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Mental Health Nursing II Exam 1: Unit 1-4

Terms in this set (59)

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors?
1.
The client's behaviors demonstrate mental illness in the form of depression.
2.
The client's behaviors are extensive, which indicates the presence of mental illness.
3.
The client's behaviors are not congruent with cultural norms.
4.
The client's behaviors demonstrate no functional impairment, indicating no mental illness.
4

The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations.
At what point should the nurse determine that a client is at risk for developing a mental illness?
1.
When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
2.
When maladaptive responses to stress are coupled with interference in daily functioning.
3.
When a client communicates significant distress.
4.
When a client uses defense mechanisms as ego protection.
2

The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired.
A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents?
1.
Reactions to stress are relative rather than absolute; individual responses to stress vary.
2.
It is abnormal for identical twins to react differently to similar stressors.
3.
Identical twins should share the same temperament and respond similarly to stress.
4.
Environmental influences to stress weigh more heavily than genetic influences.
1

The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress.
Which client should the nurse anticipate to be most receptive to psychiatric treatment?
1.
A Jewish, female social worker.
2.
A Baptist, homeless male.
3.
A Catholic, black male.
4.
A Protestant, Swedish business executive.
1

The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important to physical health.
A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement?
1.
Defense mechanisms can be appropriate responses to stress and need not be eliminated.
2.
Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated.
3.
Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated.
4.
Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
1

The nurse should determine that defense mechanisms can be appropriate during times of stress.
During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response?
1.
"It is just a routine part of our assessment. All clients are asked these same questions."
2.
"Why are you concerned about these types of questions?"
3.
"Psychological factors, like excessive stress, have been found to affect medical conditions."
4.
"We can skip these questions, if you like. It isn't imperative that we complete this section."
3

The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions.
An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee?
1.
The employee assertively confronts the boss.
2.
The employee leaves the staff meeting to work out in the gym.
3.
The employee criticizes a coworker.
4.
The employee takes the boss out to lunch.
3

The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss.
A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism?
1.
Displacement
2.
Projection
3.
Reaction formation
4.
Sublimation
3

The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors.
Which nursing statement about the concept of neurosis is most accurate?
1.
An individual experiencing neurosis is unaware that he or she is experiencing distress.
2.
An individual experiencing neurosis feels helpless to change his or her situation.
3.
An individual experiencing neurosis is aware of the psychological causes of his or her behavior.
4.
An individual experiencing neurosis has a loss of contact with reality.
2
Which nursing statement regarding the concept of psychosis is most accurate?
1.
Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2.
Individuals experiencing psychoses experience little distress.
3.
Individuals experiencing psychoses are aware of experiencing psychological problems.
4.
Individuals experiencing psychoses are based in reality.
2

The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality.
When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial?
1.
The client hides liquor bottles in a closet.
2.
The client yells at her son for slouching in his chair.
3.
The client burns dinner on purpose.
4.
The client says to the spouse, "I don't drink too much!"
4

The client's statement "I don't drink too much!" alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.
Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?
1.
"If only we could have tried again, things might have worked out."
2.
"I am so mad that the children and I had to put up with him as long as we did."
3.
"Yes, it was a difficult relationship, but I think I have learned from the experience."
4.
"I still don't have any appetite and continue to lose weight."
3

The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life.
A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health?
1.
Maintaining a long-term, faithful, intimate relationship
2.
Achieving a sense of self-confidence
3.
Possessing a feeling of self-fulfillment and realizing full potential
4.
Developing a sense of purpose and the ability to direct activities
3

The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow's hierarchy of needs.
According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse?
1.
A client rudely complaining about limited visiting hours
2.
A client exhibiting aggressive behavior toward another client
3.
A client stating that no one cares
4.
A client verbalizing feelings of failure
2

The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow's hierarchy of needs and must be fulfilled before other higher-level needs can be met.
How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following?
1.
Psychosocial, biological, or developmental process underlying mental functioning
2.
Psychological, cognitive, or developmental process underlying mental functioning
3.
Psychological, biological, or developmental process underlying mental functioning
4.
Psychological, biological, or psychosocial process underlying mental functioning
3

he new DSM-5 definition of a mental disorder is "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in the psychological, biological, or developmental process underlying mental functioning."
A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.)
1.
Fidgeting
2.
Laughing inappropriately
3.
Palpitations
4.
Nail biting
5.
Limited attention span
1, 2, 4
_______________________ is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.
Anxiety

The definition of anxiety is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness
_______________________ is a subjective state of emotional, physical, and social responses to the loss of a valued entity.
Grief

The definition of grief is a subjective state of emotional, physical, and social responses to the loss of a valued entity
In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse operating?
1.
Kantianism
2.
Christian ethics
3.
Ethical egoism
4.
Utilitarianism
2

The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is that all decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated.
during a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework?
1.
"I would want to be treated in a caring manner if I were mentally ill."
2.
"This job will pay the bills, and the workload is light enough for me."
3.
"I will be happy caring for the mentally ill. Working in med/surg kills my back."
4.
"It is my duty in life to be a psychiatric nurse. It is the right thing to do."
2

The applicant's comment reflects the ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account.
Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of retaliation. What is the ethical interpretation of the coworker's lack of involvement?
1.
Taking no action is still considered an unethical action by the coworker.
2.
Taking no action releases the coworker from ethical responsibility.
3.
Taking no action is advised when potential adverse consequences are foreseen.
4.
Taking no action is acceptable, because the coworker is only a bystander.
1

The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions.
Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve?
1.
Justice
2.
Autonomy
3.
Veracity
4.
Beneficence
2

The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that health-care workers must respect these decisions.
Which is an example of an intentional tort?
1.
A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome.
2.
A nurse physically places an irritating client in four-point restraints.
3.
A nurse makes a medication error and does not report the incident.
4.
A nurse gives patient information to an unauthorized person.
2

A tort, which can be intentional or unintentional, is a violation of civil law in which an individual has been wronged. A nurse who intentionally physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort.
An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit?
1.
Verbally redirect the client, and then refuse one-on-one interaction.
2.
Involve the hospital's security division as soon as possible.
3.
Notify the client that documenting personal staff information is against hospital policy.
4.
Continue professional attempts to establish a positive working relationship with the client.
4

The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client.
Which statement should a nurse identify as correct regarding a client's right to refuse treatment?
1.
Clients can refuse pharmacological but not psychological treatment.
2.
Clients can refuse any treatment at any time.
3.
Clients can refuse only electroconvulsive therapy (ECT).
4.
Professionals can override treatment refusal by an actively suicidal or homicidal client.
4

The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be in danger or a danger to others. This situation should be treated as an emergency, and treatment may be performed without informed consent.
Which potential client should a nurse identify as a candidate for involuntary commitment?
1.
The client living under a bridge in a cardboard box
2.
The client threatening to commit suicide
3.
The client who never bathes and wears a wool hat in the summer
4.
The client who eats waste out of a garbage can
2

The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatments is in danger and needs emergency treatment.
A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes?
1.
A client makes inappropriate sexual innuendos to a staff member.
2.
A client constantly demands attention from the nurse by begging, "Help me get better."
3.
A client physically attacks another client after being confronted in group therapy.
4.
A client refuses to bathe or perform hygienic activities.
3

The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making informed choices. The client's refusal to accept treatment can be challenged, because the client is endangering the safety of others.
A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations?
1.
The nurse refuses to give any information to the caller, citing rules of confidentiality.
2.
The nurse hangs up on the caller.
3.
The nurse confirms that the person has been at the facility but adds no additional information.
4.
The nurse suggests that the caller speak to the client's therapist.
1

The most appropriate action by the nurse is to refuse to give any information to the caller.
A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle?
1.
Autonomy
2.
Beneficence
3.
Nonmaleficence
4.
Justice
1

The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent.
An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which ethical principle should a nurse determine has been violated based on these actions?
1.
Autonomy
2.
Beneficence
3.
Nonmaleficence
4.
Justice
4

The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally, regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.
Which situation reflects violation of the ethical principle of veracity?
1.
A nurse discusses with a client another client's impending discharge.
2.
A nurse refuses to give information to a physician who is not responsible for the client's care.
3.
A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room.
4.
A nurse does not treat all of the clients equally, regardless of illness severity.
3

The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.
A client who will be receiving ECT must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent?
1.
The client is paranoid.
2.
The client is 87 years old.
3.
The client incorrectly reports his or her spouse's name, date, and time of day.
4.
The client relies on his or her spouse to interpret the information.
3

The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices.
A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home-health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate?
1.
Allow the client to decline the medication and document the decision.
2.
Tell the client that if the medication is refused, hospitalization will occur.
3.
Arrange with a relative to add the medication to the client's morning orange juice.
4.
Call for help to hold the client down while the injection is administered.
1
Which situation exemplifies both assault and battery?
1.
The nurse becomes angry, calls the client offensive names, and withholds treatment.
2.
The nurse threatens to "tie down" the client and then does so, against the client's wishes.
3.
The nurse hides the client's clothes and medicates the client to prevent elopement.
4.
The nurse restrains the client without just cause and communicates this to family.
2
A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client?
1.
The client is placed in seclusion.
2.
The client is placed in a geriatric chair with tray.
3.
The client is placed in soft Posey restraints.
4.
The client is monitored by an ankle bracelet.
4
A brother calls to speak to his sister, who has been admitted to a psychiatric unit. The nurse connects him to the community phone, and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken?
1.
The National Alliance for the Mentally Ill Act
2.
The Tarasoff Ruling
3.
The Health Insurance Portability and Accountability Act
4.
The Good Samaritan Law
3
After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department. The client threatens suicide. Which of the following criteria would enable a physician to consider involuntary commitment? (Select all that apply.)
1.
Being dangerous to others
2.
Being homeless
3.
Being disruptive to the community
4.
Being gravely disabled and unable to meet basic needs
5.
Being suicidal
1, 4, 5
A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or a service is defined as a _______________________.
right
A branch of philosophy that addresses methods for determining the rightness or wrongness of one's actions is defined as _______________________.
Ethics
A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate?
1.
"Medications only address biological factors. Environmental and interpersonal factors must also be considered."
2.
"Because biological factors are the sole cause of depression, medications will improve your mood."
3.
"Environmental factors have been shown to exert the most influence in the development of depression."
4.
"Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."
1

The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.
A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate?
1.
"The occipital lobe governs perceptions, judging them as positive or negative."
2.
"The parietal lobe has been linked to depression."
3.
"The medulla regulates key biological and psychological activities."
4.
"The limbic system is largely responsible for one's emotional state."
4
Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
1.
Peripheral nervous system
2.
Somatic nervous system
3.
Sympathetic nervous system
4.
Parasympathetic nervous system
3
Which client statement reflects an understanding of circadian rhythms in psychopathology?
1.
"When I dream about my mother's horrible train accident, I become hysterical."
2.
"I get really irritable during my menstrual cycle."
3.
"I'm a morning person. I get my best work done before noon."
4.
"Every February, I tend to experience periods of sadness."
3
Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
1.
Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy
2.
Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill
3.
Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents
4.
Studies in which monozygotic twins were raised together by mentally ill biological parents
5.
All of the above
5
Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?
1.
Neuroendocrinology
2.
Psychoneuroimmunology
3.
Diagnostic technology
4.
Neurophysiology
2
A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?
1.
Dendrites
2.
Axons
3.
Neurotransmitters
4.
Synapses
3
An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
1.
Regeneration
2.
Reuptake
3.
Recycling
4.
Retransmission
2
A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter?
1.
Acetylcholine
2.
Dopamine
3.
Serotonin
4.
Norepinephrine
4
A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated?
1.
Serotonin
2.
Dopamine
3.
Gamma-aminobutyric acid (GABA)
4.
Histamine
2
A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations?
1.
The therapist is using an interpersonal approach.
2.
The client has an alteration in neurotransmitters.
3.
It is routine practice to remind clients about nutrition, exercise, and rest.
4.
The client is susceptible to illness because of effects of stress on the immune system.
4
Which mental illness should a nurse identify as being associated with an increase in prolactin hormone level?
1.
Major depressive episode
2.
Schizophrenia
3.
Anorexia nervosa
4.
Alzheimer's disease
2
Which cerebral structure should a nursing instructor describe to students as the "emotional brain"?
1.
The cerebellum
2.
The limbic system
3.
The cortex
4.
The left temporal lobe
2

The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior.
A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?
1.
Acute mania
2.
Schizophrenia
3.
Anorexia nervosa
4.
Alzheimer's disease
3
A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms?
1.
Abnormal levels of serotonin
2.
Decreased levels of dopamine
3.
Increased levels of norepinephrine
4.
Decreased levels of acetylcholine
4
A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?
1.
Bipolar disorder: mania
2.
Schizophrenia spectrum disorder
3.
Generalized anxiety disorder
4.
Major depressive episode
4
A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?
1.
Schizophrenia spectrum disorder
2.
Major depressive disorder
3.
Body dysmorphic disorder
4.
Parkinson's disease
1
Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.)
1.
There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa.
2.
There is a possible correlation between antidiuretic hormone levels and anorexia nervosa.
3.
There is a possible correlation between low levels of gonadotropin and anorexia nervosa.
4.
There is a possible correlation between increased levels of prolactin and anorexia nervosa.
5.
There is a possible correlation between altered levels of oxytocin and anorexia nervosa.
1, 3
Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.)
1.
Depression
2.
Fatigue
3.
Increased libido
4.
Mania
5.
Hyperexcitability
1, 2
____________________________ is the study of the biological foundations of cognitive, emotional, and behavioral processes.
psychobiology
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