Ch. 4: Treatment Settings

Which criterion must be met to refer a client to a partial hospitalization program? a. The client is hospitalized at night in an inpatient setting. b. The client must be able to provide his or her own transportation daily. c. The client is able to return home each day. d. The clients are all recovering from an addiction.

c. The client is able to return home each day.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? a. Refusal of treatment. b. To send and receive mail. c. To seek legal counsel. d. To access all personal possessions.

d. To access all personal possessions.

A newly divorced 36-year-old mother of three has difficulty sleeping. When she shares this information to her gynecologist, she suggests which of the following services as appropriate for her patient's needs? a. assertive community treatment b. patients-centered medical home c. psychiatric home care d. primary care provider

d. primary care provider

deterioration of mental health

decompensation

Anergia

lack of energy

setting that provides the necessary care while allowing the greatest personal freedom

least restrictive environment

occurs before any problem manifest seeks to reduce the incidence or rate of new cases prevent or delay the onset of symptoms in predisposed individuals

primary prevention

provide evaluation, therapy, and teaching

psychiatric nurses

early identification of problems, screening, and prompt and effective treatment

secondary prevention

treatment of disease with a focus on preventing the progression to severe course, disability, or even death

territory prevention

milieu

the setting, surroundings, environment

What is the primary advantage of using a case manager when considering the planning and implementation of client care? a. Increases collaborative practice. b. Enhances resource management. c. Increases client satisfaction with care. d. Promotes evidence-based psychiatric nursing.

b. Enhances resource management.

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? a. Fostering research b. Maintaining a therapeutic milieu c. Providing sympathetic listening d. Providing constructive negative feedback

b. Maintaining a therapeutic milieu

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? a. Opportunity to act out fears and frustrations b. Providing a safe place to practice coping skills c. Meeting their physical as well as emotional needs d. Encouraging group communication about existing problems

b. Providing a safe place to practice coping skills

Anosognosia

A patient's inability to realize that he or she is ill

Assertive Community Treatment (ACT)

An intensive type of case management for people with serious, persistent psychiatric symptoms. Repeated hospitalizations are reduced through a multidisciplinary team that provides a comprehensive array of services.

The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which questions should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? select all that apply a. "Is the patient expressing suicidal thoughts?" b. Does the patient have intact judgment and insight into his situation?" c. "Does the patient have experiences with either community or inpatient mental healthcare facilities?" d. "Does the patient require a therapeutic environment to support the management of psychotic symptoms?" e. "Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?"

a, b, d, and e

homebound

a person unable to leave home independently due to physical or mental condition

Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance abuse and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? select all that apply a. He requires stabilization of multiple symptoms b. He has nutritional and self-care needs c. Medication adherence will be mandated d. He is in imminent danger of harming himself e. Intermittent supervision is available in inpatient settings

a, b, and d

Which intervention demonstrates an attempt by nursing staff to meet goals identified by the joint commission as national patient safety goals? select all that apply a. Identifying patients using both name and DOB before drawing blood b. Sitting with the patient diagnosed with an eating disorder during meals c. Administering the Beck Scale on each patient at the time of admission d. Performing a medication history assessment on each new patient e. Using the appropriate handwashing technique at all times

a, c, d, and e

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? a. All rights remain intact. b. Only rights that do not involve decision making remain intact. c. The right to refuse treatment is no longer guaranteed. d. All rights are temporarily suspended.

a. All rights remain intact.

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? a. Arranging for the client to have a screening for prostate cancer b. Notifying the family that the client will require a wheelchair when discharged c. Providing the client with organizations that help defray the cost of prescribed drug d. Arranging for respite care when the client's family needs to attend an out-of-state affair

a. Arranging for the client to have a screening for prostate cancer

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? a. Break-away closet bars to prevent hanging b. Bedroom and dining areas with locked windows to prevent jumping c. Double-locked doors to prevent escaping from the unit d. Platform beds to prevent crush injuries

a. Break-away closet bars to prevent hanging

A therapeutic inpatient milieu will include which characteristic? a. It provides for the client's safety and comfort. b. Voluntarily admitted clients are generally allowed additional privileges. c. Rules and behavioral limits are flexibly enforced. d. Staff provide frequent and ongoing negative feedback to clients.

a. It provides for the client's safety and comfort.

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? a. Nurses b. Social workers c. Clinical psychologists d. Chemical dependency counselors

a. Nurses

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? a. Private insurance b. Medicare c. Medicaid d. Private pay

a. Private insurance

When considering mental illness, recovery is best described to a client by which statement? a. Working, living, and participating in the community b. Never having to visit a mental health provider again c. Being able to understand the nature of the diagnosed illness d. A period of time when signs and symptoms are being managed

a. Working, living, and participating in the community

A Gulf War veteran has been homeless since being discharged from the military service. He is now diagnosed with schizophrenia. The nurse practitioner recognizes that assertive community treatment (ACT) is a good option for this patient since ACT provides: a. Psychiatric care b. Care for hard-to-engage, seriously ill patients c. Outpatient community mental health center care d. A comprehensive emergency service model

b. Care for hard-to-engage, seriously ill patients

The nurse frequently includes daily session involving relaxation techniques. Which assessment data would most indicate a need for this intervention to be included in the initial plan of care for the patient? a. family history of anxiety and symptoms of anxiety b. significant other has a chronic health issue c. hopes to retire in 6 months d. recently adopted infant twins

a. family history of anxiety and symptoms of anxiety

Emma is a 40-year-old married female who has found it increasingly had to leave her home due to agoraphobia. Emma's family is appropriately concerned and suggests that she seek psychiatric care. After investigating her options, Emma decides to try: a. telepsychiatry b. assertive community treatment c. psychiatric home care d. outpatient psychiatric care

a. telepsychiatry

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? a. The patients who are convicted criminals sentenced to home confinement. b. Care is provided to clients in unconventional settings. c. Care is provided by a preferred provider for a large HMO. d. The patients are provided for by a clinical specialist with the visiting nurse service.

b. Care is provided to clients in unconventional settings.

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? a. "We will help you make decisions that will keep you safe." b. "I am going to help you shower, so you will not smell so bad." c. "Your pocket knife and nail clippers will be kept in the nurses' station." d. "You will be having a number of tests to help us learn about your condition."

b. "I am going to help you shower, so you will not smell so bad."

A patient needs supportive care for the maintenance treatment of a bipolar disorder. The nurse demonstrates an understanding of the services provided by the various members of the patient's healthcare team when he makes which statement: a. "Your social worker will help you learn to budget your money effectively" b. "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today" c. "The mental health technician on staff today will administer the medication you require" d. "Remember to ask the OT about sources of financial help that you qualify for."

b. "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today"

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? a. A depressed patient with a suicidal plan b. A patient being discharged from an inpatient alcohol rehabilitation unit c. A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs d. Jeff, who has mild depression symptoms and is starting outpatient therapy

b. A patient being discharged from an inpatient alcohol rehabilitation unit

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? a. A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work b. A 30-year-old accountant who has developed symptoms of depression c. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road d. A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

c. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? a. Visiting a homeless shelter to provide mental health screenings for its clients b. Discussing the need for proper nutrition with a depressed new mother c. Providing stress reduction seminars at the local senior center d. Visiting the home of a client currently displaying manic behavior

c. Providing stress reduction seminars at the local senior center

A patient has been voluntarily admitted to a mental health facility after an unsuccessful attempt to harm himself. Which statement demonstrates a need to better educate a patient on his patient's rights? a. "I understand why I was restrained when I was out of control." b. "You can't tell my boss about the suicide attempt without my permission." c. "I have a right to know what all of you are planning to do to me." d. "I can hurt myself if I want too. It's none of your business."

d. "I can hurt myself if I want too. It's none of your business."

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? a. A client and family members attend counseling sessions together at a neighborhood clinic b. Implementation of a more flexible work schedule for staff c. Improved reimbursement for services provided in the community d. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

d. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

An adolescent female is readmitted for inpatient care after a suicide attempt. What is the most important nursing intervention to accomplish upon admission? a. Allowing the patient to return to her previous room so that she will feel safe b. Orienting the patient to the unit and introduce her to patients and staff c. Building trust through therapeutic communication d. Checking the patients belongings for dangerous items

d. Checking the patients belongings for dangerous items

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? a. Knowledge of both national and local political activism b. The ability to cross service systems c. An awareness of own cultural and personal values d. Creative problem-solving and intervention skills

d. Creative problem-solving and intervention skills

What function is shared by advanced practice and general practice psychiatric nurses? a. Prescriptive authority b. Admitting privileges c. Offers consultation services d. Membership on a multidisciplinary team

d. Membership on a multidisciplinary team

Which situation demonstrates the nurse functioning in the role of advocate? a. Providing one-to-one supervision for a client on suicide precautions b. Co-leading a medication education group for clients and families c. Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation d. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

d. Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days