Chapter 01: Mental Health and Mental Illness
Halter: Varcarolis’s Canadian Psychiatric Mental Health Nursing, 2nd Edition

MULTIPLE CHOICE

	1.	A staff nurse completes orientation to a psychiatric unit. Which of the following would the nurse expect as an advanced practice intervention?
a.	Conduct mental health assessments	
b.	Prescribe psychotropic medication	
c.	Establish therapeutic relationships	
d.	Individualize nursing care plans	

ANS:	B
Prescriptive privileges are granted to master’s-prepared nurse practitioners who have taken special courses on prescribing medication; thus it is an advanced-practice intervention. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	2.	When a nursing student expresses concerns about how mental health nurses “lose all their nursing skills,” which of the following is the best response by the mental health nurse?
a.	“Psychiatric nurses practise in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients’ problems.”	
b.	“Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”	
c.	“That’s a misconception. Psychiatric nurses frequently use high-technology monitoring equipment and manage complex intravenous therapies.”	
d.	“Psychiatric nurses do not have to deal with as much pain and suffering as medical–surgical nurses do. That appeals to me.”	

ANS:	B
The practice of psychiatric nursing requires a different set of skills from medical–surgical nursing, though there is substantial overlap. Two domains relate specifically to psychiatric nursing: behavioural, including communication, coping, and education; and safety, covering crisis and risk management. Basic psychosocial nursing concepts are central to psychiatric nursing practice and increase your competency as a practitioner in all clinical settings. Whatever setting you choose to work in, you will have the opportunity to improve the lives of people who are experiencing mental illness as an additional challenge to their health.
Your experience in the mental health nursing rotation can help you gain insight into yourself and greatly increase your insight into the experiences of others. This part of nursing education can provide guidelines for and the opportunity to learn new skills for dealing with a variety of challenging behaviours. Psychosocial pain and suffering are as real as physical pain and suffering.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	3.	When a new bill introduced in Parliament reduces funding for care of people with mental illness, a group of people with mild mental illness write letters to their elected representatives in opposition to the legislation for all people with mental illness. Which role does this action portray?
a.	Recovery	
b.	Self-care	
c.	Advocacy	
d.	Social action	

ANS:	C
An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for himself or herself. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for people with mental illness, the letter-writing campaign advocates for the cause for all people with mental illness.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	4.	Which of the following has been identified as a significant trend that will affect the future of psychiatric mental health nursing in Canada?
a.	Decrease in the aging population	
b.	Increase in cultural diversity	
c.	Role of the advanced-practice nurse	
d.	Shortage of physicians in rural and urban areas	

ANS:	B
Four significant trends have been identified that will affect the future of psychiatric mental health nursing in Canada; these include an aging population, an increase in cultural diversity, expanding technology, and an increased awareness of the impact of the determinants of health on mental illness.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Safe Effective Care Environment

	5.	Which assessment finding most clearly indicates that a patient may be experiencing a mental illness?
a.	The patient reports occasional sleeplessness and anxiety.	
b.	The patient reports a consistently sad, discouraged, and hopeless mood.	
c.	The patient is able to describe the difference between “as if” and “for real.”	
d.	The patient perceives difficulty making a decision about whether to change jobs.	

ANS:	B
The correct response describes a mood alteration, which reflects mental illness. Alterations in cognition, mood, or behaviour that are coupled with significant distress and impaired functioning characterize mental illness. The distracters describe behaviours that are mentally healthy or within the usual scope of human experience.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	6.	Which finding best indicates that the goal “Demonstrates mentally healthy behaviour” was achieved?
a.	A patient sees self as capable of achieving ideals and meeting demands.	
b.	A patient behaves without considering the consequences of personal actions.	
c.	A patient aggressively meets own needs without considering the rights of others.	
d.	A patient seeks help from others when assuming responsibility for major areas of own life.	

ANS:	A
The correct response describes an adaptive, healthy behaviour. The WHO defines mental health as “a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community” (World Health Organization, 2010). The distracters describe maladaptive behaviours.

DIF:	Cognitive Level: Apply (Application)		TOP:	Nursing Process: Evaluation
MSC:	Client Needs: Psychosocial Integrity		

	7.	A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a.	International Statistical Classification of Diseases and Related Health Problems (ICD-10)	
b.	Diagnostic and Statistical Manual of Mental Disorders (DSM-5)	
c.	A behavioural health reference manual	
d.	NurseOne online	

ANS:	B
The DSM-5 gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Safe Effective Care Environment

	8.	A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a.	Nursing Outcomes Classification (NOC)	
b.	Diagnostic and Statistical Manual of Mental Disorders (DSM-5)	
c.	The ANA’s Psychiatric–Mental Health Nursing Scope and Standards of Practice	
d.	International Statistical Classification of Diseases and Related Health Problems (ICD-10)	

ANS:	B
The DSM-5 details the diagnostic criteria for psychiatric clinical conditions and is the official guide for diagnosing psychiatric disorders. The other references are good resources but do not define the diagnostic criteria.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	9.	Which individual is demonstrating the highest level of resilience?
a.	One who is able to repress stressors.	
b.	One who becomes depressed after the death of a spouse.	
c.	One who lives in a shelter for 2 years after his or her home is destroyed by fire.	
d.	One who is able to connect with their support systems and secure the resources they need to be well.	

ANS:	D
Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is a process and outcome of complex cultural systems rather than simply an individual’s ability to overcome adversity. Repression and depression are unhealthy. Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related audience response question.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	10.	Complete this analogy. NANDA: clinical judgement; NIC: _________________
a.	Patient outcomes	
b.	Nursing actions	
c.	Diagnoses	
d.	Symptoms	

ANS:	B
Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgements. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing care activities may be direct or indirect.

DIF:	Cognitive Level: Analyze (Analysis)			TOP:	Nursing Process: Evaluation
MSC:	Client Needs: Safe Effective Care Environment

	11.	A college student said, “Most of the time I’m happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it.” According to the Epp classification, which quadrant outcome should the nurse select?
a.	Optimal mental health with mental illness	
b.	Poor mental health with mental illness	
c.	Optimal mental health without mental illness	
d.	Poor mental health without mental illness	

ANS:	C
The student is happy and has an adequate self-concept. The student is reality-oriented, works effectively, and has control over his or her own behaviour. Mental health does not mean that a person is always happy.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	12.	Which disorder is a culture-bound syndrome?
a.	Epilepsy	
b.	Schizophrenia	
c.	Running amok	
d.	Major depression	

ANS:	C
Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behaviour.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	13.	The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies which of the following?
a.	Deviant behaviours	
b.	Present disability or distress	
c.	People with mental disorders	
d.	Mental disorders people have	

ANS:	D
The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example. Deviant behaviour is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	14.	A visitor at a community health fair asks the nurse, “What is the most prevalent mental disorder in Canada?” Select the nurse’s best response.
a.	Schizophrenia	
b.	Bipolar disorder	
c.	Generalized anxiety disorder	
d.	Major depression	

ANS:	D
The prevalence of major depressive disorder is 47%, and approximately 11.3% of adults will experience major depression at some time in their lives. The prevalence of schizophrenia is 1.3% per year. The prevalence of bipolar disorder is 1.5%. The prevalence for generalized anxiety disorder is about 2.6% annually.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Health Promotion and Maintenance

	15.	Which of the following represents an outcome domain of the Nursing Outcomes Classification (NOS)?
a.	Mental health	
b.	Perceived health	
c.	Chronic illness	
d.	Mental illness	

ANS:	B
One of the seven outcome domains is perceived health; the other six are functional health, physiologic health, psychosocial health, health knowledge, family health, and community health.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Health Promotion and Maintenance

	16.	A patient’s relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health?
a.	Effectiveness in work	
b.	Communication skills	
c.	Productive activities	
d.	Fulfilling relationships	

ANS:	D
The information provided centres on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. They have rich social relationships. Data are not present to describe work effectiveness, communication skills, or activities.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	17.	Which belief will best support a nurse’s efforts to provide patient advocacy during a multidisciplinary patient care planning session?
a.	All mental illnesses are culturally determined.	
b.	Schizophrenia and bipolar disorder are cross-cultural disorders.	
c.	Symptoms of mental disorders are unchanged from culture to culture.	
d.	Assessment findings in mental disorders reflect a person’s cultural patterns.	

ANS:	D
A nurse who understands that a patient’s symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Psychosocial Integrity

	18.	A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident?
a.	Incidence	
b.	Prevalence	
c.	Comorbidity	
d.	Clinical epidemiology	

ANS:	D
Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given period.

DIF:	Cognitive Level: Understand (Comprehension)	TOP:	Nursing Process: Evaluation
MSC:	Client Needs: Safe Effective Care Environment

	19.	The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how events from childhood have anything to do with this disabling illness.” Which response by the nurse will best help the spouse understand the cause of this disorder?
a.	“Psychological stress is the basis of most mental disorders.”	
b.	“This illness results from developmental factors rather than stress.”	
c.	“Research suggests that this condition more likely has a biological basis.”	
d.	“It must be frustrating for you that your spouse is sick so much of the time.”	

ANS:	C
Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics is only one part of biological factors. Empathy does not address increasing the spouse’s level of knowledge about the cause of the disorder. The other distracters are not established facts.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Psychosocial Integrity

	20.	A category 5 tornado occurred in a community of 400 people, resulting in the destruction of many homes and businesses. In the 2 years after this disaster, 140 individuals were diagnosed with post-traumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases?
a.	Prevalence	
b.	Comorbidity	
c.	Incidence	
d.	Clinical epidemiology	

ANS:	C
Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill. Clinical epidemiology is a broad field that addresses what happens after people with illnesses are seen by clinical care providers. Comorbidity refers to having more than one mental disorder at a time.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Planning/Outcomes Identification	
MSC:	Client Needs: Safe Effective Care Environment

	21.	Most psychiatric disorders are the result of which of the following?
a.	Childhood trauma	
b.	Adverse life events	
c.	Multiple defective genes	
d.	Chronic medical conditions	

ANS:	C
Most psychiatric disorders are the result of multiple mutated or defective genes, each of which in combination may contribute to the disorder. Although disorders may be caused by childhood trauma, adverse live events, and chronic medical conditions, they are not the cause of the majority of psychiatric disorders.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	22.	Select the best response for the nurse who receives a question from another health professional seeking to understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and a nursing diagnosis.
a.	“There is no functional difference between the two. Both identify human disorders.”	
b.	“The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.”	
c.	“The DSM-5 diagnosis describes causes of disorders, whereas a nursing diagnosis does not explore etiology.”	
d.	“The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing.”	

ANS:	D
The medical diagnosis is concerned with the patient’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient’s response to stress and possible caring interventions. Both tools consider culture. The DSM-5 is multiaxial. Nursing diagnoses also consider potential problems.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

	23.	Which nursing intervention below is part of the scope of an advanced-practice psychiatric mental health nurse only?
a.	Coordination of care	
b.	Health teaching	
c.	Milieu therapy	
d.	Psychotherapy	

ANS:	D
Psychotherapy is part of the scope of practice of an advanced-practice nurse. The distracters are within a staff nurse’s scope of practice.

DIF:	Cognitive Level: Understand (Comprehension)	
TOP:	Nursing Process: Implementation	MSC:	Client Needs: Safe Effective Care Environment

MULTIPLE RESPONSE

	1.	An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you instantly know how to take care of psychotic patients.” What information should the new graduate consider when analyzing this comment? (Select all that apply.)
a.	The experienced nurse may need to be reminded of the importance of standardized classifications.	
b.	New research findings should be integrated continuously into a nurse’s practice to provide the most effective care.	
c.	Experience provides mental health nurses with the essential tools and skills needed for effective professional practice.	
d.	Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error.	
e.	An intuitive sense of patients’ needs guides effective psychiatric nurses.	

ANS:	A, B
Evidence-informed practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so 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.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Diagnosis/Analysis			
MSC:	Client Needs: Safe Effective Care Environment

	2.	Which findings are signs of a person who is mentally healthy? (Select all that apply.)
a.	Says, “I have some weaknesses, but I feel I’m important to my family and friends.”	
b.	Adheres strictly to religious beliefs of parents and family of origin	
c.	Spends all holidays alone watching old movies on television	
d.	Considers past experiences when deciding about the future	
e.	Experiences feelings of conflict related to changing jobs	

ANS:	A, D, E
Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity

	3.	A patient in the emergency department says, “Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat.” Which aspects of the patient’s mental health have the greatest and most immediate concern to the nurse? (Select all that apply.)
a.	Happiness	
b.	Appraisal of reality	
c.	Control over behaviour	
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 behaviour. Their appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patient’s control over behaviour is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusions of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.

DIF:	Cognitive Level: Apply (Application)		
TOP:	Nursing Process: Assessment	MSC:	Client Needs: Psychosocial Integrity