Test Bank Morrison-Valfre Foundations of Mental Health Care, 6th Edition

Test Bank Morrison-Valfre Foundations of Mental Health Care, 6th EditionContents Chapter 01: The History of Mental Health Care .................................................................................................................... 2 Chapter 02: Current Mental Health Care Systems .............................................................................................................. 10 Chapter 03: Ethical and Legal Issues ................................................................................................................................... 19 Chapter 04: Sociocultural Issues ......................................................................................................................................... 28 Chapter 05: Theories and Therapies ................................................................................................................................... 36 Chapter 06: Complementary and Alternative Therapies ................................................................................................... 45 Chapter 07: Psychotherapeutic Drug Therapy ................................................................................................................... 53 Chapter 8: Skills and Principles of Mental Health Care ....................................................................................................... 61 Chapter 10: Therapeutic Communication ........................................................................................................................... 70 Chapter 9: Mental Health Assessment Skills ...................................................................................................................... 79 Chapter 11: The Therapeutic Relationship .......................................................................................................................... 88 Chapter 12: The Therapeutic Environment ......................................................................................................................... 98 Chapter 13: Problems of Childhood .................................................................................................................................. 106 Chapter 14: Problems of Adolescence ............................................................................................................................... 116 Chapter 15: Problems of Adulthood .................................................................................................................................. 125 Chapter 16: Problems of Late Adulthood .......................................................................................................................... 134 Chapter 17: Cognitive Impairment, Alzheimer's Disease, and Dementia ......................................................................... 142 Chapter 18: Managing Anxiety ............................................................................................................................................151 Chapter 19: Illness and Hospitalization ............................................................................................................................. 160 Chapter 20: Loss and Grief ................................................................................................................................................ 169 Chapter 21: Depression and Other Mood Disorders ......................................................................................................... 178 Chapter 22: Physical Problems, Psychological Sources .................................................................................................... 187 Chapter 23: Eating and Sleeping Disorders ....................................................................................................................... 194 Chapter 24: Dissociative Disorders ................................................................................................................................... 202 Chapter 25: Anger and Aggression .................................................................................................................................... 212 Chapter 26: Outward-Focused Emotions: Violence ......................................................................................................... 220 Chapter 27: Inward-Focused Emotions: Suicide ............................................................................................................... 229 Chapter 28: Substance-Related Disorders ......................................................................................................................... 237 Chapter 29: Sexual Disorders ............................................................................................................................................ 245 Chapter 30: Personality Disorders .................................................................................................................................... 254 Chapter 31: Schizophrenia and Other Psychoses ............................................................................................................. 263 Chapter 32: Chronic Mental Health Disorders ................................................................................................................... 271 Chapter 33: Challenges for the Future .............................................................................................................................. 278 1 | P a g eChapter 01: The History of Mental Health Care MULTIPLE CHOICE 1. The belief of the ancient Greek philosopher Plato that the rational soul controlled the irrational soul could be compared with the belief of the more recent psychological theorist: a. Freud b. Pinel c. Fisher d. Rush ANS: A Sigmund Freud believed that mental illness was, in part, caused by forces both within and outside the personality. Philippe Pinel advocated acceptance of mentally ill individuals as human beings in need of medical assistance. Alice Fisher was a Florence Nightingale nurse who cared for the mentally ill, and Dr. Benjamin Rush was the author of the book Diseases of the Mind. PTS: 1 OBJ: 2 DIF: Cognitive Level: Comprehension TOP: Early Years of Mental Health REF: p. 4 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. During the mid-1500s, behaviors associated with mental illness were more accurately recorded by professionals. This practice led to for different abnormal behaviors. a. Classifications b. Diagnosing c. Treatment d. Education ANS: A Classification of abnormal behaviors did not begin until this time, after the practice of more accurate recording of behaviors was begun. Diagnoses, treatment guidelines, and any education regarding mental health disorders were not available during this period. PTS: 1 OBJ: 3 DIF: Cognitive Level: Knowledge REF: p. 5 TOP: Mental Illness During the Renaissance KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. During the latter part of the eighteenth century, psychiatry became a separate branch of medicine, and inhumane treatment was greatly diminished by the French hospital director: a. Dix b. Beers c. Pinel d. Carter ANS: C 2 | P a g ePhilippe Pinel advocated acceptance of the mentally ill, as well as proper treatment. Dorothea Dix crusaded for construction of mental health hospitals. Clifford Beers wrote the book A Mind That Found Itself. President Jimmy Carter established the President’s Commission on Mental Health in 1978. PTS: 1 OBJ: 4 DIF: Cognitive Level: Knowledge REF: p. 5 TOP: Mental Illness in the Eighteenth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. In 1841, surveyed asylums, jails, and almshouses throughout the United States, Canada, and Scotland and is credited with bringing about public awareness and reform for the care of the mentally ill. a. Sigmund Freud b. John Cade c. Florence Nightingale d. Dorothea Dix ANS: D Dorothea Dix spent 20 years surveying facilities that housed mentally ill individuals and is credited with major changes in the care of the mentally ill. Sigmund Freud introduced the concept of psychoanalysis, John Cade discovered lithium carbonate for the treatment of bipolar disorder, and Florence Nightingale trained nurses in England in the 1800s. PTS: 1 OBJ: 4 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Mental Illness in the Nineteenth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 5. Afors aMental direct Hygieneresult of Clif wasf oformed inrd Beers’ 1w909ork withand bao focus onok , A Mind prevention ofThat Found mental illness Itself, the Commit and: tee a. Early detection of symptoms of mental illness b. Education of caregivers c. Current treatment options d. Removing the stigma attached to mental illness ANS: D Clifford Beers’ book reflected on his attempt at suicide followed by the deplorable care he received for the next 3 years in mental hospitals. Beers’ work and book raised the consciousness of people throughout the country regarding prevention and removal of the stigma of having a mental illness. Early detection of symptoms, education of caregivers, and current treatment options regarding mental illness were not the focus of his book, nor were they a priority for the Committee for Mental Hygiene. PTS: 1 OBJ: 4 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Mental Illness in the Twentieth Century KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3 | P a g e6. During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma that could last as long as 50 hours? a. Electroconvulsive therapy b. Insulin therapy c. Humoral therapy d. Amphetamine therapy ANS: B Insulin therapy was believed to successfully treat schizophrenia in the early 1900s. Amphetamines were used to treat depression, and electroconvulsive therapy was used for severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a belief that mental illness resulted from an imbalance of the humors of air, fire, water, and earth. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge REF: p. 8 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 7. In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often used to treat? a. Schizophrenia b. Bipolar disorder c. Severe depression d. Violent behavior ANS: C ECT was found to be an effective treatment for severe depression in the 1930s. During this period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC:Client Needs: Psychosocial Integrity 8. In the early twentieth century, a frontal lobotomy was a common treatment for violent behaviors. Which description of this procedure is accurate? a. A procedure that delivers an electrical stimulus to the frontal lobes of the brain b. A surgical procedure that drills holes in the front of the skull to drain fluid c. A surgical procedure that severs the frontal lobes of the brain from the thalamus d. A surgical procedure that inserts implants into the frontal lobes of the brain ANS: C A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed from the thalamus. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which class of drugs was introduced in the 1930s for the treatment of depression? a. SSRIs b. Tricyclic antidepressants c. MAOIs d. Amphetamines 4 | P a g eANS: D In the 1930s, amphetamines were found to boost the spirits of depressed people. SSRIs, tricyclic antidepressants, and MAOIs are antidepressant agents, but they were not discovered until much later. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of mental health because it funded: a. Research on drugs for the treatment of mental health disorders b. Training of mental health professionals c. Construction of psychiatric units in facilities throughout North America d. Development of community mental health clinics ANS: C The Hill-Burton Act provided money for the construction of psychiatric units in the United States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health professionals was funded by the National Mental Health Act of 1946, and community mental health centers were not instituted until the 1960s. PTS: 1 OBJ: 5 | 9 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. The National Mental Health Act of 1946 provided a means for funding of programs that promote research on mental health and: a.b. DTrainingevelopm ofe nt of menmental healthtal he professionalsalthclinics in thecommunity c. Treatment for veterans suffering from mental health disorders d. Educating the public about mental illness ANS: B The National Mental Health Act of 1946 provided much needed training for individuals who cared for patients with mental health disorders. Community mental health clinics were initiated in the 1960s, treatment for veterans was not funded by this act, and education of the public occurred later. PTS: 1 OBJ: 5 | 9 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 12. Which of the following best describes the disorder that was first recognized in veterans following the Korean and Vietnam Wars? a. Depression b. Bipolar disorder c. Post-traumatic stress disorder d. Paranoid schizophrenic disorder ANS: C 5 | P a g ePosttraumatic stress disorder was initially discovered in veterans who had been involved in armed conflicts. The other disorders also occur in veterans but were not first recognized in soldiers who were fighting wars. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge REF: p. 6 TOP: Influences of War on Mental Health Therapies KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 13. The introduction of ill individuals. in the 1950s led to the deinstitutionalization of many mentally a. Psychotherapeutic drugs b. Community mental health clinics c. Residential treatment centers d. State mental health facilities ANS: A Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone during the 1950s. Patients were being released from state mental health facilities as a result of psychotherapeutic drug therapy. Community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients. PTS: 1 OBJ: 6 DIF: Cognitive Level: Knowledge REF: p. 7 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 14. In 1949, an Australian physician discovered which therapy to be an effective treatment for bipolar (manic-depressive) illness? a.b. InsulinWater/ice therapy therapy c. Lithium carbonate therapy d. Electroconvulsive therapy ANS: C To this day, lithium is a treatment that is used to effectively balance the manic states and depressive states of bipolar disorder. None of the other therapies listed are effective for bipolar disorder. PTS: 1 OBJ: 6 DIF: Cognitive Level: Knowledge REF: p. 7 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. In the early 1960s, a committee appointed by President John F. Kennedy recommended the development of a new approach to the way mental health care was administered, with an emphasis on the introduction of: a. Psychotherapeutic drugs b. State mental health care systems c. Community mental health centers d. Deinstitutionalization of patients ANS: C 6 | P a g eThe emergence of community mental health centers was necessary, in part because of the massive deinstitutionalization of patients from state mental health care facilities after the introduction of psychotherapeutic drugs in the 1950s. PTS: 1 OBJ: 7 DIF: Cognitive Level: Knowledge REF: p. 7 TOP: Introduction of Psychotherapeutic Drugs KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 16. The Mental Health Systems Act of 1980 was one of the most progressive mental health bills in the history of the United States, but its enactment was interrupted by the: a. Election of a new president b. Appointment of a new Surgeon General c. Rapid expansion of community centers d. National Alliance on Mental Illness (NAMI) surveys ANS: A The election of a new president and his administration led to drastic cuts in federal funding for mental health programs. None of the other three choices were a part of the Mental Health Systems Act of 1980. PTS: 1 OBJ: 9 DIF: Cognitive Level: Knowledge TOP: Congressional Actions REF: p. 7 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 17. The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with chronic mental illness in: a. Nursing homes b. SResidentialtate menta l htreatmentealth fa ccentersilities c. d. Homeless shelters ANS: A Many mentally ill, especially elderly, people were inappropriately placed in nursing homes with personnel who were not trained to care for these people. OBRA prevented this practice. State mental health facilities, residential treatment centers, and homeless shelters were not addressed in the OBRA of 1987. PTS: 1 OBJ: 9 DIF: Cognitive Level: Knowledge TOP: Congressional Actions REF: p. 8 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 18. In the late 1980s, government funding for mental health care dwindled, and most insurance companies coverage for psychiatric care. a. Withdrew b. Increased c. Decreased d. Added ANS: A Unfortunately, insurance companies followed the trend of the national government to the point of actually dropping coverage for psychiatric care. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 1 7 | P a g eOBJ: 9 TOP: Congressional Actions KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 19. In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey and grading of state mental health care for adults and learned that the overall grade for care was: a. ―A‖ b. ―B‖ c. ―C‖ d. ―D‖ ANS: D The NAMI gave a grade of ―D‖ to the mental health care system based on poor funding, limited availability of care, and patients’ lack of access to mental health care. PTS: 1 OBJ: 9 DIF: Cognitive Level: Knowledge TOP: Congressional Actions REF: p. 6 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 20. Which of the following persons has the greatest risk for developing ineffective coping behaviors? a. The middle-aged man whose diet is high in saturated fat and who has a 20-year history of tobacco use b. The single 30-year-old female facing the death of her father c. The 19-year-old college student with a family history of schizophrenia d. The 9-year-old whose parents are nurturing but provide chores and responsibilities ANS: C Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas. PTS: 1 OBJ: 2 DIF: Cognitive Level: Knowledge REF: p. 2 TOP: Introduction KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 21. In the early 1900s the first theory of mental illness that showed behavior could be changed is attributed to: a. Beers b. Dix c. Freud d. Pinel ANS: C Freud was the first person who succeeded in explaining human behavior in psychological terms and in demonstrating that behavior can be changed under the proper circumstances. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge TOP: Psychoanalysis REF: p. 8 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. The humoral theory of disease embraced by Hippocrates required a balance of which elements? (Select all that apply.) a. Fire b. Water 8 | P a g ec. Light d. Air e. Earth ANS: A, B, D, E Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental elements of air, fire, water, and earth. Each basic element had a related humor or part in the body. PTS: 1 OBJ: 2 DIF: Cognitive Level: Knowledge TOP: Greece and Rome REF: p. 2 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which aspects of adult mental health care systems did the National Alliance on Mental Illness survey focus on? (Select all that apply.) a. Availability of care b. Access to care c. Regulation of medications d. Increased funding ANS: A, B, D In 2006, the National Alliance on mentalMental healthIl lness care(NA systemsMI) cond conducteducted the ―infi rstmore co mthanpre h15ensive years‖ survey and grading of state adult (NAMI, 2006). Their results revealed a fragmented system with an overall grade of D. Recommendations focused on increased funding, availability of care, access to care, and greater involvement of consumers and their families. PTS: 1 OBJ: 9 DIF: Cognitive Level: Knowledge TOP: Twenty-first century REF: p. 8 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. Mental health is said to be influenced by which of the following factors? (Select all that apply.) a. Diet and nutritional intake b. Inherited characteristics c. Activities of daily living d. Childhood nurturing e. Life circumstances ANS: B, D, E Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas. PTS: 1 OBJ: 2 DIF: Cognitive Level: Knowledge TOP: Congressional Actions REF: p. 7 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity COMPLETION 9 | P a g e1. During the middle ages, mentally ill patients often were burned at the stake and were greatly mistreated. In an attempt to treat mentally ill people more humanely, Bethlehem Hospital, more commonly called _ , was created. ANS: Bedlam Bedlam was the nickname for Bethlehem Hospital, which prevented burning of mentally ill people at the stake but provided poor care for the mentally ill. PTS: 1 OBJ: 3 DIF: Cognitive Level: Knowledge TOP: Mental Illness in the Middle Ages KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity REF: p. 3 Chapter 02: Current Mental Health Care Systems MULTIPLE CHOICE 1. Because mental health care is not covered in Australia under the basic health plan, which citizens are more likely to receive mental health care? a. Wealthy b. Homeless c. Disabled d. Low-income ANS: A Wealthy citizens, as well as those with private insurance, are more likely to receive mental health care in Australia because they are better able to afford the care than are homeless, disabled, or low-income citizens on the basic health plan with no mental health care coverage. PTS: 1 OBJ: 1 DIF: Cognitive Level: Comprehension TOP: Mental Health Care in Australia REF: p. 11 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. Mental health care is available under the universal health care system in Britain, which is funded primarily by: a. Employers b. Private donations c. Small businesses Tax revenues ANS: D 10 | P a g eTax revenues are the primary funding source for Britain’s universal health care system. All aspects of health care, except for eye care and limited dental care, are covered under the standard benefit package for citizens of Britain. PTS: 1 OBJ: 1 DIF: Cognitive Level: Knowledge TOP: Mental Health Care in Britain REF: p. 11 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 3. The model views clients holistically with the goal of creating a support system designed to encourage independence in the client with a mental health disorder. a. Community support systems b. Case management c. Multidisciplinary health care team d. Client population ANS: A The community support systems (CSS) model works by coordinating social, medical, and psychiatric services. Case management refers to individual management of clients and takes into consideration psychosocial rehabilitation, consults, referrals, therapy, and crisis intervention. A multidisciplinary health care team is made up of all of the professionals who work within a mental health care system, and client population simply refers to individuals who may potentially seek mental health care. PTS: 1 OBJ: 3 DIF: Cognitive Level: Knowledge TOP: Outpatient Care REF: p. 12 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The home mental health nurse visits a female client to assess her ability to care for herself at home after discharge from an inpatient setting. Which component of the case management system does this demonstrate? a. Consultation b. Crisis intervention c. Resource linkage d. Psychosocial rehabilitation ANS: D Psychosocial rehabilitation assists clients in gaining independence in activities of daily living to the best of their individual capabilities. Consultation refers to assistance obtained from specialists, such as a psychiatrist; crisis intervention refers to care provided during a crisis event; and resource linkage indicates referral to community resources. PTS: 1 OBJ: 5 DIF: Cognitive Level: Comprehension TOP: Case Management Systems REF: p. 14 KEY: Nursing Process Step: InterventionMSC: Client Needs: Health Promotion and Maintenance 5. A client with a severe, treatment-resistant mental illness has been assigned to an assertive community treatment (ACT) team. An ACT treatment strategy that helps to prevent recurrent hospitalizations for mental health reasons is to meet with the client in the community setting: a. Once per week b. Two to four times per week c. Five to six times per week d. Seven to eight times per week 11 | P a g eANS: B The continuous care team that meets with a client two to four times per week has been found to be effective in directing the client’s treatment on a more continuous basis, resulting in greater stability for the client who is living in the community with the help of appropriate systems. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge TOP: Case Management Systems KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 6. Which member of the multidisciplinary mental health care team is primarily responsible for evaluating the family of the client, as well as the environmental and social surroundings of the client, and plays a major role in the admission of new clients? a. Psychiatric nS The Marketplace to Buy and Sell your Study Material b. Clinical psychologist c. Psychiatrist d. Psychiatric social worker ANS: D These are the primary responsibilities of the psychiatric social worker. The psychiatric nurse’s primary responsibilities include assisting with the client’s activities of daily living and managing individual, family, and group psychotherapy. The clinical psychologist is involved in the planning of treatment and diagnostic processes, and the psychiatrist is the leader of the team. PTS: 1 OBJ: 6 DIF: Cognitive Level: Comprehension REF: pp. 15-16 TOP: Multidisciplinary Mental Health Care Team KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 7. It is estimated that approximately million adults in the United States experience some form of mental or emotional disorder. a. 35.5 b. 61.5 c. 28.2 d. 59 ANS: B Although exact statistics are unavailable, it is estimated that at any given time at least 61.5 million adults in the United States suffer from mental-emotional disorders. ―Approximately 18.1% of American adults—about 42 milli onpeople—live with anxiety disorders‖ (National Alliance on Mental Illness, 2014). PTS: 1 REF: p. 15 DIF: Cognitive Level: Knowledge OBJ: 7 TOP: Impact of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 8. A male client with a diagnosis of bipolar disorder is admitted to an inpatient unit during a severe manic episode. As a result of guidelines implemented by the Health Care Financing REF: p. 17 12 | P a g eAdministration in 1983, the client’s Medicare will pay for his stay in this unit for: a. The length of time necessary for his condition to be stabilized b. Up to 6 months with appropriate documentation c. A pre-determined length of time based on the diagnosis d. 2 to 4 weeks ANS: C Medicare payment guidelines are based on the diagnosis, which is classified under a diagnosis- related group (DRG), and specify a pre-determined payment for a particular diagnosis. This cost containment strategy has also been adopted by some private insurance companies. After the pre- determined time, the facility is responsible for additional costs incurred by the client’s stay. PTS: 1 OBJ: 1 DIF: Cognitive Level: Comprehension TOP: Economic Issues of Mental Illness KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 9. A female client was given the diagnosis of schizophrenia and recently has lost her job. She tells the nurse that she has enough money for only two more house payments, and if she does not find a job, she fears she will become homeless. The nurse knows that this client falls into the group of nearly of U.S. citizens who live below the poverty level. a. 1% b. 6% c. 12% d. 25% ANS: C Approximately 12% of Americans (or 33 million people) live below the poverty level. Living in poverty often precipitates mental disorders, or mental disorders may occur while an individual is living in poverty. PTS: 1 OBJ: 7 DIF: Cognitive Level: Knowledge TOP: Social Issues of Mental Illness REF: p. 18 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 10. Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with: a. Permanent psychotic states b. Bipolar disorder c. Generalized anxiety disorder d. Obsessive-compulsive disorder ANS: A Permanent psychotic states are occurring in mental health clients who combine their psychotherapeutic medications with the abuse of recreational drugs. The combination of these two types of drugs is not commonly associated with bipolar disorder, generalized anxiety disorder, or obsessive-compulsive disorder. PTS: 1 OBJ: 7 DIF: Cognitive Level: Knowledge TOP: Social Issues of Mental Illness REF: p. 18 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 11. A female client who is undergoing therapy for depression is divorced and has two children, ages 2 and 4. She has just enrolled in a local community college and is worried about providing food REF: p. 18 13 | P a g eand clothes for her family while holding down a minimum wage job and devoting the time needed to be successful in school. The nurse determines that the best community resource for assisting this client to meet these needs is: a. A shelter for victims of domestic violence b. Women, Infants, and Children (WIC) c. A family-planning agency d. A family recreation center ANS: B WIC gives assistance to low-income women and children up to the age of 5 who are at nutritional risk by providing foods to supplement the diet and information on healthy eating habits. The other options do not address her situation because she has not voiced needs related to domestic violence or family planning, and a family recreation center will not meet her financial needs. PTS: 1 OBJ: 4 DIF: Cognitive Level: Application REF: p. 13 TOP: Delivery of Community Mental Health Services KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 12. The home care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife with Alzheimer’s disease. He states that he hardly has enough energy to cook and clean the house. The couple has no children, and no relatives live within a close distance. Which community agency would be of greatest benefit to this client? a. A recreational club b. An adult education program c. A day care center for the elderly d. Meals on Wheels ANS: D By providing food, Meals on Wheels would remove one responsibility for this client. A recreational club or an adult education program is appropriate, but the priority need for this couple is food. A day care center for the elderly may be necessary in the future, but it is not a priority at this time. PTS: 1 OBJ: 4 DIF: Cognitive Level: Application REF: p. 13 TOP: Deliveryof CommunityMental Health Services KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 13. A 9-year-old girl is given the diagnosis of depression. She has low self-esteem, does not enjoy group therapy, and does not show her emotions. The nurse has had difficulty establishing rapport with this client and decides to ask for assistance from another treatment team member. Which team member would best assist in this situation? a. Psychiatric assistant b. Dietitian c. Occupational therapist d. Expressive therapist ANS: D Expressive therapists work well with children who have difficulty expressing their thoughts and feelings. Expressive therapists use creative methods that appeal to children. The dietitian would not be the best team member to meet the needs of the client at this time. The psychiatric assistant, or technician, assists the nurse with daily activities and in monitoring clients during 14 | P a g eleisure activities. The occupational therapist works primarily with rehabilitational therapy, such as socialization and vocational retraining. PTS: 1 DIF: Cognitive Level: Application REF: p. 16 OBJ: 6 TOP: Multidisciplinary Mental Health Care Team KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 14. Nearly of all countries in the world have no clear governmental policy that addresses mental health issues. a. 7% b. 26% c. 50% d. 75% ANS: C In addition to nearly half of the countries in the world that have no policy on mental health issues, approximately one third have no program for coping with the increasing numbers of mental health disabilities. PTS: 1 OBJ: 1 DIF: Cognitive Level: Knowledge TOP: Current Mental Health Care Systems KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 15. A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose. The primary rationale for her admission is to: a. Have limited supervision by health care personnel b. Maintain responsibility for her own behavior c. Receive treatment in the least restrictive manner d. Provide her with a safe and secure environment ANS: D The most important advantage of inpatient psychiatric care is that it provides clients with a safe and secure environmentwhere theycan focus on and work with the problems that brought them there. PTS: 1 OBJ: 2 DIF: Cognitive Level: Knowledge TOP: Inpatient Care REF: p. 11 KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 16. A client suffering from chronic mental illness often forgets to take her medication and needs to be reminded to take care of daily hygiene. She does not have family or other support persons living in the area. The care delivery most beneficial for this client is: a. Emergency departments b. Residential program c. Community mental health center d. Psychiatric home care ANS: B Residential programs offer the protected, supervised environment this client needs to be compliant. Emergency care has stabilization and crisis as its focus, psychiatric home care works with clients and families in transition, and community mental health centers deal with crisis, counseling, and education. REF: p. 10 15 | P a g ePTS: 1 OBJ: 4 DIF: Cognitive Level: Application REF: p. 12 TOP: Community Mental Health Care Delivery KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 17. A 35-year-old client with a long history of schizophrenia who often forgets to take his medication is admitted to an inpatient unit after police find him threatening passengers on a bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example of: a. Recidivism b. Symptom exacerbation c. Noncompliance d. Rejection ANS: A Unable to cope in the community setting, people with chronic psychiatric problems often return to institutions or use community services on a revolving-door basis. This behavior pattern is known as recidivism and means a relapse (return) of a symptom, disease, or behavior PTS: 1 OBJ: 4 DIF: Cognitive Level: Knowledge TOP: Outpatient Care REF: p. 12 KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity 18. When arranging community resource linkages for a client and her children who are victims of domestic violence, which resource is the most immediately appropriate? a. Adult education program b. Family recreation center c. Mediation group d. Women’s shelter ANS: D A women’s domestic abuse shelteristhemost appropriate resource for the immediate safety needs of the family. While education programs, family recreation centers, and mediation groups also provide benefit to the family, they do not address the initial safety of the woman and her children. PTS: 1 OBJ: 4 DIF: Cognitive Level: Application REF: p. 14 TOP: Case Management: Resource Linkages KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity MULTIPLE RESPONSE 1. Which principles characterize mental health care in Canada? (Select all that apply.) a. Portability b. Universality c. Accessibility d. Comprehensiveness e. Private insurance models f. Public administration ANS: A, B, C, D, F Portability refers to retaining services in the event of moving; universality means that everyone in the nation of Canada is covered; accessibility indicates that everyone has access to health care; comprehensiveness means that all necessary treatment is covered; and public administration 16 | P a g ereveals that the health care system is publicly run and accountable. Private insurance models are the types of insurance provided in the United States. PTS: 1 OBJ: 1 DIF: Cognitive Level: Knowledge TOP: Mental Health Care in Canada REF: p. 10 KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity 2. In the United States, which factors determine whether a client requires inpatient rather than outpatient care? (Select all that apply.) a. Severity of the illness b. Level of dysfunction c. Suitability of the setting for treating the problem d. Anticipated diagnosis e. Level of client cooperation f. Ability to pay ANS: A, B, C, E, F These options are the determining factors for inpatient mental health care. If a client meets the criteria, the diagnosis does not matter in the determination of whether the client requires inpatient or outpatient care. PTS: 1 OBJ: 2 DIF: Cognitive Level: Comprehension TOP: Care Settings KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and EffectiveCare Environment 3. Which client populations are at greater risk for the development of mental health disorders? (Select all that apply.) a. Homeless b. Clients infected with HIV or AIDS c. Those in crisis d. Nurses e. Clients living in rural areas f. Older adults g. Psychiatrists h. Children ANS: A, B, C, E, F, H These individuals are considered to be at high risk for various reasons. Nurses and psychiatrists are not considered at high risk for developing mental health disorders. PTS: 1 OBJ: 7 DIF: Cognitive Level: Knowledge TOP: Client Populations REF: p. 17 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 4. The case management for a client requiring community mental health services would include which of the following? (Select all that apply.) a. Advocacy b. Crisis intervention c. Provision of referrals to a shelter d. Administration of psychotropic medications e. Developing a client’s plan of care ANS: A, B, C REF: pp. 11-12 17 | P a g eCase management is a system of interventions designed to support mentally ill clients living in the community. The major components of case management are psychosocial rehabilitation, consultation, resource linkage (referral), advocacy, therapy, and crisis intervention. Administration of medications is performed by an individual, not a system, and clients are involved in planning their care. PTS: 1 DIF: Cognitive Level: Knowledge REF: pp. 14-15 OBJ: 5 TOP: Case Management 18 | P a g eChapter 03: Ethical and Legal Issues MULTIPLE CHOICE 1. A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this client’s particular value was formed? a. Moralizing b. Modeling c. Reward-punishment d. Laissez-faire ANS: B Modeling best describes how the teenage client developed this value because his parents not only discussed this issue but behaved in a way for the teen to copy. Moralizing sets standards of right and wrong with no choices allowed; the reward-punishment model rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices. PTS: 1 OBJ: 1 DIF: Cognitive Level: Application TOP: Acquiring Values REF: p. 21 KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity 2. A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications. What process best describes how the nurse decided on the course of action taken? a. Values clarification b. Nurse’s rights c. Beliefs d. Morals ANS: A Values clarification consists of the steps of choosing, prizing, and acting. This most accurately describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed the choice, and then enacted the choice. The nurse’s rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred. PTS: 1 OBJ: 1 DIF: Cognitive Level: Application TOP: Values Clarification KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 3. Twenty-three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to: a. Include coverage for mental illness b. Include coverage for substance abuse treatment c. Include coverage for mental illness that is equal to coverage for physical illness d. Include coverage for outpatient therapy for individuals with substance abuse REF: p. 21 19 | P a g eANS: C The mental health parity laws require insurance companies to include coverage for mental illness that is equal to coverage for physical illness. Only nine states include treatment for substance abuse in their parity laws. PTS: 1 OBJ: 2 DIF: Cognitive Level: Knowledge TOP: Client Rights KEY: Nursing Process Step: Assessment MSC: Client Needs: Safe and Effective Care Environment 4. The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate? a. Fidelity b. Veracity c. Confidentiality d. Justice ANS: A Fidelity refers to the obligation to keep one’s word. The nurse violated this principle in this situation, which leads to mistrust from the client. Veracity is the duty to tell the truth, confidentiality is the duty of keeping the client’s information private, and justice indicates that all clients must be treated fairly, equally, and respectfully. PTS: 1 OBJ: 3 DIF: Cognitive Level: Application TOP: Ethical Principles KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 5. A male client is seeking help in a mental health clinic for anger management problems. He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do ―whatever it takes‖ to control his anger. Later in the week, the client’s wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing: a. A moral dilemma b. Value clarification c. An ethical conflict (or dilemma) d. A breach of confidentiality ANS: C This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both clients but must maintain confidentiality for each. Use of guidelines for ethical decision making can assist the nurse in making an ethical decision. A moral dilemma is simply a dilemma associated with making a decision between right and wrong. Value clarification is a process that helps to identify an individual’s values. PTS: 1 OBJ: 3 DIF: Cognitive Level: Application TOP: Ethical Conflict KEY: Nursing Process Step: Intervention REF: p. 23 REF: p. 23 REF: p. 22 20 | P a g eMSC: Client Needs: Safe and Effective Care Environment 6. The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question? a. National nurse practice act b. State nurse practice act c. Regional nurse practice act d. Community nurse practice act ANS: B Each state’s board of nursing determines the scope of practice in that state through a series of regulations that are called nurse practice acts. It is the nurse’s responsibility to know his or her scope of practice. The other options do not exist. PTS: 1 OBJ: 4 DIF: Cognitive Level: Comprehension TOP: Legal Concepts in Health Care KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 7. An order written by a physician is reviewed by the nursing staff, and no one is familiar with the treatment instructions. A nurse who was recently hired knows that this treatment is covered by the state’s nurse practice act. What is the nurse’s best course of action? a. Call the physician to ask for clarification b. Check the state’s nurse practice act again c. Contact the nursing supervisor for approval to carry out the treatment d. Refer to the facility’s policy and procedure to determine the course of action ANS: D Because this treatment is covered under the state’s nurse practice act, the next step is to refer to the facility’s policy and procedure manual to determine whether the ordered treatment is allowed by the facility. Calling the physician is not necessary because there was no question about how the order was written, and the state’s nurse practice act has already been checked. Contacting the nursing supervisor would be acceptable only after the facility’s policy has been checked. PTS: 1 OBJ: 4 DIF: Cognitive Level: Application TOP: Legal Concepts in Health Care KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 8. Standards of nursing practice for mental health can best be described as helping to ensure: a. That certain clients receive care b. Quality and effectiveness of care c. Proper documentation d. Proper medication administration ANS: B Most health care disciplines have standards of practice documented as guidelines with measurable criteria that can be used to evaluate the quality and effectiveness of care provided. All clients have the right to receive care, so standards of nursing practice would not address who receives care. Although proper documentation and proper medication administration might be REF: p. 25 REF: p. 25 21 | P a g epart of the evaluation process, they do not provide complete evaluation of quality and effectiveness of care. PTS: 1 OBJ: 4 DIF: Cognitive Level: Comprehension TOP: Legal Concepts in Health Care KEY: Nursing Process Step: Evaluation MSC: Client Needs: Safe and Effective Care Environment 9. If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every: a. 3 months b. 6 months c. 12 months d. 15 months ANS: C Although the case is being reviewed constantly by the mental health care team, the court must review the indefinite commitment on a yearly basis. PTS: 1 OBJ: 5 DIF: Cognitive Level: Knowledge TOP: Adult Psychiatric Admissions KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 10. A male client is being argumentative during a group therapy session. The psychiatric technician warns the client that if he does not cooperate with the nurse, he will be physically restrained and taken to his room for the remainder of the day. For which action could the technician be held liable? a. Assault b. Battery c. Privacy d. Fraud ANS: A The technician is engaging in assault, which is any act that threatens a client. Battery of a client occurs when any physical act of touching occurs without the client’s permission. Privacy refers to issues related to the body and confidentiality, and fraud is giving false information. PTS: 1 OBJ: 6 DIF: Cognitive Level: Application TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 11. Which of the following circumstances, when it occurs on an inpatient mental health unit, would be considered false imprisonment? a. An alert and oriented client is confined to his room after being loud and argumentative with another client in the recreation area. b. Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission. c. A client is housed in a private room with visual monitors after attempting suicide at home on the previous day. REF: p. 26 REF: p. 26 REF: p. 25 22 | P a g ed. An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission. ANS: A The client cannot be confined to his room if he did not pose a threat to himself or others, or if no contract was made with the client regarding consequences for inappropriate behavior. All of the other options are appropriate because they follow guidelines for client safety. PTS: 1 OBJ: 6 DIF: Cognitive Level: Analysis TOP: Areas of Potential Liability KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 12. The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent? a. Social worker b. Nurse c. Physician d. Facility’s legal representative ANS: C The physician is responsible for providing the client with the information necessary to give informed consent, including expectations and risks involved. The nurse can assist by obtaining the written documentation necessary for informed consent. PTS: 1 OBJ: 8 DIF: Cognitive Level: Knowledge TOP: Care Providers’ Responsibilities KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 13. An important responsibility of the nurse in a mental health facility is to ensure that clients do not from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions. a. Escape b. Abandon c. Flee d. Elope ANS: D The appropriate terminology used when a client runs away from a facility without a discharge order is elopement. In the event of elopement, the caregiver can be held liable if a client becomes injured. PTS: 1 OBJ: 8 DIF: Cognitive Level: Knowledge TOP: Care Providers’ Responsibilities KEY: Nursing Process Step: Intervention MSC: Client Needs: Safe and Effective Care Environment 14. If a female client tells the nurse of extensive plans she has to harm the girlfriend of her exhusband, what is the nurse’s best action? a. Try to talk with the client to convince her not to harm the girlfriend REF: p. 27 REF: p. 27 REF: p. 27