Exam 1 - Practice Questions Flashcards
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.
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
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
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
