Mental Health - Exam 1 Flashcards
When planning care for a specific client, of what significance to the psychiatric nurse is the fact that the DSM-IV-TR is multiaxial?
A. Pertinent aspects of client functioning and problems are reported.
B. Standardized treatment plans are available for each diagnosis.
C. Nursing diagnoses are included for each medical diagnosis.
D. No particular significance exists.
A. Pertinent aspects of client functioning and problems are reported.
The DSM-IV-TR axis system, by requiring judgments to be made on each of the five axes, forces the diagnostician to consider a broad range of information. The North American Nursing Diagnosis Association describes a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health problems and life processes. Therefore the DSM-IV-TR is used to diagnose a psychiatric disorder, whereas a well-defined nursing diagnosis provides the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing, such as hallucinations, low self-esteem issues, and ability to function (job/family).
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A nurse conducting research is seeking data about outcomes for depressed patients who have been treated with electroconvulsive therapy. The nurse is engaged in the field of A. experimental epidemiology. B. descriptive epidemiology. C. clinical epidemiology. D. analytic epidemiology.
C. clinical epidemiology.
Clinical epidemiology represents a broad field that addresses what happens to people with illnesses who are seen by providers of clinical care. Studies use traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms or by diagnostic procedures or treatments given for the illness or symptoms.
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A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking? A. Control over behavior B. Appraisal of reality C. Effectiveness in work D. Healthy self-concept
B. Appraisal of reality
The appraisal of reality is lacking for this client. The client does not have a picture of what is happening around himself or herself.
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A 14-year-old who belongs to a neighborhood gang is found by her parents to lie and engage in sexually promiscuous behavior. They bring her to the mental health center. The nurse performing the assessment is told by the 14-year-old that she is happy, does well in school, and sees herself as popular and well regarded by her group. She states her parents are just old fashioned and don’t understand her. The assessment the nurse will most likely make is that she
A. is displaying deviant behavior.
B. cannot accurately appraise reality.
C. is seriously and persistently mentally ill.
D. should be considered for group home placement.
A. is displaying deviant behavior.
This client is demonstrating deviant behavior. This client demonstrates undersocialized, aggressive behavior such as a repetitive and persistent pattern of aggressive conduct in which the basic rights of others are violated.
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An important concept for nurses to remember when planning care for mentally ill clients is that each client:
A. has areas of strength on which to build.
B. has right that must be respected.
C. comes with experiences that contribute to their problem.
D. share the same fears as mentally healthy individuals.
A. has areas of strength on which to build.
We are taught to evaluate our clients with mental health issues for their strengths and their areas of high functioning. You will find many attributes of mental health in some of your clients with mental health issues. These strengths should be built upon and encouraged.
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A nurse suspects that a client has a personality disorder in addition to displaying symptoms of a mood disorder. To determine whether these observations are correct, the nurse could look in the client's medical record on the DSM-IV-TR A. axis I. B. axis II. C. axis III. D. axis IV.
B. axis II.
Axes I and II were separated to ensure that the possible presence of long-term disturbance is considered when attention is directed to the current one. For example, a heroin addict would be diagnosed on axis I as having a substance-related disorder; this client might also have a longstanding antisocial personality disorder, which would be noted on axis II.
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A man frequently bursts out by loudly singing operatic arias. The neighbors in the next apartment find the noise disturbing. They go to his apartment to confront him and find that in he is wearing only his bathrobe and his apartment is messy. He acts outraged and tells them he must sing several hours daily and will not promise to be quieter. The conclusion that can be drawn is:
A. The man is demonstrating symptoms of bipolar disorder.
B. The man is socially deviant.
C. The man is egocentric.
D. The man may or may not be mentally ill.
D. The man may or may not be mentally ill.
One myth about mental illness is that to be mentally ill is to be different and odd. Another misconception is that to be healthy, a person must be logical and rational. Everyone dreams “irrational” dreams at night, and “irrational” emotions are universal human experiences and are essential to a fulfilling life. Some people show extremely abnormal behavior and are characterized as mentally ill who are far more like the rest of us than different from us. No obvious and consistent line between mental illness and mental health exists.
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A nursing diagnosis for a client with a psychiatric disorder serves the purpose of
A. justifying the use of certain psychotropic medication.
B. providing data essential for insurance reimbursement.
C. providing a framework for selecting appropriate interventions.
D. identifying information to be placed on DSM-IV-TR axis III.
C. providing a framework for selecting appropriate interventions.
Nursing diagnoses provide the framework for identifying appropriate nursing interventions for dealing with the phenomena a client with a mental health disorder is experiencing.
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A client has begun to neglect her appearance, is withdrawn and stays in her room. Her mother hears her seemingly talking to others, but no one is in the room with her. Last night she threw a chair and broke the window of her bedroom. She tells the nurse nothing is wrong. The nurse rating her current global assessment of functioning would probably assign the code A. 100. B. 70. C. 40. D. 0.
C. 40.
According to the global assessment of functioning scale (Box 1-2), this client exhibits some impairment in reality testing or communication (speech is at times illogical, obscure, or irrelevant, as demonstrated by talking when no one was with her) or major impairment in several areas, such as work or school, family relations (neglects her appearance, stays in her room) and demonstrates impairment in mood (throwing a chair and breaking a window).
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The mental health or mental illness of a particular client can best be assessed by considering
A. the degree of conformity of the individual to society’s norms.
B. the degree to which an individual is logical and rational.
C. placement on a continuum from healthy to psychotic.
D. the rate of intellectual and emotional growth.
C. placement on a continuum from healthy to psychotic.
Many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Therefore these disorders can be regarded as “diseases.” Visualizing these disorders along the mental health continuum is helpful.
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As a result of Harry Stack Sullivan, the nurse in virtually all residential and day hospital settings is involved in providing clients with: A. Security operations B. Psychoanalysis C. Analysis of behavior patterns D. A psychotherapeutic environment
D. A psychotherapeutic environment
Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings.
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The nurse is working with a severely depressed client who has very low self-esteem and is distrustful of unit staff. The client is facing role transition from wife to wife and mother. The nurse’s priority is to:
A. establish trust with the client.
B. teach the client effective mothering skills.
C. identify positive traits the client possesses.
D. teach about the client the importance of her medication.
A. establish trust with the client.
Maslow describes safety as a basic need as meaning that it is so basic to existence that it must be resolved to reduce the tension associated with them. These needs have the greatest strength and must be satisfied before a person turns his attention to higher-level needs.
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The nurse uses Maslow’s model of needs to direct the identification of an anxious client’ priority intervention to be:
A. assessing the client’s success at fulfilling her appropriate developmental level tasks.
B. assessing the client for her strengths upon which a nurse-client relationship can be based.
C. planning one-on-one time with the client to assist in identify the fears behind her anxiety.
D. evaluating the client’s ability to learn and retain essential information regarding her condition.
B. assessing the client for her strengths upon which a nurse-client relationship can be based.
The value of Maslow’s model in nursing practice is twofold. First, the emphasis on human potential and the client’s strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.
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A client comes to the clinic asking for help because his third fiancée has broken their engagement. He states "I don't know what is wrong with me, but my friends tell me I am too possessive." The type of therapy that might address his interpersonal deficit is A. psychoanalysis. B. cognitive therapy. C. behavioral therapy. D. interpersonal psychotherapy.
D. interpersonal psychotherapy.
Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.
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Role playing is associated with which type of therapy? A. Psychoanalysis B. Modeling C. Operant conditioning D. Systematic desensitization
B. Modeling
In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role playing in the consulting room for modeling therapy.
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Which of the following is considered a primary behavioral theorist? A. Freud B. Skinner C. Sullivan D. Peplau
B. Skinner
B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.
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Diathesis-stress model
Diathesis – biological predisposition
Stress – environmental stress or trauma
Most accepted explanation for mental illness
Combination of genetic vulnerability and negative environmental stressors
The DSM-IV-TR Multiaxial System
Axis I: Mental disorder that is the focus of treatment
Axis II: Personality disorders and mental retardation
Axis III: General medical disorder relevant to the mental disorder in axis I
Axis IV: Psychosocial and environmental problems
Axis V: Global Assessment of Functioning (GAF)
Freud’s personality structure
Id
Pleasure principle
Reflex action
Primary process
Ego
Problem solver
Reality tester
Superego
Moral component
Erikson’s Eight Stages of Development
Infancy (0-1.5 yr): Trust vs. Mistrust
Forming attachment to mother, which lays foundations for later trust in others
Early childhood (1.5-3 yr): Autonomy vs. shame and doubt Gaining some basic control of self and environment (e.g., toilet training, exploration)
Late childhood (3-6 yr): Initiative vs. guilt Becoming purposeful and directive
School age (6-12 yr): Industry vs. inferiority Developing social, physical, and school skills
Adolescence (12-20 yr): Identity vs. role confusion
Making transition from childhood to adulthood; developing sense of identity
Early adulthood (20-35 yr): Intimacy vs. isolation Establishing intimate bonds of love and friendship
Middle adulthood (35-65 yr): Generativity vs. self-absorption Fulfilling life goals that involve family, career, and society; developing concerns that embrace generations
Later years (65 yr-death): Integrity vs. despair Looking back over one's life and accepting its meaning
Hildegard Peplau
- Author of Interpersonal Relations in Nursing (1952)
- First nurse theorist to describe the nurse-patient relationship as the foundation of nursing practice
- Engineered a major paradigm shift from a model focused on medical treatments to an interpersonal relational model of nursing practice
- Nurse-patient relationship phases (orientation, working, termination)
- Levels of anxiety
Common Cognitive Distortions
All-or-nothing thinking - thinking in black and white, reducing complex outcomes into absolutes
Overgeneralization - using a bad outcome (or a few bad outcomes) as evidence that nothing will ever go right again
Labeling - a form of overgeneralization where a characteristic or event becomes definitive and results in an overly harsh label for self or others
Mental filter - focusing on negative detail or bad event and allowing it to taint everything else
Disqualifying the positive - maintaining a negative view by rejecting information that supports a positive view as being irrelevant, inaccurate, or accidental
Jumping to conclusions - making a negative interpretation despite the fact that there is little or no supporting evidence
Magnification or minimization - exaggerating the importance of something
Emotional reasoning - drawing a conclusion based on an emotional state
“Should” and “must” statements - rigid self-directives that presume an unrealistic amount of control over external events
Personalization - assuming responsibility for an external event or situation that was likely outside personal control
Resilience, the capacity to rebound from stressors via adaptive coping, is associated with positive mental health. Your friend has just been laid off from his job. Which of the following responses on your part would likely contribute to enhanced resilience?
- Using your connections to set up an interview with your employer.
- Connecting him with a friend of the family who owns his own business.
- Supporting him in arranging, preparing for, and completing multiple interviews.
- Helping him to understand that the layoff resulted from troubles in the economy and is not his fault.
- Supporting him in arranging, preparing for, and completing multiple interviews.
Resilience develops from the process of resolving distress through adaptive coping. It
is enhanced when a person experiences success as a result of his own efforts, which gives the
person an increased sense of control or mastery over stressful events. This is illustrated in the
choice involving helping your friend to obtain and succeed in interviewing for a replacement job.
In the other choices, you are helping the person deal with his situation and/or find a replacement
job but not in a manner that leads him to experience success via his own efforts. As a result,
these approaches do not provide your friend with an opportunity to experience a sense of mastery
over stress, so they are less likely to contribute to increased resiliency.
Which of the following situations best supports the stress-diathesis model of mental illness development?
- The rate of suicide increases during times of national disaster and despair.
- Four of five siblings in the Jones family develop bipolar disorder by the age of 30.
- A man with no prior mental health problems experiences sadness after his divorce.
- A man develops schizophrenia, but his identical twin remains free of mental illness.
- A man develops schizophrenia, but his identical twin remains free of mental illness.
The stress-diathesis theory states that some persons are born with a biological
predisposition to mental illness, but that mental illness does not necessarily develop unless those
susceptible persons are exposed to stressors which trigger the illness. Thus for two persons with
the same genetic profile, one might develop a mental illness due to stressful life experiences,
whereas his counterpart, despite having the same genetic makeup, has a different life experience
and fails to develop the illness. This scenario is best demonstrated in the case of the man who
develops schizophrenia, while his identical twin, with the same genetic makeup, remains free of the disorder. The remaining choices do not necessarily involve a combination of a common
biological predisposition and exposure to a stressor working together to trigger a mental disorder.
Identify all of the correct statements about mental illness which are correct:
- In any given year, about 20% of adults experience a mental disorder.
- Mental health is best represented as a continuum of levels of functioning.
- Mental disorders and diagnoses occur very consistently across cultures.
- Most serious mental illnesses are psychological rather than biological in nature.
- The President’s New Freedom Commission highlighted significant gaps in care.
- “Parity” refers to relating to mentally ill persons the same as to the non-mentally ill.
- In any given year, about 20% of adults experience a mental disorder.
- Mental health is best represented as a continuum of levels of functioning.
- The President’s New Freedom Commission highlighted significant gaps in care.
About 21% of the U.S. population experiences a diagnosable mental illness in any one
year. “Mental health” is not an absolute that one either has or does not have. As with physical
health, persons vary in how mentally fit and able to function they are, and mental illnesses vary
in their impact at different times and in different patients. Although providers of mental health
care strive to make diagnoses in a culturally neutral manner, there are significant variations in the
prevalence of some mental illnesses in certain cultures. For example, anorexia nervosa is usually
diagnosed less frequently outside the United States, whereas some cultures have identified
mental disorders that are not prevalent in the United States. Most serious mental illnesses such as
schizophrenia and mood disorders are believed to have a biological basis. The President’s New
Freedom Commission noted that mental health care delivery was fragmented and not meeting the
needs of many persons with mental illness and called for major changes in the delivery of care to
persons with mental illnesses. “Parity” as it relates to mental health refers to insurance and other
third-party payers reimbursing for mental health care in a manner comparable to reimbursement
for the care of physical illnesses, without restrictions or limitations specific to mental disorders.
Which of the following disorders would be included on Axis I of the DSM IV-TR?
- Major depression, dementia, and alcoholism
- Diabetes type I or II, Parkinson’s disease, and seizure disorders
- Narcissistic, borderline, and paranoid personality disorders
- Mental retardation and psychosocial stressors such as divorce
- Major depression, dementia, and alcoholism
Axis I disorders include disorders of thought (cognition), feeling, and/or behavior
which are not developmental in nature. Examples include most of the major mental disorders such as mood disorders, psychotic disorders, substance use disorders, and cognitive disorders
(such as dementia). Disorders which are developmental in nature (i.e., occur very early in life
and persist thereafter), such as mental retardation and personality disorders, are grouped on Axis
II. Concurrent or contributing medical conditions such as cardiovascular disease or diabetes,
when present, are listed on Axis III. Contributing psychosocial stressors are listed on Axis IV.
Which of the following actions represent the primary focus of psychiatric nursing for a basic-level registered nurse? Select all that apply.
- Determining a patient’s diagnosis according to the DSM-IV-TR
- Ordering diagnostic tests such as EEGs or CT or MRI scans
- Identifying how a patient is coping with a symptom such as hallucinations
- Guiding a patient to learn and use a variety of stress-management techniques
- Helping a patient without transportation find a way to his treatment appointments
- Collecting petition signatures seeking the removal of stigmatizing images on television
- Identifying how a patient is coping with a symptom such as hallucinations
- Guiding a patient to learn and use a variety of stress-management techniques
- Helping a patient without transportation find a way to his treatment appointments
- Collecting petition signatures seeking the removal of stigmatizing images on television
The focus of psychiatric nursing involves using the nursing process to promote mental
health and/or facilitate constructive responses to mental health problems or psychiatric disorders.
Although advanced practice registered nurses may prescribe diagnostic examinations or
medications or identify DSM IV-TR diagnoses for treatment, these functions typically require
advanced educational preparation and certification.
The nurse is working with a patient who lacks the ability to problem solve and seeks ways to
self-satisfy without regard for others. The nurse understands that which system of the patient’s
personality is most pronounced?
- Id
- Ego
- Conscience (superego)
- Ego ideal (superego)
- Id
Freud’s distinct yet interactive systems of the personality include the id, the ego, and
the superego. The id cannot tolerate frustration and seeks to discharge tension and return to a
more comfortable level of energy, lacks the ability to problem solve, is not logical, and operates
according to the pleasure principle. The ego is able to differentiate subjective experiences,
memory images, and objective reality; it is logical and operates based in reality. The superego,
comprising the conscience and the ego ideal, is the moral component of the personality; it seeks
perfection rather than pleasure or reason. This patient is seeking self-satisfaction without regard
for others and cannot problem solve, which is reflective of the id.
Which behavior, seen in a 30-year-old patient, would alert the nurse to the fact that the
patient is not in his appropriate developmental stage according to Erikson?
- States he is happily married
- Frequently requests to call his brother “just to check in”
- Looks forward to visits from a co-worker
- Says “I’m still trying to find myself.”
- Says “I’m still trying to find myself.”
A 30-year old patient should be in Erikson’s stage of intimacy versus isolation.
Acknowledging meaningful interpersonal relationships reflects that the patient has successfully
resolved this crisis. The statement “I’m still trying to find myself” reflects that the patient has not
successfully resolved this crisis and is actually still in the stage of identity versus role confusion,
when the individual experiences confusion about who he is.
A patient has difficulty sitting still and listening to others during group therapy. The therapist
plans to use operant conditioning as a form of behavioral modification to assist the patient.
Which action would the nurse expect to see in group therapy?
- The therapist will act as a role model for the patient by sitting still and listening.
- The patient will receive a token from the therapist for each session in which she sits still
and listens. - The patient will be required to sit in solitude for 30 minutes after each session in which
she does not sit still or listen. - The therapist will ask that the patient sit still and listen for only 2 minutes at a time to
begin and will increase the time incrementally until the patient can sit and listen 10
minutes at a time.
- The patient will receive a token from the therapist for each session in which she sits still
and listens.
This “token economy” is reflective of operant conditioning, where positive
reinforcement increases desired behaviors. By sitting still and listening herself, the therapist uses
the strategy of modeling. Requiring the patient to sit in solitude is reflective of aversion therapy,
which is akin to punishment; aversion therapy can involve a punishment that is applied after the
patient has exhibited the undesired behavior. The process whereby a patient’s fear is broken
down into components and addressed incrementally (in a step-by-step fashion) is called
systematic desensitization.
The nurse is planning care for a patient with anxiety who will be admitted to the unit shortly.
Which nursing action is most important?
- Consider ways to assist the patient to feel valued during his stay on the unit.
- Choose a roommate for the patient so that a friendship can develop.
- Identify a room where the patient will have comfortable surroundings, and order a
balanced meal plan. - Plan methods of decreasing stimuli that could cause heightened anxiety in the patient.
- Identify a room where the patient will have comfortable surroundings, and order a
balanced meal plan.
Identifying comfortable surroundings and ordering a balanced meal plan involves
physiological needs. Based on Maslow’s hierarchy, food, oxygen, water, and sleep are among the
most basic needs of each human. These needs take priority because they are on the lowest plane
of the pyramid. Once these needs are met, higher needs are able to emerge. According to
Maslow’s hierarchy, considering ways to assist the patient to feel valued involves esteem needs,
and encouraging friendship involves belongingness and love needs. There are more important
processes that must first be addressed. Decreasing stimuli addresses safety needs, according to
Maslow’s hierarchy. Although safety is a priority, there is a more important process that must
first be addressed.
An experienced nurse is monitoring a new nurse. Which action of the new nurse would cause
the experienced nurse to intervene?
- Considering ways to decrease suicide risk of a suicidal patient
- Referring an abused patient to a shelter
- Providing a safe environment for a patient with Alzheimer’s disease
- Asking a patient to justify her behaviors
- Asking a patient to justify her behaviors
The therapeutic milieu exists to provide a safe and effective environment for patients.
Pressing a patient to justify her behaviors does not encourage this milieu. The other nursing
actions are appropriate within the therapeutic milieu.
