Chapters 1, 2, 4 and 6 P.Q.'s

Question 1

Which statement about mental illness is true?

a. ) Mental illness is a matter of individual nonconformity with societal norms.
b. ) Mental illness is present when individual irrational and illogical behavior occurs.
c. ) Mental illness changes with culture, time in history, political systems, and the groups defining it.
d. ) Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

Answer 1

c.) Mental illness changes with culture, time in history, political systems, and the groups defining it.

Question 2

A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be:

a. ) Nursing Interventions Classification (NIC)
b. ) Nursing Outcomes Classification (NOC)
c. ) NANDA-I nursing diagnoses
d. ) DSM-5

Answer 2

d.) DSM-5

Question 3

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

a. ) Providing information about effective nursing techniques.
b. ) Identifying risk factors that contribute to the development of a disorder.
c. ) Identifying who in the general population will develop a specific disorder.
d. ) Identifying which individuals will respond favorably to a specific treatment.

Answer 3

c.) Identifying who in the general population will develop a specific disorder.

Question 4

Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis?

a. ) There is no functional difference between the two; both serve to identify a human deviance.
b. ) The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.
c. ) The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems.
d. ) The DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying multidisciplinary interventions.

Answer 4

c.) The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems.

Question 5

The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is:

a. ) Advocacy
b. ) Psychotherapy
c. ) Coordinationofcare
d. ) Community-based care

Answer 5

b.) Psychotherapy

Question 6

The premise that an individual’s behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:

a. ) modeling.
b. ) milieu therapy.
c. ) cognitive-behavioral therapy.
d. ) psychoanalytic psychotherapy.

Answer 6

c.) cognitive-behavioral therapy.

Question 7

Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of:

a. ) milieu therapy.
b. ) cognitive-behavioral therapy.
c. ) behavior therapy.
d. ) interpersonal psychotherapy.

Answer 7

a.) milieu therapy.

Question 8

Which of the following factors contribute to the movement of patients out of large state institutions and into community-based mental health treatment? Select all that apply.

a. ) States desire to save money by moving the patients to the community, where the federal government would pick up more of the cost.
b. ) The growing availability of generous mental health insurance coverage gave more patients the ability to seek private care in the community.
c. ) A system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment.
d. ) The Community Mental Health Centers Act of 1963 required states to develop and offer care in community-based treatment programs.
e. ) Patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive setting.
f. ) New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.

Answer 8

a, c, d, e, f

a. ) States desire to save money by moving the patients to the community, where the federal government would pick up more of the cost.
c. ) A system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment.
d. ) The Community Mental Health Centers Act of 1963 required states to develop and offer care in community-based treatment programs.
e. ) Patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive setting.
f. ) New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.

Question 9

Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications?

a. ) Help Anna to understand her illness and share in decisions about her care.
b. ) Advise Anna that if she stops her medications, her doctor will hospitalize her.
c. ) Arrange for Anna to receive daily home care so that her use of medications is monitored.
d. ) Discourage Anna from focusing on side effects and other excuses for stopping her pills.

Answer 9

a.) Help Anna to understand her illness and share in decisions about her care.

Question 10

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hos- pitalized but does not have health insurance. Which of the follow- ing responses best meets his immediate care needs and reflects the options for care a person in his position typically has?

a. ) Provide emotional support and encourage him to contact his family to see if they can help him arrange and pay for inpatient care.
b. ) Advise him that hospitals serve all persons regardless of their ability to pay, and immediately contact a Mobile Crisis team or accompany him to the nearest hospital emergency department.
c. ) Help him apply for Medicaid coverage, arrange for him to be monitored by family and friends, and once Medicaid coverage is in place, take him to an emergency room for evaluation.
d. ) Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

Answer 10

d.) Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

Question 11

Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? Select all that apply.

a. ) Interact frequently with both individuals and groups on the unit.
b. ) Attempt to introduce patients with similar backgrounds to each other to form social bonds for after discharge.
c. ) Initiate and support group interactions via therapeutic groups and activities.
d. ) Provide and encourage opportunities to practice social and other life skills.
e. ) Collaborate with housekeeping to provide a safe, pleasant environment.
f. ) Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.

Answer 11

a, c, d, f

a. ) Interact frequently with both individuals and groups on the unit.
c. ) Initiate and support group interactions via therapeutic groups and activities.
d. ) Provide and encourage opportunities to practice social and other life skills.
f. ) Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.

Question 12

The criteria for admission to an in patient psychiatric unit is that the patient:

a. ) refuses to comply with the treatment team in regard to medication, counseling, living situation, or substance abuse abstinence.
b. ) is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm.
c. ) refuses all psychotropic medication.
d. ) is court-ordered by a judge specializing in mental health.

Answer 12

b.) is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm.

Question 13

A nurse makes a post on a social media page about his peer taking care of a patient with a crime-related gunshot wound during his shift in the emergency department. He does not use the name of the patient. It can be concluded that:

a. ) the nurse has not violated confidentiality laws because he did not use the patient’s name.
b. ) the nurse cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient.
c. ) the nurse has violated confidentiality laws and can be held liable.
d. ) the nurse cannot be held liable because postings on a social media site are excluded from confidentiality laws.

Answer 13

c.) the nurse has violated confidentiality laws and can be held liable.

Question 14

Brian, a patient with schizophrenia, has been ordered an antipsychotic medication. The medication will likely benefit him, but there are side effects; in a small percentage of patients, it may cause a dangerous side effect. After medication teaching, Brian is unable to identify side effects and responds, “I won’t have any side effects because I am iron and cannot be killed.” Which response would be most appropriate under these circumstances?

a. ) Administer the medication because Brian has made a decision to take the medication, and care should be patient-centered.
b. ) Petition the court to appoint a guardian as a substitute for Brian, as he is unable to comprehend the proposed treatment.
c. ) Administer the medication because Brian’s need for treatment is the clear priority.
d. ) Withhold the medication until Brian is able to identify the benefits and risks of both consenting and refusing consent to the medications.

Answer 14

b.) Petition the court to appoint a guardian as a substitute for Brian, as he is unable to comprehend the proposed treatment.

Question 15

A family who is worried that an adult female might hurt herself asks for her to be admitted to the hospital. An assessment indicates moderate depression with no risk factors for suicide other than a depressed mood. The patient denies any intent or thoughts about self-harm. The family agrees that the patient has not done or said anything to suggest that she might be a danger to herself. Which of the following responses is consistent with the concept of “least restrictive alternative” doctrine?

a. ) Admit the patient as a temporary inpatient admission.
b. ) Persuade the patient to agree to a voluntary inpatient admission.
c. ) Admit the patient involuntarily to an inpatient mental health treatment unit.
d. ) Arrange for an outpatient counseling appointment the next day.

Answer 15

d.) Arrange for an outpatient counseling appointment the next day.

Question 16

David has an overnight pass, and he plans to spend this time with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother and needs him to babysit. You notice that the patient becomes visibly agitated when she says this. How do you balance safety and the patient’s right to confidentiality?

a. ) Cancel the pass without explanation to the sister, and reschedule it for a time when babysitting would not be required of the patient.
b. ) Suggest that the sister make other arrangements for child care, but withhold the information the patient shared regarding his concerns about harming children.
c. ) Speak with the patient about the safety risk involved in babysitting, seeking his permission to share this information and advising against the pass if he declines to share the information.
d. ) Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger toward children and the resultant risk that his babysitting would present.

Answer 16

d.) Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger toward children and the resultant risk that his babysitting would present.

Question 17

Gina is admitted for treatment of depression with suicidal ideation triggered by marital discord. Her spouse visits one night and informs Gina that he has decided to file for divorce. The staff are aware of the visit and the husband’s intentions regarding divorce but take no further action, feeling that the q15-minute suicide checks Gina is already on are sufficient. Thirty minutes after the visit ends, staff make rounds and discover Gina has hanged herself in her bathroom, using hospital pajamas she had tied together into a rope. Which of the following statements best describes this situa- tion? Select all that apply.

a. ) The nurses have created liability for themselves and their employer by failing in their duty to protect Gina.
b. ) The nurses have breached their duty to reassess Gina for increased suicide risk after her husband’s visit.
c. ) Given Gina’s history, the nurses should have expected an increased risk of suicide after the husband’s announcement.
d. ) The nurses correctly reasoned that suicides cannot always be prevented and did their best to keep Gina safe through checks every 15 minutes.
e. ) The nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina’s increased risk.
f. ) Had the nurses restricted Gina’s movements or increased their checks on her, they would have been liable for false imprisonment and invasion of privacy, respectively.

Answer 17

a, b, c, e

a. ) The nurses have created liability for themselves and their employer by failing in their duty to protect Gina.
b. ) The nurses have breached their duty to reassess Gina for increased suicide risk after her husband’s visit.
c. ) Given Gina’s history, the nurses should have expected an increased risk of suicide after the husband’s announcement.
e. ) The nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina’s increased risk.