Chapter 32: Chronic Mental Health Disorders Nursing School Test Banks

Chapter 32: Chronic Mental Health Disorders
Test Bank

MULTIPLE CHOICE

1. Persons with chronic mental health problems have much higher rates of:
a. Apathy
b. Suicide
c. Homicide
d. Physical illness
ANS: B
Individuals with chronic mental health problems have much higher rates of suicide because they often cannot see a bright future for themselves and find it difficult to meet basic needs.

DIF: Cognitive Level: Knowledge REF: p. 377 OBJ: 1
TOP: Scope of Mental Illness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

2. The process of emptying state mental hospitals and placing mentally ill persons in the community is known as:
a. Recidivism
b. Exacerbation
c. Deinstitutionalism
d. Deinstitutionalization
ANS: D
State psychiatric hospitals discharge long-term patients into the community through a practice called deinstitutionalization. Recidivism refers to a pattern of short hospital admissions and discharges; and exacerbation is a period of dysfunction accompanied by an increase in the signs, symptoms, and seriousness of a problem.

DIF: Cognitive Level: Knowledge REF: p. 375 OBJ: 2
TOP: Effects of Deinstitutionalization KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. The experience and suffering of living with mental illness:
a. Decreases as one grows older
b. Is unique to each person
c. Follows a predictable course
d. Is common to all mentally ill persons
ANS: B
Each client is a unique individual; therefore, even if clients share the same diagnosis, the experiences are unique.

DIF: Cognitive Level: Comprehension REF: p. 377 OBJ: 2
TOP: Characteristics of Chronic Mental Illness
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

4. The client finds fault in every success she has. She is afraid to try anything new because she just knows that she will fail because she is mentally ill. Her behaviors demonstrate:
a. Low self-esteem
b. Suicidal ideation
c. Low abstraction abilities
d. Altered thought processes
ANS: A
Mentally troubled people often see themselves as helpless, ineffective, and incapable of change, which leads to chronic low self-esteem. Suicidal ideation refers to persistent thoughts of suicide; low abstraction abilities refer to the inability to think conceptually; and altered thought processes refer to a disruption in the ability to think clearly.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 3
TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

5. The child has not developed the ability to respond to others. He cannot communicate his needs. He may remain dependent upon others throughout his life. He is most accurately described as having:
a. Autism
b. Anxiety
c. Mental retardation
d. Attention-deficit disorder
ANS: A
Children with autism do not develop the ability to respond to and communicate their needs, and they remain dependent on others, sometimes throughout their lives. These children do not respond well to reality. The other options do not accurately match the description in the situation.

DIF: Cognitive Level: Comprehension REF: p. 378 OBJ: 4
TOP: Children and Adolescents with Chronic Mental Illness
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

6. Approximately _____% of individuals with chronic mental illness use or abuse drugs.
a. 25
b. 50
c. 75
d. 100
ANS: C
This statistic poses a significant problem in the treatment of mental illness.

DIF: Cognitive Level: Knowledge REF: p. 379 OBJ: N/A
TOP: Persons with Multiple Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

7. The client has been diagnosed with depression for a long time. He recently started using cocaine to help relieve his depression. The most accurate description of these behaviors is a(n):
a. Addiction
b. Dual diagnosis
c. Fear of failure
d. Poor prognosis
ANS: B
Although all of the options might apply, this answer most accurately describes the behavior. Individuals with a dual diagnosis are suffering from two mental health disorders, one of which usually is substance related.

DIF: Cognitive Level: Application REF: p. 379 OBJ: 6
TOP: Persons with Multiple Disorders KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

8. The criterion that necessitates the need to hospitalize an individual with chronic mental health problems occurs when his or her:
a. Behaviors pose a threat.
b. Caregivers need a respite.
c. Subsistence benefits expire.
d. Medications need readjustment.
ANS: A
Persons with chronic mental health problems are hospitalized only when their behaviors pose a threat to themselves or others. Other options that are less disruptive than hospitalization can be found for the other situations.

DIF: Cognitive Level: Knowledge REF: p. 379 OBJ: 7
TOP: Inpatient Environment KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

9. The client has schizophrenia. He has moved frequently between the community and mental health facilities for the past 7 years. The clients behavior is an example of:
a. Relapse
b. Recidivism
c. Remission
d. Exacerbation
ANS: B
Recidivism remains a problem for both health care professionals and their clients. Coordinating care between the community and the institution helps to reduce the number of admissions to facilities. Relapse refers to the return to maladaptive behavior; remission is a period of partial or complete disappearance of symptoms; and exacerbation refers to the reoccurrence of symptoms.

DIF: Cognitive Level: Knowledge REF: p. 376 OBJ: 8
TOP: Access to Health Care KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

10. A male client is experiencing hallucinations. The intervention that would be most helpful in controlling the hallucinations is:
a. Actively listening to his concerns
b. Establishing a trusting relationship
c. Encouraging appropriate behaviors
d. Teaching him to use distraction techniques when experiencing hallucinations
ANS: D
Distraction techniques, such as whistling or telling the hallucination to go away, will be helpful in controlling the hallucinations. Actively listening to his concerns and establishing a trusting relationship are interventions that will help in improving communication skills, and encouraging appropriate behaviors will help the client build social skills.

DIF: Cognitive Level: Application REF: p. 381 OBJ: 9
TOP: Nursing Therapeutic Process KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

11. Neuroleptic drugs are prescribed to treat _____ disorders.
a. Anxiety
b. Personality
c. Psychotic
d. Somatoform
ANS: C
Neuroleptic drugs are also known as antipsychotic drugs and are used to treat psychosis.

DIF: Cognitive Level: Synthesis REF: p. 381 OBJ: 9
TOP: Pharmacological Therapy KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. Individuals with mental illness live an average of _____ years less than the general population.
a. 2 to 4
b. 5 to 8
c. 10 to 15
d. 18 to 25
ANS: C
Fifty percent of clients with mental health disorders also suffer from physical disorders, and, frequently, they are not capable of managing either disorder.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 2
TOP: Access to Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

13. Individuals with schizophrenia tend to use the chemical __________ most often.
a. Alcohol
b. Cocaine
c. Heroin
d. Hypnotics
ANS: A
Alcohol is used most commonly by individuals with schizophrenia, whereas cocaine is used most often by individuals with mood disorders, and heroin is used most frequently by those with conduct disorders. Hypnotics are not referenced as being used predominantly by any specific group.

DIF: Cognitive Level: Application REF: p. 376 OBJ: 2
TOP: Access to Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. A female client with a chronic mental health disorder tells the nurse that she has great difficulty every morning getting ready for work because she cannot decide what to wear to work or what to eat for breakfast. This client is experiencing:
a. Auditory hallucinations
b. Altered thought processes
c. Delusions of grandeur
d. Chronic low self-esteem
ANS: B
Commonly experienced with chronic mental illness is an altered thought process, which disrupts the individuals ability to think clearly, problem-solve, or make plans. Auditory hallucinations refer to hearing false sounds; delusions of grandeur refer to a false fixed belief of elevated self-worth; and chronic low self-esteem often is experienced by these individuals because they feel helpless and hopeless, but this option does not lend itself to the situation.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 3
TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. A client in an inpatient mental health setting is scheduled to be discharged, with follow-up at a community mental health center. His family is concerned that his inpatient stay was not long enough, and he will be re-admitted in the near future. The nurse knows that the average length of inpatient stay is:
a. 5 days
b. 10 days
c. 25 days
d. 1 month
ANS: B
The average length of stay for a mental illness is 10 days. The short inpatient stay, combined with a short community care involvement often leads to recidivism, as the immediate goal in the inpatient setting is to help the client control his or her behavior.

DIF: Cognitive Level: Application REF: p. 379 OBJ: 1
TOP: Inpatient Settings KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. A 50-year-old man suffering from schizophrenia and depression for the last 30 years is treated on an outpatient basis. What is the primary goal for his treatment plan?
a. Client will return to pre-illness employment and activities of daily living.
b. Client will be managed permanently on an inpatient basis due to the effects of his antipsychotic medications.
c. Client will enter into a vocational training program and not experience an exacerbation of symptoms.
d. Client will be able to live independently and purchase his own home.
ANS: C
Basic goals for chronically disordered mental health clients are to achieve stabilization and maintain the highest possible level of daily functioning. While he may be able to function outside the institution with help and support, the chronicity of his illness does not make it realistic to expect that he will return to pre-illness functioning, or be able to purchase his own home. Effects of antipsychotic medications must be assessed and addressed, however, inpatient hospitalization is not a primary goal.

DIF: Cognitive Level: Application REF: p. 380 OBJ: 7
TOP: Treatments and Therapies KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. A woman with a history of chronic mental illness was dating someone for about a month before they ended the relationship. What is the probable action the woman will take?
a. Endure a brief period of grieving and seek to begin dating again.
b. Speak to friends and other support persons and consider the positive aspects of the relationship.
c. Withdraw and refuse to seek out or enter into another relationship.
d. Take up an activity with friends to avoid staying home and thinking about the failed relationship.
ANS: C
In individuals with chronic mental health problems, basic needs for love and belonging go unmet, and they respond by becoming more emotionally paralyzed. The experience of a small success in a short-term relationship will often prevent them from making any further attempts because they just know that they will eventually fail. When self-concept is low, it is difficult to convince someone that a brighter future can exist. The other responses demonstrate positive coping strategies.

DIF: Cognitive Level: Application REF: p. 377 OBJ: 3
TOP: Psychological Characteristics KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. Which of the following clients in the community with chronic mental illness is most likely to be compliant in taking his or her prescribed medications on a consistent basis?
a. The client who has an understanding of his or her disease and medications effect in controlling symptoms
b. The client who has insurance that covers the cost of all prescribed medications
c. The client who has very little insight of his or her illness and is living with a family member
d. The client who is trying to live independently in a homeless shelter
ANS: A
The side effects of many medications are uncomfortable, and clients often stop taking them as soon as the acute symptoms subside. One of the most powerful predictors of medication refusal is ones insight into the illness, and most chronically or severely mentally ill individuals have little insight. Nurses must carefully monitor clients routinely for compliance with medications.

DIF: Cognitive Level: Application REF: p. 381 OBJ: 8
TOP: Pharmacological Therapy KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

19. In the United States today, the effects of deinstitutionalization include: (Select all that apply.)
a. A comprehensive mental health care system
b. A decrease in the need for medical treatment
c. An increase in the jail and prison populations
d. An increase in the homeless population
e. People who cannot obtain adequate food or shelter
f. Well-adjusted people with CMI
g. Unlimited access to mental health care
ANS: C, D, E
Deinstitutionalization refers to the widespread discharge of clients from psychiatric hospitals into the community, largely caused by the introduction of psychotherapeutic drugs in the 1950s.

DIF: Cognitive Level: Comprehension REF: p. 375 OBJ: 1
TOP: Deinstitutionalization KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

20. Psychiatric rehabilitation focuses on: (Select all that apply.)
a. Helping clients control their behaviors
b. Assisting clients to cope effectively with their life situations
c. Helping clients identify their feelings
d. Preventing the client from harming himself or herself
e. Assisting the client with problem-solving techniques
f. Assisting with occupational and vocational training
ANS: B, C, E, F
Helping clients control their behaviors and preventing the client from harming himself or herself are the goals of acute inpatient settings.

DIF: Cognitive Level: Comprehension REF: p. 380 OBJ: 7
TOP: Psychiatric Rehabilitation KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

21. Persons with which of the following diagnoses respond well to therapeutic interventions and may have no further problems? (Select all that apply.)
a. Psychosis
b. Depression
c. Anxiety disorders
d. Schizophrenia
e. Phobias
f. Erratic behavioral disorder
ANS: B, C
Persons with depression, anxiety disorders, or phobias often respond well to therapeutic interventions and have no further problems. However, for a certain group of individuals, mental illness becomes a way of life.

DIF: Cognitive Level: Comprehension REF: p. 374 OBJ: 1
TOP: Introduction KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

COMPLETION

22. The nurse on a mental health unit administers a medication to a female client for the purpose of reducing her psychotic symptoms and quieting her behavior. This medication is considered a __________.

ANS:
chemical restraint
Chemical restraints should be used as a last resort measure with clients. Chemical restraints require a physicians order and must adhere to specific guidelines.

DIF: Cognitive Level: Analysis REF: p. 375 OBJ: 1
TOP: Effects of Deinstitutionalization KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

23. Adolescents in whom diabetes is diagnosed have high rates of depression and __________.

ANS:
suicide
Diabetes is a chronic and life-changing illness that differentiates adolescents from others their age, leading to depression and possibly suicide.

DIF: Cognitive Level: Application REF: p. 378 OBJ: 4
TOP: Children and Adolescents with Chronic Mental Illness
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

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