Mental Health - Exam 1 – Evolve WITH 100% Acculate Solution

The mental health status of a particular client can best be assessed by considering which factor? A) The degree of conformity of the individual to society's norms B) The degree to which an individual is logical and rational C) Status placement on a continuum from health to illness D) Rate of demonstrated intellectual and emotional growth - ANSWERSANS: C. Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore, these disorders can be regarded as "diseases." Visualizing these disorders along the mental health continuum is helpful An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports what conclusion about this client? A) The client is demonstrating symptoms of bipolar disorder. B) The client is demonstrating socially deviant behavior. C) The client is engaging in egocentric behaviors. D) The client is not conforming with social norms. - ANSWERSANS: D. Behavior that deviates from socially accepted norms does not indicate a mental illness unless there is significant disturbance in mental functioning Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5? A) It is a medical psychiatric assessment system. B) It is a compendium of treatment modalities. C) It offers a complete list of nursing diagnoses. D) It suggests common interventions for mental disorders. - ANSWERSANS: A. The DSM-5 is a classification of mental disorders that includes descriptions and criteria of diagnoses. None of the other options are accurate descriptions A client tells the mental health nurse "I am terribly frightened! I hear whispering in my head that someone is going to kill me." Which criteria of mental health can the nurse assess as lacking? A) Self-control B) Rational thinking C) Learning and productivity D) Positive self-concept - ANSWERSANS: B. The ability to think rationally is lacking for this client. The client does not have an accurate picture of what is happening that is based on reliable cognitive thinking. The statement fails to meet the criteria for any of the other options What client assessment data demonstrates parity related to mental health care? A) The client is admitted for a 72-hour mental hygiene evaluation. B) Advance practice nurse can be certified as psychiatric nurse specialist. C) A client's mental health coverage is equal to his/her medical/surgical coverage. D) A client who has attempted suicide is hospitalized for a mental health evaluation. - ANSWERSANS: C. Parity refers to equivalence that requires insurers who provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. None of the other options are associated with mental health insurance coverage How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? A) Ask the client whether he views himself as being depressed. B) Identify the client's culture's view regarding suicide. C) Explain that suicide is often regarded as a desperate act. D) Assess the client for other examples of depressive behaviors. - ANSWERSANS: B. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. For example, traditional Japanese may consider suicide to be an act of honor Contrast that viewpoint with Western culture, where people who attempt or complete suicides are nearly always considered mentally ill. While the remaining options are appropriate interventions, they fail to address the possible cultural component of the client's behavior What term is used to identify the quantitative study of the distribution of mental disorders in human populations? A) Mortality. B) Prevalence. C) Epidemiology. D) Clinical epidemiology. - ANSWERSANS: C. Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental disorder at a given time. Clinical epidemiology deals with what happens to people with illnesses who are seen by providers of care. A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question? A) "Don't be afraid; it means I'm here to help, not hurt, you." B) "Psychiatric mental health nurses care for people with mental illnesses." C) "We have the specialized skills needed to care for those with mental illnesses." D) "The nurses who work in mental health facilities have that title." - ANSWERSANS: C. A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia. The nurse planning care for a mentally ill client bases interventions on which concept? A) Every client has a certain degree of resilience. B) It is a client right to be treated respectfully. C) Every client comes with experiences that contribute to their problem. D) There are universal fears that are shared by all mentally healthy individuals. - ANSWERSANS: A. Nurses are expected to evaluate clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged. Resilience is the ability and capacity for people to secure the resources they need to support their well-being. None of the remaining options describe concepts that are the foundation for the actual creation of individualized care plans Which severe mental illness is recognized across cultures? (Select all that apply). A) Antisocial disorder B) Schizophrenia C) Anorexia nervosa D) Social phobia E) Bipolar disorder F) Borderline personality disorder - ANSWERSANS: B, E. Worldwide studies indicate that both schizophrenia and bipolar disorder are recognized cross-culturally A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care? A) Justifying the use of certain psychotropic medication. B) Providing data essential for insurance reimbursement. C) Establishing a framework for selecting appropriate interventions. D) Completing the medical diagnostic statement. - ANSWERSANS: C. Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing. While the nursing diagnosis may contribute to the other options, none describe the purpose of the nursing diagnosis According to current information what factor is associated with the most disabling mental disorders? A) Biological influences B) Psychological trauma C) Learned ways of behaving D) Faulty patterns of early nurturance - ANSWERSANS: A. The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders. Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? A) Experimental. B) Descriptive. C) Clinical. D) Analytic - ANSWERSANS: C. Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms. None of the other options accurately identify the field that is associated with clinical practice According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? (Select all that apply). A) I've been really anxious for at least 2 years now. B) My anxiety has to be genetic; my mom was a terrible worrier too. C) My marriage is in trouble because I'm always so irritable. D) I've had a good physical and my health care provider says I'm in good health. E) Its hard falling asleep and even harder staying asleep; I'm restless all night. - ANSWERSANS: A, C, D, E. The DSM-V criteria for generalized anxiety disorder include excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months; sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) and irritability; the anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; the disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment? A) "By becoming active in politics leading to a potential political career." B) "By educating the public on the effects that stigmatizing has on mental health clients." C) "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." D) "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions." - ANSWERSANS: B. Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes. A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? A) "You will participate in unit activities and groups daily." B) "You will be given a schedule daily of the groups we would like you to attend." C) "You will attend a psychotherapy group that I lead that will help you care for yourself." D) "You will see your provider daily in a one-to-one session." - ANSWERSANS: C. Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit. Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? A) "My mother made decisions about my husband's funeral when I just couldn't do that." B) "Losing my job was hard but my skills will help me get another one." C) "In spite of all the treatment, I know I'll never be really healthy." D) "My kids, happiness is worth any sacrifice I have to make." - ANSWERSANS: B. Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? A) "Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." B) "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." C) "I'd like you tell me more about your depression and your suicide attempt?" D) "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here." - ANSWERSANS: A. By letting the provider know that the patient does not want the treatment the provider is prescribing, you have advocated for the patient and her right to make decisions regarding her treatment. The other selections do not describe patient advocacy since they do not represent actions by the nurse that the patient is incapable of on their own. In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A) Knowledge of both national and local political activism B) The ability to cross service systems C) An awareness of own cultural and personal values D) Creative problem-solving and intervention skills - ANSWERSANS: D. Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team Which situation demonstrates the nurse functioning in the role of advocate? A) Providing one-to-one supervision for a client on suicide precautions B) Co-leading a medication education group for clients and families C) Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation D) Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days - ANSWERSANS: D. In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues. A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? A) "We will help you make decisions that will keep you safe." B) "I am going to help you shower, so you will not smell so bad." C) "Your pocket knife and nail clippers will be kept in the nurses' station." D) "You will be having a number of tests to help us learn about your condition." - ANSWERSANS: B. Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights. The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A) Opportunity to act out fears and frustrations B) Providing a safe place to practice coping skills C) Meeting their physical as well as emotional needs D) Encouraging group communication about existing problems - ANSWERSANS: B. A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A) Visiting a homeless shelter to provide mental health screenings for its clients B) Discussing the need for proper nutrition with a depressed new mother C) Providing stress reduction seminars at the local senior center D) Visiting the home of a client currently displaying manic behavior - ANSWERSANS: C. Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? A) Fostering research B) Maintaining a therapeutic milieu C) Providing sympathetic listening D) Providing constructive negative feedback - ANSWERSANS: B. Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu What is the primary advantage of using a case manager when considering the planning and implementation of client care? A) Increases collaborative practice. B) Enhances resource management. C) Increases client satisfaction with care. D) Promotes evidence-based psychiatric nursing. - ANSWERSANS: B. Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? A) Nurses B) Social workers C) Clinical psychologists D) Chemical dependency counselors - ANSWERSANS: A. Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients. When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A) The patients who are convicted criminals sentenced to home confinement. B) Care is provided to clients in unconventional settings. C) Care is provided by a preferred provider for a large HMO. D) The patients are provided for by a clinical specialist with the visiting nurse service. - ANSWERSANS: B. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories A therapeutic inpatient milieu will include which characteristic? A) It provides for the client's safety and comfort. B) Voluntarily admitted clients are generally allowed additional privileges. C) Rules and behavioral limits are flexibly enforced. D) Staff provide frequent and ongoing negative feedback to clients. - ANSWERSANS: A. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu Which criterion must be met to refer a client to a partial hospitalization program? A) The client is hospitalized at night in an inpatient setting. B) The client must be able to provide his or her own transportation daily. C) The client is able to return home each day. D) The clients are all recovering from an addiction. - ANSWERSANS: C. Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs. Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? A) All rights remain intact. B) Only rights that do not involve decision making remain intact. C) The right to refuse treatment is no longer guaranteed. D) All rights are temporarily suspended. - ANSWERSANS: A. The hospitalized client is not a convicted criminal thus all civil rights remain What function is shared by advanced practice and general practice psychiatric nurses? A) Prescriptive authority B) Admitting privileges C) Offers consultation services D) Membership on a multidisciplinary team - ANSWERSANS: D. Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A) Private insurance B) Medicare C) Medicaid D) Private pay - ANSWERSANS: A. Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services. It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A) Refusal of treatment. B) To send and receive mail. C) To seek legal counsel. D) To access all personal possessions. - ANSWERSANS: D. A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients When considering mental illness, recovery is best described to a client by which statement? A) Working, living, and participating in the community B) Never having to visit a mental health provider again C) Being able to understand the nature of the diagnosed illness D) A period of time when signs and symptoms are being managed - ANSWERSANS: A. ecovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.' The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A) A client and family members attend counseling sessions together at a neighborhood clinic B) Implementation of a more flexible work schedule for staff C) Improved reimbursement for services provided in the community D) A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. - ANSWERSANS: C. A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A) Break-away closet bars to prevent hanging B) Bedroom and dining areas with locked windows to prevent jumping C) Double-locked doors to prevent escaping from the unit D) Platform beds to prevent crush injuries - ANSWERSANS: A. Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging' Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A) A depressed patient with a suicidal plan B) A patient being discharged from an inpatient alcohol rehabilitation unit C) A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs D) Jeff, who has mild depression symptoms and is starting outpatient therapy - ANSWERSANS: B. PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP. "Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A) A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B) A 30-year-old accountant who has developed symptoms of depression C) A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road A73 D) A 76-year-old retired librarian who is experiencing memory loss and some confusion at times - ANSWERSANS: C. Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? A) "Where can I find information on the concept of Yin-Yang?" B) "How do I go about arranging for a Chinese translator?" C) "What can I do to provide ethnic foods that are still low in fat?" D) "How can I explain why we can't provide for his request for acupuncture?" - ANSWERSANS: C. Cultural desire is a genuine interest in the patient's unique perspective; it enables nurses to provide considerate, flexible, and respectful care to patients of all cultures. Attempting to incorporate ethnic foods into the client's prescribed diet demonstrates all these characteristics. None of the other options are focused on providing such care When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects which cultural concept? A) Supernatural causes B) Negative forces C) Inheritance D) Yin-Yang - ANSWERSANS: D. Many Eastern cultures explain illness as a function of imbalance such as Yin-Yang. None of the other options are widely reflected in the Chinese culture Which idea held by the nurse would best promote the provision of culturally competent care? A) Western biomedicine is one of several established healing systems. B) Some individuals will profit from use of both Western and folk healing practices. C) Use of cultural translators will provide valuable information into health-seeking behaviors. D) Need for spiritual healing is a concept that crosses cultural boundaries. - ANSWERSANS: A. A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? A) "Is there someone in your community who usually cures your illness?" B) "What usually helps people who have the same type of illness you have?" C) "What questions would you like to ask about your condition?" D) "What sorts of stress are you presently experiencing?" - ANSWERSANS: B. Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client. No other option focuses on this information The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question? A) "What do you think is making you ill?" B) "When did you first feel ill?" C) "How can I help you get better?" D) "Did you do something to cause the illness?" - ANSWERSANS: A. Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. While appropriate assessment questions, none of the remaining options are as well suited to gather culturally influenced information. What tem is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices?