Chapter 04: Settings for Psychiatric Care

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 local resident to a community food bank d. Coordinating psychiatric home care services

A

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. Ask the patient, "Do you feel like I am a traitor?"

A

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. a. "Thank you. I would enjoy having a cup of coffee with you." b. "Thank you, but I would prefer to proceed with the assessment." c. "No, but thank you. I never accept drinks from patients or families." d. "Our agency policy prohibits me from eating or drinking in patients' homes."

A

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

Which scenario best depicts a behavioral crisis? A patient is: a. waving fists, cursing, and shouting threats at a nurse. b. curled up in a corner of the bathroom, wrapped in a towel. c. crying hysterically after receiving a phone call from a family member. d. performing push-ups in the middle of the hall, forcing others to walk around.

A

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

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to: (Select all that apply.) a. housing adequacy. b. family and support systems. c. income adequacy and stability. d. early psychosocial development. e. substance abuse history and current use.

A, B, C, E

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. a. Clear risk of danger to self or others b. Adjustment needed for doses of psychotropic medication c. Detoxification from long-term heavy alcohol consumption needed d. Respite for caregivers of persons with serious and persistent mental illness e. Failure of community-based treatment, demonstrating need for intensive treatment

A, C, E

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to: a. coordinating care of patients. b. management of milieu safety. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.

B

A nurse receives these three phone calls regarding a newly admitted patient. • The psychiatrist wants to complete an initial assessment. • An internist wants to perform a physical examination. • The patient's attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a. Advocate b. Case manager c. Milieu manager d. Provider of care

B

A nurse says, "I work with a mobile mental health unit." The listener can assume that the nurse a. works with patients who are incarcerated. b. sees clients in unconventional settings. c. is a preferred provider for a large HMO. d. is a clinical specialist with the visiting nurse service.

B

The primary advantage of using a case manager is to a. increase collaborative practice. b. enhance resource management. c. increase client satisfaction with care. d. promote evidence-based psychiatric nursing.

B

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention? a. Medication follow-up b. Teaching parenting skills c. Substance abuse counseling d. Making a referral for family therapy

B

Which attribute would be least helpful for a community mental health nurse to have? a. Flexibility b. Reactive manner c. Nonjudgmental attitude d. Ability to cross service systems

B

Which assessment information is uniquely important to the mental health client receiving outpatient care? a. Mental status examination results b. The client's strengths and deficits c. Housing adequacy and stability d. The presenting problem and referring party

C

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 client is able to care for his or her own physical and psychological needs.

C

A function shared by advanced practice and general practice psychiatric nurses is a. prescriptive authority. b. hospital privileges. c. provision of consultation services. d. collaboration with a multidisciplinary team.

D

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients' rights? a. Prohibited a patient from using the telephone b. In patient's presence, opened a package mailed to patient c. Remained within arm's length of patient with homicidal ideation d. Permitted a patient with psychosis to refuse oral psychotropic medication

A

A nurse surveys medical records. Which finding signals a violation of patients' rights? a. A patient was not allowed to have visitors. b. A patient's belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member.

A

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. 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.

A

Inpatient hospitalization for persons with mental illness is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medication at home. c. have limited support systems in the community. d. develop new symptoms during the course of an illness.

A

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by a. private insurance. b. Medicare. c. Medicaid. d. Social Security.

A

Select the example of tertiary prevention. a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated 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

A

The case manager is demonstrating an understanding of the primary goals of managed care when 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

The major difference between the psychiatric nursing assessment performed for a client who is hospitalized and for a client who will be treated in the community is: a. for the latter, the general assessment must be expanded. b. for the latter, the nursing focus is primarily on the mental status examination. c. for the former, the general assessment must be reimbursement based. d. for the former, the nursing focus is limited to the client's willingness to accept treatment.

A

Which activity best exemplifies the focus for a case manager? a. Arranging for rapid assessment of a newly hospitalized client b. Providing a comprehensive client social history to the treatment team c. Writing a report describing best practices in care for clients with depression d. Gathering data for a research study concerning side effects of a new medication

A

Which is a characteristic of a therapeutic inpatient milieu? 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

Which need is the highest priority for a seriously and persistently ill client living in the community? a. Access to medication b. Socialization and diversion c. Independent decision making d. Engaging in meaningful work

A

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? a. Resolve the crisis with the least restrictive intervention possible. b. Swift intervention is justified to maintain the integrity of a therapeutic milieu. c. Rights of an individual patient are superseded by the rights of the majority of patients. d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised.

A

A psychiatric nurse discusses rules of the therapeutic milieu and patients' rights with a newly admitted patient. Which rights should be included? (Select all that apply.) The right to: a. have visitors b. confidentiality c. a private room d. complain about inadequate care e. select the nurse assigned to their care

A, B, D

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) 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 many needs." e. lets me do whatever I choose without interfering."

A, B, D

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. 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."

A, B, E

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. 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

A, C, E

An ongoing, crucial responsibility of nurses working on an inpatient psychiatric unit is a. fostering research. b. maintaining a therapeutic milieu. c. sympathetic listening. d. providing constructive negative feedback.

B

For the psychiatric client, the greatest negative aspect of the multidisciplinary treatment team approach to care is that it a. is an expensive treatment model. b. can increase anxiety in the newly admitted client. c. requires the client to answer the same questions repeatedly. d. puts demands on the client's time and energy.

B

Select the example of primary prevention. a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill patient who assaulted a staff person

B

Which assessment finding for a patient in the community deserves priority intervention by the psychiatric nurse? The patient: a. receives Social Security disability income plus a small check from a trust fund every month. b. was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks. c. lives in an apartment with two patients who attend partial hospitalization programs. d. has a sibling who was recently diagnosed with a mental illness.

B

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a. Kindness b. Autonomy c. Compassion d. Professionalism

B

Which level of prevention activities would a nurse in an emergency department employ most often? a. Primary b. Secondary c. Tertiary

B

A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient's thoughts are now more organized, and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." The nurse should: a. ask the case manager to arrange a transfer to a long-term care facility. b. notify hospital security to handle the disturbance and escort the family off the unit. c. explain that the patient will continue to improve if the medication is taken regularly. d. contact the health care provider to meet with the family and explain the discharge rationale.

C

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? a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist

C

A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager's most appropriate action. a. Postpone the patient's discharge from the hospital. b. Contact the landlord who evicted the patient to further discuss the situation. c. Arrange a temporary place for the patient to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.

C

A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse's best initial action. a. Explore ways to help the patient stop smoking. b. Report the situation to the manager of the shelter. c. Assess the patient's weight; determine foods and amounts eaten. d. Arrange hospitalization for the patient in order to formulate a new treatment plan.

C

In an attempt to provide both safety and client comfort, psychiatric units generally have a. a varied client menu served on nonbreakable plastic dinnerware. b. comfortable seating that is well padded but secured to the floor. c. bedrooms that resemble hotel rooms but with specific safety features. d. a dayroom that has audiovisual equipment and is visible from the nurses' station.

C

The case manager plans to discuss the treatment plan with a patient's family. Select the case manager's first action. a. Determine an appropriate location for the conference. b. Support the discussion with examples of the patient's behavior. c. Obtain the patient's permission for the exchange of information. d. Determine which family members should participate in the conference.

C

The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient's projected length of stay. How should the nurse instruct the unit secretary to handle the request? a. Obtain the information from the patient's medical record and relay it to the caller. b. Inform the caller that all information about patients is confidential. c. Refer the request for information to the patient's case manager. d. Refer the request to the health care provider.

C

Which statements 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. "Mental illness results from the breakdown of American families." e. "If people with mental illness went to church, their symptoms would vanish."

C, D, E

A health care provider prescribed depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. 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

D

Although mental illness still carries a stigma, acceptance has improved over the past 40 years, partly due to a. better control of symptoms through drug therapy. b. public screenings that are well advertized in the community. c. community psychiatric nursing programs that provide in-home care. d. acknowledgment of personal mental health issues by well-known people.

D

Clinical pathways are used in managed care settings to: a. stabilize aggressive patients. b. identify obstacles to effective care. c. relieve nurses of planning responsibilities. d. streamline the care process and reduce costs.

D

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

D

The community mental health movement was least influenced by a. the advent of antipsychotic medications. b. increasing public awareness of the poor care given in some large psychiatric hospitals. c. the proliferation of federal entitlement programs, making it possible to move the mentally ill out of hospitals. d. the increasingly larger numbers of advanced practice nurses prepared to care for the mentally ill in the community.

D

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.

D

The nurse should refer which of the following patients to a partial hospitalization program? A patient who: a. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. b. needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. c. spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. d. states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

D

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient: a. feeling anxiety and a sad mood after separation from a spouse of 10 years. b. who self-inflicted a superficial cut on the forearm after a family argument. c. experiencing dry mouth and tremor related to taking haloperidol (Haldol). d. who is a new parent and hears voices saying, "Smother your baby."

D

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient? a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills

D

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. schizophrenia and four hospitalizations in the past year.

D

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 inservice 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

Which would NOT be considered a crisis on a psychiatric unit? a. Mr. R reports chest pain after eating a spicy lunch. b. Ms. T cannot speak and is holding her hands up to her neck. d. Mr. S demonstrates anger that escalates to physical assault. d. Mr. U reports hearing voices telling him to hit others.

D