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Morrison-Valfre: Foundations of Mental Health Care, 4th Edition

 

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Chapter 2: 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?

Wealthy
Homeless
Disabled
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.

DIF:    Cognitive Level: Comprehension   REF:   Page 10          OBJ:   1

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

MSC:  Client Needs: Psychosocial Integrity

2.   What percentage of U.S. citizens have no health insurance?

5%
15%
25%
35%

ANS:  B

Approximately 15% of the U.S. population does not have health insurance, which amounts to almost 50 million people. The United States is the only wealthy, industrialized nation that does not have a universal health care system.

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in the United States

KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

3.   Mental health care is available under the universal health care system in Britain, which is funded primarily by:

Employers
Private donations
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.

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

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

MSC:  Client Needs: Psychosocial Integrity

4.   A client is seen in a mental health clinic in the United States. The client is covered by an insurance plan that consists of a network of providers who accept discounted payments from the insurance company. The client is able to see specialists without a referral from the primary provider. Which type of plan does the client most likely have?

Point-of-service plan
Preferred provider organization (PPO)
Health maintenance organization (HMO)
Fee-for-service plan

ANS:  B

A PPO consists of a network of physicians, hospitals, and clinics that provide care for different organizations at a discount. With a PPO, the client is not required to have a referral to see a specialist. A point-of-service plan is similar to a PPO, with the main difference being that referrals are required for the client to see a specialist. An HMO has some similarities to a PPO; but the plan requires referrals for specialists, members have set fees for services, and mental health care is limited with some HMOs. A fee-for-service plan allows selection of any provider.

DIF:    Cognitive Level: Comprehension   REF:   Page 10          OBJ:   1

TOP:   Mental Health Care in the United States

KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

5.   Because many individuals in the United States do not seek health care for mental illness until late into the illness, many end up being seen in:

Hospitals and nursing homes
Outpatient and community services
Emergency rooms and jails
Physicians’ offices

ANS:  C

Because many individuals do not seek treatment in time, symptoms escalate to the point that emergency room visits are required, and it is estimated that up to 1 million county jail admissions across the country are due to mental illness.

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Care Settings                                   KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment

6.   The concept of recidivism is prevalent among individuals with chronic psychiatric problems. Which is the most accurate description of this concept?

Relapse of symptoms of a client’s mental health disease, resulting in frequent readmission to facilities
Coordination and cooperation between community mental health agencies and hospitals, resulting in continuity of care
Providing mental health care services to a client who lives on his own in his own home
Limited supervision in a community setting with emphasis on individual responsibility for care

ANS:  A

Recidivism occurs frequently as a result of fragmented care. Coordination and cooperation between mental health facilities and the hospital lead to lowering of recidivism rates. Outpatient mental health service consists of providing service to a client who lives on his own in his own home, and community-based mental health care involves limited supervision in a community setting with an emphasis on individual responsibility.

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

7.   The __________ model views clients holistically with the goal of creating a support system designed to encourage independence in the client with a mental health disorder.

Community support systems
Case management
Multidisciplinary health care team
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.

DIF:    Cognitive Level: Knowledge          REF:   Page 11          OBJ:   3

TOP:   Outpatient Care                              KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

8.   Which type of community setting involves care for individuals with mental health issues in a protected and supervised environment within the community?

Psychiatric home care
Community mental health centers
Residential programs
Partial hospitalization

ANS:  C

A residential program involves care for individuals with mental health issues provided in a protected and supervised environment within the community. Psychiatric home care delivers mental health care to individuals within the home. Community mental health centers consist of programs such as crisis intervention centers, family counseling, and vocational and skills training. Partial hospitalization refers to day treatment centers.

DIF:    Cognitive Level: Comprehension   REF:   Page 13          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

9.   The brother of a male mental health client is concerned because he works during the day and has no one to care for his brother, who requires almost constant supervision. He wants to keep his brother at home but is unsure of what resources are available in the community. What is the nurse’s best response?

“Have you considered a residential group home?”
“Let me give you some information on a community day treatment center.”
“Psychiatric home care might be an option.”
“A community mental health center would be good for your brother.”

ANS:  B

The needs expressed by the client’s brother are best responded to by providing information on a community day treatment center. The other options do not address the need for constant supervision during the day, other than the possibility of a residential group home, and a residential group home does not meet the client’s need to keep his brother home.

DIF:    Cognitive Level: Application          REF:   Page 13          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

10.   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?

Consultation
Crisis intervention
Resource linkage
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.

DIF:    Cognitive Level: Comprehension   REF:   Page 13          OBJ:   5

TOP:   Case Management Systems             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Health Promotion and Maintenance

11.   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:

Once per week
Two to four times per week
Five to six times per week
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.

DIF:    Cognitive Level: Knowledge          REF:   Page 14 | Page 15

OBJ:   5                    TOP:   Case Management Systems

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

12.   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?

Psychiatric nurse
Clinical psychologist
Psychiatrist
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.

DIF:    Cognitive Level: Comprehension   REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

13.   It is estimated that approximately __________ of adults experience some form of mental or emotional disorder.

11%
19%
27%
35%

ANS:  B

It is difficult to obtain exact statistics on mental health disorders because many conditions remain undiagnosed and many affected individuals may become homeless or incarcerated.

DIF:    Cognitive Level: Knowledge          REF:   Page 16          OBJ:   7

TOP:   Impact of Mental Illness                 KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

14.   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:

The length of time necessary for his condition to be stabilized
Up to 6 months with appropriate documentation
A pre-determined length of time based on the diagnosis
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.

DIF:    Cognitive Level: Comprehension   REF:   Page 17          OBJ:   1

TOP:   Economic Issues of Mental Illness KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

15.   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 in the group of nearly __________ of U.S. citizens who live below poverty level.

1%
6%
12%
25%

ANS:  C

Approximately 12% of Americans (or 33 million people) live below poverty level. Living in poverty often precipitates mental disorders, or mental disorders may occur while an individual is living in poverty. Both scenarios can cause an unbearable amount of stress.

DIF:    Cognitive Level: Knowledge          REF:   Page 17          OBJ:   7

TOP:   Social Issues of Mental Illness        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

16.   Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with:

Permanent psychotic states
Bipolar disorder
Generalized anxiety disorder
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. As a result, the question of how to care for this population is a matter of growing concern. The combination of these two types of drugs is not commonly associated with bipolar disorder, generalized anxiety disorder, or obsessive-compulsive disorder.

DIF:    Cognitive Level: Knowledge          REF:   Page 17          OBJ:   7

TOP:   Social Issues of Mental Illness        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

17.   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 shelter for victims of domestic violence
Women, Infants, and Children (WIC)
Family-planning agency
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. This will lessen some of her financial burden while she is attending school. 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.

DIF:    Cognitive Level: Application          REF:   Page 12          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

18.   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 recreational club
An adult education program
A day care center for elderly
Meals on Wheels

ANS:  D

Caring for a loved one with Alzheimer’s is very demanding, as is dealing with the client’s own depression. By providing food, Meals on Wheels would remove one responsibility for this client. A recreational club or an adult education program may be of assistance, 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.

DIF:    Cognitive Level: Application          REF:   Page 12          OBJ:   4

TOP:   Delivery of Community Mental Health Services

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

19.   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?

Psychiatric assistant
Dietitian
Occupational therapist
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.

DIF:    Cognitive Level: Application          REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

20.   Nearly __________ of all countries in the world have no clear governmental policy that addresses mental health issues.

7%
26%
50%
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.

DIF:    Cognitive Level: Knowledge          REF:   Page 9            OBJ:   1

TOP:   Current Mental Health Care Systems

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1.   Which principles characterize mental health care in Canada? Select all that apply.

Portability
Universality
Accessibility
Comprehensiveness
Private insurance models
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 type of insurance provided in the United States.

DIF:    Cognitive Level: Knowledge          REF:   Page 9            OBJ:   1

TOP:   Mental Health Care in Canada        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.

Severity of the illness
Level of dysfunction
Suitability of the setting for treating the problem
Anticipated diagnosis
Level of client cooperation
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.

DIF:    Cognitive Level: Comprehension   REF:   Page 11          OBJ:   2

TOP:   Care Settings                                   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

3.   Which client populations are at greater risk for the development of mental health disorders? Select all that apply.

Homeless
Clients infected with HIV or AIDS
Those in crisis
Nurses
Clients living in rural areas
Older adults
Psychiatrists
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.

DIF:    Cognitive Level: Knowledge          REF:   Page 15 | Page 16

OBJ:   7                    TOP:   Client Populations

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

COMPLETION

1.   A __________ is a form of health insurance that delivers health care to clients enrolled in its plan. Clients pay a fixed price for care, as long as they receive services from a provider within the company’s system.

ANS:

Health maintenance organization

Clients in a health maintenance organization (HMO) may or may not have a list of health care providers from which to choose (depending on their HMO company), and all require referrals for specialists.

DIF:    Cognitive Level: Knowledge          REF:   Page 10          OBJ:   1

TOP:   Health Insurance                            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

2.   The __________ therapist of the mental health team uses methods such as pet therapy and music therapy when working with clients and is responsible for providing leisure-time activities and for teaching inpatient clients useful ways to pass time.

ANS:

Recreational

These are the primary responsibilities of the recreational therapist, who has an advanced degree and specialized training in recreational therapy.

DIF:    Cognitive Level: Comprehension   REF:   Page 16          OBJ:   6

TOP:   Multidisciplinary Mental Health Care Team

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

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