Question 1

For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management? A case manager can:

Accepted Answer

The case manager not only provides entrance into the system of care, but he or she also coordinates the multiple referrals that so often confuse the patient who is severely and persistently mentally ill and the patient's family. Case management promotes the efficient use of services. The other options are lesser advantages or may be irrelevant.

Question 2

A patient diagnosed with severe and persistent mental illness lives in a homeless shelter. The priority nursing diagnosis for this patient is Powerlessness. Which intervention should be included in the plan of care?

Accepted Answer

Mutual goal setting is an intervention designed to promote feelings of personal autonomy and dispel feelings of powerlessness. Although it might be easier and faster for the nurse to establish a plan and outcomes, this action contributes to the patient's sense of powerlessness. Involving the patient in decision making empowers the patient and reduces feelings of powerlessness.

Question 3

A 37-year-old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child. The patient says, "That girl looked like she was 19 years old." Which defense mechanism is this patient using?

Accepted Answer

Rationalization is used to justify upsetting behaviors by creating reasons that would allow the individual to believe that the behaviors were warranted or appropriate. The patient is rationalizing molestation of a minor. Denial is used to avoid dealing with the problems and responsibilities related to one's behaviors. Identification is incorporating the image of an emulated person and then acting, thinking, and feeling like that person. Displacement is the discharge of pent-up feelings onto something or someone else in the environment that is less threatening than the original source of the feelings.

Question 4

The father of a child diagnosed with schizophrenia says, "I lost my job, so we have no health insurance." The mother says, "I must watch this child all the time. Without supervision, our child becomes violent and destructive." A sibling says, "My parents don't pay attention to me." These comments signify:

Accepted Answer

Family burden refers to the meaning that the experience of living with a person who is mentally ill has for families. The stressors mentioned are not related to live-cycle issues. The stressors described are psychosocial. Stigma refers to shame and ridicule associated with mental illness.

Question 5

A nurse prepares a plan of care for a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which intervention should be included?

Accepted Answer

The nurse's major responsibilities lie with encouraging the patient to learn and use necessary skills, assisting the patient to stay on task. The nurse is not an ever-present taskmaster or disciplinarian. The nurse does not teach work-related skills; vocational staff members assume those types of tasks.

Question 6

A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest to assist the patient and family to cope with the stigma of mental illness as well as provide support and education?

Accepted Answer

Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. The organization also offers patient and family support and education about living with mental illness. Community Mental Health Centers (CMHCs) are government agencies that provide outpatient services to persons diagnosed with SPMI. The APA is the professional organization of psychiatrists. Programs of Assertive Community Treatment (PACT) use a treatment team approach to improve symptom management and quality of life for persons diagnosed with SPMI.

Question 7

The parent of an adult diagnosed with severe and persistent mental illness asks the nurse, "Why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

Accepted Answer

Studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment; also they demonstrate significant improvement in assertiveness and work behaviors, as well as decreased depression.

Question 8

A person diagnosed with severe and persistent mental illness enters a shelter for the homeless. Which intervention should be the nurse's initial priority?

Accepted Answer

Basic psychosocial needs do not change because a person is homeless. The nurse's initial priority should be establishing rapport. Once a trusting relationship is established, then the nurse can pursue other interventions.

Question 9

A homeless patient diagnosed with severe and persistent mental illness became suspicious and delusional. The patient was given depot antipsychotic medication and housing was arranged at a local shelter. After 2 weeks, which statement by the patient indicates significant improvement?

Accepted Answer

Evaluation of a patient's progress is made based on patient satisfaction with the new health status and the health care team's estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being "bothered" by others denotes an improvement in the patient's condition. The other options suggest that the patient is in danger of relapse.

Question 10

An adult diagnosed with attention deficit hyperactivity disorder (ADHD) says, "I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job." The nurse managing care should consider:

Accepted Answer

Cognitive therapy and knowledge of ADHD will make it possible for the patient to reframe the past and present in a more positive and realistic light and to challenge internalized false beliefs about self. Aversive therapy would not be useful for the patient. Group therapy may be valuable later to allow for the testing of new coping behaviors in a safe environment. Vocational counseling can help the patient explore suitable career options while pursuing treatment.

Question 11

Which nursing diagnosis is likely to apply to the plan of care for a homeless individual diagnosed with severe and persistent mental illness?

Accepted Answer

Many individuals with severe mental illness do not live with their families and are homeless. Life on the street or in a shelter has a negative influence on the individual's self-esteem, making this nursing diagnosis one that should be considered. Insomnia may be noted in some patients but is not a universal problem. While substance abuse may be a comorbid problem, it is not an approved North American Nursing Diagnosis Association International (NANDA-I) diagnosis. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not observed in a majority of the homeless population.

Question 12

A patient diagnosed with severe and persistent mental illness lives independently. This patient often has command hallucinations and shouts warnings to neighbors. After a short hospitalization, the patient's landlord says, "You can't come back here. You cause too much trouble." What problem is the patient experiencing?

Accepted Answer

The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as the patient's problem. Recidivism refers to repetition of a previous offense. Insurance parity is not relevant to this scenario.

Question 13

Health maintenance and promotion efforts for patients diagnosed with severe and persistent mental illness should include education about the importance of regular:

Accepted Answer

Individuals diagnosed with severe and persistent mental illness have an increased prevalence of medical disorders. Patients should be taught the importance of regular visits to a primary care physician for screening for these illnesses. Home safety inspections are more often suggested for patients with physical impairments. Caregivers and family members usually evaluate self-care abilities, rather than the patient. Assessment of a patient's support system is not usually considered part of health promotion and maintenance.

Question 14

A nurse prepares for an initial interview with a patient with suspected adult attention deficit hyperactivity disorder (ADHD). Questions should be focused to elicit information about which problem?

Accepted Answer

Inattention usually persists from childhood into adult ADHD, although hyperactivity, impulsivity, and social impairments may also be present. Headaches would not be expected. Sexual impulses may be affected by adult ADHD, but this area is assessed later. Trichotillomania refers to pulling out one's hair as a tension-relieving behavior.

Question 15

Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning?

Accepted Answer

Before a nurse can be helpful to patients with sexual dysfunction, he or she must be aware of and comfortable with his or her own feelings about sex and sexuality. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure.

Question 16

The treatment team believes medication will help a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed?

Accepted Answer

Psychostimulants, such as methylphenidate and amphetamines, provide the basis for treatment of both adult and childhood ADHD. They are the most commonly used medications; therefore, the nurse could expect the health care provider to prescribe a drug in this class. None of the other drugs listed as options have proved useful in the treatment of ADHD.

Question 17

A patient says, "I often make careless mistakes and have trouble staying focused. Sometimes it's hard to listen to what someone is saying. I have problems putting things in the right order and often lose equipment." Which problem should the nurse document?

Accepted Answer

Inattention refers to the failure to stay focused. A number of the other problems are the result of failure to pay attention, which contributes to problems with organization. Impulsivity refers to acting without thinking through the consequences. Hyperactivity refers to excessive motor activity. Social impairment refers to the failure to use appropriate social skills.

Question 18

Severe and persistent mental illness is best characterized as a:

Accepted Answer

"Severe and persistent mental illness" has replaced the phrase "chronic mental illness." Global impairments in function are evident, including social skills. Physical impairments may or may not be present. Severe mental illness can be treated, but remissions and exacerbations are part of the course of the illness.

Question 19

An adult says, "When I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job." Which disorder is most likely?

Accepted Answer

Adult ADHD is usually diagnosed in early life and treated until adolescence. Treatment is often stopped because professionals think the disorder resolves itself because the hyperactive impulsive behaviors may diminish; the inattentive and disorganized behaviors tend to persist, however. Stress intolerance disorder is not found in the DSM-5. The scenario description is inconsistent with generalized anxiety disorder and borderline personality disorder.

Question 20

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the cause of the patient's ineffective management of the medication regimen as:

Accepted Answer

The patient's ineffective management of the medication regimen is most closely related to impaired reasoning abilities. The patient believes in being an exalted person who hears God's voice, rather than an individual with a serious mental illness who needs medication to control symptoms. Data do not suggest that any of the other factors often relate to medication nonadherence.

Quiz 27: Adults