TEST BANK
Psychiatric and Mental Health Nursing for Canadian Practice
Diane Kunyk, Cindy Peternelj-Taylor, and Wendy Austin
5th Edition
,Table of Contents
Chapter 1, Psychiatric and Mental Health Nursing: From Past to Present 1
Chapter 2, Mental Health, Mental Disorder, Recovery, and Wellbeing 13
Chapter 3, Identity, Inclusion, and Society 26
Chapter 4, The Context of Mental Health Care: Cultural, Socioeconomic, and Geographic 39
Chapter 5, The Continuum of Canadian Mental Health Care 53
Chapter 6, Contemporary Psychiatric and Mental Health Nursing Practice 66
Chapter 7, Communication and the Therapeutic Relationship 76
Chapter 8, Legal and Ethical Aspects of Practice 90
Chapter 9, Theoretic Basis of Practice 102
Chapter 10, Biologic Basis of Practice 116
Chapter 11, The Assessment Process 128
Chapter 12, Care Planning and Implementation in Psychiatric and Mental Health Nursing 140
Chapter 13, Psychopharmacology and Other Biologic Treatments 152
Chapter 14, Cognitive–Behavioural Interventions 166
Chapter 15, Interventions With Groups 178
Chapter 16, Family Assessment and Interventions 190
Chapter 17, Psychological Health and Safety in the Workplace 202
Chapter 18, Stress, Trauma, Crisis, and Disaster 215
Chapter 19, Anger, Aggression, and Violence 227
Chapter 20, Self-Harm and Suicidal Behaviours 239
Chapter 21, Schizophrenia Spectrum and Other Psychotic Disorders 252
Chapter 22, Depressive, Bipolar, and Related Disorders 278
Chapter 23, Anxiety, Obsessive– Compulsive, and Related Disorders 290
Chapter 24, Somatic Symptom and Related Disorders 302
Chapter 25, Eating Disorders 315
Chapter 26, Substance-Related and Addictive Disorders 328
Chapter 27, Personality Disorders and Disruptive, Impulse Control, and Conduct
Disorders 339
Chapter 28, Sleep–Wake Disorders 352
Chapter 29, Mental Health Promotion and Assessment: Children and Adolescents 365
Chapter 30, Psychiatric Disorders in Children and Adolescents 378
Chapter 31, Mental Health of Older Adults: Promotion and Assessment 390
Chapter 32, Neurocognitive Disorders: Delirium and Dementia 401
Chapter 33, Care of Persons With Concurrent Substance-Related, Addictive, and Other
Mental Disorders 414
Chapter 34, Care of Persons With Experiences of Abuse 427
Chapter 35, Care of Persons Under Forensic Purview 439
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
Chapter 1, Psychiatric and Mental Health Nursing: From Past to Present
1. During the 1800s, moral treatment became the influential idea that led to the belief that which
was the cure for mental illness?
A) arrest and confinement
B) early psychotherapy
C) humane treatment
D) the use of chains
ANS: C
Feedback:
During the 1800s, Pinel claimed that the cure for mental illness was humane treatment,
defined as kindness, compassion, and a pleasant environment. Pinel opposed earlier strategies
such as confinement and chains. Psychotherapy had not yet been introduced at this time.
PTS: 1 REF: Header: A Revolutionary Idea: Humane Treatment | Page: 3
OBJ: 1, 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
2. Who was the psychiatrist who suggested the term “mental hygiene”?
A) Clarence Hincks
B) Sigmund Freud
C) Philippe Pinel
D) Adolf Meyer
ANS: D
Feedback:
The psychiatrist who suggested the term “mental hygiene” was Adolf Meyer. He chose the
term because it was consistent with his view of mental health as the expression of physiologic
and emotional “cleanliness.”
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3, 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
3. Before the 19th century, seriously mentally ill clients with severely disturbing behaviour were
usually cared for by:
A) family members at home.
B) spiritual healers in asylums.
C) laypersons in hospitals.
D) staff in prisons and poorhouses.
ANS: D
Feedback:
Until the 19th century, mentally ill people were kept mostly at home, cared for by their
families. Only the most seriously afflicted people whose behaviour was severely disturbing or
dangerous to themselves, their families, or other citizens were locked up often in prisons or a
separate wing of a local poorhouse.
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1|Page
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
PTS: 1 REF: Header: Introduction | Page: 2 OBJ: 1, 3, 5
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. Which variable of communities had the most influence on the early forms of institutional
ways of caring for the mentally ill people?
A) quality of housing and number of professionals
B) social stability and availability of resources
C) political climate and public policy
D) legal structure and role of nurses
ANS: B
Feedback:
History reflects that, generally, social fears and tolerance for what is deemed as “deviant
behaviour” are related to social stability and availability of resources. In periods of relative
social stability, individuals with mental disorders often have a better chance to live safely
within their communities. Professionalism and nursing were not well-developed at this early
stage of care. Public policy was not usually formulated explicitly.
PTS: 1 REF: Header: Early Forms of Institutional Care | Page: 2
OBJ: 1, 3, 5
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
5. Which factor has been historically related to increased intolerance and ill treatment of people
with mental disorders?
A) social change and instability
B) increased family size and mobility
C) emphasis on religious beliefs
D) increased number of asylums treating mentally ill
ANS: A
Feedback:
History reflects that, generally, in periods of relative social stability, there are fewer fears and
more tolerances for deviant behaviour, and it is easier for individuals with mental disorders to
live safely within their communities. During periods of rapid social change and instability,
there are more general anxieties and fears and, subsequently, more intolerance and ill
treatment of people with mental disorders.
PTS: 1 REF: Header: Early Forms of Institutional Care | Page: 2
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
6. Which effects of industrialization and urbanization contributed positively to the humane
treatment of mentally afflicted treatment? Select all that apply.
A) the growing number of poor and deviant people who were not able to sustain
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2|Page
,______________________________________________________________________________________________
Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
themselves
B) more general anxieties during a period of rapid social change and instability
C) moral, pedagogical treatment that would help restore innate capacity for self-
control
D) the Enlightenment, which changed medical and social ideas about mental illness
E) recognition of mental illness by the medical community
ANS: A, C, D, E
Feedback:
As industrialization and urbanization increased during the 18th and 19th centuries, the rising
middle class became concerned about a growing number of poor and deviant people who were
not able to work and sustain themselves. At the same time, medical and social ideas about
mental illness changed under the influence of ideas associated with the Enlightenment, and
medical concerns with the treatment of mental illness increased. The insight gained ground
that, rather than being afflicted by loss of reason or evil spirits, people with mental disorders
were rational beings with a human nature common to all human beings and should be treated
humanely. As a result, the idea of a moral pedagogical treatment emerged that allegedly
would help the suffering restore their innate capacity for self-control. During periods of rapid
social change and instability, there tended to be more general anxieties about people with
mental disorders. This actually led to increased intolerance and maltreatment of persons with
mental disorders rather than turning to human treatment as the primary approach.
PTS: 1 REF: Header: Early Forms of Institutional Care
OBJ: 1, 3, 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Selection
7. Which was a primary reform accomplished by Dorothea Lynde Dix?
A) establishment of “commitment” laws in state legislatures
B) introducing compassion to the care of mentally ill clients
C) use of music to treat mentally ill clients
D) use of exercise therapy to treat mentally ill clients
ANS: B
Feedback:
Dix was outraged at the treatment of mentally ill inmates and advocated for measures that
reflected compassionate treatment. She also was instrumental in the establishment of mental
hospitals in England, Canada, and Europe in the 19th century. Exercise therapy and music
therapy, however, were not yet in existence at this time. She did not contribute to
“commitment” laws.
PTS: 1 REF: Header: A Social Reformer: Dorothea Lynde Dix | Page: 4
OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Caring BLM: Cognitive Level: Understand
NOT: Multiple Choice
8. Which province in Canada was first to open a mental institution in 1835?
A) Ontario
B) Nova Scotia
C) Quebec
D) New Brunswick
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
ANS: D
Feedback:
In Canada, New Brunswick was the first of the old British North American provinces to open
a mental institution. As the population increased in the early 1800s, so did the number of
people with mental disorders who were in need of publicly provided care. In that same year,
the provincial government approved the conversion of a building in Saint John, formerly a
hospital for cholera clients, to a Provincial Lunatic Asylum until a new facility could be built.
By 1848, this new facility was ready for use. During the latter half of the 19th century and
beginning of the 20th century, each Canadian province established a publicly funded asylum.
PTS: 1
REF: Header: Canadian trends in the 19th and Early 20th Centuries: An Era of Asylum Building |
Page: 5 OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
9. When did involuntary confinement and institutional care of mentally ill people begin to be the
foremost treatment modality?
A) the 17th and 18th centuries
B) end of the 20th century
C) beginning of the 19th century
D) last half of the 19th century
ANS: D
Feedback:
During the latter half of the 19th century and beginning of the 20th century, each Canadian
province established an asylum. This form of involuntary confinement and institutional care
became the most dominant treatment modality for mentally ill people, replacing older forms
of familial care and Poor Law–based approaches.
PTS: 1
REF: Header: Canadian Trends in the 19th and Early 20th Centuries: An Era of Asylum Building |
Page: 5 OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
10. Which was developed in 1909 by the National Mental Health Committee for Mental Hygiene?
A) mental health nurse training
B) stress management clinics
C) prison clinics
D) hydrotherapy centres
ANS: C
Feedback:
In 1909, the National Mental Health Committee formed by Clifford Beers was responsible for
the development of child guidance clinics, prison clinics, and industrial mental health
approaches.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
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4|Page
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
11. What superintendent of various Ontario psychiatric hospitals was one of the first healthcare
providers who reformed models of care to improve treatment approaches in Ontario?
A) Adolf Meyer
B) Clifford Beers
C) Charles K. Clarke
D) Charles A. Barager
ANS: C
Feedback:
Psychiatrist Charles K. Clarke (1857–1924) was an influential mental healthcare reformer in
Ontario. He is one of the first healthcare providers who reformed models of care to improve
treatment approaches in Ontario. None of the other listed individuals served as
superintendents of Ontario psychiatric hospitals.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
12. When did psychiatric nursing education in the general hospital training commence in eastern
Canada?
A) 1860s
B) 1900s
C) 1930s
D) 1950s
ANS: C
Feedback:
General hospital–based schools of nursing, especially in eastern Canada, began to integrate
psychiatric nursing into their curriculum. In Ontario, for example, under the influence of the
mental hygiene movement, general hospital nurse training schools had included care of
mentally ill clients into their training as early as the 1930s. Prior to the 1930s, psychiatry
education had not been integrated into general nursing education. Around 1950, psychiatric
attendants in the province of Saskatchewan took the lead in obtaining political support for a
different pattern of nurse education that would lead to a separate Psychiatric Nurses Act and
related training acts independent of provincial registered nurse practice acts.
PTS: 1
REF: Header: Continued Evolution of Psychiatric and Mental Health Nursing | Page: 10
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
13. Which level of legislation supported confinement of mentally ill clients in Canada in the late
19th century?
A) provincial
B) national
C) municipal
D) state
ANS: A
Feedback:
In the late 19th century, all provinces passed legislation, most often called an Insanity Act, to
provide a legal basis to publicly supported confinement of individuals with mental disorders.
Historically, there has been no formal national or municipal strategy providing a legal basis to
publicly support the confinement of individuals with mental disorders. Canada is made up of
provinces and territories only.
PTS: 1 REF: Header: The Legal Basis for Mental Health Care | Page: 6
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
14. In the earliest institutions that cared for members of the community with mental disorders,
what was the most common experience of clients?
A) intense focus on treatment
B) safer alternative to living in the community
C) emphasis on rehabilitation
D) deplorable living conditions
ANS: D
Feedback:
Despite the good intentions of early reformers, the approach inside the institution was one of
custodial care and practical management, and treatment rarely occurred. Although a medical
superintendent usually directed an institution, overcrowded wards and few resources created
rowdy, dangerous, and unbearable situations. Once admitted, many clients were cut off from
society, in part due to remote settings. In these institutions during this time, treatment rarely
occurred. Living in the community may have afforded the clients somewhat better living
conditions in comparison to what was offered in the overcrowded institutions. Management of
behaviour and acute issues related to mental disorders became more common practice than an
emphasis on rehabilitation. Use of restraints or isolation continued to be common practices.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand NOT: Multiple Choice
15. Which psychiatrist had a strong belief in the ability of female compassion and established a
new diploma in Alberta for mental health nurses?
A) Adolf Meyer
B) Charles K. Clarke
C) Clarence Hincks
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
D) Charles A. Barager
ANS: D
Feedback:
Barager introduced a nurse training school as superintendent at the Brandon Asylum. He had a
strong belief in the ability of female compassion: “The nursing of mental clients requires
women of finer personality, of wider sympathies, greater self-control and higher intelligence
than even the nursing of those who are physically ill.” Meyer, Clarke, and Hincks did not
express this specific belief.
PTS: 1 REF: Header: Regional Influences | Page: 7 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Remember NOT: Multiple Choice
16. Which new type of therapy instituted in the 1940s made skilled nursing essential?
A) cognitive–behavioural therapy
B) electroshock therapy
C) pharmacologic therapy
D) recreational therapy
ANS: B
Feedback:
Skilled nursing was essential for new therapies, such as electroshock and insulin coma therapy
introduced in the 1940s. CBT and medications were not the incentives for skilled nursing
care.
PTS: 1 REF: Header: Regional Influences | Page: 7 OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
TOP: Chapter: 1 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Remember NOT: Multiple Choice
17. Psychosocial theories of mental disorders, which were proposed in the early 1900s, believe
that what factor contributed to disorders?
A) biologic defects
B) dysfunctional family systems
C) environmental and social deprivation
D) unconscious motivators for behaviour
ANS: C
Feedback:
In the early 1900s, the psychosocial theory proposed that mental disorders resulted from
environmental and social deprivation. Moral management in an asylum was the treatment of
choice. Opposition to this theory came from groups who believed in biologic origins.
PTS: 1 REF: Header: Evolution of Scientific Thought | Page: 8
OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember
NOT: Multiple Choice
18. What was the major focus of “psychiatric pluralism,” introduced by Adolf Meyer?
A) integration of the human biologic functions with the environment
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7|Page
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
B) psychoanalysis integrated with daily activities of living
C) biologic science integrated with bloodletting treatments
D) determining the drives behind the person’s behaviours
ANS: A
Feedback:
In the early 1900s, Adolf Meyer’s psychiatric pluralism was an integration of the human
biologic functions with the environment. Bloodletting was a much earlier treatment.
Motivation and psychoanalysis emerged as later focuses.
PTS: 1 REF: Header: Meyer and Psychiatric Pluralism | Page: 8
OBJ: 1,4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
19. Which factor was believed to lead to the development of a psychosis or neurosis in an
individual according to the theory proposed by Sigmund Freud?
A) a chemical imbalance in the brain
B) social deprivation occurred late in adolescence
C) an interference in normal development
D) development of an oedipal relationship
ANS: C
Feedback:
According to the theory proposed by Sigmund Freud, a psychosis or neurosis would develop
in an individual if there were interference in normal development, particularly early in
childhood. Oedipal relationships were seen as results of neurosis, not causes. Freud prioritized
the events of childhood. He did not focus on chemical imbalances.
PTS: 1 REF: Header: Freud and Psychoanalytic Theory | Page: 8
OBJ: 1,4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
20. Who promoted university-based scientific research to influence change and find better
treatment and support for mentally ill clients?
A) Charles K. Clarke
B) Clifford Beers
C) Adolf Meyer
D) Clarence Hincks
ANS: A
Feedback:
Ontario psychiatrist Charles K. Clarke (1857–1924) had an influential role in bringing about
new models of care that would influence change of this situation. To find better treatments
and approaches, he sought to start an urban centre for the treatment of acute mental illness
under the best possible conditions and supported by university-based scientific research.
Meyer, Beers, and Hincks did not advocate for university-based research.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
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Psychiatric and Mental Health Nursing for Canadian Practice
Diane Kunyk, Cindy Peternelj-Taylor, and Wendy Austin
5th Edition
,Table of Contents
Chapter 1, Psychiatric and Mental Health Nursing: From Past to Present 1
Chapter 2, Mental Health, Mental Disorder, Recovery, and Wellbeing 13
Chapter 3, Identity, Inclusion, and Society 26
Chapter 4, The Context of Mental Health Care: Cultural, Socioeconomic, and Geographic 39
Chapter 5, The Continuum of Canadian Mental Health Care 53
Chapter 6, Contemporary Psychiatric and Mental Health Nursing Practice 66
Chapter 7, Communication and the Therapeutic Relationship 76
Chapter 8, Legal and Ethical Aspects of Practice 90
Chapter 9, Theoretic Basis of Practice 102
Chapter 10, Biologic Basis of Practice 116
Chapter 11, The Assessment Process 128
Chapter 12, Care Planning and Implementation in Psychiatric and Mental Health Nursing 140
Chapter 13, Psychopharmacology and Other Biologic Treatments 152
Chapter 14, Cognitive–Behavioural Interventions 166
Chapter 15, Interventions With Groups 178
Chapter 16, Family Assessment and Interventions 190
Chapter 17, Psychological Health and Safety in the Workplace 202
Chapter 18, Stress, Trauma, Crisis, and Disaster 215
Chapter 19, Anger, Aggression, and Violence 227
Chapter 20, Self-Harm and Suicidal Behaviours 239
Chapter 21, Schizophrenia Spectrum and Other Psychotic Disorders 252
Chapter 22, Depressive, Bipolar, and Related Disorders 278
Chapter 23, Anxiety, Obsessive– Compulsive, and Related Disorders 290
Chapter 24, Somatic Symptom and Related Disorders 302
Chapter 25, Eating Disorders 315
Chapter 26, Substance-Related and Addictive Disorders 328
Chapter 27, Personality Disorders and Disruptive, Impulse Control, and Conduct
Disorders 339
Chapter 28, Sleep–Wake Disorders 352
Chapter 29, Mental Health Promotion and Assessment: Children and Adolescents 365
Chapter 30, Psychiatric Disorders in Children and Adolescents 378
Chapter 31, Mental Health of Older Adults: Promotion and Assessment 390
Chapter 32, Neurocognitive Disorders: Delirium and Dementia 401
Chapter 33, Care of Persons With Concurrent Substance-Related, Addictive, and Other
Mental Disorders 414
Chapter 34, Care of Persons With Experiences of Abuse 427
Chapter 35, Care of Persons Under Forensic Purview 439
,______________________________________________________________________________________________
Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
Chapter 1, Psychiatric and Mental Health Nursing: From Past to Present
1. During the 1800s, moral treatment became the influential idea that led to the belief that which
was the cure for mental illness?
A) arrest and confinement
B) early psychotherapy
C) humane treatment
D) the use of chains
ANS: C
Feedback:
During the 1800s, Pinel claimed that the cure for mental illness was humane treatment,
defined as kindness, compassion, and a pleasant environment. Pinel opposed earlier strategies
such as confinement and chains. Psychotherapy had not yet been introduced at this time.
PTS: 1 REF: Header: A Revolutionary Idea: Humane Treatment | Page: 3
OBJ: 1, 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
2. Who was the psychiatrist who suggested the term “mental hygiene”?
A) Clarence Hincks
B) Sigmund Freud
C) Philippe Pinel
D) Adolf Meyer
ANS: D
Feedback:
The psychiatrist who suggested the term “mental hygiene” was Adolf Meyer. He chose the
term because it was consistent with his view of mental health as the expression of physiologic
and emotional “cleanliness.”
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3, 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
3. Before the 19th century, seriously mentally ill clients with severely disturbing behaviour were
usually cared for by:
A) family members at home.
B) spiritual healers in asylums.
C) laypersons in hospitals.
D) staff in prisons and poorhouses.
ANS: D
Feedback:
Until the 19th century, mentally ill people were kept mostly at home, cared for by their
families. Only the most seriously afflicted people whose behaviour was severely disturbing or
dangerous to themselves, their families, or other citizens were locked up often in prisons or a
separate wing of a local poorhouse.
______________________________________________________________________________________________
1|Page
,______________________________________________________________________________________________
Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
PTS: 1 REF: Header: Introduction | Page: 2 OBJ: 1, 3, 5
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand NOT: Multiple Choice
4. Which variable of communities had the most influence on the early forms of institutional
ways of caring for the mentally ill people?
A) quality of housing and number of professionals
B) social stability and availability of resources
C) political climate and public policy
D) legal structure and role of nurses
ANS: B
Feedback:
History reflects that, generally, social fears and tolerance for what is deemed as “deviant
behaviour” are related to social stability and availability of resources. In periods of relative
social stability, individuals with mental disorders often have a better chance to live safely
within their communities. Professionalism and nursing were not well-developed at this early
stage of care. Public policy was not usually formulated explicitly.
PTS: 1 REF: Header: Early Forms of Institutional Care | Page: 2
OBJ: 1, 3, 5
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
5. Which factor has been historically related to increased intolerance and ill treatment of people
with mental disorders?
A) social change and instability
B) increased family size and mobility
C) emphasis on religious beliefs
D) increased number of asylums treating mentally ill
ANS: A
Feedback:
History reflects that, generally, in periods of relative social stability, there are fewer fears and
more tolerances for deviant behaviour, and it is easier for individuals with mental disorders to
live safely within their communities. During periods of rapid social change and instability,
there are more general anxieties and fears and, subsequently, more intolerance and ill
treatment of people with mental disorders.
PTS: 1 REF: Header: Early Forms of Institutional Care | Page: 2
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
6. Which effects of industrialization and urbanization contributed positively to the humane
treatment of mentally afflicted treatment? Select all that apply.
A) the growing number of poor and deviant people who were not able to sustain
______________________________________________________________________________________________
2|Page
,______________________________________________________________________________________________
Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
themselves
B) more general anxieties during a period of rapid social change and instability
C) moral, pedagogical treatment that would help restore innate capacity for self-
control
D) the Enlightenment, which changed medical and social ideas about mental illness
E) recognition of mental illness by the medical community
ANS: A, C, D, E
Feedback:
As industrialization and urbanization increased during the 18th and 19th centuries, the rising
middle class became concerned about a growing number of poor and deviant people who were
not able to work and sustain themselves. At the same time, medical and social ideas about
mental illness changed under the influence of ideas associated with the Enlightenment, and
medical concerns with the treatment of mental illness increased. The insight gained ground
that, rather than being afflicted by loss of reason or evil spirits, people with mental disorders
were rational beings with a human nature common to all human beings and should be treated
humanely. As a result, the idea of a moral pedagogical treatment emerged that allegedly
would help the suffering restore their innate capacity for self-control. During periods of rapid
social change and instability, there tended to be more general anxieties about people with
mental disorders. This actually led to increased intolerance and maltreatment of persons with
mental disorders rather than turning to human treatment as the primary approach.
PTS: 1 REF: Header: Early Forms of Institutional Care
OBJ: 1, 3, 4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Selection
7. Which was a primary reform accomplished by Dorothea Lynde Dix?
A) establishment of “commitment” laws in state legislatures
B) introducing compassion to the care of mentally ill clients
C) use of music to treat mentally ill clients
D) use of exercise therapy to treat mentally ill clients
ANS: B
Feedback:
Dix was outraged at the treatment of mentally ill inmates and advocated for measures that
reflected compassionate treatment. She also was instrumental in the establishment of mental
hospitals in England, Canada, and Europe in the 19th century. Exercise therapy and music
therapy, however, were not yet in existence at this time. She did not contribute to
“commitment” laws.
PTS: 1 REF: Header: A Social Reformer: Dorothea Lynde Dix | Page: 4
OBJ: 3 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Caring BLM: Cognitive Level: Understand
NOT: Multiple Choice
8. Which province in Canada was first to open a mental institution in 1835?
A) Ontario
B) Nova Scotia
C) Quebec
D) New Brunswick
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,______________________________________________________________________________________________
Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
ANS: D
Feedback:
In Canada, New Brunswick was the first of the old British North American provinces to open
a mental institution. As the population increased in the early 1800s, so did the number of
people with mental disorders who were in need of publicly provided care. In that same year,
the provincial government approved the conversion of a building in Saint John, formerly a
hospital for cholera clients, to a Provincial Lunatic Asylum until a new facility could be built.
By 1848, this new facility was ready for use. During the latter half of the 19th century and
beginning of the 20th century, each Canadian province established a publicly funded asylum.
PTS: 1
REF: Header: Canadian trends in the 19th and Early 20th Centuries: An Era of Asylum Building |
Page: 5 OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
9. When did involuntary confinement and institutional care of mentally ill people begin to be the
foremost treatment modality?
A) the 17th and 18th centuries
B) end of the 20th century
C) beginning of the 19th century
D) last half of the 19th century
ANS: D
Feedback:
During the latter half of the 19th century and beginning of the 20th century, each Canadian
province established an asylum. This form of involuntary confinement and institutional care
became the most dominant treatment modality for mentally ill people, replacing older forms
of familial care and Poor Law–based approaches.
PTS: 1
REF: Header: Canadian Trends in the 19th and Early 20th Centuries: An Era of Asylum Building |
Page: 5 OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
10. Which was developed in 1909 by the National Mental Health Committee for Mental Hygiene?
A) mental health nurse training
B) stress management clinics
C) prison clinics
D) hydrotherapy centres
ANS: C
Feedback:
In 1909, the National Mental Health Committee formed by Clifford Beers was responsible for
the development of child guidance clinics, prison clinics, and industrial mental health
approaches.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
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OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
11. What superintendent of various Ontario psychiatric hospitals was one of the first healthcare
providers who reformed models of care to improve treatment approaches in Ontario?
A) Adolf Meyer
B) Clifford Beers
C) Charles K. Clarke
D) Charles A. Barager
ANS: C
Feedback:
Psychiatrist Charles K. Clarke (1857–1924) was an influential mental healthcare reformer in
Ontario. He is one of the first healthcare providers who reformed models of care to improve
treatment approaches in Ontario. None of the other listed individuals served as
superintendents of Ontario psychiatric hospitals.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
12. When did psychiatric nursing education in the general hospital training commence in eastern
Canada?
A) 1860s
B) 1900s
C) 1930s
D) 1950s
ANS: C
Feedback:
General hospital–based schools of nursing, especially in eastern Canada, began to integrate
psychiatric nursing into their curriculum. In Ontario, for example, under the influence of the
mental hygiene movement, general hospital nurse training schools had included care of
mentally ill clients into their training as early as the 1930s. Prior to the 1930s, psychiatry
education had not been integrated into general nursing education. Around 1950, psychiatric
attendants in the province of Saskatchewan took the lead in obtaining political support for a
different pattern of nurse education that would lead to a separate Psychiatric Nurses Act and
related training acts independent of provincial registered nurse practice acts.
PTS: 1
REF: Header: Continued Evolution of Psychiatric and Mental Health Nursing | Page: 10
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
13. Which level of legislation supported confinement of mentally ill clients in Canada in the late
19th century?
A) provincial
B) national
C) municipal
D) state
ANS: A
Feedback:
In the late 19th century, all provinces passed legislation, most often called an Insanity Act, to
provide a legal basis to publicly supported confinement of individuals with mental disorders.
Historically, there has been no formal national or municipal strategy providing a legal basis to
publicly support the confinement of individuals with mental disorders. Canada is made up of
provinces and territories only.
PTS: 1 REF: Header: The Legal Basis for Mental Health Care | Page: 6
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Remember NOT: Multiple Choice
14. In the earliest institutions that cared for members of the community with mental disorders,
what was the most common experience of clients?
A) intense focus on treatment
B) safer alternative to living in the community
C) emphasis on rehabilitation
D) deplorable living conditions
ANS: D
Feedback:
Despite the good intentions of early reformers, the approach inside the institution was one of
custodial care and practical management, and treatment rarely occurred. Although a medical
superintendent usually directed an institution, overcrowded wards and few resources created
rowdy, dangerous, and unbearable situations. Once admitted, many clients were cut off from
society, in part due to remote settings. In these institutions during this time, treatment rarely
occurred. Living in the community may have afforded the clients somewhat better living
conditions in comparison to what was offered in the overcrowded institutions. Management of
behaviour and acute issues related to mental disorders became more common practice than an
emphasis on rehabilitation. Use of restraints or isolation continued to be common practices.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Understand NOT: Multiple Choice
15. Which psychiatrist had a strong belief in the ability of female compassion and established a
new diploma in Alberta for mental health nurses?
A) Adolf Meyer
B) Charles K. Clarke
C) Clarence Hincks
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
D) Charles A. Barager
ANS: D
Feedback:
Barager introduced a nurse training school as superintendent at the Brandon Asylum. He had a
strong belief in the ability of female compassion: “The nursing of mental clients requires
women of finer personality, of wider sympathies, greater self-control and higher intelligence
than even the nursing of those who are physically ill.” Meyer, Clarke, and Hincks did not
express this specific belief.
PTS: 1 REF: Header: Regional Influences | Page: 7 OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter: 1 KEY: Integrated Process: Caring
BLM: Cognitive Level: Remember NOT: Multiple Choice
16. Which new type of therapy instituted in the 1940s made skilled nursing essential?
A) cognitive–behavioural therapy
B) electroshock therapy
C) pharmacologic therapy
D) recreational therapy
ANS: B
Feedback:
Skilled nursing was essential for new therapies, such as electroshock and insulin coma therapy
introduced in the 1940s. CBT and medications were not the incentives for skilled nursing
care.
PTS: 1 REF: Header: Regional Influences | Page: 7 OBJ: 1, 3
NAT: Client Needs: Safe and Effective Care Environment: Safety and Infection Control
TOP: Chapter: 1 KEY: Integrated Process: Teaching/Learning
BLM: Cognitive Level: Remember NOT: Multiple Choice
17. Psychosocial theories of mental disorders, which were proposed in the early 1900s, believe
that what factor contributed to disorders?
A) biologic defects
B) dysfunctional family systems
C) environmental and social deprivation
D) unconscious motivators for behaviour
ANS: C
Feedback:
In the early 1900s, the psychosocial theory proposed that mental disorders resulted from
environmental and social deprivation. Moral management in an asylum was the treatment of
choice. Opposition to this theory came from groups who believed in biologic origins.
PTS: 1 REF: Header: Evolution of Scientific Thought | Page: 8
OBJ: 1 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Remember
NOT: Multiple Choice
18. What was the major focus of “psychiatric pluralism,” introduced by Adolf Meyer?
A) integration of the human biologic functions with the environment
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Test Bank - Psychiatric & Mental Health Nursing for Canadian Practice, 5th Edition (Kunyk, 2023)
B) psychoanalysis integrated with daily activities of living
C) biologic science integrated with bloodletting treatments
D) determining the drives behind the person’s behaviours
ANS: A
Feedback:
In the early 1900s, Adolf Meyer’s psychiatric pluralism was an integration of the human
biologic functions with the environment. Bloodletting was a much earlier treatment.
Motivation and psychoanalysis emerged as later focuses.
PTS: 1 REF: Header: Meyer and Psychiatric Pluralism | Page: 8
OBJ: 1,4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
19. Which factor was believed to lead to the development of a psychosis or neurosis in an
individual according to the theory proposed by Sigmund Freud?
A) a chemical imbalance in the brain
B) social deprivation occurred late in adolescence
C) an interference in normal development
D) development of an oedipal relationship
ANS: C
Feedback:
According to the theory proposed by Sigmund Freud, a psychosis or neurosis would develop
in an individual if there were interference in normal development, particularly early in
childhood. Oedipal relationships were seen as results of neurosis, not causes. Freud prioritized
the events of childhood. He did not focus on chemical imbalances.
PTS: 1 REF: Header: Freud and Psychoanalytic Theory | Page: 8
OBJ: 1,4 NAT: Client Needs: Psychosocial Integrity TOP: Chapter: 1
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice
20. Who promoted university-based scientific research to influence change and find better
treatment and support for mentally ill clients?
A) Charles K. Clarke
B) Clifford Beers
C) Adolf Meyer
D) Clarence Hincks
ANS: A
Feedback:
Ontario psychiatrist Charles K. Clarke (1857–1924) had an influential role in bringing about
new models of care that would influence change of this situation. To find better treatments
and approaches, he sought to start an urban centre for the treatment of acute mental illness
under the best possible conditions and supported by university-based scientific research.
Meyer, Beers, and Hincks did not advocate for university-based research.
PTS: 1 REF: Header: Life Within Early Institutions | Page: 6
OBJ: 1, 3
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