Chapter 1, Foundations of Psychiatric–Mental Health Nursing
1. The nurse is assessing a newly admitted client with cholecystitis. When performing the admission
assessment, which statement by the client is an indicator of optimal mental health?
A. “I don’t need anyone in my life, I manage well on my own.”
B. “I practice yoga regularly since it helps manage any stress I am feeling.”
C. “My family has several people with mental health problems.”
D. “I had a history of alcohol use disorder and have been sober for 2 months.”
ANS: B
Feedback: Individual factors influencing mental health include coping or stress management
abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness
are both needed for good mental health, and therefore a healthy person would need others for
companionship. A family history of mental illness could relate to the biologic makeup of an
individual, which may have a negative impact on an individual’s mental health. A recent history of
the use of maladaptive coping mechanisms such as alcohol does not indicate that the client is
mentally healthy.
PTS: 1 REF: p. 2 | Header: Mental Health and Mental Illness
OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
2. The nurse is performing an admission assessment for a client admitted to the behavioral health
unit. Which social/cultural category will the nurse document that may be contributing to the client’s
degree of mental illness? Select all that apply.
A. The client is unable to find work and does not have enough money for housing.
B. The client states that they are discriminated against due to their country of origin.
C. The client attributes life’s problems to being without family support.
D. The client reports being unable to find anything meaningful within their life.
E. The client reports not belonging anywhere and is without family support.
ANS: A, B
Feedback: Social or cultural categories relate to a lack of resources, poverty, negative view of the
world, and discrimination and may result in isolation and violent or criminal behavior. The client that
attributes life’s problems to being without family support is not able to find meaning in life. Being
without support is interpersonal determinant of mental illness.
PTS: 1 REF: p. 2 | Header: Mental Illness OBJ: 1
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Select
3. A client grieving the recent loss of a spouse, asks, “Am I becoming mentally ill? I feel so sad”
Which is the nurse’s best response?
A. “You may have a temporary mental illness because you are experiencing so much
pain.”
B. “You are not mentally ill. This is an expected reaction to the loss you have
experienced.”
C. “Were you generally dissatisfied with your relationship before your husband’s
death?”
D. “Try not to worry about that right now. You never know what the future brings.”
, ANS: B
Feedback: Acute grief reactions are expected and therefore not considered mental illness.
Downplaying the client’s grief does not appropriately address the client’s concerns. The quality of
the relationship does not determine the presence of absence of mental illness.
PTS: 1 REF: p. 2 | Header: Mental Health and Mental Illness
OBJ: 1 NAT: Client Needs: Psychosocial Integrity
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
4. The nurse is using the DSM-5-TR for a newly admitted client diagnosed with bipolar I disorder.
Which information will the nurse obtain to assist with the use of this resource?
A. Devise a plan of care for a newly admitted client
B. Predict the client’s prognosis of treatment outcomes
C. Document the appropriate diagnostic code in the client’s medical record
D. Use as a guide for client assessment
ANS: D
Feedback: The DSM-5-TR provides standard nomenclature, presents defining characteristics, and
identifies underlying causes of mental disorders. It does not provide care plans or prognostic
outcomes of treatment. The DSM-5-TR does not provide coding for record-keeping or billing
purposes.
PTS: 1 REF: p. 2 | Header: Mental Illness OBJ: 2
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
5. A client with the inability to work due to relapsing schizophrenia is receiving Social Security
Benefits. Which benefit will this provide to the client experiencing serious mental illness?
A. The client will be able to maintain some level of independence financially.
B. The client will have the option to only obtain inpatient treatment.
C. The client will be able to pay all of their bills as well as purchase medication.
D. The client will have the ability to obtain psychiatric service regardless of setting.
ANS: A
Feedback: Federal legislation was passed to provide an income for disabled persons:
supplemental security income (SSI) and Social Security disability income (SSDI). This allowed
people with severe and persistent mental illness to be more independent financially and to not rely
on family for money. This does not prevent the client in acute crisis from a relapse from being
admitted to the inpatient setting if they are at risk of harm to self or others. Social security is limited
and the client may still have some degree of financial difficulty. The client may be limited to state
owned facilities and not be able to seek treatment at a private facility. This does not dictate to the
client the level of care offered to the client.
PTS: 1 REF: p. 4 | Header: Development of Psychopharmacology
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Choice
,6. The nurse working in the ED of an urban hospital notifies the manager that there are several
clients with mental health disorders still present in the ED that have been there over 48 hours.
Which issue related to this phenomenon does the nurse discuss with the manager?
A. Temporary detaining orders for clients
B. Decision to practice boarding
C. The revolving door for clients
D. The cost of holding clients in the ED for over 48 hours
ANS: B
Feedback: The practice of boarding is frustrating to health care personnel in EDs since it may
interfere with the acute care and emergencies that are required in that setting. Clients become
dissatisfied with care, and their families feel as though clients are not receiving the care needed to
move through the crisis and some believe an increase in suicide. Provision of an adequate number
of psychiatric inpatient beds could better meet the needs of clients and might even decrease
homelessness, incarceration, and violence. The revolving door phenomenon is the increase in
short-stay admissions repeatedly. Having to obtain a temporary detaining order improves the
transition into inpatient care. Cost is not the immediate issue of the nurse.
PTS: 1 REF: p. 3–4 | Header: Mental Illness in the 21st Century
OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Communication and Documentation
BLM: Cognitive Level: Apply NOT: Multiple Choice
7. The nurse is working in an inpatient mental health facility and caring for several clients. Which
client is most likely to experience the revolving door phenomenon?
A. A client living with both parents that adheres to prescribed medication regimen
B. A client with a dual diagnosis of heroin use disorder and bipolar I disorder
C. A client that has depression on antidepressants receiving electroconvulsive
therapy.
D. A client with an acute situational crisis due to a natural disaster
ANS: B
Feedback: A client with a dual diagnosis including a substance use disorder and a mood disorder
is most likely to continue to require inpatient services. Many people have a dual problem of both
severe mental illness and a substance use disorder. Use of alcohol and drugs exacerbates
symptoms of mental illness, again making rehospitalization more likely. Substance use disorders
cannot be dealt within 3 to 5 days typical for admissions in the current managed care environment.
A client adhering to a medication regiment and having family support will not likely require
readmission frequently. A client with depression and receiving electroconvulsive therapy may
receive this on an outpatient basis and not require admission. An acute situational crisis will pass
over a period of time with appropriate cognitive behavioral therapy that is used on an outpatient
basis.
PTS: 1 REF: p. 4 | Header: Revolving Door OBJ: 4
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Analyze NOT: Multiple Choice
8. The nurse is caring for clients in an outpatient facility for those that have persistent or severe
mental health disorders. Which factor(s) does the nurse assess that indicates the outcome of
nontreatment of this client population? Select all that apply.
A. Seeking assistance from other mental health providers
B. Criminal behavior and incarceration
C. Deterioration of personal relationships
, D. Worsening of the untreated mental health disorder
E. Physical health disorders
ANS: B, C, D, E
Feedback: Nontreatment of mental health disorders will cause many factors to surface since the
underlying disorder is not being controlled with medication, therapy, or support. Criminal behavior
and incarceration may occur since the behavior may include taking risks that would be otherwise
controlled with medication and therapy. The deterioration of relationships with friends and family
will occur through self-isolation or that others may not want to be around the escalating mentally ill
client. Without treatment, the condition will worsen until the client is not able to function within
societal norms. Since the client is not able to care for their mental health, they will be unlikely to
care for their physical needs. Seeking assistance from other mental health providers would indicate
the client is attending to their mental health needs.
PTS: 1 REF: p. 5 | Header: Community-Based Care
OBJ: 4
NAT: Client Needs: Physiological Integrity: Basic Care and Comfort
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Apply NOT: Multiple Select
9. Which significant change in the treatment of people with mental illness occurred in the 1950s?
A. Community support services were established.
B. Legislation dramatically changed civil commitment procedures.
C. The Patient’s Bill of Rights was enacted.
D. Psychotropic drugs became available for use.
ANS: D
Feedback: The development of psychotropic drugs, or drugs used to treat mental illness, began in
the 1950s. Community support, client rights, and commitment procedures were addressed more
directly in later decades.
PTS: 1 REF: p. 4 | Header: Development of Psychopharmacology
OBJ: 3
NAT: Client Needs: Safe and Effective Care Environment: Management of Care
TOP: Chapter 1: Foundations of Psychiatric–Mental Health Nursing
KEY: Integrated Process: Nursing Process
BLM: Cognitive Level: Understand NOT: Multiple Choice
10. Prior to the period of the enlightenment, which treatment of the mentally ill was prevalent?
A. Creating large institutions to provide custodial care
B. Focusing on religious education to improve their souls
C. Placing the mentally ill on display for the public’s amusement
D. Providing a safe refuge or haven offering protection
ANS: C
Feedback: In 1775, visitors at St. Mary of Bethlehem were charged a fee for viewing and ridiculing
the mentally ill, who were seen as animals, less than human. Custodial care was not often
provided as persons who were considered harmless were allowed to wander in the countryside or
live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In
early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed
as evil or possessed. Priests performed exorcisms to rid evil spirits, and in the colonies, witch
hunts were conducted with offenders burned at the stake. It was not until the period of
enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven
offering protection at institutions.
PTS: 1
