Principles and Practice of Psychiatric Nursing 10th Edition by Gail Wiscarz Stuart test bank

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Principles and Practice of Psychiatric Nursing 10th Edition by Gail Wiscarz Stuart test bank

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Chapter 9: Policy and Advocacy in Mental Health Care
Test Bank

MULTIPLE CHOICE

1. Health professionals planning treatment initiatives should be most concerned with the burden of disease created by:
a.
violence and injury.
b.
environmental quality.
c.
behavioral health problems.
d.
irresponsible sexual behavior.

ANS: C
Depression ranks as the second most common cause of disability measured in disability-adjusted life years in the United States, and four other psychiatric disorders are in the top 10 worldwide, including alcohol use, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. Which disorder is the leading psychiatric cause of disability in the world?
a.
Depression
b.
Schizophrenia
c.
Bipolar disorder
d.
Obsessive-compulsive disorder

ANS: A
A large international study found that depression was the number one psychiatric cause of disability in the world. Four other psychiatric disorders also were among the top 10, including alcohol abuse, bipolar disorder, schizophrenia, and obsessive-compulsive disorder.

DIF: Cognitive Level: Knowledge REF: Text Page: 127
TOP: Nursing Process: N/A MSC: NCLEX: Health Promotion and Screening

3. To work effectively within the health care system, a nurse must understand the current interface between mental health care and the environment. Which statement accurately reflects this interface?
a.
The once simple system has grown from two to six parts, which has significantly complicated the interface.
b.
Biases on the part of providers have largely been abolished, greatly improving the effectiveness of the interface.
c.
Reimbursers and insurers are primarily concerned with protecting the patients constitutional rights regarding access to care and treatment received.
d.
In general, families are becoming less concerned with education and empowerment for family members who are patients.

ANS: A
The interface between mental health care and the environment has become increasingly complex in recent years. It once consisted only of mental health providers and patients, but the interface now includes patients, providers, families, reimbursers and insurers, lawmakers and regulators, and the judiciary; each of these components has its own agenda.

DIF: Cognitive Level: Comprehension REF: Text Page: 127
TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

4. Managed behavioral health care settings are involved in:
a.
health care reform.
b.
universal health care.
c.
health care for the underserved.
d.
treating mental and substance abuse disorders.

ANS: D
Behavioral health covers both mental illness and substance abuse disorders.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. A committee is formed to increase the publics understanding that mental health is essential to overall health. A nurse would expect that the focus of this groups work would be:
a.
improving access to quality care that is culturally competent.
b.
protecting and enhancing the rights of people with mental illness.
c.
developing and implementing integrated electronic health record and personal health information systems.
d.
collaborating with the emergency department to treat mental health problems with the same urgency as physical health problems.

ANS: D
Recommendations of the New Freedom Commission on Mental Health would address the means of having mental health issues handled with the same urgency as physical health issues.

DIF: Cognitive Level: Application REF: Text Pages: 128-130
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. A patient receiving mental health services complains about having to get a referral from a primary care physician in order to obtain mental health services. The nurse should explain to the patient that this is a cost control practice used in managed care that is described as:
a.
gatekeeping.
b.
utilization review.
c.
case management.
d.
preadmission certification.

ANS: A
Gatekeeping is a process that limits direct access to specialists, hospitals, and expensive procedures. Patients select a primary care provider who manages everyday care and is a gatekeeper for referral to other health care providers.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. A patient tells a nurse, I belong to a health maintenance organization (HMO) that advertises being a capitated system. What does that mean? The nurse replies:
a.
Its complicated but if you like Ill have the payments office discuss it with you.
b.
You pay a sliding fee for each illness based on your monthly take-home income.
c.
You pay a fixed fee per month while the HMO provides all medically necessary care.
d.
The HMO pays your physician a flat fee for a particular episode of illness regardless of the number of office visits you make.

ANS: C
Capitation calls for the consumer to pay a fixed fee or a per-member-per-month premium. In return, the managed care company agrees to provide all medically necessary health care for all covered people.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. Access to care refers to the:
a.
availability of health care.
b.
degree to which services are comprehensive.
c.
overall use of mental health services in a community.
d.
convenience and ease of obtaining service and information.

ANS: D
Access is the degree to which services and information about care are easily obtained. The ideal comprehensive system would provide multiple points of entry for treatment, including direct access through self-referral.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. In many rural communities the ratio of consumers to doctors is higher than it is in cities. This is an example of:
a.
a health access problem in rural areas.
b.
a lack of compassion among physicians.
c.
reimbursement barriers in rural states.
d.
appropriate distribution of health care providers.

ANS: A
Access is the degree to which services and information about care are easily obtained. When the consumer/doctor ratio is high, access is often compromised.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. A psychiatric nurse advocating for behavioral health system change would focus on which topic?
a.
Abolishing the health maintenance organization (HMO) system
b.
Strengthening current utilization review guidelines
c.
Limiting consumer empowerment initiative options
d.
Increasing resources for chronic care mental health services

ANS: D
Although gains have been made in medical treatment for behavioral illness, little attention has been given to preventive, rehabilitative, and chronic care services. This is a topic worthy of nursing advocacy.

DIF: Cognitive Level: Application REF: Text Page: 131
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

11. A case manager at the local mental health center evaluates the clinical appropriateness of a patients current level of care. To do this, the case manager will assess:
a.
the type of service currently provided.
b.
the vigor of the patient to whom the service is provided.
c.
the type, amount, and level of care needed to achieve positive outcomes.
d.
whether the level of the patients care is currently considered cost effective.

ANS: C
Clinical appropriateness is the degree to which the type, amount, and level of clinical services are delivered to promote the best clinical outcomes.

DIF: Cognitive Level: Comprehension REF: Text Page: 131
TOP: Nursing Process: Evaluation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. A nurse works in an organization that provides an integrated behavioral continuum of care. The goal of treatment in the crisis clinic is:
a.
remission.
b.
recovery.
c.
stabilization.
d.
optimal level of wellness.

ANS: C
The goal of crisis treatment is stabilization, with the expected outcome being no harm to self or others.

DIF: Cognitive Level: Comprehension REF: Text Page: 132
TOP: Nursing Process: Outcome Identification
MSC: NCLEX: Psychosocial Integrity

13. Which is a suitable goal and expected outcome for a patient who is admitted for the recurrence of psychotic symptoms related to noncompliance with medication therapy?
a.
Goal, safety; outcome, no risk for violence
b.
Goal, remission; outcome, symptom relief
c.
Goal, recovery; outcome, improved functioning
d.
Goal, rehabilitation; outcome, attain optimal quality of life

ANS: B
The goal of remission can probably be attained if the patient resumes medication therapy. The outcome of symptom relief will be attained during an acute, short-term stay.

DIF: Cognitive Level: Application REF: Text Page: 132
TOP: Nursing Process: Outcome Identification
MSC: NCLEX: Psychosocial Integrity

14. Which type of managed care plan allows the most flexibility in choosing health services and providers?
a.
Health maintenance organization (HMO)
b.
Independent practice organization (IPO)
c.
Preferred provider organization (PPO)
d.
Point of service plan (POS)

ANS: D
A POS plan allows consumers to choose between delivery systems at the time they seek care. The other types of plans listed limit the clinicians and/or the agencies that can be used for health care services.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: N/A
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

15. A nurse who advocates for consumer empowerment will seek to help psychiatric patients:
a.
achieve a sense of self-responsibility.
b.
comply with provider-prescribed treatment programs.
c.
understand that their viewpoints are flawed by mental illness.
d.
use resources predominantly from the formal mental health system.

ANS: A
Nurses who advocate for consumer empowerment for patients with mental health disorders assist patients in achieving a sense of personal responsibility, in collaborating with health professionals to determine their treatment plans, in being respected for the legitimacy of their points of view, and in using resources from the entire community rather than just the formal mental health system.

DIF: Cognitive Level: Application REF: Text Page: 132
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

16. Which nurse in a managed care setting has the greatest responsibility for allocating resources to an individual patient?
a.
Treatment nurse
b.
Case manager
c.
Risk manager
d.
Patient educator

ANS: B
The case manager has the greatest responsibility for allocating resources for a particular patient through the development of a comprehensive treatment plan; he or she then coordinates with all involved staff and agencies.

DIF: Cognitive Level: Application REF: Text Page: 134
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

17. A trend in psychiatric nursing related to cost controls imposed in the managed care environment is:
a.
reduced emphasis on utilization review.
b.
a marked increase in the use of risk managers.
c.
reduced use of patient and family educators to promote compliance.
d.
a shift from acute inpatient to community-based positions.

ANS: D
With cost consciousness, greater emphasis is being placed on the continuum of care. The number of inpatient hospitalization days will continue to decrease, and nurses will be needed to staff alternate treatment sites.

DIF: Cognitive Level: Application REF: Text Page: 133
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. A health provider study group should explore which option as a means to improve access to care in rural areas servicing a scattered population?
a.
Installation of telehealth services
b.
An increased number of satellite centers
c.
Implementation of mobile mental health clinics
d.
Federal grants to supplement the agency budget for personnel

ANS: A
Health technology and telehealth improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.

DIF: Cognitive Level: Application REF: Text Page: 127
TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

19. A psychiatric nurse notes that the expected outcome of treatment for a patient with depression is the relief of symptoms. The nurse determines that this patient is in which stage of treatment in an integrated behavioral continuum of care?
a.
Crisis
b.
Acute
c.
Maintenance
d.
Health promotion

ANS: B
The expected outcome for a patient during the acute stage of treatment is symptom relief. The expected outcome during crisis is that the patient does no harm to self or others. The expected outcome during maintenance is improved functioning. The expected outcome during health promotion is to attain an optimal quality of life.

DIF: Cognitive Level: Application REF: Text Page: 132
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

20. A patients goal of treatment is stabilization. The patient is in which stage of treatment in an integrated behavioral continuum of care?
a.
Crisis
b.
Acute
c.
Maintenance
d.
Health promotion

ANS: A
The expected goal for a patient in crisis is stabilization. The goal during the acute stage of treatment is remission. The goal during the maintenance stage of treatment is recovery. The goal during the health promotion phase is optimal level of wellness.

DIF: Cognitive Level: Application REF: Text Page: 132
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

21. A patient is transferred to a rehabilitation-oriented residential mental health program. Which expected outcome applies to the new care setting?
a.
Symptom relief
b.
Improved functioning
c.
No harm to self or others
d.
Attain optimal quality of life

ANS: B
A rehabilitation-oriented residential treatment program is a level of care provided during the maintenance stage of treatment in an integrated behavioral continuum of care. The expected outcome of care in this stage is improved functioning, and the overall goal is recovery.

DIF: Cognitive Level: Application REF: Text Page: 132
TOP: Nursing Process: Outcome Identification
MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. A patient asks a nurse, How do managed care systems control costs? The nurse should reply that the HMOs cost saving strategies include using: (Select all that apply.)
a.
utilization reviews.
b.
case management.
c.
easy repayment plans.
d.
preadmission certifications.
e.
inexpensive health care plans.

ANS: A, B, D
Preadmission certification ensures the proper treatment setting; utilization review evaluates the appropriateness and necessity of services; and case management focuses on desirable outcomes, appropriate lengths of stay, and efficient use of resources. Each of these helps control costs. The remaining options are not suggested by HMOs. The correct response does not respond to the patient in an effective way.

DIF: Cognitive Level: Comprehension REF: Text Page: 129
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. When a facility administrator mentions that the employee assistance program (EAP) may be discontinued because of its expense, the health liaison nurse disagrees, stating that the program pays for itself through: (Select all that apply.)
a.
prevention of illness encouraged by educational programs.
b.
early disease detection brought about by offered screenings.
c.
its primary focus on alcohol and drug abuse awareness sessions.
d.
decreased work-related injuries resulting from ergonomics training.
e.
mandated immunization policies regarding acquired job-related illnesses.

ANS: A, B, D, E
Cost-effectiveness studies document the value of EAPs, particularly their contributions to prevention in areas such as workplace education, skill development, and policy and environmental changes. The primary focus is not abuse awareness.

DIF: Cognitive Level: Application REF: Text Pages: 129-130
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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