Deck 30: Serious Mental Illness

Question 1

A patient with severe schizophrenia is seen at a community mental health center.He tells the nurse,"I am here to save the world.I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as:

A) poor alliance with clinicians.
B) inadequate discharge planning.
C) dislike of drug side effects.
D) poor insight into his illness.

Answer 1

poor insight into his illness.

Question 2

The brother of a patient who is seriously mentally ill asks why the patient has been assigned a case manager.The nurse's reply should cite the major advantage of the use of case management as:

A) "The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible."
B) "Case managers coordinate services and help with accessing them,making sure the patient gets what he needs."
C) "The case manager can focus on social skills training and esteem building out in the real world where he lives."
D) "Having a case manager has been shown to reduce hospitalizations,which prevents disruption and saves money."

Answer 2

"Case managers coordinate services and help with accessing them,making sure the patient gets what he needs."

Question 3

A judge notices that many of the persons brought before her criminal court are mentally ill people who have committed minor offenses,are off their medications,and who probably offended because of their illness.She consults the nurse director of the local community mental health center for guidance about how to most helpfully respond when handling such cases.Which advice from the nurse would be most appropriate?

A) "Sometimes a little time in jail makes a person rethink what they've been doing and puts them back on the right track."
B) "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses."
C) "Actually,police arresting these people helps them in the long run;sometimes I can't hospitalize them,but in jail they'll at least get their meds."
D) "Research suggests that special 'mental health courts' aren't making much of a difference so far,but outpatient commitment does seem to help."

Answer 3

"Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses."

Question 4

A patient,aged 30 years,tells his case manager,"I do not have bipolar disorder anymore,so I do not need the medicine and the blood tests.I was in the hospital twice for a few days a year or so ago,then I got a place to live and SSI checks.All that is wrong now is I am bored and I need to get something going." The nurse assesses the patient as demonstrating:

A) denial.
B) projection.
C) rationalization.
D) identification.

Question 5

A patient with schizophrenia,aged 60 years,spent 5 years in a state hospital before being discharged to a community residence.The patient requires persistent direction to accomplish daily activities of living,has difficulty determining what to do with his time,and is resistant to behaving independently,expecting others to provide meals or wash his clothes.The nurse assesses this passive behavior as being the probable result of:

A) dependency caused by institutionalization.
B) cognitive deterioration from schizophrenia.
C) brain damage from recreational drug use.
D) side effects of neuroleptic medications.

Question 6

A patient with severe mental illness who lives independently in an apartment and attends a psychosocial rehabilitation program 4 days a week presents at the emergency department seeking admission to the inpatient psychiatric unit.The mental status examination reveals no acute symptoms of psychiatric disorder.Her chief complaint is that she has no money to pay her rent or refill her antipsychotic medication prescription.The best action for the emergency department nurse would be to:

A) arrange for a short in-patient admission and begin discharge planning.
B) send the patient to a homeless shelter until housing can be arranged.
C) involve the patient's case manager to provide crisis intervention.
D) explain that one must have more psychiatric symptoms to be admitted.

Question 7

A man with severe mental illness dies suddenly at the age of 52.He had been living successfully in the community for 5 years without a hospitalization and worked for the past 6 months in the first job he had held for more than 20 years.His family is in shock,having been caught completely by surprise by his death,and asks why this has happened.Which of the following responses accurately reflects the research on mortality and serious mental illness and best addresses the family's question?

A) "A certain number of people die young from undetected diseases,and it's just one of those sad things that happens sometimes to unlucky people."
B) "Mentally ill people tend to die much younger than others,perhaps because they do not take as good care of their health,or smoke more,or are overweight."
C) "We will have to wait for the autopsy to see for sure what happened.He had had some medical problems,but we were not expecting this."
D) "We are all surprised.He had been doing so well,and he sees the nurse every other week;all we knew was wrong was that he was overweight."

Question 8

The nurse wishes to enroll a patient with poor social skills in a training program for patients with schizophrenia.Which description accurately describes how social skills training works?

A) Complex interpersonal skills are taught by breaking them into simpler behaviors.
B) Patients learn to improve their attention and concentration via computer drills.
C) The group leaders provide support without challenging the patient to change.
D) Patients learn social skills by practicing them in a supported employment setting.

Question 9

A patient with paranoid schizophrenia and anosognosia has had several hospitalizations.He responds quickly to antipsychotic medication but stops taking the medication soon after discharge.Discharge planning will include follow-up at the mental health clinic,placement in a group home,and daily attendance at a psychosocial day program.Which medication strategy will most likely be used as he transitions from hospital to community?

A) Administer a second-generation antipsychotic to help negative symptoms.
B) Prescribe a long-acting intramuscular antipsychotic medication.
C) Involve the patient in the decision about which medication is best.
D) Prescribe a quick-dissolving formulation to reduce "cheeking."

Question 10

A seriously mentally ill patient who lives in a homeless shelter has a nursing diagnosis of Powerlessness.Which intervention would best address this nursing diagnosis?

A) Reinforce participation in social activity.
B) Help the patient set long-term goals.
C) Role-play assertive communication skills.
D) Role-model effective conflict resolution.

Question 11

Which three health maintenance and promotion interventions would be most indicated and beneficial for patients with serious mental illness? Select all that apply.

A) Walk with the patient during meetings and to nearby appointments.
B) Point out that smoking is dangerous to one's health and discourage it.
C) Screen the patient regularly for hypertension and diabetes mellitus.
D) Encourage the patient to join a health club to promote exercise.
E) Help the patient learn to prepare nutritious,tasty,inexpensive meals.

Question 12

A severely mentally ill man neglects to pay his rent and becomes homeless,so he sleeps in 24-hour laundromats and washes in public restrooms.His SSI checks are returned as undeliverable.Without money he cannot buy food,and as a result he steals a bag of chips,leading to incarceration.Which nursing diagnosis would most likely apply?

A) Social isolation
B) Risk for low self-esteem
C) Impaired social interaction
D) Self-care deficit

Question 13

A man with severe mental illness has difficulty with boredom,feels that attending the day program does not challenge him,and wishes to earn money.Which of the following options would be most appropriate for addressing these issues?

A) Involve him in volunteer work at the consumer-run clubhouse program at the mental health center.
B) Help the patient apply for services at the state's Bureau of Vocational Rehabilitation.
C) Rapidly pace him in a competitive job of his choosing,accompanied by a coach on the job site.
D) First involve the patient in prevocational training,then in employment in a sheltered workshop.

Question 14

A middle-class family is talking with the nurse about the impact a seriously mental ill son has had on the family.Insurance has only partially covered treatment expenses,and the family has spent much of their savings to care for him.The patient's younger sister mentions she feels lost because her parents are so focused on her brother that it seems as though they have no time for her.The parents are concerned that when the siblings move out and they themselves become aged,there will be no one to care for the patient.Which response would be most helpful?

A) Acknowledge their concerns,and indicate that you will consult with the treatment team about ways to bring the patient's symptoms under better control.
B) Give them the names of financial advisors and banks that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
C) Refer them to crisis intervention services to learn ways to manage caregiver stress,and provide the titles of some helpful books for families of SMI persons.
D) Discuss the benefits of participating in National Alliance on Mental Illness programs,and discuss ways to help the son become more independent.

Question 15

A patient with severe schizophrenia is seen at a community mental health center.Although he continues to attend programming at the center,he tells the nurse,"I threw away the pills because they keep me from hearing God." Which of the following responses would be most likely to benefit this patient?

A) "You need your medicines;your schizophrenia will get worse without them."
B) "Do you want to end up in the hospital again? You have to take your medicines."
C) "I noticed that with the medicine,you have been able to hold a job you wanted."
D) "I would like you to come to the medication education group each Thursday."

Question 16

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there.Which interventions are likely to help achieve this goal? Select all that apply.

A) Increase the length of medication education groups.
B) Improve working conditions to reduce staff turnover.
C) Make it easier to access prescribers and pay for drugs.
D) Require adherence in order to participate in the day program.
E) Prescribe drugs in smaller but more frequent dosages.

Question 17

A homeless individual with severe mental illness,anosognosia,and a history of persistent treatment nonadherence is persuaded to come to the day program at the community mental health center.Which intervention should be the team's initial priority?

A) Educate him about the importance of treatment adherence.
B) Help him obtain employment in a local sheltered workshop.
C) Interact regularly and supportively without trying to change him.
D) Teach appropriate health maintenance and prevention practices.

Question 18

A man with schizophrenia states: "I will not take medicine-there is nothing wrong with me! Why would I take medicine when I'm not sick! They only put me here because they want to steal my thoughts so they can sell them." What is this patient demonstrating?

A) Denial
B) Anosognosia
C) Rationalization
D) Hallucinations

Question 19

A patient with serious mental illness who has just moved into a homeless shelter tells the nurse that his "life just got out of control." He says he could not depend on others,so he kept to himself.Then he added,"I am like a leaf at the mercy of the wind." The nurse adds the nursing diagnosis of Powerlessness to his care plan.Which entry in his chart best suggests that the treatment plan is helping with this diagnosis?

A) "Spent the day applying for positions at four local fast food places."
B) "Playing chess with peer,went for walk earlier,no paranoia noted."
C) "Hygiene adequate,no body odor noted,washed clothes on his own."
D) "Patient reports that he has made friends with a peer at the group home."