Test Bank For Varcaroliss Canadian Psychiatric Mental Health Nursing 3rd Edition By Sonya, Exams of Nursing

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Chapter 01: Mental Health and Mental Illness

Pollard: Varcarolis’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach, 3rd

Edition

MULTIPLE CHOICE

1. Which of the following is considered an Advanced Practice Intervention? a. Conducting mental health assessments (MSA) b. Prescribing psychotropic medication c. Establishing therapeutic relationships d. Individualizing nursing care plans ANS: B Registered nurses and registered psychiatric nurses can further their education at a baccalaureate levelor at the graduate level (master’s doctorate) and become qualified to practise psychiatric mental health nursing at two levels – basic and advanced – developing on their education preparation. Prescriptive privileges are granted to master’s- prepared Nurse Practitioners (NPs) as they have taken additional advanced courses on prescribing medication. Appropriate use of diagnostic tests must be completed aswell as having hospital admitting privileges. Establishing therapeutic relationship, conducting mental health assessments (MSAs), and individualizing nursing care plans are foundational psychiatric nursing skills. Therefore, they are considered Basic-Level Interventions. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
2. Which has been identified as a priority for national plans and strategies in 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 In early phases of strategic development, the Mental Health Commission of Canada identified cultural diversity as a priority for national plans and strategies. Increasing cultural diversity within Canada warrants deeper attention to culturally safe care and concern for the mental health consequences of colonization and racism. An aging population and shortage of physicians are important to future trends. The role of the advanced practice nurse is continuing to evolve in psychiatric mental health nursing in Canada. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
3. Which serves as the official guide for diagnosing psychiatric disorders? a. International Classification of Diseases (ICD-11) b. Diagnostic and Statistical Manual of Mental Disorders (DSM) c. A behavioural health reference manual

d. NurseOne online ANS: B The first Diagnostic and Statistical Manual of Mental Disorders (DSM) was published by the American Psychiatric Association in 1952. Its purpose was to provide clinicians, educators, and researchers with a common framework to understand and communicate about mental disorders. With a common understanding about mental disorders, researchers and clinicians could work together in their attempts to improve care for people with mental illness. The current DSM- 5 serves as the official guide for diagnosing psychiatric disorders. The International Classification of Diseases ( ICD ) sets the global health information standard for mortality and morbidity statistics. Clinicians and researchers use this classification system to define diseases, study disease patterns, monitor outcomes, and subsequently allocate resources based on the prevalence of disease. The Canadian Institute for Health Information developed an enhanced version of the previous version , ICD- 10 referred to as the ICD 10-CA period that version extends beyond defining and classifying diseases to describe conditions and situations that are not diseases, including for example, risk factors to health and psychosocial circumstances. A behavioral health reference manual and NurseOne online are not used as official guides for diagnosis. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe Effective Care Environment

4. When locating the description and 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
5. Which individual is demonstrating the highest level of resilience? a. (^) An individual repressing their stressors who is having a difficult time coping with activities of daily living (ADLs) b. (^) An individual who is in a depressed state after the death of their spouse c. (^) An individual who lives in a shelter for 2 years after their home is destroyed by a fire d. An individual who navigates and negotiates resources to support their well-being ANS: D

A characteristic of mental health increasingly being promoted as essential to the recovery process is resilience. Resilience is a process and outcome of complex, cultural systems, rather than as an individual capacity to overcome adversity. In this way, when exposed to adversity, one’s resilience depends on the navigation and negotiation of resources that can support well-being. Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. An individual who is repressing their stressors may need support for developing coping strategies. It is important for the individual who is in a depressed state after the death of their spouse to navigate and negotiate resources that can support their well-being (e.g., grief support or counselling). An individual living in a shelter needs immediate support and assistance when entering the shelter to navigate services and supports. Shelters are short-term resources. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Psychosocial Integrity

6. A multidisciplinary team is working with two groups of patients diagnosed with depression. One group of patients receives supportive interventions and psychotropic medication (e.g., antidepressants). The other group receives only psychotropic medication. Outcomes are measured for each group. Which is being studied? 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: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
7. A category 5 tornado occurred in a community of 400 people, resulting in 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 individuals? 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| Nursing Process: Outcome Identification MSC: Client Needs: Safe Effective Care Environment

8. Which individual is considered to have positive attributes of mental health? a. (^) An individual who can laugh and play b. An individual who is unable to experience joy c. An individual who has a difficult time managing interpersonal conflict d. An individual who has limited insight and judgement ANS: A Mental health is described as more than merely the absence of mental disorders or disabilities. Laughing and play are considered positive attributes of mental health. Individuals who are unable to experience joy, who have a difficult time managing interpersonal conflict, and who have limited insight and judgement may require further support, enhanced coping strategies and promotion of positive mental health from mental health clinicians. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
9. Which report highlighted the importance of issues related to mental health and mental illness in Canada? a. (^) The ERB Report b. The ERG Report c. The EDD Report d. The EPP Report ANS: D Published in 1988, Mental Health for Canadians: Striking a Balance , commonly called the Epp Report, highlighted the importance of issues related to mental health and mental illness in Canada. It proposed seven guiding principles for the development of public policies to support mental health. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning| Nursing Process: Outcome Identification MSC: Client Needs: Health Promotion and Maintenance
10. Which of the following indicates reflection and discovery of resilience? a. Why do I not have the inner strength I once did? b. (^) How have I gotten through difficult times? c. (^) Why doesn’t anything ever go right for me? d. Why do people always make me feel this way? ANS: B

When reflecting on resilience questions should be framed in a positive way. An individual asking, “ How have I gotten through difficult times ?” demonstrates a positive reflection and an attempt to discover progression through difficult times, thus indicating resilience. Questions relating to, “ Why do I not have the inner strength I once did, ” “ Why doesn’t anything ever go right for me, ” and “ Why do people always make me feel this way ” are not framed in a positive way. The distractors, are not related to inner strength, competence, optimism, flexibility, and the ability to cope effectively when faced with adversity. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

11. Which is a standard measure for mental health? a. The Epp Report b. The Diagnostic and Statistical Manual for Mental Disorders (DSM) c. There is no standard measure for mental health d. Nature versus nurture ANS: C There is no standard measure for mental health, in part because it is culturally defined and is based on interpretations of effective functioning according to societal norms. One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable or unacceptable behavior. The Epp Report highlights the importance of issues related to mental health and mental illness in Canada but is not a standard measure. The DSM serves as the official guide for diagnosing psychiatric disorders. Nature versus nurture is not a standard measure for mental health. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
12. Which is currently the most accepted explanation for mental illness? a. Biological Model b. Diathesis-Stress Model c. (^) Psychological Model d. Sociological Model ANS: B Currently, the Diathesis-Stress Model , in which diathesis represents biological predisposition and stress represents environmental stress or trauma, is the most accepted explanation for mental illness. This nature-plus-nurture model asserts that most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors. Biological, Psychological, and Sociological models only have a specific focus, which leads to segregation and isolation of people. Singularly these models are not identified as causative factors for mental illness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
13. Crisis and risk management are considered which of the following? a. Nursing Outcomes Classification (NOC) b. Nursing Diagnoses

c. Evidence-Informed Practice d. Nursing Interventions Classification (NIC) ANS: D Crisis and risk management are considered to be part of the Nursing Interventions Classifications (NIC) are another tool used to standardize, define, and measure nursing care. There are seven domains: basic physiological, complex physiological, behavioural, safety, family, health system, and community. Two domains relate specifically to psychiatric nursing behavioural, including communication, coping, and education, and safety, covering crisis and risk management. The Nursing Outcome Classification (NOC) provides a comprehensive list of standardized outcomes, definitions, and measures to describe patient outcomes influenced by nursing practice. A nursing diagnosis is a clinical judgement about individual, family, or community responses to actual or potential health problems and life processes. Evidence-Informed Practice is care based on the collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research- derived evidence. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment

14. A college student is struggling with depressive symptoms and is identifying feeling overwhelmed. The counsellor at the college working with the student, seeks support, assessment, and follow-up from a psychiatrist at the local hospital using a secure video connection. This is an example of which of the following? a. Cultural diversity b. Physical environments c. (^) Telepsychiatry d. Resilience ANS: C Telepsychiatry is also known as telemedicine. In this practice, real-time consultations typically occur in facilities using a secured telecommunication connection to enable psychiatric assessment or consultation. With telepsychiatry, the mental health needs of a greater range of people in a wider range of locations can be met with timely professional assessments and prescribed interventions. The counsellor at the college working with a student and specifically seeking support, assessment, and a follow-up from the psychiatrist in a local hospital using a secure video connection therefore at this time cultural diversity, physical environment, and resilience would not apply. These may be discussed in the assessment with the psychiatrist, student, and counsellor. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
15. An individual diagnosed with schizophrenia has recently been diagnosed with hypertension. Which is correct documentation? a. The individual has a comorbid condition of schizophrenia and hypertension. b. The individual has a diagnosis of schizophrenia and disparity of hypertension. c. The individual has a diagnosis of hypertension secondary to schizophrenia. d. The individual has a diagnosis of schizophrenia. ANS: A

Comorbid conditions are those disorders that occur at the same time as another condition. For example, an individual diagnosed with schizophrenia may also have comorbid hypertension. Hypertension is not a specific disparity of schizophrenia. Hypertension is not diagnosed secondary to schizophrenia. Not acknowledging hypertension in the person at all is incorrect. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

16. A psychiatric mental health nurse is invited to a local college to discuss mental health and mental illness. A student asks about the role of psychiatric mental health nurses. Which is the best response? a. (^) “We practice in safer environments than other specialties. Nurse-to-patient ratios are significantly lower because of the nature of the patients’ concerns.” b. (^) “We work with a broad population of patients in diverse settings. We use therapeutic communication skills, as well as critical thinking to promote optimal mental health.” c. (^) “We frequently use high technology monitoring equipment and manage complex therapies.” d. (^) “We do not have to treat patients with as much pain and suffering as other specialties do. We only talk about mental health.” ANS: B Two domains relate specifically to psychiatric mental health nursing: behavioural, including communication, coping, and education; and safety, covering crisis and risk management. The therapeutic nurse–patient relationship, therapeutic communication, critical thinking, and clinical judgement are central nursing concepts for psychiatric mental health nursing practice. Psychiatric mental health nurses work with a broad population of patients in diverse settings to promote optimal mental health. While there are safety protocols in place within mental health environments, it is not correct to say the environment is safer than another discipline. Nurse-to-patient ratios may be different based on observation levels within mental health, but they are not significantly lower. Telepsychiatry is the use of secured telecommunication connections enabling psychiatric assessments, or consultations but is not used to manage complex therapies. Psychosocial pain and suffering are as real as physical pain and suffering. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
17. Which mental disorder is the most prevalent in Canada? a. (^) Schizophrenia and psychosis b. Bipolar disorder c. Attention-deficit disorder d. Major depressive episode ANS: D In accordance with current statistics major depressive episode is the most prevalent mental disorder in Canada with the prevalence over 12 months of 4.7% and a lifetime prevalence of 11.3%. Attention deficit disorder has a prevalence over 12 months of 2.6%. Bipolar disorder has a prevalence over 12 months of 1.5% and 2.6% of lifetime prevalence. Schizophrenia and psychosis have a prevalence over 12 months of 1.3%.

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

18. Which of the following is used to define diseases, study disease patterns, monitor outcomes, and subsequently allocate resources based on the prevalence of disease? a. (^) International Classification of Diseases (ICD) b. (^) Diagnostic and Statistical Manual of Mental Disorders (DSM) c. A behavioral health reference manual d. The Canadian Institute for Health Information ANS: B The International Classification of Diseases ( ICD ) sets the global health information standard for mortality and morbidity statistics. Clinicians and researchers use this classification system to define diseases, study disease patterns, monitor outcomes, and subsequently allocate resources based on the prevalence of disease. The Diagnostic and Statistical Manual of Mental Disorders (DSM) current fifth edition serves as the official guide for diagnosing psychiatric disorders. A behavioural health reference manual and The Canadian Institute for Health Information are not used to define diseases, study disease patterns, monitor outcomes, and subsequently allocate resources based on the prevalence of disease. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe Effective Care Environment
19. An individual has a high level of resilience. Which is another characteristic the nurse could expect this individual to have? a. Social support b. Expressiveness c. (^) Aggressiveness d. Depressed affect ANS: A Resilience is more closely connected to social and environmental factors than any individual characteristic. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Psychosocial Integrity
20. Mental illness is characterized by alterations in cognition, mood or behaviour, significant distress, and which other key feature? a. Altered social status b. Impaired intellect c. Impaired functioning d. Personality changes ANS: C

Mental health is described as more than merely the absence of mental disorders or disabilities. Mental health is not the same as mental illness. However, poor mental health can lead to mental and physical illness. It is alterations in cognition, mood, or behaviour coupled with significant distress and impaired functioning that characterize mental illness. Mental illness refers to all mental disorders with definable diagnoses. Mental illness impairs functioning – for instance in social, occupational, and daily living. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE

1. Which of the following represents an outcome domain of the Nursing Outcomes Classification (NOC)? ( Select all that apply. ) a. (^) Mental health b. (^) Perceived health c. Functional health d. Physiological health e. Psychosocial health ANS: B, C, D, E The Nursing Outcomes Classification (NOC) provides “a comprehensive list of standardized outcomes, definitions, and measures to describe patient outcomes influenced by nursing practice.” Outcomes are organized into seven domains: functional health, physiological health, psychosocial health, health knowledge and behaviour, perceived health, family health, and community health. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
2. Which is important for all psychiatric mental health nurses? ( Select all that apply. ) a. Frequent review of the importance of standardized classifications. b. (^) Integrating evidence-informed practice into practice to provide the most effective care. c. (^) Experience provides psychiatric mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced nurses have learned the best ways to care for patients through trial and error. e. There is a distinction between mental illness and physical illness. 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. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Nursing Diagnosis| Nursing Process: Analysis MSC: Client Needs: Safe Effective Care Environment

3. A patient identifies they are experiencing auditory hallucinations to imminently harm people and have broken a spoon to use as a weapon. Which aspects of the patient’s mental health are of immediate concern to the nurse? ( Select all that apply. ) a. Happiness b. (^) Appraisal of reality c. (^) Control over behaviour d. Effectiveness in work e. Safety to self and others ANS: B, C, E The aspects of mental health of greatest concern are the patient’s: appraisal of reality, control over behaviour, and safety to self and others. It is important for the safety of the nurse, patient, and others, that the patient’s auditory hallucinations are in control. This is a psychiatric emergency and appropriate policies, and procedures must be followed for safety. 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: Analyze (Analysis) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Psychosocial Integrity
4. Which of the following is considered a Basic-Level Intervention for psychiatric mental health nurses? ( Select all that apply. ) a. Milieu therapy b. Psychotherapy c. Coordination of care d. (^) Consultation e. Pharmacological therapies ANS: A, C, E Milieu therapy is a Basic-Level Intervention, where the nurse provides, structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other health care clinicians. All nurses can coordinate care, by implementing nursing care plans and documenting the coordination of their care. Pharmacological therapies are a Basic-Level Intervention, where nurses apply current knowledge to assessing patients’ responses to medication, provide teaching and communicate observations to other members of the health care team. Psychotherapy is an Advanced Practice Intervention where nurses provide individual, couple, group or family therapy using evidence- informed therapeutic frameworks. Consultation is when Advanced Practice nurses share clinical expertise with nurses or those in other disciplines to enhance their treatment of patients or address systems issues. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
5. 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: Nursing Diagnosis| Nursing Process: Analysis MSC: Client Needs: Safe Effective Care Environment

6. 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
7. 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. The 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

Chapter 02: Historical Overview of Psychiatric Mental Health Nursing

Pollard: Varcarolis’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach, 3rd

Edition

MULTIPLE CHOICE

1. Which has largely been excluded from Canadian nursing history? a. Female nurses’ role in psychiatric nursing b. (^) Mental health field of study c. Male attendants’ role in institutions d. Generalist registered nurses’ role ANS: B While there has been much historical analysis of psychiatric mental health nursing in England, Holland, and the United States, Canadian nursing history has largely excluded the mental health field. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
2. Which is true of asylums? a. Short-term admissions b. Cognitive-behavioural therapy experts c. Place where people with mental illness could be cured d. (^) Middle to upper socioeconomic status patients with mental illness received treatment ANS: C Asylums, designed to be retreats from society, were built with the hope that, with early intervention and several months of rest, people with mental illness could be cured. Generally, people in asylums were patients from a lower socioeconomic status and those without family. Cognitive-behavioural therapy did not occur in asylums, and the stays were generally long term. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
3. Which represents a seventeenth- to eighteenth-century societal view of people with mental illness? a. Restraints were not to be used on patients with mental illness. b. (^) Those with mental illness were immune to human discomforts. c. Informed consent was required prior to admission to an asylum.

d. Patient neglect rarely if ever occurred in asylums. ANS: B Patients in these settings were often chained or caged, and cruelty or neglect was not uncommon. This type of treatment reflected the societal view that people with mental illness were bestial or less human in nature and, therefore, required discipline and were immune to human discomforts such as hunger or cold. Informed consent was to be a requirement of the very distant future. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

4. Which could a nurse expect to implement when caring for a patient in an asylum in the mid-1800s in Canada? a. Assisting with eating and dressing b. Group therapy interventions c. Electroconvulsive therapy (ECT) d. Medication administration (specifically antipsychotic medications) ANS: A In many asylums, a large population of people received only minimal custodial care – assistance in performing the basic daily necessities of life, such as dressing, eating, using a toilet, and walking. There were very few medications used in the 1800s and there was no formal group therapy or ECT treatments. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
5. Who was instrumental in lobbying for the first mental health hospital in the United States and for reform in British and Canadian institutions? a. (^) Michel Foucault b. (^) Dorothea Dix c. The Grey Nuns d. Philippe Pinel ANS: B During an encounter at a Boston jail, Dorothea Dix was shocked to witness the degrading treatment of a woman with mental illness who was imprisoned there. Passionate about social reform, she began advocating for the improved treatment and public care of people with mental illness. Dix met with many politicians and even the Pope to push her agenda forward. Ultimately, she was influential in lobbying for the first public mental hospital in the United States and for reform in British and Canadian institutions. Michel Foucault was a French philosopher. Philippe Pinel was a French physician. The Grey Nuns were early providers of care for people with mental illness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
6. The first asylum in Canada opened in which province? a. Alberta b. Quebec c. Ontario

d. New Brunswick ANS: D The first asylum was created in Saint John, New Brunswick, in 1835 and became the Provincial Lunatic Asylum in 1848. It housed patients with difficult conditions. Soon, more asylums were established in Upper and Lower Canada, the Maritime Colonies, and Canada’s West. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

7. Which province opened the first psychiatric nurse training program in Canada? a. Alberta b. (^) Quebec c. Ontario d. British Columbia ANS: C In 1888, Rockwood Asylum in Kingston, Ontario, became the first psychiatric institution in Canada to open a training program for nurses. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
8. The exclusion of males from attending psychiatric nurse training programs hindered which of the following? a. The availability of students to enter the training program b. The ability of institutions to maintain enough trained nursing staff c. The recognition of the importance of nursing knowledge and skills d. The position of female nurses by lowering their status ANS: C Consistent with societal beliefs of the time about women’s innate caring capacity, the training was offered only to females. This exclusion of males from the program hindered the recognition of the importance of nursing knowledge and skills as well as lowered the status of male attendants at the time. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
9. The Canadian National Association of Trained Nurses was established in which of the following years? a. (^1898) b. 1908 c. 1918 d. 1928 ANS: B

In the early part of the twentieth century, nurses’ lack of control over their own profession began to shift with changes to nursing education models and blossoming political advocacy by nursing groups across Canada, particularly with the formation of the Canadian National Association of Trained Nurses in 1908. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning| Nursing Process: Outcome Identification MSC: Client Needs: Psychosocial Integrity

10. Which was instrumental for the establishment of a psychiatry rotation in the nursing curriculum of Eastern and Atlantic Canada? a. (^) The Registered Nurses’ Association of Ontario (RNAO) b. The “Weir Report” c. The Canadian Nurses Association d. The Canadian Medical Association ANS: B In 1927, the Canadian Medical Association and the Canadian Nurses Association conducted a joint study on the state of nursing education in Canada. The result, known as the “Weir Report,” was released in 1932. It concluded that drastic changes were needed in nursing education programs, including standardization of curriculum, work hours, and instructor training. Further, the care of people with mental illness needed to be integrated into all generalist programs. From the beginning, the Registered Nurses Association of Ontario (RNAO) accepted the asylum-based programs for licensing of perspective nurses who were affiliated with a General Hospital. It also represented nurses working in asylum settings providing them with advocacy and nursing leadership. With the support of nurse leaders like Nettie Fiddler and the publication of the “Weir Report,” more generalist hospital programs began adding a psychiatry rotation to the curriculum. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Psychosocial Integrity
11. Which movement created the shift from caring for people with mental illness in institutions to caring for them in communities? a. Enhanced growing nursing research b. Deinstitutionalization c. (^) Provincial legislation d. Specialty-focused psychiatric nursing training ANS: B Psychiatric nursing continued to take place predominantly in hospital settings until the 1960s. Discovery of new medications assured a permanent recovery, at the very least symptom stabilization related to mental disorders. These new treatments allowed patients an early return home. The psychiatric Deinstitutionalization movement – the shift from caring for people with mental illness in institutions to caring for them in communities began not only in Canada but also all over the world. While enhanced growing nursing research, provincial legislation, and specialty-focused psychiatric nursing training were important, they were not movements creating the shift from caring for people with mental illness in institutions to caring for them in communities.

DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Planning| Nursing Process: Outcome MSC: Client Needs: Health Promotion and Maintenance

12. Which nursing theorist focused on the role of the nurse in therapeutic relationships? a. (^) Dorothea Dix b. (^) Marguerite d’Youville c. Philippe Pinel d. Hildegard Peplau ANS: D Hildegard Peplau , the first published nursing theorist since Florence Nightingale, contributed to the expansion of specialized nursing knowledge and related skills in the psychiatric mental health field. Much of Peplau’s work focused on the role of the nurse in therapeutic relationships and anxiety management. Philippe Pinel began to advocate for more humane treatment of people with mental illness by literally removing the chains of patients. Marguerite d’Youville founded the Sisters of Charity, formally known as the Grey Nuns, a Canadian religious institute. Dorothea Dix was influential in lobbying for the first public mental hospital in the United States and for reform in British and Canadian institutions. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment
13. Which organization established the standards of practice for psychiatric mental health nursing? a. Registered Nurses of Ontario b. The Canadian Medical Association c. The Canadian Federation of Mental Health Nurses d. The Mental Health Commission of Canada ANS: C Under the umbrella of the Canadian Nurses Association and with consumer input, the Canadian Federation of Mental Health Nurses, an organization of registered nurses across Canada who specialize in psychiatric mental health nursing, established the standards of practice for psychiatric mental health nursing, now in the 4th edition. The 2014 Standards of Psychiatric Mental Health Nursing build on the Canadian Nurses Association Code of Ethics. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE
14. Which are holistic, historical approaches to mental health care utilized by Indigenous peoples? ( Select all that apply. ) a. Sweat lodges b. Restraint and confinement c. Sundance d. Potlatch e. Abandonment

ANS: A, C, D Canada’s Indigenous peoples had a variety of approaches to caring for people with mental illness. Most were holistic – treating mind, body, and soul – and included sweat lodges, animistic charms, potlatch, and Sundance. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

2. By the end of the nineteenth century, the new field of psychiatry was being challenged to provide a medical cure for mental illness. Which experimental treatments were used at that time? ( Select all that apply. ) a. Leeching b. Hydrotherapy c. Electroconvulsive therapy d. Insulin shock treatment e. Milieu management therapy ANS: A, B, D Since there were few medications available other than heavily alcohol-based sedatives, doctors used many experimental treatments – for example, leeching (using bloodsucking worms), spinning (tying the patient to a chair and spinning it for hours), hydrotherapy (forced baths), and insulin shock treatment (injections of large doses of insulin to produce daily comas over several weeks). ECT was not introduced until the mid-twentieth century. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
3. Clinical Nurse Specialists (CNS) can practice in which of the following areas of psychiatric mental health nursing? ( Select all that apply. ) a. Psychotherapy b. Consulting c. Education d. (^) Inpatient clinicians e. Outpatient clinicians ANS: A, B, C, D, E Advanced practice nursing (APN) includes the role of Clinical Nurse Specialist (CNS). Each province has its own regulations guiding the licensing and scope of practice for psychiatric mental health nursing. The CNS role has been well established in psychiatry since 1972. CNSs can provide psychotherapy, and have worked as consultants, educators, and clinicians in inpatient and outpatient psychiatry throughout Canada. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Chapter 03: Overview of Psychiatric Mental Health Nursing Care Within Various Settings

Pollard: Varcarolis’s Canadian Psychiatric Mental Health Nursing: A Clinical Approach, 3rd

Edition

MULTIPLE CHOICE

1. Regardless of where mental health services are provided, nurses and other providers must be aware of which of the following? a. Wait times b. Patient goals c. Their surroundings d. Community partnerships ANS: C Regardless of where mental health services are provided, nurses and other providers must be aware of their surroundings. Think about the environment. Are there other people nearby? Is there adequate lighting? Is there good ventilation? Is it hot, cold, raining, windy? DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning| Nursing Process: Outcome MSC: Client Needs: Safe Effective Care Environment
2. Which is an example of secondary prevention in mental health? a. (^) Day care centres b. (^) Nursing homes c. Public health clinics d. Psychosocial rehabilitation programs ANS: B Nursing homes are an example of secondary prevention in mental health. Daycare centres and public health clinics are examples of primary prevention in mental health. Psychosocial rehabilitation programs are an example on tertiary prevention in mental health. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
3. Which mental health service provides intensive case management in response to the community living needs of individuals with serious, persistent psychiatric symptoms? a. Assertive Community Treatment (ACT) b. Partial Hospitalization Programs c. Disaster Response Teams d. Mobile Crisis Intervention Teams ANS: A

Assertive Community Treatment (ACT) is an intensive type of case management developed in response to the community living needs of people with serious, persistent psychiatric symptoms. ACT teams work intensively with patients in their homes, in agencies, hospitals, or clinics. Partial hospitalization Program s offer intensive, short-term treatment like inpatient care, except the patient is able to return home each day. Nurses working within community mental health settings are often part of the intersectoral disaster response planning committee for the community in which they work period following a disaster, the immediate goal is to ensure that those affected have shelter, food, and first aid as necessary. Crisis teams operate out of community clinics, emergency departments, or standalone offices. Partnership with the local police authorities has been found to be an extremely effective way to meet the needs of individuals in acute psychiatric crisis and has led to decreased criminalization and improved access to services for people with severe chronic mental illness. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Nursing Diagnosis MSC: Client Needs: Health Promotion and Maintenance

4. Which level of government is responsible for Indigenous peoples’ mental health services? a. Provincial b. Federal c. Municipal d. International ANS: B The federal government continues to maintain health care responsibility for select populations: Indigenous peoples, armed forces, Royal Canadian Mounted Police, individuals in federal penitentiary, and refugees. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning| Nursing Process: Outcome MSC: Client Needs: Health Promotion and Maintenance
5. The Canadian Government spends which percentage of gross potential product (GDP) on health care? a. (^1) b. 15 c. 25. d. 11. ANS: D The Canadian Government spends 11.5% of the entire gross potential product (GDP) on healthcare. Canadians pay directly or indirectly for all healthcare: 70% through taxation, 12% through private or employment insurance plans, 15% out of pocket, and another 3% through other means. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Health Promotion and Maintenance
6. Which improves the effectiveness of communication among caregivers? a. Read back of verbal orders b. Following hand hygiene guidelines c. Using at least two ways, to identify patients

d. Encouraging patients to report safety concerns ANS: A Reading back verbal orders improves the effectiveness of communication among caregivers. Following hand cleaning guidelines from the World Health Organization reduces the risk of healthcare-associated infections. Using at least two ways, such as the patients’ name and date of birth to identify patients improves the accuracy of patient identification. Encouraging patients and families to report safety concerns encourages active involvement in care. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

7. Which organization publishes required patient safety practices for Canadian hospitals? a. Canadian Nurses Association b. Canadian Medical Association c. Accreditation Canada d. Provincial College of Nurses ANS: C Accreditation Canada publishes required patient safety practices for Canadian hospitals. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
8. A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to which of the following? a. Coordinating care of patients b. Management of milieu safety c. Management of the interpersonal climate d. Use of therapeutic intervention strategies ANS: B Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse’s concerns, are unrelated to the observations cited. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
9. Which patient is considered a priority to admit and begin treatment as soon as possible? a. An individual who is feeling anxiety after the death of their spouse 10 years ago b. (^) An individual who self-inflicted a superficial cut on the forearm after a family argument c. (^) An individual experiencing dry mouth and tremor related to taking haloperidol (Haldol) d. (^) An individual who delivered a baby 1 month ago is crying and is hearing voices to harm their baby ANS: D

Inpatient psychiatric care has undergone significant change over the past half-century. Consequences of deinstitutionalization have included a reduction in long-stay psychiatric beds, decreased length of hospital stay, increased use of crisis services, an increased number of individuals with mental illness who are homeless, or in the penitentiary system. Fewer psychiatric inpatient beds mean that acuity within psychiatric facilities has been increasing, wait times for admissions are increasing, and admission is commonly reserved for those people who are acutely suicidal, actively homicidal, or extremely disabled and in need of short-term acute care. The admission criteria begin with the premise that the person is suffering from a mental illness and include evidence of one or more of the following high risk of harming self, high risk of harming others, and inability to care for basic needs, which will likely cause substantial mental or physical deterioration or physical serious physical impairments. An individual who delivered a baby 1 month ago, who is hearing voices to harm their baby, is a serious risk to their baby and requires admission and stabilization for potential post-partum psychosis. The individual experiencing dry mouth and tremor is likely experiencing extrapyramidal side effects related to their Haldol. While important to treat, this can be treated in any health care setting with benztropine (Cogentin) and follow-up. An individual who self-inflicted a superficial cut on their forearm after an argument needs to be assessed for risk of harming self. If no imminent risk, could be treated in the community in partial hospitalization programs and followed up with case management services. An individual who is feeling anxiety after the death of their spouse 10 years ago would require assessment to assess if there are new triggers for anxiety, or if this is unresolved grief. Medication could be suggested along with grief counselling, partial hospitalization programming, and case management. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment

10. A nurse reviewing medical records finds which of the following a violation of patients’ rights? a. A patient not allowed to send letters to their family. b. A patient’s belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member. ANS: A The patient has the right to send and receive communication and encouraging patient autonomy and community connectedness will support patient recovery. Inspecting patients’ belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
11. Clinical pathways are used by the multidisciplinary team in managed care settings to do which of the following? a. Stabilize aggressive patients. b. Identify obstacles to effective care. c. (^) Relieve nurses of planning responsibilities. d. Streamline the care process and improve outcomes.

ANS: D Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and improve outcomes. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Safe Effective Care Environment

12. A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, “I don’t know what to do with my free time.” Which member of the multidisciplinary treatment team would be most helpful to this patient? a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist ANS: C Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other patient services. Social workers focus on the patient’s support system. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
13. Which action violates patients’ rights? a. (^) Prohibiting a patient from using the telephone b. In the patient’s presence, opening a package mailed to patient c. Being within arm’s length of patient with homicidal ideation d. Permitting a patient experiencing psychosis to refuse oral psychotropic medication ANS: A The patient has a right to use the telephone for communication with family members or to secure counsel. The patient should be protected against possible harm to self or others. Patients have rights to send and receive mail and be present during package inspection. Patients have rights to refuse treatment. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Safe Effective Care Environment
14. Which is an example of tertiary prevention psychiatric mental health nursing? a. (^) Helping an individual diagnosed with a serious mental illness learn to manage money b. Restraining an agitated patient who has become aggressive and assaultive c. Teaching school-aged children about the dangers of drugs and alcohol d. Genetic counselling with a young couple expecting their first child

ANS: A Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraints are secondary prevention. Genetic counselling and teaching school-aged children about substance abuse and dependence are examples of primary prevention. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

15. A nurse receives the following three phone calls regarding a community patient.
    • The psychiatrist wants to complete a follow-up assessment.
    • An internist wants to schedule a physical examination.
    • The patient’s attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a. Advocate b. (^) Case manager c. Milieu manager d. Provider of care ANS: B Case managers design individually tailored treatment services for patients and track outcomes of care. The new case management includes assessing patient needs, developing a plan for service, linking the patient with necessary services, monitoring the effectiveness of services, and advocating for the patient as needed. Nurses routinely coordinate patient services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the patient’s behalf. The role of milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the patient. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment
16. Which individual would be most appropriate to refer for Assertive Community Treatment (ACT)? a. (^) An individual with a fear of crowded places b. (^) An individual with single episode depression c. An individual expressing a catastrophic reaction to a tornado in the community d. (^) An individual diagnoses with schizophrenia and four hospitalizations in the past year ANS: D Assertive community treatment (ACT) provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. Fear of crowded places, single episode depression, catastrophic reaction to a tornado in the community all identify mental health concerns of a more episodic nature. These do not meet ACT criteria. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment
17. Which level of prevention activities would a nurse in an Emergency Department (ED) employ most often?

a. Primary b. Secondary c. Tertiary d. Primary and secondary ANS: B An ED nurse would generally see patients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities. DIF: Cognitive Level: Understand (Comprehension) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

18. The case manager plans to discuss the treatment plan with a patient’s family. Which is the case manager’s first action? a. Determine an appropriate location for the conference. b. (^) Support the discussion with examples of the patient’s behaviour. c. (^) Obtain the patient’s permission for the exchange of information. d. Determine which family members should participate in the conference. ANS: C The case manager must respect the patient’s right to privacy and confidentiality, which extends to discussions with family. Talking to family members is part of the case manager’s role, with the patients consent. Actions identified in the distracters occur after the patient has given permission. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment
19. Which is appropriate for a nurse exclusively in community-based primary prevention? a. Medication follow-up b. Teaching parenting skills c. Substance abuse counselling d. Making^ a referral for^ family^ therapy ANS: B Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. The distracters represent secondary or tertiary prevention activities. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
20. A psychiatrist prescribes depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. For this plan to be successful, which factor will be of critical importance? a. The attitude of significant others toward the patient b. Nutrition services in the patient’s neighbourhood c. (^) The level of trust between the patient and nurse d. The availability of transportation to the clinic ANS: D

The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, nonadherence will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this problem. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Assessment MSC: Client Needs: Safe Effective Care Environment

21. Which of the following individuals could be referred to a Partial Hospitalization Program (PHP)? a. (^) An individual who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up b. An individual who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes c. (^) An individual who spent yesterday in a supervised crisis care centre and continues to have active suicidal ideation d. (^) An individual who states, “I’m not sure I can avoid using alcohol when my spouse goes to work every morning.” ANS: D This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility for supervision. An individual expressing active suicidal ideation requires increased observation and inpatient hospitalization. The other patients can be supported in the community or with individual visits. DIF: Cognitive Level: Apply (Application) TOP: Nursing Process: Planning MSC: Client Needs: Safe Effective Care Environment
22. Which is a critical aspect to improving the well-being and mental health of all Canadians? a. (^) Recovery b. (^) Case management c. Partial hospitalization programs d. Inpatient psychiatric mental health programs ANS: A Recovery is a critical aspect to improving the well-being and mental health of all Canadians. It is described as the ability of the individual to work, live, and participate in the community. It is a journey that provides individuals with hope, empowerment, and confidence to take an active role in determining their own treatment paths. Case management involves liaising with family, significant others, and other health care or community resource personnel of care regarding referrals, assistance with paperwork applications, connection to resources, and overall navigation of the health care system to coordinate an effective plan. Partial hospitalization programs offer intensive, short-term treatment like inpatient care, except that the patient can return home each day. DIF: Cognitive Level: Analyze (Analysis) TOP: Nursing Process: Outcome Evaluation MSC: Client Needs: Health Promotion and Maintenance