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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?
- A. Happiness
- B. Appraisal of reality
- C. Control over behavior
- D. Effectiveness in work
- E. Healthy self-concept
Correct Answer: B,C,E
Rationale: 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.
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The partner of a patient diagnosed with schizophrenia says, 'I don't understand why childhood experiences have anything to do with this disabling illness.' Which nurse's response will best help the partner understand this condition?
- A. Psychological stress is actually at the root of most mental disorders.
- B. We now know that all mental illnesses are the result of genetic factors.
- C. It must be frustrating for you that your spouse is sick so much of the time.
- D. Research has shown schizophrenia has a biological rather than psychological origin.
Correct Answer: D
Rationale: Many of the most prevalent and disabling mental disorders have been found to have strong biological influences. Helping the partner understand the importance of his or her role as a caregiver is also important. Empathy is important but does not increase the spouse's level of knowledge about the cause of the patient's condition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root of most mental disorders.
A patient tells a nurse, 'I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems.' What is the nurse's best response?
- A. Comparing yourself with others has no real advantages.
- B. Why do you blame yourself for having a psychiatric illness?
- C. Mental illness affects 50% of the adult population in any given year.
- D. Are you are concerned that others don't experience the same challenges as you.
Correct Answer: D
Rationale: Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing.
A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult?
- A. U.S. Department of Health and Human Services
- B. Journal of the American Psychiatric Association
- C. North American Nursing Diagnosis Association International (NANDA-I)
- D. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Correct Answer: D
Rationale: The DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful information but are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder.
A participant at a community education conference asks, 'What is the most prevalent type of mental disorder in the United States?' What is the nurse's best response?
- A. Why do you ask?
- B. Schizophrenia
- C. Affective disorders
- D. Anxiety disorders
Correct Answer: D
Rationale: The prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression, dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 18.1%.
Which statements most clearly reflect the stigma of mental illness?
- A. Many mental illnesses are hereditary.
- B. Mental illness can be evidence of a brain disorder.
- C. People claim mental illness, so they can qualify for disability.
- D. If people with mental illness went to church, they would be fine.
- E. Mental illness is a result of the breakdown of the American family.
Correct Answer: C,D,E
Rationale: Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.