Basic Concepts in Psychiatric Mental Health Nursing

Considering the many criteria for good mental health, the nursing student has been instructed to list four of these criteria. The student's list consists of the following: (1) an appropriate perception of reality, (2) the ability to accept oneself, (3) the ability to establish relationships, (4) a need for detachment and the desire for privacy. How would the nurse evaluate the nursing student's list?

A) Excellent. All the student's criteria are correct.

B) Good. Three of the four are correct.

C) Mediocre. Two of the four criteria are correct.

D) Poor. All four of the criteria are correct.

A) Excellent. All the student's criteria are correct.

Which assessment is most important when evaluating signs and symptoms of mental illness?

A) The decreased amount of creativity a client exhibits.

B) The inability to face problems within one's life.

C) The intensity of an emotional reaction.

D) The client's social and cultural norms.

D) The client's social and cultural norms.

Which is an example of an interpersonal intervention for a client on an inpatient psychiatric unit?

A) Assist the client to note common defense mechanisms and coping skills that are being used.

B) Discuss "acting-out" behaviors and assist the client in understanding why the occur.

C) Ask the client to record thoughts he or she is having before "acting-out" behaviors occur.

D) Ask the client to acknowledge one positive person in his or her life to assist the client after discharge.

D) Ask the client to acknowledge one positive person in his or her life to assist the client after discharge.

Which is an example of appropriate psychosexual development?

A) An 18-month-old boy relieves anxiety by the use of a pacifier.

B) A 5-year-old boy focuses on relationships with other boys.

C) A 7-year-old girl identifies with her mother.

D) A 12-month-old begins learning about independence and control.

A) An 18-month-old boy relieves anxiety by the use of a pacifier.

Which client situation is an example of normal ego development?

A) A client continuously calls out to get his or her needs met.

B) A client complains of poor self-esteem because of punishments from his or her past.

C) A client exhibits the ability to assert himself or herself without anger or aggression.

D) A client feels guilty about wanting to have sexual relations outside of marriage.

C) A client exhibits the ability to assert himself or herself without anger or aggression.

After studying the concepts of personality development, the nursing student understands that Freud is to psychoanalytic theory as Peplau is to:

A) Psychosocial theory

B) Nursing theory

C) Interpersonal theory

D) Object relations theory

B) Nursing theory

Nursing theorists identify the nurse-client relationship as central to nursing practice. After studying these concepts, the nursing student understands that Peplau is to the phases of the nurse-client relationship as Watson is to:

A) Seven assumptions about the science of caring.

B) Cultural care diversity and universality.

C) Modeling and role modeling.

D) Human energy fields.

A) Seven assumptions about the science of caring.

After studying nursing interventions in the context of nursing theory, the nursing student understands that Neuman is to primary, secondary, or tertiary prevention as Roy is to:

A) Activities needed to meet self-care demands and solve self-care deficits.

B) Assisting the client to examine and understand the meaning of life experiences.

C) Interventions that alter or manage stimuli so that adaptive responses can occur.

D) Interactions with versus for the client to achieve maximum potential.

C) Interventions that alter or manage stimuli so that adaptive responses can occur.

Which is the goal of the cognitive-behavioral theory model according to Beck and Ellis?

A) Developing satisfactory relationships, maturity, and relative freedom from anxiety.

B) Substituting rational for irrational beliefs and eliminating self-defeating behaviors.

C) Facing reality and developing standards for having responsibly.

D) Reducing bodily tensions and managing stress by biofeedback and relaxation training.

B) Substituting rational for irrational beliefs and eliminating self-defeating behaviors.

Which interaction is an example of dialogue that would be used in the context of reality therapy?

A) Client: "I'm so anxious I can't sleep." Nurse: "I have a relaxation exercise I can show you."

B) Client: "I was punished frequently by my mother and now can't do anything right." Nurse "Tell me about your feelings of anger."

C) Client: "I can't sit still; I'm too anxious and jittery." Nurse: "Let's sit for a while and discuss your anxiety."

D) Client: "The stupid doctor revoked my pass for tomorrow." Nurse: "What did you do that showed that you were not ready for a pass?"

D) Client: "The stupid doctor revoked my pass for tomorrow." Nurse: "What did you do that showed that you were not ready for a pass?"

A 4-year-old child is unable to consider another child's ideas about playing house. This situation is an example of which concept of Piaget's theory of cognitive development?

A) Object permanence

B) Reversibility and spatiality

C) Egocentrism

D) Formal operations

C) Egocentrism

The statement "Growth involves resolution of critical tasks through the eight stages of the life cycle" is a concept of which therapeutic model?

A) Interpersonal

B) Congnitive-behavioral

C) Intrapersonal

D) Psychoanalytic

C) Intrapersonal

A 25-year-old client diagnosed with major depressive disorder remains in his room and avoids others. According to Erikson, what describes this client's developmental task assessment?

A) Stagnation

B) Despair

C) Isolation

D) Role confusion

C) Isolation

A 7-year-old is active in sports and has received a most-improved player award at his baseball tournament. According to Erikson, what describes this client's developmental task assessment?

A) Autonomy

B) Identity

C) Industry

D) Initiative

C) Industry

Which scenario describes an individual in Erikson's developmental stage of "old age" exhibiting a negative outcome of despair?

A) A 60-year-old woman having difficulty taking care of her aged mother.

B) A 50-year-old man reviewing the positive and negative aspects of his life.

C) A 65-year-old man openly discussing his life's accomplishments and failures.

D) A 70-year-old woman angry about where her life has ended up.

D) A 70-year-old woman angry about where her life has ended up.

Which is an example of a individual successfully completing Erikson's "school age" stage of development?

A) A 14-year-old girl verbalizes that she resisted peer pressure to drink alcohol at a party.

B) A 5-year-old boy is able to ask others in his class to play hide-and-seek with him.

C) A 3-year-old boy is able to play by himself while other family members play games.

D) An 11-year-old girl is trying out for cheerleading.

D) An 11-year-old girl is trying out for cheerleading.

Which initial information gathered by the nurse is most important when assessing Erikson's stages of development?

A) The chronological age of the individual.

B) The developmental age exhibited through behaviors.

C) The time-frame needed to complete a successful outcome at a previous stage.

D) The implementation of interventions based on developmental age.

A) The chronological age of the individual.

According to Maslow's hierarchy of needs, which of the following client actions would be considered most basic? Select all that apply.

A) A client discusses the need for order in his or her life and freedom from fear.

B) A client feels lonely and is seeking to share life experiences.

C) A client begins to realize his or her full potential.

D) A client is role-playing a situation with a nurse to practice assertiveness skills.

E) A client seeks shelter at a center for battered women.

ANS: A, E

According to Maslow's hierarchy of needs, which client action would be an example of a highly evolved, mature client?

A) A client discusses the need for avoiding harm and maintaining comfort.

B) A client states the need for giving and receiving support from others.

C) A client begins to discuss feelings of self-fulfillment.

D) A client discusses the need to achieve success and recognition in work.

C) A client begins to discuss feelings of self-fulfillment.

According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention?

A) A client is disturbed that family can be seen only during visiting hours.

B) A client exhibits hostile and angry behaviors toward another client.

C) A client states, "I have no one who cares about me."

D) A client states, "I have never met my career goals."

B) A client exhibits hostile and angry behaviors toward another client.

Rank the following statements using Maslow's hierarchy of needs, starting with the basic level of attainment and progressing toward self-actualization.

1. _______"I am glad I can now be assertive in controversial situations."

2. ______ "My wife and I are planning a second honeymoon for our 20th anniversary."

3. ______ "Using my CPAP machine consistently has eliminated my sleep apnea."

4. ______ "I change my smoke alarm batteries every year on New Year's Day."

5. ______ "Getting my graduate degree was a wonderful 50th birthday gift to myself."

Order: 4, 3, 1, 2, 5

sleep apnea (1)

smoke alarms (2)

honeymoon (3)

assertive (4)

graduate degree (5)

A client is developing a sense of identity and learning to form relationships with persons of the opposite sex. According to Sullivan's theory, this client would be assessed at which stage of development?

A) Childhood (18 months-6 years)

B) Juvenile (6-9 years)

C) Preadolescence (9-12 years)

D) Early adolescents (12-14 years)

D) Early adolescents (12-14 years)

Which of the following client statements are correctly matched with the personality structure as described by Freud that they exemplify? Select all that apply.

A) "I'll return the purse I found. It's never right to steal." : Superego

B) "Coming on to my friend's boyfriend is just plain wrong." : Ego

C) I might get pregnant if I have sex, so I won't do it." " Id

D) "I need that car. No one will miss it." : Id

E) "Cheating on a test could get me expelled, so I won't do it" : Ego

ANS: A, D, E

According to Maslow's hierarchy of needs, which situation demonstrates the lowest level of attainment?

A) An individual demonstrates an ability to discuss objectively all points of view and possesses a strong sense of ethics.

B) An individual avoids harm while maintaining comfort, order, and physical safety.

C) An individual establishes meaningful interpersonal relationships and can identify himself or herself within a group.

D) An individual desires prestige from personal accomplishments.

B) An individual avoids harm while maintaining comfort, order, and physical safety.

Which of the following statements are true as they relate to the history of psychopharmacology? Select all that apply.

A) Before 1950, only sedatives and amphetamines were available as psychotropics.

B) Phenothiazines were initially used in pain management for their sedative effect.

C) Atypical antipsychotics were the first medications used to treat the positive symptoms of schizophrenia.

D) Psychotropic medications have assisted health-care providers in their struggle to cure mental illness.

E) Newly developed atypical psychotropics have shown much promise in controlling the negative symptoms of schizophrenia.

ANS: A, E

Which of the following are true statements about neurotransmitters? Select all that apply.

A) Neurotransmitters are responsible for essential functions in human emotions and behaviors.

B) Neurotransmitters are targets for the mechanism of actions of many psychotropic medications.

C) Neurotransmitters are only studied for their effect related to psychiatric disease processes.

D) Neurotransmitters are nerve cells that generate and transmit the body's electrochemical impulses.

E) Neurotransmitters are cholinergic, such as serotonin, norepinephrine, dopamine, and histamine.

ANS: A, B

Which functions does the limbic system regulate?

A) Perceptions and interpretations of most sensory information.

B) Auditory functions and short-term memory.

C) Emotional experiences.

D) Visual reception and interpretation.

C) Emotional experiences.

Regarding the etiology of schizophrenia spectrum disorders, which of the following support(s) a biological theory? Select all that apply.

A) Dopamine hypothesis

B) Prenatal exposure to influenza

C) Ventricular and sulci atrophy

D) Downward drift hypothesis

E) Increased levels of serotonin

ANS: A, B, E

A client is hearing voices saying "Kill mother soon." The client states, "I am a prophet." The nurse understands that these symptoms are exhibited because of which brain alteration?

A) A decrease in dopamine in the mesocortical dopamine pathway.

B) An increase in dopamine in the mesolimbic dopamine pathway.

C) An increase in dopamine in the nigrostriatal dopamine

D) A decrease in dopamine in the tuberoinfundibulnar dopamine pathway.

B) An increase in dopamine in the mesolimbic dopamine pathway.

Which situation supports the biological theory of the development of bipolar affective disorder?

A) A client is prescribed a selective serotonin reuptake inhibitor and then exhibits impulsive behaviors, expansive mood, and flight of ideas.

B) A client has three jobs, which require increased amounts of energy and the ability to multitask.

C) A client experiences thoughts of negative self-image and then expresses grandiosity when discussing abilities at work.

D) A client has been raised in a very chaotic household where there was a lack of impulse control related to excessive spending.

A) A client is prescribed a selective serotonin reuptake inhibitor and then exhibits impulsive behaviors, expansive mood, and flight of ideas.

Which of the following medications can cause confusion, depression, and increased anxiety? Select all that apply.

A) Meperidine (Demerol)

B) Dextromethorphan (Robitussin)

C) Loratadine (Claritin)

D) Levodopa (Sinemet)

E) Pseudoephedrine (Sudafed)

ANS: A, D

A physician has ordered genetic testing for a client who is experiencing difficulty metabolizing prescribed medications. To answer the client's questions regarding this new order, which of the following nursing statements should be included? Select all that apply. The genetic testing will:

A) Identify which medications will or will not cause significant side effects.

B) Identify a specific gene that impacts the ability to covert folic acid into active form L-methylfolate

C) Require the client to fast for 12 hours prior to having a blood sample drawn.

D) Work exclusively for clients experiencing depression, anxiety, and attention deficit-hyperactivity disorders.

E) Identify one specific medication to be prescribed for the symptoms experienced.

ANS: A, B

A student nurse asks the instructor about the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Which of the following instructor statements are correct? Select all that apply.

A) "The DSM-5 lists all psychiatric and general medical diagnoses."

B) "The DSM-5 allows clinicians to rate disorders along a continuum of severity."

C) "Conditions that do not meet DSM-5 criteria are termed 'not elsewhere defined' (NED)."

D) "Dimensional assessment tools are included in the DSM-5."

E) Global Assessment of Functioning (GAF) is included in the DSM-5."

ANS: A, B, C, D

Which of the following are reasons for the utilization of the DSM-5 in the mental health-care system? Select all that apply.

A) It is a convenient format for organizing and communicating clinical data.

B) It is a means for considering the complexity of clinical situations.

C) It is a means for describing the unique symptoms of psychiatric clients.

D) It is a format for evaluating clients based on a regulated approach.

E) It is a means to better understand the etiology of many psychiatric disorders.

ANS: A, B

How is the DSM-5 helpful to mental health providers? Select all that apply.

A) The DSM-5 provides a common language related to the diagnoses of mental illness.

B) The DSM-5 lists medications that are appropriate for the treatment of mental disorders.

C) The DSM-5 presents standard criteria for the classification of mental disorders.

D) The DSM-5 provides an axis system to evaluate clients holistically.

E) The DSM-5 presents a comprehensive list of community resources.

ANS: A, C