Deck 5: Psychiatric Mental Health Nursing in Community Settings

Question 1

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) A calm external manner
C) Ability to cross service systems
D) Knowledge of psychopharmacology

Answer 1

Ability to cross service systems

Question 2

A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications every 3 weeks at the clinic.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 neighborhood
C) The level of trust between the patient and nurse
D) The availability of transportation to the clinic

Answer 2

The availability of transportation to the clinic

Question 3

Select the example of primary prevention.

A) Assisting a person with serious and persistent mental illness to fill a pill-minder
B) Helping school-age children describe normal emotions people experience
C) Leading a psychoeducational group in a partial hospitalization program
D) Medicating an acutely ill patient who assaulted a staff person

Answer 3

Helping school-age children describe normal emotions people experience

Question 4

The nurse assigned to assertive community treatment (ACT)should explain the program's treatment goal as:

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 5

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

A) was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.
B) lives in an apartment with two patients who attend partial hospitalization programs.
C) receives Social Security disability income plus a small check from a trust fund.
D) has a sibling who is interested and active in care planning.

Question 6

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

A) Explore ways to stop smoking with the patient.
B) Report the situation to the manager of the soup kitchen.
C) Assess the patient's weight;determine foods and amounts eaten.
D) Arrange hospitalization for the patient while a new treatment plan is formulated.

Question 7

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) With the patient's consent,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) Seek inpatient hospitalization.

Question 8

Select the example of tertiary prevention.

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

Question 9

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

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

Question 10

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

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

Question 11

A patient with schizophrenia has been stable in the community for 6 weeks.Today the patient's spouse calls the nurse to report the patient's thinking is disorganized.The nurse makes a home visit and learns the patient is willing to take medication but forgot to have the prescription refilled.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 12

A patient tells the nurse at the clinic,"I have been leaving out my midday dose of antidepressant medication.I have lunch with friends and don't want them to know I take pills." Select the nurse's most effective intervention.

A) Investigate the possibility of once-daily dosing of the antidepressant.
B) Explain how taking each dose of medication on time relates to health maintenance.
C) Suggest the patient take the medication when none of the friends is watching.
D) Establish the nursing diagnosis,Ineffective management of the therapeutic regimen.

Question 13

A community psychiatric nurse assesses that a serious and persistently mentally ill patient with a mood disorder is more depressed than on the clinic visit a month ago,but 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 14

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

A) Substance abuse counseling
B) Teaching parenting skills
C) Medication follow-up
D) Depression screening

Question 15

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

A) Primary
B) Secondary
C) Tertiary
D) Autonomy

Question 16

A patient with serious mental illness lives alone in a neighborhood.The patient receives monthly depot medication injections but lately has missed regular clinic appointments,saying,"My life is so busy I couldn't find time to come in." To prevent decompensation and hospitalization,the community mental health nurse should arrange for:

A) a psychosocial rehabilitation program.
B) assertive community treatment (ACT).
C) an appointment with a nurse in private practice.
D) insurance authorization to change to daily oral medication.

Question 17

In a rush of words,a patient tells the community mental health nurse,"Everything's a disaster! I cannot concentrate.My disability check did not come.My roommate moved out and I cannot afford the rent.My therapist is moving away.I don't know what to do and feel like I'm coming apart." Which nursing diagnosis applies?

A) Decisional conflict related to challenges to personal values.
B) Spiritual distress related to ethical implications of treatment regimen.
C) Anxiety related to changes perceived as threatening to psychological equilibrium.
D) Self-concept disturbance related to solving multiple problems affecting security needs.

Question 18

Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed with:

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) paranoid schizophrenia and four hospitalizations in the past year.

Question 19

The nurse would refer which patient to a partial hospitalization program? A patient who:

A) spent yesterday in a supervised crisis care center and continues to be actively suicidal.
B) needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
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 20

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

A) "No,thank you.I do not use products that contain caffeine."
B) "Thank you.I would enjoy having a cup of coffee with you."
C) "Thank you,but I would prefer to proceed with the assessment."
D) "Our agency policy prohibits me from eating or drinking in patients' homes."

Question 21

Which statement(s)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 checks."
D) "If people with mental illness went to church,they would be fine."
E) "Mental illness results from the breakdown of American families."

Question 22

Which statement(s)by patients with serious,persistent mental illness best demonstrate that the case manager has established an effective long-term relationship? (Select all that apply. )
"My case manager:

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

Question 23

A person in the community asks the nurse,"People with mental illnesses went to state hospitals in earlier times.Why has that changed?" Select the nurse's accurate response(s).(Select all that apply. )

A) "Science has made significant improvements in drugs for mental illness,so now many persons 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 24

A patient with schizophrenia lives in the community.On a home visit,the community psychiatric nurse case manager learns that the patient:
· Will begin attending an activities group at the mental health outreach center.
· Is worried about being able to pay for the therapy.
· Does not know how to get from home to the outreach center.
· Has an appointment to have blood work at the same time the activities group meets.
· Wants to attend services at a church that is a half mile from the patient's home.
Which task(s)would be 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 center
D) Accompanying the patient to church services weekly
E) Monitoring to ensure the patient's basic needs are met

Question 25

Sequence the intensity of these psychiatric treatments from highest to lowest:

A) Clinic visits at a community mental health center
B) Psychosocial rehabilitation program
C) Partial hospitalization
D) Crisis stabilization