Test Bank For Foundations Of Mental Health Care 5th Ed By Michelle Morrison – Valfre

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Foundations of Mental Health Care 5th Ed By Michelle Morrison – Valfre

Chapter 1: The History of Mental Health Care

Test Bank

 

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:   p. 2                OBJ:   2

TOP:   Early Years of Mental Health         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:   p. 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 President’s Commission on Mental Health in 1978.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 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:   p. 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:   p. 5                OBJ:   4

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:   p. 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:   p. 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:   p. 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:   p. 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:   p. 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:   p. 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:   p. 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. Community mental health clinics and residential treatment centers resulted from the deinstitutionalization of patients.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 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 is effective for bipolar disorder.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 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:   p. 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:   p. 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:   p. 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:   p. 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:   p. 8                OBJ:   9

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following persons has the greatest risk for developing ineffective coping behaviors?
a. The middle-aged man whose diet is high in saturated fat and has a 20-year history of tobacco use
b. The single 30-year-old female facing the death of her father
c. The 19-year-old college student with a family history of schizophrenia
d. The 9-year-old child whose parents are nurturing but provide chores and responsibilities

 

 

ANS:  C

Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas.

 

DIF:    Cognitive Level: Application          REF:   p. 1                OBJ:   2

TOP:   Introduction   KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. In the early 1900s the first theory of mental illness that showed behavior could be changed is attributed to:
a. Beers
b. Dix
c. Freud
d. Pinel

 

 

ANS:  C

Freud was the first person who succeeded in “explaining human behavior in psychological terms and in demonstrating that behavior can be changed under the proper circumstances.”

 

DIF:    Cognitive Level: Knowledge          REF:   p. 6                OBJ:   5

TOP:   Psychoanalysis                               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:   p. 3                OBJ:   3

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

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. The humoral theory of disease embraced by Hippocrates required a balance of which elements? (Select all that apply.)
a. Fire
b. Water
c. Light
d. Air
e. Earth

 

 

ANS:  A, B, D, E

Hippocrates viewed mental illness as a result of an imbalance of humors—the fundamental elements of air, fire, water, and earth. Each basic element had a related humor or part in the body.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 2                OBJ:   2

TOP:   Greece and Rome                           KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which aspects of adult mental health care systems did the National Alliance on Mental Illness survey focus on? (Select all that apply.)
a. Availability of care
b. Access to care
c. Regulation of medications
d. Increased funding

 

 

ANS:  A, B, D

In 2006, the National Alliance for Mental Illness (NAMI) conducted the “first comprehensive survey and grading of state adult mental health care systems conducted in more than 15 years” (NAMI, 2006). Their results revealed a fragmented system with an overall grade of D. Recommendations focused on increased funding, availability of care, access to care, and greater involvement of consumers and their families.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 8                OBJ:   9

TOP:   Twenty-First Century                                KEY:              Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Mental health is said to be influenced by which of the following factors? (Select all that apply.)
a. Diet and nutritional intake
b. Inherited characteristics
c. Activities of daily living
d. Childhood nurturing
e. Life circumstances

 

 

ANS:  B, D, E

Mental health is influenced by three factors: inherited characteristics, childhood nurturing, and life circumstances. The risk for developing ineffective coping behaviors increases when problems exist in any one of these areas.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 1                OBJ:   2

TOP:   Congressional Actions                    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

 

Chapter 3: Ethical and Legal Issues

Test Bank

 

MULTIPLE CHOICE

 

  1. A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s 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 client’s 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 reward valued behavior and punishes undesired behavior; and the laissez-faire model imposes no restriction or direction on choices.

 

DIF:    Cognitive Level: Application          REF:   p. 21              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. Nurse’s 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 nurse’s rights were not violated, and beliefs and morals do not describe the entire decision-making process that occurred.

 

DIF:    Cognitive Level: Application          REF:   p. 21              OBJ:   1

TOP:   Values Clarification                        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 include coverage for:
a. Mental illness
b. Substance abuse treatment
c. Mental illness that is equal to coverage for physical illness
d. 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:   p. 22              OBJ:   2

TOP:   Client Rights                                   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 one’s 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 client’s information private, and justice indicates that all clients must be treated fairly, equally, and respectfully.

 

DIF:    Cognitive Level: Application          REF:   p. 23              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 client’s 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 (or dilemma)
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 individual’s values.

 

DIF:    Cognitive Level: Application          REF:   p. 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 state’s 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 nurse’s responsibility to know his or her scope of practice. The other options do not exist.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 25              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 state’s nurse practice act. What is the nurse’s best course of action?
a. Call the physician to ask for clarification.
b. Check the state’s nurse practice act again.
c. Contact the nursing supervisor for approval to carry out the treatment.
d. Refer to the facility’s 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 facility’s 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 state’s nurse practice act has already been checked. Contacting the nursing supervisor would be acceptable only after the facility’s policy has been checked.

 

DIF:    Cognitive Level: Application          REF:   p. 23              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:   p. 25              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 _____ months.
a. 3
b. 6
c. 12
d. 15

 

 

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:   p. 26              OBJ:   5

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

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 client’s permission. Privacy refers to issues related to the body and confidentiality, and fraud is giving false information.

 

DIF:    Cognitive Level: Application          REF:   p. 26              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 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:   p. 27              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. Facility’s 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:   p. 27              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:   p. 28              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 nurse’s 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 client’s 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:   p. 28              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. “Let’s 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 one’s 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:   p. 23              OBJ:   3

TOP:   Ethical Principles                            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The charge nurse on a busy inpatient psychiatric unit is concerned because a nurse and a nursing assistant have called out for the shift. Upon calling the nursing office, the charge nurse is informed that there is no one to replace them. In addition, the emergency call button at the nurse’s station is malfunctioning. This charge nurse sees this as a violation of:
a. Legal rights
b. The patient bill of rights
c. Care provider rights
d. Ethical principles

 

 

ANS:  C

Care provider rights provide for respect, safety, and competent assistance. Patient’s Bill of Rights deals with provision for client rights. Legal rights are not impacted and although ethical principles serve as behavior guidelines, it is not the most appropriate response in this case.

 

DIF:    Cognitive Level: Application          REF:   p. 22              OBJ:   1

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

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The nurse encounters a client crying in her room. Upon talking to the client, it is discovered that she is upset because a new nursing assistant made her go out for a walk with the group even though the client informed her that she waits for her daughter to go for her walk. This is a potential violation of which ethical principle?
a. Beneficence
b. Autonomy
c. Confidentiality
d. Nonmaleficence

 

 

ANS:  B

Autonomy refers to the right of people to act for themselves and make personal choices. The principle of beneficence refers to actively doing good and maleficence refers to doing no harm. Confidentiality is not violated in this situation

 

DIF:    Cognitive Level: Application          REF:   p. 23              OBJ:   1

TOP:   Ethical Principles                            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client preparing for discharge from an inpatient unit asks a nurse which psychiatrist she would recommend to use for follow-up as an outpatient. The nurse responds, “There are several good physicians on your list. Make sure you do not use Dr. Smith. I have heard some terrible things about his methods of treatment.” This is an example of which type of potential liability?
a. Slander
b. Invasion of privacy
c. Assault
d. Libel

 

 

ANS:  A

Slander is verbal defamation that is false communication and can result in harm to the psychiatrist’s practice. Libel is written defamation and assault is threat of bodily harm. Invasion of privacy pertains to confidential information and is not pertinent in this case.

 

DIF:    Cognitive Level: Application          REF:   p. 26              OBJ:   6

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

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. A client frequently wanders around the unit, and the staff frequently needs to reorient the client to the environment and remind her not to walk into the rooms of other clients on the unit. Due to short staffing, the decision is made to use a restraint device to prevent this from occurring. This action may constitute:
a. Assault
b. Defamation
c. False imprisonment
d. Negligence

 

 

ANS:  C

The application of protective devices and restraints may constitute false imprisonment. Restraints must be used only to protect the client, not for staff convenience. All less restrictive measures should first be attempted and documented.

 

DIF:    Cognitive Level: Application          REF:   p. 27              OBJ:   6

TOP:   Areas of Potential Liability             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:   p. 26              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 provider’s misconduct meet? (Select all that apply.)
a. The provider owed a duty to the client.
b. The provider breached a duty to the client.
c. The provider had intent to harm the client.
d. The provider caused injury to the client by action or inaction.
e. The provider caused loss or damage through his or her actions.

 

 

ANS:  A, B, D, E

These four criteria must be present for an act of a health care provider to be considered negligent. Intent to harm would be considered a criminal action rather than an action of negligence.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 27              OBJ:   7

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

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The use of protective devices may be considered false imprisonment. In order to assure the rights of the client are not violated, which practices must be implemented when using a device? (Select all that apply.)
a. A written medical order must be on the medical record.
b. Client must be confined to bed.
c. Restraints must be removed and limb exercised every 2 hours.
d. Implement use of restraints in the event of short staffing as a preventive measure.
e. Client must be assessed and monitored every 15 minutes.

 

 

ANS:  A, C, E

Restraints must be used only to protect the client, not for staff convenience. All less restrictive measures should first be attempted and documented. A written medical order for restraints must be on file in the client’s chart. Once restraints have been applied, the caregivers have an increased obligation to observe, assess, and monitor the client every 15 minutes. The restraints must be removed, one limb at a time, and the limb exercised every 2 hours. All observations and actions must be documented. Restraints are removed as soon as the client’s behavior is under control.

 

DIF:    Cognitive Level: Application          REF:   p. 27              OBJ:   7

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

MSC:  Client Needs: Safe and Effective Care Environment

 

COMPLETION

 

  1. The nurse documents on the medication administration record that a medication has been given as ordered on a daily basis, but the medication actually has been out of stock for a week. This nurse is guilty of __________.

 

ANS:

Fraud

This nurse is committing fraud by giving false information. Not only is this illegal, but it could bring harm to the client in several ways.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 26              OBJ:   6

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

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. __________ is either omitting or committing a duty that a reasonable and prudent person would or would not do that brings harm to an individual in a health care environment.

 

ANS:

Negligence, Malpractice

Malpractice, Negligence

Negligence on the part of a professional is called malpractice.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 27              OBJ:   7

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

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. __________ describes an individual’s attitudes, beliefs, and values and helps a person distinguish between what is considered right and wrong behavior.

 

ANS:

Morals

Morals are developed through learned behavior, teachings of others, and experience.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 20              OBJ:   1

TOP:   Values and Morals                          KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Safe and Effective Care Environment

 

Chapter 11: The Therapeutic Relationship

Test Bank

 

MULTIPLE CHOICE

 

  1. The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is currently administering medications to all clients on the unit. The newly admitted client asks the nurse to sit and talk with her for a while. What is the nurse’s best response?
a. “I am busy right now, but I will come back later.”
b. “Give me just a few more minutes to finish passing medication to the other clients.”
c. “I will return in 20 minutes so we can talk.”
d. “I have to finish giving all the clients their medications, but I will then come back so we can talk.”

 

 

ANS:  D

This is an honest statement that lets the client know exactly what the nurse is doing and helps to build trust in that the nurse is not making up excuses or making false promises. The nurse’s statement that she is busy right now would make the client feel unimportant. The nurse would be making false promises if she were to say that she will be back in only a few minutes or even in 20 minutes because most likely, it will take more than this amount of time to finish giving out medications.

 

DIF:    Cognitive Level: Application          REF:   p. 118            OBJ:   2

TOP:   Trust              KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A nurse is working with a male client in a mental health outpatient clinic. The client voices a desire to become more autonomous. Which goal will assist the client in becoming more autonomous?
a. The client will check his calendar each night to plan for commitments scheduled on the following day.
b. The nurse will remind the client weekly of his appointment at the clinic for the following week.
c. The client will ask the nurse to call him to remind him of his appointment.
d. The nurse will complete the client’s calendar of daily commitments scheduled for the week.

 

 

ANS:  A

Autonomy refers to the ability to direct and control one’s activities and destiny. Working toward this goal is a simple way to begin to develop control over one’s life. Reminding the client and completing the client’s calendar are nursing goals rather than client goals. If the client asks the nurse to call him to remind him, no responsibility is placed on the client.

 

DIF:    Cognitive Level: Application          REF:   p. 118            OBJ:   2

TOP:   Autonomy      KEY:  Nursing Process Step: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by:
a. Telling a client several times a day that he or she cares about him or her
b. Asking a client what his or her favorite movie is, then showing that movie during a movie night on the unit
c. Giving a client a card that has a sentiment that says the nurse cares about him or her
d. Telling a client that he or she is the favorite client

 

 

ANS:  B

Showing a favorite movie is a safe way of showing the client that you are aware of him or her as an individual, rather than as just another client. If the nurse only tells the client that she cares about him or her, it does not prove to the client that the nurse cares. Giving a client a card or telling the client that he or she is a favorite is too personal and may mislead the client regarding the development of a social relationship.

 

DIF:    Cognitive Level: Application          REF:   p. 119            OBJ:   2

TOP:   Caring            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope?
a. “You need to take your lithium unless you want to relapse.”
b. “You are doing so well that there is nothing you can’t do if you put your mind to it.”
c. “You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication.”
d. “A lot of people are much worse off than you are, so you should be thankful that you are doing as well as you are.”

 

 

ANS:  C

This option is realistic and provides hope without providing false hope. Stating that the client will relapse if she discontinues medication suggests that the nurse is threatening the client, which provides no hope. Telling the client that “there is nothing that you can’t do” may be providing false hope. Reminding the client that others are worse off is disregarding the client’s feelings.

 

DIF:    Cognitive Level: Application          REF:   p. 119            OBJ:   2

TOP:   Hope              KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The client’s current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope?
a. Affective
b. Contextual
c. Temporal
d. Affiliative

 

 

ANS:  B

Although all the dimensions of hope listed in these options may be difficult for this client, the dimension that is representative of the living and job situation for this client is contextual, because this refers to inadequate physical, financial, and emotional resources.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 120            OBJ:   2

TOP:   Hope              KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient setting and is attending group therapy sessions. She is working on controlling the compulsion of touching her head three times every time she talks. To maintain the therapeutic relationship established with the client, by which action can the nurse show acceptance?
a. Ignoring the compulsion during the group therapy session and talking with the client privately about the behavior
b. Asking the group to remind the client every time she touches her head to help her consciously stop the compulsion
c. Pointing out the compulsion to the group each time the client exhibits the behavior
d. Asking the client to stop talking during the group session until she has learned to control her compulsion

 

 

ANS:  A

Ignoring the behavior in group therapy shows acceptance of the behavior because the nurse does not embarrass the client in front of the group. Talking with her privately shows compassion for the client. Asking the group to remind the client of the compulsion and pointing out the compulsion to the group could belittle the client. Asking the client to stop talking would defeat the purpose of the support of belonging to a therapeutic group.

 

DIF:    Cognitive Level: Application          REF:   p. 120            OBJ:   4

TOP:   Acceptance    KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The characteristic of genuineness helps in establishing a therapeutic relationship with a client. Which nurse response is the best example of a display of genuineness to a client who is going through a difficult divorce?
a. “I know exactly how you feel. My husband and I divorced 2 years ago because of his infidelity.”
b. “Divorcing my husband was the best thing I ever did.”
c. “I have friends who have gone through a divorce. It must be difficult for you.”
d. “I am sorry that you have to go through this difficult time.”

 

 

ANS:  C

This response shows the client sincerity and honesty, which are components of being genuine. The nurse should not offer too much personal information, such as providing information about her own divorce. When the nurse says that she is sorry that the client is experiencing the difficult time, it is an example of a sympathetic response.

 

DIF:    Cognitive Level: Application          REF:   p. 121            OBJ:   4

TOP:   Genuineness  KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. During the preparation phase of a therapeutic relationship with a client, what is the main task to be completed by the nurse?
a. To establish with the client the purpose of the relationship
b. To gather and review all possible information regarding the client
c. To build trust with the client
d. To obtain agreement from the client to work in conjunction with the nurse

 

 

ANS:  B

The main task during the preparation phase is to gather and review all possible information regarding the client; this can be accomplished by obtaining data from past and current medical records and from the client’s significant others. The other options are tasks that occur during the orientation phase.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 121            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. When should the nurse begin preparations for the termination phase of a therapeutic relationship?
a. During the orientation phase
b. Prior to the last meeting
c. During the last meeting
d. After all goals have been met

 

 

ANS:  B

Preparing for termination of the relationship should begin prior to the last meeting to allow for review of whether goals have been met and to prepare for client independence. The orientation phase is too early in the relationship to prepare for termination, and the last meeting is too late. Unfortunately, not all goals are always met, so preparing for termination of the relationship after goals have been met may not be a possibility.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 123            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. The nurse is preparing an adult male client, who has been successfully treated for a social phobia, for the termination phase of the therapeutic relationship. During their last meeting, the client told the nurse that he noticed he has developed a nervous habit that started a few days ago of checking his door at home several times a day to be sure it is locked. This client is exhibiting the client response to termination known as:
a. Continuation
b. Regression
c. Withdrawal
d. Confabulation

 

 

ANS:  A

Continuation sometimes occurs when a client is fearful of ending the therapeutic relationship. This response is characterized by a client’s trying to continue the relationship by bringing up new problems or having the caregiver solve his problems. Regression and withdrawal are also client responses to termination, but they do not fit the description in this situation. Confabulation is not a response to termination. It refers to the making up of answers by a client who is experiencing a memory loss.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 123            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. When a caregiver becomes a role model for a client during a therapeutic relationship, the caregiver is functioning in the role of:
a. Teacher
b. Therapist
c. Technician
d. Change agent

 

 

ANS:  D

Serving as a role model is one of the many functions of a change agent. The role of a change agent also includes promoting a climate of anticipation of positive change for the client and serving as a socializing agent. The other options are roles of the caregiver, but role model is not included in those roles.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 123            OBJ:   7

TOP:   Roles of the Caregiver                    KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A male client is being discharged from a mental health facility and is worried about what to tell his friends and co-workers regarding his time away. The nurse helps the client plan what to say to others about his disease. The nurse is functioning in the role of:
a. Change agent
b. Teacher
c. Therapist
d. Technician

 

 

ANS:  B

This is an example of a teaching opportunity that the nurse is involved in during a therapeutic relationship. Other teaching opportunities include teaching the client how to cope with stressors, early signs of relapse, and effects of medications and providing public education regarding mental illness. The other options do not incorporate the teaching role as a function.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 124            OBJ:   7

TOP:   Roles of the Caregiver                    KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A female client is admitted with suicidal tendencies. The client is placed in suicide precautions for the first 24 hours of her stay. Ensuring client safety is included in the therapeutic role of:
a. Change agent
b. Teacher
c. Therapist
d. Technician

 

 

ANS:  D

In addition to ensuring safety, the role of technician includes medication management, management of medical problems in the mental health environment, and management of environmental factors. These responsibilities are not a function of the other roles.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 124            OBJ:   7

TOP:   Roles of the Caregiver                    KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Safe and Effective Care Environment

 

  1. The nurse who is caring for a client begins to have very protective feelings toward the client that are interfering with the therapeutic relationship between the nurse, the client, and the client’s family. This is an example of a problem that is encountered in some therapeutic relationships and is known as:
a. An environmental problem
b. Resistance
c. Transference
d. Countertransference

 

 

ANS:  D

Countertransference, the inappropriate emotional response of a caregiver to a client, is occurring in this relationship. Environmental problems refer to items such as privacy and noise levels, resistance is a behavior of the client that demonstrates unwillingness to change or accept the need for change, and transference is the client’s inappropriate feelings or behaviors directed toward the caregiver.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 125            OBJ:   8

TOP:   Problems with Care Providers         KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. A 19-year-old male client is being treated for a drug addiction. He continually voices his dread of being discharged because he knows he will have to live with his parents and follow their rules until he can earn enough money to live on his own. He is showing increasing resistance to treatment measures, such as attending group sessions, but is refusing to acknowledge that he has an addiction or that he needs treatment. Which behavior is the client demonstrating?
a. Transference
b. Primary resistance
c. Secondary resistance
d. Tertiary resistance

 

 

ANS:  C

This is an example of secondary resistance in view of the fact that the client is displaying behaviors that will prolong his discharge from the facility, in an attempt to avoid his perception of the unpleasant living situation that awaits him upon discharge. Transference is a client’s emotional response, based on earlier relationships, to the care provider. Primary resistance refers to simple avoidance of change or admitting the need for change. Tertiary resistance is not a used term.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 125            OBJ:   8

TOP:   Problems with Clients                               KEY:              Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client response to the termination phase of the therapeutic relationship is withdrawal. This response most often is manifested by client behaviors such as:
a. Bringing up new problems
b. Being absent from appointments
c. Returning to maladaptive behavior
d. Having increased anxiety

 

 

ANS:  B

Being absent from appointments is a behavior that is commonly seen when clients are withdrawing from the termination phase of the relationship. It actually is a response that occurs because the client does not want the therapeutic relationship to end. Bringing up new problems refers to the continuation response, and returning to maladaptive behavior and having increased anxiety refer to the regression response.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 123            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. A 22-year-old woman with depression misses her scheduled meeting with the nurse.  Although they have established a contract to meet on an agreed upon schedule, the nurse understands that the client is still testing the relationship and working on trusting her care provider. This behavior usually manifests itself during which phase of the therapeutic relationship?
a. Termination
b. Orientation
c. Working
d. Preparation

 

 

ANS:  B

Testing is an important step during the orientation phase in establishing trust in the therapeutic relationship. Although clients may not appear for scheduled appointments, use profane language, or resist sharing their feelings, the caregiver must demonstrate a willingness to continue the therapeutic relationship.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 122            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. The new nurse confides to his supervisor, “I am feeling frustrated. Mr. J has been doing so well in dealing with his issues over the last month, and today he refused to discuss anything productive in our session.” What is the most appropriate response?
a. “You are still in the preparation phase and need to check the medical record for information.”
b. “The orientation phase is a time where in which the client is building trust and testing you.”
c. “During the working phase the client may have growth and resistance.”
d. “The termination phase is a difficult one for both nurse and client.”

 

 

ANS:  C

The working phase of the therapeutic relationship has periods of growth that are accompanied by episodes of resistance. Changing one’s behavior is very hard work. It requires energy and self-disclosure. Clients often feel self-conscious, shameful, and vulnerable during this time.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 122            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

 

  1. Which of the following actions indicates that the nurse has gone beyond the boundaries of the client–caregiver relationship?
a. The nurse consciously focuses on the client during meetings.
b. The nurse works to establish a trusting relationship with the client.
c. The nurse instills a sense of hope in the client.
d. The nurse defends the client to her family and the staff.

 

 

ANS:  D

Defending the client to health care providers and the client’s family is a behavior that demonstrates a blurring of the therapeutic relationship. Trust, hope, and therapeutic use of self are essential to the therapeutic relationship.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 125            OBJ:   8

TOP:   Problems with Care Providers         KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. As the nurse begins to discuss discharge plans for a 45-year-old female client hospitalized for anxiety, the client states, “You never really cared whether I get better!  Why not stop this charade?” The nurse recognizes this to be:
a. Transference
b. Secondary gain
c. Countertransference
d. Insecurity

 

 

ANS:  A

Transference is a client’s emotional response based on earlier relationships.

The most outstanding characteristic of transference is the inappropriateness of the client’s responses.  Secondary gain occurs when clients profit from or avoid unpleasant situations by remaining ill.  Countertransference is based on caregiver’s inappropriate response.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 126            OBJ:   8

TOP:   Problems with Clients                               KEY:              Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. For which roles is the caregiver responsible in a therapeutic relationship? (Select all that apply.)
a. Teacher
b. Therapist
c. Technician
d. Friend
e. Change agent
f. Confidante

 

 

ANS:  A, B, C, E

These are the typical roles of the caregiver in mental health services. The caregiver should avoid becoming friends with clients because this can cause strain on the professional relationship. The caregiver also should avoid becoming a confidante of the client because this term usually describes someone whom a person trusts with secret or private matters. This is not a role that the caregiver can play, given that caregivers have a responsibility to share with other team members information pertinent to the client’s care.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 123            OBJ:   7

TOP:   Roles of the Care Providers            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following are characteristics of a therapeutic relationship? (Select all that apply.)
a. Acceptance
b. Rapport
c. Problem solving
d. Genuineness
e. Therapeutic use of self
f. Mutual support

 

 

ANS:  A, B, D, E

The focus of the therapeutic relationship is on the client.  It is consciously directed as the care provider establishes a connection with the client to help him or her cope with life demands.  Acceptance, rapport, genuineness, and therapeutic use of self are the characteristics used to accomplish this.  Problem solving on the part of the care provider does not help the client to cope.  Support is provided for the client, it is not mutual.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 120            OBJ:   4

TOP:   Roles of the Care Providers            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  1. __________ refers to the ability of the nurse to establish a meaningful connection with a client.

 

ANS:

Rapport

Rapport is necessary if a therapeutic relationship is to be established with a client. It involves being accepting, caring, and compassionate and showing a genuine interest in the client.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 120            OBJ:   3

TOP:   Characteristics of the Therapeutic Relationship

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

 

  1. The acronym TEACH represents the components of a therapeutic relationship, including __________, __________, __________, __________, and __________.

 

ANS:

trust, empathy, autonomy, caring, hope

These components serve as the framework for the development of a therapeutic relationship between caregiver and client.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 120            OBJ:   2

TOP:   Characteristics of the Therapeutic Relationship

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

 

OTHER

 

  1. A therapeutic relationship has four phases. Place these phases in proper order. (Separate letters by a comma and space as follows: A, B, C, D.)
  2. Orientation
  3. Termination
  4. Preparation
  5. Working

 

ANS:

C, A, D, B

Each of the phases of the therapeutic relationship has identifiable tasks and goals that must be met before advancement to the next phase.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 121            OBJ:   6

TOP:   Phases of the Therapeutic Relationship

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

Chapter 21: Depression and Other Mood Disorders

Test Bank

 

MULTIPLE CHOICE

 

  1. A prolonged emotional state that influences one’s whole personality and life functioning is called:
a. Mood
b. Feeling
c. Attitude
d. Intellectual response

 

 

ANS:  A

This is the definition of mood. Moods range from elation to despair and can be either adaptive or maladaptive.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 236            OBJ:   1

TOP:   Theories Relating to Emotions and Their Disorders

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

 

  1. The moods of adolescents:
a. Are stable
b. Vary widely
c. Develop slowly
d. Are not related to growth and development

 

 

ANS:  B

The moods of adolescents commonly swing from depression to elation. This is a time of hormonal changes and a time when teens are trying to develop their identity and both gain control over and express their emotions.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 238            OBJ:   3

TOP:   Emotions in Adolescence               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Depression in the elderly is:
a. Rare
b. Common
c. Nonexistent
d. Seen occasionally

 

 

ANS:  B

Major depression affects as many as 40% of older Americans and is seen most often in women, persons with medical illnesses, and those individuals who are living in long-term care facilities.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 238            OBJ:   3

TOP:   Depression in Older Adulthood      KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Theories that view depression as a group of learned responses are called ____ theories.
a. Social
b. Behavioral
c. Biological
d. Psychoanalytical

 

 

ANS:  B

Behaviorists view depression as a group of learned responses. Social theorists view depression as the result of flawed social interactions; biological theory focuses on causes of depression such as biochemical imbalances and genetics; and psychoanalytical theorists believe that mood disorders occur as a result of anger turned inward.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 237            OBJ:   2

TOP:   Theories Relating to Emotions and Their Disorders

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

 

  1. Severe, prolonged depression affects a person’s risk for physical illness by ____ the risk.
a. Decreasing
b. Increasing
c. Not affecting
d. Having little effect on

 

 

ANS:  B

Severe, prolonged depression results in many physical changes and increases one’s risk for illness by lowering an individual’s immune response.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 240            OBJ:   4

TOP:   Major Depressive Disorder             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n) ____ disorder.
a. Anxiety
b. Bipolar
c. Dysthymic
d. Major depressive

 

 

ANS:  C

A dysthymic disorder is daily moderate depression that lasts for longer than 2 years. Anxiety refers to a vague uneasy feeling; bipolar disorder is manic-depressive disorder; and major depressive disorder refers to severe depression.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 240            OBJ:   4

TOP:   Dysthymic Disorder                       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The client’s diagnosis is most likely:
a. Bipolar disorder
b. Major depression
c. An anxiety disorder
d. Dysthymic disorder

 

 

ANS:  A

The hallmark of a bipolar disorder is sudden and dramatic shifts in emotional extremes.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 241            OBJ:   5

TOP:   Bipolar Disorder                             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is most effective in improving symptoms in people who are experiencing:
a. Bipolar disorder
b. Moderate depression
c. Postpartum depression
d. Seasonal affective disorder

 

 

ANS:  D

Daily exposure to full-spectrum light reduces the symptoms of seasonal affective disorder, which is also known as winter depression and typically occurs from October to April.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 242            OBJ:   6

TOP:   Other Problems with Affect            KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. The goal of treatment during the first phase of depression is to:
a. Develop a plan for treatment.
b. Reduce uncooperative behaviors.
c. Help the client to adjust to antidepressants.
d. Reduce symptoms and inappropriate behaviors.

 

 

ANS:  D

The goal during the first phase (acute phase) is to reduce symptoms and inappropriate behaviors. This phase may last 6 to 12 weeks and may require hospitalization. Developing a treatment plan and helping the client to adjust to antidepressants refers to the second phase, which is known as the continuation phase; and reducing uncooperative behaviors may or may not occur with depression.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 242            OBJ:   9

TOP:   Treatments and Therapies               KEY:  Nursing Process Step: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse must be alert to signs of suicidal thoughts with clients in whom major depressive disorders have been diagnosed because approximately _____ die from suicide.
a. 5%
b. 15%
c. 25%
d. 35%

 

 

ANS:  B

This figure makes it vitally important to monitor these individuals for suicidal thoughts.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 240            OBJ:   4

TOP:   Major Depressive Disorder             KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. During the continuation phase of therapy, a client with a diagnosis of depression asks, “What is the goal of therapy during this 4- to 9-month period?” What is the nurse’s best response?
a. “We are going to work together to try to reduce your symptoms.”
b. “Our goal is to determine the cause of your depression and cure it.”
c. “We want to prevent you from ever having any depressive episodes in the future.”
d. “Our goal is to prevent you from relapsing and experiencing distressing emotional states.”

 

 

ANS:  D

The continuation phase is the second phase of therapy for clients with depression. Working together to try to reduce symptoms occurs during the acute phase of treatment. Determining the cause of depression and preventing future depression most likely are not possible.

 

DIF:    Cognitive Level: Application          REF:   p. 243            OBJ:   9

TOP:   Treatments and Therapies               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT).  Which point will the nurse teach the client?
a. “ECT treatments take about 1 hour.”
b. “You will most likely receive between 6 and 12 treatments over several weeks.”
c. “ECT often is used as one of the first treatments for major depression.”
d. “ECT treatments help your depression by decreasing levels of the neurotransmitter norepinephrine.”

 

 

ANS:  B

This is the normal duration for ECT treatments. ECT treatments usually take only about 15 minutes, so it is incorrect to tell the client that they will last 1 hour. ECT is an invasive treatment that is usually a last resort rather than one of the first selected treatments. ECT raises levels of norepinephrine rather than lowering them.

 

DIF:    Cognitive Level: Application          REF:   p. 243            OBJ:   9

TOP:   Treatments and Therapies               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Physiological Integrity

 

  1. A client asks the nurse which types of antidepressants have the fewest side effects. What is the nurse’s most accurate response?
a. “Tricyclic antidepressants”
b. “Nontricyclic antidepressants”
c. “Monoamine oxidase inhibitors (MAOIs)”
d. “Selective serotonin reuptake inhibitors (SSRIs)”

 

 

ANS:  D

SSRIs are the most widely prescribed antidepressants now because of their low incidence of side effects. MAOIs are the last group of choice because of their severe and potentially fatal side effects.

 

DIF:    Cognitive Level: Application          REF:   p. 244            OBJ:   8

TOP:   Drug Therapies—Antidepressants  KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Physiological Integrity

 

  1. A male client with bipolar disorder who takes lithium tells the nurse that he has been “nauseous a lot lately,” feels tired, and has had “some blurry vision.” The client most likely is suffering from what level of lithium toxicity?
a. Insignificant
b. Mild
c. Moderate
d. Severe

 

 

ANS:  C

These are signs of symptoms of moderate lithium toxicity, with blood serum levels of 1.5 to 2.5 mEq/L. Additional signs and symptoms of moderate toxicity include ringing in the ears, irregular tremors, and frank muscle twitching. “Insignificant” is not a level of toxicity. Mild and severe levels of toxicity have signs and symptoms different from those of moderate toxicity.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 246            OBJ:   8

TOP:   Drug Therapies—Antimanics         KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Physiological Integrity

 

  1. Which one of the following are biological causes of mood disorders?
a. Anger turned inward
b. Impaired nurturing
c. Reactions to external stressors
d. Imbalance of neurotransmitters

 

 

ANS:  D

Biological evidence points to several links to mood disorders including defects in neurotransmitter imbalances, which excite or inhibit brain circuits involved in mood regulation and can cause depression. Anger turned inward is a psychoanalytical theory belief. Impaired nurturing and reactions to external stressors are supported by social theorists.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 237            OBJ:   2

TOP:   Biological Evidence                        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client seen in the community mental health clinic appears for one appointment in multiple layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in the waiting room about a date she had the previous evening. The next visit she is dressed in old, drab clothes and has no makeup on. She has a flat affect and is not making eye contact. The most probable cause of her behaviors is which of the following conditions?
a. Bipolar I disorder
b. Psychosis
c. Bipolar II disorder
d. Major depressive episode

 

 

ANS:  A

Bipolar I disorder is characterized by episodes of depression alternating with episodes of mania. Bipolar II disorder is characterized by episodes of depression alternating with episodes of hypomania. Depression and psychosis are not characterized by the signs exhibited in the scenario.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 242            OBJ:   5

TOP:   Bipolar Disorder                             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which client would be a candidate for ECT?
a. A client with mild depression
b. A severely depressed client with congestive heart failure
c. A client with severe, long-lasting depression
d. A severely depressed client with history of a brain tumor

 

 

ANS:  C

ECT is indicated for clients with severe long-lasting depression after attempts to stabilize with other therapies is unsuccessful. It is contraindicated in clients with recent heart disease, high or low blood pressure, stroke, or congestive heart failure.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 243            OBJ:   9

TOP:   Treatment and Therapy: Electroconvulsive Therapy

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

 

  1. Which client is suffering from a major depressive episode?
a. An adolescent who expresses feeling lost after the death of his mother last week
b. A 50-year-old male who has been depressed for a month and is contemplating suicide
c. A 30-year-old female who is being treated for episodes of depression she has suffered since the age of 21
d. An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer given to her 8 days ago

 

 

ANS:  B

A major depressive episode is one in which the depression lasts more than two 2 weeks and encompasses every part of the person’s functioning. Suicide is entertained. Feeling lost one 1 week after the death of a parent is considered minor depression. Major depressive episodes that repeat for more than 2 years is considered a major depressive disorder.

 

DIF:    Cognitive Level: Application          REF:   p. 240            OBJ:   4

TOP:   Major Depressive Disorder             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. Which statements regarding depression are correct? (Select all that apply.)
a. It occurs in all age groups.
b. It rarely occurs in the elderly.
c. It occurs in men more often than in women.
d. It occurs in women more often than in men.
e. It is rarely seen but is severe when it occurs.
f. It is common in those who must cope with illness.
g. It is one of the most common and treatable mental disorders.

 

 

ANS:  A, D, F, G

These are common characteristics of depression. Depression often is seen in the elderly, affecting as many as 40% of the elderly population, and it is not always severe. Depression occurs in a greater number of women than men.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 239            OBJ:   4

TOP:   Emotions throughout the Life Cycle

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

 

  1. In which groups does postpartum depression occur more frequently? (Select all that apply.)
a. Older mothers
b. Younger mothers
c. Women who do not have a husband
d. Women who have had a difficult delivery
e. Women who experienced complicated pregnancies
f. Those who are also coping with illness
g. Women who are not emotionally prepared for motherhood

 

 

ANS:  D, E, G

These women are at higher risk for postpartum depression. Postpartum depression is connected to a hormonal imbalance. The incorrect options are not characteristic of postpartum depression.

 

DIF:    Cognitive Level: Analysis               REF:   p. 242            OBJ:   7

TOP:   Other Problems with Affect            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A client is experiencing an episode at the level of mania. Which behaviors are characteristic of this level? (Select all that apply.)
a. Outgoing, happy, and worry free
b. Decreased ability to concentrate
c. Confident
d. Disoriented
e. Unstable affect
f. Pressured speech
g. Poor hygiene

 

 

ANS:  E, F

Unstable affect and pressured speech are seen most frequently at the mania level of manic behavior. Outgoing behavior, decreased ability to concentrate, and increased confidence are seen at the level of hypomania; disorientation and poor hygiene are seen at the level of delirium.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 241            OBJ:   5

TOP:   Bipolar Disorder                             KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following statements are true regarding depression in the elderly? (Select all that apply.)
a. Highest rates are among individuals who receive long-term care.
b. It is a normal consequence of aging.
c. Most depressed older adults volunteer to share their feelings.
d. Depression is higher in elderly women than elderly men.
e. Older adults express feelings of depression in more subtle ways than younger persons.

 

 

ANS:  A, D, E

Depression is highest in elderly persons who are women, medically ill, and receiving long-term care. Many older adults do not complain or volunteer to share their feelings. It is important to carefully assess and observe the older adults for signs of depression as because they express themselves in more subtle ways, such as changes in daily routine, sleeping, and eating patterns.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 239            OBJ:   3

TOP:   Emotions in Older Adulthood         KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which group of medications for depression will the nurse tell the client to take at bedtime? (Select all that apply.)
a. Tricyclic antidepressants
b. Nontricyclic antidepressants
c. Monoamine oxidase inhibitors (MAOIs)
d. Selective serotonin reuptake inhibitors (SSRIs)

 

 

ANS:  A, D

Tricyclic antidepressants often have the side effect of sedation soon after the dose is given, so it should be taken at bedtime. SSRIs may also cause drowsiness and dizziness, and clients should also be encouraged to be taken take them at bedtime. The other medications should be taken early in the day.

 

DIF:    Cognitive Level: Comprehension   REF:   p. 245            OBJ:   8

TOP:   Drug Therapies—Antidepressants  KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Physiological Integrity

 

COMPLETION

 

  1. __________ is the electrolyte that the nurse must teach the client to monitor in his or her diet when taking lithium.

 

ANS:

Sodium

Clients must monitor sodium intake because of its relationship with lithium.

 

DIF:    Cognitive Level: Knowledge          REF:   p. 244            OBJ:   8

TOP:   Drug Therapies                               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Physiological Integrity

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