Mental Health study guide
1. A 26-month-old child displays negative behaviors. The parent says, "My child refuses toilet training
and shouts, 'No!' when given direction. What do you think is wrong?" Select the nurse's best reply.
a. "This is normal for your child's age. The child is striving for independence."
b. "The child needs firmer control. Punish the child for disobedience and say, 'No.'"
c. "There may be developmental problems. Most children are toilet trained by age 2 years."
d. "Some undesirable attitudes are developing. A child psychologist can help you develop a remedial
plan." - ✔✔ANS: A
These negative behaviors are typical of a child around the age of 2 years whose developmental task is to
develop autonomy. The incorrect options indicate the child's behavior is abnormal.
1. A basic level registered nurse works with patients in a community setting. Which groups should this
nurse expect to lead? Select all that apply.
a. Symptom management
b. Medication education
c. Family therapy
d. Psychotherapy
e. Self-care - ✔✔ANS: A, B, E
Symptom management, medication education, and self-care groups represent psychoeducation, a
service provided by the basic level registered nurse. Advanced practice registered nurses provide family
therapy and psychotherapy.
A nurse can best address factors of critical importance to successful community treatment for persons
with mental illness by including assessments related to which of the following? Select all that apply.
a. Housing adequacy and stability
b. Income adequacy and stability
c. Family and other support systems
d. Early psychosocial development
e. Substance abuse history and current use - ✔✔ANS: A, B, C, E
Early psychosocial developmental history is less relevant to successful outcomes in the community than
the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on
,other treatment issues is impossible. Sufficient income for basic needs and medication is necessary.
Adequate support is a requisite to community placement. Substance abuse undermines medication
effectiveness and interferes with community adjustment.
A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia.
Additional monitoring of the medication's effects and side effects will be most important if the patient is
also diagnosed with which health problem? Select all that apply.
a. Parkinson disease
b. Graves disease
c. Osteoarthritis
d. Epilepsy
e. Diabetes - ✔✔ANS: A, D, E
Antipsychotic medications may produce weight gain, which complicates the care of a patient with
diabetes or lowers the seizure threshold or both, which complicates the care of a patient with epilepsy.
Parkinson disease involves changes in transmission of dopamine and acetylcholine; therefore these
drugs also complicate the care of a patient with the disorder. Osteoarthritis and Graves disease should
have no synergistic effect with this medication.
A nurse volunteers for a committee that must revise the hospital policies and procedures for suicide
precautions. Which resources would provide the best guidance? Select all that apply.
a. Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5)
b. State's nurse practice act
c. State and federal regulations that govern hospitals
d. Summary of common practices of several local hospitals
e. American Nurses Association Scope and Standards of Practice for Psychiatric-Mental Health Nursing -
✔✔ANS: C, E
Regulations regarding hospitals provide information about the minimal standard. The American Nurses
Association (ANA) national standards focus on elevating practice by setting high standards for nursing
practice. The DSM-5 and the state's nurse practice act would not provide relevant information. A
summary of common practices of several local hospitals cannot be guaranteed to be helpful because the
customs may or may not comply with laws or best practices.
A patient asks a nurse, "What are neurotransmitters? My doctor says mine are out of balance." The best
reply would be:
,a. "You must feel relieved to know that your problem has a physical basis."
b. "Neurotransmitters are chemicals that pass messages between brain cells."
c. "It is a high-level concept to explain. You should ask the doctor to tell you more."
d. "Neurotransmitters are substances we eat daily that influence memory and mood." - ✔✔ANS: B
Stating that neurotransmitters are chemicals that pass messages between brain cells gives the most
accurate information. Neurotransmitters are messengers in the central nervous system. They are
released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the
postsynaptic neuron. The incorrect responses do not answer the patient's question, are demeaning, and
provide untrue and misleading information.
A patient in the emergency department reports, "I hear voices saying someone is stalking me. They
want to kill me because I found the cure for cancer. I will stab anyone that threatens me." Which aspects
of mental health have the greatest immediate concern to a nurse? Select all that apply.
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept - ✔✔ANS: B, C, E
The aspects of mental health of greatest concern are the patient's appraisal of and control over
behavior. The patient's appraisal of reality is inaccurate, and auditory hallucinations are evident, as well
as delusions of persecution and grandeur. In addition, the patient's control over behavior is tenuous, as
evidenced by the plan to "stab" anyone who seems threatening. A healthy self-concept is lacking. Data
are not present to suggest that the other aspects of mental health (happiness and effectiveness in work)
are of immediate concern.
A psychiatric nurse best implements the ethical principle of autonomy when he or she:
a. intervenes when a self-mutilating patient attempts to harm self.
b. stays with a patient who is demonstrating a high level of anxiety.
c. suggests that two patients who are fighting be restricted to the unit.
d. explores alternative solutions with a patient, who then makes a choice. - ✔✔ANS: D
Autonomy is the right to self-determination, that is, to make one's own decisions. When the nurse
explores alternatives with the patient, the patient is better equipped to make an informed, autonomous
decision. Staying with a highly anxious patient or intervening with a self-mutilating patient demonstrates
beneficence and fidelity. Suggesting that two fighting patients be restricted to the unit demonstrates the
principles of fidelity and justice.
, An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by
this patient best demonstrates resilience? The patient:
a. says, "I knew this would happen eventually."
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, "I don't need that silly thing."
d. says, "Maybe some physical therapy will help me with my balance." - ✔✔ANS: D
Resiliency is the ability to recover from or adjust to misfortune and change. The correct response
indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying "I
knew this would happen eventually" and discontinuing healthy activities suggest a hopeless perspective
on the health change. Refusing to use a walker indicates denial.
An experienced nurse says to a new graduate, "When you've practiced as long as I have, you will
instantly know how to take care of psychotic patients." What is the new graduate's best analysis of this
comment? Select all that apply.
a. The experienced nurse may have lost sight of patients' individuality, which may compromise the
integrity of practice.
b. New research findings must be continually integrated into a nurse's practice to provide the most
effective care.
c. Experience provides mental health nurses with the tools and skills needed for effective professional
practice.
d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial
and error.
e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs. -
✔✔ANS: A, B
Evidence-based practice involves using research findings to provide the most effective nursing care.
Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse
also maintains respect for each patient as an individual. Overgeneralization compromises that
perspective. Intuition and trial and error are unsystematic approaches to care.
1. Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization
is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
