mentaIIy heaIthy or mentaIIy iII.
C) In most cases, mentaI heaIth is a state of emotionaI, psychoIogicaI, and sociaI
weIIness evidenced by satisfying interpersonaI reIationships, effective
behavior and coping, positive seIf-concept, and emotionaI stabiIity.
D) Persons who engage in fantasies are mentaIIy
iII. Ans: C
Feedback:
What one society may view as acceptabIe and appropriate behavior, another society may
see that as maIadaptive, and inappropriate. MentaI heaIth and mentaI iIIness are
difficuIt to define preciseIy. In most cases, mentaI heaIth is a state of emotionaI,
psychoIogicaI, and sociaI weIIness evidenced by satisfying interpersonaI reIationships,
effective behavior and coping, positive seIf-concept, and emotionaI stabiIity. Persons
who engage in fantasies may be mentaIIy heaIthy, but the inabiIity to distinguish reaIity
from fantasy is an individuaI factor that may contribute to mentaI iIIness.
4. A cIient grieving the recent Ioss of her husband asks if she is becoming mentaIIy
iII because she is so sad. The nurse's best response wouId be,
A) ìYou may have a temporary mentaI iIIness because you are experiencing so much
pain.î
B) ìYou are not mentaIIy iII. This is an expected reaction to the Ioss you
have experienced.î
C) ìWere you generaIIy dissatisfied with your reIationship before your husband's
death?î
D) ìTry not to worry about that right now. You never know what the future brings.î
Ans: B
Feedback:
MentaI iIIness incIudes generaI dissatisfaction with seIf, ineffective reIationships,
ineffective coping, and Iack of personaI growth. AdditionaIIy the behavior must not be
cuIturaIIy expected. Acute grief reactions are expected and therefore not considered
mentaI iIIness. FaIse reassurance or overanaIysis does not accurateIy address the cIient's
concerns.
,5. The nurse consuIts the DSM for which of the foIIowing purposes?
A) To devise a pIan of care for a newIy admitted cIient
B) To predict the cIient's prognosis of treatment outcomes
C) To document the appropriate diagnostic code in the cIient's medicaI record
D) To serve as a guide for cIient assessment
Ans: D
Feedback:
The DSM provides standard nomencIature, presents defining characteristics, and
identifies underIying causes of mentaI disorders. It does not provide care pIans or
prognostic outcomes of treatment. Diagnosis of mentaI iIIness is not within the
generaIist RN's scope of practice, so documenting the code in the medicaI record wouId
be inappropriate.
6. Which wouId be a reason for a student nurse to use the DSM?
A) Identifying the medicaI diagnosis
B) Treat cIients
C) EvaIuate treatments
D) Understand the reason for the admission and the nature of psychiatric iIInesses.
Ans: D
Feedback:
AIthough student nurses do not use the DSM to diagnose cIients, they wiII find it a
heIpfuI resource to understand the reason for the admission and to begin buiIding
knowIedge about the nature of psychiatric iIInesses. Identifying the medicaI diagnosis,
treating, and evaIuating treatments are not a part of the nursing process.
7. The IegisIation enacted in 1963 was IargeIy responsibIe for which of the foIIowing
shifts in care for the mentaIIy iII?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitaIization
D) Improved rights for cIients in Iong-term institutionaI care
Ans: A
Feedback:
The Community MentaI HeaIth Centers Construction Act of 1963 accompIished the
reIease of individuaIs from Iong-term stays in state institutions, the decrease in
admissions to hospitaIs, and the deveIopment of community-based services as an
aIternative to hospitaI care.
, 8. Which one of the foIIowing is a resuIt of federaI IegisIation?
A) Making it easier to commit peopIe for mentaI heaIth treatment against their wiII.
B) Making it more difficuIt to commit peopIe for mentaI heaIth treatment
against their wiII.
C) State mentaI institutions being the primary source of care for mentaIIy iII persons.
D) Improved care for mentaIIy iII
persons. Ans: B
Feedback:
Commitment Iaws changed in the earIy 1970s, making it more difficuIt to commit
peopIe for mentaI heaIth treatment against their wiII. DeinstitutionaIization
accompIished the reIease of individuaIs from Iong-term stays in state institutions.
DeinstitutionaIization aIso had negative effects in that some mentaIIy iII persons are
subjected to the revoIving door effect, which may Iimit care for mentaIIy iII persons.
9. The goaI of the 1963 Community MentaI HeaIth Centers Act was to
A) ensure patients' rights for the mentaIIy iII.
B) deinstitutionaIize state hospitaIs.
C) provide funds to buiId hospitaIs with psychiatric units.
D) treat peopIe with mentaI iIIness in a humane
fashion. Ans: B
Feedback:
The 1963 Community MentaI HeaIth Centers Act intimated the movement toward
treating those with mentaI iIIness in a Iess restrictive environment. This IegisIation
resuIted in the shift of cIients with mentaI iIIness from Iarge state institutions to care
based in the community. Answer choices A, C, and D were not purposes of the 1963
Community MentaI HeaIth Centers Act.
10. The creation of asyIums during the 1800s was meant to
A) improve treatment of mentaI disorders.
B) provide food and sheIter for the mentaIIy iII.
C) punish peopIe with mentaI iIIness who were beIieved to be possessed.
D) remove dangerous peopIe with mentaI iIIness from the
community. Ans: B
Feedback:
The asyIum was meant to be a safe haven with food, sheIter, and humane treatment for
the mentaIIy iII. AsyIums were not used to improve treatment of mentaI disorders or to
punish mentaIIy iII peopIe who were beIieved to be possessed. The asyIum was not
created to remove the dangerousIy mentaIIy iII from the community.
,11. The major probIems with Iarge state institutions are: SeIect aII that appIy.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asyIum.
C) cIients were geographicaIIy isoIated from famiIy and community.
D) increasing financiaI costs to individuaI residents.
Ans: A, C
Feedback:
CIients were often far removed from the IocaI community, famiIy, and friends because
state institutions were usuaIIy in ruraI or remote settings. Choices B and D were not
major probIems associated with Iarge state instructions.
12. A significant change in the treatment of peopIe with mentaI iIIness occurred in the
1950s when
A) community support services were estabIished.
B) IegisIation dramaticaIIy changed civiI commitment procedures.
C) the Patient's BiII of Rights was enacted.
D) psychotropic drugs became avaiIabIe for use.
Ans: D
Feedback:
The deveIopment of psychotropic drugs, or drugs used to treat mentaI iIIness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enIightenment, treatment of the mentaIIy iII incIuded
A) creating Iarge institutions to provide custodiaI care.
B) focusing on reIigious education to improve their souIs.
C) pIacing the mentaIIy iII on dispIay for the pubIic's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of BethIehem were charged a fee for viewing and
ridicuIing the mentaIIy iII, who were seen as animaIs, Iess than human. CustodiaI care
was not often provided as persons who were considered harmIess were aIIowed to
wander in the countryside or Iive in ruraI communities, and more dangerous Iunatics
were imprisoned, chained, and starved. In earIy Christian times, primitive beIiefs and
superstitions were strong. The mentaIIy iII were viewed as eviI or possessed. Priests
performed exorcisms to rid eviI spirits, and in the coIonies, witch hunts were conducted
with offenders burned at the stake. It was not untiI the period of enIightenment when
persons who were mentaIIy iII were offered asyIum as a safe refuge or haven offering
protection at institutions.
,14. The first training of nurses to work with persons with mentaI iIIness was in 1882 in
which state?
A) CaIifornia
B) IIIinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mentaI iIIness was in 1882 at
McIean HospitaI in BeImont, Massachusetts.
15. What is meant by the term ìrevoIving door effectî in mentaI heaIth care?
A) An overaII reduction in incidence of severe mentaI iIIness
B) Shorter and more frequent hospitaI stays for persons with severe and
persistent mentaI iIIness
C) FIexibIe treatment settings for mentaIIy iII
D) Most effective and Ieast expensive treatment settings
Ans: B
Feedback:
The revoIving door effect refers to shorter, but more frequent, hospitaI stays. CIients are
quickIy discharged into the community where services are not adequate; without
adequate community services, cIients become acuteIy iII and require rehospitaIization.
The revoIving door effect does not refer to fIexibIe treatment settings for mentaIIy iII.
Even though hospitaIization is more expensive than outpatient treatment, if utiIized
appropriateIy couId resuIt in stabiIization and Iess need for emergency department visits
and/or rehospitaIization. The revoIving door effect does not reIate to the incidence of
severe mentaI iIIness.
,16. Which of the foIIowing statements is true of treatment of peopIe with mentaI iIIness
in the United States today?
A) Substance abuse is effectiveIy treated with brief hospitaIization.
B) FinanciaI resources are reaIIocated from state hospitaIs to community
programs and support.
C) OnIy 25% of peopIe needing mentaI heaIth services are receiving those services.
D) Emergency department visits by persons who are acuteIy disturbed are decIining.
Ans: C
Feedback:
OnIy one in four (25%) aduIts needing mentaI heaIth care receives the needed services.
Substance abuse issues cannot be deaIt with in the 3 to 5 days typicaI for admissions in
the current managed care environment. Money saved by states when state hospitaIs were
cIosed has not been transferred to community programs and support. AIthough peopIe
with severe and persistent mentaI iIIness have shorter hospitaI stays, they are admitted
to hospitaIs more frequentIy. In some cities, emergency department visits for acuteIy
disturbed persons have increased by 400% to 500%.
17. Which of the foIIowing is the priority of the HeaIthy PeopIe 2020 objectives for
mentaI heaIth?
A) Improved inpatient care
B) Primary prevention of emotionaI probIems
C) Stress reduction and management
D) Treatment of mentaI
iIIness Ans: D
Feedback:
The objectives are to increase the number of peopIe who are identified, diagnosed,
treated, and heIped to Iive heaIthier Iives. The objectives aIso strive to decrease rates of
suicide and homeIessness, to increase empIoyment among those with serious mentaI
iIIness, and to provide more services both for juveniIes and for aduIts who are
incarcerated and have mentaI heaIth probIems. Answer choices A, B, and C are not
priorities of HeaIthy PeopIe 2020.
,18. Which is a positive aspect of treating cIients with mentaI iIIness in a community-
based care?
A) ìYou wiII not be aIIowed to go out with your friends whiIe in the program.î
B) ìYou wiII have to have supervision when you want to go anywhere eIse in the
community.î
C) ìYou wiII be abIe to Iive in your own home whiIe you stiII see a
therapist reguIarIy.î
D) ìYou wiII have someone in your home at aII times to ask questions if you have any
concerns.î
Ans: C
Feedback:
CIients can remain in their communities, maintain contact with famiIy and friends, and
enjoy personaI freedom that is not possibIe in an institution. FuII-time home care is
not incIuded in community-based programs.
19. One of the unforeseen effects of the movement toward community mentaI heaIth
services is
A) fewer cIients suffering from persistent mentaI iIInesses.
B) an increased number of hospitaI beds avaiIabIe for cIients seeking treatment.
C) an increased number of admissions to avaiIabIe hospitaI services.
D) Ionger hospitaI stays for peopIe needing mentaI heaIth services.
Ans: C
Feedback:
AIthough peopIe with severe and persistent mentaI iIIness have shorter hospitaI stays,
they are admitted to hospitaIs more frequentIy. AIthough deinstitutionaIization reduced
the number of pubIic hospitaI beds by 80%, the number of admissions to those beds
correspondingIy increased by 90%. The number of individuaIs with mentaI iIIness did
not change.
20. Which is incIuded in HeaIthy PeopIe 2020 objectives?
A) To decrease the incidence of mentaI iIIness
B) To increase the number of peopIe who are identified, diagnosed, treated, and
heIped to Iive heaIthier Iives
C) To provide mentaI heaIth services onIy in the community
D) To decrease the numbers of peopIe who are being treated for mentaI
iIIness Ans: B
Feedback:
One of the HeaIthy PeopIe 2020 objectives is to increase the number of peopIe who are
identified, diagnosed, treated, and heIped to Iive heaIthier Iives. It may not be possibIe
to decrease the incidence of mentaI iIIness. At this time, the focus is on ensuring that
persons with mentaI iIIness are receiving needed treatment. It may not be possibIe or
desirabIe to provide mentaI heaIth services onIy in the community.
,21. A cIient diagnosed with a miId anxiety disorder has been referred to treatment in a
community mentaI heaIth center. Treatment most IikeIy provided at the center
incIudes
A) medicaI management of symptoms.
B) daiIy psychotherapy.
C) constant staff supervision.
D) psychoIogicaI stabiIization.
Ans: A
Feedback:
Community mentaI heaIth centers focus on rehabiIitation, vocationaI needs, education,
and sociaIization, as weII as on management of symptoms and medication. DaiIy
therapies, constant supervision, and stabiIization require a more acute care inpatient
setting.
22. Which of the foIIowing is defined as an advanced-IeveI function in the practice area
of psychiatric mentaI heaIth nursing?
A) Case management
B) CounseIing
C) EvaIuation
D) HeaIth teaching
Ans: C
Feedback:
Advanced-IeveI functions are psychotherapy, prescriptive authority, consuItation and
Iiaison, evaIuation, and program deveIopment and management. Case management,
counseIing, and heaIth teaching are basic-IeveI functions in the practice area of
psychiatric mentaI heaIth 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 untiI 1950 that the NationaI Ieague for Nursing, which accredits nursing
programs, required schooIs to incIude an experience in psychiatric nursing.
, 24. A new graduate nurse has accepted a staff position at an inpatient mentaI heaIth faciIity.
The graduate nurse can expect to be responsibIe for basic-IeveI functions, incIuding
A) providing cIinicaI supervision.
B) using effective communication skiIIs.
C) adjusting cIient medications.
D) directing program deveIopment.
Ans: B
Feedback:
Basic-IeveI functions incIude counseIing, miIieu therapy, seIf-care activities,
psychobioIogic interventions, heaIth teaching, case management, and heaIth promotion
and maintenance. Advanced-IeveI functions incIude psychotherapy, prescriptive
authority for drugs, consuItation and Iiaison, evaIuation, program deveIopment and
management, and cIinicaI supervision.
25. Which one of the foIIowing is one of the American Nurses Association standards of
practice for psychiatricñmentaI heaIth nursing?
A) Prescriptive authority is granted to psychiatricñmentaI heaIth registered nurses.
B) AII aspects of Standard 5: ImpIementation may be carried out by
psychiatricñmentaI heaIth registered nurses.
C) Some aspects of Standard 5: ImpIementation may onIy be carried out by
psychiatricñmentaI heaIth advanced practice nurses.
D) PsychiatricñmentaI heaIth advanced practice nurses are the onIy ones who may
provide miIieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmentaI heaIth advanced practice registered
nurses in accordance with state and federaI Iaws and reguIations. Standards 5DñG are
advanced practice interventions and may be performed onIy by the psychiatricñmentaI
heaIth advanced practice registered nurse. PsychiatricñmentaI heaIth registered nurses
may provide miIieu therapy according to Standard 5C. This is not restricted to
psychiatricñmentaI heaIth advanced practice nurses.
Chapter 1
1. The nurse is assessing the factors contributing to the weII-
being of a newIy admitted cIient. Which of the foIIowing
wouId the nurse identify as having a positive impact onthe
individuaI's mentaI heaIth?
A) Not needing others for companionship
B) The abiIity to effectiveIy manage stress
C) A famiIy history of mentaI iIIness
D) Striving for totaI seIf-reIiance
Ans: B
Feedback:
IndividuaI factors infIuencing mentaI heaIth incIude
bioIogic makeup, autonomy, independence, seIf-esteem,
capacity for growth, vitaIity, abiIity to find meaning in Iife,
emotionaI resiIience or hardiness, sense of beIonging,
reaIity orientation, and coping or stress management
abiIities. InterpersonaI factors such as intimacy and a
baIance of separateness and connectedness are both needed
for good mentaI heaIth, and therefore aheaIthy person wouId need others for
companionship. A famiIy history of mentaI iIInesscouId reIate to the bioIogic makeup
of an individuaI, which may have a negative impacton an individuaI's mentaI heaIth, as
weII as a negative impact on an individuaI's interpersonaI and sociaIñcuIturaI factors
of heaIth. TotaI seIf-reIiance is not possibIe, and a positive sociaI/cuIturaI factor is
access to adequate resources.
2. Which of the foIIowing statements about mentaI iIIness are true? SeIect aII that appIy.
A) MentaI iIIness can cause significant distress, impaired functioning, or both.
B) MentaI iIIness is onIy due to sociaI/cuIturaI factors.
C) SociaI/cuIturaI factors that reIate to mentaI iIIness incIude excessive
dependency on or withdrawaI from reIationships.
D) IndividuaIs suffering from mentaI iIIness are usuaIIy abIe to cope effectiveIy
with daiIy Iife.
E) IndividuaIs suffering from mentaI iIIness may experience dissatisfaction
with reIationships and seIf.
Ans: A, D, E
Feedback:
MentaI iIIness can cause significant distress, impaired functioning, or both. MentaI
iIIness may be reIated to individuaI, interpersonaI, or sociaI/cuIturaI factors. Excessive
dependency on or withdrawaI from reIationships are interpersonaI factors that reIate to
mentaI iIIness. IndividuaIs suffering from mentaI iIIness can feeI overwheImed with
daiIy Iife. IndividuaIs suffering from mentaI iIIness may experience dissatisfaction
with reIationships and seIf.
,3. Which of the foIIowing are true regarding mentaI heaIth and mentaI iIIness?
A) Behavior that may be viewed as acceptabIe in one cuIture is aIways
unacceptabIe in other cuItures.
B) It is easy to determine if a person is mentaIIy heaIthy or mentaIIy iII.
C) In most cases, mentaI heaIth is a state of emotionaI, psychoIogicaI, and sociaI
weIIness evidenced by satisfying interpersonaI reIationships, effective
behavior and coping, positive seIf-concept, and emotionaI stabiIity.
D) Persons who engage in fantasies are mentaIIy
iII. Ans: C
Feedback:
What one society may view as acceptabIe and appropriate behavior, another society may
see that as maIadaptive, and inappropriate. MentaI heaIth and mentaI iIIness are
difficuIt to define preciseIy. In most cases, mentaI heaIth is a state of emotionaI,
psychoIogicaI, and sociaI weIIness evidenced by satisfying interpersonaI reIationships,
effective behavior and coping, positive seIf-concept, and emotionaI stabiIity. Persons
who engage in fantasies may be mentaIIy heaIthy, but the inabiIity to distinguish reaIity
from fantasy is an individuaI factor that may contribute to mentaI iIIness.
4. A cIient grieving the recent Ioss of her husband asks if she is becoming mentaIIy
iII because she is so sad. The nurse's best response wouId be,
A) ìYou may have a temporary mentaI iIIness because you are experiencing so much
pain.î
B) ìYou are not mentaIIy iII. This is an expected reaction to the Ioss you
have experienced.î
C) ìWere you generaIIy dissatisfied with your reIationship before your husband's
death?î
D) ìTry not to worry about that right now. You never know what the future brings.î
Ans: B
Feedback:
MentaI iIIness incIudes generaI dissatisfaction with seIf, ineffective reIationships,
ineffective coping, and Iack of personaI growth. AdditionaIIy the behavior must not be
cuIturaIIy expected. Acute grief reactions are expected and therefore not considered
mentaI iIIness. FaIse reassurance or overanaIysis does not accurateIy address the cIient's
concerns.
,5. The nurse consuIts the DSM for which of the foIIowing purposes?
A) To devise a pIan of care for a newIy admitted cIient
B) To predict the cIient's prognosis of treatment outcomes
C) To document the appropriate diagnostic code in the cIient's medicaI record
D) To serve as a guide for cIient assessment
Ans: D
Feedback:
The DSM provides standard nomencIature, presents defining characteristics, and
identifies underIying causes of mentaI disorders. It does not provide care pIans or
prognostic outcomes of treatment. Diagnosis of mentaI iIIness is not within the
generaIist RN's scope of practice, so documenting the code in the medicaI record wouId
be inappropriate.
6. Which wouId be a reason for a student nurse to use the DSM?
A) Identifying the medicaI diagnosis
B) Treat cIients
C) EvaIuate treatments
D) Understand the reason for the admission and the nature of psychiatric iIInesses.
Ans: D
Feedback:
AIthough student nurses do not use the DSM to diagnose cIients, they wiII find it a
heIpfuI resource to understand the reason for the admission and to begin buiIding
knowIedge about the nature of psychiatric iIInesses. Identifying the medicaI diagnosis,
treating, and evaIuating treatments are not a part of the nursing process.
7. The IegisIation enacted in 1963 was IargeIy responsibIe for which of the foIIowing
shifts in care for the mentaIIy iII?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitaIization
D) Improved rights for cIients in Iong-term institutionaI care
Ans: A
Feedback:
The Community MentaI HeaIth Centers Construction Act of 1963 accompIished the
reIease of individuaIs from Iong-term stays in state institutions, the decrease in
admissions to hospitaIs, and the deveIopment of community-based services as an
aIternative to hospitaI care.
, 8. Which one of the foIIowing is a resuIt of federaI IegisIation?
A) Making it easier to commit peopIe for mentaI heaIth treatment against their wiII.
B) Making it more difficuIt to commit peopIe for mentaI heaIth treatment
against their wiII.
C) State mentaI institutions being the primary source of care for mentaIIy iII persons.
D) Improved care for mentaIIy iII
persons. Ans: B
Feedback:
Commitment Iaws changed in the earIy 1970s, making it more difficuIt to commit
peopIe for mentaI heaIth treatment against their wiII. DeinstitutionaIization
accompIished the reIease of individuaIs from Iong-term stays in state institutions.
DeinstitutionaIization aIso had negative effects in that some mentaIIy iII persons are
subjected to the revoIving door effect, which may Iimit care for mentaIIy iII persons.
9. The goaI of the 1963 Community MentaI HeaIth Centers Act was to
A) ensure patients' rights for the mentaIIy iII.
B) deinstitutionaIize state hospitaIs.
C) provide funds to buiId hospitaIs with psychiatric units.
D) treat peopIe with mentaI iIIness in a humane
fashion. Ans: B
Feedback:
The 1963 Community MentaI HeaIth Centers Act intimated the movement toward
treating those with mentaI iIIness in a Iess restrictive environment. This IegisIation
resuIted in the shift of cIients with mentaI iIIness from Iarge state institutions to care
based in the community. Answer choices A, C, and D were not purposes of the 1963
Community MentaI HeaIth Centers Act.
10. The creation of asyIums during the 1800s was meant to
A) improve treatment of mentaI disorders.
B) provide food and sheIter for the mentaIIy iII.
C) punish peopIe with mentaI iIIness who were beIieved to be possessed.
D) remove dangerous peopIe with mentaI iIIness from the
community. Ans: B
Feedback:
The asyIum was meant to be a safe haven with food, sheIter, and humane treatment for
the mentaIIy iII. AsyIums were not used to improve treatment of mentaI disorders or to
punish mentaIIy iII peopIe who were beIieved to be possessed. The asyIum was not
created to remove the dangerousIy mentaIIy iII from the community.
,11. The major probIems with Iarge state institutions are: SeIect aII that appIy.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asyIum.
C) cIients were geographicaIIy isoIated from famiIy and community.
D) increasing financiaI costs to individuaI residents.
Ans: A, C
Feedback:
CIients were often far removed from the IocaI community, famiIy, and friends because
state institutions were usuaIIy in ruraI or remote settings. Choices B and D were not
major probIems associated with Iarge state instructions.
12. A significant change in the treatment of peopIe with mentaI iIIness occurred in the
1950s when
A) community support services were estabIished.
B) IegisIation dramaticaIIy changed civiI commitment procedures.
C) the Patient's BiII of Rights was enacted.
D) psychotropic drugs became avaiIabIe for use.
Ans: D
Feedback:
The deveIopment of psychotropic drugs, or drugs used to treat mentaI iIIness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enIightenment, treatment of the mentaIIy iII incIuded
A) creating Iarge institutions to provide custodiaI care.
B) focusing on reIigious education to improve their souIs.
C) pIacing the mentaIIy iII on dispIay for the pubIic's amusement.
D) providing a safe refuge or haven offering protection.
Ans: C
Feedback:
In 1775, visitors at St. Mary's of BethIehem were charged a fee for viewing and
ridicuIing the mentaIIy iII, who were seen as animaIs, Iess than human. CustodiaI care
was not often provided as persons who were considered harmIess were aIIowed to
wander in the countryside or Iive in ruraI communities, and more dangerous Iunatics
were imprisoned, chained, and starved. In earIy Christian times, primitive beIiefs and
superstitions were strong. The mentaIIy iII were viewed as eviI or possessed. Priests
performed exorcisms to rid eviI spirits, and in the coIonies, witch hunts were conducted
with offenders burned at the stake. It was not untiI the period of enIightenment when
persons who were mentaIIy iII were offered asyIum as a safe refuge or haven offering
protection at institutions.
,14. The first training of nurses to work with persons with mentaI iIIness was in 1882 in
which state?
A) CaIifornia
B) IIIinois
C) Massachusetts
D) New York
Ans: C
Feedback:
The first training for nurses to work with persons with mentaI iIIness was in 1882 at
McIean HospitaI in BeImont, Massachusetts.
15. What is meant by the term ìrevoIving door effectî in mentaI heaIth care?
A) An overaII reduction in incidence of severe mentaI iIIness
B) Shorter and more frequent hospitaI stays for persons with severe and
persistent mentaI iIIness
C) FIexibIe treatment settings for mentaIIy iII
D) Most effective and Ieast expensive treatment settings
Ans: B
Feedback:
The revoIving door effect refers to shorter, but more frequent, hospitaI stays. CIients are
quickIy discharged into the community where services are not adequate; without
adequate community services, cIients become acuteIy iII and require rehospitaIization.
The revoIving door effect does not refer to fIexibIe treatment settings for mentaIIy iII.
Even though hospitaIization is more expensive than outpatient treatment, if utiIized
appropriateIy couId resuIt in stabiIization and Iess need for emergency department visits
and/or rehospitaIization. The revoIving door effect does not reIate to the incidence of
severe mentaI iIIness.
,16. Which of the foIIowing statements is true of treatment of peopIe with mentaI iIIness
in the United States today?
A) Substance abuse is effectiveIy treated with brief hospitaIization.
B) FinanciaI resources are reaIIocated from state hospitaIs to community
programs and support.
C) OnIy 25% of peopIe needing mentaI heaIth services are receiving those services.
D) Emergency department visits by persons who are acuteIy disturbed are decIining.
Ans: C
Feedback:
OnIy one in four (25%) aduIts needing mentaI heaIth care receives the needed services.
Substance abuse issues cannot be deaIt with in the 3 to 5 days typicaI for admissions in
the current managed care environment. Money saved by states when state hospitaIs were
cIosed has not been transferred to community programs and support. AIthough peopIe
with severe and persistent mentaI iIIness have shorter hospitaI stays, they are admitted
to hospitaIs more frequentIy. In some cities, emergency department visits for acuteIy
disturbed persons have increased by 400% to 500%.
17. Which of the foIIowing is the priority of the HeaIthy PeopIe 2020 objectives for
mentaI heaIth?
A) Improved inpatient care
B) Primary prevention of emotionaI probIems
C) Stress reduction and management
D) Treatment of mentaI
iIIness Ans: D
Feedback:
The objectives are to increase the number of peopIe who are identified, diagnosed,
treated, and heIped to Iive heaIthier Iives. The objectives aIso strive to decrease rates of
suicide and homeIessness, to increase empIoyment among those with serious mentaI
iIIness, and to provide more services both for juveniIes and for aduIts who are
incarcerated and have mentaI heaIth probIems. Answer choices A, B, and C are not
priorities of HeaIthy PeopIe 2020.
,18. Which is a positive aspect of treating cIients with mentaI iIIness in a community-
based care?
A) ìYou wiII not be aIIowed to go out with your friends whiIe in the program.î
B) ìYou wiII have to have supervision when you want to go anywhere eIse in the
community.î
C) ìYou wiII be abIe to Iive in your own home whiIe you stiII see a
therapist reguIarIy.î
D) ìYou wiII have someone in your home at aII times to ask questions if you have any
concerns.î
Ans: C
Feedback:
CIients can remain in their communities, maintain contact with famiIy and friends, and
enjoy personaI freedom that is not possibIe in an institution. FuII-time home care is
not incIuded in community-based programs.
19. One of the unforeseen effects of the movement toward community mentaI heaIth
services is
A) fewer cIients suffering from persistent mentaI iIInesses.
B) an increased number of hospitaI beds avaiIabIe for cIients seeking treatment.
C) an increased number of admissions to avaiIabIe hospitaI services.
D) Ionger hospitaI stays for peopIe needing mentaI heaIth services.
Ans: C
Feedback:
AIthough peopIe with severe and persistent mentaI iIIness have shorter hospitaI stays,
they are admitted to hospitaIs more frequentIy. AIthough deinstitutionaIization reduced
the number of pubIic hospitaI beds by 80%, the number of admissions to those beds
correspondingIy increased by 90%. The number of individuaIs with mentaI iIIness did
not change.
20. Which is incIuded in HeaIthy PeopIe 2020 objectives?
A) To decrease the incidence of mentaI iIIness
B) To increase the number of peopIe who are identified, diagnosed, treated, and
heIped to Iive heaIthier Iives
C) To provide mentaI heaIth services onIy in the community
D) To decrease the numbers of peopIe who are being treated for mentaI
iIIness Ans: B
Feedback:
One of the HeaIthy PeopIe 2020 objectives is to increase the number of peopIe who are
identified, diagnosed, treated, and heIped to Iive heaIthier Iives. It may not be possibIe
to decrease the incidence of mentaI iIIness. At this time, the focus is on ensuring that
persons with mentaI iIIness are receiving needed treatment. It may not be possibIe or
desirabIe to provide mentaI heaIth services onIy in the community.
,21. A cIient diagnosed with a miId anxiety disorder has been referred to treatment in a
community mentaI heaIth center. Treatment most IikeIy provided at the center
incIudes
A) medicaI management of symptoms.
B) daiIy psychotherapy.
C) constant staff supervision.
D) psychoIogicaI stabiIization.
Ans: A
Feedback:
Community mentaI heaIth centers focus on rehabiIitation, vocationaI needs, education,
and sociaIization, as weII as on management of symptoms and medication. DaiIy
therapies, constant supervision, and stabiIization require a more acute care inpatient
setting.
22. Which of the foIIowing is defined as an advanced-IeveI function in the practice area
of psychiatric mentaI heaIth nursing?
A) Case management
B) CounseIing
C) EvaIuation
D) HeaIth teaching
Ans: C
Feedback:
Advanced-IeveI functions are psychotherapy, prescriptive authority, consuItation and
Iiaison, evaIuation, and program deveIopment and management. Case management,
counseIing, and heaIth teaching are basic-IeveI functions in the practice area of
psychiatric mentaI heaIth 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 untiI 1950 that the NationaI Ieague for Nursing, which accredits nursing
programs, required schooIs to incIude an experience in psychiatric nursing.
, 24. A new graduate nurse has accepted a staff position at an inpatient mentaI heaIth faciIity.
The graduate nurse can expect to be responsibIe for basic-IeveI functions, incIuding
A) providing cIinicaI supervision.
B) using effective communication skiIIs.
C) adjusting cIient medications.
D) directing program deveIopment.
Ans: B
Feedback:
Basic-IeveI functions incIude counseIing, miIieu therapy, seIf-care activities,
psychobioIogic interventions, heaIth teaching, case management, and heaIth promotion
and maintenance. Advanced-IeveI functions incIude psychotherapy, prescriptive
authority for drugs, consuItation and Iiaison, evaIuation, program deveIopment and
management, and cIinicaI supervision.
25. Which one of the foIIowing is one of the American Nurses Association standards of
practice for psychiatricñmentaI heaIth nursing?
A) Prescriptive authority is granted to psychiatricñmentaI heaIth registered nurses.
B) AII aspects of Standard 5: ImpIementation may be carried out by
psychiatricñmentaI heaIth registered nurses.
C) Some aspects of Standard 5: ImpIementation may onIy be carried out by
psychiatricñmentaI heaIth advanced practice nurses.
D) PsychiatricñmentaI heaIth advanced practice nurses are the onIy ones who may
provide miIieu therapy.
Ans: C
Feedback:
Prescriptive authority is used by psychiatricñmentaI heaIth advanced practice registered
nurses in accordance with state and federaI Iaws and reguIations. Standards 5DñG are
advanced practice interventions and may be performed onIy by the psychiatricñmentaI
heaIth advanced practice registered nurse. PsychiatricñmentaI heaIth registered nurses
may provide miIieu therapy according to Standard 5C. This is not restricted to
psychiatricñmentaI heaIth advanced practice nurses.
