Chapter 33: Challenges for the Future

Morrison-Valfre: Foundations of Mental Health Care, 7th Edition

Multiple Choice

1. The need for mental health applies to: a. all persons. b. people with illnesses. c. all married persons. d. people with mental problems.

ANS: A

The need for mental health applies to all people. Every person experiences periods of emotional turmoil and crises, and, at some time, most individuals need some assistance with coping strategies.

DIF: Cognitive Level: Knowledge REF: p. 395 OBJ: 1

TOP: Introduction KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. social b. cultural c. environmental d. technological

2. An aging population, an overburdened welfare system, and a cost conscious U.S. Congress exerting its influence on the health care system are all examples of changes.

ANS: A

These are all examples of social changes that affect today’s health care system. Cultural changes are exhibited in the population served in the health care setting; the environment refers to the health care setting; and technological advances guide the level of care and the way care is delivered.

DIF: Cognitive Level: Knowledge REF: p. 396 OBJ: 6

TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. 14 b. 28 c. 38 d. 44

3. Families without a home now make up % of the homeless population in the United States.

ANS: C

Nearly half of this population work, but they do not earn enough to pay for housing.

DIF: Cognitive Level: Comprehension REF: p. 396 OBJ: 2

TOP: Homelessness KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

4. To implement the concept of the least restrictive treatment environment, health care team members: a. monitor the medications schedule. b. assess the client’s ability to live alone. c. assess available financial resources. d. assess available community resources.

ANS: D

The main function of the mental health care team is to coordinate care as the client moves from inpatient to community settings because this is the least restrictive treatment environment. The other options involve actions of care team members, but they are not directly related to the surroundings.

DIF: Cognitive Level: Synthesis REF: p. 399 OBJ: 4

TOP: The Mental Health Care Team

KEY: Nursing Process Step: Planning | Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

5. A treatment team member works with a client who is living in a residential treatment facility with a diagnosis of severe paranoid schizophrenia. The team member who collaborates with the physician to coordinate the client’s therapy and medications and necessary referrals is the: a. nurse case manager. b. psychiatric technician. c. certified nursing assistant. d. home health care provider.

ANS: A

While the psychiatric technician, certified nursing assistance, and home health care provider are important care team members in the collaboration effort, they do function as independently as the nurse case manager in coordination of the client’s care.

DIF: Cognitive Level: Knowledge REF: p. 401 OBJ: 7

TOP: Expanded Role for Nurses

MSC: Client Needs: Psychosocial Integrity

KEY: Nursing Process Step: Intervention

6. Routine health screenings, regular educational discussions, and support groups are nursing responsibilities that are: a. curative. b. educational. c. restorative. d. preventive.

ANS: D

All of the options are responsibilities of the nurse, but preventive best represents the criteria listed in the question. Preventive health care is an important responsibility of the nurse. Prevention reduces the incidence of illness and the difficulty associated with treatment.

DIF: Cognitive Level: Comprehension REF: p. 401 OBJ: 7

TOP: Expanded Roles for Nurses KEY: Nursing Process Step: Intervention

MSC: Client Needs: Psychosocial Integrity

7. A way of helping people with mental health problems to readjust and adapt to life in the community that is based on a nonmedical model of treatment is: a. client advocacy. b. psychosocial treatment. c. compliance with medications. d. psychosocial rehabilitation.

ANS: D

The psychosocial (psychiatric) rehabilitation model of treatment focuses on wellness, wholeness, and the abilities of the client, and it encourages freedom of choice and self-direction.

DIF: Cognitive Level: Knowledge REF: p. 402 OBJ: 7

TOP: Expanded Roles for Nurses KEY: Nursing Process Step: Planning

MSC: Client Needs: Psychosocial Integrity

8. The deliberate effort to make things different within a system is called: a. planned change. b. unplanned change. c. unexpected change. d. workplace dynamics.

ANS: A

Planned change is the deliberate effort to make things different within a system. Unplanned or unexpected change often is not desired change. With both types of change, workplace dynamics is affected and change often is met with strong reactions.

DIF: Cognitive Level: Knowledge REF: p. 402 OBJ: 8

TOP: The Change Process KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

9. Each complaint of people with HIV/AIDS must be investigated carefully because CNS problems can be mistaken for: a. anxiety. b. delusions. c. compulsions. d. psychiatric problems.

ANS: D

Individuals with HIV can have signs of CNS damage that may present as a psychiatric illness before HIV or AIDS is detected.

DIF: Cognitive Level: Comprehension REF: p. 403 OBJ: 9

TOP: Persons With AIDS KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. 4 b. 8 c. 12 d. 16

10. In the United States, 1 in individuals has a diagnosable mental health disorder.

ANS: A

This figure equates to 46.6 million individuals in the United States.

DIF: Cognitive Level: Knowledge REF: p. 395 OBJ: 1

TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

11. Historically, the homeless population has primarily consisted of: a. families. b. African American men over 40 years of age. c. white male adults with an average age of 50 years. d. individuals in their 30s with mental and physical disabilities.

ANS: C

This group constituted the majority of the homeless population in the past, but the face of the homeless population has changed over time.

DIF: Cognitive Level: Comprehension REF: p. 396 OBJ: 2

TOP: Homelessness KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. 40% b. One-third c. One-half d. 50%

12. Adults with chronic mental illness account for approximately of the homeless population.

ANS: A

Decreased community mental health services and lack of ability for the individual to function in daily life have led to the growing number of homeless persons with chronic mental illness.

DIF: Cognitive Level: Knowledge REF: p. 396 OBJ: 1

TOP: Homelessness KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

13. A male client was discharged to home from an inpatient setting with the diagnosis of obsessive-compulsive disorder. Upon discharge, he was able to reason, understand, and make informed choices regarding his care. Now, he is unable to leave his house, is engaging in compulsive behaviors, and is not taking his medication. The best description of this situation is that the client is lacking in: a. competency. b. client rights. c. self-direction. d. self-determination.

ANS: A

Competency incorporates the four criteria of being able to make a choice, understand important information, apply reasoning, and understand one’s own situation. This client is demonstrating inability in all of these areas.

DIF: Cognitive Level: Application REF: p. 399 OBJ: 5

TOP: Competency KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

14. A nurse is overheard by a family member of a client discussing the condition of the client. This nurse is in violation of the: a. client’s informed consent. b. right to competent care. c. Americans with Disabilities Act. d. Health Insurance Portability and Accountability Act.

ANS: D

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first national standard instituted for the protection of the privacy of an individual’s health information. Informed consent refers to appropriate information given to the client in order for the client to make informed decisions regarding his care. The right to competent care refers to the right of the client to receive care from an individual who is knowledgeable and skilled in providing care; and the Americans with Disabilities Act refers to the rights of individuals with disabilities.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 6

TOP: Obligations of Care Providers KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity

15. A woman whose culture believes her depression is the result of being possessed by the spirit of a deceased relative is considered to have a(an): a. impaired coping mechanism b. culture-bound disorder c. medically diagnosed disorder d. projection-based disorder

ANS: B

Some mental health problems may be specifically limited to the members of a certain group. These types of problems are called culture-bound disorders because they appear to be related to specific cultures. For example, the Hispanic disorder susto is an emotional anxiety that results from “soul loss.”

DIF: Cognitive Level: Comprehension REF: p. 398 OBJ: 1

TOP: Cultural Influences KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. The client will maintain compliance in medication administration. b. The client will adjust to the limitations of chronic illness. c. The client will keep in mind his limitations as a barrier to achievement of goals. d. The client will focus on continued progress and improvements in planning goals.

16. The nurse who advocates for a health-oriented approach to clients is likely to encourage the development of which outcome?

ANS: D

A health-oriented approach focuses on the possibilities and positive achievements that are within the client’s grasp. The other options focus on the limitations and negative view of the client’s illness.

DIF: Cognitive Level: Comprehension REF: p. 404 OBJ: 8

TOP: A Look to the Future KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. Begin to prepare clients for his departure by assisting to transition them to another nurse. b. Increase dosage of medications for each client in anticipation of the effect his leaving will have on their progress. c. Do not inform clients until after the nurse leaves to avoid additional anxiety. d. Wait until the nurse’s last day to inform clients to allow them to say goodbye, but avoid additional anxiety.

17. A nurse at the mental health clinic is leaving his job and relocating to another part of the country in 6 months. What is the best way for him to deal with his clients?

ANS: A

Planning changes for clients slowly and incrementally allow for minimal resistance. Although there may be a sense of anxiety and loss, it is diminished if done in steps. Increasing medication dosages, and not informing clients until the nurse is gone or on his last day do not provide for the open communication and preparation.

DIF: Cognitive Level: Comprehension REF: p. 400 OBJ: 8

TOP: The Change Process KEY: Nursing Process Step: Assessment

MSC: Client Needs: Psychosocial Integrity a. The client has a right to be discharged to the least restrictive environment. b. The client is not competent to be discharged without community mental health resources for his transition to a less restrictive environment. c. The client has a responsibility to ask to remain in the inpatient setting. d. The client will demonstrate improved compliance with treatment once in a less restrictive environment.

18. A person suffering from paranoid schizophrenia is discharged from an inpatient facility before community mental health services can be established for him. Which statement most appropriately describes this action?

ANS: B