Morrison-Valfre: Foundations of Mental Health Care, 6th Edition
Contents Chapter 01: The History of Mental Health Care ................................
... [Show More] ....................... 2 Chapter 02: Current Mental Health Care Systems ................................ ..................... 10 Chapter 03: Ethical and Legal Issues ................................ ............................... 18 Chapter 04: Sociocultural Issues ................................ ................................ ... 26 Chapter 05: Theories and Therapies ................................ ............................... 34 Chapter 06: Complementary and Alternative Therapies ................................ ............... 42 Chapter 07: Psychotherapeutic Drug Therapy ................................ ........................ 50 Chapter 8: Skills and Principles of Mental Health Care ................................ ................ 58 Chapter 10: Therapeutic Communication ................................ ........................... 67 Chapter 9: Mental Health Assessment Skills ................................ ......................... 75 Chapter 11: The Therapeutic Relationship ................................ .......................... 84 Chapter 12: The Therapeutic Environment ................................ .......................... 94 Chapter 13: Problems of Childhood ................................ ............................... 102 Chapter 14: Problems of Adolescence ................................ ............................. 111 Chapter 15: Problems of Adulthood ................................ ............................... 120 Chapter 16: Problems of Late Adulthood ................................ ........................... 129 Chapter 17: Cognitive Impairment, Alzheimer's Disease, and Dementia ................................ . 136 Chapter 18: Managing Anxiety ................................ ................................ ... 145 Chapter 19: Illness and Hospitalization ................................ ............................ 153 Chapter 20: Loss and Grief ................................ ................................ ...... 162 Chapter 21: Depression and Other Mood Disorders ................................ .................. 170 Chapter 22: Physical Problems, Psychological Sources ................................ ............... 178 Chapter 23: Eating and Sleeping Disorders ................................ ......................... 186 Chapter 24: Dissociative Disorders ................................ ................................ 193 Chapter 25: Anger and Aggression ................................ ................................ 202 Chapter 26: Outward-Focused Emotions: Violence ................................ ................... 210 Chapter 27: Inward-Focused Emotions: Suicide ................................ ..................... 218 Chapter 28: Substance-Related Disorders ................................ .......................... 226 Chapter 29: Sexual Disorders ................................ ................................ .... 233 Chapter 30: Personality Disorders ................................ ................................ 242 Chapter 31: Schizophrenia and Other Psychoses ................................ .................... 250 Chapter 32: Chronic Mental Health Disorders ................................ ....................... 258 Chapter 33: Challenges for the Future ................................ ............................. 265
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 ofthe
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
6. 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
3 | P a g eANS: 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
ANS: 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
4 | P a g e10. 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
Posttraumatic 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
mentally ill individuals.
a. Psychotherapeutic drugs
in the 1950s led to the deinstitutionalization of many
5 | P a g eb. 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
The 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
6 | P a g eANS: 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
OBJ: 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
REF: p. 1
7 | P a g eKEY: 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
c. 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
8 | P a g eANS: 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
1. 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
DIF: Cognitive Level: Knowledge
OBJ: 3
TOP: Mental Illness in the Middle Ages
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
REF: p. 3
9 | P a g eChapter 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
Tax 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
3. The
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
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
10 | P a g e4. 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
ANS: 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 nSuturvsiea.com 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
REF: p. 15
11 | P a g eMSC: 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
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
Administration 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
REF: p. 18
REF: p. 17
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
DIF: Cognitive Level: Knowledge
REF: p. 18
12 | P a g eOBJ: 7
TOP: Social Issues of Mental Illness
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 and 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.
13 | P a g ePTS: 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
leisure 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.
REF: p. 10
14 | P a g ePTS: 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.
PTS: 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
KEY: Nursing Process Step: Planning
REF: p. 12
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
15 | P a g eMULTIPLE 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 reveals 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 REF: pp. 11-12
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
DIF: Cognitive Level: Knowledge
REF: p. 17
16 | P a g eOBJ: 7
TOP: Client Populations
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
Case 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
17 | P a g eChapter 03: Ethical and Legal Issues [Show Less]