Chapter 33: Challenges for the Future Nursing School Test Banks

Chapter 33: Challenges for the Future
Test Bank

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. 384 OBJ: 1
TOP: Introduction KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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.
a. Social
b. Cultural
c. Environmental
d. Technological
ANS: A
These are all examples of social changes that affect todays 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. 384 OBJ: 6
TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. Families without a home now make up _____% of the homeless population in the United States.
a. 14
b. 28
c. 38
d. 44
ANS: C
Nearly half of this population work, but they do not earn enough to pay for housing.

DIF: Cognitive Level: Comprehension REF: p. 385 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, care team members:
a. Monitor the medications schedule.
b. Assess the clients 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. 387 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 who has a diagnosis of severe paranoid schizophrenia. The team member who collaborates with the physician to coordinate the clients 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 clients care.

DIF: Cognitive Level: Knowledge REF: p. 390 OBJ: 7
TOP: Providers of Care KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

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. 390 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. 390 OBJ: 7
TOP: Expanded Roles for Nurses KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

8. As many as 75% of people with chronic mental health disorders:
a. Live alone
b. Refuse to take their medications
c. Use or abuse drugs
d. Use or abuse their prescribed medications
ANS: C
Individuals with a dual diagnosis experience two or more disorders, one of which is commonly drug abuse.

DIF: Cognitive Level: Comprehension REF: p. 386 OBJ: 1
TOP: Dual Diagnoses KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

9. 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. 391 OBJ: 8
TOP: The Change Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

10. 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. 392 OBJ: 9
TOP: Persons with AIDS KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

11. In the United States, 1 in _____ individuals has a diagnosable mental health disorder.
a. 4
b. 8
c. 12
d. 16
ANS: A
This figure equates to 58 million individuals in the United States.

DIF: Cognitive Level: Knowledge REF: p. 384 OBJ: 1
TOP: Changes in Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

12. 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. 385 OBJ: 2
TOP: Homelessness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

13. Adults with chronic mental illness account for approximately _____ of the homeless population.
a. 40%
b. one third
c. one quarter
d. 50%
ANS: A
Decreased community mental health services and lack of ability of 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. 385 OBJ: 1
TOP: Homelessness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

14. 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 ones own situation. This client is demonstrating inability in all of these areas.

DIF: Cognitive Level: Application REF: p. 388 OBJ: 5
TOP: Competency KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

15. 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. Clients 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 individuals health information. Informed consent refers to appropriate information given to the client in order for the client to make informed decisions regarding his or her 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. 389 OBJ: 6
TOP: Obligations of Care Providers KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. 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(n):
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. 386 OBJ: 1
TOP: Cultural Influences KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. The nurse who advocates for a health-oriented approach to clients is likely to encourage the development of which outcome?
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.
ANS: D
A health-oriented approach focuses on the possibilities and positive achievements that are within the clients grasp. The other options focus on the limitations and negative view of the clients illness.

DIF: Cognitive Level: Comprehension REF: p. 393 OBJ: 8
TOP: A Look to the Future KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

18. 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?
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 nurses last day to inform clients to allow them to say good-bye, but avoid additional anxiety.
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. 391 OBJ: 8
TOP: The Change Process KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

19. 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?
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.
ANS: B
The concept of least restrictive environment begins to break down when the client is unable to care for himself. Competence must be demonstrated. It is not the responsibility of a client who is not competent to request a longer length of stay. Without proper support and resources, compliance with treatment will most likely not improve.

DIF: Cognitive Level: Comprehension REF: p. 388 OBJ: 5
TOP: Competency KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

20. In the United States today, the seriously mentally ill constitute: (Select all that apply.)
a. The neglected, the abused, and the confined
b. A large segment of jail and prison populations
c. More than half of all homeless persons
d. More than one third of the homeless population
e. The main pool of workers covered under the ADA
f. Most persons receiving medical treatment
g. Unmarried, intermittently employed, white adult males
ANS: B, D
These are characteristics of homeless persons in the United States.

DIF: Cognitive Level: Comprehension REF: p. 385 OBJ: 2
TOP: Homelessness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

21. What should the client do to cope with information overload? (Select all that apply.)
a. Learn to think critically.
b. Ignore any information.
c. Be open to new information.
d. Promise yourself that you will look at it later.
e. Learn to find relationships in new information.
f. Learn at least one new piece of information a day.
g. Ignore new information unless it relates directly to the job.
ANS: A, C, E, F
Information overload is a state of mind in which many facts have been absorbed and all become an unrelated clutter of stored information. This is a common phenomenon in todays society with the ease of obtaining new information from so many sources, such as the Internet.

DIF: Cognitive Level: Application REF: p. 393 OBJ: 10
TOP: Information Overload KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

22. In order to be actively involved in a plan of care, the client must demonstrate which of the following responsibilities? (Select all that apply.)
a. Truthfulness
b. Education
c. Acceptance
d. Responsibility
e. Cooperation
ANS: A, D, E
In order to be involved in a plan of care that is effective for them, clients must demonstrate truthfulness in sharing information with the health care provider, responsibility in actions and behaviors and cooperation with the treatment plan. Provision of education and acceptance are obligations of the health care provider.

DIF: Cognitive Level: Comprehension REF: p. 388 OBJ: 6
TOP: Obligations of Clients KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

COMPLETION

23. A person is considered __________ according to the Americans With Disabilities Act (ADA) if he has a mental or physical impairment that significantly limits one or more major life activities.

ANS:
disabled
An employer must make reasonable adjustments for disabled employees.

DIF: Cognitive Level: Knowledge REF: p. 386 OBJ: 3
TOP: Americans With Disabilities Act KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

24. Because of the active role of the consumer in todays society, the term __________ is used frequently to describe the consumer of health care.

ANS:
client
The term patient has a passive connotation and frequently has been replaced by the term client.

DIF: Cognitive Level: Knowledge REF: p. 388 OBJ: 5
TOP: Empowerment of Clients KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

25. The __________ is the member of the mental health treatment team who has advanced certified nursing assistant training and provides care in both inpatient and community settings.

ANS:
patient care technician (PCT)
These individuals work with the nurse in providing care to the mental health client.

DIF: Cognitive Level: Knowledge REF: p. 389 OBJ: 4
TOP: Providers of Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

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