Chapter 33: Community Mental Health Nursing School Test Banks

Chapter 33: Community Mental Health
Test Bank

MULTIPLE CHOICE

1. A community/public health nurse working in the late 1960s saw an increase in the number of psychiatric patients who were being cared for in the community. What was the reason for this increase?
a. Phenothiazine drugs such as chlorpromazine had been discovered.
b. Lobbyists had demanded closure of state psychiatric hospitals.
c. State funding encouraged the establishment of community mental health centers.
d. Community-based therapy was found to be effective at controlling psychiatric symptoms.
ANS: A
Phenothiazine drugs such as chlorpromazine (Thorazine) were miraculous at that time because they reduced the most challenging of psychiatric symptoms. Although symptoms were improved, clients were not ready to reenter the community, nor was the community prepared to receive them. Many patients lacked family support, and some still exhibited behaviors that interfered with social interactions. The federal government appropriated funds for community mental health centers in 1963, and this money was to be matched by state funds.

DIF: Cognitive Level: Application REF: pp. 822-823

2. Why did many psychiatric patients have impaired social interaction, decision-making skills, and life skills when they were discharged from the large state mental hospitals?
a. They had families who had not socialized them appropriately.
b. They heard nurses tell them too often that they were incompetent and incapable.
c. They lacked the ability to learn how to behave in front of others.
d. They were accustomed to having needs met and decisions made by the institution.
ANS: D
The patients had a condition called institutionalization, characterized by long-term adaptation to the demands of the setting, as evidenced by impaired social interaction and decision making and lack of life skills with which to function in society.

DIF: Cognitive Level: Knowledge REF: p. 823

3. In the 1960s, what was recommended by the Mental Health Survey Acts Joint Commission on Mental Illness and Health?
a. That an increased number of professionals who were prepared to treat the mentally ill be educated and employed
b. That mental health patients be deinstitutionalized and treatment be given to them in the community
c. That families reintegrate the ill family member into the home
d. That large state institutions be demolished and smaller, more homelike cottages be built
ANS: B
The Joint Commission on Mental Illness and Healths recommendation was to deinstitutionalize the mentally ill, with treatment to be moved from large state hospitals to the community.

DIF: Cognitive Level: Knowledge REF: p. 823

4. What was one of the suggestions given to President Carter in the 1970s when the mental health needs of the nation were reassessed?
a. Decrease support for mental health research.
b. Establish national health insurance that includes coverage for mental health services.
c. Require private insurance carriers to include mental health coverage.
d. Return responsibility for mental health from the states to the federal level.
ANS: B
The report to the President focused on strengthening the community mental health care system. Among other suggestions were to establish national health insurance that included coverage for mental health services and to encourage private insurance carriers to include mental health coverage. There was no requirement for private carriers to do so, only a recommendation.

DIF: Cognitive Level: Knowledge REF: p. 823

5. A community/public health nurse providing care for the mentally ill in the 1980s had difficulty finding funds to provide care for her clients. What was the end result of this lack of funding?
a. Many of the mentally ill died from lack of care and basic life necessities.
b. Most of the mentally ill returned to the large state institutions.
c. New, more progressive, modern state institutions were designed, built, and included community-based services.
d. Severely disabled clients remained in state institutions, and the less disabled clients used the services of community mental health centers.
ANS: D
A two-tiered system resulted; the most severely disabled clients were within state institutions and the less disabled clients used the community mental health centers.

DIF: Cognitive Level: Application REF: pp. 823-824

6. What major event related to the mental health care system occurred in the late 1980s?
a. The Reagan administrations Omnibus Budget Reconciliation Act terminated funding specifically for community mental health services.
b. States refused to continue to be told how to spend their money by the federal level and refused to provide matching funds to community mental health centers.
c. The budget crisis resulted in less funding for mental health services on the federal level and more funding on the local level.
d. The Presidents Commission on Mental Health confirmed that community mental health centers were ineffective in meeting the needs of the patients.
ANS: A
The Reagan Administrations Omnibus Budget Reconciliation Act moved authority for mental health programs from the National Institute of Mental Health to the individual states. Federal funding ceased as such, and each state received a block grant to cover services of the states choices.

DIF: Cognitive Level: Knowledge REF: p. 824

7. A community/public health nurse caring for mental health patients in the late 1990s noticed changes in the services that were available for this population. What led to these changes?
a. Communities began banding together to demand increased funding from the federal budget.
b. Psychiatrists were given some power to speak for their patients about services necessary to facilitate their recovery.
c. Psychiatric patients and their families organized and became involved in policy development.
d. States convinced the federal government that they could not cope with the demands of this population.
ANS: C
The recipients of services became involved in planning efforts when organizations of former hospital residents were formed. The primary goal behind organizing was to be heard and to influence public policy related to mental health programs.

DIF: Cognitive Level: Application REF: p. 824

8. A patient asks the community/public health nurse why there has been an increase in the number of self-help programs in the community. What was one factor that led to the popularity of these programs?
a. Community mental health centers wanted to avoid paying professionals to work as counselors.
b. Families were unhappy with professional care and helped their family members to do it yourself.
c. There was a lack of professionals available to fulfill these needed responsibilities.
d. Patients chose to do this to give their lives meaning by making a difference to someone else through giving as well as receiving.
ANS: D
Patient-run services provide former patients with a belief that they can make a difference to someone else, that they can give as well as receive, and that their lives have meaning. There was no problem with professional staff working in the community.

DIF: Cognitive Level: Application REF: p. 824

9. According to E. Fuller Torrey, where would a person most likely encounter a mentally ill person?
a. State mental hospital
b. State prison or jail
c. Grocery store
d. Living with a family member
ANS: B
According to Dr. Torrey, data from 2004 to 2005 indicated that in the United States, there are more than three times more seriously mentally ill people in jails and prisons than in hospitals. At least 16% of inmates in jails and prisons have a serious mental illness; this percentage increased from 6.4% in 1983. Forty percent of individuals with serious mental illnesses have been in jail or prison at some time during their lives.

DIF: Cognitive Level: Comprehension REF: p. 824

10. A community/public health nurse has contacted her legislator to discuss a bill that would enact the provisions of Timothys Law in the state where she lives. Which of the following statements would the nurse most likely make during this conversation?
a. Timothys Law suggests that foster care is often the only workable approach to children in trouble.
b. Timothys Law encourages an increase in the amount of support and counseling available in schools.
c. Timothys Law demonstrates how helpful it is for families to have insurance coverage.
d. Timothys Law shows off the success of local collaboration to address the inequities in mental health coverage.
ANS: D
Timothy, a 12-year-old boy, committed suicide after spending time in the foster care system in which he was placed so that he would be eligible for Medicaid services and unrestricted access to mental health services. Public outrage was so vast that the law named after him was created to ensure that such a loss did not recur. The law in New York requires that group health insurance provide at least 30 inpatient days and 20 outpatient visits per year for mental health treatment so that parents will not become so desperate as to give up their child to foster care in order to be eligible for Medicaid coverage for mental health care.

DIF: Cognitive Level: Application REF: p. 824

11. Which of the following is an example of a catchment area?
a. A community mental health center that provides comprehensive services
b. A community where the homeless meet each evening and are taken to a shelter for safety
c. A jail or prison where the severely mentally ill are kept isolated from prisoners who do not suffer from such illnesses
d. A city or several rural communities small enough to allow collaboration among themselves
ANS: D
Community is defined in mental health terms as a catchment area, which is a city or several rural communities whose total population ranges from 75,000 to 200,000. This is a manageable segment for the delivery of mental health services because it is small enough to allow collaboration among the components of the system.

DIF: Cognitive Level: Application REF: p. 826

12. What is the leading cause of disability in the United States among individuals aged 15 to 44?
a. Arthritis
b. Cardiac conditions
c. Cerebrovascular disorders
d. Mental illness
ANS: D
Mental illness is the leading cause of disability in the United States and Canada among individuals aged 15 to 44.

DIF: Cognitive Level: Knowledge REF: p. 826

13. A nurse was creating health education units to be taught in the community high school. Which unit would be most helpful to adolescents, their teachers, and the community as a whole?
a. First aid and preparedness in case of natural disasters
b. Healthy lifestyles with an emphasis on the need for physical activity
c. Signs of depression and suicide and ways of helping someone at risk for suicide
d. Sex education about subjects ranging from abstinence to avoiding pregnancy and sexually transmitted diseases (STDs) among teenagers who are sexually active
ANS: C
One of the best ways to help the community is by using primary prevention strategies; these strategies allow the nurse to intervene before a problem occurs. Although any such educational programs could be useful, the choice may depend in part on the local communitys needs and belief systems. The sexual education course may be an excellent approach, but in certain areas of the country, it would cause an uproar in the community. Physical education is also a high priority, but the leading causes of death in adolescents are accidents, homicide, and suicide. Therefore, preventing suicide would be the highest priority in the list.

DIF: Cognitive Level: Synthesis REF: p. 827

14. A community/public health nurse would like to implement a secondary prevention strategy within the community to meet the needs of the families caring for members with mental illness. Which of the following interventions would the nurse be most likely to complete?
a. Providing counseling services for the family members
b. Offering mental health consultation services to businesses in which family members are employed
c. Developing discharge planning instructions for the family members
d. Advocating within the political arena for the rights of the family members
ANS: A
Providing counseling services for family members exemplifies secondary prevention, as this intervention demonstrates intervening with a group at risk for problems before a problem develops. Offering mental health consultation services and advocating within the political arena are examples of primary prevention. Developing discharge planning instructions is an example of tertiary prevention.

DIF: Cognitive Level: Application REF: pp. 828-829

15. A community/public health nurse links a mental health client with the necessary services in the community. This is an example of which category of individual client-focused interventions?
a. Consulting
b. Teaching
c. Providing therapy
d. Case management
ANS: D
There are four categories of individual client-focused interventions: teaching, case management, consulting, and providing therapy. Case management addresses the multifaceted and complex needs of the client and includes assessing the clients needs, compiling a plan for services, and linking the client with needed services. Consulting allows the nurse to offer mental health services to agencies within the community. While providing therapy, the nurse is concerned with symptom management, relationship building, and ego strengthening. Teaching describes providing education to the client, family, and community.

DIF: Cognitive Level: Application REF: pp. 830-831

MULTIPLE RESPONSE

1. A community/public health nurse was caring for mentally ill clients in the community during the 1960s. Which of the following changes in the community was the nurse likely to notice? (Select all that apply.)
a. Communities resented becoming dumping grounds for such severely ill people.
b. Community health centers were rapidly built, staffed, and prepared to provide appropriate care.
c. Families were relieved that they did not have to travel so far to visit their ill family member.
d. Housing units were quickly built for the patients capable of independent living.
e. Psychiatric patients were feared, mocked, and stigmatized and found life outside frightening.
f. Without adequate financial support, patients were admitted for crisis care but were quickly discharged.
ANS: A, E, F
When institutions first began to discharge large numbers of clients, communities were unprepared. Financial support was lacking, housing and treatment facilities were scarce, and community attitudes were inhospitable. Patients were feared, mocked, misunderstood, and stigmatized. Former patients were unwelcome and rebuffed and found that life outside the hospital was frightening and unappealing. They were often caught up in a vicious cycle of short inpatient stays, rapid discharge, and eventual repeat admissions.

DIF: Cognitive Level: Application REF: p. 831

2. A community/public health nurse is providing care for the mentally ill. Of the following needs that the nurse can help the client meet, which are most important? (Select all that apply.)
a. Access to medications
b. Basic life necessities
c. Integration of provided services
d. Funding for care
e. Options for day treatment
f. Support for family members
ANS: A, B, C, F
The needs of severely mentally ill clients include basic life necessities, a sense that life is meaningful, access to medications, support for family members, and integration of nursing, medical, and social services. Many chronically mentally ill clients are without basic items. Access to medications is essential in order for the mental illness to be treated successfully. The burden of caregiving can be quite high, and so family support is crucial. Integration of services provided is necessary so that these clients can navigate the maze of services necessary to stay in the community. Not all these clients need a day treatment program, and some clients may not need additional services that require concern related to funding.

DIF: Cognitive Level: Application REF: pp. 835-836

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