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Test Bank For Foundations Of Mental Health Care 4e by Morrison-Valfre Test Bank

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WITH ANSWERS

 

Foundations of Mental Health Care 4e by Morrison-Valfre Test Bank

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

 

Test Bank

 

Chapter 1: The History of Mental Health Care

 

MULTIPLE CHOICE

 

  1. The belief of the ancient Greek philosopher Plato that the rational soul controlled the irrational soul could be compared with the belief of the more recent psychological theorist:
a. Freud
b. Pinel
c. Fisher
d. Rush

 

 

ANS:  A

Sigmund Freud believed that mental illness was, in part, caused by forces both within and outside the personality. Philippe Pinel advocated acceptance of mentally ill individuals as human beings in need of medical assistance. Alice Fisher was a Florence Nightingale nurse who cared for the mentally ill, and Dr. Benjamin Rush was the author of the book, Diseases of the Mind.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 5 | Page 6

OBJ:   2                    TOP:   Early Years of Mental Health

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

 

  1. If a persons behaviors interfere with daily activities, impair her judgment, or alter her perception of reality, this person is considered to be:
a. Confused
b. Disoriented
c. Mentally healthy
d. Mentally ill

 

 

ANS:  D

Mentally ill individuals cannot perform activities of daily living easily, nor do they have good judgment or perceive things realistically. Confused and disoriented people differ from mentally ill people in that they typically are not oriented to who they are, where they are, or the general time frame. Mentally healthy individuals are able to perform activities of daily living, to problem solve, and to adapt to change, and they are in touch with reality.

 

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

TOP:   Mental Illness                                 KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. During the mid-1500s, behaviors associated with mental illness were more accurately recorded by professionals. This practice led to ______________ for different abnormal behaviors.
a. Classifications
b. Diagnosing
c. Treatment
d. Education

 

 

ANS:  A

Classification of abnormal behaviors did not begin until this time, after the practice of more accurate recording of behaviors was begun. Diagnoses, treatment guidelines, and any education regarding mental health disorders were not available during this period.

 

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

TOP:   Mental Illness During the Renaissance

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

 

  1. During the latter part of the eighteenth century, psychiatry became a separate branch of medicine, and inhumane treatment was greatly diminished by the French hospital director:
a. Dix
b. Beers
c. Pinel
d. Carter

 

 

ANS:  C

Philippe Pinel advocated acceptance of the mentally ill, as well as proper treatment. Dorothea Dix crusaded for construction of mental health hospitals. Clifford Beers wrote the book, A Mind That Found Itself. President Jimmy Carter established the Presidents Commission on Mental Health in 1978.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 4            OBJ:   4

TOP:   Mental Illness in the Eighteenth Century

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

 

  1. In 1841, _______________ surveyed asylums, jails, and almshouses throughout the United States, Canada, and Scotland and is credited with bringing about public awareness and reform for the care of the mentally ill.
a. Sigmund Freud
b. John Cade
c. Florence Nightingale
d. Dorothea Dix

 

 

ANS:  D

Dorothea Dix spent 20 years surveying facilities that housed mentally ill individuals and is credited with major changes in the care of the mentally ill. Sigmund Freud introduced the concept of psychoanalysis, John Cade discovered lithium carbonate for the treatment of bipolar disorder, and Florence Nightingale trained nurses in England in the 1800s.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 5            OBJ:   4

TOP:   Mental Illness in the Nineteenth Century

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

 

  1. As a direct result of Clifford Beers work and book, A Mind That Found Itself, the Committee for Mental Hygiene was formed in 1909 with a focus on prevention of mental illness and:
a. Early detection of symptoms of mental illness
b. Education of caregivers
c. Current treatment options
d. Removing the stigma attached to mental illness

 

 

ANS:  D

Clifford Beers book reflected on his attempt at suicide followed by the deplorable care he received for the next 3 years in mental hospitals. Beers work and book raised the consciousness of people throughout the country regarding prevention and removal of the stigma of having a mental illness. Early detection of symptoms, education of caregivers, and current treatment options regarding mental illness were not the focus of his book, nor were they a priority for the Committee for Mental Hygiene.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 5            OBJ:   4

TOP:   Mental Illness in the Twentieth Century

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

 

  1. In the early 1900s, the neurophysiologist Sigmund Freud is credited with introducing which concept?
a. Psychoanalysis
b. Insanity
c. Lunacy
d. Mental illness

 

 

ANS:  A

Psychoanalysis is the observation of and theory behind how mental illness occurs. Insanity, lunacy, and mental illness are terms that are considered synonyms.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 5            OBJ:   5

TOP:   Mental Illness in the Twentieth Century

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

 

  1. During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma that could last as long as 50 hours?
a. Electroconvulsive therapy
b. Insulin therapy
c. Humoral therapy
d. Amphetamine therapy

 

 

ANS:  B

Insulin therapy was believed to successfully treat schizophrenia in the early 1900s. Amphetamines were used to treat depression, and electroconvulsive therapy was used for severe depression. Humoral therapy, which originated in ancient Greece and Rome, was a belief that mental illness resulted from an imbalance of the humors of air, fire, water, and earth.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5

TOP:   Influences of War on Mental Health Therapies

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

 

  1. In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often used to treat?
a. Schizophrenia
b. Bipolar disorder
c. Severe depression
d. Violent behavior

 

 

ANS:  C

ECT was found to be an effective treatment for severe depression in the 1930s. During this period, schizophrenia was treated with insulin therapy, and violent behavior was treated with a lobotomy. In 1949, lithium carbonate was discovered as a treatment for bipolar disorder.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5

TOP:   Influences of War on Mental Health Therapies

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

 

  1. In the early twentieth century, a frontal lobotomy was a common treatment for violent behaviors. Which description of this procedure is accurate?
a. A procedure that delivers an electrical stimulus to the frontal lobes of the brain
b. A surgical procedure that drills holes in the front of the skull to drain fluid
c. A surgical procedure that severs the frontal lobes of the brain from the thalamus
d. A surgical procedure that inserts implants into the frontal lobes of the brain

 

 

ANS:  C

A frontal lobotomy is a surgical procedure in which the frontal lobes of the brain are severed from the thalamus.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5

TOP:   Influences of War on Mental Health Therapies

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

 

  1. Which class of drugs was introduced in the 1930s for the treatment of depression?
a. SSRIs
b. Tricyclic antidepressants
c. MAOIs
d. Amphetamines

 

 

ANS:  D

In the 1930s, amphetamines were found to boost the spirits of depressed people. SSRIs, tricyclic antidepressants, and MAOIs are antidepressant agents, but they were not discovered until much later.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5

TOP:   Influences of War on Mental Health Therapies

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

 

  1. In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of mental health because it funded:
a. Research on drugs for the treatment of mental health disorders
b. Training of mental health professionals
c. Construction of psychiatric units in facilities throughout North America
d. Development of community mental health clinics

 

 

ANS:  C

The Hill-Burton Act provided money for the construction of psychiatric units in the United States. Research on drugs was not a part of the Hill-Burton Act. Training of mental health professionals was funded by the National Mental Health Act of 1946, and community mental health centers were not instituted until the 1960s.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5 | 9

TOP:   Influences of War on Mental Health Therapies

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

 

  1. The National Mental Health Act of 1946 provided a means for funding of programs that promote research on mental health and:
a. Development of mental health clinics in the community
b. Training of mental health professionals
c. Treatment for veterans suffering from mental health disorders
d. Educating the public about mental illness

 

 

ANS:  B

The National Mental Health Act of 1946 provided much needed training for individuals who cared for patients with mental health disorders. Community mental health clinics were initiated in the 1960s, treatment for veterans was not funded by this act, and education of the public occurred later.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5 | 9

TOP:   Influences of War on Mental Health Therapies

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

 

  1. Which of the following best describes the disorder that was first recognized in veterans following the Korean and Vietnam Wars?
a. Depression
b. Bipolar disorder
c. Posttraumatic stress disorder
d. Paranoid schizophrenic disorder

 

 

ANS:  C

Posttraumatic stress disorder was initially discovered in veterans who had been involved in armed conflicts. The other disorders also occur in veterans but were not first recognized in soldiers who were fighting wars.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   5

TOP:   Influences of War on Mental Health Therapies

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

 

  1. The introduction of ___________ in the 1950s led to the deinstitutionalization of many mentally ill individuals.
a. Psychotherapeutic drugs
b. Community mental health clinics
c. Residential treatment centers
d. State mental health facilities

 

 

ANS:  A

Psychotherapeutic drugs allowed for better control of behaviors than did other therapies alone during the 1950s. Patients were being released from state mental health facilities as a result of psychotherapeutic drug therapy, and community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   6

TOP:   Introduction of Psychotherapeutic Drugs

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

 

  1. In 1949, an Australian physician discovered which therapy to be an effective treatment for bipolar (manic-depressive) illness?
a. Insulin therapy
b. Water/ice therapy
c. Lithium carbonate therapy
d. Electroconvulsive therapy

 

 

ANS:  C

To this day, lithium is a treatment that is used to effectively balance the manic states and depressive states of bipolar disorder. None of the other therapies listed are effective for bipolar disorder.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 6            OBJ:   6

TOP:   Introduction of Psychotherapeutic Drugs

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

 

  1. In the early 1960s, a committee appointed by President John F. Kennedy recommended the development of a new approach to the way mental health care was administered, with an emphasis on the introduction of:
a. Psychotherapeutic drugs
b. State mental health care systems
c. Community mental health centers
d. Deinstitutionalization of patients

 

 

ANS:  C

The emergence of community mental health centers was necessary, in part because of the massive deinstitutionalization of patients from state mental health care facilities after the introduction of psychotherapeutic drugs in the 1950s.

 

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

TOP:   Introduction of Psychotherapeutic Drugs

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

 

  1. The Mental Health Systems Act of 1980 was one of the most progressive mental health bills in the history of the United States, but its enactment was interrupted by the:
a. Election of a new president
b. Appointment of a new Surgeon General
c. Rapid expansion of community centers
d. National Alliance for Mental Illness (NAMI) surveys

 

 

ANS:  A

The election of a new president and his administration led to drastic cuts in federal funding for mental health programs. None of the other three choices were a part of the Mental Health Systems Act of 1980.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 7            OBJ:   9

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with chronic mental illness in:
a. Nursing homes
b. State mental health facilities
c. Residential treatment centers
d. Homeless shelters

 

 

ANS:  A

Many mentally ill, especially elderly, people were inappropriately placed in nursing homes with personnel who were not trained to care for these people. OBRA prevented this practice. State mental health facilities, residential treatment centers, and homeless shelters were not addressed in the OBRA of 1987.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 7            OBJ:   9

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. In the late 1980s, government funding for mental health care dwindled, and most insurance companies __________ coverage for psychiatric care.
a. Withdrew
b. Increased
c. Decreased
d. Added

 

 

ANS:  A

Unfortunately, insurance companies followed the trend of the national government to the point of actually dropping coverage for psychiatric care.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 7            OBJ:   9

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey and grading of state mental health care for adults and learned that the overall grade for care was:
a. A
b. B
c. C
d. D

 

 

ANS:  D

The NAMI gave a grade of D to the mental health care system based on poor funding, limited availability of care, and patients lack of access to mental health care.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 7            OBJ:   9

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. During the Dark Ages, demonical exorcisms were performed as a result of the belief that mental illness was punishment for sins, the result of witchcraft, or caused by:
a. Imbalance of fundamental elements
b. Possession by the devil
c. Rational soul controlling the irrational soul
d. Chemical imbalances within the body

 

 

ANS:  B

The belief that mental illness occurred as the result of possession by the devil accounted for the need for demonical exorcisms during the Middle Ages. Theories on an imbalance of fundamental elements and beliefs involving the rational and irrational soul were popular in ancient Greece and Rome. Chemical imbalance was determined to be a cause of some mental illness in more recent times.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 2            OBJ:   2 | 3

TOP:   Mental Illness in the Dark Ages      KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  1. During the middle ages, mentally ill patients often were burned at the stake and were greatly mistreated. In an attempt to treat mentally ill people more humanely, Bethlehem Hospital, more commonly called ___________, was created.

 

ANS:

Bedlam

Bedlam was the nickname for Bethlehem Hospital, which prevented burning of mentally ill people at the stake but provided poor care for the mentally ill.

 

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

TOP:   Mental Illness in the Middle Ages   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. In the early 1800s, Dr. Benjamin Rush wrote the first psychiatric text, Diseases of the Mind, in which he advocated which conditions for the mentally ill? Select all that apply.
a. Kindness
b. Clean conditions
c. Good air, lighting, and food
d. Proper administration of psychotherapeutic drugs

 

 

ANS:  A, B, C

Dr. Rush advocated all of these conditions. Psychotherapeutic drugs were not introduced until the 1950s.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 4            OBJ:   4

TOP:   Mental Illness in the Nineteenth Century

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

 

  1. Based on the concept of the health-illness continuum, which actions can a mentally healthy individual do? Select all that apply.
a. Avoid stressors during activities of daily living
b. Respond to stress with effective behaviors
c. Develop effective coping mechanisms
d. Set realistic goals for themselves

 

 

ANS:  B, C, D

A mentally healthy individual responds effectively to stress, is able to develop coping mechanisms in response to stress, and can set realistic goals in his life while continually fluctuating between states of wellness and illness. No one can avoid stressors, but how one responds to stressors is an important part of mental health.

 

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

TOP:   Mental Health                                           KEY:              Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

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

 

Test Bank

 

Chapter 3: Ethical and Legal Issues

 

MULTIPLE CHOICE

 

  1. A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The clients friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this clients particular value was formed?
a. Moralizing
b. Modeling
c. Reward-punishment
d. Laissez-faire

 

 

ANS:  B

Modeling best describes how the teenage client developed this value because his parents not only discussed this issue but behaved in a way for the teen to copy. Moralizing sets standards of right and wrong with no choices allowed; the reward-punishment model rewards valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices.

 

DIF:    Cognitive Level: Application          REF:   Page 20          OBJ:   1

TOP:   Acquiring Values                            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications. What process best describes how the nurse decided on the course of action taken?
a. Values clarification
b. Nurses rights
c. Beliefs
d. Morals

 

 

ANS:  A

Values clarification consists of the steps of choosing, prizing, and acting. This most accurately describes how the nurse made the proper decision. The nurse chose the best action, reaffirmed the choice, and then enacted the choice. The nurses rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred.

 

DIF:    Cognitive Level: Application          REF:   Page 20          OBJ:   1

TOP:   Values Clarification                        KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which patient right may clients with mental health disorders lose during treatment?
a. Confidentiality of records
b. Freedom from restraint or seclusion
c. Humane treatment environment
d. Referral to other mental health providers on discharge

 

 

ANS:  B

A client could lose the right of freedom from restraint or seclusion in emergency situations, such as being a threat to himself or others. The other rights must be upheld at all times.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 21          OBJ:   2

TOP:   Client Rights                                   KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Twenty three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to:
a. Include coverage for mental illness
b. Include coverage for substance abuse treatment
c. Include coverage for mental illness that is equal to coverage for physical illness
d. Include coverage for outpatient therapy for individuals with substance abuse

 

 

ANS:  C

The mental health parity laws require insurance companies to include coverage for mental illness that is equal to coverage for physical illness. Only nine states include treatment for substance abuse in their parity laws.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 21          OBJ:   2

TOP:   Client Rights                                   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The rights of the care provider include the right to:
a. Fair pay
b. Fair benefits from employers
c. Refuse to care for individuals who may cause harm to the care provider
d. Respect as individuals

 

 

ANS:  D

In addition to the right to respect as individuals, the rights of the care provider include the rights to safety, competent assistance, set standards for quality and development of policies that affect client care, and full and equal participation as a member of the health care team.  Fair pay and benefits are not addressed by care provider rights. A care provider has the right to safety but cannot refuse to care for an individual because he may fear harm from the client. Proper safety measures must be implemented.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 21          OBJ:   1

TOP:   Care Provider Rights                       KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The Nurses Code of Ethics includes the main concepts of autonomy, beneficence, justice, and:
a. Rights
b. Morals
c. Nonmaleficence
d. Prudence

 

 

ANS:  C

Nonmaleficence is the fourth main concept of the Nurses Code of Ethics. The concept is that the nurse must do no harm to the client. Rights are a power or privilege that a person has just claim to, morals are a persons belief regarding what is right or wrong, and prudence refers to the ability to judge between virtuous and vicious actions.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 21          OBJ:   3

TOP:   Ethical Principles                            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate?
a. Fidelity
b. Veracity
c. Confidentiality
d. Justice

 

 

ANS:  A

Fidelity refers to the obligation to keep ones word. The nurse violated this principle in this situation, which leads to mistrust from the client. Veracity is the duty to tell the truth, confidentiality is the duty of keeping the clients information private, and justice indicates that all clients must be treated fairly, equally, and respectfully.

 

DIF:    Cognitive Level: Application          REF:   Page 22          OBJ:   3

TOP:   Ethical Principles                            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A male client is seeking help in a mental health clinic for anger management problems.  He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do whatever it takes to control his anger. Later in the week, the clients wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing:
a. A moral dilemma
b. Value clarification
c. An ethical conflict
d. A breach of confidentiality

 

 

ANS:  C

This is an example of an ethical conflict or ethical dilemma. The nurse wants to help both clients but must maintain confidentiality for each. Use of guidelines for ethical decision making can assist the nurse in making an ethical decision. A moral dilemma is simply a dilemma associated with making a decision between right and wrong. Value clarification is a process that helps to identify an individuals values.

 

DIF:    Cognitive Level: Application          REF:   Page 22 | Page 23

OBJ:   3                    TOP:   Ethical Conflict

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question?
a. National nurse practice act
b. State nurse practice act
c. Regional nurse practice act
d. Community nurse practice act

 

 

ANS:  B

Each states board of nursing determines the scope of practice in that state through a series of regulations that are called nurse practice acts. It is the nurses responsibility to know his or her scope of practice. The other options do not exist.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 23          OBJ:   4

TOP:   Legal Concepts in Health Care       KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. An order written by a physician is reviewed by the nursing staff, and no one is familiar with the treatment instructions. A nurse who was recently hired knows that this treatment is covered by the states nurse practice act. What is the nurses best course of action?
a. Call the physician to ask for clarification
b. Check the states nurse practice act again
c. Contact the nursing supervisor for approval to carry out the treatment
d. Refer to the facilitys policy and procedure to determine the course of action

 

 

ANS:  D

Because this treatment is covered under the state nurse practice act, the next step is to refer to the facilitys policy and procedure manual to determine whether the ordered treatment is allowed by the facility. Calling the physician is not necessary because there was no question about how the order was written, and the states nurse practice act has already been checked. Contacting the nursing supervisor would be acceptable only after the facilitys policy has been checked.

 

DIF:    Cognitive Level: Application          REF:   Page 23 | Page 24

OBJ:   4                    TOP:   Legal Concepts in Health Care

KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Standards of nursing practice for mental health can best be described as helping to ensure:
a. That certain clients receive care
b. Quality and effectiveness of care
c. Proper documentation
d. Proper medication administration

 

 

ANS:  B

Most health care disciplines have standards of practice documented as guidelines with measurable criteria that can be used to evaluate the quality and effectiveness of care provided. All clients have the right to receive care, so standards of nursing practice would not address who receives care. Although proper documentation and proper medication administration might be part of the evaluation process, they do not provide complete evaluation of quality and effectiveness of care.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 24          OBJ:   4

TOP:   Legal Concepts in Health Care       KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every:
a. 3 months
b. 6 months
c. 12 months
d. 15 months

 

 

ANS:  C

Although the case is being reviewed constantly by the mental health care team, the court must review the indefinite commitment on a yearly basis.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 25          OBJ:   5

TOP:   Adult Psychiatric Admissions         KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. While dining in a restaurant, the nurse overhears two co-workers in the next booth discussing a client who is being cared for on the mental health unit in which they work.  What action have the nurses co-workers committed for which they could be held liable?
a. Libel
b. Slander
c. Invasion of privacy
d. Assault

 

 

ANS:  C

Confidentiality is included in a clients right to privacy, and a breach in confidentiality is considered a liability issue. Invasion of privacy can result in a criminal case and/or job termination.  Libel refers to written defamation, and slander is verbal defamation of character. Assault is an act that threatens another individual.

 

DIF:    Cognitive Level: Application          REF:   Page 25          OBJ:   6

TOP:   Areas of Potential Liability             KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A male client is being argumentative during a group therapy session. The male psychiatric technician warns the client that if he does not cooperate with the nurse, he will physically restrain him and take the client to his room for the remainder of the day.  For which action could the technician be held liable?
a. Assault
b. Battery
c. Privacy
d. Fraud

 

 

ANS:  A

The technician is engaging in assault, which is any act that threatens a client. Battery of a client occurs when any physical act of touching occurs without the clients permission.  Privacy refers to issues related to the body and confidentiality, and fraud is giving false information.

 

DIF:    Cognitive Level: Application          REF:   Page 25          OBJ:   6

TOP:   Areas of Potential Liability             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. Which of the following circumstances when it occurs on an inpatient mental health unit would be considered false imprisonment?
a. An alert and oriented client is confined to his room after repeatedly being loud and argumentative with another client in the recreation area.
b. Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission.
c. A client is housed in a private room with visual monitors after attempting suicide at home on the previous day.
d. An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission.

 

 

ANS:  A

The client cannot be confined to his room if he did not pose a threat to himself or others, or if no contract was made with the client regarding consequences for inappropriate behavior. All of the other options are appropriate because they follow guidelines for client safety.

 

DIF:    Cognitive Level: Analysis               REF:   Page 25          OBJ:   6

TOP:   Areas of Potential Liability             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. When using physical restraints for client safety, the nurse must follow the guidelines of observing, assessing, and monitoring the client every __________ minutes; the restraint must be removed from one limb at a time, and each limb must be exercised every __________ hours.
a. 5; 2
b. 15; 2
c. 5; 4
d. 15; 4

 

 

ANS:  B

Appropriate guidelines include monitoring every 15 minutes and exercising every 2 hours to prevent circulatory, muscle, and nerve impairment. Either the nurse or a delegate of the nurse must perform these interventions, and the nurse is responsible for ensuring proper implementation of the interventions.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 26          OBJ:   6

TOP:   Areas of Potential Liability             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent?
a. Social worker
b. Nurse
c. Physician
d. Facilitys legal representative

 

 

ANS:  C

The physician is responsible for providing the client with the information necessary to give informed consent, including expectations and risks involved. The nurse can assist by obtaining the written documentation necessary for informed consent.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 26          OBJ:   8

TOP:   Care Providers Responsibilities     KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. An important responsibility of the nurse in a mental health facility is to ensure that clients do not __________ from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions.
a. Escape
b. Abandon
c. Flee
d. Elope

 

 

ANS:  D

The appropriate terminology for when a client runs away from a facility without a discharge order is elopement. In the event of elopement, the caregiver can be held liable if a client becomes injured.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 26          OBJ:   8

TOP:   Care Providers Responsibilities     KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-husband, what is the nurses best action?
a. Try to talk with the client to convince her not to harm the girlfriend
b. Have the client sign a contract with you stating that she will not harm the girlfriend
c. Inform the ex-husband of the intentions of the client
d. Inform the girlfriend of the intentions of the client

 

 

ANS:  D

Health care providers have a duty to warn others when serious harm may occur as the result of actions taken by the client. This does not breach confidentiality because providers have an obligation to protect the public as well as the client. In addition to warning the client, the nurse should inform the clients physician and the nursing supervisor and must document the situation and actions taken. The other options are not adequate to meet the duty to warn or to prevent harm to the girlfriend.

 

DIF:    Cognitive Level: Application          REF:   Page 26          OBJ:   8

TOP:   Care Providers Responsibilities     KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic medication for schizophrenia, has any side effects. Which response by the nurse would violate the ethical concept of veracity?
a. I am not sure, but I will find out.
b. Risperdal has no documented side effects
c. Risperdal does have some side effects.
d. Lets talk to your physician about potential side effects.

 

 

ANS:  B

The ethical concept of veracity refers to the duty of being truthful with the client, within the scope of ones practice. Stating that the drug has no side effects is not a truthful statement because the medication does have side effects.

 

DIF:    Cognitive Level: Application          REF:   Page 22          OBJ:   2

TOP:   Ethical Principles                            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

MULTIPLE RESPONSE

 

  1. If a person is perceived to be a threat to himself or others, who can implement an involuntary commitment to a mental health facility? Select all that apply.
a. Family members
b. Police
c. Physicians
d. Social workers
e. Representatives of a county administrator

 

 

ANS:  B, C, E

Police, physicians, and representatives of a county administrator are the only individuals who can implement an involuntary admission to a mental health facility. An involuntary admission can last from days to years, depending on the need. A court order is necessary for extended involuntary admissions.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 24          OBJ:   5

TOP:   Adult Psychiatric Admissions         KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. For a nurse or health care provider to be found negligent, what requirements must the providers misconduct meet? Select all that apply.
a. The provider owed a duty to the client.
b.

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