Chapter 001100

Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition
Chapter 01: Mental Health and Mental llness

!est "an#
M$%!P%E CH&CE
1. A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an
advanced practice nurse to perform which additional interventions?
a. Conduct mental health assessments
b. Establish therapeutic relationships
c. Individualize nursin care plans
d. !rescribe psychotropic medication
A"#$ %
!rescriptive privilees are ranted to masters&prepared nurse practitioners who have ta'en
special courses on prescribin medication. The nurse prepared at the basic level is permitted
to perform mental health assessments( establish relationships( and provide individualized care
plannin.
%I)$ Conitive *evel$ Comprehension +E)$ Text !ae$ 1,
T-!$ "ursin !rocess$ Implementation
.#C$ Client "eeds$ #afe and Effective Care Environment
/. Two nursin students discuss their career plans after raduation. -ne student wants to
enter psychiatric nursin. The other as's( 01hy would you want to be a psychiatric
nurse? The only thin they do is tal'. 2ou3ll lose all your s'ills.4 #elect the best response.
a. 0!sychiatric nurses practice in safer environments than other specialties. "urse&to&
patient ratios must be better because of the nature of the patients3 problems.4
b. 0!sychiatric nurses use complex communication s'ills as well as critical thin'in
to solve multidimensional problems. I am challened by those situations.4
c. 0I thin' I will be ood in the mental health field. I did not li'e clinical rotations in
school( so I do not want to continue them after I raduate.4
d. 0!sychiatric nurses do not have to deal with as much pain and sufferin as
medical&surical nurses do. That appeals to me.4
A"#$ 5
The practice of psychiatric nursin re6uires a different set of s'ills than medical&surical
nursin( thouh there is substantial overlap. !sychiatric nurses must be able to help patients
with medical as well as mental health problems( reflectin the holistic perspective these
nurses must have. "urse&patient ratios and wor'loads in psychiatric settins have increased(
7ust li'e other specialties. !sychiatric nursin involves clinical practice( not 7ust
documentation. !sychosocial pain and sufferin is as real as physical.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 8&,
Elsevier items and derived items 9 /:1:( /::; by #aunders( an imprint of Elsevier Inc.
Test 5an'
<. A new bill introduced in Conress would reduce fundin for care of persons with mental
illness. =roups of nurses write letters to their elected representatives in opposition to the
leislation. 1hich role have the nurses fulfilled?
a. Advocacy
b. Attendin
c. +ecovery
d. Evidence&based practice
A"#$ A
An advocate defends or asserts another3s cause( particularly when the other person lac's the
ability to do that for self. Examples of individual advocacy include helpin patients
understand their rihts or ma'e decisions. -n a community scale( advocacy includes political
activity( public spea'in( and publication in the interest of improvin the human condition.
#ince fundin is necessary to deliver 6uality prorammin for persons with mental illness( the
letter&writin campain advocates for that cause on behalf of patients who are unable to
articulate their own needs.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ /:&/1
>. An informal roup of patients discusses their perceptions of nursin care. 1hich
comment best indicates a patient perceived the nurse was carin? 0.y nurse$
a. always as's me which type of 7uice I want to help me swallow my medication.4
b. explained my treatment plan to me and as'ed for my ideas about how to ma'e it
better.4
c. told me that if I ta'e all the medicines the doctor prescribes( then I will et
dischared soon.4
d. spends time listenin to me tal' about my problems. That helps me feel li'e I3m
not alone.4
A"#$ %
Carin evidences empathetic understandin as well as competency. It helps chane pain and
sufferin into a shared experience( creatin a human connection that alleviates feelins of
isolation. The distracters ive examples of statements that demonstrate advocacy or ivin
advice.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1?&18
T-!$ "ursin !rocess$ Evaluation .#C$ Client "eeds$ !sychosocial Interity
?. 1hich findin best indicates that a patient has a mental illness? The patient$
a. responds to rules( routines( and customs of a roup.
b. reports mood is consistently sad( discouraed( and hopeless.
c. performs tas's attempted within the limits set by own abilities.
d. is able to see the difference between the 0as if4 and the 0for real.4
A"#$ 5
1&/
Test 5an'
The correct response describes a mood alteration( which further reflects mental illness. The
distracters describe mentally healthy behaviors.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ >&8
T-!$ "ursin !rocess$ Assessment .#C$ Client "eeds$ !sychosocial Interity
;. 1hich findin best indicates that the oal Demonstrate mentally healthy behavior4 was
achieved? A patient$
a. sees self as approachin ideals and capable of meetin demands.
b. see's others to assume responsibility for ma7or areas of own life.
c. behaves without considerin the conse6uences of personal actions.
d. aressively meets own needs without considerin the rihts of others.
A"#$ A
The correct response describes an adaptive( healthy behavior. The distracters describe
maladaptive behaviors.
%I)$ Conitive *evel$ Application +E)$ Text !ae$ <
8. A nurse encounters an unfamiliar psychiatric disorder on a new patient3s admission form.
To determine criteria used to establish this dianosis( the nurse should consult which
resource?
a. Diagnostic and Statistical Manual of Mental Disorders
b. A nursin dianosis handboo'
c. A psychiatric nursin textboo'
d. A behavioral health reference manual
A"#$ A
The DSM-IV-TR ives the criteria used to dianose each mental disorder. The distracters may
not contain dianostic criteria for a psychiatric illness.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1/&1>
T-!$ "ursin !rocess$ Assessment
,. 1hich documentation of dianosis would a nurse expect in a psychiatric treatment
settin?
a. I Acute renal failure
II 8?
III 5ipolar disorder I( mixed
I@ *oss of disability benefits / months ao
@ "one
b. I #chizophrenia( paranoid type
II %eath of spouse last year
III ;:
I@ "one
1&<
Test 5an'
@ %iabetes( type /
c. I !olysubstance dependence
II "arcissistic !ersonality %isorder
III A:
I@ Byperlipidemia
@ Chares pendin for assault
d. I .a7or %epression
II Avoidant !ersonality %isorder
III Bypertension
I@ Bome destroyed by hurricane last year
@ ,:
A"#$ %
The DSM-IV-TR profiles psychiatric dianoses on five axes. Each axis defines a specific
aspect of the dianosis. Axis I identifies ma7or clinical disorders. Axis II details personality
and developmental disorders. Axis III identifies eneral medical conditions. Axis I@ details
psychosocial and environmental problems. Axis @ rates the =lobal Assessment of
)unctionin.
%I)$ Conitive *evel$ Analysis +E)$ Text !aes$ 1>&1,
T-!$ "ursin !rocess$ Analysis
A. A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes
information that it$
a. focuses on plans for treatment.
b. includes nursin and medical dianoses.
c. classifies problems in multiple areas of functionin.
d. uses the framewor' of a specific biopsychosocial theory.
A"#$ C
The use of five axes re6uires assessment beyond dianosis of a mental disorder and includes
relevant medical conditions( psychosocial and environmental problems( and lobal assessment
of functionin. The DSM-IV-TR does not include treatment plans or nursin dianoses. It does
not use specific biopsychosocial theories.
%I)$ Conitive *evel$ Comprehension +E)$ Text !aes$ 1<&1;
1:. A nurse wants to find a description of dianostic criteria for anxiety disorders. 1hich
resource would have the most complete information?
a. The ICD-1
b. !ursing "utcomes Classification
c. Diagnostic and Statistical Manual of Mental Disorders
d. The A"A #sychiatric-Mental $ealth !ursing Sco%e and Standards of #ractice
1&>
Test 5an'
A"#$ C
The DSM-IV-TR details the dianostic criteria for psychiatric clinical conditions. The other
references are ood resources but do not define the dianostic criteria.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1<&1;
11. 1hich comment most clearly shows a spea'er views mental illness with stima?
a. 0#ome mental illnesses are inherited.4
b. 0.ost people with mental illness are unmotivated.4
c. 0#evere environmental stress sometimes causes mental illness.4
d. 0#ome mental illnesses are brain disorders resultin from chanes in how impulses
are transmitted.4
A"#$ 5
#tima refers to stereotypical( neative beliefs. 1ith respect to mental health and mental
illness( stima often leads to discrimination and uncarin attitudes. .ental illness has multiple
causes( includin stress( chanes in brain structure or function( and enetic transmission.
%I)$ Conitive *evel$ Analysis +E)$ Text !aes$ 8( /:
1/. Complete this analoy. "A"%A $ clinical 7udment $$ !IC $ CCCCCCCCCCCCCCCCC
a. patient outcomes
b. nursin actions
c. dianosis
d. symptoms
A"#$ 5
Analoies show parallel relationships. "A"%A( the "orth American "ursin %ianosis
Association( identifies dianostic statements reardin human responses to actual or potential
health problems. These statements represent clinical 7udments. !IC D!ursing Interventions
ClassificationE identifies actions provided by nurses that enhance patient outcomes. "ursin
care activities may be direct or indirect.
%I)$ Conitive *evel$ Analysis +E)$ Text !aes$ 18&1,
1<. A collee student said( 0.ost of the time I3m happy and feel ood about myself. I have
learned that what I et out of somethin is proportional to the effort I put into it.4 1hich
number on this mental health continuum should the nurse select?
.ental Illness .ental Bealth
1 / < > ?
a. 1
b. /
c. <
1&?
Test 5an'
d. >
e. ?
A"#$ E
The student is happy and has an ade6uate self&concept. The student is reality oriented( wor's
effectively( and has control over own behavior. .ental health does not mean that a person is
happy all the time.
%I)$ Conitive *evel$ Application +E)$ Text !ae$ >
1>. A newly admitted patient is uncommunicative about recent life events. The nurse suspects
marital and economic problems( but the social wor'er3s assessment is not yet available.
#elect the nurse3s best action.
a. )ocus assessment 6uestions on these two topics.
b. As' another patient who shares a room with this patient.
c. Avoid see'in information on these topics at this time.
d. +efer to axis I@ of the DSM-IV-TR in the medical record.
A"#$ %
The admittin physician would use axis I@ to record psychosocial and environmental
problems pertinent to the patient3s situation( providin another source of information for the
nurse. !ersistent 6uestionin may cause the patient to withdraw. The other distracters
demonstrate violation of the patient3s privacy rihts and are not an effective solution.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1/&1>
1?. The Dianostic and #tatistical .anual of .ental Disorders classifies$
a. deviant behaviors.
b. people with mental disorders.
c. present disability or distress.
d. mental disorders people have.
A"#$ %
The DSM-IV-TR classifies disorders people have rather than people themselves. The
terminoloy of the tool reflects this distinction by referrin to individuals with a disorder
rather than as a 0schizophrenic4 or 0alcoholic(4 for example. %eviant behavior is not enerally
considered a mental disorder. !resent disability or distress is only one aspect of the dianosis.
%I)$ Conitive *evel$ Comprehension +E)$ Text !ae$ 1/
1;. A nurse participatin in a community health fair is as'ed( 01hat is the most prevalent
mental disorder in the Fnited #tates?4 #elect the nurse3s best response.
1&;
Test 5an'
a. #chizophrenia
b. 01hy do you as'?4
c. 5ipolar disorder
d. Alzheimer3s disease
A"#$ %
The prevalence for Alzheimer3s disease is 1:G for persons older than ;? and ?:G for persons
older than ,?. The prevalence of schizophrenia is 1.1G per year. The prevalence of bipolar
disorder is /.;G. It is important for the nurse to provide information rather than probe the
reason for the person3s 6uestion.
%I)$ Conitive *evel$ Comprehension +E)$ Text !ae$ 11
.#C$ Client "eeds$ Bealth !romotion and .aintenance
18. In the ma7ority culture of the Fnited #tates( which individual has the reatest ris' to be
labeled mentally ill? -ne who$
a. describes hearin =od3s voice spea'in.
b. is usually pessimistic but strives to meet personal oals.
c. is wealthy and ives away H/: bills to needy individuals.
d. always has an optimistic viewpoint about life and havin own needs met.
A"#$ A
The 6uestion as's about ris'. Bearin voices is enerally associated with mental illness( but in
charismatic reliious roups( hearin the voice of =od or a prophet is a desirable event.
Cultural norms vary( which ma'es it more difficult to ma'e an accurate dianosis. The
individuals described in the other options are less li'ely to be labeled mentally ill.
%I)$ Conitive *evel$ Analysis +E)$ Text !aes$ ;&8
1,. A patient3s relationships are intense and unstable. The patient initially idealizes the
sinificant other and then devalues them( resultin in fre6uent feelins of emptiness. This
patient will benefit from interventions to develop which aspect of mental health?
a. Effectiveness in wor'
b. Communication s'ills
c. !roductive activities
d. )ulfillin relationships
A"#$ %
The information iven centers on relationships with others( which are described as intense and
unstable. The relationships of mentally healthy individuals are stable( satisfyin( and socially
interated. %ata are not present to describe wor' effectiveness( communication s'ills( or
activities.
%I)$ Conitive *evel$ Comprehension +E)$ Text !ae$ <
1&8
Test 5an'
1A. A patient is depressed( mute( and motionless. Accordin to family members( the patient
has refused to bathe or eat for a wee'. The patient3s lobal assessment of functionin
score is$
a. 1::
b. ?:
c. /?
d. 1:
A"#$ %
The patient is unable to maintain personal hyiene( oral inta'e( or verbal communication. The
patient is a daner to self because of not eatin. The distracters represent hiher levels of
functionin.
%I)$ Conitive *evel$ Analysis +E)$ Text !ae$ 1?
/:. 1hich belief will best support a nurse3s efforts to provide patient advocacy durin a
multidisciplinary patient care plannin session?
a. All mental illnesses are culturally determined.
b. #chizophrenia and bipolar disorder are cross&cultural disorders.
c. #ymptoms of mental disorders are unchaned from culture to culture.
d. Assessment findins in mental disorders reflect a person3s cultural patterns.
A"#$ %
A nurse who understands that a patient3s symptoms are influenced by culture will be able to
advocate for the patient to a reater deree than a nurse who believes that culture is of little
relevance. The distracters are untrue statements.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1/&1<( 18
T-!$ "ursin !rocess$ Implementation .#C$ Client "eeds$ !sychosocial Interity
/1. A nurse is part of a multidisciplinary team wor'in with roups of depressed patients.
Balf the patients receive supportive interventions and antidepressant medication. The
other half receives only medication. The team measures outcomes for each roup. 1hich
type of study is evident?
a. !revalence
b. Clinical epidemioloy
c. %escriptive epidemioloy
d. Experimental epidemioloy
A"#$ 5
Clinical e%idemiology is a broad field that addresses what happens to people with illnesses
seen by providers of clinical care. This study is concerned with the effectiveness of various
interventions. #revalence refers to numbers of new cases. Descri%tive e%idemiology provides
estimates of the rates of disorders in a eneral population and its subroups. &'%erimental
e%idemiology tests presumed assumptions between a ris' factor and a disorder.
1&,
Test 5an'
%I)$ Conitive *evel$ Comprehension +E)$ Text !aes$ 11&1/
T-!$ "ursin !rocess$ Evaluation
//. The spouse of a patient with schizophrenia says( 0I don3t understand how nurturin or
toilet trainin in childhood has anythin to do with this incredibly disablin illness.4
1hich response by the nurse will best help the spouse understand this disorder?
a. 0This illness is the result of enetic factors.4
b. 0!sycholoical stress is at the root of most mental disorders.4
c. 0It must be frustratin for you that your spouse is sic' so much of the time.4
d. 0"ew findins show that this condition more li'ely has bioloical rather than
psycholoical oriins.4
A"#$ %
.any of the most prevalent and disablin mental disorders have stron bioloical influences.
=enetics are only one part of bioloical factors. Empathy does not address increasin the
spouse3s level of 'nowlede about the cause of the disorder. The other distracters are not
established facts.
%I)$ Conitive *evel$ Application +E)$ Text !ae$ A
/<. A >:&year&old who lives with parents and wor's at an unchallenin 7ob says( 0I3m as
happy as anyone else( even thouh I don3t socialize much outside of wor'. .y wor' is
routine( but when new thins come up( my boss explains thins a few times to ma'e sure
I catch on. At home( my parents ma'e decisions for me( and I o alon with their ideas.4
The nurse should identify interventions to improve this patient3s$
a. self&concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
A"#$ A
The patient sees self as needin multiple explanations of new tas's at wor' and allows the
parents to ma'e decisions( even thouh she is >: years old. These behaviors indicate a poorly
developed self&concept.
%I)$ Conitive *evel$ Application +E)$ Text !ae$ <
T-!$ "ursin !rocess$ !lannin .#C$ Client "eeds$ !sychosocial Interity
/>. The psychiatric nurse addresses axis I of the %#. as the focus of treatment but must also
consider physical health problems that may affect treatment. 1hich axis contains the
desired information?
a. II
b. III
c. I@
d. @
1&A
Test 5an'
A"#$ 5
Axis III indicates any relevant eneral medical conditions. Axis II refers to personality
disorders and mental retardation. Toether they constitute the classification of abnormal
behavior dianosed in the individual. Axis I@ reports psychosocial and environmental
problems that may affect the dianosis( treatment( and pronosis. Axis @ is the lobal
assessment of functionin.
%I)$ Conitive *evel$ Comprehension +E)$ Text !ae$ 1<
T-!$ "ursin !rocess$ Assessment .#C$ Client "eeds$ !hysioloical Interity
/?. #elect the best response for the nurse who receives a 6uery from another mental health
professional see'in to understand the difference between a DSM-IV-TR dianosis and a
nursin dianosis.
a. 0There is no functional difference between the two. 5oth identify human
disorders.4
b. 0The DSM-IV-TR dianosis disreards culture( whereas the nursin dianosis ta'es
culture into account.4
c. 0The DSM-IV-TR dianosis is associated with present distress or disability(
whereas a nursin dianosis considers past and present responses to actual mental
health problems.4
d. 0The DSM-IV-TR dianosis affects the choice of medical treatment( whereas the
nursin dianosis offers a framewor' for identifyin interventions for phenomena
a patient is experiencin.4
A"#$ %
The medical dianosis is concerned with the patient3s disease state( causes( and cures( whereas
the nursin dianosis focuses on the patient3s response to stress and possible carin
interventions. 5oth tools consider culture. The DSM-IV-TR is multiaxial. "ursin dianoses
also consider potential problems.
%I)$ Conitive *evel$ Application +E)$ Text !ae$ 18
M$%!P%E 'E(P&N(E
1. An experienced nurse says to a new raduate( 01hen you3ve practiced as lon as I have(
you3ll instantly 'now how to ta'e care of psychotic patients.4 1hich information should
the new raduate consider when analyzin this comment? (ou may select more than one
ans)er*
a. The experienced nurse may have lost siht of patients3 individuality( which may
compromise the interity of practice.
b. "ew research findins should be interated continuously into a nurse3s practice to
provide the most effective care.
c. Experience provides mental health nurses with the essential tools and s'ills needed
for effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill
1&1:
Test 5an'
patients throuh trial and error.
e. An intuitive sense of patients3 needs uides effective psychiatric nurses.
A"#$ A( 5
Evidence&based practice involves usin research findins and standards of care to provide the
most effective nursin care. Evidence is continuously emerin( so nurses cannot rely solely
on experience. The effective nurse also maintains respect for each patient as an individual.
-vereneralization compromises that perspective. Intuition and trial and error are
unsystematic approaches to care.
%I)$ Conitive *evel$ Application +E)$ Text !aes$ 1>&1,
T-!$ "ursin !rocess$ Analysis
/. A patient as's the nurse( 0I read an article online about psychosocial factors that influence
depression. 1hat are psychosocial factors?4 Examples a nurse could cite to support the
premise that a patient3s depression may be influenced by psychosocial factors include$
+Select all that a%%ly,
a. havin a hostile and overinvolved family.
b. havin two first&deree relatives with bipolar disorder.
c. feelin stron uilt over havin an abortion when one3s reliion forbids it.
d. experiencin the death of a parent a month before the onset of depression.
e. experiencin symptom remission when treated with antidepressant medication.
A"#$ A( C( %
)amily influence is a psychosocial factor affectin a patient3s mental health. A hostile(
overinvolved family is critical of the patient and contributes to low self&esteem. =enetic
factors influence an individual3s ris' for mental disorder but are not psychosocial factors.
+eliious influences are psychosocial in nature. *ife experiences( especially crises and losses(
are psychosocial influences on mental health. Treatment with a bioloical aent( such as
antidepressant medication( is an example of a bioloical influence.
%I)$ Conitive *evel$ Analysis +E)$ Text !ae$ ,
<. A patient in the emerency department says( 0The voices say someone is stal'in me.
They want to 'ill me because I developed a cure for cancer. I have a 'nife and will stab
anyone who is a threat.4 1hich aspectDsE of mental health should be of reatest
immediate concern to the nurse? Select all that a%%ly*
a. Bappiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in wor'
e. Bealthy self&concept
A"#$ 5( C( E
1&11
Test 5an'
The aspects of mental health of reatest concern are the patient3s appraisal of and control over
behavior. The appraisal of reality is inaccurate. There are auditory hallucinations( delusions of
persecution( and delusions of randeur. In addition( the patient3s control over behavior is
tenuous( as evidenced by the plan to stab anyone who seems threatenin. A healthy self&
concept is lac'in( as evidenced by the delusion of randeur. %ata are not present to suest
that the other aspects of mental health Dhappiness and effectiveness in wor'E are of immediate
concern.
%I)$ Conitive *evel$ Analysis +E)$ Text !aes$ <( ?
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Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition

Chapter 01: Mental Health and Mental llness

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