Deck 5: Settings for Psychiatric Care

Question 1

A community psychiatric nurse facilitates medication adherence for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance?

A) Attitude of significant others toward the patient
B) Nutritional services in the patient's neighborhood
C) Level of trust between the patient and the nurse
D) Availability of transportation to the clinic

Answer 1

Availability of transportation to the clinic

Question 2

To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?

A) Problem-solving skills
B) Calm and caring manner
C) Ability to cross service systems
D) Knowledge of psychopharmacology

Answer 2

Ability to cross service systems

Question 3

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

A) No treatment plan is present in record.
B) Patient belongings are searched at admission.
C) Physical restraint is used to prevent harm to self.
D) Patient is placed on one-to-one continuous observation.

Answer 3

No treatment plan is present in record.

Question 4

A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under staff supervision. These observations relate to:

A) management of milieu safety.
B) coordinating care of patients.
C) management of the interpersonal climate.
D) use of therapeutic intervention strategies.

Question 5

A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, "I'm willing to take my medicine, but I forgot to get my prescription refilled." Which outcome should the nurse add to the plan of care?

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

Question 6

The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who:

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

Question 7

A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, "I feel the same." Which intervention supports the nurse's assessment while preserving the patient's autonomy?

A) Arrange for a short hospitalization.
B) Schedule weekly clinic appointments.
C) Refer the patient to the crisis intervention clinic.
D) Call the family and ask them to observe the patient closely.

Question 8

Which patient would a nurse refer to partial hospitalization? An individual who:

A) spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
B) because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy.
C) has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
D) states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

Question 9

The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, "It's too soon for discharge. Hospitalization is needed for at least a month." The nurse should:

A) call the psychiatrist to come explain the discharge rationale.
B) explain that health insurance will not pay for a longer stay for the patient.
C) call security to handle the disturbance and escort the family off the unit.
D) explain that the patient will continue to improve if medication is taken regularly.

Question 10

Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:

A) present a clear danger to self or others.
B) are noncompliant with medications at home.
C) have no support systems in the community.
D) develop new symptoms during the course of an illness.

Question 11

A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to:

A) cancel the patient's discharge from the hospital.
B) contact the landlord who evicted the patient to discuss the situation.
C) arrange a temporary place for the patient to stay until new housing can be arranged.
D) document that the adverse medication reaction was feigned because the patient had nowhere to live.

Question 12

A patient tells the nurse at the clinic, "I haven't been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and don't want them to ask me about the pills." Select the nurse's most appropriate intervention.

A) Investigate the possibility of once-daily dosing of the antidepressant.
B) Suggest to the patient to take the medication when no one is watching.
C) Explain how taking each dose of medication on time relates to health maintenance.
D) Add the following nursing diagnosis to the plan of care: ineffective therapeutic regimen management, related to lack of knowledge.

Question 13

A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting?

A) A treatment plan will be formulated.
B) The health care provider will order neuroimaging studies.
C) The team will request a court-appointed advocate for the patient.
D) Assessment of the patient's need for placement outside the home will be undertaken.

Question 14

Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?

A) Resolve behavioral crises using the least restrictive intervention possible.
B) Rights of the majority of patients supersede the rights of individual patients.
C) Swift intervention is justified to maintain the integrity of the therapeutic milieu.
D) Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.

Question 15

A patient hurriedly tells the community mental health nurse, "Everything's a disaster! I can't concentrate. My disability check didn't come. My roommate moved out, and I can't afford the rent. My therapist is moving away. I feel like I'm coming apart." Nursing interventions should be focused on which problem?

A) Assisting the patient to clarify personal values
B) Coping with feelings of abandonment
C) Coping with anxiety that may lead to psychological disequilibrium
D) Clarifying misperceptions of the environment,

Question 16

Which employer's health plan is required to include parity provisions related to mental illnesses?

A) Employer with more than 50 employees
B) Cancer thrift shop staffed by volunteers
C) Day care center that employs 7 teachers
D) Church that employs 15 people

Question 17

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

A) Report the situation to the manager of the shelter.
B) Tell the patient, "You must stop smoking to save money."
C) Assess the patient's weight; determine the foods and amounts eaten.
D) Seek hospitalization for the patient while a new plan is being formulated.

Question 18

Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient:

A) receives Social Security disability income plus a small check from a trust fund.
B) lives in an apartment with two patients who attend day hospital programs.
C) has a sibling who is interested and active in care planning.
D) purchases and uses marijuana on a frequent basis.

Question 19

A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, "Only a traitor would make me go to the hospital." Which solution is best?

A) Arrange a bed in a local homeless shelter with nightly onsite supervision.
B) Negotiate a way to provide medication so the patient can remain at home.
C) Hospitalize the patient until the symptoms have stabilized.
D) Seek inpatient hospitalization for up to 1 week.

Question 20

A student nurse prepares to administer oral medication to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should:

A) tell the patient, "I'll get an unsatisfactory grade if I don't give you the medication."
B) tell the patient, "Refusing your medication is not permitted. You are required to take it."
C) discuss the patient's concerns about the medication, and report to the staff nurse.
D) document the patient's refusal of the medication without further comment.

Question 21

A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following? (Select all that apply.)

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

Question 22

A community member asks a nurse, "People diagnosed with mental illnesses used to go to a state hospital. Why has that changed?" Select the nurse's accurate responses. (Select all that apply.)

A) "Science has made significant improvements in drugs for mental illness, so now many people may live in their communities."
B) "A better selection of less restrictive settings is now available in communities to care for individuals with mental illness."
C) "National rates of mental illness have declined significantly. The need for state institutions is actually no longer present."
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 have shifted the focus to community rather than institutional settings."