Question 1

A community mental health nurse is interviewing a man who is homeless and has been brought in for services by a local outreach program. The man has been previously diagnosed with schizophrenia and has a history of active alcoholism. What is the nurse's first priority?

A) Explore options for community housing.
B) Provide referrals for housing rental agents.
C) Require symptom control as the first step in providing assistance.
D) Refer the patient for an inpatient detoxification and recovery program.

Explore options for community housing.

Accepted Answer

1. The nationwide emphasis now is on housing first programs that house people first and build in supports for treatment and recovery in stages as the person demonstrates the readiness to engage. It is essential to include treatment options in any treatment planning. It is important for nurses to note that it is not necessary for an individual to have good control of the specific symptoms of mental illness to get basic needs met for safety, food, shelter, and income. The patient has not indicated motivation for a recovery program at this time. A housing rental agent will not be able to offer supportive services.

Question 2

A nurse is meeting with a patient with borderline personality disorder who is being admitted to a partial hospitalization program (PHP). The patient asks what she should do to make sure that people in the program will like her. What is an appropriate response the nurse might make?

A) "People will like you if you follow all the rules and come every day."
B) "The program usually works best if you can focus on what you need, not on how others feel. Can you tell me some things you would like to see happen here?
C) "People sometimes avoid people who are depressed. Getting your symptoms under control and learning how to make friends is the best way to get people to like you."
D) "Getting people to like you is not an appropriate goal. You need to work on understanding how to set goals and then on what you have to do in order to accomplish them."

Accepted Answer

2. In community mental health, the nurse is not there to do things for the person, but rather to find out what the individual would like to accomplish and establish a collaborative plan. The overall goal of the PHP is to promote patients to make decisions about their own treatment and rehabilitation plans. Telling the patient what to do or how to act does not engage them in their treatment plan. Criticism is not a therapeutic form of communication.

Question 3

A 22-year-old diagnosed with schizophrenia has returned home to live with his family after a period of time during which he stopped taking his medications and began living on the street. He has been taking his medications as ordered for about two weeks. The patient is driven to his appointment with the nurse case manager by his father, who reports that the patient is doing better now that he is "on his meds again." Which service will the nurse discuss with the patient as part of a comprehensive, community-based treatment program?

A) Supported employment
B) Dual diagnosis program
C) Family education and engagement
D) Partial hospitalization program (PHP)

Family education and engagement

Accepted Answer

3. Family education and engagement can support the patient's family in developing their coping skills for responding empathically and knowledgably to the family member who is struggling with mental illness. There is no indication that the patient is seeking or even ready for job training and employment at this time. The patient does not have a dual diagnosis. Partial hospitalization programs offer an intensive level of support that may not be necessary if the patient is stable on his medications and able to live at home.

Question 4

Which patient is a nurse likely to see in a dual diagnosis program?&#10;A) A patient with schizophrenia and diabetes&#10;B) A patient with bipolar disorder and alcoholism&#10;C) A patient with schizoaffective disorder and chronic unemployment&#10;D) A patient with adjustment disorder with depressed mood and substance abuse problems&#10;

Accepted Answer

2. There is considerable evidence that the addition of a substance use disorder for a person already struggling with symptoms of serious mental illness, such as bipolar disorder, is a factor that often slows progress and recovery. Access to integrated services in a dual diagnosis program can result in improved treatment outcomes. Dual diagnosis programs specifically address serious mental health and substance abuse problems, not physical conditions or employment issues. An adjustment disorder, although it may warrant mental health treatment, is not considered a serious mental illness.

Question 5

A patient with bipolar disorder has been prescribed lithium. Which is the priority nursing intervention?&#10;A) Assist the patient in developing self-determination.&#10;B) Discuss environmental modifications.&#10;C) Change medications to control side effects.&#10;D) Teach the patient about the medication.&#10;

Accepted Answer

4. Although community health nurses do assist patients in developing self-determination and making environmental modifications, the priority nursing intervention is to provide patient teaching about the medication and to ensure monitoring of the patient's lithium levels to evaluate the therapeutic level of the drug and to prevent toxicity. If side effects are observed or reported, the nurse should consult with the prescribing provider, who will determine if the medication needs to be changed.

Question 6

A nurse is providing services in a day rehabilitation program. A patient in the program who has a diagnosis of schizophrenia is struggling with weight gain from his medications and managing his mental illness. He is also lonely and finds it difficult to relax. Following best practices, what are some topics that would be included in a group education program that could be useful for this patient? Select all that apply.

A) Coping with stress
B) Finding useful employment
C) Learning recovery strategies
D) Using medications effectively
E) Building social support

Accepted Answer

1. Nine topics typically covered in the Illness Management and Recovery (IMR) best-practice model include: learning recovery strategies; practical facts about mental illness; stress vulnerability model and treatment strategies; building social support and reducing relapses; using medications effectively; coping with stress; coping with problems and symptoms; meeting one's needs in the mental health service system; addressing drug and alcohol use. Finding employment is not a standard part of this protocol.
3. Nine topics typically covered in the Illness Management and Recovery (IMR) best-practice model include: learning recovery strategies; practical facts about mental illness; stress vulnerability model and treatment strategies; building social support and reducing relapses; using medications effectively; coping with stress; coping with problems and symptoms; meeting one's needs in the mental health service system; addressing drug and alcohol use. Finding employment is not a standard part of this protocol.
4. Nine topics typically covered in the Illness Management and Recovery (IMR) best-practice model include: learning recovery strategies; practical facts about mental illness; stress vulnerability model and treatment strategies; building social support and reducing relapses; using medications effectively; coping with stress; coping with problems and symptoms; meeting one's needs in the mental health service system; addressing drug and alcohol use. Finding employment is not a standard part of this protocol.
5. Nine topics typically covered in the Illness Management and Recovery (IMR) best-practice model include: learning recovery strategies; practical facts about mental illness; stress vulnerability model and treatment strategies; building social support and reducing relapses; using medications effectively; coping with stress; coping with problems and symptoms; meeting one's needs in the mental health service system; addressing drug and alcohol use. Finding employment is not a standard part of this protocol.

Question 7

The mental health nurse at a community health center reviews the charts of the patients who present for appointments at the beginning of the day. Which patient will the nurse see first?&#10;A) A college student who has been referred from the student health center for an ADHD evaluation&#10;B) A 43-year-old woman with schizophrenia who reports she has stopped taking her medication because it makes her feel sick&#10;C) A 35-year-old woman with bipolar disorder who requires a medication evaluation&#10;D) A 25-year-old man with obsessive-compulsive disorder who reports a relapse of symptoms&#10;

Accepted Answer

2. The patient with schizophrenia who has stopped taking her medication is at risk for relapse and possibly risk for injury if symptoms such as delusions or hallucinations return. The nurse will see this patient first to assess the reasons for medication nonadherence and try to help motivate the patient to return to the treatment plan. The nurse should also see this patient first to ensure the patient does not leave if she lacks the motivation to wait. Patients with schizophrenia are also likely to have co-morbid conditions, so this patient's risk for injury may increase in the presence of a co-occurring medical illness if the patient is not following the treatment plan. The remaining patients the nurse can see in order of arrival.

Question 8

The nurse case manager is working with a 20-year-old college student who has just been discharged from inpatient care for treatment for anorexia nervosa. Which resources and treatment options will the nurse discuss with the patient and the interprofessional team? Select all that apply.

A) Individual counseling
B) Group psychotherapy
C) Medication management
D) Family psychoeducation
E) Assertive community treatment (ACT)

Accepted Answer

1. Family, group, and individual counseling are all effective treatment options for anorexia nervosa and are often combined. There are no specific medications used in the treatment of anorexia. ACT programs are used with patients requiring comprehensive and intensive community supports.
2. Family, group, and individual counseling are all effective treatment options for anorexia nervosa and are often combined. There are no specific medications used in the treatment of anorexia. ACT programs are used with patients requiring comprehensive and intensive community supports.
4. Family, group, and individual counseling are all effective treatment options for anorexia nervosa and are often combined. There are no specific medications used in the treatment of anorexia. ACT programs are used with patients requiring comprehensive and intensive community supports.

Question 9

A patient diagnosed with bipolar disorder and alcohol abuse has been receiving treatment in a dual diagnosis integrated program for three months. What statement would indicate that the patient is in the recovery process?

A) "I have things under control now."
B) "My girlfriend really wants me to stop drinking."
C) "I really appreciate all the help you are giving me."
D) "I see how alcohol might make my bipolar symptoms worse."

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Accepted Answer

4. Linking alcohol abuse and mental health symptoms indicates an early stage in recovery of awareness and acknowledgement. The process of recovery is not quick. Motivation that depends on others is not a step in recovery. The focus in recovery needs to be on one's own behavior, not that of others.

Question 10

A nurse in a dual diagnosis program has been working with a patient who has been diagnosed with schizophrenia and substance abuse. The patient has been in the program for several months. What might indicate to the nurse that this program is working effectively for this patient?

A) The patient attends the program regularly.
B) The patient says that the nurse is a good person.
C) The patient reports no longer needing the program.
D) The patient understands that continued sobriety is necessary to stay in the program.

Accepted Answer

1. Dual diagnosis programs include the principle of long-term retention that keeps treatment, rehabilitation, and support available and easily accessible for as long as necessary. Dual diagnosis programs depend on patient engagement. Continued engagement by a patient with schizophrenia is a sign of program effectiveness. Although a good opinion of the nurse may enhance client engagement, it is not an indication of program effectiveness. A statement that the program is no longer necessary does not provide an evidence of its effectiveness. Treatments should match the patient's level of motivation and stage of recovery.

Question 11

A patient with severe mental illness was admitted to an inpatient psychiatric unit for treatment for major depressive disorder and a co-occurring substance use disorder. The patient is progressing well on the unit but will require intensive, daily support on discharge. Which treatment option will the interprofessional team discuss with the patient as the best option after discharge?

A) Supported employment
B) Assertive community treatment
C) Peer support
D) Partial hospitalization program

Accepted Answer

The answer of A patient with severe mental illness was...

Question 12

The nurse case manager is discussing the various community support programs for a patient who is scheduled to be discharged from an inpatient mental health facility. Which statement by the patient indicates that the nurse's teaching about supported employment (SE) programs has been effective? Select all that apply.

A) "The goal of these programs is competitive employment."
B) "Treatment and employment are integrated in these programs."
C) "The goal of these programs is to provide job readiness classes."
D) "Assessment of intellect and abilities are integrated in these programs."
E) "Everyone who shows interest in employment is eligible for these programs."

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Accepted Answer

The answer of The nurse case manager is discussing the...

Question 13

A psychiatric advanced practice registered nurse (APRN) works for a local community health center. Which patients is she likely to see? Select all that apply.&#10;A) A 76-year-old man who was found wandering the parking lot of a local shopping mall&#10;B) A 40-year-old woman with diabetes and a history of depression&#10;C) A 16-year-old girl with a BMI of 15.75&#10;D) A 60-year-old woman with a sprained ankle&#10;E) A 17-year-old football player with fluid volume deficit and a cut on his right hand&#10;

Accepted Answer

The answer of A psychiatric advanced practice registered nurse (APRN)...

Question 14

A nurse working in a substance abuse clinic is assigned a patient with recurring substance abuse issues. Which strategy is the first priority when providing care to this patient?&#10;A) Administering medication&#10;B) Ordering psychological testing&#10;C) Arranging for inpatient hospital care&#10;D) Assessing the patient's current health status&#10;

Accepted Answer

The answer of A nurse working in a substance abuse...

Question 15

The interprofessional treatment team is discussing appropriate strategies for a homebound patient who has a history of medication nonadherence. A treatment team member suggests that the nurse case manager make daily home visits to administer medications to the patient. What is the best response from the nurse case manager?

A) "My job description does not include medication administration to patients in the home."
B) "My time is better spent supervising others to provide this type of direct care."
C) "My daily schedule is too full to commit this amount of time to administering medications."
D) "My role as case manager is to remain objective and organize and coordinate care, not to provide direct patient care."

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Accepted Answer

The answer of The interprofessional treatment team is discussing appropriate...

Question 16

Which patient will the nurse case manager consider referring for supported employment services?&#10;A) A 55-year-old man diagnosed with schizophrenia who wants to continue his work as an artist&#10;B) A 35-year-old woman with bipolar disorder who was fired from her last job as a beautician and wants her job back&#10;C) A 47-year-old woman with major depression who wants to continue providing care for her three young children&#10;D) A 21-year-old man diagnosed with schizophrenia who dropped out of college and wants to continue his education&#10;

Accepted Answer

The answer of Which patient will the nurse case manager...

Question 17

The nurse case manager is discussing the various community support programs for a patient who is scheduled to be discharged from an inpatient mental health facility. Which statement by the patient indicates that the nurse's teaching about supported employment (SE) programs has been effective? Select all that apply.

A) "The goal of these programs is competitive employment."
B) "Treatment and employment are integrated in these programs."
C) "The goal of these programs is to provide job readiness classes."
D) "Assessment of intellect and abilities are integrated in these programs."
E) "Everyone who shows interest in employment is eligible for these programs."

Accepted Answer

The answer of The nurse case manager is discussing the...

Question 18

The nurse at a community mental health clinic is planning to refer patients to various members of the community-based recovery team. Which patient would the nurse refer to the psychiatrist?&#10;A) An anxious patient who would benefit from group therapy&#10;B) A patient with schizophrenia who has housing and employment issues&#10;C) A patient with bipolar disorder who is experiencing frequent mood cycling&#10;D) A patient newly diagnosed with panic disorder who needs psychoeducation&#10;

Accepted Answer

The answer of The nurse at a community mental health...

Question 19

A nurse is seeing a patient for individual treatment who has been diagnosed with bipolar disorder. Although the patient has been compliant with prescribed medications, the patient is experiencing an increase in symptoms, including disturbed sleep patterns, hyperactivity, increased credit card use, and grandiose statements. What treatment option might the nurse consider?

A) Family education
B) Peer support group
C) In-patient hospitalization
D) Partial hospitalization program (PHP)

Accepted Answer

The answer of A nurse is seeing a patient for...

Question 20

A patient, referred by a homeless outreach program, has been diagnosed with schizophrenia and substance abuse. The patient has not been taking any prescribed medications. What program might be an effective treatment strategy?

A) Supported Employment
B) Mental Health First Aid
C) Assertive Community Treatment (ACT)
D) Partial Hospitalization Program (PHP)

Accepted Answer

The answer of A patient, referred by a homeless outreach...

Deck 29: Community-Based Care