Deck 3: Overview of Psychiatric Mental Health Nursing Care Within Various Settings

Question 1

Which principle has the highest priority when addressing a behavioural crisis in an inpatient setting?

A) Suspend the patients' rights until the crisis is resolved.
B) Swift intervention is justified to maintain the integrity of a therapeutic milieu.
C) Rights of an individual patient are superseded by the rights of the majority of patients.
D) Patients should have opportunities to regain control without intervention if the safety of others is not compromised.

Answer 1

Suspend the patients' rights until the crisis is resolved.

Question 2

A nurse receives the following three phone calls regarding a community patient.
.The psychiatrist wants to complete a follow-up assessment.
.An internist wants to schedule a physical examination.
.The patient's attorney wants an appointment with the patient.
The nurse schedules the activities for the patient. Which role has the nurse fulfilled?

A) Advocate
B) Case manager
C) Milieu manager
D) Provider of care

Answer 2

Case manager

Question 3

A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient's thoughts are now more organized, and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." Which of the following should the nurse do?

A) Ask the case manager to arrange a transfer to a long-term care facility.
B) Notify hospital security to handle the disturbance and escort the family off the unit.
C) Explain that the patient will continue to improve if the medication is taken regularly.
D) Contact the health care provider to meet with the family and explain the discharge rationale.

Answer 3

Explain that the patient will continue to improve if the medication is taken regularly.

Question 4

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room?

A) Kindness
B) Autonomy
C) Compassion
D) Professionalism

Question 5

Clinical pathways are used by the multidisciplinary team, in managed care settings, to do which of the following?

A) Stabilize aggressive patients
B) Identify obstacles to effective care
C) Relieve nurses of planning responsibilities
D) Streamline the care process and improve outcomes

Question 6

A nurse surveys medical records. Which finding signals a violation of patients' rights?

A) A patient was not allowed to send letters to family.
B) A patient's belongings were searched at admission.
C) A patient with suicidal ideation was placed on continuous observation.
D) Physical restraint was used after a patient was assaultive toward a staff member.

Question 7

Select the response that is an example of tertiary prevention.

A) Helping a person diagnosed with a serious mental illness learn to manage money
B) Restraining an agitated patient who has become aggressive and assaultive
C) Teaching school-age children about the dangers of drugs and alcohol
D) Genetic counselling with a young couple expecting their first child

Question 8

A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the nurse learned that the patient received a notice of eviction immediately prior to admission. Select the nurse's most appropriate action.

A) Postpone the patient's discharge from the hospital.
B) Contact the landlord who evicted the patient to further discuss the situation.
C) Arrange a temporary place for the patient to stay until new housing can be arranged.
D) Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.

Question 9

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients' rights?

A) Prohibited a patient from using the telephone
B) In patient's presence, opened a package mailed to patient
C) Remained within arm's length of patient with homicidal ideation
D) Permitted a patient with psychosis to refuse oral psychotropic medication

Question 10

Inpatient hospitalization for persons with mental illness is generally reserved for which of the following patients?

A) Patients who present a clear danger to self or others
B) Patients who are noncompliant with medication at home
C) Patients who have limited support systems in the community
D) Patients who develop new symptoms during the course of an illness

Question 11

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted?

A) The patient who is feeling anxiety and a sad mood after separation from a spouse of 10 years.
B) The patient who self-inflicted a superficial cut on the forearm after a family argument.
C) The patient experiencing dry mouth and tremor related to taking haloperidol (Haldol).
D) The patient who is a new parent and hears voices saying, "Smother your baby."

Question 12

A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, "I don't know what to do with my free time." Which member of the multidisciplinary treatment team would be most helpful to this patient?

A) Psychologist
B) Social worker
C) Recreational therapist
D) Occupational therapist

Question 13

A patient with which of the following diagnoses would be most appropriate to refer for assertive community treatment (ACT)?

A) A phobic fear of crowded places.
B) A single episode of major depression.
C) A catastrophic reaction to a tornado in the community.
D) Schizophrenia and four hospitalizations in the past year.

Question 14

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to which of the following?

A) Coordinating care of patients
B) Management of milieu safety
C) Management of the interpersonal climate
D) Use of therapeutic intervention strategies

Question 15

Select the response that is an example of primary prevention.

A) Assisting a person diagnosed with a serious mental illness to fill a pill-minder
B) Helping school-age children identify and describe normal emotions
C) Leading a psychoeducational group in a community care home
D) Medicating an acutely ill patient who assaulted a staff person

Question 16

The nurse assigned to assertive community treatment (ACT) should explain the program's treatment goal as which of the following?

A) Assisting patients to maintain abstinence from alcohol and other substances of abuse
B) Providing structure and a therapeutic milieu for mentally ill patients whose symptoms require stabilization
C) Maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness
D) Providing services for mentally ill individuals who require intensive treatment to continue to live in the community

Question 17

Which of the following scenarios best depicts a behavioural crisis?

A) A patient is waving fists, cursing, and shouting threats at a nurse.
B) A patient is curled up in a corner of the bathroom, wrapped in a towel.
C) A patient is crying hysterically after receiving a phone call from a family member.
D) A patient is performing push-ups in the middle of the hall, forcing others to walk around.

Question 18

Which aspect of direct care is an experienced, inpatient registered nurse most likely to provide for a patient?

A) Hygiene assistance
B) Diversional activities
C) Assistance with job hunting
D) Building assertiveness skills

Question 19

Which level of prevention activities would a nurse in an emergency department employ most often?

A) Primary
B) Secondary
C) Tertiary

Question 20

A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse's best initial action.

A) Explore ways to help the patient stop smoking.
B) Report the situation to the manager of the shelter.
C) Assess the patient's weight; determine foods and amounts eaten.
D) Arrange hospitalization for the patient in order to formulate a new treatment plan.

Question 21

The nurse should refer which of the following patients to a partial hospitalization program?

A) A patient who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
B) A patient who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
C) A patient who spent yesterday in a supervised crisis care centre and continues to have active suicidal ideation.
D) A patient who states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

Question 22

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to which of the following:

A) Source of income
B) Family and support systems
C) Housing adequacy and stability
D) Early psychosocial development
E) Substance abuse history and current use

Question 23

A nurse makes an initial visit to a homebound patient diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. Select the nurse's best response.

A) "Thank you. I would enjoy having a cup of coffee with you."
B) "Thank you, but I would prefer to proceed with the assessment."
C) "No, but thank you. I never accept drinks from patients or families."
D) "Our agency policy prohibits me from eating or drinking in patients' homes."

Question 24

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention?

A) Medication follow-up
B) Teaching parenting skills
C) Substance abuse counselling
D) Making a referral for family therapy

Question 25

The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy?

A) Clear risk of danger to self or others
B) Adjustment needed for doses of psychotropic medication
C) Detoxification from long-term heavy alcohol consumption needed
D) Respite for caregivers of persons with serious and persistent mental illness
E) Failure of community-based treatment, demonstrating need for intensive treatment

Question 26

A psychiatric nurse discusses rules of the therapeutic milieu and patients' rights with a newly admitted patient. Which rights should be included?

A) The right to received information
B) The right to confidentiality
C) The right to retain legal counsel
D) The right to an independent panel review, if certified
E) The right to select the nurse assigned to their care

Question 27

The case manager plans to discuss the treatment plan with a patient's family. Select the case manager's first action.

A) Determine an appropriate location for the conference.
B) Support the discussion with examples of the patient's behaviour.
C) Obtain the patient's permission for the exchange of information.
D) Determine which family members should participate in the conference.

Question 28

A psychiatrist prescribed depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. For this plan to be successful, which factor will be of critical importance?

A) The attitude of significant others toward the patient
B) Nutrition services in the patient's neighbourhood
C) The level of trust between the patient and nurse
D) The availability of transportation to the clinic

Question 29

Which assessment finding for a patient in the community deserves priority intervention by the psychiatric nurse?

A) The patient receives provincial disability income plus a small cheque from a trust fund every month.
B) The patient was absent from three of six planned Alcoholics Anonymous meetings in the past 2 weeks.
C) The patient lives in an apartment with two patients who attend partial hospitalization programs.
D) The patient has a sibling who was recently diagnosed with a mental illness.

Question 30

A Category V tornado hits a community, destroying many homes and businesses. Which nursing intervention would best demonstrate compassion and caring?

A) Encouraging people to describe their memories and feelings about the event
B) Arranging transportation to the local community mental health centre
C) Referring a local resident to a community food bank
D) Coordinating psychiatric home care services

Question 31

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, "Only a traitor would make me go to the hospital." Select the nurse's best initial intervention.

A) Collaborate with the patient to contact resources to provide medications without charge temporarily.
B) Arrange a bed in a local homeless shelter with nightly on-site supervision.
C) Hospitalize the patient until the symptoms have stabilized.
D) Ask the patient, "Do you feel like I am a traitor?"

Question 32

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient's spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.

A) The patient's spouse will mark dates for prescription refills on the family calendar.
B) The nurse will obtain prescription refills every 90 days and deliver to the patient.
C) The patient will call the nurse weekly to discuss medication-related issues.
D) The patient will report to the clinic for medication follow-up every week.

Question 33

A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns the following:
.The patient wants to attend an activity group at the mental health outreach centre
.The patient is worried about being able to pay for the therapy
.The patient does not know how to get from home to the outreach centre
.The patient has an appointment to have blood work at the same time an activity group meets
.The patient wants to attend services at a church that is about a kilometre from the patient's home
Which tasks are part of the role of a community mental health nurse?

A) Rearranging conflicting care appointments
B) Negotiating the cost of therapy for the patient
C) Arranging transportation to the outreach centre
D) Accompanying the patient to church services weekly
E) Monitoring to ensure the patient's basic needs are met

Question 34

Which statements most clearly reflect the stigma of mental illness?

A) "Many mental illnesses are hereditary."
B) "Mental illness can be evidence of a brain disorder."
C) "People claim mental illness so they can get disability cheques."
D) "Mental illness results from the breakdown of nuclear families."
E) "If people with mental illness went to church, their symptoms would vanish."

Question 35

Which statements by patients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship?

A) "My case manager talks in language I can understand."
B) "My case manager helps me keep track of my medication."
C) "My case manager gives me little gifts from time to time."
D) "My case manager looks at me as a whole person with many needs."
E) "My case manager lets me do whatever I choose without interfering."

Question 36

A person in the community asks, "People with mental illnesses went to isolated hospitals in earlier times. Why has that changed?" Select the nurse's accurate responses.

A) "Science has made significant improvements in drugs for mental illness, so now many people may live in their communities."
B) "There's now a better selection of less restrictive treatment options available in communities to care for people with mental illness."
C) "National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore."
D) "Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe conditions."
E) "Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings."