MULTIPLE CHOICE

1. A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced

practice nurse to perform which additional intervention? a. Conduct mental health

assessments.

b. Prescribe psychotropic medication.

c. Establish therapeutic relationships.

d. Individualize nursing care plans.

ANS: B

In most states, prescriptive privileges are granted to master’s-prepared nurse practitioners and

clinical nurse specialists who have taken special courses on prescribing medication. The nurse

prepared at the basic level is permitted to perform mental health assessments, establish

relationships, and provide individualized care planning.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-23 TOP:

Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

2. A nursing student expresses concerns that mental health nurses “lose all their clinical nursing

skills.” Select the best response by the mental health nurse.

a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient

ratios must be better because of the nature of the patients’ problems.”

b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve

multidimensional problems. I am challenged by those situations.”

c. “That’s a misconception. Psychiatric nurses frequently use high technology monitoring

equipment and manage complex intravenous therapies.”

d. “Psychiatric nurses do not have to deal with as much pain and suffering as medical–

surgical nurses do. That appeals to me.”

ANS: B

The practice of psychiatric nursing requires a different set of skills than medical–surgical

nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients

with medical as well as mental health problems, reflecting the holistic perspective these

nurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased,

just like other specialties. Psychiatric nursing involves clinical practice, not just

documentation. Psychosocial pain and suffering are as real as physical pain and suffering.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 1-2, 21 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

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3. When a new bill introduced in Congress reduces funding for care of persons diagnosed with

mental illness, a group of nurses write letters to their elected representatives in opposition to

the legislation. Which role have the nurses fulfilled?

a. Recovery

b. Attending

c. Advocacy

d. Evidence-based practice

ANS: C

An advocate defends or asserts another’s cause, particularly when the other person lacks the

ability to do that for self. Examples of individual advocacy include helping patients

understand their rights or make decisions. On a community scale, advocacy includes political

activity, public speaking, and publication in the interest of improving the human condition.

Since funding is necessary to deliver quality programming for persons with mental illness, the

letter-writing campaign advocates for that cause on behalf of patients who are unable to

articulate their own needs.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-26 TOP:

Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment

4. A family has a long history of conflicted relationships among the members. Which family

member’s comment best reflects a mentally healthy perspective?

a. “I’ve made mistakes but everyone else in this family has also.”

b. “I remember joy and mutual respect from our early years together.”

c. “I will make some changes in my behavior for the good of the family.”

d. “It’s best for me to move away from my family. Things will never change.”

ANS: C

The correct response demonstrates the best evidence of a healthy recognition of the

importance of relationships. Mental health includes rational thinking, communication skills,

learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may

be healthy, but the correct response shows a higher level of mental health. The other incorrect

responses show blaming and avoidance.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 1-2, 3, 32 (Figure 1-1) TOP: Nursing Process: Assessment MSC:

Client Needs: Psychosocial Integrity

5. Which assessment finding most clearly indicates that a patient may be experiencing a mental

illness? The patient

a. reports occasional sleeplessness and anxiety.

b. reports a consistently sad, discouraged, and hopeless mood.

c. is able to describe the difference between “as if” and “for real.”

d. perceives difficulty making a decision about whether to change jobs.

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ANS: B

The correct response describes a mood alteration, which reflects mental illness. The

distracters describe behaviors that are mentally healthy or within the usual scope of human

experience.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 1-2 to 4 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

6. Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was

achieved for an adult patient? The patient

a. sees self as capable of achieving ideals and meeting demands.

b. behaves without considering the consequences of personal actions.

c. aggressively meets own needs without considering the rights of others.

d. seeks help from others when assuming responsibility for major areas of own life.

ANS: A

The correct response describes an adaptive, healthy behavior. The distracters describe

maladaptive behaviors.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 1-2 to 4 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form.

Which resource should the nurse consult to determine criteria used to establish this diagnosis? a.

International Statistical Classification of Diseases and Related Health Problems

(ICD-10)

b. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice

c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V)

d. A behavioral health reference manual

ANS: C

The DSM-V gives the criteria used to diagnose each mental disorder. It is the official guideline

for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a

psychiatric illness.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 1-18, 19 TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

8. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource

would have the most complete information?

a. Nursing Outcomes Classification (NOC)

b. DSM-V

c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10

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ANS: B

The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official

guideline for diagnosing psychiatric disorders. The other references are good resources but do

not define the diagnostic criteria.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 1-18, 19 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

9. Which individual is demonstrating the highest level of resilience? One who

a. is able to repress stressors.

b. becomes depressed after the death of a spouse.

c. lives in a shelter for 2 years after the home is destroyed by fire.

d. takes a temporary job to maintain financial stability after loss of a permanent job.

ANS: D

Resilience is closely associated with the process of adapting and helps people facing

tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the

resources they need to support their well-being. Repression and depression are unhealthy.

Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related

audience response question.

PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-5, 6

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

10. Complete this analogy. NANDA: clinical judgment: NIC: a. patient

outcomes.

b. nursing actions.

c. diagnosis.

d. symptoms.

ANS: B

Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis

Association, identifies diagnostic statements regarding human responses to actual or potential

health problems. These statements represent clinical judgments. NIC (Nursing Interventions

Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing

care activities may be direct or indirect.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 1-21, 22 TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment

11. An adult says, “Most of the time I’m happy and feel good about myself. I have learned that

what I get out of something is proportional to the effort I put into it.” Which number on this

mental health continuum should the nurse select?

5

Ment al Illness Mental Health

1 2 3 4 5

a. 1

b. 2

c. 3

d. 4

e. 5

ANS: E

The adult is generally happy and has an adequate self-concept. The statement indicates the

adult is reality-oriented, works effectively, and has control over own behavior. Mental health

does not mean that a person is always happy.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 1-2, 3, 32 (Figure 1-1) TOP: Nursing Process: Assessment MSC:

Client Needs: Psychosocial Integrity

12. Which disorder is an example of a culture-bound syndrome?

a. Epilepsy

b. Schizophrenia

c. Running amok

d. Major depressive disorder

ANS: C

Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized

by people in those cultures. A syndrome recognized in parts of Southeast Asia is running

amok, in which a person (usually a male) runs around engaging in furious, almost

indiscriminate violent behavior.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-7 TOP:

Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

13. The DSM-V classifies:

a. deviant behaviors.

b. present disability or distress.

c. people with mental disorders.

d. mental disorders people have.

ANS: D

The DSM-V classifies disorders people have rather than people themselves. The terminology

of the tool reflects this distinction by referring to individuals with a disorder rather than as a

“schizophrenic” or “alcoholic,” for example. Deviant behavior is not generally considered a

mental disorder. Present disability or distress is only one aspect of the diagnosis.

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PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 1-18, 19 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

14. A citizen at a community health fair asks the nurse, “What is the most prevalent mental disorder

in the United States?” Select the nurse’s correct response. a. Schizophrenia

b. Bipolar disorder

c. Dissociative fugue

d. Alzheimer’s disease

ANS: D

The 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65% and 50%

for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence

of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 1-33 (Table 1-1) TOP: Nursing Process: Implementation MSC: Client

Needs: Health Promotion and Maintenance

15. In the majority culture of the United States, which individual has the greatest risk to be labeled

mentally ill? One who

a. describes hearing God’s voice speaking.

b. is usually pessimistic but strives to meet personal goals.

c. is wealthy and gives away $20 bills to needy individuals.

d. always has an optimistic viewpoint about life and having own needs met.

ANS: A

The question asks about risk. Hearing voices is generally associated with mental illness, but in

charismatic religious groups, hearing the voice of God or a prophet is a desirable event.

Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The

individuals described in the other options are less likely to be labeled mentally ill.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 1-3, 4

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

16. A patient’s relationships are intense and unstable. The patient initially idealizes the significant

other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will

benefit from interventions to develop which aspect of mental health? a. Effectiveness in work

b. Communication skills

c. Productive activities

d. Fulfilling relationships

ANS: D

The information given centers on relationships with others that are described as intense and

unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially

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integrated. Data are not present to describe work effectiveness, communication skills, or

activities.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 1-32 (Figure 1-1) TOP: Nursing Process: Planning MSC: Client

Needs: Psychosocial Integrity

17. Which belief will best support a nurse’s efforts to provide 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 unchanged from culture to culture.

d. Assessment findings in mental illness reflect a person’s cultural patterns.

ANS: D

Symptoms must be understood in terms of a person’s cultural background. 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. The

distracters are untrue statements.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-27

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial

Integrity

18. A nurse is part of a multidisciplinary team working with groups of depressed patients. One

group of patients receives supportive interventions and antidepressant medication. The other

group receives only medication. The team measures outcomes for each group. Which type of

study is evident?

a. Incidence

b. Prevalence

c. Comorbidity

d. Clinical epidemiology

ANS: D

Clinical epidemiology is a broad field that addresses studies of the natural history (or what

happens if there is no treatment and the problem is left to run its course) of an illness, studies

of diagnostic screening tests, and observational and experimental studies of interventions used

to treat people with the illness or symptoms. Prevalence refers to numbers of new cases.

Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the

number of new cases of mental disorders in a healthy population within a given period. See

related audience response question.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 1-17 TOP:

Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment

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19. The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how events

from childhood have anything to do with this disabling illness.” Which response by the nurse

will best help the spouse understand the cause of this disorder?

a. “Psychological stress is the basis of most mental disorders.”

b. “This illness results from developmental factors rather than stress.”

c. “Research shows that this condition more likely has a biological basis.”

d. “It must be frustrating for you that your spouse is sick so much of the time.”

ANS: C

Many of the most prevalent and disabling mental disorders have strong biological influences.

Genetics are only one part of biological factors. Empathy does not address increasing the

spouse’s level of knowledge about the cause of the disorder. The other distracters are not

established facts.

PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 1-5, 6

TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

20. A category 5 tornado occurred in a community of 400 people. Many homes and businesses were

destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with

posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases?

a. Prevalence

b. Comorbidity

c. Incidence

d. Parity

ANS: C

Incidence refers to the number of new cases of mental disorders in a healthy population within

a given period of time. Prevalence describes the total number of cases, new and existing, in a

given population during a specific period of time, regardless of when they became ill. Parity

refers to equivalence, and legislation required insurers that provide mental health coverage to

offer annual and lifetime benefits at the same level provided for medical–surgical coverage.

Comorbidity refers to having more than one mental disorder at a time.