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Which belief by a nurse supports the highest degree of 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 constant from culture to culture.
- D. Some symptoms of mental disorders may reflect a person's cultural patterns.
Correct Answer: D
Rationale: 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. All mental illnesses are not culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but this understanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture to culture.
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An 86 year old, previously healthy and independent, falls after an episode of vertigo. Which statement made by this patient best demonstrates resilience?
- A. I knew this would happen eventually.
- B. Attending my weekly water aerobics class is too risky.
- C. I don't need that silly walker to get around by myself.
- D. Maybe some physical therapy will help me with my balance.
Correct Answer: D
Rationale: Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying 'I knew this would happen eventually' and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial.
A 40-year-old adult living with parents' states, 'I'm happy but I don't socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them.' A nurse should identify interventions to improve which patient characteristic?
- A. Self-concept
- B. Overall happiness
- C. Appraisal of reality
- D. Control over behavior
Correct Answer: A
Rationale: The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Although the patient reports being happy, the subsequent comments refute that self-appraisal. The patient's comments do not indicate that he/she is out of touch with reality. The patient's needs are broader than control over own behavior.
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.
Which basic intervention should a psychiatric mental health nurse plan to provide for a patient diagnosed with a mood disorder?
- A. Sharing clinical expertise to enhance patient treatment
- B. Performing individual or group psychotherapy for the patient
- C. Using appropriate diagnostic tests to monitor patient condition
- D. Conducting stress reduction and health maintenance classes
Correct Answer: D
Rationale: Conducting stress reduction and health maintenance classes is the basic intervention that should be performed by a psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management classes are examples of health maintenance classes. The other options are advanced practice interventions.
The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care to be achieved within 3 days?
- A. Patient describes feelings associated with loss and stress.
- B. Patient meet own needs before considering the rights of others.
- C. Patient will identify healthy coping behaviors in response to stressful events.
- D. Patient will allow others to assume responsibility for major areas of own life.
Correct Answer: C
Rationale: The patient's ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors.