Test Bank: Psychiatric-Mental Health Nursing 8th edition Mohr 978-1609137083

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  • Test Bank: Psychiatric-Mental Health Nursing 8th edition Mohr 978-1609137083
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  • Published: 2012
  • ISBN-10: 1609137086
  • ISBN-13: 978-1609137083
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Test Bank: Psychiatric-Mental Health Nursing 8th edition Mohr 978-1609137083

Chapter: Chapter 01: Introduction to Psychiatric-Mental Health Nursing

Multiple Choice

1.  A nurse is giving a presentation about preventing mental illness to college freshmen. A student asks, “What does it mean to be mentally healthy?” Which of the following potential responses by the nurse is best?

A)  “Mental health is difficult to define and depends on cultural norms.”

B)  “Mental health is marked by productivity, fulfilling relationships, and adaptability.”

C)  “Mental health is characterized by the absence of mental illness.”

D)  “Mental health is the performance of behavior that is accepted as normal.”

Ans:  B

Chapter:  01

Client Needs:  C

Cognitive Level:  Knowledge

Difficulty:  Easy

Integrated Process:  Teaching/Learning

Objective:  01

Page and Header:  2, Mental Health

Feedback:  Mental health means the successful performance of mental function, resulting in productive activities, fulfilling relationships, and the ability to adapt to change and cope with adversity. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

2.  A 48-year-old independent, successful woman is recovering from a modified radical mastectomy. She states she was grateful that during the first few weeks after surgery her mother stayed with her and did “everything” for her. Which element of mental health does this reflect?

A)  Reality orientation

B)  Mastery of the environment

C)  Self-governance

D)  Tolerance of the unknown

Ans:  C

Chapter:  01

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  2, Elements of and Influences on Mental Health

Feedback:  In self-governance, the person acts independently, dependently, or interdependently as the need arises without permanently losing his or her autonomy. Tolerance of the unknown means the person faces the uncertainty of life and the certainty of death with faith and hope. To master the environment, the person becomes competent, effective, and creative in interacting with and influencing his or her environment. Reality orientation involves differentiating fact from fantasy and behaving accordingly.

3.  Why is the document Mental Health: A Report of the Surgeon General (1999) most significant?

A)  Because it states clearly that there are effective treatments for mental illness

B)  Because it allocates research money to psychiatric facilities

C)  Because it sets new guidelines for use of restraints

D)  Because it establishes reimbursement guidelines for third-party payers

Ans:  A

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  02

Page and Header:  3, Mental Health as a National Priority

Feedback:  Mental Health: A Report of the Surgeon General addressed that mental health is fundamental to and necessary for a healthy life; mental disorders are real health conditions with enormous consequences for individuals, families, communities, and the nation; effective treatments for mental disorders are available; a range of treatment options is available for most mental disorders; and those with mental disorders or symptoms should seek treatment.

4.  While a nurse is performing an admission assessment for a mental health client, the client states that all of his problems have been caused by his parents. The nurse knows that psychological factors that can influence mental health include which of the following?

A)  Neuroanatomy

B)  Emotional developmental level

C)  Values and beliefs

D)  Religion

Ans:  B

Chapter:  01

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  3, Figure 1.2

Feedback:  Psychological influences on mental health include interactions, intelligence quotient, self-concept, skills, creativity, and emotional developmental level. Neuroanatomy is a biological influence on mental health. Values, beliefs, and religion are sociocultural influences on mental health.

5.  What is the primary purpose of the five-axis system used in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR)?

A)  To separate the various mental disorders into five related categories

B)  To give a comprehensive picture of client functioning

C)  To improve prognostic ability

D)  To provide a decision-making algorithm for pharmacologic treatment

Ans:  B

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  03

Page and Header:  7, Five Axes of the DSM

Feedback:  The categorical classification of the DSM-IV-TR uses a five-axis system to give a comprehensive picture of the client’s functioning.

6.  One limitation of the DSM relates to diagnostic labels given to children. The most problematic issue caused by applying adult categories to children is which of the following?

A)  It prevents the proper treatment of childhood disorders.

B)  The criteria for diagnosis of a disorder are flexible for an adult, but not for children.

C)  Categories are based on manifestations of adult disorders, not research in children.

D)  The DSM was written before childhood psychological conditions were recognized.

Ans:  C

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Communication and Documentation

Objective:  03

Page and Header:  8, Limitations and Criticisms of the DSM

Feedback:  The DSM diagnostic labels for children were derived from adult categories. The most problematic related issue is that the diagnoses are not based on a body of research on children—similar disorders may have different signs and symptoms for each age group.

7.  Which of the following represents a problem complicating the treatment of people with mental illness?

A)  Insurers’ reimbursement decisions

B)  Increased responsibility for care by state mental hospitals

C)  Overuse of the well-coordinated mental health care system

D)  Lack of effective treatments

Ans:  A

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Knowledge

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  10, Cost-Related Issues

Feedback:  A goal of behavioral health-managed care has been to reduce hospital admissions, which are the most expensive part of psychiatric care. Unfortunately, some managed care “gatekeepers” have denied or restricted access to needed services and therefore have added to the discouragement, distress, and even despair of clients and their families.

8.  Julie, a 47-year-old woman, missed 1 week of work when she was hospitalized with bipolar disorder. She was placed on medication and was able to return to work. When asked about her absence, Julie informed coworkers that she was suffering from influenza. What is the most likely reason Julie lied about her illness?

A)  This is a sign that the medication is not effectively treating her illness.

B)  Fear of rejection, isolation, and discrimination based on her mental health diagnosis

C)  Due to workplace policies that encourage the firing of those with mental illnesses

D)  To avoid eliciting sympathy among her coworkers

Ans:  B

Chapter:  01

Client Needs:  C

Cognitive Level:  Evaluation

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  10, Stigma

Feedback:  Strong stigma still attaches to people who suffer from mental illness, largely related to public misunderstandings, misconceptions, and associated fears. At a personal level, people with mental illness must deal with painful rejection, isolation, and discrimination that erode self-assurance and can systematically undermine self-confidence. Stigma creates or reinforces interpersonal, financial, employment, and social barriers to accessing care.

9.  A 22-year-old man with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client attended a prestigious art school and enjoyed many social and leisure activities. Of the following long-term goals for this client, which is consistent with an overarching recovery goal for all clients with mental disorders?

A)  The client will not injure himself.

B)  The client’s symptoms will be reduced.

C)  The client will show interest in social and leisure activities.

D)  The client will resume pre-illness functioning.

Ans:  D

Chapter:  01

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing process

Objective:  04

Page and Header:  12, Beyond Response to Recovery

Feedback:  The aim now is for clients to recover or to experience a remission and be restored to pre-illness functioning in various domains, such as occupationally, socially, and educationally.

10.  Which of the following approaches to care best reflects cultural competence?

A)  Always assign nurses of a specific ethnic background to clients with the same ethnic background.

B)  Learn the behaviors and values associated with people of specific ethnic backgrounds.

C)  Assess the culturally mediated beliefs of each client.

D)  Believe that people are more alike than they are different.

Ans:  C

Chapter:  01

Client Needs:  C

Cognitive Level:  Analysis

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  12, Culturally Competent Care

Feedback:  Culturally competent care means that care is provided in a manner acceptable to the person’s cultural background, regardless of whether it is provided by a care provider from the same ethnic or minority group as the client. Health care professionals must be able to incorporate cultural factors including language, customs, beliefs, and traditions into plans of care.

11.  The family advocacy movement and the National Alliance for the Mentally Ill (NAMI) have identified stages through which families progress when confronting the mental illness of a loved one. Which of the following accurately reflects the stages identified in the Family Advocacy Model?

A)  Dealing with a catastrophic event, learning to cope, moving into advocacy

B)  Learning acceptance, experiencing grief, developing advocacy

C)  Beginning recognition, denial, grief, acceptance, advocacy

D)  Learning to cope, understanding, advocating

Ans:  A

Chapter:  01

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  14, Table 1.2 and Table 1.3

Feedback:  Initially, when dealing with the catastrophic event, the family is overwhelmed, confused, and lost. They then learn to cope and realize the illness is a reality. The family often expresses grief, fear, and sorrow over lost possibilities and the uncertain future. Finally, moving into advocacy is evidenced when family members develop empathy, acknowledge and own the situation, and focus anger and grief on empowerment.

12.  According to research conducted by the National Alliance for the Mentally Ill (NAMI), the first event and stage of the Client Adaptation Model includes which of the following?

A)  Event: crisis, stage: recuperation

B)  Event: awakening, stage: recuperation

C)  Event: decision, stage: rebuilding

D)  Event: crisis, stage: recovery/discovery

Ans:  A

Chapter:  01

Client Needs:  C

Cognitive Level:  Knowledge

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  05

Page and Header:  14, Table 1.3

Feedback:  The first event and stage of the Client Adaptation Model are crisis and recuperation, the second event and stage are decision and rebuilding, and the final event and stage are awakening and recovery/discovery.

13.  Which of the following interventions is appropriate for a psychiatric–mental health nurse at the basic level of practice?

A)  Promoting symptom management

B)  Managing psychotropic medications

C)  Conducting family therapy

D)  Interpreting laboratory tests

Ans:  A

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  06

Page and Header:  15, Levels of Practice

Feedback:  Basic psychiatric–mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric–mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

14.  An adolescent has a history of self-mutilation. The nurse questions the client about factors that the client believes to contribute to her behavior. The nurse’s questioning reflects which principle?

A)  That every person deserves respect

B)  That all people share basic human needs

C)  That through the therapeutic use of self, nurses can help people adapt, change, and grow

D)  That all behavior is meaningful and can be understood from the person’s perspective

Ans:  D

Chapter:  01

Client Needs:  C

Cognitive Level:  Application

Difficulty:  Difficult

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  16, Guiding Principles

Feedback:  Psychiatric–mental health nursing is built on certain principles or beliefs about people and the care they deserve: Every person is worthy of dignity and respect; every person has the potential to change and grow; all people share basic human needs; all behavior is meaningful and can be understood from the person’s perspective; people have the right to participate in decisions affecting their health and treatment. Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. While all the above principles are followed, the nurse’s questioning in the stem best reflects the principle that all behavior has meaning and can be understood from the person’s perspective.

15.  A 44-year-old client with a history of alcohol abuse and schizophrenia is being treated as an outpatient. He is living in a group home, has been stable for several months, is not abusing alcohol, and is not experiencing delusions or auditory hallucinations. Which of the following interventions most appropriately includes the client in decisions about his treatment?

A)  Suggest the client decide whether to take his medication, based on his symptoms.

B)  Include the client in developing a treatment plan in case he becomes acutely psychotic in the future.

C)  Agree with the client’s suggestion that he terminate treatment and call if he experiences a relapse.

D)  Encourage the client to make a decision about living independently.

Ans:  B

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Application

Difficulty:  Moderate

Integrated Process:  Teaching/Learning

Objective:  06

Page and Header:  16, The Role of the Psychiatric Nurse as a Team Member

Feedback:  The nurse is a member of an interdisciplinary team. The team also includes the client and his or her family. Collaboration implies that members work toward a common goal and share responsibility for the outcomes of care.

16.  The legal system orders a client with antisocial personality disorder into treatment. He has a history of spousal abuse and multiple arrests and convictions for drug trafficking. Based on the history, the nurse decides to perform a quick assessment and give him information about the anger management classes he is mandated to attend. The nurse’s brief visit and superficial intervention are which of the following?

A)  Appropriate, because clients with antisocial personality disorder resist treatment

B)  Appropriate, because the client is not in treatment willingly

C)  Inappropriate, because all people have the potential to change and grow

D)  Inappropriate, because the nurse did not address the client’s history of drug abuse

Ans:  C

Chapter:  01

Client Needs:  A-1

Cognitive Level:  Evaluation

Difficulty:  Moderate

Integrated Process:  Caring

Objective:  04

Page and Header:  16, Guiding Principles

Feedback:  Psychiatric–mental health nursing is built on certain principles or beliefs about people and the care they deserve: Every person is worthy of dignity and respect; every person has the potential to change and grow; all people share basic human needs; all behavior is meaningful and can be understood from the person’s perspective; people have the right to participate in decisions affecting their health and treatment; and through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow.

17.  What is the main tool at the nurse’s disposal in treating clients with mental disorders?

A)  Psychotropic medications

B)  The therapeutic use of self

C)  Self-help groups

D)  Family education and therapy

Ans:  B

Chapter:  01

Client Needs:  C

Cognitive Level:  Comprehension

Difficulty:  Moderate

Integrated Process:  Nursing process

Objective:  06

Page and Header:  16, Guiding Principles

Feedback:  Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. Medications and education will influence and enhance growth, but the therapeutic use of self is the nurse’s primary tool. Self-help groups do not involve health care professionals.

18.  An adult woman with a diagnosis of major depression has found that few of her peers and family members accurately understand the etiology of her health problem. Which of the following statements best describes the etiology of mental illnesses?

A)  Despite advances in neuroscience, the etiology of mental illnesses is largely unknown.

B)  Mental illnesses are the result of impaired coping skills and personality deficits.

C)  Each specific mental illness is linked to a particular gene defect.

D)  Mental illnesses result from a combination of genetic and environmental factors.

Ans:  D

Chapter:  01

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  01

Page and Header:  7, Etiology

Feedback:  The roots of mental illness are a combination of biologic and environmental factors; however, it is inaccurate to think that any one gene is responsible for any mental disorder. Coping skills and personality affect the onset and course of mental illnesses but these factors are not solely, or even primarily, responsible for their etiology.

19.  A male client with a history of depression and suicide attempts has established a psychiatric advanced directive specifying that he does not wish to be treated with psychotropic medications. The client has been admitted to the hospital following a suicide attempt and has been deemed an acute risk to his own safety. How will the individual’s advanced directive affect his plan of care?

A)  The client will be treated with all appropriate interventions with the exception of medications.

B)  The client will be administered medications if they are determined to be essential to his care.

C)  The client will need to waive his advanced directive if he is to be successfully treated.

D)  The client will be administered medications without his knowledge.

Ans:  B

Chapter:  01

Client Needs:  D-2

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  14, Psychiatric Advanced Directives

Feedback:  Advanced directives are not meant to supersede care necessary to protect client safety. As such, the client may be treated with medications despite his advanced directive. Administering medications without the client’s knowledge is never a preferred approach.

20.  A psychiatric–mental health nurse has witnessed first-hand the high incidence and prevalence of depression in the American population, particularly among older adults. What phenomenon is known to complicate the diagnosis and treatment of depression in older adults?

A)  The disorder is often attributed to the aging process rather than treated aggressively.

B)  Depression results from organic brain changes that occur in both healthy and unhealthy adults.

C)  Older adults are frequently suspicious of psychiatry and of psychotropic medications.

D)  The disorder is often internalized by older adults, making accurate diagnosis challenging.

Ans:  A

Chapter:  01

Client Needs:  D-4

Cognitive Level:  Analysis

Difficulty:  Moderate

Integrated Process:  Nursing Process

Objective:  04

Page and Header:  4, Incidence and Prevalence

Feedback:  Depression, a serious mental health problem for all age groups, is particularly challenging for older adults. Although 8% to 15% of them have depression, the condition often is undiagnosed and untreated for older clients because they, their families, or health care providers mistakenly confuse signs and symptoms with “normal aging.” This phenomenon is more significant than suspicion, internalization of symptoms or organic brain changes.

Test Bank: Psychiatric-Mental Health Nursing 8th edition Mohr 978-1609137083