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Foundations of psychiatric- mental health nursing
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 - ✔✔Ans: B Feedback: 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 social- cultural factors of health. Total self-reliance is not possible, and a positive social/cultural factor is access to adequate resources. 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. - ✔✔Ans: B Feedback: 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. 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 Feedback: 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. A significant change in the treatment of people with mental illness occurred in the 1950s when 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. - ✔✔Ans: D Feedback: 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. 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. - ✔✔Ans: C Feedback: 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. The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California
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%. Which of the following is the priority of the Healthy People 2020 objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness - ✔✔Ans: D Feedback: 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. Which is a positive aspect of treating clients with mental illness in a community-based care? A) "You will not be allowed to go out with your friends while in the program." B) "You will have to have supervision when you want to go anywhere else in the community." C) "You will be able to live in your own home while you still see a therapist regularly." D) "You will have someone in your home at all times to ask questions if you have any concerns." - ✔✔Ans: C Feedback: 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. One of the unforeseen effects of the movement toward community mental health services is 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. - ✔✔Ans: C
Feedback: 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 not change. 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 daily life. E) Individuals suffering from mental illness may experience dissatisfaction with relationships and self. - ✔✔Ans: A, D, E Feedback: 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. 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 - ✔✔Ans: B Feedback: 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.
Which one of the following is one of the American Nurses Association standards of practice for psychiatric-mental health nursing? A) Prescriptive authority is granted to psychiatric-mental health registered nurses. B) All aspects of Standard 5: Implementation may be carried out by psychiatric-mental health registered nurses. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatric-mental health advanced practice nurses. D) Psychiatric-mental health advanced practice nurses are the only ones who may provide milieu therapy. - ✔✔Ans: C Feedback: Prescriptive authority is used by psychiatric-mental health advanced practice registered nurses in accordance with state and federal laws and regulations. Standards 5D-G are advanced practice interventions and may be performed only by the psychiatric-mental health advanced practice registered nurse. Psychiatric-mental health registered nurses may provide milieu therapy according to Standard 5C. This is not restricted to psychiatric-mental health advanced practice nurses. Which of the following is a standard of practice? A) Quality of care B) Outcome identification C) Collegiality D) Performance appraisal - ✔✔Ans: B Feedback: 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. 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 Feedback: 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. 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, "That didn't come out right. What I meant was..." C) state that it was a joke. D) ignore the error, since no one is perfect. - ✔✔Ans: B Feedback: 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, "That didn't come out right. What I meant was..." 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. 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.
A) Identifying the medical diagnosis B) Treat clients C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses. - ✔✔Ans: D Feedback: 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. 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 - ✔✔Ans: A Feedback: 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. 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 their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons. - ✔✔Ans: B Feedback: 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.
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. - ✔✔Ans: B Feedback: 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. A client with schizophrenia has been non-compliant with medications. The client requires frequent admissions to the psychiatric unit for acute psychotic episodes. What is this process called? - ✔✔revolving door If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief? - ✔✔C) "I can accept that you feel it is lucky, so let's get to our activities for the day." Nursing education has become broad in practice settings. The addition of Psychiatric nursing became a requirement in nursing education in 1950 by whom? - ✔✔C) National League of Nursing The case manager is providing an educational seminar for the nursing staff, she includes objectives from Healthy People 2020. Which of the following is the priority of the objectives for mental health? - ✔✔D) Treatment of mental illness The Geri-Psych nurse understands that the DSM-5 describes all mental disorders with specific criteria. The DSM-5 has the following purposes: Select all that apply. - ✔✔B) to provide a standardized nomenclature and language for all mental health professionals. D) to present defining characteristics or symptoms that differentiate specific diagnoses. E) to assist in identifying the underlying causes of disorders.
