Exam 1 - Practice Questions Flashcards Preview

N3526 Psychiatric and Mental Health Care > Exam 1 - Practice Questions > Flashcards

Flashcards in Exam 1 - Practice Questions Deck (50):
1

The primary impact that the development and use of psychotropic drugs had on nursing’s role in the care of clients with mental health disorders was:

A. the availability of mental health therapies as an outpatient service

B. the expansion of the role assumed by professionally trained nurses

C. nurses were needed to fill the gap created by a lack of medical personnel

D. more nurses were required to address the needs of the now treatable mental health clients.

C. nurses were needed to fill the gap created by a lack of medical personnel

 

With the influx of mental health clients who were now treatable, the role of the professional nurse was expanded to assist in meeting their needs for care management, treatment implementation, and evaluation of care in both inpatient and outpatient settings. While availability of outpatient mental health therapies increased with the introduction of psychotic medications, that development affected delivery of the services more directly than it did the role of the professional nurse in the care of psychiatric clients. Nursing is a health care profession that is unique and has never attempted to fill the role of the medical health care professional. While the expansion of services and the number of treatable clients increased with the development of psychotropic medications, the professional nurse’s role was affected by more than simply a need for increased numbers of nurses.

2

Which nursing activity demonstrates the role of a professional psychiatric nurse as identified by Hildegard Peplau?

A. Managing the milieu

B.Caring for the client’s physiological needs

C. Providing counseling

D. Documenting client behaviors

C. Providing counseling

 

Hildegard Peplau identified the role of counselor or psychotherapist as the heart of psychiatric nursing and a role unique to this nursing specialty. Managing the milieu, attending to the client’s physiological needs, and documenting client behaviors and responses are responsibilities of all professional nurses and are not unique to the role of a psychiatric nurse

3

Which nursing activity is a direct result of the Community Mental Health Centers Act of 1963?

A. Being a member of a client’s multidisciplinary treatment team

B. Performing an extensive admissions assessment for each hospitalized client

C. Using physical restraints as only the last resort when client safety requires it

D. Educating a client on the role of neurotransmitters in chronic depression

A. Being a member of a client’s multidisciplinary treatment team

 

The Community Mental Health Centers Act of 1963 encouraged the formation of multidisciplinary treatment teams which is used extensively today in the delivery of mental health care. The Act also provided funding for the development of outpatient services in order to decrease the need for hospitalization of the mentally ill client. While the use of physical restraints has been mandated as the last resort in providing client and milieu safety, the directive is not the result of the Community Mental Health Centers Act of 1963. The growth of psychobiology in the 1980s not the Community Mental Health Centers Act of 1963 brought about the need for educating clients on the role of neurotransmitters in chronic depression

4

What differentiates the Psychiatric-Mental Health Registered Nurse (RN-PMH) from the Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH)?

A. Only the APRN-PMH is responsible for milieu management

B. The APRN-PMH exercises a greater degree of autonomy when providing care

C. Only the RN-PMH provides medication education to the client

D. The RN-PMH has less experience working with the mentally ill

B. The APRN-PMH exercises a greater degree of autonomy when providing care

 

The APRN-PMH exercises a greater degree of autonomy when providing care as a result of appropriate knowledge earned at the master’s or doctorate levels. Milieu management is not reserved strictly for the APRN. Client education related to medication therapy is not the exclusive role of the RN-PMH. The roles of the RN-PMH and the APRN-PMH are not defined by experience alone but by advanced education in the field of mental health nursing.

5

In order to become political advocates for the mentally ill, psychiatric nurses must first:

A. be willing to learn the legislative and regulatory processes at both the federal and state levels

B. recognize the need to work in partnership with the American Medical Association

C. be willing to put aside differences and unite for a common mental health cause

D. recognize the value of their understanding of the needs of the mentally ill

D. recognize the value of their understanding of the needs of the mentally ill

 

The collective experience and knowledge possessed by psychiatric nurses are invaluable to understanding and advocating for the mentally ill. Psychiatric nurses must recognize that value and then move towards being political advocates for the mentally ill in our nation. While necessary to become politically effective, learning legislative and regulatory processes is not the first task to be addressed. Professional nursing has as a mandate to act as our clients’ advocate. This role is not viewed as a joint venture with any other health care profession or agency. While a factor in becoming politically effective, recognizing the need to work in partnership with the American Medical Association is not the first task to be addressed

6

Which nursing intervention best builds a therapeutic nurse-client relationship?

A. Actively listening as the client expresses his or her thoughts and feelings

B. Intervening when the client begins to state beliefs that come from his or her illness

C. Evaluating a client’s behaviors and interpersonal relationships frequently to identify stressors

D. Passively allowing the client to control the communication and tone of the discussions

A. Actively listening as the client expresses his or her thoughts and feelings

 

An effective nurse-client relationship is built upon communication that encourages and respects varying points of view in a nonjudgmental atmosphere. Challenging beliefs and values is not appropriate until the relationship is well established. Evaluating a client’s behaviors and interpersonal relationships frequently to identify stressors is not an initial goal when attempts are being made to establish a therapeutic nurse-client relationship. While the nurse encourages the client to communicate in an honest, unrestricted manner, a passive approach on the nurse’s part would not be therapeutic.

7

A nurse best engages in self-analysis that will benefit a specific nurse-client relationship when:

A. refraining from expressing any negative feelings about a client’s behaviors.

B. asking, “What barriers exist that make it difficult for me to provide effective care for this client?

C. reporting to the nurse manager that, “I’ve tried but I just can’t work therapeutically with this client

D. avoiding conflict with the client by seldom setting boundaries or disagreeing with his or her beliefs.

B. asking, “What barriers exist that make it difficult for me to provide effective care for this client?

 

Self-analysis is best reflected in the nurse’s willingness to evaluate personal feelings about clients in order to first identify and then eliminate any barriers there may be to an effective therapeutic relationship. The nurse’s role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous client behaviors. Asking for a change in assignments should occur only when all other attempts to manage barriers have failed. The nurse’s role includes setting appropriate boundaries and exploring the possible causes of maladaptive or dangerous client behaviors.

8

Which nurse-focused action demonstrates an understanding of the importance of value clarification to the therapeutic relationship between nurse and client?

A. Intently listening while the client describes physical abuse she was exposed to as a child

B. Offering to arrange for the hospital chaplain to visit a client who is severely depressed

C. Asking a client to explain his or her cultural beliefs regarding the role of women

D. Encouraging the client to read a newspaper article that debates various political issues

C. Asking a client to explain his or her cultural beliefs regarding the role of women

 

Values learned from various life experiences are influenced by one’s cultural history and beliefs. In order to understand and accept a client’s belief, the nurse must understand his or her culture. While appropriate, as an example of “being available in the moment” to the client, the past experiences of physical abuse do not have relevance regarding value clarification. Arranging for the chaplain to visit may support a value but only when the request is initiated by the client and not the nurse. Encouraging such activities as reading articles that discuss various points of view will help broaden a client’s knowledge but has little effect on clarifying existing values.

9

The nurse demonstrates appropriate Asian-American cultural sensitivity when:

A. substituting the word “sadness” for depression when participating at a health fair at a local Asian-American senior center.

B. anticipating that the Asian-American teenager is well educated concerning the dangers of tobacco and marijuana abuse.

C. being particularly interested in the older Asian-American’s view regarding the role of alcohol in managing stress.

D. evaluating the critical thinking skills and short-term recall abilities of the Asian-American female over the age of 70.

A. substituting the word “sadness” for depression when participating at a health fair at a local Asian-American senior center

 

The Asian-American population generally holds the view that mental illness is shameful and will seek to identify alternative reasons for psychiatric disorders. Using a less threatening word like “sadness” as a substitute for depression would be an example of cultural sensitivity. There is no current research to support the belief that Asian-American teenagers are better educated about the dangers of either tobacco or marijuana use, that older Asian-Americans hold a view concerning the role of alcohol in managing stress that differs from the general population, or that elderly Asian-American females experience a high risk for cognitive and memory-related disorders.

10

Which statement made by a mental health nurse demonstrates the need for further education regarding active listening as a therapeutic communication technique?

A. “When I use therapeutic silence, I’m giving the client time to think and reflect.”

B. “Sharing perceptions doesn’t mean I tell the client how my experiences are similar to his.”

C. “I generally find it helpful to ask the client why he blames others for the mistakes he’s made.”

D. “It’s not therapeutic to give the client suggestions as to what he needs to do to fix his problems.”

C. “I generally find it helpful to ask the client why he blames others for the mistakes he’s made.”

 

Asking why he is behaving in a particular manner is often viewed as judgmental by the client. Presenting such an attitude would be a barrier to communication and thus non-therapeutic. Stating, “When I use therapeutic silence, I’m giving the client time to think and reflect.” describes an effective use of silence. Sharing perceptions is used to clarify an understanding of what the client is thinking or feeling. Suggestions are therapeutic only when given as possible alternatives for the client to consider, not when given as advice.

11

The nurse demonstrates an understanding of the first assumption of Stuart’s Stress Adaptation Model when:

A. encouraging a client’s adult children to accompany their parent to family group therapy sessions.

B. discussing with a client’s health team which interventions should be included in the plan of care.

C. planning interventions based on a particular nursing theory that is relevant to the client’s problem.

D. identifying community resources that will help a mentally ill client live in his own home.

A. encouraging a client’s adult children to accompany their parent to family group therapy sessions.

 

The first assumption of Stuart’s Stress Adaptation Model is that nature is hierarchical—from the simplest unit to the most complex with each level being a part of all of the other levels. Nothing exists in isolation. Thus the individual is part of a family, group, community, society, and the larger biosphere. Recognizing that the client is a member of a family and including the family in the treatment is consistent with the first assumption. While appropriate, discussing the client’s needs with a health care team does not relate specifically to any particular assumption of Stuart’s Stress Adaptation Model. Stuart’s Stress Adaptation Model’s second assumption states that nursing care is provided within a biological, psychological, sociocultural, legal, ethical, policy, and advocacy context. Basing nursing care on a particular nursing theory would be consistent with this assumption. Stuart’s Stress Adaptation Model’s fourth assumption includes prevention, treatment, and recovery by describing four stages of psychiatric care: crisis, acute, health maintenance, and health promotion. Promoting autonomy and independence is consistent with this assumption.

12

A young adult tells the nurse at the local free clinic that he is currently living in his car and panhandling for money. The nurse asks the individual the reason for his decision to live as he does. Which response will the nurse follow up on to determine if the individual is experiencing mental health issues?

A. “I’ll live in a house and get a job when the government gives everyone those opportunities.”

B. “I live like this for 3 months each year just to remind myself how much I really have.”

C.“This way they can’t find me and if they can’t find me they can’t hurt me.”

D. “The law says I can live any way I want to as long as I’m not hurting anyone.”

C.“This way they can’t find me and if they can’t find me they can’t hurt me.”

 

“This way they can’t find me and if they can’t find me they can’t hurt me.” suggests that the individual may be paranoid. Such a statement requires further investigation. “I’ll live in a house and get a job when the government gives everyone those opportunities.” reflects strong political beliefs but does not necessarily suggest mental health issues. “I live like this for 3 months each year just to remind myself how much I really have.” provides a logical explanation for the individual’s decision. “The law says I can live any way I want to as long as I’m not hurting anyone.” reflects a strong belief in personal freedom but does not necessarily suggest mental health issues.

13

Which statement by an older adult who has recently had hip replacement surgery supports that her positive attitude is contributing to her mental health wellness?

A. “I know I can’t go hiking like I did but I really miss it so much.”

B. “I can’t go hiking but I still enjoy walking in the park in the afternoon.”

C. “If I work really hard in rehab, I think I’ll be able to hike again next spring.”

D. “Hiking gave me such pleasure but if I can’t hike, I’ll just have to get used to it.”

B. “I can’t go hiking but I still enjoy walking in the park in the afternoon.”

 

Positive attitudes toward self include an acceptance of oneself and self-awareness. A person must have some objectivity about the self and realistic aspirations that necessarily change with age. Finding pleasure in a similar activity is consistent with possessing a positive attitude. I know I can’t go hiking like I did but I really miss it so much.” reflects the individual’s reaction to the loss without showing any positive adjustment to it. “If I work really hard in rehab, I think I’ll be able to hike again next spring.” reflects a lack of acceptance of the loss and possibly an unrealistic expectation as well. “Hiking gave me such pleasure but if I can’t hike, I’ll just have to get used to it.” reflects the individual’s resignation to the loss without showing any positive adjustment to it.

14

Which statement made by a teenager indicates an increased risk for poor stress management as a result of a psychosocial factor?

A. “I couldn’t survive if my boyfriend left me.”

B. “My father tried to kill himself when I was 10 years old.”

C. “Our religion does not accept homosexuality as a lifestyle choice.”

D. “In my culture mental illness is thought of as a punishment not a sickness.”

A. “I couldn’t survive if my boyfriend left me.”

 

Psychosocial risk factors include a poor sense of control over one’s life. When she expresses an inability to “survive” without the boyfriend, she is demonstrating a belief consistent with such a risk factor. Biological predisposing risk factors include genetic background. Depression is a mental illness with a familial risk factor. Sociocultural predisposing risk factors include religious upbringing and beliefs and cultural background and values. The statements reflecting religious and cultural beliefs could prove to be risks in certain situations

15

What is the long-term benefit of successfully implementing a constructive coping mechanism?

A. Similar stressors will no longer have a negative affect in the future.

B. One’s ability to avoid stressors in the future is greatly improved.

C. Stress is no longer viewed as a barrier to future happiness and success.

D. Confidence in one’s ability to manage stress in the future is reinforced.

D. Confidence in one’s ability to manage stress in the future is reinforced.

 

Once used successfully, constructive coping mechanisms modify the way past experiences are used to meet future threats and confidence to manage such threats strengthens. Successfully coping with stressors does not result in any of the following: a total eradication of the effect of stress in the future, the ability to avoid stress but rather to deal with it when it occurs, or a distorted view of the effects of stress.

16

The client’s chart indicates that she has experienced trauma to the cerebral cortex as a result of injuries sustained during an attempted suicide. Which observation is most likely the result of this injury?

A. Client is often found crying into her pillow.

B. Client demonstrates involuntary twitching of facial muscles.

C. Client states, “What do you mean ‘it’s raining cats and dogs’?”

D. Client asks, “Can you address this letter to my mom; I forget her address?”

C. Client states, “What do you mean ‘it’s raining cats and dogs’?”

 

Damage to the cerebral cortex may hinder the ability to think abstractly resulting in the client’s failure to understand the phrase “it’s raining like cats and dogs.” Crying is a characteristic of sadness or depression that results from altered serotonin levels rather than trauma to the cerebral cortex. Involuntary muscle contraction is a characteristic of trauma to the basal ganglia rather than trauma to the cerebral cortex. Memory loss results from damage to the limbic system rather than trauma to the cerebral cortex.

17

A client suspected of being schizophrenic is scheduled for a computed tomography (CT). The nurse informs the client that the diagnostic test will:

A. confirm the diagnosis of schizophrenia.

B. trace the flow of blood through his brain.

C. allow the doctors to view the structures of his brain.

D. help determine the areas of his brain that are overreacting.

C. allow the doctors to view the structures of his brain.

 

Computed tomography (CT) provides visualization of brain structures. It can detect enlargement of the cerebral ventricles—a characteristic seen in schizophrenia. No one diagnostic test would confirm a mental illness. PET, SPECT, and other functional magnetic resonance imaging (fMRI) techniques can measure the amount of blood flowing in a region of the brain (regional cerebral blood flow). Techniques that show brain function include positron emission tomography (PET), which measures brain activity.

18

A client diagnosed with depression has reported fatigue and poor concentration. When she is told that the results of her sleep study show that she has excessive REM sleep cycles, the client asks the nurse to explain what those results mean. The nurse best answers the client’s concerns by replying:

A. “It means that you are sleep deprived.”

B. “REM sleep stands for rapid eye movement sleep.”

C. “Too much REM sleep deprives you of deep restoring sleep.”

D. “Depressed individuals generally experience prolonged periods of REM sleep.”

 

C. “Too much REM sleep deprives you of deep restoring sleep.”

 

Rationale: Studies show that in depressed persons, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense. Thus, although they may sleep 6 to 9 hours each night, people with depression frequently report fatigue, poor concentration, and irritability associated with sleep deprivation. While the incorrect statements are true, they do not fully explain the importance of excessive REM cycle sleep to the client.

19

The greatest benefit derived from current work being done related to pharmacogenetics is that:

A. the cost of medication manufacturing will be drastically reduced.

B. research and development of new drugs will be much less costly.

C. medications will be designed so that they do not cause unwanted side effects.

D. medications will be formulated so that only one dose per day will be required.

C. medications will be designed so that they do not cause unwanted side effects.

 

The new field of pharmacogenetics will eventually allow researchers to formulate drugs that will target the causes of a specific illness and so avoid non-illness targets in the body, thereby eliminating unwanted drug effects. The reduction in the cost of medication, in the cost of medication’s research and development, or in the number of medication doses needed daily are not necessarily expected outcomes of the field of pharmacogenetics.

20

The psychiatric nurse best demonstrates an understanding of the general health challenges facing a mentally ill client who reports auditory hallucinations when asking:

A. “When did you first start hearing voices?”

B. “What did you have to eat last night for supper?”

C. “May I have your permission to take your blood pressure?”

D. “Do you understand why you need to take your medication?”

C. “May I have your permission to take your blood pressure?”

 

A serious health problem is the higher rates of mortality and medical co-morbidity among patients who are mentally ill. Psychiatric patients experience high rates of a wide range of undiagnosed and untreated physical illnesses, including heart disease, diabetes, hypertension, cancer, and pulmonary illness. The psychiatric nurse needs to assess the client for such medical problems. “When did you first start hearing voices?” assesses the current mental health issue but does not address the client’s general physical health. “What did you have to eat last night for supper?” assesses the client’s access to food but does not address the client’s general physical health. “Do you understand why you need to take your medication?” assesses the client’s understanding of his treatment plan but does not address the client’s general physical health.

21

The mental health nurse is about to conduct an admissions interview with an older adult being admitted for depression. Which action demonstrates an understanding of the appropriate integration of the mental health status examination into an assessment interview?

A. Conducting the interview in a quiet, private location

B. Informing the client that his mental health status will be assessed

C. Asking the mental health assessment questions at the beginning of the interview

D. Including mental health questions among the general assessment interview questions

D. Including mental health questions among the general assessment interview questions

 

Much of the information needed for the mental status examination can be gathered during the course of the routine nursing assessment. Mental health questions should be integrated into the nurse’s assessment in a smooth manner without drawing attention to them. Using a quiet, private location represents the appropriate environment for any assessment. There is no need to draw attention to the questions; doing so may cause the client embarrassment and so be a barrier to an effective interview. There is no need to begin the interview with the mental health status questions but rather integrate them into the assessment.

22

During an assessment interview with a newly admitted client, the nurse identifies a sense of anger developing in response to the client’s defiant statements. In order to maintain a therapeutic environment, the nurse:

A. asks that another nurse continue the assessment.

B. identifies for the client the inappropriateness of his statements.

C. shares with the client that he appears angry about being admitted. 

D. postpones the remainder of the interview until the client is more cooperative.

C. shares with the client that he appears angry about being admitted. 

 

It is important for nurses to monitor their own feelings and reactions while implementing the mental status examination. A nurse’s gut reactions may reflect subtle emotions being expressed by the patient. The nurse needs to be aware of these feelings and respond in a therapeutic manner toward the patient, regardless of the nature of such feelings. By reflecting those feelings back to the client, the nurse has opened communication of the feelings. The nurse needs to professionally handle those feelings rather than identifying with them and asking to be relieved of the responsibility. Confronting the client at this point would be nontherapeutic since it is likely to be viewed as judgmental. The nurse needs to professionally handle those feelings rather than postpone the interview.

23

A client diagnosed with chronic depression appears sad and joyless when arriving at the mental health clinic for a scheduled appointment. The nurse best assesses the client’s mood by:

A. observing the client’s posture, dress, and hygiene in detail.

B. asking, “You seem very sad and forlorn; are you depressed today?”

C. asking, “On a scale of 0 to 10 with 10 being as happy as you can ever remember being, how do you feel today?”

D. observing the way the client interacts with other staff to determine whether the client is demonstrating signs of depression.

C. asking, “On a scale of 0 to 10 with 10 being as happy as you can ever remember being, how do you feel today?”

 

Mood can be evaluated by asking a simple, nonleading question, such as “How are you feeling today?” Asking the patient to rate his mood on a scale of 0 to 10 can help provide the nurse with an immediate reading. While observing the client may provide indications of depression, therapeutically asking the client to rate his mood is a more effective technique. Asking if the client is depressed is nontherapeutic since the question leads the client to an answer and expresses an assumption about the client’s mood. While observing the way the client interacts with others may help confirm possible indications of depression, therapeutically asking the client to rate his mood is a more effective technique.

24

The Mini Mental State Exam is most appropriately used when the:

A. focus of the exam is the client’s cognitive function.

B. interview must be completed in 10 minutes or less.

C. client is agitated and unwilling to complete the full version.

D. test is meant to establish a client’s mood at the time of admission.

A. focus of the exam is the client’s cognitive function.

 

It is “mini” because it concentrates on only the cognitive aspects of mental functions. While this version can be completed in 5 to 10 minutes and is shorter and likely to be accepted more readily by an agitated client, those are not the criteria for its use. This version excludes questions concerning mood, abnormal psychological experiences, and the content or process of thinking.

25

Which statement demonstrates an understanding of the value of using rating scales when assessing and documenting client responses?

A. “Documentation is standardized for all depressed clients when you use the depression rating scale.”

B. “The depression rating scale makes tracing a client’s response to antidepressant medication much more reliable.”

C. “Clients seem to be able to assign a number to their feelings of depression better than describing them verbally.”

D. “Depressed clients seldom have the energy to adequately respond to an assessment if a depression rating scale isn’t used.”

B. “The depression rating scale makes tracing a client’s response to antidepressant medication much more reliable.”

 

Behavioral rating scales help clinicians measure the extent of the patient’s problem, make an accurate diagnosis, track patient progress over time, and document the efficacy of treatment. While the statement about standardization is true, the goal is not standardization among clients but standardization among ongoing assessments for the individual client. The statements about assigning numbers to feelings and clients lacking energy are not necessarily true for all depressed clients.

26

According to the World Health Organization study, which nursing activity addresses the number one psychiatric cause of disability in the world today?

A. Arranging for a client’s transportation to Alcoholics Anonymous meetings

B. Helping the family understand their mother’s obsessive-compulsive disorder

C. Offering a depression screening at a local school for students in grades 8 through 12

D. Providing nursing care at a free clinic that serves the schizophrenic population in a large city

C. Offering a depression screening at a local school for students in grades 8 through 12

 

The World Health Organization’s (WHO) global burden of disease study revealed that mental disorders are the second most disabling category of illnesses around the world. The data showed that depression was the number one psychiatric cause of disability in the world. Alcohol abuse, obsessive-compulsive disorder, and schizophrenia were identified among the top 10 causes of disability in the world.

27

It has been estimated that 20%, or 45 million, adults ages 18 or older in the United States have experienced a mental illness in the past year. Which nursing intervention is directed toward addressing the greatest barrier to successful treatment outcomes for these individuals?

A. Educating clients as to the importance of completing their treatment recommendations

B. Identifying resources where medications can be secured at reduced or no cost

C. Actively involving the client in the planning of his or her mental health care

D. Evaluating the client for compliance with his or her plan of care frequently

A. Educating clients as to the importance of completing their treatment recommendations

 

For individuals with mental illness who received treatment, 20% quit before completing treatment recommendations. Educating the client as to the importance of completing treatment recommendations will help minimize this barrier. While poor access to prescribed medications can be a barrier, it has not been identified as the greatest barrier to positive care outcomes. While involving the client in his or her personal care planning has been shown to improve compliance, it has not been identified as the greatest barrier to positive care outcomes. While evaluation of client compliance with his or her plan of care is a critical component of care, lack of such an intervention has not been identified as the greatest barrier to positive care outcomes.

28

Currently, the mental health system in the United States focuses on managing client disabilities. It has been suggested that the focus be changed. Which nursing intervention demonstrates an attempt to work toward that recommended focus?

A. Assessing the depressed client often for suicidal ideations

B. Teaching stress management techniques to new mothers

C. Sharing the client’s wish that his medications be provided in liquid form if possible

D. Discussing with the client when his follow-up mental health visit can be scheduled

B. Teaching stress management techniques to new mothers

 

It has been found that the current system is unintentionally focused on managing disabilities associated with mental illness rather than promoting recovery. It has been recommended that the focus be shifted to promoting recovery and building resilience by supporting the individual’s ability to withstand stresses and life challenges such as through teaching stress management techniques. While vital to client safety, assessing the depressed client for suicidal ideations, sharing the client’s wishes about the preferred form of medication, and discussing follow-up visits all focus on managing disabilities rather than promoting recovery and wellness.

29

Access to mental health care services has been identified as a necessary component in an effective mental health care system. Which intervention demonstrates an attempt to meet the needs of an underserved group of Americans?

A. Establishing a mobile mental health clinic that serves residents in a rural farming community

B. Providing instructions on a variety of stress management techniques to police and fire personnel

C. Conducting eating disorder screenings at local high schools and colleges

D. Educating the parents of adolescents on the signs of depression

A. Establishing a mobile mental health clinic that serves residents in a rural farming community

 

Unmet needs for treatment are greatest in traditionally underserved groups, including residents of rural areas. By bringing mental health services to them this barrier can be minimized. Police and fire personnel, high school and college students, and adolescents are not generally considered underserved groups since they generally have health care insurance or access to school or state services.

30

Words are powerful and language can stigmatize the individual dealing with mental illness. How can a nurse personally advocate for such individuals with this in mind?

A. Encouraging all clients to be aware of their communication so as to not offend others

B. Teaching the client diagnosed with schizophrenia to avoid pressured speech

C. Role modeling language that is respectful to those with mental illnesses

D. Engaging in communication that is always therapeutic

C. Role modeling language that is respectful to those with mental illnesses

 

Awareness of and changing personal language to avoid stereotypes and common negative references to the mentally ill is one form of personal advocacy. The role of advocate is focused on supporting and protecting the client. Encouraging clients to be cautious of their communication suggests that clients need to change in order to protect others from the effects of their speech. While teaching the client to avoid pressured speech has some therapeutic value, it is not an example of advocacy involving the power of one’s own language on the person with mental illness. Therapeutic communication would not stigmatize a client who is mentally ill.

31

Which nursing intervention is directed toward one of the aims of primary preventive psychiatric nursing care?

A. Counseling both physical and sexual abuse victims

B. Providing stress management classes to new parents

C. Screening senior citizens for both acute and chronic depression

D. Arranging for clients to be transported to area Alcoholics Anonymous meetings

B. Providing stress management classes to new parents

 

A primary aim of preventive psychiatric nursing is the lowering of the incidence of newly developing mental illness. Providing instruction regarding stress management to an at- risk population would qualify as preventive psychiatric nursing care. Counseling is representative of secondary prevention since it is a strategy to provide effective care to those already experiencing illness. Screening is representative of secondary prevention since it is a strategy to provide early detection of those already experiencing illness. Supporting the recovery of an alcoholic is representative of tertiary prevention since it is a strategy to provide rehabilitation to those already experiencing illness.

32

The initial step in providing effective mental health-focused public health services is:

A. securing adequate funding to support needed psychiatric services.

B. identifying key providers to assure the delivery of required services.

C. surveying the targeted community to identify needs of the high-risk groups.

D. recruiting community leaders to provide support for utilization of provided services.

C. surveying the targeted community to identify needs of the high-risk groups.

 

In order to assure that the appropriate services are provided to the population in greatest need, the initial step is to identify needed services and at-risk populations. Funding will be addressed once needs are identified. Delivery of services cannot be addressed until needs are identified. Recruitment of community leaders to encourage community use of services will be addressed once services are established.

33

The nurse demonstrates an understanding of the importance of assessment in prevention of mental illness when:

A. observing the partner of a pregnant woman for evidence of effective support and caring.

B. educating the family of a client diagnosed with depression as to the signs of suicide planning.

C. encouraging the parents of a teenager diagnosed with anorexia to attend family counseling.

D. assessing the problem-solving skills of a client diagnosed with obsessive-compulsive disorder.

A. observing the partner of a pregnant woman for evidence of effective support and caring.

 

Preventive assessment involves identifying individuals who are vulnerable to the development of a mental disorder such as a pregnant woman who is at risk for anxiety and/or depression related to pregnancy. Educating the family regarding suicide ideations and encouraging attendance at family counseling sessions is not preventive since the client is already mentally ill. Assessing skills of a client diagnosed with a mental illness is not an example of preventive assessment.

34

Which statement made by a client who has been the victim of physical abuse by her partner supports the nurse’s belief that the client has developed competence?

A. “Women in my family seem to be destined to be victims.”

B. “I have the strength to leave if I ever begin to feel threatened.”

C. “My partner loves me but he has an anger management issue.”

D. “He cares about me and has promised never to hurt me again.”

B. “I have the strength to leave if I ever begin to feel threatened.”

 

A competent individual is one who is aware of resources and alternatives, can make reasoned decisions, and can cope adaptively with problems. Having the strength and confidence to leave when feeling threatened is an example of competence. The statement about victimization of women in the family demonstrates a sense of hopelessness not competence. The statement concerning the partner’s anger issues demonstrates her tendency to make excuses for his behavior. The statement that the man cares about her and will not hurt her again demonstrates a sense of denial or false hope not competence.

35

Nursing advocacy directed towards eliminating the stigma attached to mental illness is based on the fact that:

A. stigmatization only serves to increase the stress felt by the mentally ill.

B. no one is immune to mental illness or emotional problems.

C. mental illness is often chronic and incurable.

D. the mentally ill deserve our support.

B. no one is immune to mental illness or emotional problems.

 

Society as a whole needs to realize that no one is immune to mental illness or emotional problems and that the fear, anxiety, and anger we feel about those who are mentally ill often reflects our own deepest fears and anxieties. While the incorrect statements may be true, they do not address the basic truth that no one is immune to the development of a mental illness or emotional problem.

36

Which individual demonstrates the greatest risk for experiencing major depression?

A. A teenaged male who failed to make the football team

B. A young adult female who recently gave birth to her first child

C. An older adult female who retired after 25 years of factory work

D. A middle-aged male who is a self-employed small business owner

B. A young adult female who recently gave birth to her first child

 

The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. While the teenaged male and the retired female do present with risk for depression in the forms of disappointment and being a teenager, and retirement and being a female, there is an individual with several substantial risk factors. The middle-aged male’s risk for major depression is relatively small.

37

When attempting to substantiate a client’s diagnosis of major depression the nurse:

A. assesses the client for signs of anorexia.

B. asks, “Have you ever been depressed like this before?”

C. assesses the client for behaviors associated with drug abuse.

D. asks, “Are you having any problems falling or staying asleep?”

B. asks, “Have you ever been depressed like this before?”

 

While most untreated episodes of major depression last 6 to 24 months, more than 50% of those who have one episode will eventually have another, and 25% of patients will have chronic, recurrent depression. While anorexia, drug abuse, and dysfunctional sleep patterns may be co-morbid conditions associated with depression, they are not strong risk factors for developing the disorder.

38

In order to address the potential risk for depression among a population, the nurse will:

A. provide a depression screening at a local afterschool program site.

B. present educational programming on depression to a senior citizen group.

C. routinely assess all chronically ill clients for depression during their admission interview.

D. include the signs of postpartum depression in the discharge packet for each new mother.

C. routinely assess all chronically ill clients for depression during their admission interview.

 

A high incidence of depression is found among all patients hospitalized for medical illnesses. These depressions are largely unrecognized and untreated by general health care providers. Studies suggest that about one third of medical inpatients report mild or moderate symptoms of depression and up to one fourth may have major depression. Chronic medical conditions are often associated with depression. A depression screening is becoming more common since research suggests the incidence of depression in school age children is significant. Presenting educational programs on depression to senior citizens is becoming more common since research suggests the incidence of depression in the older adult is significant. Including depression information to new mothers is becoming more common since research suggests the incidence of depression in postpartum women is significant.

39

In the absence of a previous suicide attempt, the nurse is most concerned about a client’s risk for self-harm when he shares that:

A. his wife divorced him 6 months ago.

B. he was diagnosed with major depression 10 years ago.

C. his mother experienced postpartum depression after his birth.

D. he often spends days alone in a cabin located miles away from the main road.

B. he was diagnosed with major depression 10 years ago.

 

Although previous suicide attempts indicate risk, the longer the time spent depressed is a major factor in determining long-term risk of suicide. Divorce triggers depression in some individuals but is not the greatest risk factor among those provided as not all those experiencing a divorce become depressed. A history of depression in an immediate family member is considered a risk factor but is not the greatest risk factor provided as it does not affect the client directly. Social isolation is considered a risk factor but is not the greatest risk factor among those provided. Episodic solitude may be normal in this individual.

40

The nurse is managing the care of an older adult diagnosed with bipolar disorder who is in a manic phase. The nurse closely monitors the client for risks to his safety. This intervention is especially appropriate for this client because:

A. older adults experience physical conditions that greatly increase the potential for injury.

B. the manic phase will be followed by a phase of severe depression.

C. mania can result in irresponsible and physically risky behaviors.

D. such a client is easily abused by other aggressive clients.

C. mania can result in irresponsible and physically risky behaviors.

 

Patients in the manic phase of bipolar disorder may have misperceptions about their power and importance and involve themselves in senseless, irresponsible, and risky activities that can result in physical harm. While it is true that older adults are at risk for injury related to both acute and chronic illness, that depression generally follows mania, and that manic individuals are at risk for injury caused by those who are affected by or who misunderstand the behavior, the primary risk to this client comes from the manic behavior itself.

41

A client’s history documents that there have been examples of indirect self-destructive behavior. Which nursing assessment data supports this diagnosis?

A. Client has attempted suicide on three other occasions.

B. Reports of abusing alcohol since the age of 16.

C. Client experiences episodes of hypoglycemia on a regular basis.

D. While acknowledging suicidal thoughts, the client denies any plan.

B. Reports of abusing alcohol since the age of 16.

 

Indirect self-destructive behaviors are any activity harmful to the person’s physical well-being that may result in death. Alcohol abuse is an example of such behavior. A suicide attempt is a direct self-destructive behavior. Regular episodes of hypoglycemia an example of risk for physical harm but not necessarily of self-destructiveness unless there is some element of conscious attempt at self-harm. Suicidal thoughts without a plan are considered direct self-destructive behaviors.

42

Which statement made by a client demonstrates a prominent behavior related to noncompliance with prescribed treatment?

A. “I broke my hip last fall and it’s still hard to get around.”

B. “I have type 2 diabetes but I can still eat the way I always have.”

C. “Weight has been a problem I’ve struggled with my entire adult life.”

D. “My wife says I need to exercise if I’m ever going to get my blood pressure down.”

B. “I have type 2 diabetes but I can still eat the way I always have.”

 

The most prominent behavior associated with noncompliance is refusal to admit the seriousness of the health problem. This denial interferes with acceptance of treatment such as maintaining a healthy diet for the treatment of type 2 diabetes. The broken hip statement, the statement about weight problems, and the comment about exercise show dissatisfaction, frustration, and lack of incentive with the state of health, but not a denial of the seriousness of the problem.

43

A client has not been taking his antidepressant medication as prescribed and is admitted with suicidal ideations. The nurse demonstrates an understanding of a possible underlying cause of a client’s noncompliance with the treatment plan designed to help manage his depression when:

A. asking, “Do you feel that you don’t have any control over your depression?”

B. assessing the client’s understanding of the risk depression presents for suicide.

C. documenting the son’s statement that, “We will do everything we can to help.”

D. observing the client interacting with family members when they visit the mental health unit.

A. asking, “Do you feel that you don’t have any control over your depression?”

Noncompliant people are also struggling for control. Asking the client to discuss feelings related to control will help assess the depth of the problem. While the client’s understanding of his dysfunction is important, discussing risk factors will have minimal impact on identifying if the client feels a lack of control over the disorder and the resulting noncompliance with treatment. While family support is important, it will have minimal impact on compliance with treatment if the problem is the client’s perceived lack of control of his depression. While effective family interaction is a positive factor in the support a family can provide, it will have little impact on the client’s compliance with treatment if the problem is the client’s perceived lack of control of his depression.

44

The nurse is concerned that a depressed client may be displaying a nonverbal suicidal threat when he presents another client with his favorite shirt as a “gift.” The nurse’s initial intervention is to:

A. place the client on suicide precautions including 15-minute checks.

B. ask the client if he is experiencing suicidal ideations with a plan to hurt himself.

C. support the client by telling him that he will need the shirt when he’s discharged.

D. document that the client has shown behaviors that are likely subtle suicide threats.

B. ask the client if he is experiencing suicidal ideations with a plan to hurt himself.

 

Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life such as in giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the client on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the client that he will need his shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is non-conclusive and subjective.

45

Which statement is most concerning regarding a depressed client’s state of mind?

A. “I just want to go to sleep and not wake up.”

B. “When I get out of here I’m going to kill myself.”

C. “I’m so tired of living like this; I want it to be over.”

D. “Shooting myself with dad’s gun will end it all quickly.”

D. “Shooting myself with dad’s gun will end it all quickly.”

 

The most suicidal person is the one who has a plan that is lethal, specific, and available. This option presents a plan that is specific, lethal, and available to the individual. The statements about going to sleep and not waking up and about being tired living a certain way demonstrate wishes, not a specific, lethal plan that the individual can implement. The statement “When I get out of here I’m going to kill myself.” lacks a specific plan as to how the threat will be carried out.

46

Which statement regarding behaviors of psychotic clients made by a float nurse requires follow-up by the mental health unit’s nurse manager?

A. “It must be so frightening to be psychotic since no one else can understand what you are feeling.”

B. “Psychotic individuals are difficult to manage since they are unpredictable and dangerous.”

C. “You must monitor psychotic clients closely since they are at risk for hurting themselves.”

D. “Individuals demonstrating psychotic tendencies are usually out of touch with reality.”

B. “Psychotic individuals are difficult to manage since they are unpredictable and dangerous.”

 

Psychosis refers to the mental state of not being in touch with reality. During an episode of psychosis, the person does not realize that others are not experiencing the same things and wonders why others are not reacting in the same way. One should be watchful but not assume the psychotic individual is unpredictable or dangerous. The statements in the incorrect options are true and do not require follow-up.

47

The nurse demonstrates an understanding of the most common co-morbid condition observed in a schizophrenic individual when asking:

A. “Have you ever been diagnosed with an eating disorder?”

B. “How often do you drink enough alcohol to get drunk?”

C. “How old were you when you became sexually active?”

D. “Would you describe yourself as being depressed?”

B. “How often do you drink enough alcohol to get drunk?”

 

About 50% of patients with schizophrenia have a co-occurring substance abuse disorder, most frequently alcohol or cannabis. Assessing alcohol consumption patterns will help identify this co-morbid condition. Eating disorders are not generally observed in the schizophrenic individual. Sexual habits are not generally viewed as being abnormal in the schizophrenic individual. While depression may occur, it is not a primary co-morbid condition

48

The nurse documents that a client is demonstrating a negative symptom of schizophrenia when observing the client:

A. refusing to eat anything that is not tasted by the staff first.

B. reporting hearing voices telling him that the world will end soon.

C. communicating using a pattern of speech identified as “word salad.”

D. having difficulty focusing on any task for more than a few minutes.

D. having difficulty focusing on any task for more than a few minutes.

 

Attention impairment is considered a negative symptom since it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms since they are an exaggeration or distortion of normal brain function.

49

The nurse is confident that an individual prescribed antipsychotic medication has been experiencing medication efficacy and showing insight when he:

A. has been regularly attending his prescribed therapy sessions.

B. is able to effectively assess the reality of his thinking processes.

C. can restate the importance of medication compliance.

D. no longer experiences hallucinations or delusional thinking.

B. is able to effectively assess the reality of his thinking processes.

 

Attaining insight is demonstrated by the ability to make reliable reality checks. This takes 6 to 18 months and depends on medication efficacy and ongoing support. While attending therapy sessions and restating the important of medication compliance are positive behaviors, they do not show insight since there is no critical thinking involved. The lack of hallucinations or delusion thinking reflects positive outcomes but not necessarily insight since there is no critical thinking involved.

50

Which statement made by a nurse interviewing a client who reports the fear that people are trying to poison him requires follow-up by the nurse’s unit manager?

A. “Have other members of your family ever experienced this kind of thing?”

B. “Tell me more about how someone keeps trying to poison your food.”

C. “How has this affected your ability to keep a job or care for yourself?”

D. “Let’s discuss the stressors you have in your life right now.”

B. “Tell me more about how someone keeps trying to poison your food.”

 

It is nontherapeutic to reinforce the delusion by encouraging the individual to focus on the details such as suggested in the correct option. The incorrect options do not reinforce the delusion. Rather, they help gain knowledge about the history of the disorder in the family, the extent of the dysfunction the fear is causing, and the triggers that may have resulted in this behavior.