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Which of the following is a defining characteristic of a mental disorder?
1. A psychological group of symptoms associated with disability
2. A psychological group of symptoms associated with distress
3. A response that is other than that expected and culturally accepted to an event
4. A psychological group of symptoms associated with suffering, pain, loss of freedom, or death
3. Rationale: This characteristic distinguishes mental disorders from other disorders that nurses may encounter
"Deviant behavior" itself does not define mental disorders, unless the deviance or conflict is symptomatic of the individual's dysfunction. "Deviant" behavior is defined by which of the following? Select all that apply.
1. historical and social norms
2. Situational context
3. Peer relationships
4. Understanding of human behavior
5. Political norms
1. Rationale: Today, the "ship of fools" would be described as mass murder
2. Rationale: The man on the street corner who calls himself Napoleon is deviant, yet the man at the masquerade who calls himself Napoleon is ordinary.
4. Rationale: Homosexuality was voted out of the DSM-III in 1973
5. Rationale: Soviet dissidents were diagnosed and institutionalized for deviant behavior labeled as mental illness ("Delusions of Societal Reform")
One of the obstacles in describing mental disorders is that the phrase "deviant behavior":
1. Has a pejorative connotation
2. Derives its meaning from the culture
3. Is used colloquially
4. Is value-free
1. Rationale: It is challenging to describe behavior that deviates from the norm with nonjudgemental , value-neutral language
In the early 19th century, individuals with mental disorders were believed to be:
1. Controlled by evil spirits
2. Influenced by the moon
3. Incurable and dangerous
4. Divinely inspired
3. Rationale: In the early 19th century the emphasis was on classification of symptoms of mental disorders. The mentally ill were seen as dangerous and incurable
Mental disorders were conceptualized as disordered neurology under the purview of medicine by:
4. Rationale: Rush, the father of American psychiatry, viwed mental illness as a neurophysiological disorder.
The nurse is assessing the client for a possible mental disorder using contemporary beliefs about mental illness as a theoretical base for practice. Given this approach, the nurse would definitely as about:
1. Current medications and recent stressors
2. Early childhood experiences and dreams
3. Religious practices
4. Recent blood transfusions
1. Rationale: Asking about current medications will elicit information about any current psychotropic drugs that treat mental illness from a biochemical perspective. Asking about recent stressors will elicit information from the social dimension. These areas reflect contemporary thinking related to mental illness.
Which mental disorders rank among the top ten causes of disability worldwide? (Select all that apply)
2. Antisocial personality disorder
3. Bipolar affective disorder
4. anxiety disorders
3. and 5.
Which mental disorder ranks first among the top ten causes of disability worldwide?
1. Depression ranks first among the top ten causes of disability worldwide
According to Healthy People 2010 report, major mental health problems do not include clients with which of the following? (Select all that apply)
1. Rationale: Only bullet 8 includes people who abuse substances (as individuals with co-occuring substance abuse and mental disorders)
2. Rationale: As veterans return from abroad, incidence and prevalence of PTSD will increase
5. Rationale: As veterans return from abroad, incidence and prevalence of co-occuring mental disorders and traumatic brain injury will increase.
The Healthy People 2010 report suggests that the mental health problems listed are associated with which of the following? (Select all that apply)
2. Rationale: Bullets 5, 7, 8, 1o and 11 pertain to treatment of individuals with identified mental disorders
3. Rationale: the theme of "individuals with identified mental disorders who do not receive treatment," coupled with bullet 10 (cultural competence), suggests that stigma may interfere with treatment
4. Rationale: Bullets 1, 4, 10, 11, and 12 involve screening and identification of at-risk individuals
The basis for evidence-based practice is:
1.The nursing process
2 Clinical reasearch and practice.
3. Critical thinking
4. Clinical algorithms
2. Rationale: Clinical research is the basis for evidence-based practice
An outcome of evidence-based practice includes:
1. Practice guidelines
2. Standardized care
3.Reduced hospital length of stay
4. Reduced workload for nurses
1. Rationale: Based on clinical research and clinical practice, nurses can develop clinical quidelines for nursing care.
Which of the following critical thinking competencies is NOT applicable to evidence-based practice?
1. Identifying meaningful research evidence
2. Critically and objectively critiquing research evidence
3. Integrating personal experiences and beliefs into the process
4. Developing a plan of care based on research findings.
3. Rationale: Including personal experiences and beliefs will inhibit one's ability to remain objective
A benefit of critical pathways is that they:
1. Clearly define skills required to care for clients.
2. Reflect client outcomes based on nursing interventions.
3. Are professional mandates to clinical practice.
4. Are based on trial-and-error nursing.
2. Rationale: Critical pathways integrate nursing interventions to achieve client outcomes
Which step in the nursing process is necessary to initiate a change to evidence-based practice?
1. Rationale: In order to make a change, an assessment of the need to change is needed
The nurse knows that to maintain an evidence-based practice model of care, the nurse will:
1. Follow traditions and customs that have been practiced for years
2. Rely in trial and error to determine the safest method of care
3. Follow the agency's policies and prcedures of care
4. Review current nursing research
4. Rationale: Reviewing current current nursing research will assist the nurse in maintaining an evidence-based model of care
A nurse's first scientific responsibility in conducting research is to:
1. Identify what research questions to pursue
2. Apply to the Institutional Review Board (IRB) for permission to conduct research
3. Identify the participants in the study after the study has been approved
4. Select members of the oversight committee.
1. Rationale: the first step in any research project is to establish the research the research questions that the study will try to answer
In determining a nurse's readiness to engage in evidence-based practice, the nurse will:
1. Ask other staff members what their beliefs are related to evidence-based practice
2. Identify resources needed to access evidence-based information
3. Recognize the value of maintaining the status quo
4. Let other staff initiate the change process
2. Rationale: Determining availability of resources to assist in the change to evidence-based practice will support the change process
To objectively evaluate the findings of a research study, the nurse will:
1. Compare the findings to a similar study
2. Rely on clinical experience and knowledge
3. Replicate the study to determine if similar results are obtained
4. Establish criteria to be used in the evaluation process
4. Rationale: Decide what criteria you will use to evaluate this study's value to clients in your clinical area
The best evidence on which to base your clinical practice is based on:
1. Standards of nursing care
2. Outcomes of a research project
3. Practice guidelines
4. Critical pathways
2. Rationale: Outcomes of research will reveal evidence to support clinical practice
The nurse and physician are discussing a thepeutic approach for a client experiencing depression. The nurse states that clients ahve control over their own lives. What therapeutic approach does this opinion represent?
3. Rationale: The belief that individuals control their own lives and events is the basis of interactionism.
A philosophy of service to benefit humanity through science, reason, and democracy is:
1. Symbolic interactionism
4. Psychic determinism
3. Rationale: Humanism focuses on humanity, science, and democracy.
Which of the following are characterisitcs of a holistic approach to psychiatric-mental health nursing care? (Select all that apply)
1. The biological aspect of illness is considred
2. Physical symptoms are interrelated with mental factors
3. Mental illness does not impact physiologi homeostasis
4. The client's socioeconomic status is considered in planning care
5. The client's spiritual needs are not considered when planning nursing care
1. Rationale: A holistic approach to psychiatric-mental health nursing care examines how physiologic changes that occur with an illness affect emotional well-being.
2. Rationale: Physical symptoms can directly impact a client's emotional well-being and mental health.
4. Rationale: A client's socioeconomic status can directly affect a client's ability to access health care.
The psychiatric mental-health nurse is utilizing interactionism as a theraeutic modality for clients. In using this model, the nurse understansa that:
1. The underlying cause of mental illness is organic and located in the CNS
2. Each psychic event is determined by the ones that preceed it
3. All behavior has meaning
4. The focus of treatment is on the present rather than the past.
3. Rationale: The belief that behavior has different meanings for different people reflects interactionism
According to psychoanalytic theory, the superego is concerned with:
1. The desire to seek pleasure while avoiding pain
2. the ability to delay an immediate release of tension or achievement of pleasure
3. Moral behavior
4. Mutually satisfying relationships with others
3. Rationale: The superego focuses on moral behavior.
The role of the nurse in a humanistic interactional therapeutic model includes:
1. Participating in political systems to promote a holistic approach to mental health care
2. Advanced knowledge of cient dynamics and personality development
3. Implementing a token economy to reward desirable client behavior
4. Outreach and case management to a large group of clients with chronic mental illness
1. Rationale: The humanistic interactional model promotes a holisitc approach to mental health care.
The nurse asks the client to describe what the client was feeling prior to an outburst of aggressive behavior during group therapy. The nurse is utilizing what theoretical framework?
3. Cognitive behavioral
3. Rationale: Cognitive behavioral interventions focus on what the client thinks and feels and identifies the meaning of behavior
The nurse explains to a group of clients that they will receive an additional 30 minutes of recreation time if they actively participate in group therapy. What is this an example of?
1. Conditioned response
3. Operant conditioning
4. Positive punishment
2. Rationale: Reinforcement rewards desired behaviors
The belief that emotional and behavioral disturbances are teh result of a disease process reflects which theory?
1. Psychic determinism
3. Symbolic interactionism
4. Rationale: Psychobiology focuses on the disease process and how it impacts mental health
In the general systems theory framework, nursing care is based on the belief that:
1. Mental illness is caused by an organic disease process
2. Clients need to understan the meaning of their behavior before they can overcome it.
3. Individuals have the capacity to avoid anxiety and establish security
4. A holistic approach to care includes the client system.
4. Rationale: General systems theory looks at the whole being, including the family structure, and is a holistic approach.
Which of the following is most congruent with the nursing process?
1. Social readjustment rating
2. General adaptation syndrome
3. Process of cognitive appraisal
4. Categorization of individuals as either "disease prone" or "self-healing"
3. Rationale: The steps of primary appraisal, secondary appraisal, coping, and reappraisal may be equated with assessment, planning, implementation, and evaluation.
Your client, a survivor of Hurricane Katrina, now owns her own house and business. She describes herself as "successful and blessed." She reports difficulty falling asleep "nearly every night" and has had sleep deprivation for over 2 years. "I didn't have insomnia before the storm. I should be happy. I have more than I ever did before." Based on this information, your tentative nursing diagnosis is:
1. Insomnia related to anticipation of threat to basic needs and security
2. Insomnia related to survivor guilt
3. Alteration in self-concept related to survivoe guilt
4. Anxiety related to inevitability of future loss
1. Rationale: The sleep pattern disturbance of insomnia is the client's presenting problem. The etiology relates to potential threat. Either actual interference with basic needs or anticipation of interference with basic needs may cause anxiety.
Which of the following scenarios depicts an individual using symbolic substitutes as a coping strategy?
1. Despite knowledge of the health consequences, a health care provider smokes a pack a day, and two packs every Monday. The individual reports smoking as "soothing"
2. Your client has been in recovery form alcohol and chemical dependence for 25 years. The client states, "When I don't know what else to do I go to bed. i always feel better when I get out of bed."
3. Your co-worker, a psychiatric-mental health nurse, does not believe psychotherapy whould be effective for herself. "I'm into self-analysis. I usually get what I need as i meditate the problem"
4. Your friend informs you that when she is stressed, she copes with massages, mancures, and osmetic makeovers. "When my body looks better and feels better, it makes me feel emotionally grounded, like the outside mirrors the inside."
4. Rationale: For this individual, physical appearance and comfort are a symbolic substitute for management of emotional tension
Everyday methods people use to cope and Antonovsky's generalized resistance resources (GRRs) are congruent with which of the following?
1. Resistance phase of the General Adaption Syndrome
2. the client's score on the Social Readjustment Scale
3. Defense mechanisms
4. Lazarus's Secondary appraisal results
4. Rationale: Generalized resistance resources (factors in the person, group, or organization that help in managing tension) equate to secondary appraisal results (coping resources and options)
A peer on the Medical-Surgical floor consults with you regarding a client admitted with an infection-induced delirium. Her family reports she has never discussed religion, but in her delirium, she appears fearful and screams, "I repent here before the fires of Hell!" Your peer says, "Her family wants to know where that came from." The information you reccommend for the family is based on your knowledge of which of the following defense mechanisms?
1. Rationale: Repression is the basis for all defense mechanisms and refers to the unconscious exclusion of distressing thoughts and feelings from awareness. Clients experiencing delirium may verbalize feelings such as guilt that were previously repressed.
Which of the following statements is FALSE?
1. Fantasy is a common defense mechanism of young children.
2. Dissociation is functional for adults
3. Projection and reaction formation are associated with paranoid thinking
4. Rationalization is associated with rejection of personal responsibility
2. Rationale: Dissociation is often disruptive for adults when they act without conscious awareness and have periods of time for which they can not account. Dissociation serves an important purpose for a child in a traumatic situation, keeping the trauma from conscious awareness.
Whenever you inquire about the circumstances of your client's admission to your inpatient psychiatric unit, your client responds, "I would rather not talk about that." As the client's discharge date approaches, which nursing intervention is most essential?
1. Reiterate the need to deal with recent stressors, since discharge is imminent.
2. Confront the client's denial
3.Review the police report and list some coping strategies for the client to utilize after discharge.
4. Create a safe interpersonal environment so that the client can explore precipitating events.
4. Rationale: A safe interpersonal environment reduces anxiety. If the client perceives decreased anxiety, the client will experience decreased threat and increased ability to work with the nurse.
Your client blames his family for the exacerbation of ulcerative colitis. You establish the foundation for a trusting relationship. the client reports "having rapport" with you. If your goal is to explore family relationships, which nursing strategy should you implement next?
1. Gather date about family circumstances
2. Matter-of-factly point out the need to accept responsibility for physical illness
3. Explore strressors and methods of coping that have been effective in the past.
4. Connect the client's family with a chronic illness support group
1. Rationale: An accurate assessment of family circumstances and the client's perception is the basis on which interventions are built.
Your client has been hospitalized for the 17th time with chronic schizophrenia, paranoid type. For years, he has steadfastly denied having mental illness. During this hospitalization, you overhear him telling another client that he thinks he may have "this horrible disease". Which nursing intervention is most essential?
1. Modify his priority nursing care plan problem from "Ineffective Denial" to "Spiritual Distress"
2. Give him positive reinforcement for his insight
3. Gather more data regarding his mental status.
4. Reassure him that many clients with schizophrenia may lead productive lives
3. Rationale: You need more data regarding the nature of "this horrible disease." (He may not be referring to schizophrenia). If the disease to which he refers is schizophrenia, denial has been protecting him form anxiety. He may experience increased disorganization and may harm himself.
Clients whose medical conditions are intensely influenced by psychological or behavioral factors:
1. Have few dependence and aggression conflicts
2. Are excellent candidates for long-term psychotherapy
3. Display insight and interest in self-awareness and personal growth
4. Demonstrate involvement of the neurological, endocrine, and immunological systems.
4. Rationale: The emotional centers of the brain-the cerebral cortex and limbic system- are intimately tied to the endocrine organs, through the axis of the hypothalamus and the anterior pituitary.
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