University of San Francisco - NURS 320

Chapter 02: Historical Issues

Keltner: Psychiatric Nursing, 8th Edition

MULTIPLE CHOICE

1)A person says, “What mental health issues are a major concern for the general population.” The nurse’s reply should be based on what confirmed fact concerning mental health issues?

1. 1. Bipolar disorder is a rare diagnosis among the general population.
   2. A diagnosis of schizophrenia is rarely confirmed during the teenage years.
   3. Major depression is very prevalent among the adult population.
   4. Alcohol-related issues are minimal considering the entire adult population.

2. A nurse, preparing a community presentation, should include what information concerning the most accurate characterization of treatment of the mentally ill prior to the Period of Enlightenment?
   1. Large public asylums provided custodial care.
   2. Care for the mentally ill was more compassionate.
   3. Care focused on reducing stress and meeting basic human needs.
   4. Patients were often displayed for public amusment.

3. A nurse is preparing to present a discussion to a group of nursing students on meeting the needs of the mentally ill. What concerns should be identified as the focus of society’s concerns during both the Period of Enlightenment and the Period of Community Mental Health?
   1. Moving patients out of asylums
   2. Studying brain structure and function
   3. Meeting basic human needs humanely
   4. Providing medication to control symptoms

4. Which statement made by a nurse demonstrates an understanding of the issue affecting the delivery of care to the mentally ill that motivated passage of the Community Mental Health Centers Act in 1963?
   1. “Involuntary hospitalized occurs only if a client demonstrated violent behavior.”
   2. “We attempt to address the issues that occur when a client is geographically isolated from family and community.”
   3. “Legally a voluntarily admitted client can demand to be discharged before receiving adequate treatment.”
   4. “Mental ill clients must give informed consent before being used as subjects in pharmacologic research.”

5. Which of Freud’s contribution to psychiatry most affects current psychiatric nursing?
   1. The challenge to look at humans objectively
   2. Recognition of the importance of human sexuality
   3. Theories about the importance of sleep and dream
   4. Discoveries about the effectiveness of free association

6. The greatest impact in the care of the mentally ill over the past 50 years is represented in which nursing statement to a newly admitted patient?

1. 1. “You will benefit from attending the assigned self-help groups”
   2. “Outpatient therapy will be prescribed as a part of your post discharge therapy.”
   3. “Let’s talk about the psychotropic drugs you’ve been prescribed.”
   4. “This is a written copy of your patients’ rights.”

7. An adult diagnosed with schizophrenia is being discharged from a state mental hospital after 20 years of institutionalization. What intervention should the nurse include in discharge planning to best manage the relapse of symptoms?
   1. Discuss methods to assist in the transition from hospitalization to community.
   2. Encourage the client to use community support services.
   3. Evaluate the client’s ability to effectively self-administer antipsychotic medications as prescribed.
   4. Educate the client and family to the likely need for crisis or emergency psychiatric interventions from time to time.

8. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient’s insurance form. Which resource should the nurse use to discern the criteria used to establish this diagnosis?
   1. The Diagnostic and Statistical Manual of Mental Disorders (DSM)
   2. Nursing Diagnosis Manual
   3. A psychiatric nursing textbook
   4. A behavioral health reference manual

9. Which nursing intervention is associated with a shift in the psychiatric nursing focus during the community mental health period of the 1960s?
   1. De-emphasizing the high numbers of people seeking treatment
   2. Making substance abuse the primary focus of care

1. 3. Focusing services on persons with serious mental illness
   4. Assessing the client’s potential for improvement

10. An adult with serious mental illness is being admitted to a community behavioral health inpatient unit. Recognizing current trends in hospitalization, the nurse can reasonable assume the need to prioritize which intervention?
    1. Providing education regarding the need for medication adherence
    2. Evaluating whether the client has a clear understanding of the illness
    3. Implementing safety precautions to address aggressive behavior
    4. Counseling the client concerning risks involved in demanding discharge against medical advice

11. When a nurse working in a well-child clinic asks a parent’s address, the parent responds, “My children and I are homeless.” What assumption should the nurse make of this response?
    1. It is a common occurrence, because 1 out of 50 children are homeless.
    2. It signals a need to investigate the possibility that the parent has severe mental illness.
    3. Confirms that evidence of child abuse or neglect that should be reported to social service agencies.
    4. Suggests that the parent may have substance abuse problem.

12. Which individual should the nurse assess as having the highest risk for homelessness?
    1. An older adult woman with mild dementia who lives alone in an apartment
    2. An adult with serious mental illness and no family
    3. An adolescent with an eating disorder
    4. A married person with alcoholism

13. A nurse begins working in a clinic housed in a homeless shelter. The nurse asks the clinic director, “What topic should I review to improve my effectiveness as I begin my new job?” Which topic should the clinic director suggest?
    1. Care of school-age children
    2. Psychiatric assessment
    3. Communicable disease prevention strategies
    4. Sexually transmitted disease signs and symptoms

14. Which skill is most important to a nurse working as a member of a community mental health team that strives to use a seamless continuum of care?
    1. Case management
    2. Diagnostic ability
    3. Physical assessment skills
    4. Patients’ rights advocacy

15. The broadened scope of psychiatric nursing practice is attributable primarily to what factor?
    1. Increased use of psychotropic drugs
    2. Opening of community mental health centers
    3. Legislation that changed nurse practice acts across the country

1. 4. Recidivism of seriously mentally ill patients in public mental hospitals

16. A patient diagnosed with an acute was hospitalized for a week and is now being discharged to a halfway house, where care is managed by a community mental health nurse. Which inference applies to this community?
    1. Additional mental health services should be made available for the severely mentally ill.
    2. A seamless continuum of services is in place to serve persons with severe mental illness.
    3. Case management services should be expanded to care for acute as well as long-term system consumers.
    4. Care is effective for only a few selective psychiatric diagnoses.

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17. Which of these services is most appropriate for an older client requiring minimal mental health interventions?
    1. Day treatment
    2. Hospitalization
    3. Scheduled visits at a community mental health center
    4. Regular attendance at a senior center facility

MULTIPLE RESPONSE

1. Which changes in psychiatric nursing practice are directly attributable to events occurring during the Decade of the Brain? (Select all that apply.)
   1. Homeless shelters became practice sites.
   2. Nurses upgraded knowledge of psychopharmacology.
   3. Nurses provided psychoeducation to patients and families.
   4. Nurses viewed psychiatric symptoms as resulting from brain irregularities.
   5. Nurses were more likely to advocate for patients’ rights related to involuntary commitment.

2. A community mental health nurse works in a mental health services system that is undergoing change to become a seamless system. To promote integrity of the new system, the nurse

should focus on:

1. 1. psychopathology.
   2. symptom stabilization.
   3. medication management.

1. 4. patient and family psychoeducation.
   5. patient reintegration into the community.
   6. holistic issues relating to patient care.

3. A newcomer to a community support meeting asks a nurse, “Why aren’t people with mental illnesses treated at state institutions anymore?” What would be the nurse’s accurate responses? (Select all that apply.)
   1. “Funding for treatment of mental illness now focuses on community treatment.”
   2. “Psychiatric institutions are no longer accepted because of negative stories in the press.”
   3. “There are less restrictive settings available now to care for individuals with mental illness.”