Chapter 1: Mental Health and Mental Illness

Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the clients behaviors? A The clients behaviors de onstrate ental illness in the for of depression. . ! The clients behaviors are extensive, which indicates the presence of ental illness. . " The clients behaviors are not congruent with cultural nor s. . # The clients behaviors de onstrate no functional i pair ent, indicating no ental . illness.

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$. At what point should the nurse deter ine that a client is at ris% for developing a ental illness? A &hen thoughts, feelings, and behaviors are not reflective of the #'()*+)T, criteria. . ! &hen aladaptive responses to stress are coupled with interference in daily functioning. . " &hen a client co unicates significant distress. . # &hen a client uses defense echanis s as ego protection. .

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-. A nurse is assessing a set of 1.)year)old identical twins who respond very differently to stress. /ne twin beco es anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents? A ,eactions to stress are relative rather than absolute0 individual responses to stress vary. . ! *t is abnor al for identical twins to react differently to si ilar stressors. . " *dentical twins should share the sa e te pera ent and respond si ilarly to stress. . # 1nviron ental influences to stress weigh ore heavily than genetic influences. .

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2. A nurse is co pleting an interview in which a clients spouse reports that a client drin%s excessively and has lost driving privileges due to conviction of driving while i paired. ,efusing treat ent, the client states, 3* wor% hard every day to provide for y fa ily. * dont see why * cant relax with a little drin%.4 The nurse should recogni5e that this response indicates the use of which defense echanis ? A 6ro7ection . ! ,ationali5ation .

" ,egression . # 'ubli ation .

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.. &hich client should the nurse anticipate to be A A 8ewish, fe ale social wor%er . ! A !aptist, ho eless ale . " A "atholic, blac% ale . # A 6rotestant, 'wedish business executive .

ost receptive to psychiatric treat ent?

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9. &hich state ent about a clients use of defense echanis s should a nurse identify as being correct? A #efense echanis s can be appropriate responses to stress and need not be eli inated. . ! #efense echanis s are a aladaptive atte pt of the ego to anage anxiety and should . always be eli inated. " #efense echanis s, used by individuals with wea% ego integrity, should be . discouraged and not eli inated. # #efense echanis s cause disintegration of the ego and should be fostered and . encouraged.

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:. #uring an inta%e assess ent, a nurse as%s both physiological and psychosocial ;uestions. The client angrily responds, 3* here for y heart, not y head proble s.4 &hich is the nurses best response? A 3*ts 7ust a routine part of our assess ent. All clients are as%ed these sa e ;uestions.4 . ! 3&hy are you concerned about these types of ;uestions?4 . " 36sychological factors, li%e excessive stress, have been found to affect edical . conditions.4 # 3&e can s%ip these ;uestions, if you li%e. *t isnt i perative that we co plete this . section.4

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<. &hich state ent reflects a student nurses accurate understanding of the concepts of illness? A The concepts are rigid and religiously based. . ! The concepts are ultidi ensional and culturally defined. . " The concepts are universal and unchanging. . # The concepts are unidi ensional and fixed. .

ental health and

ental

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=. >oo%ing at a clients history and physical exa , a nurse notices that a diagnosis of rheu atoid arthritis has not been placed on any axis. !ased on %nowledge of the #'()*+)T,, where should the nurse anticipate the coding of this assess ent? A Axis * . ! Axis ** . " Axis *** . # Axis *+ . 1 Axis + .

____ 1?. A nurse understands that 3financial and legal difficulties4 are to Axis *+ of the #'()*+)T, as 3bipolar disorder4 is to which axis? A Axis * . ! Axis ** . " Axis *** . # Axis *+ .

____ 11. &hich state ent should a nurse identify as the ost accurate description of the #'()*+)T,s definition of a ental disorder? A A ental disorder is said to exist when an individuals behavior deviates fro the group . nor . ! A ental disorder results when an individual is unable to cope with the stressors of . everyday life. " A ental disorder exists when sub7ective distress causes the individual to fail at any . tas%s. # A ental disorder is a clinically significant behavioral or psychological pattern that is . associated with present distress or disability.

____ 1$. An e ployee uses the defense echanis of displace ent when the boss openly disagrees with suggestions. &hat behavior would be expected fro this e ployee? A The e ployee assertively confronts the boss. . ! The e ployee leaves the staff eeting to wor% out in the gy . . " The e ployee critici5es a cowor%er. . # The e ployee ta%es the boss out to lunch.

____ 1-. A teenage boy is attracted to a fe ale teacher. &ithout ob7ective evidence, a school nurse overhears the boy state, 3* %now she wants e.4 This state ent reflects which defense echanis ? A #isplace ent . ! 6ro7ection . " ,ationali5ation . # 'ubli ation .

____ 12. A fourth)grade boy teases and a%es 7o%es about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense echanis ? A #isplace ent . ! 6ro7ection . " ,eaction for ation . # 'ubli ation .

____ 1.. &hich state ent about the concept of neuroses should a nurse define as ost accurate? A An individual experiencing neurosis is unaware that he or she is experiencing distress. . ! An individual experiencing neurosis feels helpless to change his or her situation. . " An individual experiencing neurosis is aware of psychological causes of his or her . behavior. # An individual experiencing neurosis has a loss of contact with reality. .

____ 19. &hich state ent should a nurse identify as ost accurate regarding the concept of psychosis? A *ndividuals experiencing psychoses are aware that their behaviors are aladaptive. . ! *ndividuals experiencing psychoses experience little distress. . " *ndividuals experiencing psychoses are aware of experiencing psychological proble s. . # *ndividuals experiencing psychoses are based in reality. .

____ 1:. &hile ta%ing a clients health history, a nurse learns that, when under stress, a client routinely uses an excessive a ount of alcohol. The client states that a spouse constantly yells at the client about the chronic alcohol abuse. &hich reported action should the nurse associate with the use of the defense echanis of denial? A Hiding li;uor bottles in a closet. . ! @elling at their son for slouching in his chair. . " !urning dinner on purpose. . # 'aying to the spouse, 3* dont drin% too uchA4 .

____ 1<. #evastated by a divorce fro an abusive husband, a wife co pletes grief counseling. &hich state ent by the wife should indicate to a nurse that the client is in the acceptance stage of grief? A 3*f only we could have tried again, things ight have wor%ed out.4 . ! 3* a so ad that the children and * had to put up with hi as long as we did.4 . " 3@es, it was a difficult relationship, but * thin% * have learned fro the experience.4 . # 3* still dont have any appetite and continue to lose weight.4 .

____ 1=. A nurse is perfor ing a ental health assess ent on an adult client. According to (aslows hierarchy of needs, which client action would de onstrate the highest achieve ent in ter s of ental health? A (aintaining a long)ter , faithful, inti ate relationship. . ! Achieving a sense of self)confidence. . " 6ossessing a feeling of self)fulfill ent and reali5ing full potential. . # #eveloping a sense of purpose and the ability to direct activities. .

____ $?. According to (aslows hierarchy of needs, which situation on an in)patient psychiatric unit would re;uire priority intervention by a nurse? A A client rudely co plaining about li ited visiting hours. . ! A client exhibiting aggressive behavior toward another client. . " A client stating that no one cares. . # A client verbali5ing feelings of failure. .

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 1. A nurse is assessing a client who appears to by experiencing so e anxiety during ;uestioning. &hich sy pto s ight the client de onstrate that would indicate anxiety? B'elect all that apply.C A Didgeting . ! >aughing inappropriately . " 6alpitations . # Eail biting . 1 >i ited attention span .

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$. &hich infor ation should a nurse code on a #'()*+)T, axis? B'elect all that apply.C A 6hysical disorders . ! 6sychosocial stressors . " Treat ent reco endations . # Flobal assess ent of functioning . 1 6ast suicide atte pts .

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-. How is the #'()*+)T, useful in the practice of psychiatric nursing? B'elect all that apply.C A *t considers level of functioning as well as proble s. . ! *t represents progress toward a ore holistic view of indGbody. . " *t provides a fra ewor% for interdisciplinary co unication. . # *t provides a te plate for nursing care plans. . 1 *t provides a fra ewor% for co unication with the client. .

Chapter 1: Mental Health and Mental Illness Answer Section

MULTIPLE CHOICE 1. AE'H # The nurse should assess that the clients daily functioning is not i paired. The client who experiences feelings of sadness after the loss of a pet is responding within nor al expectations. &ithout significant i pair ent, the clients distress does not indicate a ental illness. 6T'H 1 ,1DH 6ageH 9 I1@H "ognitive >evelH Analysis J *ntegrated 6rocessH Assess ent $. AE'H ! The nurse should deter ine that the client is at ris% for ental illness when responses to stress are aladaptive and interfere with daily functioning. The #'()*+)T, indicates that in order to be diagnosed with a ental illness, daily functioning ust be significantly i paired. The clients ability to co unicate distress would be considered a positive attribute. 6T'H 1 ,1DH 6ageH 9 I1@H "ognitive >evelH Application J *ntegrated 6rocessH Assess ent -. AE'H A The nurse should explain to the parents that, although the twins have identical #EA, there are several other factors that affect reactions to stress. (ental health is a state of being that is relative to the individual client. 1nviron ental influences and te pera ent can affect stress reactions. 6T'H 1 ,1DH 6ageH . I1@H "ognitive >evelH Application J *ntegrated 6rocessH * ple entation 2. AE'H ! The nurse should recogni5e that the client is using rationali5ation, a co on defense echanis . The client is atte pting to a%e excuses and create logical reasons to 7ustify unacceptable feelings or behaviors. 6T'H 1 ,1DH 6ageH = I1@H "ognitive >evelH "o prehension J *ntegrated 6rocessH Assess ent .. AE'H A The nurse should anticipate that the client of 8ewish culture would place a high i portance on preventative health care and would consider ental health as e;ually i portant as physical health. &o en are also ore li%ely to see% treat ent for ental health proble s than en. 6T'H 1 ,1DH 6ageH 2 I1@H "ognitive >evelH Application J *ntegrated 6rocessH 6lanning 9. AE'H A The nurse should deter ine that defense echanis s can be appropriate during ti es of stress. The client with no defense echanis s ay have a lower tolerance for stress, thus leading to anxiety disorders. #efense echanis s should be confronted when they i pede the client fro developing healthy coping s%ills.

6T'H 1 ,1DH 6ageH < I1@H "ognitive >evelH Application J *ntegrated 6rocessH * ple entation :. AE'H " The nurse should atte pt to educate the client on the negative effects of excessive stress on edical conditions. *t is not appropriate to s%ip physiological and psychosocial ;uestions, as this would lead to an inaccurate assess ent. 6T'H 1 ,1DH 6ageH < I1@H "ognitive >evelH Analysis J *ntegrated 6rocessH "o unicationK#ocu entation

<. AE'H ! The student nurse should understand that ental health and ental illness are ultidi ensional and culturally defined. *t is i portant for nurses to be aware of cultural nor s when evaluating the clients ental state. 6T'H 1 ,1DH 6ageH 2 I1@H "ognitive >evelH Application J *ntegrated 6rocessH 1valuation =. AE'H " The nurse should anticipate that a diagnosis of rheu atoid arthritis should be coded on Axis *** of the #'() *+)T, diagnosis. The #'()*+)T, uses a ultiaxial syste in which each axis refers to a different do ain of infor ation. Axis * should include clinical disorders and other conditions that ay be a focus of clinical attention. Axis ** should include infor ation about personality disorders andKor ental retardation. Axis *** should include infor ation about general edication conditions. Axis *+ should include infor ation on the clients psychosocial and environ ental proble s. Axis + provides a Flobal Assess ent of Dunctioning BFADC. 6T'H 1 ,1DH 6ageH 1$ I1@H "ognitive >evelH Inowledge J *ntegrated 6rocessH "o unicationK#ocu entation

1?. AE'H A The nurse should understand that clinical disorders, such as bipolar disorder, should be included in Axis * of the #'()*+)T, diagnosis. The #'()*+)T, uses a ultiaxial syste in which each axis refers to a different do ain of infor ation. Axis * should include clinical disorders and other conditions that ay be a focus of clinical attention. Axis ** should include infor ation about personality disorders andKor ental retardation. Axis *** should include infor ation about general edication conditions. Axis *+ should include infor ation on the clients psychosocial and environ ental proble s. Axis + provides a Flobal Assess ent of Dunctioning BFADC. 6T'H 1 ,1DH 6ageH 1$ I1@H "ognitive >evelH Inowledge J *ntegrated 6rocessH "o unicationK#ocu entation

11. AE'H # The nurse should identify that a ental disorder indicates a pattern of aladaptive clinically significant behavioral or psychological proble s. The #'()*+)T, also specifies that the behavior or pattern is not an expectable and culturally sanctioned response to a particular event. 6T'H 1 ,1DH 6ageH . I1@H "ognitive >evelH "o prehension J *ntegrated 6rocessH "o unicationK#ocu entation

1$. AE'H " The nurse should expect that the client using the defense echanis displace ent would critici5e a cowor%er after being confronted by the boss. #isplace ent refers to transferring feelings fro one target to a neutral or less)threatening target. 6T'H 1 ,1DH 6ageH = I1@H "ognitive >evelH Analysis J *ntegrated 6rocessH Assess ent 1-. AE'H ! The nurse should deter ine that the clients state ent reflects the defense echanis pro7ection. 6ro7ection refers to the attribution of ones unacceptable feelings or i pulses to another person. &hen the client 3passes the bla e4 of the undesirable feelings, anxiety is reduced. #isplace ent refers to transferring feelings fro one target to another. ,ationali5ation refers to a%ing excuses to 7ustify behavior. 'ubli ation refers to channeling unacceptable drives or i pulses into ore constructive, acceptable activities. 6T'H 1 ,1DH 6ageH = I1@H "ognitive >evelH Application J *ntegrated 6rocessH Analysis 12. AE'H " The nurse should identify that the boy is using reaction for ation as a defense echanis . ,eaction for ation is the atte pt to prevent undesirable thoughts fro being expressed by expressing opposite thoughts or behaviors. #isplace ent refers to transferring feelings fro one target to another. ,ationali5ation refers to a%ing excuses to 7ustify behavior. 6ro7ection refers to the attribution of unacceptable feelings or behaviors to another person. 'ubli ation refers to channeling unacceptable drives or i pulses into ore constructive, acceptable activities. 6T'H 1 ,1DH 6ageH = I1@H "ognitive >evelH Application J *ntegrated 6rocessH Assess ent 1.. AE'H ! The nurse should define the concept of neuroses with the following characteristicsH The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are aladaptive, the client is unaware of the psychological causes of the distress, and the client experiences no loss of contact with reality. 6T'H 1 ,1DH 6ageH < I1@H "ognitive >evelH "o prehension J *ntegrated 6rocessH TeachingK>earning 19. AE'H ! The nurse should understand that the client with psychoses experiences little distress due to his or her lac% of awareness of reality. The client with psychoses is unaware that his or her behavior is aladaptive or that he or she has a psychological proble . 6T'H 1 ,1DH 6ageH 1? I1@H "ognitive >evelH "o prehension J *ntegrated 6rocessH TeachingK>earning 1:. AE'H #

The nurse should associate the client state ent 3* dont drin% too uchA4 with the use of the defense echanis of denial. The client who refuses to ac%nowledge the existence of a real situation and the feelings associated with it is using the defense echanis denial. 6T'H 1 ,1DH 6ageH = I1@H "ognitive >evelH Application J *ntegrated 6rocessH Assess ent 1<. AE'H " The nurse should evaluate that the client 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 eaning in relation to life. 6T'H 1 ,1DH 6ageH 11 I1@H "ognitive >evelH Analysis J *ntegrated 6rocessH 1valuation

1=. AE'H " The nurse should identify that the client who possesses a feeling of self)fulfill ent and reali5es his or her full potential has achieved self)actuali5ation, the highest level on (aslows hierarchy of needs. 6T'H 1 ,1DH 6ageH 2 I1@H "ognitive >evelH Application J *ntegrated 6rocessH Assess ent $?. AE'H ! The nurse should i ediately intervene when a client exhibits aggressive behavior toward another client. 'afety and security are considered lower level needs according to (aslows hierarchy of needs and ust be fulfilled before other higher level needs can be et. "lients who co plain, have feelings of failure, or state that no one cares are struggling with higher level needs such as the need for love and belonging or the need for self)estee . 6T'H 1 ,1DH 6ageH 2 I1@H "ognitive >evelH Analysis J *ntegrated 6rocessH * ple entation MULTIPLE RESPO SE 1. AE'H A, !, # The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with ental illness unless there is significant i pair ent in other areas of daily functioning. /ther indicators of ore serious anxiety are restlessness, difficulty concentrating, uscle tension, and sleep disturbance. 6T'H 1 ,1DH 6ageH < I1@H "ognitive >evelH Application J *ntegrated 6rocessH Assess ent $. AE'H A, !, # The nurse should include physical disorders, psychosocial stressors, and the Flobal Assess ent of Dunction BFADC in the #'()*+)T, diagnosis. The #'()*+)T, diagnosis is ultidi ensional and contains infor ation that ay help guide the course of treat ent. 6revious suicide atte pts indicate a clinical disorder such as bipolar disorder or a7or depressive disorder, which would be included on Axis *. 6T'H 1 ,1DH 6ageH 1$ I1@H "ognitive >evelH Application J *ntegrated 6rocessH "o unicationK#ocu entation

-. AE'H A, !, " The #'()*+)T, is useful in the practice of psychiatric nursing because it facilitates co prehensive evaluation of the client. *t considers the clients current level of functioning, represents a holistic view, and provides a fra ewor% for interdisciplinary co unication. 6T'H 1 ,1DH 6ageH 1$ I1@H "ognitive >evelH Application J *ntegrated 6rocessH "o unicationK#ocu entation