Chapter 2

Question 1

1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient:
   a. says, “I knew this would happen eventually.”
   b. stops attending her weekly water aerobics class.
   c. refuses to use a walker and says, “I don’t need that silly thing.”
   d. says, “Maybe some physical therapy will help me with my balance.”

Answer 1

ANS: D
Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying “I knew this would happen eventually” and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial.

Question 2

2. Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as “In Our Own Voice” (IOOV)?
   a. American Psychiatric Association (APA)
   b. National Alliance on Mental Illness (NAMI)
   c. United States Department of Health and Human Services (USDHHS)
   d. North American Nursing Diagnosis Association International (NANDA-I)

Answer 2

ANS: B
Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses. The APA publishes the DSM 5. The USDHHS regulates and administers health policies.

Question 3

3. A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient:
   a. describes coping and relaxation strategies used when feeling anxious.
   b. describes mood as consistently sad, discouraged, and hopeless.
   c. can perform tasks attempted within the limits of own abilities.
   d. reports occasional problems with insomnia.

Answer 3

ANS: B
A patient who reports having a consistently negative mood is describing a mood alteration. The incorrect options describe mentally healthy behaviors and common problems that do not indicate mental illness.

Question 4

4. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will:
   a. describe feelings associated with loss and stress.
   b. meet own needs without considering the rights of others.
   c. identify healthy coping behaviors in response to stressful events.
   d. allow others to assume responsibility for major areas of own life.

Answer 4

ANS: C
The patient’s ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors.

Question 5

5. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient’s insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis?
   a. A psychiatric nursing textbook
   b. NANDA International (NANDA-I )
   c. A behavioral health reference manual
   d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Answer 5

ANS: D
The DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manual may not contain diagnostic criteria.

Question 6

6. A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of:
   a. the degree of conformity of the individual to society’s norms.
   b. the degree to which an individual is logical and rational.
   c. a continuum from mentally healthy to unhealthy.
   d. the rate of intellectual and emotional growth.

Answer 6

ANS: C
Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to society’s norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness.

Question 7

7. A 40-year-old adult living with parents states, “I’m happy but I don’t socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them.” A nurse should identify interventions to improve this patient’s:
   a. self-concept.
   b. overall happiness.
   c. appraisal of reality.
   d. control over behavior.

Answer 7

ANS: A
The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Although the patient reports being happy, the subsequent comments refute that self-appraisal. The patient’s comments do not indicate that he/she is out of touch with reality. The patient’s needs are broader than control over own behavior.

Question 8

8. A patient tells a nurse, “I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems.” Select the nurse’s best response.
   a. “Comparing yourself with others has no real advantages.”
   b. “Why do you blame yourself for having a psychiatric illness?”
   c. “Mental illness affects 50% of the adult population in any given year.”
   d. “It sounds like you are concerned that others don’t experience the same challenges as you.”

Answer 8

ANS: D
Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing.

Question 9

9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurse’s best response.
   a. “No functional difference exists between the two diagnoses. Both serve to identify a human deviance.”
   b. “The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.”
   c. “The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.”
   d. “The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience.”

Answer 9

ANS: D
The medical diagnosis, defined according to the DSM-5, is concerned with the patient’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient’s response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems.

Question 10

10. The spouse of a patient diagnosed with schizophrenia says, “I don’t understand why childhood experiences have anything to do with this disabling illness.” Select the nurse’s response that will best help the spouse understand this condition.
    a. “Psychological stress is actually at the root of most mental disorders.”
    b. “We now know that all mental illnesses are the result of genetic factors.”
    c. “It must be frustrating for you that your spouse is sick so much of the time.”
    d. “Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important.”

Answer 10

ANS: D
Many of the most prevalent and disabling mental disorders have been found to have strong biological influences. Helping the spouse understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse’s level of knowledge about the cause of the patient’s condition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.

Question 11

11. Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session?
    a. All mental illnesses are culturally determined.
    b. Schizophrenia and bipolar disorder are cross-cultural disorders.
    c. Symptoms of mental disorders are constant from culture to culture.
    d. Some symptoms of mental disorders may reflect a person’s cultural patterns.

Answer 11

ANS: D
A nurse who understands that a patient’s symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.

Question 12

12. A patient’s history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient’s needs are not met. Which aspect of mental health is a problem?
    a. Effectiveness in work
    b. Communication skills
    c. Productive activities
    d. Fulfilling relationships

Answer 12

ANS: D
The information provided centers on relationships with others, which are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

Question 13

13. In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill?
    a. Person who is usually pessimistic but strives to meet personal goals
    b. Wealthy person who gives $20 bills to needy individuals in the community
    c. Person with an optimistic viewpoint about life and getting his or her own needs met
    d. Person who attends a charismatic church and describes hearing God’s voice

Answer 13

ANS: D
Hearing voices is generally associated with mental illness; however, in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill.

Question 14

14. A participant at a community education conference asks, “What is the most prevalent type of mental disorder in the United States?” Select the nurse’s best response.
    a. “Why do you ask?”
    b. “Schizophrenia”
    c. “Affective disorders”
    d. “Anxiety disorders”

Answer 14

ANS: D
The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.

Question 15

15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult?
    a. U.S. Department of Health and Human Services
    b. Journal of the American Psychiatric Association
    c. North American Nursing Diagnosis Association International (NANDA-I)
    d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Answer 15

ANS: D
The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful information but are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder.

Question 16

16. A patient in the emergency department reports, “I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me.” Which aspects of mental health have the greatest immediate concern to a nurse? Select all that apply.
    a. Happiness
    b. Appraisal of reality
    c. Control over behavior
    d. Effectiveness in work
    e. Healthy self-concept

Answer 16

ANS: B, C, E
The aspects of mental health of greatest concern are the patient’s appraisal of and control over behavior. The patient’s appraisal of reality is inaccurate, and auditory hallucinations are evident, as well as delusions of persecution and grandeur. In addition, the patient’s control over behavior is tenuous, as evidenced by the plan to “stab” anyone who seems threatening. A healthy self-concept is lacking. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.

Question 17

17. Which statements most clearly reflect the stigma of mental illness? Select all that apply.
    a. “Many mental illnesses are hereditary.”
    b. “Mental illness can be evidence of a brain disorder.”
    c. “People claim mental illness so they can get disability checks.”
    d. “If people with mental illness went to church, they would be fine.”
    e. “Mental illness is a result of the breakdown of the American family.”

Answer 17

ANS: C, D, E
Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.