Test Bank & Instr. Manual: Psychiatric Mental Health Nursing 6th Videbeck 978-1469847634
Test Bank – Ch 1- Foundations of Psychiatric-Mental Health Nursing
1. The nurse is assessing the factors contributing to the well-being of a newly admitted
client. Which of the following would the nurse identify as having a positive impact on
the individual’s mental health?
A) Not needing others for companionship
B) The ability to effectively manage stress
C) A family history of mental illness
D) Striving for total self-reliance
Individual factors influencing mental health include biologic makeup, autonomy,
independence, self-esteem, capacity for growth, vitality, ability to find meaning in life,
emotional resilience or hardiness, sense of belonging, reality orientation, and coping or
stress management abilities. Interpersonal factors such as intimacy and a balance of
separateness and connectedness are both needed for good mental health, and therefore a
healthy person would need others for companionship. A family history of mental illness
could relate to the biologic makeup of an individual, which may have a negative impact
on an individual’s mental health, as well as a negative impact on an individual’s
interpersonal and socialñcultural factors of health. Total self-reliance is not possible,
and a positive social/cultural factor is access to adequate resources.
2. Which of the following statements about mental illness are true? Select all that apply.
A) Mental illness can cause significant distress, impaired functioning, or both.
B) Mental illness is only due to social/cultural factors.
C) Social/cultural factors that relate to mental illness include excessive dependency
on or withdrawal from relationships.
D) Individuals suffering from mental illness are usually able to cope effectively with
E) Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
Ans: A, D, E
Mental illness can cause significant distress, impaired functioning, or both. Mental
illness may be related to individual, interpersonal, or social/cultural factors. Excessive
dependency on or withdrawal from relationships are interpersonal factors that relate to
mental illness. Individuals suffering from mental illness can feel overwhelmed with
daily life. Individuals suffering from mental illness may experience dissatisfaction with
relationships and self.
3. Which of the following are true regarding mental health and mental illness?
A) Behavior that may be viewed as acceptable in one culture is always unacceptable
in other cultures.
B) It is easy to determine if a person is mentally healthy or mentally ill.
C) In most cases, mental health is a state of emotional, psychological, and social
wellness evidenced by satisfying interpersonal relationships, effective behavior
and coping, positive self-concept, and emotional stability.
D) Persons who engage in fantasies are mentally ill.
What one society may view as acceptable and appropriate behavior, another society may
see that as maladaptive, and inappropriate. Mental health and mental illness are difficult
to define precisely. In most cases, mental health is a state of emotional, psychological,
and social wellness evidenced by satisfying interpersonal relationships, effective
behavior and coping, positive self-concept, and emotional stability. Persons who engage
in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy
is an individual factor that may contribute to mental illness.
4. A client grieving the recent loss of her husband asks if she is becoming mentally ill
because she is so sad. The nurse’s best response would be,
A) ìYou may have a temporary mental illness because you are experiencing so much
B) ìYou are not mentally ill. This is an expected reaction to the loss you have
C) ìWere you generally dissatisfied with your relationship before your husband’s
D) ìTry not to worry about that right now. You never know what the future brings.î
Mental illness includes general dissatisfaction with self, ineffective relationships,
ineffective coping, and lack of personal growth. Additionally the behavior must not be
culturally expected. Acute grief reactions are expected and therefore not considered
mental illness. False reassurance or overanalysis does not accurately address the client’s
5. The nurse consults the DSM for which of the following purposes?
A) To devise a plan of care for a newly admitted client
B) To predict the client’s prognosis of treatment outcomes
C) To document the appropriate diagnostic code in the client’s medical record
D) To serve as a guide for client assessment
The DSM provides standard nomenclature, presents defining characteristics, and
identifies underlying causes of mental disorders. It does not provide care plans or
prognostic outcomes of treatment. Diagnosis of mental illness is not within the
generalist RN’s scope of practice, so documenting the code in the medical record would
6. Which would be a reason for a student nurse to use the DSM?
A) Identifying the medical diagnosis
B) Treat clients
C) Evaluate treatments
D) Understand the reason for the admission and the nature of psychiatric illnesses.
Although student nurses do not use the DSM to diagnose clients, they will find it a
helpful resource to understand the reason for the admission and to begin building
knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis,
treating, and evaluating treatments are not a part of the nursing process.
7. The legislation enacted in 1963 was largely responsible for which of the following shifts
in care for the mentally ill?
A) The widespread use of community-based services
B) The advancement in pharmacotherapies
C) Increased access to hospitalization
D) Improved rights for clients in long-term institutional care
The Community Mental Health Centers Construction Act of 1963 accomplished the
release of individuals from long-term stays in state institutions, the decrease in
admissions to hospitals, and the development of community-based services as an
alternative to hospital care.
8. Which one of the following is a result of federal legislation?
A) Making it easier to commit people for mental health treatment against their will.
B) Making it more difficult to commit people for mental health treatment against
C) State mental institutions being the primary source of care for mentally ill persons.
D) Improved care for mentally ill persons.
Commitment laws changed in the early 1970s, making it more difficult to commit
people for mental health treatment against their will. Deinstitutionalization
accomplished the release of individuals from long-term stays in state institutions.
Deinstitutionalization also had negative effects in that some mentally ill persons are
subjected to the revolving door effect, which may limit care for mentally ill persons.
9. The goal of the 1963 Community Mental Health Centers Act was to
A) ensure patients’ rights for the mentally ill.
B) deinstitutionalize state hospitals.
C) provide funds to build hospitals with psychiatric units.
D) treat people with mental illness in a humane fashion.
The 1963 Community Mental Health Centers Act intimated the movement toward
treating those with mental illness in a less restrictive environment. This legislation
resulted in the shift of clients with mental illness from large state institutions to care
based in the community. Answer choices A, C, and D were not purposes of the 1963
Community Mental Health Centers Act.
10. The creation of asylums during the 1800s was meant to
A) improve treatment of mental disorders.
B) provide food and shelter for the mentally ill.
C) punish people with mental illness who were believed to be possessed.
D) remove dangerous people with mental illness from the community.
The asylum was meant to be a safe haven with food, shelter, and humane treatment for
the mentally ill. Asylums were not used to improve treatment of mental disorders or to
punish mentally ill people who were believed to be possessed. The asylum was not
created to remove the dangerously mentally ill from the community.
11. The major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing the residents.
B) stigma associated with residence in an insane asylum.
C) clients were geographically isolated from family and community.
D) increasing financial costs to individual residents.
Ans: A, C
Clients were often far removed from the local community, family, and friends because
state institutions were usually in rural or remote settings. Choices B and D were not
major problems associated with large state instructions.
12. A significant change in the treatment of people with mental illness occurred in the 1950s
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) the Patient’s Bill of Rights was enacted.
D) psychotropic drugs became available for use.
The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Answer choices A, B, and C did not occur in the 1950s.
13. Before the period of the enlightenment, treatment of the mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve their souls.
C) placing the mentally ill on display for the public’s amusement.
D) providing a safe refuge or haven offering protection.
In 1775, visitors at St. Mary’s of Bethlehem were charged a fee for viewing and
ridiculing the mentally ill, who were seen as animals, less than human. Custodial care
was not often provided as persons who were considered harmless were allowed to
wander in the countryside or live in rural communities, and more dangerous lunatics
were imprisoned, chained, and starved. In early Christian times, primitive beliefs and
superstitions were strong. The mentally ill were viewed as evil or possessed. Priests
performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted
with offenders burned at the stake. It was not until the period of enlightenment when
persons who were mentally ill were offered asylum as a safe refuge or haven offering
protection at institutions.
14. The first training of nurses to work with persons with mental illness was in 1882 in
D) New York
The first training for nurses to work with persons with mental illness was in 1882 at
McLean Hospital in Belmont, Massachusetts.
15. What is meant by the term ìrevolving door effectî in mental health care?
A) An overall reduction in incidence of severe mental illness
B) Shorter and more frequent hospital stays for persons with severe and persistent
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings
The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are
quickly discharged into the community where services are not adequate; without
adequate community services, clients become acutely ill and require rehospitalization.
The revolving door effect does not refer to flexible treatment settings for mentally ill.
Even though hospitalization is more expensive than outpatient treatment, if utilized
appropriately could result in stabilization and less need for emergency department visits
and/or rehospitalization. The revolving door effect does not relate to the incidence of
severe mental illness.
16. Which of the following statements is true of treatment of people with mental illness in
the United States today?
A) Substance abuse is effectively treated with brief hospitalization.
B) Financial resources are reallocated from state hospitals to community programs
C) Only 25% of people needing mental health services are receiving those services.
D) Emergency department visits by persons who are acutely disturbed are declining.
Only one in four (25%) adults needing mental health care receives the needed services.
Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in
the current managed care environment. Money saved by states when state hospitals were
closed has not been transferred to community programs and support. Although people
with severe and persistent mental illness have shorter hospital stays, they are admitted to
hospitals more frequently. In some cities, emergency department visits for acutely
disturbed persons have increased by 400% to 500%.
17. Which of the following is the priority of the Healthy People 2020 objectives for mental
A) Improved inpatient care
B) Primary prevention of emotional problems
C) Stress reduction and management
D) Treatment of mental illness
The objectives are to increase the number of people who are identified, diagnosed,
treated, and helped to live healthier lives. The objectives also strive to decrease rates of
suicide and homelessness, to increase employment among those with serious mental
illness, and to provide more services both for juveniles and for adults who are
incarcerated and have mental health problems. Answer choices A, B, and C are not
priorities of Healthy People 2020.
18. Which is a positive aspect of treating clients with mental illness in a community-based
A) ìYou will not be allowed to go out with your friends while in the program.î
B) ìYou will have to have supervision when you want to go anywhere else in the
C) ìYou will be able to live in your own home while you still see a therapist
D) ìYou will have someone in your home at all times to ask questions if you have any
Clients can remain in their communities, maintain contact with family and friends, and
enjoy personal freedom that is not possible in an institution. Full-time home care is not
included in community-based programs.
19. One of the unforeseen effects of the movement toward community mental health
A) fewer clients suffering from persistent mental illnesses.
B) an increased number of hospital beds available for clients seeking treatment.
C) an increased number of admissions to available hospital services.
D) Longer hospital stays for people needing mental health services.
Although people with severe and persistent mental illness have shorter hospital stays,
they are admitted to hospitals more frequently. Although deinstitutionalization reduced
the number of public hospital beds by 80%, the number of admissions to those beds
correspondingly increased by 90%. The number of individuals with mental illness did
20. Which is included in Healthy People 2020 objectives?
A) To decrease the incidence of mental illness
B) To increase the number of people who are identified, diagnosed, treated, and
helped to live healthier lives
C) To provide mental health services only in the community
D) To decrease the numbers of people who are being treated for mental illness
One of the Healthy People 2020 objectives is to increase the number of people who are
identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to
decrease the incidence of mental illness. At this time, the focus is on ensuring that
persons with mental illness are receiving needed treatment. It may not be possible or
desirable to provide mental health services only in the community.
21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a
community mental health center. Treatment most likely provided at the center includes
A) medical management of symptoms.
B) daily psychotherapy.
C) constant staff supervision.
D) psychological stabilization.
Community mental health centers focus on rehabilitation, vocational needs, education,
and socialization, as well as on management of symptoms and medication. Daily
therapies, constant supervision, and stabilization require a more acute care inpatient
22. Which of the following is defined as an advanced-level function in the practice area of
psychiatric mental health nursing?
A) Case management
D) Health teaching
Advanced-level functions are psychotherapy, prescriptive authority, consultation and
liaison, evaluation, and program development and management. Case management,
counseling, and health teaching are basic-level functions in the practice area of
psychiatric mental health nursing.
23. Psychiatric nursing became a requirement in nursing education in which year?
It was not until 1950 that the National League for Nursing, which accredits nursing
programs, required schools to include an experience in psychiatric nursing.
24. A new graduate nurse has accepted a staff position at an inpatient mental health facility.
The graduate nurse can expect to be responsible for basic-level functions, including
A) providing clinical supervision.
B) using effective communication skills.
C) adjusting client medications.
D) directing program development.
Basic-level functions include counseling, milieu therapy, self-care activities,
psychobiologic interventions, health teaching, case management, and health promotion
and maintenance. Advanced-level functions include psychotherapy, prescriptive
authority for drugs, consultation and liaison, evaluation, program development and
management, and clinical supervision.
25. Which one of the following is one of the American Nurses Association standards of
practice for psychiatricñmental health nursing?
A) Prescriptive authority is granted to psychiatricñmental health registered nurses.
B) All aspects of Standard 5: Implementation may be carried out by
psychiatricñmental health registered nurses.
C) Some aspects of Standard 5: Implementation may only be carried out by
psychiatricñmental health advanced practice nurses.
D) Psychiatricñmental health advanced practice nurses are the only ones who may
provide milieu therapy.
Prescriptive authority is used by psychiatricñmental health advanced practice registered
nurses in accordance with state and federal laws and regulations. Standards 5DñG are
advanced practice interventions and may be performed only by the psychiatricñmental
health advanced practice registered nurse. Psychiatricñmental health registered nurses
may provide milieu therapy according to Standard 5C. This is not restricted to
psychiatricñmental health advanced practice nurses.
26. Which of the following is a standard of professional performance?
Education is a standard of professional performance. Other standards of professional
performance include the quality of practice, professional practice evaluation,
collegiality, collaboration, ethics, research, resource utilization, and leadership.
Assessment, planning, and implementation are components of the nursing process, not
standards of professional performance.
27. Which of the following is a standard of practice?
A) Quality of care
B) Outcome identification
D) Performance appraisal
Standards of practice include assessment, diagnosis, outcomes identification, planning,
implementation, coordination of care, health teaching and health promotion, and milieu
therapy. The standards of professional performance include quality of practice,
education, professional practice evaluation, collegiality, collaboration, ethics, research,
resource utilization, and leadership.
28. A student appears very nervous on the first day of clinical in a psychiatric setting. The
student reviews the instructor’s guidelines and appropriately takes which of the
following actions? Select all that apply.
A) Tells the client about personal events and interests
B) Discusses the anxious feelings with the instructor
C) Assumes that the client’s unwillingness to talk to a student nurse is a personal
insult or failure
D) Builds rapport with the patient before asking personal questions
E) Consults the instructor if a shocking situation arises
F) Gravitates to clients that the student may know personally
Ans: B, D, E
Listening carefully, showing genuine interest, and caring about the client are extremely
important rather than speaking about oneself. The student must deal with his or her own
anxiety about approaching a stranger to talk about very sensitive and personal issues.
Student nurses should not see the client’s unwillingness to talk to a student nurse as a
personal insult or behavior. Being available and willing to listen are often all it takes to
begin a significant interaction with someone. Questions involving personal matters
should not be the first thing a student says to the client. These issues usually arise after
some trust and rapport have been established. The nursing instructor and staff are
always available to assist if the client is shocking or distressing to the student. If the
student recognizes someone he or she knows, it is usually best for the student to talk
with the client and reassure him or her about confidentiality. The client should be
reassured that the student will not read the client’s record and will not be assigned to
work with the client.
29. The appropriate action for a student nurse who says the wrong thing is to
A) pretend that the student nurse did not say it.
B) restate it by saying, ìThat didn’t come out right. What I meant was…î
C) state that it was a joke.
D) ignore the error, since no one is perfect.
No one magic phrase can solve a client’s problems; likewise, no single statement can
significantly worsen them. Listening carefully, showing genuine interest, and caring
about the client are extremely important. A nurse who possesses these elements but says
something that sounds out of place can simply restate it by saying, ìThat didn’t come out
right. What I meant wasÖî Pretending that the student nurse did not say it, stating that it
was a joke, and ignoring the error are not likely to help the student nurse build and
maintain credibility with the client.