Psychiatric Nursing
Final Test Solutions
Course Introduction
Psychiatric Nursing is a specialized field of nursing that focuses on the assessment, diagnosis, and treatment of individuals with mental health disorders. This course examines the theories and concepts underlying psychiatric nursing practice, including therapeutic communication, psychosocial interventions, and the collaborative role of the nurse within multidisciplinary mental health teams. Students will explore the biological, psychological, and sociocultural factors influencing mental illness, develop skills for conducting mental health assessments, and learn strategies for promoting patient recovery and well-being. The course emphasizes patient-centered care, ethical and legal considerations, and the development of empathy and professional boundaries when working with diverse populations experiencing acute and chronic mental health conditions.
Recommended Textbook
Foundations of Mental Health Care 6th Edition by Michelle Morrison Valfre
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33 Chapters
803 Verified Questions
803 Flashcards
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Page 2
Chapter 1: The History of Mental Health Care
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Sample Questions
Q1) The belief of the ancient Greek philosopher Plato that the rational soul controlled the irrational soul could be compared with the belief of the more recent psychological theorist:
A)Freud
B)Pinel
C)Fisher
D)Rush
Answer: A
Q2) In the late 1980s,government funding for mental health care dwindled,and most insurance companies __________ coverage for psychiatric care.
A)Withdrew
B)Increased
C)Decreased
D)Added
Answer: A
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Page 3
Chapter 2: Current Mental Health Care Systems
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Sample Questions
Q1) Which client populations are at greater risk for the development of mental health disorders? (Select all that apply. )
A)Homeless
B)Clients infected with HIV or AIDS
C)Those in crisis
D)Nurses
E)Clients living in rural areas
F)Older adults
G)Psychiatrists
H)Children
Answer: A,B,C,E,F,H
Q2) Which principles characterize mental health care in Canada? (Select all that apply. )
A)Portability
B)Universality
C)Accessibility
D)Comprehensiveness
E)Private insurance models
F)Public administration
Answer: A,B,C,D,F
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Chapter 3: Ethical and Legal Issues
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Sample Questions
Q1) The psychiatrist asks the nurse to perform a procedure that she is not familiar with,and the nurse is unsure whether this is something within the scope of practice.Where can the nurse find the answer to her question?
A)National nurse practice act
B)State nurse practice act
C)Regional nurse practice act
D)Community nurse practice act
Answer: B
Q2) If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-husband,what is the nurse's best action?
A)Try to talk with the client to convince her not to harm the girlfriend
B)Have the client sign a contract with you stating that she will not harm the girlfriend
C)Inform the ex-husband of the intentions of the client
D)Inform the girlfriend of the intentions of the client
Answer: D
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Chapter 4: Sociocultural Issues
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Sample Questions
Q1) Culture includes common beliefs and practices in areas such as religion,economics,diet,health,and:
A)Genetics
B)Occupations
C)Patterns of communication
D)Stereotypes
Q2) A 45-year-old married man comes to the community mental health center after he is suspended from his job for fighting.Upon talking to him,the nurse discovers he and his wife recently moved to the United States and his wife needs to work to pay bills.He is angry and embarrassed that he cannot be the sole provider for his family.His behavior may be the result of:
A)Cultural stereotyping
B)Gender role conflict
C)Religious beliefs
D)Territoriality conflicts
Q3) Which client communication problem can the nurse most easily correct?
A)Age differences
B)Altered cognition
C)Cultural differences
D)Gender differences
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Chapter 5: Theories and Therapies
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Sample Questions
Q1) How many stages of the human life cycle did Erik Erikson identify?
A)Two
B)Four
C)Six
D)Eight
Q2) A male client who has a diagnosis of generalized anxiety disorder (GAD)is seen in the emergency department with complaints of chest pain,shortness of breath,and inability to concentrate,along with feelings of overwhelming anxiety.The nurse uses Maslow's theory to triage the client's complaints,knowing that which complaint must be addressed first?
A)Inability to concentrate
B)Shortness of breath
C)Overwhelming anxiety
D)Chest pain
Q3) Which of the following assessment parameters is a priority in a biobehavioral model of practice?
A)Blood chemistry
B)Physiologic needs
C)Coping mechanisms
D)Psychosocial level
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Chapter 6: Complementary and Alternative Therapies
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Sample Questions
Q1) Which theory best describes energy medicine?
A)There is a harmony within the body,nature,and the world.
B)The body has a natural ability to heal itself.
C)There is a vital,life-force energy that flows through an individual's body.
D)The mind and spirit affect body functions and influence illness.
Q2) An allopathic mental health practitioner would most likely recommend which treatment for a client suffering from anxiety?
A)Expressive therapy
B)Acupuncture
C)Antianxiety agents
D)Dietary supplements
Q3) A female client is receiving therapy for severe depression that consists of repetitive transcranial magnetic stimulation.This form of therapy is considered to be:
A)Energy medicine
B)Illegal according to FDA regulations
C)A form of expressive therapy
D)A biofield therapy
Q4) CAM is an acronym for __________.
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Chapter 7: Psychotherapeutic Drug Therapy
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Sample Questions
Q1) The __________ constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.
A)Benzodiazepines
B)Tricyclics
C)Azaspirones
D)Beta-blockers
Q2) Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system.Which of the following is considered a sympathetic response?
A)Pupil dilation
B)Increased saliva production
C)Decreased heart rate
D)Constricted airway
Q3) When educating a client being treated with lithium,which item(s)in his or her diet should be monitored or avoided?
A)Fresh fruit
B)Whole milk
C)Hot dogs and ham
D)Fresh vegetables
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Chapter 8: Principles and Skills of Mental Health Care
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Sample Questions
Q1) An important component of providing good care is for health caregivers to take care of,or nurture,themselves.Which of the following are ways that effectively assist health caregivers to nurture themselves? (Select all that apply. )
A)Be supportive of colleagues
B)Recognize and accept one's own limitations,and strive to improve
C)Take pride in oneself
D)Accept all challenges presented
E)Be responsible and accountable for one's own actions
Q2) A caregiver is said to be practicing __________ care not only when she takes into consideration the client's actual or potential problems but also when she considers the client's family,work responsibilities,and social aspects of life.Which of the following best describes this caregiving concept?
A)Competent
B)Complete
C)Holistic
D)Crisis
Q3) __________ mechanisms are thoughts or actions that are used to help individuals handle or reduce stress.
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10
Chapter 9: Mental Health Assessment Skills
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Sample Questions
Q1) A client seen in the emergency department is noted to be stuporous.Which of the following assessment findings would be of most concern?
A)Elevated blood pressure
B)Elevated cholesterol levels
C)New exercise routine
D)Painting furniture in a windowless room
Q2) The nurse suspects the client is experiencing a manic episode based on which of the following observations?
A)Clothing is very colorful and mismatched,and client cannot sit in chair during interview
B)Hair is not combed,clothing is dirty,and client has no interest in surroundings
C)Client repeatedly washes her hands and picks at a button on her shirt
D)Client expresses fear that someone is waiting outside the room to harm her
Q3) List the five steps of the nursing process in proper order.
Q4) __________ is how the client displays his or her emotions through facial,vocal,or gestural behavior.
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Chapter 10: Therapeutic Communication
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Sample Questions
Q1) During the process of communication,a chain of events occurs as soon as the message is sent.Steps in this chain include transmission,perception,and evaluation.Place these steps in proper order.
A)Transmission
B)Perception
C)Evaluation
Q2) The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations.For this communication to be most effective,the nurse should:
A)Sit with the client and encourage him to not verbalize
B)Do most of the talking
C)Discuss several different topics to keep the client's attention
D)Use simple,concrete language
Q3) A client has difficulty in communicating as a result of his illness.He displays a rapid,confusing delivery of speech patterns.Which term best describes this difficulty in communicating?
A)Aphasia
B)Dyslexia
C)Speech cluttering
D)Incongruent communications
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Chapter 11: The Therapeutic Relationship
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Sample Questions
Q1) The acronym TEACH represents the components of a therapeutic relationship: __________,__________,__________,__________,and __________.
Q2) A male client is being discharged from a mental health facility and is worried about what to tell his friends and co-workers regarding his time away.The nurse helps the client plan what to say to others about his disease.The nurse is functioning in the role of:
A)Change agent
B)Teacher
C)Therapist
D)Technician
Q3) For which roles is the caregiver responsible in a therapeutic relationship? (Select all that apply. )
A)Teacher
B)Therapist
C)Technician
D)Friend
E)Change agent
Q4) __________ refers to the ability of the nurse to establish a meaningful connection with a client.
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Chapter 12: The Therapeutic Environment
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Sample Questions
Q1) Which are common causes for client noncompliance in the plan of care? (Select all that apply. )
A)Financial concerns
B)Lack of support by family
C)Staff dislike of a client
D)Inability to understand the treatment plan
E)Lack of access to treatment services
Q2) Admission to an inpatient mental health unit is often a stressful event.Which actions on the part of the health care provider will help to decrease the anxiety of the client?
(Select all that apply. )
A)Conduct the admission interview with a team of health care providers
B)Answer any questions the client may have
C)Support the client in being oriented to the unit
D)Provide simple,clear instructions and repeat if needed
E)Communicate concern for the client
Q3) Discharge planning for an inpatient mental health facility client begins on __________.
Q4) __________ refers to the process of achieving one's full potential in life.
Q5) __________ describes the setting or environment in which mental health care is provided.
Page 14
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Chapter 13: Problems of Childhood
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Sample Questions
Q1) The developmental period of middle childhood is considered to encompass the ages of __________ to __________ years.
Q2) A 10-year-old male client is 20 pounds overweight.Which intervention by the nurse is the most effective in this situation?
A)Place the client on a strictly controlled calorie-restricted diet
B)Talk to the client about why he is so overweight
C)Teach the client and his parents about healthy eating habits and choices
D)Make a list of foods that are to be restricted in the client's diet
Q3) __________ is a disorder that involves an individual's ability to communicate,interact with others,use the imagination,and display appropriate behavior.
Q4) A 7-year-old male client displays behaviors such as an inability to make eye contact with others,inappropriate facial expressions,difficulty in making friends,and showing little emotion with family members.He talks with adults but is awkward in his conversation.Given these behaviors,what is this client most likely experiencing?
A)Childhood disintegrative disorder
B)Asperger's syndrome
C)Dyslexia
D)Rett syndrome
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Page 15
Chapter 14: Problems of Adolescence
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Sample Questions
Q1) A 16-year-old teenage boy who is bullied at school has recently started staying in his room and not associating with his friends.His grades are dropping and he refuses to eat dinner with his family.What actions should his parents be advised to take?
A)Accept this as a normal part of adolescent behavior and do not interfere
B)Take the door off his room and scold him for his behavior
C)Realize that his peer group will handle this as he needs to break away from family
D)Set limits with him in a respectful manner and assist him to problem-solve
Q2) One of the major goals of therapy for adolescents with chemical dependency is:
A)Replacing the use of the chemical with effective coping skills
B)Placing the chemically dependent adolescent in a residential treatment program
C)Finding a group home setting to which the adolescent will be able to adjust
D)Isolating the adolescent from family and friends during withdrawal from the chemical
Q3) Adolescence is defined as beginning at age __________ years and ending at age ____________ years.
Q4) Obesity is defined as body weight that is __________% above average,based on the individual's height and build.
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Page 16
Chapter 15: Problems of Adulthood
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Sample Questions
Q1) The __________ environment defines stressful or anxious situations.
Q2) An increasing number of ______ are the head of the household of families in the United States.
A)Married couples
B)Single women
C)Single men
D)Relatives
Q3) Therapeutic interventions are effective in the prevention of mental and emotional disorders and assisting the client to cope.Which of the following interventions assist in providing for a positive personal identity? (Select all that apply. )
A)Continue to define identity in terms of role in nuclear family
B)Develop career path and goals
C)Recognize how emotions influence achievement of goals and relationships
D)Maintain personal distance in relationships
Q4) How many people in the United States have a severe mental illness?
A)500,000
B)1.3 million
C)5.4 million
D)10 million
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Chapter 16: Problems of Late Adulthood
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Sample Questions
Q1) __________ refers to a state of wholeness or quality of one's character.
Q2) Although __________ is often a desire of older adults,it can bring loss of income and loss of opportunities for socialization.
Q3) It is important for the nurse to be aware that __________% of individuals over 45 years old take prescription medications,over-the-counter medications,or a combination of these medications.
A)35
B)55
C)75
D)95
Q4) __________% of older adults are living at poverty level.
A)12
B)18
C)26
D)23
Q5) A 2015 survey estimates the average number of elderly who are abused is _______.
A)2,150,000
B)3,250,000
C)1,850,000
D)1,500,000
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Chapter 17: Cognitive Impairment, Alzheimers Disease, and Dementia
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Sample Questions
Q1) Which interventions will help to lessen the effects of sundown syndrome? (Select all that apply. )
A)Provide activity which stimulates the client's interest
B)Assist in toileting to prevent incontinence
C)Turn on lights before the room gets dark
D)Provide companionship
E)Prepare client for sleep by turning off lights
F)Reduce environmental stimulation at dinner
G)Maintain client's familiar routine
Q2) The average time that a person with Alzheimer's disease lives after diagnosis is:
A)2 years
B)8 years
C)10 years
D)20 years
Q3) The causes of confusion are grouped into five categories known as the five D's.These categories consist of damage,delirium,dementia,depression,and __________.
Q4) __________ refers to thinking and thought processes.
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Chapter 18: Managing Anxiety
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Sample Questions
Q1) Symptoms of obsessive-compulsive disorder can occur in children as young as:
A)3 years old
B)5 years old
C)7 years old
D)9 years old
Q2) A client tells the nurse that exercising in the gym helps him keep his stress level reduced.Which type of coping mechanism best describes this situation?
A)Spiritual
B)Emotional
C)Intellectual
D)Physical
Q3) A female college student is seeking help from the counseling center for test anxiety.She reports that during an exam,she "freezes," and says,"It feels like the time I have to take the exam is racing by,and I can't answer any of the questions when I know the answers." Which level of anxiety is the client experiencing?
A)Mild
B)Moderate
C)Severe
D)Panic
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Page 20
Chapter 19: Illness and Hospitalization
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Sample Questions
Q1) The most important reason for performing a crisis assessment on hospitalized clients is that it allows the care provider to:
A)Implement appropriate care measures
B)Encourage clients to share their concerns
C)Identify the requirements for additional supplies and personnel
D)Identify problems before a crisis develops and plan preventive interventions
Q2) The client has been admitted to the medical unit for unexplained weight loss and fatigue.He does not speak except to answer questions,and he refuses to interact with other people except when necessary.Which coping mechanism is he using to deal with his hospitalization?
A)Anger
B)Shock
C)Anxiety
D)Withdrawal
Q3) For most people,being hospitalized is seen as a/n:
A)Crisis
B)Annoyance
C)Chance to rest
D)Expensive hotel
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Page 21
Chapter 20: Loss and Grief
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Sample Questions
Q1) The last stage of growth and development is called:
A)Dying
B)Old age
C)Wisdom
D)Maturity
Q2) Following the funeral of her husband,the widow is seen crying and holding his picture.She is demonstrating __________.
Q3) When care is provided for a dying client in pain,addiction to analgesics is:
A)Not an issue
B)To be evaluated daily
C)To be carefully avoided
D)To be prevented with pain management techniques
Q4) Place the steps of grieving in proper order.
A)Acceptance and recovery
B)Depression and identification
C)Denial
D)Yearning
Q5) __________ occurs when an individual who has experienced a loss is working through or resolving his or her grief.
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Chapter 21: Depression and Other Mood Disorders
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Sample Questions
Q1) Which client would be a candidate for ECT?
A)A client with mild depression
B)A severely depressed client with congestive heart failure
C)A client with severe,long-lasting depression
D)A severely depressed client with history of a brain tumor
Q2) The goal of treatment during the first phase of depression is to:
A)Develop a plan for treatment
B)Reduce uncooperative behaviors
C)Help the client to adjust to antidepressants
D)Reduce symptoms and inappropriate behaviors
Q3) During the continuation phase of therapy,a client with a diagnosis of depression asks,"What is the goal of therapy during this 4- to 9-month period?" What is the nurse's best response?
A)"We are going to work together to try to reduce your symptoms."
B)"Our goal is to determine the cause of your depression and cure it."
C)"We want to prevent you from ever having any depressive episodes in the future."
D)"Our goal is to prevent you from relapsing and experiencing distressing emotional states."
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23
Chapter 22: Physical Problems, Psychological Sources
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Q1) The main feature of a factitious disorder is that symptoms are purposefully produced to allow the individual to:
A)Get out of work
B)Assume the sick role
C)Assume control of treatment
D)Get the attention of health care providers
Q2) The client can acknowledge the possibility that she exaggerates her symptoms,but she continues to hold on to the belief that something is physically wrong,in the face of evidence to the contrary.What is the client's diagnosis most likely to be?
A)Malingering
B)Hypochondriasis
C)A conversion reaction
D)Body dysmorphic disorder
Q3) Which are the essential features of conversion disorders? (Select all that apply. )
A)Preoccupation with fears of disease
B)Deficits in motor function
C)Long history of vague complaints
D)Deficits in sensory function
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Chapter 23: Eating and Sleeping Disorders
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Sample Questions
Q1) Sleep terrors usually occur only once a night,during stages 3 and 4 of NREM sleep.They are often accompanied by which physical sign?
A)Intense stress
B)Sexual arousal
C)Physical strength
D)Intense motor activity
Q2) The first step in the treatment of sleep disorders is to:
A)Teach prevention
B)Give hypnotics for sleep
C)Evaluate sleeping patterns
D)Teach clients to retire early
Q3) Which disorder is associated with persons with a body weight that is normal or even slightly above average?
A)Pica
B)Bulimia
C)Obesity
D)Anorexia nervosa
Q4) The medical term for a sleep test is __________.
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Chapter 24: Dissociative Disorders
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Q1) The care provider is aware that in addition to assessment,one of the first goals of therapy for the client with a dissociative disorder is:
A)Revisiting of past traumas
B)Pharmacological therapy
C)Stabilization
D)Family therapy
Q2) A client with the diagnosis of depersonalization disorder notices that he experiences periods of depersonalization when confronted with certain stressors.When developing the care plan,the nurse is aware that one of the most helpful activities in self-control for this client is for the client to:
A)Contact a treatment team member to discuss his thoughts and feelings every time he is confronted with a stressor
B)Keep a daily journal of his thoughts and feelings,paying special attention to thoughts and feelings during stressful times
C)Recall periods of stressful times in his life during his clinic visit
D)Join an exercise program that will help to decrease his stress level
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Chapter 25: Anger and Aggression
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Q1) During the psychosocial portion of the assessment of a client with anger,aggression,or violent behavior issues,the nurse will assess which of the following? (Select all that apply. )
A)Coping skills
B)General appearance
C)Value and belief systems
D)Cultural,spiritual,and occupational interests
E)Potential for engaging in inappropriate behavior
Q2) In the assault cycle,people are unable to listen to reason,follow directions,or engage in mental exercises during the stage of:
A)Crisis
B)Trigger
C)Recovery
D)Escalation
Q3) Level one interventions for potentially assaultive clients should be practiced as:
A)Therapy
B)Control methods
C)Assessment measures
D)Preventive measures
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Page 27
Chapter 26: Outward-Focused Emotions: Violence
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Q1) Mr.Right employs 22 children in his clothing factory.Each child is no older than 10 years of age and works 11 hours a day,6 days a week.Mr.Right is practicing:
A)Abuse
B)Neglect
C)Violence
D)Exploitation
Q2) Eating disorders,substance abuse,delinquent behaviors,posttraumatic stress disorder,and suicide most commonly are seen as the result of abuse in this population: A)Children
B)Adolescents
C)Adults
D)Elderly
Q3) The term that describes repeated physical abuse,usually of a woman,child,or elder,is:
A)Neglect
B)Battering
C)Exploitation
D)Gender abuse
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Chapter 27: Inward-Focused Emotions: Suicide
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Q1) A terminally ill female client chooses the time and place of her own death.This is an example of:
A)Suicide
B)Self-injury
C)Rational suicide
D)Planned suicide
Q2) The nurse is caring for a male client with a major depressive disorder who has not responded well to various treatments in the past.The latest treatment method has resulted in slight improvement in the client's symptoms.On this particular day,the client has a very positive affect and says he feels "amazingly better." The nurse should:
A)Congratulate him on his recovery
B)Document the client's improvement
C)Ask him what he feels has helped him feel better so suddenly
D)Assess the client for signs and symptoms of suicidal thoughts
Q3) After establishing a no-harm contract with the client,the nurse should:
A)Begin to assess client risk factors
B)Continue to maintain close observation
C)Decrease observation activity to allow client autonomy
D)Begin treatment with antidepressants
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Page 29
Chapter 28: Substance-Related Disorders
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Q1) The nurse assessing a newborn shortly after delivery notes that the infant is very jittery,irritable,and has a high-pitched cry.The nurse suspects that the mother took which substance during pregnancy?
A)Alcohol
B)Heroin
C)Cocaine
D)Analgesics
Q2) Which of the following persons is said to have a dual diagnosis?
A)The anorexic adolescent suffering from depression
B)The school-age child suffering from a learning disorder and asthma
C)The older adult suffering from hypertension and diabetes
D)The young adult suffering from psychosis who smokes marijuana regularly
Q3) __________ is a processed stimulant that reaches the brain immediately and produces an intense but short-lived high.
A)Heroin
B)Opioids
C)Cocaine
D)Crack
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Chapter 29: Sexual Disorders
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Sample Questions
Q1) A male client is transsexual and decides to become a female through major surgery and hormonal therapy.The nurse informs the client that this process may be delayed for as long as:
A)2 years
B)5 years
C)8 years
D)10 years
Q2) Choose the types of relationships that put individuals at greatest risk for sexually transmitted diseases,including HIV/AIDS (Select all that apply):
A)Bisexual
B)Asexual
C)Functional homosexual
D)Dysfunctional homosexual
E)Open-coupled homosexual
Q3) By the time they enter school,it is thought that most children identify with:
A)Same-sex peers
B)Opposite-sex peers
C)The same-sex parent
D)The opposite-sex parent
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Chapter 30: Personality Disorders
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Q1) The central feature of one of our most pressing mental health problems today is a pervasive pattern of disregard for,and violation of,the rights of others.This personality disorder is called:
A)Avoidant
B)Paranoid
C)Dependent
D)Antisocial
Q2) Infants who experience nurturing environments develop the ability to:
A)Test others
B)Trust others
C)Manipulate others
D)Model others' behaviors
Q3) A male client has a schizotypal personality disorder.A female client compliments him on his style of dressing,and he interprets this as her caring deeply for him and desiring to date him.What is the client experiencing?
A)Paranoia
B)Ideas of reference
C)Inappropriate affect
D)Delusions of grandeur
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Page 32
Chapter 31: Schizophrenia and Other Psychoses
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Q1) The police bring a man to the emergency department because he is wandering the streets yelling to people.He attempted to attack the police officer because he accused him of "being a part of that plot to kill the president and me." Which category of schizophrenia is he exhibiting?
A)Paranoid
B)Catatonic
C)Disorganized
D)Residual
Q2) Schizophrenia in children as young as 5 years:
A)Is a myth
B)Can occur
C)Never occurs
D)Cannot occur
Q3) The client in whom schizophrenia has been diagnosed usually is medicated with what class of drugs?
A)Antianxiety
B)Antipsychotic
C)Antidepressant
D)Antihypertensive
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Page 33
Chapter 32: Chronic Mental Health Disorders
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Q1) Individuals with schizophrenia tend to use the chemical __________ most often.
A)Alcohol
B)Cocaine
C)Heroin
D)Hypnotics
Q2) The experience and suffering of living with mental illness:
A)Decreases as one grows older
B)Is unique to each person
C)Follows a predictable course
D)Is common to all mentally ill persons
Q3) In the United States today,the effects of deinstitutionalization include (Select all that apply):
A)A comprehensive mental health care system
B)A decrease in the need for medical treatment
C)An increase in the jail and prison populations
D)An increase in the homeless population
E)People who cannot obtain adequate food or shelter
Q4) Adolescents in whom diabetes is diagnosed have high rates of depression and
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Chapter 33: Challenges for the Future
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Q1) Families without a home now make up __________% of the homeless population in the United States.
A)14
B)28
C)38
D)44
Q2) As many as 75% of people with chronic mental health disorders
A)Live alone
B)Refuse to take their medications
C)Use or abuse drugs
D)Use or abuse their prescribed medications
Q3) The deliberate effort to make things different within a system is called:
A)Planned change
B)Unplanned change
C)Unexpected change
D)Workplace dynamics
Q4) Because of the active role of the consumer in today's society,the term __________ is used frequently to describe the consumer of health care.
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