Question 1

Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present?

Accepted Answer

Managed care exerts cost-control measures such as recertification of admissions, utilization review, and case managementóall of which have altered inpatient treatment significantly. There has been some progress in treatment options for mentally ill persons, but that is not the primary factor that has changed mental health inpatient hospital care. There is lesser stigma associated with mental illness, but that is not the primary factor that has changed mental health inpatient hospital care. In the 1980s, a typical psychiatric unit emphasized milieu therapy, which required long lengths of stay because clients with more stable conditions helped to provide structure and support for newly admitted clients with more acute conditions.

Question 2

The factor having the most influence on the current trend in treatment settings is the fact in recent years,

Accepted Answer

Adequate funding has not kept pace with the need for community programs and treatment. Commitment laws have led to deinstitutionalization. Large state hospitals emptied as a result. Treatment in the community was intended to replace much of state hospital inpatient care, but funding has been inadequate.

Question 3

A patient who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this patient at this time?

Accepted Answer

Long-stay clients in an inpatient setting are people with severe and persistent mental illness who continue to require acute care services despite the current emphasis on decreased hospital stays. This population includes clients who were hospitalized before deinstitutionalization and remain hospitalized despite efforts at community placement. It also includes clients who have been hospitalized consistently for long periods despite efforts to minimize their hospital stays. Partial hospitalization is designed for patients transitioning to independent living. Residential treatment and clubhouse model provide supervised independent living.

Question 4

A patient with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes

Accepted Answer

A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between residents and staff, and milieu therapy, meaning the total environment and its effect on the client's treatment. Partial hospitalization programs teach skills for daily living.
Clubhouse models provide patients opportunities for leisure activities and self- monitoring of treatment.

Question 5

Which of the following is the highest priority for admission to inpatient care?

Accepted Answer

Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care but the priority is safety.

Question 6

The priority of inpatient care for people with severe mental illness is

Accepted Answer

Rapid assessment, stabilization of symptoms, and discharge planning are the focus of inpatient care today. Family issues, insight into illness, and social skills would not be priorities of care for clients with severe mental illness.

Question 7

Discharge planning from inpatient care for people with severe mental illness must address which of the following to be effective? Select all that apply.

Accepted Answer

Clinicians help clients recognize symptoms, identify coping skills, and choose discharge supports in the inpatient setting. People are able to remain in the community for longer periods of time when discharge planning addresses environmental supports, housing, transportation, and access to community support services. Finding a job for the client may be helpful if appropriate but may not be appropriate for the individual at the time of discharge from inpatient care. Improving family support and identifying ideal recreational activities are desirable but not essential for successful reintegration with the community.

Question 8

Which type of community residential treatment setting is most likely to be permanent in any state?

Accepted Answer

Because the evolving consumer household is a permanent living arrangement, it eliminates the problem of relocation. Halfway houses usually serve as temporary placements that provide support as the clients prepare for independence. Clients who are served by respite housing are those who live in group homes or independently most of the time but have a need for respite from their usual residences when the client experiences a crisis, feels overwhelmed, or cannot cope with problems or emotions.
Independent living programs are available in many states, but may vary a great deal in regard to services provided with some agencies providing a broad range of services or shelter but few services.

Question 9

A patient is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually

Accepted Answer

The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without onsite supervision from paid staff.

Question 10

What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood?

Accepted Answer

Frequently, residents oppose plans to establish a group home or residential facility in their neighborhood. They argue that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation. Local residents must be given the facts, and nurses are in a position to advocate for clients by educating members of the community. The neighborhood residents who object to the establishment of a group home or residential setting may not be motivated to understand the needs of mentally ill people. It is not the responsibility for the nurse to provide for the safety and security of the neighborhood or protect the safety and security of persons in the group home.

Question 11

What are the two essential components of transitional care discharge model that is used in Canada and Scotland?

Accepted Answer

Two essential components of the transitional care discharge model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization. Poverty among people with mental illness is a significant barrier to maintaining housing. Mentally ill persons often rely on government entitlements for their income which forces people to have to choose continuation of the entitlement and dependence versus working inconsistently in unskilled, part-time, and low-paying jobs with no health insurance.

Question 12

Some residential treatment settings are transitional. This means that clients are eventually expected to

Accepted Answer

Transitional housing is temporary; clients are expected to move to another residential setting. Clients using transitional treatment settings are not expected to become totally self-sufficient, find employment, or not be in need of medication.

Question 13

The primary advantage of an evolving consumer household is that clients

Accepted Answer

An evolving consumer household is a permanent living situation, eliminating the need to change residential settings as clients gain independence. Many clients in evolving consumer households rely on Social Security Insurance or Social Security Disability Insurance. Clients function without onsite supervision.

Question 14

The primary goal of a psychiatric rehabilitation program is to promote

Accepted Answer

Psychiatric rehabilitation goes beyond management of symptoms and medication management to include personal growth, reintegration into the community, empowerment, increased independence, and improved quality of life. It is not a goal of psychiatric rehabilitation to return to the prior level of functioning that may have been dysfunctional. It may not be realistic for the client to completely recover from mental illness, but rehabilitation can improve the quality of life for the client.

Question 15

What is required for a transitional care model to be most effective in promoting the client's health and well-being and prevent relapse and rehospitalization? Select all that apply.

Accepted Answer

Two essential components of transitional care model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community.
Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization.

Question 16

A patient has just begun daily participation in a community-based partial hospitalization program. The patient can expect the staff to assist with which of the following treatment goals? Select all that apply.

Accepted Answer

Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. In day treatment programs, clients return to home at night; evening programs are just the reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric symptoms, monitoring drug effectiveness, stabilizing living environment, improving activities of daily living, learning to structure time, developing social skills, obtaining meaningful work, paid employment, or a volunteer position, and providing follow-up of any health concerns. Finding a better job and improving family support are not goals of partial hospitalization programs.

Question 17

A patient has just been referred to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include: Select all that apply.

Accepted Answer

Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Monitoring of symptoms and medication education are major foci of partial hospitalization programs

Question 18

Which type of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances?

Accepted Answer

The clubhouse model of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances. Assertiveness community treatment (ACT) has a problem- solving orientation, and staff members who are in the community attend to specific life issues of the client. Group homes are a residential form of treatment for mental illness but do not provide complete psychiatric rehabilitation. Respite housing is temporary housing for mentally ill persons and does not provide complete psychiatric rehabilitation.

Question 19

Which is the orientation of assertive community treatment (ACT)?

Accepted Answer

An ACT program has a problem-solving orientation: Staff members attend to specific life issues, no matter how mundane. ACT programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices.

Question 20

Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply.

Accepted Answer

Crisis resolution or respite care is a type of care for clients who have a perception of being in crisis and needing a more structured environment. A client having access to respite services is more likely to perceive his or her situation more accurately, feel better about asking for help, and avoid hospitalization.

Quiz 4: Treatment Settings and Therapeutic Programs