Chapter 1 Flashcards
- A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention?
a. Conduct mental health assessments.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
B: In most states, prescriptive privileges are granted to master’s-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.
When a nursing student expresses concerns about how mental health nurses “lose all their nursing skills,” the best response by the mental health nurse is:
a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients’ problems.”
b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”
c. “That’s a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies.”
d. “Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me.”
B: The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering.
When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Recovery
b. Attending
c. Advocacy
d. Evidence-based practice
C:An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter- writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs.
Which comment best indicates that a patient perceived the nurse was caring? “My nurse:
a. always asks me which type of juice I want to help me swallow my medication.”
b. explained my treatment plan to me and asked for my ideas about how to make it better.”
c. spends time listening to me talk about my problems. That helps me feel like I am not alone.”
d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner.”
C: Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice.
Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient:
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between “as if” and “for real.”
d. perceives difficulty making a decision about whether to change jobs.
B: The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience.
Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was achieved? A patient:
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of own life.
A: The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.
A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. A behavioral health reference manual
d. Wikipedia
B: The DSM-5 gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness.
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice
d. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
B: The DSM-5 details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria.
Which individual is demonstrating the highest level of resilience? One who:
a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for two years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
D: Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and depression are unhealthy. Living in a shelter for two years shows a failure to move forward after a tragedy. See related audience response question.
Complete this analogy. NANDA: clinical judgment: NIC: _________________
a. patient outcomes
b. nursing actions
c. diagnosis
d. symptoms
B: Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing care activities may be direct or indirect.
A college student said, “Most of the time I’m happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it.” Which number on this mental health continuum should the nurse select?
Mental Illness Mental Health
1 2 3 4 5
a. 1
b. 2
c. 3
d. 4
e. 5
E: The student is happy and has an adequate self-concept. The student is reality-oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is always happy.
Which disorder is a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depression
C: Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies:
a. deviant behaviors.
b. present disability or distress.
c. people with mental disorders.
d. mental disorders people have.
D: The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.
A citizen at a community health fair asks the nurse, “What is the most prevalent mental disorder in the United States?” Select the nurse’s best response.
a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer’s disease
D: The 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder. See related audience response question.
In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who:
a. describes hearing God’s voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals.
d. always has an optimistic viewpoint about life and having own needs met.
A: The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.
