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Foundations of Mental Health Care 5th Edition By Michelle Morrison -Test Bank
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Chapter 2: Current Mental Health Care Systems
Test Bank
MULTIPLE CHOICE
- Because mental health care is not covered in Australia under the basic health plan, which citizens are more likely to receive mental health care?
| a. | Wealthy |
| b. | Homeless |
| c. | Disabled |
| d. | 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 on the basic health plan with no mental health care coverage.
DIF: Cognitive Level: Comprehension REF: p. 11 OBJ: 1
TOP: Mental Health Care in Australia KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Mental health care is available under the universal health care system in Britain, which is funded primarily by:
| a. | Employers |
| b. | Private donations |
| c. | Small businesses |
| d. | 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: p. 11 OBJ: 1
TOP: Mental Health Care in Britain KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- 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.
| a. | Community support systems |
| b. | Case management |
| c. | Multidisciplinary health care team |
| d. | 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: p. 12 OBJ: 3
TOP: Outpatient Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- 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?
| a. | Consultation |
| b. | Crisis intervention |
| c. | Resource linkage |
| d. | 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: p. 14 OBJ: 5
TOP: Case Management KEY: Nursing Process Step: Intervention
MSC: Client Needs: Health Promotion and Maintenance
- 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 _____ per week.
| a. | Once |
| b. | Two to four times |
| c. | Five to six times |
| d. | Seven to eight times |
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: p. 15 OBJ: 5
TOP: Case Management KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- 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?
| a. | Psychiatric nurse |
| b. | Clinical psychologist |
| c. | Psychiatrist |
| d. | 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: p. 16 OBJ: 6
TOP: Multidisciplinary Mental Health Care Team
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- It is estimated that approximately __________ of adults experience some form of mental or emotional disorder.
| a. | 11% |
| b. | 19% |
| c. | 27% |
| d. | 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: p. 17 OBJ: 7
TOP: Impact of Mental Illness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- 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:
| a. | The length of time necessary for his condition to be stabilized |
| b. | Up to 6 months with appropriate documentation |
| c. | A predetermined length of time based on the diagnosis |
| d. | 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 predetermined 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: p. 18 OBJ: 1
TOP: Economic Issues of Mental Illness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
- 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.
| a. | 1% |
| b. | 6% |
| c. | 12% |
| d. | 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.
DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 7
TOP: Social Issues of Mental Illness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with:
| a. | Permanent psychotic states |
| b. | Bipolar disorder |
| c. | Generalized anxiety disorder |
| d. | 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. 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: p. 18 OBJ: 7
TOP: Social Issues of Mental Illness KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- 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 also 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. | A shelter for victims of domestic violence |
| b. | Women, Infants, and Children (WIC) |
| c. | Family-planning agency |
| d. | 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. 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: p. 13 OBJ: 4
TOP: Delivery of Community Mental Health Services
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- The home care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife who has 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. | A recreational club |
| b. | An adult education program |
| c. | A daycare center for elderly |
| d. | Meals on Wheels |
ANS: D
By providing food, Meals on Wheels would remove one responsibility for this client. A recreational club or an adult education program might be beneficial, but the priority need for this couple is food. A daycare center for the elderly may be necessary in the future, but it is not a priority at this time.
DIF: Cognitive Level: Application REF: p. 13 OBJ: 4
TOP: Delivery of Community Mental Health Services
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- 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 be the best choice to assist in this situation?
| a. | Psychiatric assistant |
| b. | Dietitian |
| c. | Occupational therapist |
| d. | 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 rehabilitation therapy, such as socialization and vocational retraining.
DIF: Cognitive Level: Application REF: p. 16 OBJ: 6
TOP: Multidisciplinary Mental Health Care Team
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
- Nearly __________ of all countries in the world have no clear governmental policy that addresses mental health issues.
| a. | 7% |
| b. | 26% |
| c. | 50% |
| d. | 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: p. 10 OBJ: 1
TOP: Current Mental Health Care Systems
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose. The primary rationale for her admission is to:
| a. | Have limited supervision by health care personnel. |
| b. | Maintain responsibility for her own behavior. |
| c. | Receive treatment in the least restrictive manner. |
| d. | Provide her with a safe and secure environment. |
ANS: D
The most important advantage of inpatient psychiatric care is that it provides clients with a safe and secure environment where they can focus on and work with the problems that brought them there.
DIF: Cognitive Level: Knowledge REF: p. 11 OBJ: 2
TOP: Inpatient Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A client suffering from chronic mental illness often forgets to take her medication and needs to be reminded to take care of daily hygiene. She does not have family or other support persons living in the area. The care delivery provider facility that would be most beneficial for this client is:
| a. | Emergency departments |
| b. | Residential program |
| c. | Community mental health center |
| d. | Psychiatric home care |
ANS: B
Residential programs offer a protected, supervised environment, which is what this client needs to be compliant. Emergency department care has stabilization and crisis as its focus, psychiatric home care works with clients and families in transition, and community mental health centers deal with crisis, counseling, and education.
DIF: Cognitive Level: Comprehension REF: p. 13 OBJ: 4
TOP: Community Mental Health Care Delivery
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- A 35-year-old client with a long history of schizophrenia who often forgets to take his medication is admitted to an inpatient unit after police found him threatening passengers on a bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example of:
| a. | Recidivism |
| b. | Symptom exacerbation |
| c. | Noncompliance |
| d. | Rejection |
ANS: A
Unable to cope in the community setting, people with chronic psychiatric problems often return to institutions or use community services on a revolving-door basis. This behavior pattern is known as recidivism and means a relapse of a symptom, disease, or behavior. Recidivism is a major problem in mental health care.
DIF: Cognitive Level: Application REF: p. 12 OBJ: 4
TOP: Outpatient Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Arranging community resource linkages for a client and her children who are victims of domestic violence, which resource would be the most immediately appropriate community resource link for a client and her children who are victims of domestic violence?
| a. | Adult education program |
| b. | Family recreation center |
| c. | Mediation group |
| d. | Women’s shelter |
ANS: D
The women’s domestic abuse shelter is the most appropriate resource for immediate safety needs of the family. While education programs, family recreation centers, and mediation groups also provide benefit to the family, they do not address the initial safety of the woman and her children.
DIF: Cognitive Level: Application REF: p. 14 OBJ: 4
TOP: Case Management: Resource Linkages
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
- Which principles characterize mental health care in Canada? (Select all that apply.)
| a. | Portability |
| b. | Universality |
| c. | Accessibility |
| d. | Comprehensiveness |
| e. | Private insurance models |
| f. | 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: p. 10 OBJ: 1
TOP: Mental Health Care in Canada KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity
- In the United States, which factors determine whether a client requires inpatient rather than outpatient care? (Select all that apply.)
| a. | Severity of the illness |
| b. | Level of dysfunction |
| c. | Suitability of the setting for treating the problem |
| d. | Anticipated diagnosis |
| e. | Level of client cooperation |
| f. | 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: p. 11 OBJ: 2
TOP: Care Settings KEY: Nursing Process Step: Assessment
MSC: Client Needs: Safe and Effective Care Environment
- Which client populations are at greater risk for the development of mental health disorders? (Select all that apply.)
| a. | Homeless |
| b. | Clients infected with HIV or AIDS |
| c. | Those in crisis |
| d. | Nurses |
| e. | Clients living in rural areas |
| f. | Older adults |
| g. | Psychiatrists |
| h. | 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: p. 17 OBJ: 7
TOP: Client Populations KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- The case management for a client requiring community mental health services would include which of the following? (Select all that apply.)
| a. | Advocacy |
| b. | Crisis intervention |
| c. | Provision of referrals to a shelter |
| d. | Administration of psychotropic medications |
| e. | Developing a client’s plan of care |
ANS: A, B, C
Case management is a system of interventions designed to support mentally ill clients living in the community. The major components of case management are psychosocial rehabilitation, consultation, resource linkage (referral), advocacy, therapy, and crisis intervention. Administration of medications is performed by an individual, not a system, and clients are involved in planning their care.
DIF: Cognitive Level: Knowledge REF: p. 14 OBJ: 5
TOP: Case Management KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
COMPLETION
- 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: p. 16 OBJ: 6
TOP: Multidisciplinary Mental Health Care Team
KEY: Nursing Process Step: Intervention
MSC: Client Needs: Safe and Effective Care Environment
Chapter 4: Sociocultural Issues
Test Bank
MULTIPLE CHOICE
- An older Asian female with a diagnosis of depression is cared for by her granddaughter. Her granddaughter is very attentive to the client’s needs, attends every therapy session, and is active in the planning and implementing of the treatment plan. The granddaughter’s valuing of her grandmother is most likely due to her:
| a. | Ethnicity |
| b. | Cultural beliefs |
| c. | Religion |
| d. | Stereotype |
ANS: B
Cultural beliefs develop over many generations and are a learned set of values, beliefs, and behaviors. Asian cultures commonly value their elderly family members. Ethnicity and religion do not explain the granddaughter’s behavior in that ethnicity describes customs and socialization patterns, and religion refers to an organized form of worship. Stereotyping is a preconceived belief about another cultural group, so it does not apply to this situation.
DIF: Cognitive Level: Application REF: p. 31 OBJ: 1
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A traditional Arab female client is brought to the emergency room by her husband. She complains of feeling very anxious and short of breath and has chest pain. What would likely be a hindrance to the care of this client?
| a. | The emergency room physician is female. |
| b. | Her husband asks if he can stay with his wife. |
| c. | One of the emergency room nurses is of Arab descent. |
| d. | The only caregivers available in the emergency room are male. |
ANS: D
In some traditional Arab cultures, a woman will not make eye contact with any man except her husband and may not be touched by another man. Having only male staff in the emergency room on this shift would block necessary care. Arrangements would have to be made to have a female staff member come to the emergency room to assist in client care. The other options should not cause a problem.
DIF: Cognitive Level: Application REF: p. 32 OBJ: 3
TOP: Characteristics of Culture KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity
- Disease is defined as _____ dysfunction.
| a. | Social |
| b. | Emotional |
| c. | Physical |
| d. | Intellectual |
ANS: C
Disease differs from illness in that disease is an abnormal physical function, whereas illness refers to social, emotional, and intellectual dysfunction. Illness is affected by culture, but disease is not.
DIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Physiological Integrity
- The nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks English, but she is accompanied by her mother who does not. The client has a history of mental illness, and through the interpreter, the nurse learns that the mother, who has traditional Puerto Rican cultural beliefs, believes that the client’s mental illness is caused by:
| a. | Witchcraft |
| b. | Stress |
| c. | Chemical imbalances |
| d. | A trance |
ANS: A
It is a common traditional Puerto Rican cultural belief that mental illness is caused by witchcraft, magic, or evil spells, as opposed to more traditional Western medicine, which believes that stress and chemical imbalances play a role in mental illness. A trance is considered a state of consciousness in some cultures.
DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A client is continually late for his appointment at the mental health clinic. What is a likely reason for his lack of punctuality?
| a. | Need for environmental control |
| b. | Time orientation |
| c. | Space comfort zone |
| d. | Territorial needs |
ANS: B
Mental dysfunction can lead to incorrect perception of time, causing the client to be continually late. In addition, some cultures do not see schedules and specific appointment times as important, causing the client to be continually late in the eyes of the caregiver. Environmental control refers to an individual’s need to control his or her perception of the environment. Comfort zones are highly culture based, meaning that individual interpretation of personal space varies among cultures. Territorial needs provide a sense of identity and security for some clients.
DIF: Cognitive Level: Comprehension REF: p. 36 OBJ: 5
TOP: Space, Territory, and Time in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- Which client communication problem can the nurse most easily correct?
| a. | Age differences |
| b. | Altered cognition |
| c. | Cultural differences |
| d. | Gender differences |
ANS: C
The nurse can easily correct communication problems caused by cultural differences in a number of ways, including learning what cultural beliefs and practices are important to the client and being accepting of those beliefs. Communication problems due to age and gender differences and altered cognition cannot be corrected by the nurse.
DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5
TOP: Communication in Cultural Assessment
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- What is the social orientation among most middle-class American families?
| a. | Extended |
| b. | Friends |
| c. | Significant others |
| d. | Nuclear |
ANS: D
The nuclear family is the social orientation of family that is seen most frequently in this group. The extended family is seen as the social orientation for cultures such as some Alaskan, traditional Chinese, and Mexican cultures. Friends and significant others are not identified as a social orientation of family.
DIF: Cognitive Level: Knowledge REF: p. 36 OBJ: 5
TOP: Social Organization in Cultural Assessment
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- It is important for the nurse to be familiar with the religious practices of clients cared for most often in a particular region because attitudes toward health and illness, death and burial, food, and procreation have a strong impact on a client’s beliefs and practices. The nurse knows that the religion practiced most often around the world is:
| a. | Buddhism |
| b. | Jehovah’s Witness |
| c. | Christianity |
| d. | Ahmadiyya |
ANS: C
More than 2 billion individuals throughout the world are practicing Christians. Although these religions are seen in large numbers worldwide, it is important for the nurse to be familiar with the religions most frequently seen in the client populations with whom he works within his own area.
DIF: Cognitive Level: Knowledge REF: p. 37 OBJ: 6
TOP: Social Organization in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- The metabolism of psychotropic medications is most likely to be affected by:
| a. | Ethnicity |
| b. | Religion |
| c. | Culture |
| d. | Values |
ANS: A
Ethnicity is a determining factor in a person’s genetic makeup. Religious and cultural practices could play a role in the metabolism of medications as a result of food or alternative treatment interactions with medications, but the metabolism is more closely related to the genetic makeup. Values have little to do with the metabolism of medications.
DIF: Cognitive Level: Knowledge REF: p. 37 OBJ: 5
TOP: Biological Factors in Cultural Assessment
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- A male Hmong client from Laos is a client at an outpatient mental health clinic who is being seen for his diagnosis of bipolar disorder. The importance of lithium testing was stressed in his discharge plans; however, it is discovered that he has had his lithium level checked only once, rather than the three scheduled times. What is the nurse’s best action?
| a. | Remind the client about the importance of lithium level testing. |
| b. | Make scheduled appointments for the client to get his lithium level tested. |
| c. | Give the client written information regarding the importance of lithium level testing and written instructions on how to make appointments for testing. |
| d. | Talk with the client to see if there is a reason that he is not getting his lithium levels checked as outlined in his discharge plans. |
ANS: D
In the Hmong culture, it is believed that loss of blood leads to decreased body strength, which can cause the soul to leave the body, resulting in death. If the nurse did not discuss why the client was not getting his blood levels tested and gave him additional instructions as listed in the other options, the nurse would not understand and would not be able to incorporate the client’s cultural beliefs into the plan of care. The nurse and the client can now make revisions that will be acceptable while meeting the needs of the client.
DIF: Cognitive Level: Application REF: p. 37 OBJ: 5
TOP: Biological Factors in Cultural Assessment
KEY: Nursing Process Step: Intervention MSC: Client Needs: Psychosocial Integrity
- Culture includes common beliefs and practices in areas such as religion, economics, diet, health, and:
| a. | Genetics |
| b. | Occupations |
| c. | Patterns of communication |
| d. | Stereotypes |
ANS: C
In addition to shared beliefs and practices in religion, economics, diet, and health, a person’s cultural integration consists of patterns of communication, politics, art, and kinship. The other three options are not part of a person’s culture.
DIF: Cognitive Level: Comprehension REF: p. 31 OBJ: 3
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- What is the usual approach to care for individuals who practice folk medicine?
| a. | Fragmented |
| b. | Impersonal |
| c. | Disjointed |
| d. | Personalized |
ANS: D
Folk medicine is highly personalized; the descriptors fragmented, impersonal, and disjointed more often are associated with the Western medicine approach to health care.
DIF: Cognitive Level: Knowledge REF: p. 32 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A Navajo Native American is traveling across the country and becomes ill. He visits a hospital emergency room and appears very uncomfortable in the surroundings. The nurse knows that traditional Navajo Native Americans typically receive health care in:
| a. | Homes |
| b. | Small hospitals |
| c. | Physicians’ offices |
| d. | Outpatient clinics |
ANS: A
Many traditional Native Americans receive health care in their homes, community settings, or social places. The emergency room setting would be very uncomfortable for this client.
DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A client seen in the mental health clinic feels her depression is the result of being “punished” due to becoming pregnant as an adolescent and giving the infant up for adoption against her family’s wishes. This view of her depression is considered:
| a. | Exaggerated |
| b. | Naturalistic |
| c. | Personalistic |
| d. | Stress |
ANS: C
Personalistic illnesses are seen as aggression or punishment directed toward a specific person. Naturalistic illnesses are caused by impersonal factors without regard for the individual. Forces that exist outside the individual cause mental illness.
DIF: Cognitive Level: Comprehension REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- The nurse in the Emergency Department finds a woman collapsed on the floor and crying loudly. The woman’s husband was in a car accident and is being attended to by the medical staff. Which statement by the nurse best demonstrates acting in a culturally competent manner?
| a. | “You need to control yourself. Your husband was not injured that badly.” |
| b. | “Let me take you to a room with more privacy so we can talk.” |
| c. | “I am concerned about how you are acting right now. No one else here is acting like this.” |
| d. | “We will call the psychiatrist to see if medication can be ordered for you.” |
ANS: B
The nurse is demonstrating cultural competence and using cross-cultural therapeutic health care skills by offering to allow the client to express herself. The nurse is imposing personal beliefs on expected behavior in the other options.
DIF: Cognitive Level: Application REF: p. 35 OBJ: 2
TOP: Cultural Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A 45-year-old married man comes to the community mental health center after he is suspended from his job for fighting. Upon talking to him, the nurse discovers he and his wife recently moved to the United States and his wife needs to work to pay bills. He is angry and embarrassed that he cannot be the sole provider for his family. His behavior may be the result of:
| a. | Cultural stereotyping |
| b. | Gender role conflict |
| c. | Religious beliefs |
| d. | Territoriality conflicts |
ANS: B
Traditional roles for men and women are in conflict with societal expectations of Western society in this situation. Men tend to demonstrate more violent and abusive behaviors as mental health problems with this conflict. Cultural stereotyping is imposed by someone outside the culture, and religious and territoriality conflicts do not apply to this circumstance.
DIF: Cognitive Level: Application REF: p. 36 OBJ: 4
TOP: Social Organization: Gender Roles KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- A nurse preparing to interview a client in the client’s room begins to move newspapers off a chair to sit down. The client requests that the nurse sit in another chair and leave the newspapers where they were. The client is demonstrating:
| a. | Personal space |
| b. | Paranoia |
| c. | Manipulation |
| d. | Territoriality |
ANS: D
Territoriality is the need to gain control over an area of space and claim it for oneself, as it helps to provide a sense of identity, security, autonomy, and control over the environment. Personal space is the distance maintained between people. Manipulation and paranoia are not demonstrated in this case.
DIF: Cognitive Level: Application REF: p. 36 OBJ: 5
TOP: Space, Territory, and Time in Cultural Assessment
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
- A male client is visiting his family in the United States and experiences what his family describes as a “breakdown.” His family takes him to a stress treatment center at a local mental health clinic. The client is a follower of traditional folk medicine practices and is agitated when he learns that he must see a licensed psychiatrist. Which care providers is this client most likely accustomed to? (Select all that apply.)
| a. | Healers |
| b. | Shamans |
| c. | Nurse practitioners |
| d. | Spiritualists |
| e. | Lay unlicensed therapists |
ANS: A, B, D, E
Individuals who practice folk medicine for care typically do not see licensed health care providers, such as nurse practitioners and physicians. Folk medicine beliefs regarding the causes of disorders and treatments are different from Western medicine beliefs.
DIF: Cognitive Level: Knowledge REF: p. 33 OBJ: 4
TOP: Health and Illness Beliefs KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Which areas comprise the DSM-IV-TR cultural assessment tool for clients? (Select all that apply.)
| a. | Cultural identity of the client |
| b. | Overall cultural assessment |
| c. | Cultural explanation of the illness |
| d. | Cultural factors relating to previous mental illness |
| e. | Cultural factors relating to psychosocial environment |
| f. | Cultural elements of relationship between client and care provider |
| g. | Cultural factors related to level of functioning |
ANS: A, B, C, E, F, G
The six categories of cultural identity of the client, cultural explanation of the illness, cultural factors relating to psychosocial environment, cultural factors relating to level of functioning, cultural elements of the relationship between client and care provider, and overall cultural assessment constitute the cultural assessment tool, which allows mental health care providers to learn how clients perceive their world and how they cope, according to their culture. Previous mental illness would be found in the history section of a client’s assessment.
DIF: Cognitive Level: Comprehension REF: p. 35 OBJ: 5
TOP: Cultural Assessment KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Refugees frequently experience depression, anxiety, and stress-related disorders caused by their particular circumstances. Therefore, in addition to a cultural assessment, what is important for the nurse to assess? (Select all that apply.)
| a. | Immigration history |
| b. | History of arrival in the new country |
| c. | How long the refugee has been in the new country |
| d. | Whether anyone or anything was lost in coming to the new country |
| e. | What type of medical insurance the refugee will be seeking to obtain |
ANS: A, B, C, D
A refugee is a person who flees from his or her home or country, usually because of war or persecution in the homeland. The refugee has experienced trauma not only in his life experiences, but also in the process of fleeing from home. Therefore, a more accurate assessment can be performed if these questions are answered. The type of medical insurance obtained is of little concern to this person at this time.
DIF: Cognitive Level: Comprehension REF: p. 37 OBJ: 7
TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- Cultural assessments allow the health care provider to understand the unique beliefs clients may have regarding mental illness and how they cope. Key areas to assess include: (Select all that apply.)
| a. | Communication |
| b. | Space and territory |
| c. | Biological orientation |
| d. | Defense mechanisms |
| e. | Social orientation |
ANS: A, B, C, E
The six areas of cultural assessment on various tools include: communication, environmental control, space and territory, time, social orientation, and biological factors. Defense mechanisms do not pertain to cultural assessments.
DIF: Cognitive Level: Comprehension REF: p. 34 OBJ: 5
TOP: Culture and Mental Health Care KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
COMPLETION
- A __________ is a simplified or standardized belief or conception regarding people who belong to another culture.
ANS:
stereotype, stereotyping
stereotyping, stereotype
Stereotyping can be negative or positive but can cause a mental health client to resist care if he feels he is being stereotyped by his caregiver. Extreme stereotyping is referred to as prejudice.
DIF: Cognitive Level: Knowledge REF: p. 31 OBJ: 2
TOP: Characteristics of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- __________ is a term that divides people into groups based on biological characteristics, including skin color, features, hair texture, and self-identification.
ANS:
Race
Race differs from ethnicity in that ethnicity refers to similar characteristics but is better defined socially.
DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 1
TOP: Nature of Culture KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity
- When a person believes that there is a power greater or higher than any human being, he is referring to his __________.
ANS:
spirituality
This is an important concept for many individuals in terms of the progression of their illness and the plan of care.
DIF: Cognitive Level: Knowledge REF: p. 30 OBJ: 1
TOP: Nature of Culture KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
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