Chapter 1
1. Th nurse is assessing th factors contributing to th well-being of a newly admitted client. Whchof th following would th nurse identify as
... [Show More] having a positive impact on th individual's mental health?
A) Not needing othrs for companionship
B) Th 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 threfore a healthy person would need othrs for companionship. A family history of mental illness could relate to th biologic makeup of an individual, whchmay 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. Whchof th 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.
3. Whchof th following are true regarding mental health and mental illness?
A) Behavior that may be viewed as acceptable in one culture is always unacceptable in othr 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. Ans: C
Feedback:
What one society may view as acceptable and appropriate behavior, anothr 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 th inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness.
4. A client grieving th recent loss of her husband asks if she is becoming mentally ill because she is so sad. Th nurse's best response would be,
A) ìYou may have a temporary mental illness because you are experiencing so much pain.î
B) ìYou are not mentally ill. This is an expected reaction to th loss you have experienced.î
C) ìWere you generally dissatisfied with your relationship be4 your husband's death?î
D) ìTry not to worry about that right now. You never know what th future brings.î Ans: B
Feedback:
Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally th behavior must not be culturally expected. Acute grief reactions are expected and threfore not considered mental illness. False reassurance or overanalysis does not accurately address th client's concerns.
5. Th nurse consults th DSM for whchof th following purposes?
A) To devise a plan of care for a newly admitted client
B) To predict th client's prognosis of treatment outcomes
C) To document th appropriate diagnostic code in th client's medical record
D) To serve as a guide for client assessment Ans: D
Feedback:
Th 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 th generalist RN's scope of practice, so documenting th code in th medical record would be inappropriate.
6. Whchwould be a reason for a student nurse to use th DSM?
A) Identifying th medical diagnosis
B) Treat clients
C) Evaluate treatments
D) Understand th reason for th admission and th nature of psychiatric illnesses. Ans: D
Feedback:
Although student nurses do not use th DSM to diagnose clients, thy will find it a helpful resource to understand th reason for th admission and to begin building knowledge about th nature of psychiatric illnesses. Identifying th medical diagnosis, treating, and evaluating treatments are not a part of th nursing process.
7. Th legislation enacted in 1963 was largely responsible for whchof th following shifts in care for th mentally ill?
A) Th widespread use of community-based services
B) Th advancement in pharmacothrapies
C) Increased access to hospitalization
D) Improved rights for clients in long-term institutional care Ans: A
Feedback:
Th Community Mental Health Centers Construction Act of 1963 accomplished th release of individuals from long-term stays in state institutions, th decrease in admissions to hospitals, and th development of community-based services as an alternative to hospital care.
8. Whchone of th following is a result of federal legislation?
A) Making it easier to commit people for mental health treatment against thir will.
B) Making it more difficult to commit people for mental health treatment against thir will.
C) State mental institutions being th primary source of care for mentally ill persons.
D) Improved care for mentally ill persons. Ans: B
Feedback:
Commitment laws changed in th early 1970s, making it more difficult to commit people for mental health treatment against thir will. Deinstitutionalization accomplished th release of individuals from long-term stays in state institutions. Deinstitutionalization also had negative effects in that some mentally ill persons are subjected to th revolving door effect, whchmay limit care for mentally ill persons.
9. Th goal of th 1963 Community Mental Health Centers Act was to
A) ensure patients' rights for th 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:
Th 1963 Community Mental Health Centers Act intimated th movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in th shift of clients with mental illness from large state institutions to care based in th community. Answer choices A, C, and D were not purposes of th 1963 Community Mental Health Centers Act.
10. Th creation of asylums during th 1800s was meant to
A) improve treatment of mental disorders.
B) provide food and shelter for th mentally ill.
C) punish people with mental illness who were believed to be possessed.
D) remove dangerous people with mental illness from th community. Ans: B
Feedback:
Th asylum was meant to be a safe haven with food, shelter, and humane treatment for th mentally ill. Asylums were not used to improve treatment of mental disorders or to punish mentally ill people who were believed to be possessed. Th asylum was not created to remove th dangerously mentally ill from th community.
11. Th major problems with large state institutions are: Select all that apply.
A) attendants were accused of abusing th 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 th 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 th treatment of people with mental illness occurred in th 1950s when
A) community support services were established.
B) legislation dramatically changed civil commitment procedures.
C) th Patient's Bill of Rights was enacted.
D) psychotropic drugs became available for use. Ans: D
Feedback:
Th development of psychotropic drugs, or drugs used to treat mental illness, began in th 1950s. Answer choices A, B, and C did not occur in th 1950s.
13. Be4 th period of th enlightenment, treatment of th mentally ill included
A) creating large institutions to provide custodial care.
B) focusing on religious education to improve thir souls.
C) placing th mentally ill on display for th 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 th 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 th 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. Th mentally ill were viewed as evil or possessed. Priests performed exorcisms to rid evil spirits, and in th colonies, witch hunts were conducted with offenders burned at th stake. It was not until th period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions.
14. Th first training of nurses to work with persons with mental illness was in 1882 in whchstate?
A) California
B) Illinois
C) Massachusetts
D) New York Ans: C Feedback:
Th 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 th 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 mental illness
C) Flexible treatment settings for mentally ill
D) Most effective and least expensive treatment settings Ans: B
Feedback:
Th revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into th community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. Th 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. Th revolving door effect does not relate to th incidence of severe mental illness.
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