Deck 6: Psychiatric Mental Health Nursing in Community Settings

Question 1

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

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."

Answer 1

"My case manager talks in language I can understand."
"My case manager helps me keep track of my medication."
"My case manager looks at me as a whole person with many needs."

Question 2

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

A) Primary
B) Secondary
C) Tertiary

Answer 2

Secondary

Question 3

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.

Answer 3

Assess the patient's weight; determine foods and amounts eaten.

Question 4

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 5

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 6

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

Question 7

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 8

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 9

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 10

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 11

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 12

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 13

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 14

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

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 15

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 16

Which statements most clearly reflect the stigma of mental illness? Select all that apply.

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 17

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 18

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 19

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 20

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 21

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. 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) "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."

Question 22

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? Select all that apply.

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