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CHAPTER 2 – HISTORY AND TRENDS
1. Which of the following is an inappropriate example of the role of a psychiatric nurse?
A) Establishing a therapeutic relationship and environment
B) Assisting clients learn positive coping skills concerning real-life problems
C) Providing care for physical symptoms
D) Giving advice to clients on a variety of topics
All except giving advice are appropriate roles for psychiatric nurses. The role of the psychiatric nurse is to assist the client to arrive at his or her own answers to problems, not to give advice to the client.
2. Which of the following factors has the least influence on the development of mental health in the client who has anxiety disorder?
A) The client’s mother also suffered from an anxiety disorder.
B) The client was raised in a household with high stress and frequent geographic moves.
C) The client’s mother often related to her in ways that reflected her mother’s high level of anxiety.
D) The client is often late to school and makes poor grades in most of her subjects.
Being late to school and making poor grades are behaviors that indicate that the client is having difficulty; they are not factors influencing the development of her anxiety disorder.
3. Which of the following describes an application of Psychiatric–Mental Health Nursing: Scope and Standards of Practice (ANA, 2007)?
A) Diagnosing disorders using the Diagnostic and Statistical Manual III-R published by the American Psychiatric Association
B) Assisting clients in regaining or improving previous coping abilities and preventing further disability
C) Providing psychoanalysis to unravel psychoneuroses common to clients with schizophrenia
D) Applying somatic therapies, such as electroconvulsive therapy, to severely depressed clients
All of these activities except the activity described in option B are not considered to be within the scope of practice of the psychiatric–mental health nurse.
4. An appropriate goal for clients who are learning about the healthy use of ego defense mechanisms is what?
A) Reduce fear and protect self-esteem.
B) Eliminate anxiety and apprehension.
C) Avoid conflict and unpleasant consequences.
D) Reduce workload and communicate better.
Ego defense mechanisms help to reduce fear and protect self-esteem. It is not a goal to eliminate anxiety, avoid conflict, or reduce workload.
5. A client asks the nurse to help her understand what her psychologist meant when he said that she displaced her anger. The nurse replies that displacement is?
A) Replacing consciously unacceptable emotions, drives, attitudes, or needs by those that are more acceptable
B) Making up for a real or imagined inability or deficiency by engaging in a specific behavior to maintain self-respect or self-esteem
C) Transferring feelings, such as frustration, hostility, or anxiety, from an idea, person, or object to one that is less threatening
D) Negating a previous unconsciously tolerable action or experience to reduce or alleviate feelings of guilt
Displacement means the transferal of feelings from one object to another. It involves neither replacement or making up for feelings nor negating them.
6. When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which of the following beliefs is more applicable to the Middle Ages?
A) Emotional disorders were believed to be an organic dysfunction.
B) Treatment included sedation, good nutrition and hygiene, and music and recreation.
C) Mental illness was considered a disturbance of the four body fluids, or “humors.”
D) Belief in demonic possession and exorcism was common.
While some of these answers are true of both ancient Greece and the Middle Ages, belief in demonic possession and exorcism was more common in the Middle Ages.
7. Suppression has been likened to voluntary forgetting and is used to protect one’s self-esteem. Which of the following statements alerts the nurse to the use of this mechanism by a 19-year-old woman who lost her leg in a car accident?
A) “I don’t remember anything about what happened to me.”
B) “I’d rather not talk about it right now.”
C) “It’s all Andy’s fault! He was going 90 miles an hour on the freeway.”
D) “My mother is heartbroken about this.”
The correct answer reflects the idea that the client has not remembered the event. The other options imply that the client is able to remember. Suppression protects one’s self-esteem by providing a loss of memory about the event.
8. The major goal of the Community Mental Health Act of 1963 was what?
A) Develop centers in which biopsychiatric research could take place within the community.
B) Build mental health centers that would provide mental health care within the local community.
C) Attract more health care providers into local psychiatric clinics.
D) Facilitate the integration of biology with the psychosocial components of treatment.
The 1963 Community Mental Health Act was designed to provide community-centered mental health care.
9. According to Maslow, mentally healthy people who achieve self-actualization have the ability to do what?
A) Use varied approaches to solve problems
B) Form distant relationships with others
C) Be dependent in thought and action
D) Make decisions pertaining to fantasy rather than reality
According to Maslow, mentally healthy people who achieve self-actualization are able to form close relationships with others, make decisions pertaining to reality rather than fantasy, be independent or autonomous in thought and action, and use a variety of approaches as they perform tasks and solve problems.
10. A student nurse states that he does not want to think about the upcoming final exam. He will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism?
Suppression is the voluntary rejection of unacceptable thoughts or feelings from conscious awareness. Denial is unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable. Regression is the retreat to past developmental states to meet basic needs. Conversion is the unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.
11. Which of the following criteria is the most important component of a definition of mental health?
A) The individual is financially self-sufficient.
B) The individual is able to cope with daily stressors.
C) The individual has rich social life.
D) The individual carries himself or herself with a joyful demeanor.
Mental health is a positive state in which one is responsible, displays self-awareness, is self-directive, is reasonably worry free, and can cope with usual daily tensions. Financial success, social connectedness, and a joyful demeanor may be outcomes of mental health, but none is a prerequisite for mental health.
12. Dawn, a nursing student, is discussing the patient whom she cared for that morning with a fellow student in the same clinical group. Dawn states that her patient has schizophrenia and mentions that she found out that it “runs in the patient’s family.” Dawn’s classmate is incredulous, saying that mental illness results from traumatic circumstances. What explanation of the factors that contribute to mental illness is most accurate?
A) Mental health is thought to be determined by genes, circumstances, and childhood nurturing.
B) Mental health and mental illness have been proven to be genetically predetermined.
C) Mental health is primarily a result of the effective use of ego defense mechanisms.
D) Mental health is determined by the interplay of intelligence, ingenuity, and genetic makeup.
Three factors influence the development of mental health: genetic characteristics, nurturing during childhood, and life circumstances.
13. Mrs. Ames is a 68-year-old widow who shares her house with her son Aaron, a 39-year-old man who has a diagnosis of bipolar disorder. Aaron has been experiencing increasingly serious exacerbations of his illness, and the unpredictability of his condition, combined with the fact that she is his sole caregiver, has left her feeling exhausted and defeated. The nurse would recognize that Mrs. Ames is at risk for what?
A) Bipolar disorder
B) Compassion fatigue
C) Failure to thrive
Compassion fatigue, also referred to by many as burnout, may occur when one provides care for others but loses the ability to take care of oneself.
14. Which of the following statements is suggestive of the stigmatization of mental illness?
A) “We’re sure not putting enough money into public programs for people who are mentally ill.”
B) “It’s too bad that there aren’t better medications to treat mental illness.”
C) “I feel bad for the mentally ill, but I wish we didn’t have to see them panhandling on every single corner.”
D) “I think that we should look at people who are mentally ill much like we see people who are physically ill.”
Creating a division between “us” and “them” is a component of stigmatization. Being dissatisfied with treatment options for mental illness does not mean that the speaker is stigmatizing mental illness.
15. How can the mental health nurse best advocate for individuals with mental illness and prevent stigmatization?
A) By emphasizing the creativity and freedom that accompany a mental illness
B) By emphasizing that all people with mental illness can eventually be cured
C) By tactfully correcting misperceptions about abnormal behavior and mental illness
D) By informing people that most mental illness is actually a manifestation of substance abuse
There are several perceptions about mental illness and abnormal behavior that have the power to contribute to stigmatization. The nurse should counter these perceptions. It would be inaccurate to characterize mental illness as a positive experience, to state that all people with mental illness can be cured, or to attribute mental illness to substance abuse.
16. The nurse has heard a member of public lamenting the fact that a mentally ill person committed a high-profile crime, saying, “I don’t know what no one could see it coming.” What perception about abnormal behavior and mental illness is this person exhibiting?
A) Internal forces are responsible for abnormal behavior.
B) Abnormal behavior can be predicted and evaluated.
C) Maladaptive behavior is always inherited.
D) Mental illness is incurable.
If an individual believes that abnormal behavior can always be identified by warning signs ahead of time, he or she agrees that it can be predicted.
17. In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend?
A) Increased numbers of homeless mentally ill people
B) Higher employment rates among previously institutionalized people
C) Increased numbers of for-profit institutions for the mentally ill
D) Increased numbers of training programs for the mentally ill
In 1970, the deinstitutionalization of clients from state mental hospitals to community living was considered a positive move; however, insufficient federal funding resulted in an increase in the number of homeless mentally ill people.
18. Andrew has been unsuccessful in his psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric–Mental Health Nursing Scope and Standards of Practice, which are?
A) Future goals for the nursing profession as a whole
B) The legal documents that allow a nurse to practice
C) Descriptions of the responsibilities for which nurses are accountable
D) Explanations of the ideal character of the psychiatric or mental health nurse
Standards of practice are authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They do not have the same standing as laws, and they are not future goals but are instead current standards.
19. A recent nursing graduate has been hired as a parish nurse in the church that she has attended for many years. How should the nurse understand this new role?
A) The nurse will focus on the assessment and management of acute illnesses among the members of the church.
B) The nurse will implement spiritually based interventions in disease management as an alternative to western biomedicine.
C) The nurse will consider the whole church congregation to be her client using a community health model.
D) The nurse will serve as a specialized health advisor to the leadership of the church.
Parish nursing is a program that promotes health and wellness of body, mind, and spirit using the community health nursing model as its framework. The church congregation is the client.
20. A college’s nursing program has added an elective in forensic nursing to the curriculum. Which of the following phenomena underlies the expanded role for forensic nursing that is expected in the future?
A) The fact that most crimes are committed by people who have mental illness
B) The fact that people with mental illness are the most common victims of crime
C) The fact that there are high rates of mental illness among the populations of jails and prisons
D) The fact that many states now require all prison inmates to be assessed by a mental nurse daily
Forensic nursing is expected to become one of the fastest growing nursing specialties of the 21st century because recent studies have noted the high rates of mental illness in jails and prisons. People with mental illness are not responsible for most crimes. They are vulnerable to crime, but this fact does not underlie the growth of forensic nursing.
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