Psychiatric Mental Health Nursing 4th Edition by Frisch, Noreen Cavan, Frisch, Lawrence E. – Test Bank A+

Description

1. An individual’s beliefs, behaviors, the way in which that individual communicates his or her beliefs, and the way that person behaves, is within a cultural context.

ANS: T PTS: 1

1. Culture does not have an effect on nonverbal communication.

ANS: F PTS: 1

1. Culture defines the values and norms of a society.

ANS: T PTS: 1

1. Ethnicity includes these elements: ancestry, language, and religion.

ANS: T PTS: 1

1. An ethnic group has a common set of characteristics not shared with other groups with which it comes into contact.

ANS: T PTS: 1

1. Beliefs about causation of illness and disease do not vary across cultures.

ANS: F PTS: 1

COMPLETION

1. A person who attempts to treat all persons fairly by ignoring differences when in actuality there are some cultural differences is said to be displaying ____________________.

ANS: cultural blindness

PTS: 1

1. The belief that one’s own culture is superior to all other cultures is called ____________________.

ANS: ethnocentrism

PTS: 1

1. You are working on a unit that admits a number of people who have recently immigrated to this country and who do not speak English. The hospital employs someone to interpret the language, culture, and cultural health care needs of these clients and to help the nurses better understand the cultural health needs of people from different cultures. The person employed to do this is called a ____________________.

ANS:

cultural facilitator

cultural broker

PTS: 1

1. A student from a rural area of the country who enrolls in a large city college is overwhelmed by the differences in expectations and communications. This student mentions to the college nurse that she is feeling overwhelmed. The nurse would suspect that this student is likely experiencing the condition called ____________________.

ANS: culture shock

PTS: 1

1. Making an assumption that people will think and act similarly because they share certain characteristics is called ____________________.

ANS: stereotyping

PTS: 1

MULTIPLE CHOICE

1. Cultural assessment assumes that the nurse adopt a cultural perspective that includes the interacting viewpoints of objective, subjective, and which of the following?

a.	abstract
b.	contextual
c.	introspective
d.	retrospective

ANS: B

In addition to the objective and subjective viewpoints, the nurse’s cultural perspective would include the contextual viewpoint. The contextual viewpoint refers to the context of the cross-cultural encounter, which includes the broader cultural, socioeconomic, and political inferences operating within the health care system and affecting the client and nurse.

PTS: 1 DIF: Knowledge REF: Cultural Sensitivity

1. To provide culturally safe and effective care, the nurse must understand:

a.	when to stop giving care based on medical guidelines
b.	the entire cultural perspective for each client
c.	the need to refrain from exploring culture to avoid embarrassment
d.	culture-based variations in the who, what, and when of care seeking

ANS: D

Understanding cultural variation regarding the who, what, and when of care seeking is critical for providing culturally safe and effective care because it helps the nurse understand what behaviors and attitudes are considered normal and abnormal in the client’s culture. Furthermore, such understanding of cultural variation will assist the nurse in determining what method of treatment would be most appropriate for the client.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Beliefs about Mental Illness and Care

1. Sociologically, the beliefs about causation of illness tend to fall into the categories of sorcery, intrusion of diseased object, intrusion of a disease-causing spirit, loss of soul, and:

a.	avoiding ancestors
b.	breach of taboo
c.	communicating anger
d.	disrespect of self

ANS: B

Breach of taboo is one of the five categories of beliefs relating to the cause of mental illness. These beliefs are found particularly in less or non-industrialized societies, although they can also be seen, to a lesser extent, in segments of fully industrial societies. These five categories are not exclusive of one another. Some cultures have a combination of these five categories as a basis for their belief regarding the cause of mental illness.

PTS: 1 DIF: Knowledge

REF: Cultural Sensitivity| Beliefs about Mental Illness and Care

1. You have been asked to join a task force to plan for a community mental health center to deal with substance abuse. You are concerned that the center provides culturally acceptable care for a group of Native Americans living in your area. Which of the following strategies would be MOST effective?

a.	Advertise around town about the new center.
b.	Go to the schools and recruit student helpers.
c.	Include a Native American practitioner among the staff.
d.	Call the center “Native Hope.”

ANS: C

Of the three options, including a Native American practitioner on the staff is the best choice. Since the issue at hand is providing culturally acceptable care for Native Americans, a Native American practitioner would be best able to advise the rest of the staff as to which practices would be culturally acceptable. Not only could such an individual help avert actions by the rest of the staff that could be considered culturally insensitive, but he or she could also advise staff on ways to maximize their effectiveness in providing care to Native Americans through their understanding of the culture.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Beliefs about Mental Illness and Care| Care Seeking and Acceptable Care

1. Which of the following groups of people are MOST likely to seek help initially from a folk healer, herbalist, or curandero, rather than making an appointment to see a physician or nurse practitioner?

a.	upper-middle-class Americans
b.	recent immigrants, Native Americans, and Hispanics
c.	people of French, German, and Dutch ancestry
d.	people of English, Scottish, and Irish ancestry

ANS: B

Immigrants, Native Americans, and Hispanics may initially seek help from a folk healer because that has been the traditional healing resource in their culture. The folk healer, herbalist, and curandero traditionally took on the role of “primary health care provider” in these cultures, where physicians and nurses previously were unknown, and even now, may be difficult to access.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Beliefs about Mental Illness and Care| Care Seeking and Acceptable Care

1. You are working with an Asian client. The client has suffered from mental illness for a long time, but has not sought help and is in the hospital now only because of physical problems. From your knowledge of the Asian culture, you suspect that this client was reluctant to seek help for the mental illness because the client was:

a.	afraid of Western, modern medicine administered predominantly by Caucasians
b.	fearful of a terminal diagnosis
c.	not wanting to lose control
d.	of the opinion that the best healing source lies within the family

ANS: D

Many Asian cultures believe that the best source of healing lies within the family and that it may even be counterproductive to seek counseling or therapy outside of one’s family. This belief may be exacerbated by the fact that such counseling methods stem from a Western model, which is not in tune with the healing model traditionally found in Asian cultures.

PTS: 1 DIF: Analysis REF: Cultural Sensitivity| Interpersonal Interaction

1. Beliefs about the role of psychic forces in mental status have:

a.	a cultural and theological basis
b.	been displaced by the DSM-IV
c.	no place in professional care
d.	undermined tolerance for religious orientations

ANS: A

Most beliefs regarding the role of psychic or spiritual forces in mental illness have a strong basis in the culture and theological basis. Because spiritual concerns are deeply entwined with self-perception and perception of the world around us, the nurse providing care must understand the client’s beliefs with regard to self, others, and God or a transcendent being and how these beliefs may affect care.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Culturally Inappropriate Therapy

1. Which of the following would you anticipate from a client who holds the cultural perspective of inequity of status and power?

a.	a request to share a room with another client
b.	an expectation of different levels of care for less important people
c.	asking for family members to bring pictures from home for the room
d.	asking staff many questions about the procedures

ANS: B

A client holding a cultural perspective of inequality of status and power is most likely to expect different levels of care for less important people. Such a person has been conditioned to believe that those of higher socioeconomic status or class receive or deserve better treatment than those of a lower status or class.

PTS: 1 DIF: Analysis REF: Cultural Sensitivity| Cultural Identity

1. When the nurse and client are from two different cultures, there is a likelihood that:

a.	patterns can be readily shared between them
b.	valuing of the feminine perspective will be shifted
c.	situational variables can be similarly interpreted
d.	they will misunderstand each other’s behaviors

ANS: D

Due to the wide variation between cultural beliefs and norms, a nurse and client from two different cultures will likely misunderstand each other’s behaviors. Everything from manner of speech, eye contact, distance between people when communicating, touching, and protocol for interaction between those of different socioeconomic status varies within cultures. For example, one person’s standard for normal eye contact between professional acquaintances may be interpreted by someone of another culture as being hostile or even sexually suggestive.

PTS: 1 DIF: Comprehension REF: Competencies

1. When a client and nurse do not speak the same language, accurate communication can BEST be facilitated through the use of:

a.	gestures
b.	a book of pictures
c.	a culture broker
d.	slow, enunciated speech

ANS: C

A cultural broker would be best able to facilitate accurate communication through his or her understanding of both the language and the culture of the individual. The cultural broker can move beyond simply conveying the message to the client that the nurse wishes. The cultural broker, through his or her understanding of the culture, will have insight into how best to present the information in a manner that will most likely encourage the client’s full participation and cooperation.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Verbal and Nonverbal Communication

1. When using an interpreter, the nurse should do which of the following?

a.	Write out the messages for the interpreter to give the client.
b.	Look at the interpreter while telling him or her what to tell the client.
c.	Have the interpreter write the message in the client’s language.
d.	Speak in his or her own language directly to the client.

ANS: D

The nurse should speak directly to the client for several reasons, even though the client must listen to the interpreter to understand. One reason is that nonverbal cues (e.g., voice tone, eye contact, facial expressions) may be understood by the client, even if the client does not fully understand the words. Another reason is that by talking directly to the client, the nurse is acknowledging the client and his role in the decision making process. If the nurse simply spoke with the interpreter and not the client, the client could get the impression that he or she is not truly involved in the process, beyond that of a spectator.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication

1. A reasonable source of interpreters is:

a.	a supermarket that imports foods
b.	the high school language club
c.	the telephone company
d.	the public aid office

ANS: C

The telephone company is a reasonable source of interpreters because often interpreters are employed by the telephone company to deal with situations involving international calls. Other groups that may be able to provide interpreters or direct the nurse to interpreters are the local consulate or embassy for the country in question, large universities, local cultural centers, and the Internet.

PTS: 1 DIF: Knowledge

REF: Cultural Sensitivity| Verbal and Nonverbal Communication

1. Recognizing that communication is the primary tool of psychiatric mental health nursing, you are cognizant of the impact of nonverbal components such as tone of voice. If a client from a Middle Eastern country approaches you and says in a forceful voice, “Give me your newspaper,” you will:

a.	move away, thinking that the client is dangerous and rude
b.	find out if this tone and behavior is normal in the client’s culture
c.	call for help immediately
d.	have an interpreter tell the client that he or she needs to ask for things politely

ANS: B

The correct response is to find out if the tone and behavior is normal in the client’s culture, because different cultures communicate (even nonverbally) in different manners. In this example, such a request would be considered rude in American culture, but is considered completely normal in Middle-Eastern culture. Such cultural differences in communication are not limited to people of different nationalities, but can exist between people who are from different parts of the same country. For example, some people from the East Coast of the United States find many people from the East Coast (e.g., New York, Boston) to be overly rude, when in fact, such communication is seen as normal on the East Coast.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication

1. You are at a meeting of health care professionals from several countries. If you observe someone from an Arabic or Hispanic country beginning a conversation with someone from America, what are you likely to witness with regard to proxemics?

a.	The person from America will step back, and the Arabic or Hispanic person will step forward.
b.	Both people will move apart before speaking.
c.	The person from America will move closer, while the Arabic or Hispanic person moves back.
d.	Both people will move closer together.

ANS: A

The person from America will step back and the Arabic or Hispanic person will step forward due to the different culture’s perception of personal space. As a general rule, European Americans require a greater distance when talking to professional acquaintances than do Arabic or Hispanic people. In such a situation, the distance comfortable for an Arabic or Hispanic person when talking to a professional acquaintance is too close and too intimate for a European American, and the European American’s preferred distance is too far for an Arabic or Hispanic person.

PTS: 1 DIF: Analysis

REF: Cultural Sensitivity| Verbal and Nonverbal Communication| Proxemics (Space and Distance)

1. Touch is an important part of therapeutic nursing and conveying comfort. However, the cultural meaning and the cultural contexts of touch must be considered. As a culturally competent nurse, which is the BEST approach to using touch?

a.	Discuss the expectations of touch with the client to avoid miscommunication.
b.	Avoid using touch with any client, regardless of age, of the opposite gender.
c.	Consult with the attending provider about using touch with a particular client.
d.	Wear gloves whenever first touching any client, so he or she will not fear contamination.

ANS: A

The best approach for the nurse is to discuss the expectations of the touch with the client, because different cultures have very different norms regarding when, where, and who can touch another person, even in a health care environment. Explaining the intended purpose of any touching of the client by the health care practitioner can help avert misinterpretation of those actions by the client.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication| Touch

1. A large percentage of the world’s Hispanic population believes in mal ojo, whereby:

a.	an animal casts an evil spell on a child and makes the child sick for a long time
b.	witches make a child ill
c.	a child becomes ill if given excessive admiration or admiration without touching
d.	the child’s eyes become bad if a person looks at him or her

ANS: C

Mal ojo (more commonly termed Mal de Ojo) means “evil eye.” Although many cultures have a general concept of the evil eye, each culture has its own variation on the central theme. In Hispanic cultures, infants and children are especially susceptible to mal ojo. Common protective measures include placing an amulet on the child.

PTS: 1 DIF: Knowledge

REF: Cultural Sensitivity| Verbal and Nonverbal Communication| Touch

1. You are speaking with an Asian client. During an interaction with this client, you would do which of the following as a culturally competent nurse?

a.	Immediately reply to the client’s remarks.
b.	Carry most of the conversation to decrease the client’s anxiety.
c.	Wait in silence a few moments before answering.
d.	Talk through any silences to maintain a connection.

ANS: C

The proper course of action is to wait a few moments in silence before answering, because this is considered most appropriate in many Asian cultures. Different cultures have different protocols regarding responding to one another during conversation. Hispanic people tend to respond before the original speaker has finished talking. European Americans tend to respond immediately after the person stops talking. Asian people tend to respond only after waiting a few seconds in silence after the person has finished talking. In all of these cultures, responding too early or too late (based on their norms) could be considered undesirable.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication| Silence

1. You are working with an elderly farmer from near Salisbury, Maryland. During an interaction with him, he asks you a question and you:

a.	immediately respond to his inquiry, using reflection
b.	provide in-depth explanation to the question
c.	wait in silence a few moments before answering
d.	talk through any silences to maintain a connection

ANS: A

The proper course of action is to immediately begin answering after the person has finished asking his question, because this is considered most appropriate in European American culture. Different cultures have different protocols regarding responding to one another during conversation. Hispanic people tend to respond before the original speaker has finished talking. European Americans tend to respond immediately after the person stops talking. Asian people tend to respond only after waiting a few seconds in silence after the person has finished talking. In all of these cultures, responding too early or too late (based on their norms) could be considered undesirable.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication| Silence

1. American social interactions are generally considered to be:

a.	stylized
b.	rigid
c.	respectful
d.	informal

ANS: D

American social interactions are considered fairly informal compared to many other cultures. It is quite rare for people in differing socioeconomic groups, let alone an employee speaking to his superior, to call each other by their first names. Furthermore, such a personal and informal interaction even among social equals would not occur nearly as quickly in other cultures as it does in American culture, where first names are often used upon initial introduction to others.

PTS: 1 DIF: Knowledge REF: Cultural Sensitivity| Cultural Awareness

1. As a culturally competent nurse, you know that if a client comes from a culture that emphasizes the present time frame, you can expect the client to:

a.	express interest in working with you on client outcomes
b.	make health care appointments well in advance
c.	delay gratification for the benefit of a future outcome
d.	deal with what is deemed pleasing at the moment

ANS: D

The client will most likely deal with what is pleasing at the moment, because his emphasis on the present time frame will place less importance on future events. Because the future is not the focus of such a person, delaying gratifications is not seen to be of great benefit. What is happening right now is of primary importance to this type of person.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Time Orientation

1. Biological variation, an important cultural consideration, may account for which of the following differences in Asians when compared to Caucasians?

a.	require smaller doses of neuroleptics
b.	require higher doses of pain medication
c.	are more often misdiagnosed as psychotic
d.	more rapidly metabolize medications

ANS: A

Research by Andrews and Boyle (2008) suggests that Asians require smaller doses of neuroleptics. This may be due in part to a slower metabolism and the low-protein, high-carbohydrate diet of Asians in comparison to European Americans.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Biological Variation

1. There is variety in the way people organize activities from one culture to another. In some cultures, people tend to be sequentially organized. Sequentially organized people tend to do which of the following?

a.	complete one task at a time and be punctual
b.	do many tasks at once and be late
c.	delegate tasks to others
d.	organize others as well as self

ANS: A

Sequentially organized people (as the name implies) organize their activities in sequence. Sequentially organized people prefer to focus their attention on one task at a time and not begin another task until the previous one has been completed. This contrasts with synchronically organized people who can (and in many cases prefer to) carry out two or more tasks at once.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Time Orientation

1. A young adult male is selling artifacts at a local arts and crafts festival along with several members of his extended family who are from an island in Southeast Asia. He is brought to the community mental health center by the police for evaluation for involuntary admission for psychiatric intervention following an “incident” with a customer at the festival. He is accompanied by several members of his family. One of the police officers remarks, “The whole family is acting nuts.” During your assessment, you determine that the family is very confused and puzzled as to why the incident occurred and why the police were called. This family most likely views the young man’s behavior during the “incident” as:

a.	a form of mental illness that needs formal psychiatric treatment
b.	unusual, eccentric behavior that should be managed independently by the family
c.	normal behavior that is explained by their culture of origin
d.	a response to stress that requires religious ritual cleansing to correct

ANS: C

The family views the young man’s behavior as normal because they share the same culture and have an understanding of the context in which this behavior is considered appropriate. There is no universal definition for mental illness that spans across cultures. Behavior that may be considered extremely inappropriate, and perhaps a sign of mental illness, in one context and culture may be perfectly normal in another context or culture.

PTS: 1 DIF: Analysis REF: The Culturally Competent Mental Health Nurse

1. You make a home visit to a 32-year-old single woman who has worked for the same company for 22 years and has lived with her parents all of her life. She has been referred for psychiatric consultation by a home health nurse because she looks almost continuously at the floor, exhibits very little range or spontaneity of affect, and waits for her parents to comment or direct her before she responds to any questions or comments. The parents have always been present throughout the home health nurse’s visits. When you interview her by herself, she maintains eye contact, displays animated affect, readily answers all questions, and voices contentment with her life circumstances. As a culturally competent psychiatric nurse, you view this referral as having occurred primarily because:

a.	the client displayed objective signs of mental illness as defined by the DSM-IV
b.	of family dynamics that require a referral for adult protective services investigation
c.	the client needs help to integrate the home health care treatment culture
d.	of the home health nurse’s cultural norms related to mental illness and treatment

ANS: D

The home health nurse made the referral based on her own beliefs regarding normal behavior and indications of mental illness. In many cultures, behaviors such as not making direct eye contact to those senior and taking on an explicitly subordinate role when in the presence of one’s elders not only is considered normal but to do otherwise would be considered highly aberrant. The client may have learned to adjust her behavior depending upon whether she is in the presence of her parents, who may expect such submissive behavior, and when she is not in their presence.

PTS: 1 DIF: Analysis REF: The Culturally Competent Mental Health Nurse

1. You are working as an on-call emergency mental health clinician in a large American city. You are called to the emergency department to assess a second-generation American of an immigrant family. To provide culturally competent care, your assessment needs to be based on all EXCEPT which of the following?

a.	the culture of origin
b.	the culture of the society where treatment is being initiated
c.	your own cultural norms related to mental illness and treatment
d.	client’s display of objective signs of mental illness as defined by the DSM-IV

ANS: D

The nurse’s assessment would not be based on displays of objective signs of mental illness as defined by the DSM-IV due to differing cultural norms for behavior. What may be seen as a clear sign of mental illness in one culture (e.g., talking to spirits, spontaneous chanting) could be perfectly normal in the client’s culture. The nurse must use all of the information available, including knowledge of the client’s culture, to make an assessment.

PTS: 1 DIF: Application REF: The Culturally Competent Mental Health Nurse

1. You have been providing culturally competent care to a client at a mental health clinic for several years. The client has responded well to the current treatment program. You observe a student nurse greet this client in the clinic waiting room by the client’s first name. When the client starts to walk in the wrong direction, you observe the student nurse’s attempt to physically guide the client by touch. The client reacts by flailing the arms and pushing the student nurse away. You help the student nurse to identify the most likely areas that produced miscommunication during this interaction as all EXCEPT which of the following?

a.	proxemics
b.	formal style of interaction
c.	use of the client’s first name
d.	ethnocentric behavior of the student nurse

ANS: B

The student’s behavior is not considered a formal style of interaction. Touching the client and using the client’s first name is considered by many to be very informal. In some cultures doing so in a professional environment could be considered extremely rude. The student nurse should be advised on what would be considered a more appropriate style of interaction between the nurse and a client from this culture.

PTS: 1 DIF: Analysis REF: Cultural Sensitivity| Cultural Awareness

1. A nurse is caring for a client whose culture is different from the nurse’s. The nurse recognizes that according to Andrews and Boyle (1999) which of the following would be considered an action cue of nonverbal communication that the nurse needs to assess?

a.	the client’s tone of voice
b.	the client’s facial expression
c.	the quality of the client’s voice
d.	the clothing worn by the client

ANS: B

Andrews and Boyle (1999) divided nonverbal components into five categories: action cues, vocal cues, object cues, care of belongings and use of personal and territorial space, and touch. Action cues would include posture, facial expression, and gestures. Tone and quality of voice are considered vocal cues, while clothing worn would be considered an object cue.

PTS: 1 DIF: Application

REF: Cultural Sensitivity| Verbal and Nonverbal Communication

1. The nurse administering medications to mental health clients would recognize which of the following to be TRUE regarding psychotropic and tranquilizing medications?

a.	Asian Americans may need higher doses of psychotropic and tranquilizing medications.
b.	Pacific Islanders should never be prescribed tricyclic antidepressants.
c.	Up to 20% of Blacks may metabolize Valium poorly.
d.	Agranulocytosis is seldom seen in Jewish American clients receiving clozapine.

ANS: C

The nurse administering psychotropic and tranquilizing medications would recognize that up to 20% of Blacks may metabolize Valium poorly. Asian Americans may need lower doses of these medications. Asians and Pacific Islanders may need only the usual dose of tricyclic antidepressants. In addition, Jewish North Americans and other Ashkenazi may develop agranulocytosis when clozapine is used for schizophrenia.

PTS: 1 DIF: Comprehension

REF: Cultural Sensitivity| Biological Variation

CHAPTER 9 ETHICAL AND LEGAL BASES FOR CARE

TRUE/FALSE

1. Normative ethics is a term used for guidelines and procedures useful in establishing moral decisions and actions.

ANS: T PTS: 1

1. Nurses rarely confront ethical decisions.

ANS: F PTS: 1

1. Nurses are often relieved after studying ethics, as ethical study can tell a nurse exactly how to behave in any given decision.

ANS: F PTS: 1

1. Law most often dictates what a person must not do, while ethics most often dictates what a person should do.

ANS: T PTS: 1

1. In the American Holistic Nurses Association’s code of ethics, nurses have a responsibility to model health behaviors, including achieving harmony in their own lives.

ANS: T PTS: 1

COMPLETION

1. An individual’s obligation to honor commitments and contracts is the definition for the ethical principle of ____________________.

ANS: fidelity

PTS: 1

1. The ethical principle described as the belief that all treatments must be done for the good of the client is ____________________.

ANS: beneficence

PTS: 1

1. The two broad ethical theories that guide the development of professional ethics are deontology and ____________________.

ANS: utilitarianism

PTS: 1

1. The ethical principle that is least often considered in professional codes of ethics is the principle of ____________________.

ANS: justice

PTS: 1

1. The ethical principle that caregivers, including nurses, must above all else do no harm is the principle of ____________________.

ANS: nonmaleficence

PTS: 1

MULTIPLE CHOICE

1. The American Holistic Nurses Association published a code of ethics for nursing practices. The Code of Ethics for Holistic Nurses contains provisions for:

a.	only the nurse’s responsibilities toward clients
b.	the nurse’s responsibilities toward clients and the facility
c.	the client’s responsibilities toward the nurse, and the nurse’s responsibilities toward the client
d.	the nurse’s responsibilities toward the client, coworkers, the self, the environment, and other nurses

ANS: D

The American Holistic Nurses Association code of ethics includes many of the principles of other nursing ethical codes (responsibilities toward client and coworkers and protection of the client from harmful acts). In addition, this code adds provision for nurses’ responsibilities toward self and the environment and their behavior toward other nurses.

PTS: 1 DIF: Knowledge

REF: Ethical Issues in Psychiatric Mental Health Nursing| Normative Ethics| Reflective Thinking

1. You are the nurse working on the night shift. You are assigned a middle-aged client who was admitted through the emergency room 4 hours previously. The lab work is not completed or available. The client is from another city, so the family has not been in. The attending physician has not yet seen the client, who seems somewhat confused. The charge nurse has requested that a sedating medication be given. The provider has been called, and a telephone order for a sedative has been received. You are in conflict about this medication order because you believe it violates the ethical principle of:

a.	beneficence
b.	confidentiality
c.	fidelity
d.	justice

ANS: A

You are in conflict about this medication order because you believe it violates the ethical principle of beneficence.Your concern is that the lab work is not available to determine whether negative consequences could occur as a result of the medication.Beneficence is the view that all treatments must be for the client’s good.

PTS: 1 DIF: Analysis

REF: Ethical Issues in Psychiatric Mental Health Nursing| Ethical Theories

1. When applying the value analysis model, the first question to ask yourself is:

a.	What are the true reported facts about the client?
b.	What is the value question that I identify?
c.	Would this principle fit if this client were my parent?
d.	Would I be legally liable?

ANS: B

The first question asked when applying the value-added model would be what value question is being identified. The nurse must identify and clarify the value question when making ethical decisions. Without a clear understanding of the question at hand, a final decision becomes very difficult.

PTS: 1 DIF: Application

REF: Ethical Issues in Psychiatric Mental Health Nursing| Making Ethical Decisions| Steps of Value Analysis Model

1. You find yourself in a situation in which you are uncertain about following a provider’s order for a medication. You feel uncomfortable giving the medication based on your assessment or lack of information about the client’s health history or status. When applying the value analysis model, which question would you use to come to a decision?

a.	What are the true reported facts about this client?
b.	What is the value question that I identify?
c.	Would this principle fit if this client was one of my parents?
d.	Would I be legally liable if anything goes wrong?

ANS: C

If you are uncomfortable regarding a medication order based on your assessment or lack of information, you should ask yourself if the principle would fit if this were one of your parents. This question is one from the value analysis model. By asking this question, you are testing the value principle by putting yourself in the position of a person involved with the decision.The situation becomes more personal when it relates to your own parents.

PTS: 1 DIF: Application

REF: Ethical Issues in Psychiatric Mental Health Nursing| Making Ethical Decisions| Steps of Value Analysis Model

1. A nurse is working with a young adult who has a history of severe anxiety. This client tells the nurse that he uses cannabis to calm down. In your state, cannabis is illegal, even for medical use. The nurse judges that this law is against the interest of the client and advises the client to continue to self-medicate. In so doing, the nurse is:

a.	at risk of being judged guilty of unethical behavior
b.	being unconditionally supportive of the client
c.	supporting the ethical principle of nonmaleficence
d.	within the parameters of scope of practice for the profession

ANS: A

Even though the use of the drug is in the client’s best interest, because it is against the law in this state the nurse is at risk of being judged guilty of unethical behavior. Nurses and other mental health professionals risk being judged guilty of unethical behavior if they violate laws, even laws they judge to be against the interest of their clients. If a nurse disagrees with a law, the nurse should take action to change the law.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Ethical Actions for the Social Good

1. Maintaining confidentiality is a nurse’s:

a.	privilege
b.	obligation
c.	decision
d.	choice

ANS: B

It is generally recognized that nurses have an obligation to maintain confidentiality. In any situation, where a client can show that a breach of confidentiality has caused the client damage (e.g., damage to his or her reputation), the client may sue the nurse in civil court for inappropriate disclosure of professional, confidential information.

PTS: 1 DIF: Knowledge

REF: Legal Issues in Psychiatric Mental Health Nursing: Right to Privacy

1. A client diagnosed with a mental disorder has the right to enter into legal contracts unless he or she has:

a.	contracted with the nurse to give up that right
b.	been judged incompetent via a legal procedure
c.	been convicted of a serious crime such as a felony
d.	family members to do it for him or her

ANS: B

A client diagnosed with a mental disorder has the right to enter into legal contracts unless he or she has been judged incompetent via a legal procedure. Probate proceeding are often carried out to establish a judicial ruling that an individual is or is not competent to manage activities. These are court proceedings wherein a judge hears evidence of the individual’s ability to function and makes a judgment of “competence” or “incompetence.” Incompetence is a legal term reflecting that the individual has a mental disorder, the disorder causes inability to make judgments, and the disorder renders the person unable to handle his or her own affairs.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Enter into Legal Contracts

1. You are working with a young adult client who attempted suicide and has been hospitalized. The client’s mother and wife have been calling the hospital asking if the client has been admitted. The client has not signed any release-of-information forms and refuses to sign anything. He refuses to see anyone, have any visitors, or let anyone know he is in the hospital. Your BEST response to the wife and mother is which of the following?

a.	“Yes, but he won’t talk with you.”
b.	“You will have to call his doctor to get a report.”
c.	“I cannot tell you if he is here or not; however, if he is, I will give him your telephone number.”
d.	“There is no way that I can tell you anything about any of the clients here in this hospital.”

ANS: C

The nurse’s best response is to tell the caller that the nurse cannot say if the client is on the unit or not. The nurse can also suggest that the callers leave their telephone number. To say, “Yes, but he won’t talk with you,” violates the client’s right of confidentiality. To say, “You will have to call his doctor to get a report,” places the responsibility on the doctor; however, the nurse should know that the doctor is bound by the same legal principles. To say, “There is no way that I can tell you anything about any of the clients here in this hospital,” demonstrates poor communication skills by the nurse.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Right of Privacy| Reflective Information

1. To release information to another health care facility or third party regarding a client with a psychiatric diagnosis, the nurse must obtain which of the following?

a.	signed release-of-information form stating specific information to be released
b.	verbal consent of the client and the client’s guardian or next of kin
c.	signed release-of-information form from the attending psychiatrist
d.	permission from the health care team, including all who participate in treatment planning

ANS: A

To release information to another health care facility or third party, the nurse must obtain a signed release from the client. This release must be in writing and identify which parts of a clinical record can be released and to whom.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right of Privacy

1. Anyone providing health care services as a “covered entity” is required to comply with the U.S. Department of Health and Human Services (HHS) regulations concerning privacy and confidentiality under the Health Insurance Portability and Accountability Act (HIPAA), implemented in 2003. Mental health facilities are considered to be “covered entities” if they:

a.	employ less than five service providers
b.	exchange billing or insurance eligibility data by electronic means
c.	provide care on a “fee for service” basis
d.	make and record psychiatric diagnoses according to the DSM-IV

ANS: B

Mental health facilities are considered to be “covered entities” if they exchange billing or insurance eligibility data by electron means. The HIPAA regulations provide civil and criminal penalties when patient information is released inappropriately.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Privacy

1. In a medical emergency, Health Insurance Portability and Accountability Act (HIPAA) regulations allow for sharing clinical information with other persons providing care, even without the client’s explicit permission. However, this is:

a.	without restriction or written or verbal authorization for the duration of the emergency
b.	including any and all information that is authorized by the next of kin
c.	if the receiving health care provider requests it
d.	including only information that is reasonably necessary to safely resolve the emergency

ANS: D

In medical emergencies, HIPAA regulations allow for sharing clinical information with other persons providing care without the client’s explicit permission. However, this is based on a “need to know basis” and includes only information that is reasonably necessary to safely resolve the emergency.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Privacy

1. A psychiatric nurse is called to the pediatric unit to assess a child for possible abuse. The nurse knows that the Health Insurance Portability and Accountability Act (HIPAA) regulations:

a.	require the nurse to contact the child’s legal guardian before reporting possible abuse
b.	do not limit the nurse’s right or obligation to report evidence of child abuse
c.	leave it up to each individual health care provider as to what constitutes reportable abuse
d.	stipulate that the nurse must be able to prove that abuse has occurred before reporting it

ANS: B

The HIPAA regulations do not limit the nurse’s right or obligation necessary to save life or to comply with the law. If a nurse suspects child abuse, the nurse is required by law to report it to the appropriate authorities.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Privacy

1. The emergency department nurse manager observes one of his staff nurses reading the admission history of a client being admitted to the psychiatric unit after an overdose. The staff nurse was not assigned to nor involved in the client’s care while the client was treated in the emergency department. The nurse manager knows that under the Health Insurance Portability and Accountability Act (HIPAA) regulations:

a.	this is a violation of the client’s privacy
b.	the staff nurse has legal access to the record under the emergency care provisions
c.	any health care provider working at the facility has legal access to any client’s record
d.	the nurse may read the record, but may not divulge its contents to anyone else

ANS: A

The nurse manager knows that under HIPAA regulations, it is a violation of the client’s privacy for a staff member to read the records, if the staff member is not involved with the care of the client. Conversely, HIPAA does not prevent sharing clinical information with persons who are providing care to an individual and have a clear “need to know” about the client.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Privacy

1. Competency to stand trial requires that an individual be able to:

a.	pass a test to ensure orientation in four areas
b.	prove that he or she is not delusional or hallucinatory, nor psychotic in any way
c.	understand the nature of legal proceedings and be able to tell his or her story to the attorney and court
d.	know right from wrong and can prove this through taking a battery of projective tests

ANS: C

Competency to stand trial requires that an individual be able to understand the nature of legal proceedings and be able to tell his or her story to the attorney and court. Tests of competency can vary from individual to individual.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Enter into Legal Contracts

1. The M’Naghten test requires that if a defendant either does not know the significance of his or her actions or does not know that it was wrong, he or she:

a.	must be hospitalized
b.	can still be tried in criminal court
c.	must be appointed a guardian
d.	cannot be held legally accountable

ANS: D

The M’Naghten test requires that a defendant either does not know the significance of his or her actions or does not know that it was wrong; he or she cannot be held legally accountable. The legal definition of the M’Naghten test was put forth after a famous nineteenth-century murder trial in which Daniel M’Naghten was found not guilty by virtue of insanity.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Enter into Legal Contracts

1. In regard to intimate or sexual relationships with present or former clients, the ANA Standards of Psychiatric-Mental Health Clinical Nursing Practice:

a.	discourage these intimate or sexual relationships
b.	have nothing written on this subject, leaving it to the state boards of nursing
c.	forbid such interactions with present or former clients
d.	recommend a waiting period of 5 years after caring for a client

ANS: A

The ANA Standards of Psychiatric-Mental Health Clinical Nursing Practice explicitly prohibits intimate or sexual relationships with present or former clients. Sexual liaisons between therapist and client are prohibited by statute in a number of states. Violation of such statutes may result in loss or suspension of one’s professional license.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Sexual Involvement with Clients

1. The client’s right of habeas corpus means that the individual has the right to:

a.	have clear information about treatment options
b.	handle personal affairs, and make decisions for him- or herself
c.	have a speedy legal hearing and evaluation
d.	withdraw consent for treatment at any time

ANS: C

Habeas corpus is a right protected by the U.S. Constitution that permits a speedy legal hearing and evaluation for any individual who claims he is being detained illegally. In such a hearing, a judge (and at times a jury as well) hears evidence and makes a determination of whether or not the individual may be released or detained for psychiatric treatment.

PTS: 1 DIF: Knowledge

REF: Legal Issues in Psychiatric Mental Health Nursing| Right of Habeas Corpus

1. A client has been on the unit for an evaluation. A hearing for this client was scheduled and held. The outcome was a ruling of incompetence. What is the next likely step?

a.	A conservator will be appointed to handle the client’s affairs.
b.	The client will be accorded the right to refuse treatment and refuse medications.
c.	The client will need to stand trial for the M’Naghten test.
d.	The nursing staff will need to seclude the client.

ANS: A

If a client is found incompetent, the next step would be to appoint a conservator of the person or a conservator of the estates for persons whose mental status makes them unable to care for their daily needs or to handle their financial affairs. Many individuals who are mentally ill, retarded, or demented will need conservators. Some states allow an individual to select his or her own conservator (subject to court approval).

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Enter into Legal Contracts

1. Other than the client’s right to autonomy, which of the following is one of the explicit considerations in deciding to medicate a client against his or her will?

a.	anxiety of other clients on the unit
b.	alternative, less-intrusive treatments
c.	cost of the medication if poured and refused
d.	voluntary or involuntary admission status

ANS: B

Explicit consideration in deciding to medicate a client against his or her will is determining whether this action violates the client’s right to autonomy and whether alternative, less-intrusive treatments are available. Other considerations are the benefits of the treatment and what is in the client’s best interest. Issues of treatment refusal are in some cases being addressed by psychiatric advance directives. With advance directives a client may indicate–while well–the conditions under which he or she would consent to treatment should he or she become ill and unable to make decisions.

PTS: 1 DIF: Comprehension REF: Right to Refuse Treatment

1. Which phrase is used to describe urgent institutionalization for a short period for evaluation of a person’s mental status?

a.	against-the-will commitment
b.	beneficent action
c.	competency hearing stay
d.	emergency hospitalization

ANS: D

Emergency hospitalization is the power of states to detain a person in an emergency situation for a limited time until further evaluation and court proceedings can occur. Emergency hospitalization is usually for a short period only, typically 48 to 72 hours, and allows the need for longer inpatient treatment to be assessed.

PTS: 1 DIF: Knowledge

REF: Legal Issues in Hospitalization and Inpatient Treatment

1. What is the main distinction between involuntary hospitalization and involuntary commitment?

a.	The client is in the criminal justice system, not the health care system.
b.	The amount of direct one-on-one attention required by the client differs between the systems.
c.	The psychiatrist’s decision has no impact on the client in either system.
d.	The length of stay is much shorter when involuntary commitment is involved.

ANS: A

The major difference between voluntary hospitalization and involuntary commitment is that the individual who is admitted involuntarily is part of the legal system. Involuntary admissions are generally only invoked if the individual is judged potentially harmful to self, harmful to others, or unable to care for self.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues in Hospitalization and Inpatient Treatment

1. Which statement is applicable to the involuntarily hospitalized client? The client has:

a.	forfeited the right to informed consent
b.	lost the right to control personal affairs
c.	retained the right of free will to leave at any time
d.	retained the right to receive and refuse treatment

ANS: D

Clients admitted involuntarily retain the right to receive and refuse treatment. They also retain the right to informed consent and the right to control personal affairs. However, they lose the right of free will to leave the hospital at any time.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues in Hospitalization and Inpatient Treatment

1. Although procedures for decisions about civil involuntary commitment vary from state to state, almost all involve a court hearing. Which standard is likely to be used to decide if the person is to be hospitalized?

a.	availability of conservator
b.	beyond a reasonable doubt
c.	clear and convincing evidence
d.	habeas corpus

ANS: C

Procedures for approving civil commitment, court hearings may use a standard of “clear and convincing evidence.” This standard is lower than the “beyond a reasonable doubt” standard used in criminal cases. Availability of conservator and habeas corpus are not court standards.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues in Hospitalization and Inpatient Treatment

1. You are assigned to work with a young adult, single female seen in the emergency department after a suicide attempt that involved a drug overdose. This client has told the staff, “I don’t want to go on, just let me die.” Her blood pressure readings have been extremely erratic. She has a history of drug abuse, and detoxification management is in order. When this client’s roommate asks you to have her admitted, you respond:

a.	“She doesn’t want help, so I doubt that she’ll be admitted.”
b.	“What kind of insurance does she have? It might only cover part of the care.”
c.	“That’s not up to me. It depends on how many times she has done this before.”
d.	“For her safety, the doctor can seek to have her hospitalized involuntarily.”

ANS: D

Clients who attempt suicide can be admitted to the hospital involuntarily by the physician for the clients’ own safety. Reasons for involuntary admissions are potentially harmful to self, potentially harmful to others, or unable to care for self. Because the client has attempted to suicide, has a history of drug abuse, and states she does not want to go on, she is a safety risk to herself.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues in Hospitalization and Inpatient Treatment

1. On assessing a young adult client who is admitted after a suicide attempt and also has a habitual drug-abuse problem, you note that this client is agitated, restless, and sweating, and has obviously begun withdrawal. You note that the client refused medication when the staff tried to administer it in the emergency department. Under the circumstances, what is the next thing you will do?

a.	Explain to the client that he or she must take the medication because the provider ordered it.
b.	Make sure the room is quiet with subdued lighting and that there are blankets if needed.
c.	Talk with the client about the impending discomfort and potential hazards of withdrawal.
d.	Get an order for restraints so the client will be protected and you can administer the medication.

ANS: B

If a client, with a history of a drug abuse problem, is admitted after a suicide attempt and is refusing medications, the most appropriate intervention by the nurse is to make sure the room is quiet with subdued lighting and that there are blankets if needed. The client has the right to refuse the medication. By making sure the room is quiet and providing a blanket, the nurse is addressing the complications of the drug withdrawal. The subdued lighting will reduce unnecessary environmental stimulation and the blanket can be used if the client becomes chilled because of the excess sweating.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues in Hospitalization and Inpatient Treatment

1. When you check the vital signs of a client who is suicidal, the client tells you, “Go away, I’m not worth saving,” and “Take that thing off of my arm.” In addition to talking to this client, what do you do?

a.	Leave the room.
b.	Call for help.
c.	Leave the blood pressure (BP) cuff on while you discuss options with the client.
d.	Move the cuff to the other arm, and hope the client will be too busy to notice.

ANS: C

If a suicidal client refuses treatment and asks the nurse to remove the BP cuff and go away, the nurse should remain with the client and leave the BP cuff on while discussing the options with the client. Communicating with the client is needed to develop a trusting relationship. It is important for the nurse to explain to the client the need to monitor the BP after a suicide attempt. Changes in vital signs are an indication of whether the client’s physical status is improving or declining.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Refuse Treatment

1. A client who is suicidal and is withdrawing from controlled substances continues to be agitated and disruptive. When a neuroleptic medication is ordered for agitation, you question its use because you know:

a.	the client is a drug abuser and may be reacting this way to get a dose of drugs
b.	all neuroleptics require metabolism through the liver, and drug abusers can’t have neuroleptics
c.	chemical restraint is regarded as unethical
d.	the client has a right to die, if he or she so chooses

ANS: C

Because the client is withdrawing from controlled substances, the use of chemical restraint would be regarded as unethical. The use of chemical restraints could violate the treatment principle of the least restrictive alternative, as well as compromise the client’s health as a result of a drug reaction. Other less restrictive options for behavioral control should be explored.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Control of Violent or Self-Destructive Behaviors

1. A drug-abusing client who has detoxified in the hospital is to be discharged. You make an appointment for this client to be seen at the community mental health clinic. You do this as an example of your ethical:

a.	autonomy
b.	justice
c.	nonmaleficence
d.	obligation

ANS: D

If a client has been detoxified as a result of drug abuse, the nurse has a legal obligation to refer the client to appropriate follow-up care in the community. The community referral would ensure that continuity of care continues after discharge.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues Related to Care in the Community

1. Mental health professionals working with clients who have psychiatric problems or drug abuse problems have an obligation to:

a.	arrange for continuing care and follow-up of the client
b.	bill for all services provided to the client in advance
c.	provide the client with a free copy of all written records, such as the chart
d.	see the same client in both the inpatient and outpatient settings

ANS: A

Mental health professionals working with clients who have psychiatric problems or drug abuse problems have an obligation to arrange for continuing care and follow-up of the client. Clinicians make an implicit contract with their clients at the time of initiating care that they will provide continuing service. Continuing care after discharge implies referral to an appropriate outpatient facility.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Legal Issues Related to Care in the Community

1. Which of the following is the BEST definition of negligence?

a.	failure to behave in a way that a prudent individual would
b.	failure to ensure fairness, equity, and honesty
c.	legal principle that the client be treated with the least constraint to his or her liberty, consistent with safety
d.	judicial determination of the competence of the client to manage personal affairs

ANS: A

The best definition of negligence is failure to behave in a way that a prudent individual would. Individuals who are negligent fail to use the diligence and care expected of a reasonable individual in similar circumstances.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Professional Negligence

1. Which of the following is an example of professional negligence?

a.	provision of care in spite of a client’s refusal of treatment
b.	failure to warn potential victims of a dangerous client’s behavior
c.	damages sought because reasonable care was not provided
d.	failure to change treatment to the newest method available

ANS: C

Professional negligence results when reasonable care is not provided. In this situation, damages can be sought. In general, professional negligence occurs when there was a duty, the duty was not performed by the professional and harm occurred as a result of the professional not performing the duty.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Professional Negligence

1. Warning a potential victim about a threat to his or her safety made by a client is known as:

a.	negligent behavior
b.	breach of confidentiality
c.	shirking of duty
d.	duty to warn

ANS: D

In situations when a client discloses that he or she is likely to inflict harm on another, the health care provider has a “duty to warn” the person. The health care professional has a legal obligation to ensure that the potential victim is warned so that protection may be sought.

PTS: 1 DIF: Knowledge

REF: Legal Issues in Psychiatric Mental Health Nursing| Failure to Prevent Dangerous Client Behavior

1. Following appropriate guidelines for commitment, informed consent, and medication treatment can protect the nurse against lawsuits for:

a.	breach of confidentiality
b.	failure to honor individual rights
c.	breach of the least restrictive alternative principle
d.	failure to provide appropriate treatment

ANS: B

Following appropriate guidelines for commitment, informed consent, and medication treatment can protect the nurse against lawsuits related to failure to honor individual rights. If the nurse understands and respects the rights of the client than the other options would be included. Client rights are a more global issues and would encompass the other options listed.

PTS: 1 DIF: Comprehension

REF: Legal Issues in Psychiatric Mental Health Nursing| Failure to Honor Individual Rights

1. Which of the following is an example where it is acceptable to share information about a client with another person?

a.	when the client’s caring and concerned spouse requests information
b.	when nurses from other institutions or facilities meet to discuss client-education ideas
c.	when the client threatens to harm a specific person
d.	when you discuss the day’s events with your own nurse-psychotherapist

ANS: C

When a client threatens to harm a specific person, the health care provider has a legal obligation to warn the person. The other options would result in a violation of the client’s right to privacy.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Failure to Prevent Dangerous Client Behavior

1. Sometimes nursing staff must make special efforts to ensure the safety of other clients when a client is agitated and aggressive toward others. Efforts include such interventions as requesting on-site police or guards, one-to-one staffing, or:

a.	doubling the dose of medication
b.	putting the client in a separate room
c.	using chemical restraints
d.	transferring the client to another ward

ANS: B

Efforts to ensure the safety of others when a client is agitated and aggressive toward others include such interventions as seclusion. Seclusion is putting someone in a usually empty or padded room or cell by him- or herself. This form of treatment is used to prevent imminent harm to self and others and is a less-restrictive approach than use of restraints.

PTS: 1 DIF: Application

REF: Legal Issues in Psychiatric Mental Health Nursing| Control of Violent or Self-Destructive Behaviors

1. A registered nurse (RN) is supervising the 7:00 p.m. to 7:00 a.m. shift in a long-term care facility. Two aides call in sick and cannot be replaced, leaving the shift “short-handed.” The RN instructs the licensed practical nurse (LPN) to administer prescribed sleeping pills or narcotic analgesics to any restless client so that clients will require less care and be less likely to wander or get up out of bed unassisted while the limited staff are busy elsewhere. This intervention is considered to be:

a.	chemical restraint and therefore unethical
b.	upholding the ethical principle of beneficence
c.	compliant with the principle of least restrictive alternative
d.	promoting the principle of utilitarianism

ANS: A

Administering chemical restraints to clients for the sole purpose of reducing the amount of care needed is unethical. Chemical restraints should never be used as a substitute for close nursing attention and supervision.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Control of Violent or Self-Destructive Behaviors

1. A client is admitted to the psychiatric unit under an involuntary admission and is resting in his room quietly. When the nurse enters the room and attempts to administer the client’s injection of Thorazine, the client refuses stating, “I don’t want that medication. I have a friend who received those shots and he acts like a zombie.” After the nurse discusses the reason for the medication and its actions, the client continues to refuse. Which action should the nurse take next?

a.	Contact the physician immediately.
b.	Notify the nursing supervisor on call.
c.	Hold the medication and chart the client’s refusal.
d.	Administer the injection anyway because the client was admitted involuntarily.

ANS: C

The nurse should hold the medication and chart the client’s refusal. Even though the client was admitted involuntarily, he retains his legal right to refuse being medicated. It is important to chart that the med was not given and the reason for this action.

PTS: 1 DIF: Analysis

REF: Legal Issues in Psychiatric Mental Health Nursing| Right to Refuse Treatment

1. A nurse is assigned to a client who was admitted to the mental health unit after being incarcerated for child molestation. At the end of one of their sessions, the nurse tells the client that she will return at their next scheduled time. When the nurse leaves the client’s room, she immediately contacts the charge nurse stating, “I refuse to take care of that pervert any longer. He abuses children and doesn’t have any remorse. You have to assign him to another nurse.” Which ethical principle would the nurse violate if she discontinues caring for this client?

a.	justice
b.	fidelity
c.	autonomy
d.	nonmaleficence

ANS: B

The nurse would be violating the principle of fidelity. Fidelity is an individual’s obligation to be faithful to commitments and contracts. The nurse has informed the client that she will return at their next scheduled visit. However, her actions and statement to the charge nurse indicate that she does not plan to have another visit with the client.

PTS: 1 DIF: Analysis

REF: Ethical Issues in Psychiatric Mental Health Nursing| Ethical Theories

CHAPTER 11 THE CLIENT UNDERGOING CRISIS

TRUE/FALSE

1. A crisis is always bad.

ANS: F PTS: 1

1. In seemingly identical crises, all persons respond essentially the same way.

ANS: F PTS: 1

1. The elderly may have more difficulty coping with crises than younger individuals because of physical limitations and periods of disorientation and confusion.

ANS: T PTS: 1

1. Strong social support, including adequate financial resources, has no effect on how well a person deals with a crisis.

ANS: F PTS: 1

1. The first and third stages of the general adaptation syndrome are broken down into shock and countershock.

ANS: T PTS: 1

1. Crisis intervention is considered short-term therapy lasting a month or less.

ANS: T PTS: 1

COMPLETION

1. The four phases of a crisis–(1) threat to the individual resulting in anxiety, (2) increased anxiety and decreased coping, (3) escalation of anxiety, and (4) panic state, or psychosis or depression–were identified by ____________________.

ANS: Caplan

PTS: 1

1. The term fight-or-flight response was coined by ____________________.

ANS: Engel

PTS: 1

1. An individual’s ability to respond to a stressor is known as ____________________.

ANS: adaptive energy

PTS: 1

1. The nursing theory that describes the three states of coping potential as arousal, equilibrium, and impoverishment is the ____________________.

ANS: Adaptive Potential Assessment Model

PTS: 1

1. The nursing theory that promotes unconditional humanistic care for a person in crisis as the goal of nursing is ____________________.

ANS: Watson’s Theory of Human Care

PTS: 1

MULTIPLE CHOICE

1. A crisis results in psychiatric problems when:

a.	adversity occurs
b.	coping mechanisms fail
c.	unpredictable events occur
d.	stress is experienced

ANS: B

A crisis can turn into psychiatric problems when an individual’s normal coping mechanisms fail. Because of the challenge that the crisis presents, the person is called to adjust to the unexpected and to adapt to a situation or event that is unpredictable. When the person is unable to meet the challenge through normal coping mechanisms, a crisis ensues.

PTS: 1 DIF: Comprehension REF: Competencies

1. A crisis is BEST defined as which of the following?

a.	unexpected life demand
b.	turning point
c.	negative or positive event
d.	a time of bad luck

ANS: B

The Oxford English Dictionary (1989) defines crisis as the turning point in a disease, the decisive stage in the progress of anything, a state of affairs in which change for the better or worse is imminent. The original use of the term was for a turning point in an illness. The other options could be true of a crisis, but turning point is the best definition.

PTS: 1 DIF: Knowledge REF: What Is Crisis?

1. A family is staying overnight in a resort area. In the morning, they discover that their automobile has been stolen. Most of their luggage and money was left in the car, so they have little clothing or money. This family is experiencing which of the following types of crisis?

a.	community crisis
b.	maturational crisis
c.	cultural crisis
d.	situational crisis

ANS: D

The loss of their automobile, luggage, and clothing can be seen as a situational crisis. This type of crisis is any event that poses a threat or challenge to an individual or family. A community crisis is a crisis of a proportion to affect an entire community of people. A maturational crisis is a stage in a person’s life where adjustment and adaptation to new responsibilities and life patterns are necessary. A cultural crisis is a situation where a person experiences culture shock in the process of adapting or adjusting to a new culture or returning to one’s own culture after being assimilated into another.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Kinds of Crisis

1. A young adult woman who was born in Central America and spoke only Spanish emigrated to the United States and lived with Spanish-speaking cousins. This young woman enrolled in a local college. After graduation, she married and later gave birth to a child. Which of the following would MOST likely have been a cultural crisis for this young woman?

a.	attending college and speaking English
b.	getting married and the relationship
c.	living with her cousins
d.	having her first child

ANS: A

Attending college and speaking English would most likely cause the woman to experience a cultural crisis because she was originally from Central America and spoke only Spanish. By definition a cultural crisis is a situation where a person experiences culture shock in the process of adapting or adjusting to a new culture.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Kinds of Crisis

1. Which of the following events has the potential for creating a maturational crisis?

a.	an earthquake in Los Angeles
b.	becoming an adolescent
c.	winning the lottery
d.	getting a divorce

ANS: B

Becoming an adolescent has the potential for creating a maturational crisis. Adolescence is a period in the individual’s life where adjustments and adaptation to new responsibilities and life patterns are necessary. Making the transition from adolescence to adulthood can be very stressful. An earthquake is an example of a community crisis; winning the lottery or getting a divorce are examples of a situational crises.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Kinds of Crisis

1. When the river flooded several small towns, leaving people homeless and making travel difficult, this type of crisis would MOST likely be described as which of the following types of crisis?

a.	maturational
b.	situational
c.	community
d.	cultural

ANS: C

When the river flooded, it affected the entire community: therefore it would be considered a community crisis. A situational crisis is any event that poses a threat or challenge to an individual or family. A maturational crisis is a stage in a person’s life where adjustment and adaptation to new responsibilities and life patterns are necessary. A cultural crisis is a situation where a person experiences culture shock in the process of adapting or adjusting to a new culture or returning to one’s own culture after being assimilated into another.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Kinds of Crisis

1. A maturational crisis can occur at any time during the life cycle. The key task for the nurse providing intervention to a client who is experiencing a maturational crisis is to:

a.	discuss the current crisis with the family members
b.	support the client’s adaptive defense mechanisms
c.	challenge the client’s defense mechanisms
d.	explore the client’s past psychological history

ANS: B

A priority intervention for the nurse when caring for an individual experiencing a maturational crisis is to support the client’s adaptive defense mechanisms. This support will facilitate the individual’s return to a precrisis level of functioning.

PTS: 1 DIF: Application REF: What Is Crisis?| Kinds of Crisis

1. Older adolescents typically become more distressed in a crisis situation when:

a.	their access to mother is limited
b.	siblings are upset with them
c.	interactions with their peer group are disrupted
d.	contact with their church group is limited

ANS: C

Older adolescents are particularly distressed when their interactions with their peer group are disrupted. For the adolescent, the peer group serves as the major form of a support system.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Personal Development and Crisis

1. The three stages of Hans Selye’s General Adaptation Syndrome are:

a.	fight, flight, norming
b.	shock, resistance, fatigue
c.	alarm, resistance, exhaustion
d.	shock, countershock, homeostasis

ANS: C

Selye’s General Adaptation Syndrome includes three major stages. The individual’s initial response involves an alarm reaction, then a stage of resistance, and a final stage of exhaustion. The first and third stages are broken down further to include shock and countershock.

PTS: 1 DIF: Knowledge REF: What Is Crisis?| Stress Theory

1. In Callista Roy’s Adaptation Model (1980), the person is seen as having component parts that are:

a.	internal and external
b.	biopsychosocial
c.	physical and cognitive
d.	psychophysical

ANS: B

According to Roy, the person is seen as having component parts. These parts are biopsychosocial components. Health is defined in terms of an equilibrium or balance between the parts that promotes harmony or adjustment.

PTS: 1 DIF: Knowledge REF: Nursing Theory and Crisis| Adaptation Theories

1. Erickson and colleagues introduced the Adaptive Potential Assessment Model that described three states of coping potential as:

a.	stress, adaptation, maladaptation
b.	impoverishment, nourishment, starvation
c.	imbalance, homeostasis, balance
d.	arousal, equilibrium, and impoverishment

ANS: D

The Adaptive Potential Assessment Model described three stages of coping potential. These states are arousal, equilibrium, and impoverishment. In arousal the person has coping resources, whereas in impoverishent the resources are depleted.

PTS: 1 DIF: Knowledge REF: Nursing Theory and Crisis| Adaptation Theories

1. A client voices that he feels “anxious, but excited” about an upcoming job interview. The psychiatric nurse correctly assesses the client as being in the stress state of:

a.	impoverishment
b.	arousal
c.	adaptive equilibrium
d.	maladaptive equilibrium

ANS: B

The psychiatric nurse would correctly assess a client as being in the arousal state of stress if the client states he feels anxious but excited. In the arousal state the person has coping resources. The person will react, attempting to reestablish balance or equilibrium.

PTS: 1 DIF: Application REF: Nursing Theory and Crisis| Adaptation Theories

1. A client voices that she feels “overwhelmed” because her husband moved out of the home and filed for divorce. The psychiatric nurse correctly assesses the client as being in the stress state of:

a.	impoverishment
b.	arousal
c.	adaptive equilibrium
d.	maladaptive equilibrium

ANS: A

A client who voices feeling overwhelmed is most likely experiencing the impoverishment state. In a state of impoverishment the individual’s resources are depleted.

PTS: 1 DIF: Application REF: Nursing Theory and Crisis| Adaptation Theories

1. You are working with a client who reveals in the assessment that she was raped while returning to her parked car one night. After the rape, she broke up with her boyfriend and went through counseling for 6 months. Two years later, she is unable to have a relationship with any man. Based on Erickson’s Adaptive Potential Assessment Model, which state of coping best describes the client’s current state?

a.	impoverishment
b.	arousal
c.	adaptive equilibrium
d.	maladaptive equilibrium

ANS: D

Based on Erickson’s Adaptive Potential Assessment Model, a woman unable to have a relationship with a man after being the victim of rape is most likely in a state of maladaptive equilibrium. The woman is unable to reestablish her precrisis level of equilibrium and balance.

PTS: 1 DIF: Analysis REF: Nursing Theory and Crisis| Adaptation Theories

1. Madeleine Leininger’s theory directs the nurse to understand the meaning of crisis events for the client from:

a.	within the client’s cultural perspective
b.	a comparison with American culture
c.	the nurse’s perspective of the event
d.	whatever cultural rules are known

ANS: A

Leininger’s theory directs the nurse to understand the meaning of crisis events for the client from within a client’s cultural perspective. Nurses skilled in cultural care understand that there are important cultural perspectives in all life’s events. Related to crisis, cultural care theory guides the nurse in two matters: recognizing that crises are culturally determined and understanding that insensitive cross-cultural experiences can produce crisis and culture conflict for the nurse and client.

PTS: 1 DIF: Comprehension

REF: Nursing Theory and Crisis| Culture Care Theory

1. Critical incident stress management (CISM) is provided to help emergency personnel successfully manage the stress produced by the crises and disasters that they are called upon to respond to. As a result of meta-analysis of existing data about the effectiveness of CISM, Bledsoe recommends that CISM:

a.	is universally helpful to emergency personnel even if they initially resist the intervention
b.	is most effective when offered in a peer group counseling format
c.	should never be mandatory, because it may lead to a worsening of stress symptoms
d.	should be provided as one-on-one individual counseling over six or more sessions

ANS: C

Bledsoe recommends that CISM should never be mandatory, because it may lead to a worsening of stress symptoms. It is believed that debriefing may not always be effective and for some individuals it may actually lead to a worsening of the stress symptoms.

PTS: 1 DIF: Comprehension

REF: What Is Crisis?| Critical Incident Stress Management: A Controversial Intervention

1. A Vietnamese family comes to the emergency room after the death of one of their family members. The nurse informs them that only one member of the family is able to see the person who died. The family members begin to chant and cry out loud. The BEST action for the nurse at this time is to:

a.	inform the family that the rules are the same for everyone
b.	ask the family members what behaviors they need to perform after a death
c.	realize that this is probably a culturally related habit and show sympathy for the family
d.	look up information on the Internet that describes the needs of the Vietnamese after a death

ANS: B

The best action for the nurse to take at this time is to ask the family members what behaviors they need to perform after a death. This would demonstrate that the nurse is sensitive to the family’s cultural practices and rituals.

PTS: 1 DIF: Application REF: Nursing Theory and Crisis| Cultural Care Theory

1. In research involving a study of persons who were experiencing the crisis of losing their home and possessions because of fire, victims reacted to the statement, “You are lucky no one was hurt,” in which of the following ways?

a.	appreciation for the insight of the person making the statement
b.	relief after being reminded that their loss was small
c.	confusion and a state of amnesia
d.	feeling misunderstood and their situation trivialized

ANS: D

Victims felt misunderstood and their situation trivialized. The comment that they were lucky was viewed as uncaring and left the victims feeling neglected. In general, loss of possessions was trivialized leaving the victims without permission to display grief.

PTS: 1 DIF: Analysis

REF: What Is Crisis? Restructuring Life After Home Loss Fire| Study Findings

1. A client comes into the emergency room and is in a state of panic. Which of the following nursing actions is a priority in assisting this client?

a.	Talk with the family about the client.
b.	Determine the precipitating event for the panic.
c.	Construct a care plan for the client.
d.	Assess the client’s psychiatric history.

ANS: B

A priority for the nurse intervening with a client in a state of panic is to determine the precipitating event for the panic. The nurse’s initial assessment would not focus on the client’s psychiatric history or involve talking with the family. In addition, a care plan is not developed until the assessment is complete and a nursing diagnosis is made.

PTS: 1 DIF: Analysis REF: Application of the Nursing Process| Assessment

1. A client in the community is experiencing an emotional crisis after her family was killed in a house fire. The client states, “I can’t take it anymore.” To provide safe care, which of the following actions would the nurse take first?

a.	Recommend hospitalization.
b.	Provide emotional support.
c.	Conduct a suicide assessment.
d.	Provide reassurance of access to care.

ANS: C

The client’s comment should alert the nurse to conduct a suicide assessment. The nurse must determine if the client is experiencing feelings of severe despair that could lead to self-destructive or suicidal behavior. This assessment would begin with questioning the client about thoughts of self-harm.

PTS: 1 DIF: Analysis REF: Application of the Nursing Process| Assessment

1. Which of the following initial actions on the part of the nurse are MOST important in delivering compassionate and effective nursing care to clients experiencing a crisis?

a.	listening to the client’s feelings and responding to his or her needs
b.	telling the client what to expect and what to do
c.	gathering all possible data about the client from all sources
d.	instructing the client’s family on what to do for the client

ANS: A

The initial and most important nursing action when caring for a client experiencing a crisis is to listen to the client’s feelings and respond to the client’s needs. The nurse must establish trust with the client, ensure confidentiality, and seek to develop a good understanding of the client’s experiences and feelings. For the client, describing emotions and reactions to the nurse serves to release feelings.

PTS: 1 DIF: Analysis

REF: Application of the Nursing Process| Planning/Interventions

1. A client is experiencing a crisis and is unable to cope emotionally with the situation that precipitated the crisis. Based on caring theories such as those of Jean Watson or Hildegard Peplau, the most immediate intervention for the nurse to provide is:

a.	reporting any maladaptive responses to the provider
b.	educating about the phases of crisis
c.	listening to the affective experience of the client
d.	assessing the client’s level of emotional vulnerability

ANS: C

According to caring theories, the most immediate intervention for the nurse is to listen to the affective experience of the client. The nurse will be interested in the client’s subjective experience of the crisis. Therefore these caring theories would direct the nurse to meet the client at the client’s level with an attitude of sincere caring, accept the client’s view as an important perspective of the event, seek to understand the client’s subjective experience of the crisis, and interpret the meaning of the crisis to the client.

PTS: 1 DIF: Analysis REF: Nursing Theory and Crisis| Caring Theories

1. You are working with a client who was recently in a building that was bombed. This client has been hospitalized for weeks and is beginning to show progress in physical recovery; however, the client often says something like, “I feel like I can’t control the events in my life. Everything is fate. I have given up trying to order my life.” Which of the following nursing diagnoses would you likely find after further assessment of this client?

a.	anxiety
b.	risk for violence
c.	powerlessness
d.	dysfunctional grieving

ANS: C

Powerlessness is a subjective feeling that expresses the client’s belief that he cannot control the events in his life. The nurse can make this diagnosis when there is sufficient validation from the client that he, indeed, feels out of control and has given up.

PTS: 1 DIF: Application

REF: Application of the Nursing Process| Nursing Diagnosis

1. You have been working with a client whose wife was killed by a burglar who broke into their home while the client was out of town on a business trip. The client comes to his session today and asks about places where he can donate his wife’s clothes and belongings “when I’m ready to give them up.” You correctly view this statement as an indication that the client is most likely:

a.	preparing to commit suicide in order to rejoin his deceased wife
b.	entering the impoverishment phase as symbolized by the giving away of possessions
c.	stuck in the maladaptive equilibrium phase shown by his need to get rid of her things
d.	beginning to shift from the present- to future-directed thinking

ANS: D

A client who is beginning to think about disposing of the belongings of a loved one who died tragically is most likely beginning to shift from the present- to future-directed thinking.

PTS: 1 DIF: Analysis REF: Application of the Nursing Process| Evaluation

1. You are working with a client who is postcrisis and who denies having any symptoms of stress. You realize that for some individuals, a common complaint and the only clue that they are still feeling stress in the postcrisis period is which of the following?

a.	disturbances in sleep patterns
b.	uncontrollable anger
c.	teeth grinding
d.	feeling of euphoria

ANS: A

Disturbed sleep pattern is common postcrisis and for some individuals will be the only clue that they are still feeling stress. Thus the nurse must ask questions related to sleep even when clients state there are no immediate stressors or crises in their lives.

PTS: 1 DIF: Application

REF: Application of the Nursing Process| Nursing Diagnosis

1. Which of the following is MOST likely to be an effective intervention strategy for clients who have survived a community crisis?

a.	anxiety medication
b.	a support group
c.	psychotherapy
d.	relocation to another community

ANS: B

Support groups have proven to be highly effective when treating the survivors of a community crisis. Through groups, the community members can share experiences and learn from each other possible strategies for dealing with the crisis. Support groups assist individual members that they are not alone in their experience, a concept known as universality.

PTS: 1 DIF: Application

REF: Application of the Nursing Process| Selecting a Nursing Theory

1. The crisis intervention model is aimed at:

a.	behavior modification
b.	increasing the client’s functional level
c.	problem solving and adaptive coping
d.	catharsis and introspection

ANS: C

The major aim of the crisis intervention model is to assist the client with problem solving and adaptive coping. Alternate coping strategies are explored, which can facilitate the client’s return to precrisis level of function or better.

PTS: 1 DIF: Comprehension

REF: Application of the Nursing Process| Evaluation| Crisis Intervention as Mental Health Prevention

1. The successful outcome of work with the client through a crisis event is BEST evaluated by the:

a.	client’s confidence in returning to a normal life
b.	nurse’s judgment about the resolution of the crisis
c.	client’s ability to forget the event causing the crisis
d.	nurse’s measure of the client’s psychological growth

ANS: A

The nurse and client together can determine whether there was a successful resolution of a crisis. However, the client’s confidence in returning to a normal life is the best example of a good outcome.

PTS: 1 DIF: Comprehension

REF: Application of the Nursing Process| Evaluation

1. You are working with a client who has a fatal illness. The client says to you, “It’s not an easy thing to cope with a fatal illness.” Which of the following responses is MOST therapeutic?

a.	“I know, because someone in my family close to me went through the same thing.”
b.	“You are doing an excellent job of coping with this crisis.”
c.	“It is difficult. I am certain I could not do as well as you do.”
d.	“No, it never is easy. Can you tell me some of the things that are particularly difficult for you?”

ANS: D

The most therapeutic response is to say, “No, it never is easy. Can you tell me some of the things that are particularly difficult for you?” The nurse acknowledges the client’s feelings and offers to listen to the client’s concerns. This enhances trust and strengthens the nurse/client relationship. The other responses do not encourage the client to express feelings.

PTS: 1 DIF: Application

REF: Application of the Nursing Process| Evaluation| Crisis Intervention as Mental Health Prevention

1. The BEST example of primary mental-health crisis intervention would be:

a.	providing CISM to members of the fire department who responded to a series of fatal house fires
b.	discussing the psychological aspects to having a loved one injured in a car accident with newly licensed teenage drivers
c.	responding on call to the emergency room to counsel the victims of a serial rapist
d.	leading group therapy for individuals diagnosed with post-traumatic stress disorder

ANS: B

The best example of primary mental-health crisis intervention would be discussing the psychological aspects to having a loved one injured in a care accident with newly licensed teenage drivers. The other options are examples of secondary and tertiary prevention.

PTS: 1 DIF: Analysis

REF: Application of the Nursing Process| Evaluation| Crisis Intervention as Mental Health Prevention

1. Follow-up for more than 2 decades has shown that what percent of the Buffalo Creek survivors still have significant post-traumatic stress disorder (PTSD) symptoms?

a.	10%	c.	35%
b.	25%	d.	50%

ANS: B

Follow-up for more than 2 decades has shown that about 25% of the Buffalo Creek survivors still have significant post-traumatic stress disorder (PTSD) symptoms. Overall the severity of symptoms has been decreasing for most of the survivor cohort. Follow-up of child Buffalo Creek survivors has found a steady decrease in symptomatology with PTSD diagnosed in 7% of persons up to 17 years after the original event.

PTS: 1 DIF: Knowledge

REF: What Is Crisis?| Stress Theory| Everything in Its Path

1. Studies of Hurricane Katrina victims have indicated that what percentage of individuals experienced serious mental illness 1 year post Katrina?

a.	6.4%	c.	14.0%
b.	10.9%	d.	20.9%

ANS: C

Studies of Hurricane Katrina victims have indicated that 14.0% of the survivors experienced serious mental illnesses 1 year post Katrina. Of the survivors, 10.9% experienced serious mental illness and 20.9% experienced PTST prior to Katrina; while 6.4% experienced suicidal ideations post Katrina.

PTS: 1 DIF: Analysis

REF: What Is Crisis?| Stress Theory| Everything in Its Path