Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd Test Generator Questions

Test Bank for Essentials of Psychiatric Nursing 2nd Edition Boyd Test Generator Questions PREFACE TEST BANK with Complete Questions and Solutions. To clarify, this is the TEST BANK, not the textbook. You get immediate access to download your test bank. You will receive a complete test bank; in other words, all chapters shown in the table of contents in this preview will be there. Test banks come in PDF format; therefore, you do not need specialized software to open them. Chapter 1, Mental Health and Mental Disorders Multiple Choice 1. As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? Epidemiology: A) Helps promote understanding of the patterns of occurrence associated with mental disorders. B) Helps explain research findings about the neurophysiology that causes mental disorders. C) Provides a thorough theoretical explanation of why specific mental disorders occur. D) Predicts when a specific psychiatric client will recover from a specific mental disorder. Ans: A Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 4 Page Number: Feedback: 2 Epidemiology is the study of patterns of disease distribution and determinants of health within populations. It contributes to the overall understanding of the mental health status of population groups, or aggregates, and it examines the associations among possible factors. Epidemiology does not explain research findings about neurophysiology, provide theoretical explanations for why specific disorders occur, or predict recovery. 2. A nurse is working in a community mental health center that provides care to a large population of people of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address? A) Public stigma B) Self-stigma C) Label avoidance D) Negative life events Ans: C Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 5 Page Number: 4 1 Psychosocial Integrity Understand Nursing Process Safe, Effective Care Environment:Management of Care Apply Teaching/LearningFeedback: Although public stigma and self-stigma may be areas needing to be addressed, in this cultural group, label avoidance would be most important. Label avoidance or avoiding treatment/care so as not to be labeled mentally ill is a type of stigma that influences why so few people with mental health problems actually receive assistance. Asian cultures commonly have negative views of mental illness that influence the willingness of members to seek treatment; they possibly ignore the symptoms or refuse to seek treatment because of this stigma. Negative life events affect anyone, not just those of the Asian culture. 3. A nursing student is assigned to care for a client diagnosed with schizophrenia. When talking about this client in a clinical post-conference, the student would use which terminology when referring to the client? A) Committed client B) Schizophrenic C) Schizophrenic client D) Person with schizophrenia Ans: D Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 5 Page Number: Feedback: 4 Just as a person with diabetes should not be referred to as a “diabetic” but rather as a “person with diabetes,” a person with a mental disorder should never be referred to as a “schizophrenic” or “bipolar,” but rather as a “person with schizophrenia” or a “person with bipolar disorder.” Doing so helps to counteract the negative effects of stigma. 4. A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The student interprets this as which of the following? A) Rate B) Prevalence C) Point prevalence D) Incidence Ans: D Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 4 Page Number: Feedback: 3 The article is describing incidence, which refers to a rate that includes only new cases that have occurred within a clearly defined time period. The most common time period evaluated is 1 year. Rate reflects the proportion of cases in the population compared with the total population. Prevalence refers to the total number of people with the disorder within a given population at a specified time, regardless of how long ago the disorder started. Point prevalence refers to the proportion of individuals in the population that have a disorder at a specific point in time. 5. While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the clients is “really psycho.” Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) Lack of knowledge B) Public stigma C) Label avoidance 2 Psychosocial Integrity Apply Nursing Process Psychosocial Integrity Apply CommunicationandDocumentationD) Self-stigma Ans: B Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 5 Page Number: Feedback: 4 The receptionist's statementreflects the negative effects of stigmatization, more specifically public stigma. Self-stigma reflects a person's internalization of a negative stereotype; that is, the person with the mental illness begins to believe that he or she is what the public thinks he or she is. Label avoidance refers to avoiding treatment or care so as not to be labeled mentally ill. Lack of knowledge is often the underlying theme associated with any type of stigma. 6. After educating a group of students on mental health and mental illness, the instructor determines that the education was successful when the group identifies which of the following as reflecting mental disorders? A) Capacity to interact with others B) Ability to deal with ordinary stress C) Alteration in mood or thinking D) Lack of impaired functioning Ans: C Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 3 Page Number: Feedback: 3 Mental disorders are health conditions characterized by alterations in thinking, mood, or behavior and are associated with distress or impaired functioning. Mental health is the emotional and psychological well-being of an individual who has the capacity to interact with others, deal with ordinary stress, and perceive one's surroundings realistically. 7. A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) “Mental disorders are defined by an underlying biological pathology.” B) “Numerous laboratory tests are used to aid in the diagnosis of mental disorders.” C) “Clusters of behaviors, thoughts, and feelings characterize mental disorders.” D) “Manifestations of mental disorders are within normal, expected parameters.” Ans: C Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 3 Page Number: Feedback: 2 Unlike many medical disorders, mental disorders are defined by clusters of behaviors, thoughts, and feelings, not underlying biologic pathology. The alterations in thoughts, behaviors, and feelings are unexpected and outside the normal, culturally defined limits. Laboratory tests are not used in diagnosing mental disorders. 3 Psychosocial Integrity Apply Teaching/Learning Psychosocial Integrity Apply Nursing Process8. A psychiatric–mental health nurse is providing care for a client with a mental disorder. The client is participating in the decision-making process. The nurse interprets this as which component of recovery? A) Self-direction B) Collaborative C) Person-centered D) Holistic Ans: B Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 6 Page Number: Feedback: 4 In recovery-oriented care, the person with a mental health problem develops a partnership with a clinician to manage the illness, strengthen coping abilities, and build resilience for life’s challenges. Being involved in decision making helps the client transition from a dependent-driven relationship to a collaborative recovery-oriented one. Self-direction is reflected as individuals define their own goals and design a path to meet those goals. Individualized and person-centered is reflected by the individual's use of his or her own unique strengths and resilience as well as needs, preferences, experiences, and cultural background. Holistic involves the whole life of the individual— mind, body, spirit, and community. 9. A nurse is explaining recovery to the family of a client diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this process? A) “It is a step-by-step process from being ill to being well.” B) “The client focuses mainly on the emotional aspects of their condition.” C) “The client is helped to live a meaningful life to their fullest potential.” D) “Although peer support is important, the self-acceptance is essential.” Ans: C Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 6 Page Number: Feedback: 4 Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. It is a nonlinear process with setbacks. It also is strength-based. Peer support is important, but so is respect by the community and consumers, along with self-acceptance to ensure inclusion and participation in all aspects of life. 10. After teaching a group of nursing students on recovery, the instructor determines that more education is needed when the group identifies which of the following as a characteristic? A) Self-direction in life B) Improvement in health and wellness C) Achievement of full potential D) One-time change situation Ans: D Chapter: 1 Client Needs: Psychosocial Integrity 4 Psychosocial Integrity Apply Teaching/Learning Psychosocial Integrity Apply Nursing ProcessCognitive Level: Integrated Process: Objective: 6 Page Number: Feedback: 4 Recovery from mental disorders and/or substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. 11. When describing the treatment of mental illness, which of the following would a nurse identify as the primary goal? A) Functional status B) Stigma reduction C) Stress reduction D) Recovery Ans: D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Apply Teaching/Learning Understand Integrated Process: Nursing Process Objective: 6 Page Number: Feedback: 4 Although reducing stigma, reducing stress, and improving functional status are important components involved in the treatment of mental illness, recovery is the single most important goal for individuals with mental disorders. 12. A nurse is working as part of the multidisciplinary team and developing a plan of care for a client who is receiving recovery-oriented treatment. Which of the following would the nurse integrate into this plan? A) Focusing primarily on the mind B) Limiting support from others C) Using hope as motivation D) Avoiding underlying trauma Ans: C Chapter: Client Needs: Cognitive Level: Integrated Process: Objective: 6 Page Number: Feedback: 5 Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future—that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.. Recovery is also holistic, addressing an individual's whole life, including body, mind, spirit and community. Recovery is supported by peers and allies and through relationships and social networks. Finally, recovery is supported by addressing trauma, such that services and supports should be trauma- informed to foster safety. 13. A nurse is assessing a client to evaluate the client's mental health and wellness. Applying the eight dimensions of wellness, which of the following would the nurse identify as reflecting emotional wellness? A) Finding ways to expand creative abilities B) Recognizing the need for sleep and nutrition C) Searching for meaning in life 5 1 Psychosocial Integrity Apply Nursing ProcessD) Developing skills for dealing with stress Ans: D Chapter: Client Needs: Cognitive Level: Integrated Process: Objective: 1 Page Number: Feedback: 2 The emotional dimension of wellness focuses on developing skills and strategies to cope with stress. The intellectual dimension focuses on recognizing creative abilities and finding ways to expand one's knowledge and skills. The physical dimension focuses on recognizing the need for physical activity, diet, sleep and nutrition. The spiritual dimension focuses on the search for meaning and purpose in the human experience. 14. Which of the following would be a major barrier affecting the treatment of individuals with mental health problems? A) Lack of a diagnostic criteria B) Inability to obtain epidemiologic data C) Stigma associated with mental health problems D) Limited hope for recovery Ans: C Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 3 Page Number: Feedback: 3 Stigma is one of the major treatment barriers facing individuals with mental health problems and their families. Diagnostic criteria have been established for mental disorders, and evidence through epidemiologic research provides valuable information about the mental health status of population groups and associated factors. A guiding principle of recovery is hope, the belief that recovery is real and that the people can and do overcome the internal and external challenges, barriers and obstacles confronting them. 15. Which statement best reflects measures to address public stigma? A) “The client with schizophrenia needs additional assistance.” B) “The bipolar in room 222 is really out of control today.” C) “That client down the hall is a raving maniac.” D) “That hyperactive client is acting like a psycho.” Ans: A Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 5 Page Number: Feedback: 4 One way to reduce public stigma is to use nonstigmatizing language. Rather than referring to the client as schizophrenic or bipolar, it is more appropriate to say "the client with schizophrenia" or "the client with bipolar disorder." Terms such as maniac and psycho reinforce the negative images of mental illness. 6 Psychosocial Integrity Apply Nursing Process Psychosocial Integrity Apply Nursing Process 1 Psychosocial Integrity Apply Nursing Process16. When assessing a client with a mental illness, the nurse determines that the client is experiencing label avoidance when the client states which of the following? A) “I'm at the cause of my illness.” B) “I'll never be able to function in the world.” C) “I'm as crazy as everybody thinks I am.” D) “I really don't need to see anyone.” Ans: D Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 5 Page Number: Feedback: 4 Label avoidance involves an individual not seeking treatment so as not to be labeled as mentally ill. The statement about not really needing to see anyone suggests label avoidance. The statements about being the cause of the illness, not being able to function in the world, and being as crazy as everyone says reflect self-stigma, the internalization of negative stereotypes by individuals with mental illness. 17. A nurse is describing the four dimensions of recovery to a group of new psychiatric--mental health nurses. Which dimension is the nurse describing when addressing relationships and social networks? A) Health B) Home C) Purpose D) Community Ans: D Chapter: 1 Client Needs: Cognitive Level: Integrated Process: Objective: 6 Page Number: Feedback: 4 There are four dimensions that support recovery: health (managing disease and living in a physically and emotionally healthy way), home (a safe and stable place to live), purpose (meaningful daily activities and independence, resources and income), and community (relationships and social networks). 18. A nurse is reading a journal article about epidemiologic research and mental illness. Which of the following mental health conditions would the nurse expect to find as being projected as the leading burden of disease worldwide by the year 2030? A) Depression B) Anxiety C) Substance abuse D) Anorexia nervosa Ans: A Chapter: 1 Client Needs: Cognitive Level: Psychosocial Integrity Apply 7 Psychosocial Integrity Apply Teaching/Learning Psychosocial Integrity Apply Nursing ProcessIntegrated Process: Objective: 4 Page Number: Feedback: 2 Based on epidemiologic research, depression is one of the leading disease burdens in middle- and high-income countries, such as the United States. By 2030, depression is projected to be the leading burden worldwide. 19. Which of the following would be used to document a specific pattern of symptoms that occurs within a community? A) Cultural syndrome B) Stigma C) Wellness D) Stereotype Ans: A Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: Feedback: 3 A cultural syndrome refers to a specific pattern of symptoms that occurs within a specific cultural group or community. Stigma refers to a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others. Wellness is a purposeful process of individual growth, integration of experience, and meaningful connection with others. It reflects personally valued goals and strengths, and results in being well and living by values. Multiple Select 20. A psychiatric–mental health nurse is preparing a presentation about recovery for a group of newly hired nurses at the mental health facility. Which would the nurse identify as important concepts? (Select all that apply.) A) Self-direction B) Peer support C) Respect D) Hope E) Culturally-based Ans: A, B, C, D Chapter: 1 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 6 Page Number: Feedback: 5 Recovery is multifactorial. It encompasses self-direction, peer support, and respect as fundamental components for recovery; hope–the catalyst of the recovery process–is one of the most important concepts. It is through hope that individuals and families can overcome the barriers and obstacles facing them. Culture and cultural background in all of its diverse representations including values, traditions, and beliefs are key in determining a person's journey and unique pathway to recovery. Nursing Process 8Chapter 2, Cultural and Spiritual Issues Related to Mental Health Care Multiple Choice 1. When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which would the nurse identify as a reason for this belief about many mental health facilities? A) Require periods of hospitalization B) Do not provide 24-hour emergency services C) Are not reimbursed by third-party payers D) Do not accommodate their cultural needs Ans: D Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 2 Page Number: Feedback: 10 Studies reveal that Hispanic Americans are reluctant to seek mental health services because they believe that those services do not accommodate their cultural needs (e.g., language, beliefs, values), cost of care, and concerns regarding immigration status. Many instead seek help through supportive family services and the church. Required hospitalization, lack of 24-hour emergency services, and lack of reimbursement do not play a role. 2. A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Native Hawaiian adolescents, the nurse would address high rates of which? A) Schizophrenia B) Manic disorders C) Dementia D) Suicide Ans: D Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 2 Page Number: Feedback: 11 Research regarding specific mental health problems in Asian cultures is sparse, but various data suggest rates of suicide for Native Hawaiian adolescents are higher than those of other adolescents in the United States. 3. A psychiatric–mental health nurse is providing care to a client who has recently immigrated to the United States from Eastern Europe. Which of the following would be least effective in providing culturally competent care? A) Demonstrating a genuine interest in the client B) Avoiding assumptions about the client’s culture C) Learning a few key words in the native language provides quality care D) Acquiring information about the client’s country Ans: C 9 Psychosocial Integrity Apply Teaching/Learning Psychosocial Integrity Remember Culture & SpiritualityChapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 1 Page Number: Feedback: 9 Although communicating with the client in his native language may be appropriate, speaking the same language does not guarantee shared meaning and understanding of the client and his or her culture, a necessary component of cultural competence. Demonstrating a genuine interest, avoiding assumptions, and acquiring information about the client’s country are appropriate and effective actions for providing culturally competent care. 4. A psychiatric–mental health nurse is meeting with a military spouse who is Asian American. When the client describes their spouse’s mental health problems, which response would the nurse most likely expect? A) “Oh, they may seem depressed, but it is just a vitamin deficiency. It runs in their family.” B) “I know the war messed their mind up. They’ll never be the same.” C) “Sometimes they hallucinate that they are back in Vietnam.” D) “They never talk to me about what is bothering them.” Ans: A Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 2 Page Number: Feedback: 11 Generally, Asian cultures have a tradition of denying or disguising the existence of mental illness. In many of these cultures, it is an embarrassment to have a family member treated for mental illness, which may explain the extremely low utilization of mental health services. The response about the war messing up the spouse’s mind, or the statement about hallucinations, reflects some acknowledgment of a mental health problem. The response about never talking about what is bothering them also indicates some understanding of an underlying problem. Psychosocial Integrity Apply Culture & Spirituality Psychosocial Integrity Apply Culture & Spirituality 5. A psychiatric–mental health nurse is working with a client who is being treated for depression. Which client statement would indicate that their spirituality is intact? A) “My church friends came to visit me this past Sunday afternoon.” B) “Nothing will ever be the same again; my life is not worth living.” C) “I know I am as well off as I can be under the circumstances.” D) “I know God must be punishing me for all my sins.” Ans: C Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 4 Page Number: Feedback: 14 Perception of well-being and health in persons with severe mental illness has been positively associated with spirituality; Answer C implies that the client has a sense of well-being despite their depression. The statement about church friends visiting reflects the client’s religiousness or participation in a community of people who gather around common ways of worshiping. The statements about life not being worth living and that God is punishing them for their sins reflect hopelessness. 6. A client is being treated for prostate cancer; his prognosis is very poor. The client has a strong faith, and he has 10 Psychosocial Integrity Apply Culture & Spiritualitybeen active in his church for many years. He is concerned about his health and thechalengeshefaces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for the client? A) “I’ll take you to visit my church if you can get a pass.” B) “You have to belong to the same church I do if you’re going to go to heaven.” C) “Would you like me to bring you a guided imagery audiotape?” D) “We can pray together if you’d like.” Ans: D Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 4 Page Number: Feedback: 14 To carry out spiritual interventions, the nurse enters a therapeutic relationship with the client and uses the self as a therapeutic tool. Offering to pray with the client is the only intervention that allows the nurse to use herself as a therapeutic tool. Prayer is an appropriate spiritual intervention in this situation because of the client’s religious background and his need for solace and hope. The statements about taking the client to the nurse’s church and belonging to the same church to get to heaven focus on meeting the nurse’s need rather than the client’s need. The statement about bringing a guided imagery audiotape, although an appropriate spiritual intervention, would not be helpful for this client at this time because of his poor prognosis and concerns about the challenges he will face. 7. A psychiatric–mental health nurse is educating a class at a community health center on social factors associated with mental illness. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk? A) Older adults B) Individuals with physical disabilities C) Single-parent families D) Homeless individuals Ans: D Chapter: 2 Client Needs: Psychosocial Integrity Cognitive Level: Psychosocial Integrity Apply Caring Remember Integrated Process: Nursing Process Objective: 1 Page Number: Feedback: 10 Poverty affects all cultural groups and other groups such as older adults, people with physical disabilities, individuals with psychiatric impairments, and single-parent families. Often, those in poverty become trapped in a downward economic spiral as tensions and stress mount. The homeless population is the group most at risk for becoming unable to escape the spiral of poverty. 8. During an assessment, the client states,“Werely on our large extensive family for moral support and help, and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of them.” How should the nurse interpret this statement? A) Acculturation B) Cultural identity C) Cultural competence D) Linguistic competence Ans: B 11Chapter: 2 Client Needs: Cognitive Level: Integrated Process: Objective: 2 Page Number: Feedback: 9 Everyone has a cultural identity or a set of cultural beliefs with which one looks for standards of behavior. The client’s statements reflect their cultural identity. Acculturation refers to the socialization process by which minority groups learn and adopt selective aspects of the dominant culture, eventually leading to the evolvement of a new minority culture (one that is different from the native culture and different from the dominant culture). Cultural competence involves an adjustment or recognition of one’s own culture in order to understand the client’s culture. Linguistic competence is the capacity to communicate effectively and convey information that is easily understood by diverse audiences. 9. Within the context of the culture of poverty, which most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral? A) Unemployment causes poverty; a lack of will power and motivation can, in turn, cause unemployment in people who do not have a strong work ethic. B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications. C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty. D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty. Ans: C Chapter: 2 Client Needs: Psychosocial Integrity Cognitive Level: Psychosocial Integrity Apply Culture & Spirituality Remember Integrated Process: Nursing Process Objective: 2 Page Number: Feedback: 10 Families experiencing poverty are under tremendous financial and emotional stress, which may trigger or exacerbate mental health problems. Along with the daily stressors of trying toprvide fodand shelter for themselves and their families, the lack of time, energy, and money prevents them from attending to their psychological needs. Often, these families become trapped in a downward economic spiral as tensions and stress mount. The inability to gain employment and the lack of financial independence add to feelings of powerlessness and low self-esteem. Feeling powerless and having low self-esteem have the potential to keep these individuals from trying to find employment. 10. The nurse has a very religious client. How should the nurse define religiousness? A) Feeling of connectedness B) Way of interpreting life events C) Relationship with a unifying force D) Community participation in common worship Ans: D Chapter: 2 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Nursing Process Objective: 3 Page Number: 12 Feedback: Religiousness refers to the participation in a community of people who gather around common 12ways of worshiping. Spirituality refers to feelings of connectedness with God, spirit, nature, or a unifying force, and is a way of interpreting life events. Multiple Select 11. A psychiatric–mental health nurse works in a rural mental health clinic. What should the nurse understand impacts the use of mental health services for rural populations? Select all that apply. A) Limited access to care B) Lack of available resources C) Geographical similarities D) Diverse cultural groups E) Consistency in treatment approaches Ans: Chapter: A, B, D 2 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Nursing Process Objective: 2 Page Number: 11, 12 Feedback: All age groups in rural areas have limited access to health care. The lack of resources is particularly problematic since most mental health services are located in urban areas because more people live near cities. Rural areas are also diverse in both geography and culture. For example, accesstomentalhealthfor those in the Deep South is different from access for those with the same problems in the Northwest. Treatment approaches may be accepted in one part of the country but not in another.