Question 1

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to (Select all that apply)

Accepted Answer

Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.

Question 2

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.

Accepted Answer

Hospitalization may damage the nurse-patient relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.

Question 3

Which assessment finding for a patient diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse? The patient

Accepted Answer

Patients who use alcohol or illegal substances often become medication non-adherent. Medication non-adherence, along with the disorganizing influence of substances on cellular brain function, promotes relapse. The distracters do not suggest problems.

Question 4

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

Accepted Answer

Each correct answer is an example of appropriate nursing foci: communicating at a level understandable to the patient, providing medication supervision, and using holistic principles to guide care. The distracters violate relationship boundaries or suggest a laissez faire attitude on the part of the nurse.

Question 5

The nurse should refer which of the following patients to a partial hospitalization program? A patient who

Accepted Answer

This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility for supervision. A suicidal patient needs inpatient hospitalization. The other patients can be served in the community or with individual visits.

Question 6

A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, "I don't know what to do with my free time." Which member of the treatment team would be most helpful to this patient?

Accepted Answer

Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other patient services. Social workers focus on the patient's support system.

Question 7

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

Accepted Answer

Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.

Question 8

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

Accepted Answer

The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.

Question 9

After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. This action by the nurse best demonstrates

Accepted Answer

Tornado victims are at risk for psychiatric problems as a consequence of stress and trauma. Primary prevention occurs before any problem is manifested and seeks to reduce the incidence, or rate of new cases. Primary prevention may prevent or delay the onset of symptoms in predisposed individuals. Coping strategies and psychosocial support for vulnerable people are effective interventions in prevention. Disaster victims benefit from telling their story. Triage refers to the process of sorting out victims based on the immediacy of their needs for treatment. Psychosocial rehabilitation programs are designed to assist persons diagnosed with serious mental illness to develop living skills. Psychiatric case management refers to services to assist patients in finding housing or obtaining entitlements.

Question 10

A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the patient: · wants to attend an activity 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 an activity group meets.
· wants to attend services at a church that is a half-mile from the patient's home.
Which tasks are part of the role of a community mental health nurse? (Select all that apply.)

Accepted Answer

The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement.

Question 11

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

Accepted Answer

Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. The distracters represent secondary or tertiary prevention activities.

Question 12

A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a patient with a history of medication nonadherence. For this plan to be successful, which factor will be of critical importance?

Accepted Answer

The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The long acting antipsychotic medication injections relieve the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, non-adherence will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.

Question 13

A psychiatric nurse discusses rules of the therapeutic milieu and patients' rights with a newly admitted patient. Which rights should be included? The right to (Select all that apply)

Accepted Answer

Patients' rights should be discussed shortly after admission. Patients have rights related to receiving/refusing visitors, privacy, filing complaints about inadequate care, and accepting/refusing treatments (including medications). Patients do not have a right to a private room or selecting which nurse will provide care.

Question 14

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.

Accepted Answer

The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as medication is taken as prescribed.

Question 15

The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy? (Select all that apply)

Accepted Answer

Medication doses can be adjusted on an outpatient basis. The goal of caregiver respite can be accomplished without hospitalizing the patient. The other options are acceptable, evidence-based criteria for admission of a patient to an inpatient service.

Question 16

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.

Accepted Answer

Accepting refreshments or chatting informally with the patient and family represent therapeutic use of self and help to establish rapport. The distracters fail to help establish rapport.

Question 17

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients' rights?

Accepted Answer

The patient has a right to use the telephone. The patient should be protected against possible harm to self or others. Patients have rights to send and receive mail and be present during package inspection. Patients have rights to refuse treatment.

Quiz 4: Treatment Settings