VNSG 1238: Unit 1 Mental Health Exam 2023 with verified questions and answers

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice? Promoting symptom management Explanation: Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness. Which is a clinical activity of only the advanced practice registered nurse? Psychotherapy Explanation: Clinical activities of the advanced practice registered nurse include psychotherapy, community interventions, and clinical supervision. Milieu therapy, crisis intervention, and triage are clinical activities of the psychiatric-mental health registered nurse. Which provides the best definition for mental illness? Inability to function in a manner that manages both external and internal stressors effectively Explanation: Mental illness is best defined as a syndrome characterized by symptoms and/or impairment in functioning. Not all mental illnesses are characterized by cognitive impairment or altered sensory perceptions. Genetic and environmental factors are not the only known causes of mental illness. Which is a difference between counseling and psychotherapy? Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. Explanation: The psychiatric nurse uses counseling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling. Transference and countertransference are significant obstacles in both modes, and neither intervention is appropriate during acute psychotic episodes. A nurse is reading a journal article about practices involved during the moral treatment movement in psychiatric-mental health care. Which practice would most likely be included as being used during this time? Asylums Explanation: In the moral treatment period (), the use of kindness, compassion, and a pleasant environment was adopted. Individuals with mental disorders were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Blood letting, exorcisms and incarceration were not practices associated with the moral treatment period. Which individual has experienced the consequences of deinstitutionalization? A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure Explanation: The process of deinstitutionalization involves moving chronically mentally ill clients from state psychiatric hospitals back to their homes or to community-supervised facilities. Medical insurance coverage for medical illnesses is greater than for psychiatric illnesses. What term best describes this discrepancy? Lack of parity Explanation: Parity refers to the various inequities inherent in any health care system. Many health plans cover the costs of psychotropic drugs at far lower rates than they do for other medications. Health care inequities are largely a result of social values and perceived significance. A gap exists between the most effective treatments available and what people actually receive. It is difficult for clients and families to determine what services are needed and where to find them, which causes limited access to services. Medication noncompliance occurs when clients do not take their medications as prescribed. Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function? Milieu therapy Explanation: A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management. The application of psychiatric mental health nursing theory to promote holistic client care in the therapeutic relationship is grounded in the work of which historical figure? Peplau Explanation: In 1952, Peplau published the landmark work, Interpersonal Relations in Nursing. It introduced psychiatric and mental health nursing practice to the concepts of interpersonal relations and the importance of the therapeutic relationship. The nurse-client relationship supported a holistic perspective on client care. Which client would not be able to undergo a magnetic resonance imaging scan (MRI)? A client with a pacemaker Explanation: Clients with pacemakers or metal implants, such as heart valves or orthopedic devices, cannot undergo an MRI. There are not contraindications for obese clients can to undergo an MRI. Clients who are claustrophobic or those with anxiety can have an MRI but may need special intervention such as sedation. An older adult resident of a group home has been receiving treatment for schizophrenia for several decades. The nurse who oversees care at the facility believes that the resident may be developing tardive dyskinesia. What assessment findings would support this suspicion? Select all that apply. The client often smacks lips when at rest The client makes repetitive movements with the fingers Explanation: Tardive dyskinesia is usually characterized by repetitive involuntary movements. Syncope, sleep disturbances, and symptom exacerbation are not suggestive of tardive dyskinesia. Benzodiazepines work by the following mechanism of action: They act directly on GABA receptors and are thought to increase the amount of GABA available. Explanation: Benzodiazepines act directly on GABA receptors and are thought to increase GABA available to dampen neural overstimulation. Benzodiazepines and buspirone are included in which therapeutic category? Anxiolytics Explanation: Benzodiazepines have the pharmacologic effects of anxiolysis, sedation, centrally mediated muscle relaxation, and elevation of the seizure threshold. Which is a major difference between the atypical antipsychotics (such as clozapine) and the typical antipsychotics (such as haloperidol)? Atypical antipsychotics block both serotonin and dopaminergic receptors. Explanation: Typical antipsychotics do have side effects, often lead to weight gain, and, in rare cases, cause dysrhythmias and kidney failure. Thus, atypical antipsychotics block both serotonin and dopaminergic receptors is the correct answer. Neurotransmission is important in the function of the CNS. For neurotransmission to occur, how do neurons communicate with other cells? Chemically Explanation: The transmission of information between two nerves or between a nerve and a gland or muscle is chemical. Selectively, excitably, and accessibly are incorrect. A client is experiencing acute stress leading to the stimulation of increased gastric acid. In this situation, which body system uses acetylcholine as a neurotransmitter? Cholinergic Explanation: The cholinergic system uses acetylcholine as a neurotransmitter. The dopaminergic system uses dopamine as its neurotransmitter. The GABA-ergic system uses GABA as its neurotransmitter. The noradrenergic system uses norepinephrine as its neurotransmitter. The nurse is preparing to orient a graduate nurse to the mental-health unit. When teaching the new nurse about general principles related to psychoimmunology/psychoneuroimmunology the nurse includes what information? Select all that apply. inflammatory bowel disease heart disease rheumatoid arthritis Explanation: Psychoimmunology or psychoneuroimmunology examines the effect of psychosocial stressors on the body's immune system, nervous system, endocrine system and behaviors, thoughts, and feelings. A compromise in the body's immune system could contribute to the development of a variety of illnesses such as systemic lupus erythematosus, allergies, and anaphylaxis. Immune dysregulation may also be involved in the development of psychiatric disorders. This can occur by allowing neurotoxins to affect the brain, damaging neuroendocrine tissue, or damaging tissues in the brain at locations such as the receptor sites. Normal functioning of the endocrine system is often disturbed in people with psychiatric disorders. For example, thyroid functioning is often low in those with bipolar disorder, and people with schizophrenia have a higher incidence of diabetes. Psychoimmunology/psychoneuroimmunology does not include the renal, reproductive systems, cardiovascular, pulmonary, integumentary, musculoskeletal , or gastrointestinal systems. When a client who is generally pleasant and cooperative begins to show aggressive behavior toward most clients in a community care facility, the nurse suspects the client has experienced cerebral trauma. Which brain structure is responsible? Frontal Lobes Explanation: Frontal lobe damage shows symptoms that include loss of emotional control, rage, violent behavior as well as changes in mood and personality and uncharacteristic behavior. Thus, when a client who is generally pleasant and cooperative begins to show aggressive behavior toward most members of the milieu, the nurse suspects the client has experienced cerebral trauma to the frontal lobe. Temporal, occipital, and limbic lobe damage do not exhibit aggressive behavior or personality changes. A client with a diagnosis of schizophrenia lacks insight into the illness. The client presents with significantly declined function and is consistently nonadherent with medications. Which medication administration route is best suited for optimal treatment of this client's condition? IM Explanation: If a client is nonadherent and there is a significant decline in functioning, antipsychotic drugs are most often administered intramuscularly. Antipsychotic medications are not normally administered by the intravenous or subcutaneous routes, and oral administration is more challenging when a client is noncompliant with treatment. Which antidepressant is potentially lethal in overdose? Phenelzine Explanation: Phenelzine, an MAOI, is potentially lethal in overdose (hypertensive crisis) and poses a potential risk in clients with depression who may be considering suicide. None of the other medications carry that risk. A cognitive technique to identify automatic thoughts is to ... ask the client to recount a very problematic situation. Explanation: A cognitive technique to identify automatic thoughts is to ask the client to recount a very problematic situation. Client 1 has been talking to Client 2 about Client 2's frequent denial in the group for two weeks. On the third week, Client 2 comes late to the group. When they begin to discuss Client 2's lateness, Client 2 gets up and leaves. The content of this exchange is the discussion. The process that is occurring may be that ... Client 2 is angry with Client 1 for the confrontation. Explanation: A group is three or more people with related goals. Factors that influence these goals include interpersonal and intrapersonal needs, physical environment, and unique group dynamics. Group process involves the underlying feeling, tone, and messages within the group's interactions. An 81-year-old resident of a long-term care facility has confided in the nurse that the client is profoundly fearful of death. Within Erikson's psychosocial theory, this statement may suggest a failure to resolve which developmental conflict? Ego integrity vs. despair Explanation: Erikson identifies the central area of conflict and resolution in late adulthood as ego integrity vs. despair. Successfully navigating this conflict involves "letting go," and the fear of death suggests an inability to resolve this conflict. Which statement is inconsistent with the concept of milieu therapy, originally developed by Henry Stack Sullivan? Clients work independently to solve day-to-day problems. Explanation: The concept of milieu therapy, originally developed by Sullivan, involved clients' interactions with one another, including practicing interpersonal relationship skills, giving one another feedback about behavior, and working cooperatively as a group to solve day-to-day problems. Which client would the nurse assess as having the priority need for attendance at a life and social skills group? A 38-year-old homeless man with a history of chronic paranoid schizophrenia Explanation: The homeless man with a history of chronic paranoid schizophrenia could learn activities of daily living, communication, and other social skill deficits caused by his chronic illness. The waitress is able to work and plan for her future without professional assistance. The 20-year-old university student who is afraid to speak in front of large groups is incorrect, because this is a common phobia that can be overcome with experience or by taking a public speaking class. The woman reentering the dating scene is incorrect because she does not have a longstanding disability that interferes with social skills. A psychiatric-mental health nurse practitioner is conducting an inservice presentation for a group of psychiatric-mental health nurses about cognitive behavioral therapy. The nurse practitioner determines that additional discussion is needed when the group identifies which information as being associated with this type of therapy? An event is the underlying issue causing the disturbance. Explanation: According to cognitive behavioral therapy, people are disturbed not by an event but by the perception of the event. Whenever and however a belief develops, the individual believes it. Work and practice can modify beliefs that create difficulties in living. This type of therapy is used to alter distorted beliefs and problem behaviors by identifying and replacing negative inaccurate thoughts and changing the rewards for behaviors. A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Maintenance of the therapeutic environment Which type of setting is used for clients who continue to need supervision but not long-term admission? Partial (day) hospitalization Explanation: Partial (day) hospitalization programs are for clients who continue to need supervision but not long-term admission. Which best describes the scope of what community support services provide? A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Explanation: A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities. A client with psychiatric illness is referred to the day treatment program. Which services should the nurse include while teaching the client about the program? Select all that apply. Development of social skills. Stabilization of symptoms. Training to perform activities of daily living. Explanation:Day treatment program (partial hospitalization) provides services for mentally ill clients such as developing social skills, stabilizing psychiatric symptoms, and improving the skills required for activities of daily living. These programs do not perform prognostic testing for mentally ill clients. Services for treating comorbid medical illnesses are not provided in this program. The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program? Empower clients to achieve the highest level of functioning possible Explanation: Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. In-home detoxification promotes careful detoxification from alcohol and sbstances. The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions. The forensic nurse is assessing a client with new onset of hallucinations and agitation in a police station. Which finding is most consistent with mentally ill clients in the criminal justice system? Risk of violence Explanation:There is a higher risk of serious violence (homicide) for those with a first-episode psychosis who have not yet been treated than for those who have previously received treatment. Offenders with mental illnesses are less likely to reoffend than someone who has been in prison who does not have a mental illness. People with mental illnesses are more likely to harm themselves than someone else. Despite the large number of people with mental illnesses who commit crimes, the majority of their encounters with the justice system occur when individuals with mental illness are victims of crime. A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and the client's temperature is 103°F, pulse rate is 116 beats per minute, respirations are 34 breaths per minute, and blood pressure is 100/50 mmHg. The nurse should investigate further for which condition? Neuroleptic malignant syndrome Explanation: The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication. A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying? Pseudoparkinsonism Explanation:Symptoms of pseudoparkinsonism include the classic triad of Parkinson's disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever. A nurse is preparing a continuing education presentation about various psychopharmacologic agents for a group of psychiatric-mental health nurses. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply. fluoxetine sertraline Explanation:Selective serotonin reuptake inhibitors include fluoxetine and sertraline. Duloxetine and venlafaxine are serotonin norepinephrine reuptake inhibitors. Bupropion is a norepinephrine dopamine reuptake inhibitor. Amoxapine is a tricyclic antidepressant. During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate? Assessing the client for target symptoms and side effects Explanation: During stabilization, the medication dosage is adjusted or titrated to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess target symptoms, looking for changes or improvements and side effects. Education about relapse prevention and target symptoms and assessing if the medication is losing its effect occur during the maintenance phase. Tapering occurs during the discontinuation phase. The client presents to the mental health clinic with reports of fibromyalgia, migranes, and GI distress. The nurse talks about the different neurotransmitters and what each neurotransmitter does. How would you elaborate on the type of symptoms this client is demonstrating? "Lack of serotonin in the body produces symptoms such as irritability, sleep disturbances, and compulsiveness. Explanation: Serotonin is a neurotransmitter found only in the brain, primarily an excitatory neurotransmitter that is diffusely distributed within the cerebral cortex, limbic system, and basal ganglia. Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions, such as sleep and appetite. As a neurotransmitter in the central nervous system, norepinephrine increases alertness and arousal, and speeds reaction time. Low levels of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Histamines boost blood flow in the area of your body allergens affect. This causes inflammation, which lets other chemicals from your immune system step in to do repair work. Too little histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Dopamine is an excitatory neurotransmitter found in distinct regions of the CNS and is involved in cognition, complex movements, motivation, and regulation of emotional responses. Dopamine is the neurotransmitter that stimulates the body's natural "feel good" reward pathways, producing pleasant euphoric sensation under certain conditions. After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid: Phenalizine Explanation: Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine, such as tap beers, matured and aged cheeses, dried aged and fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and soy sauce. Cognitive interventions are based on the concept of cognition. Who developed cognitive behavioral therapy? Aaron Beck Explanation: Beginning in the 1960s, more cognitive-based theories and therapeutic approaches were developed, the most prominent being cognitive behavioral therapy by Aaron Beck. A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be what? Restructure how a person perceives events. Explanation: The goal of CT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change. 16s According to Maslow, mentally healthy people who achieve self-actualization are able to do what? Use varied approaches to solve problems Explanation: Individual psychotherapy consists of three phases. Which statement by the group therapist would reflect that the group is in the working phase of therapy? "James, when Shane speaks, it seems you become angry and tend to withdraw." Explanation: During the working phase, client behaviors and feelings are shared, and conflicts may become apparent and be talked about in the group. When engaged in rational emotive behavior therapy, which would be addressed during the activating event sequence? Assessing the consequences of the problem Explanation: During the activating event, the problem would be identified, defined, and agreed upon, and assessment of the consequences of the belief would occur. Teaching about the connection between beliefs and consequences would occur during the belief system portion of the framework. Facilitating the working-through process occurs during the effective outlook portion of the framework. Preparing the client to deepen conviction in rational beliefs occurs during the dispute portion of the framework. The nurse is caring for a 4-year-old child during a well-child visit. According to the Sullivan's stages of development, which behavior would the nurse expect to find in this child? The child performs actions to earn praise from parents.' Explanation: According to Sullivan's life stages, this child is in the childhood stage. During this stage, children look at their parents as sources of praise and appreciation. If the child is in the infant stage (0-language), the child's primary need is to have bodily contact and tenderness and would most likely prefer to sit in the mother's lap. The preadolescent child (8-12 years) tends to move away from family as the primary satisfaction in the relationship and start making friends. In the juvenile stage (5-8 years), the child learns to negotiate individual needs. Expressing views and ideas to the parents begin at this age. Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated?q Operant Conditioning Explanation: In operant conditioning, the focus is on the consequences of a behavioral response, not a specific stimulus. If a behavior is reinforced or regarded with success, praise, money, and so on, the behavior will probably be repeated. Modeling is one person trying to be similar to another. Self-efficacy is a person's sense of the individual's ability to deal effectively with the environment. Behaviorism is a learning theory that focuses only on objectively observable behaviors and discounts any independent activities of the mind. A group of psychiatric-mental health nurses is reviewing information about the different types of groups. The nurses demonstrate understanding of the information when they identify which as a characteristic of a self-help group that differentiates itself from a supportive therapy group? The group is led by people concerned with coping with a problem. Explanation: Self-help groups are led by people who are concerned about coping with a specific problem or life crisis. These groups do not explore psychodynamic issues in depth. Professionals usually do not attend these groups nor serve as consultants. Psychiatric nurses lead supportive therapy groups. Both types of groups focus on a specific problem. The nurse is caring for a client with depression using milieu therapy. Which intervention should the nurse include in this therapy? Select all that apply. Promote growth by role modeling Maintain a therapeutic environment Encourage communication between clients Explanation: The concept of milieu therapy involves clients practicing interpersonal relationships through role modeling and communication between clients along with the nurse. The nurse should foster and maintain a therapeutic environment to allow the client to improve interpersonal relationships. Medications are not considered a component of milieu therapy. Encouraging independence is a component of cognitive therapy. Which client would be most likely to qualify for psychiatric care in a long-term care setting? A client who has multiple sclerosis and a history of depression Explanation: Individuals may receive psychiatric care in a long-term care setting unless they require specialized services such as substance abuse counseling, electroshock therapy, or intense individual or group psychotherapy. A lack of family support is not an admission criterion for long-term care. Which is often more predictive of the client's success than the characteristics of his or her illness? Living environment Explanation: Living environment is more predictive of the client's success than are characteristics of his or her illness.