01 Ch 4 Treatment Settings and Therapeutic Programs

The introduction of psychotropic medications occurred in which decade?

1950's

How does the rate of suicide among active and veteran military personnel compare to that of the civilization population?

2 times higher

The population that is mentally ill is arrested and prosecuted at a rate that is how many times that of the general population?

4

Which mental health clients is most likely to frequently present in the emergency department in hospital?

A 34-year-old person diagnosed with an amphetamine addiction who has overdosed

Which client would be most likely to qualify for psychiatric care in a long-term care setting?

A client who has multiple sclerosis and a history of depression

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness?

Assertive community treatment

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model?

Case management Coordinated care is often accomplished through a case management service model in which a case manager locates services, links the patient with them, and then monitors the patient's receipt of these services. This type of case management is referred to as the "broker" model. Crisis intervention, partial hospitalization, and respite residential care are not known as the "broker" model.

A nurse encourages a client to enroll in outpatient services immediately upon discharge from the inpatient setting. The nurse does this to promote which outcome?

Community reintegration.

Which is an example of secondary prevention in the forensic setting?

Crisis intervention

A client with psychiatric illness is referred to the day treatment program. Which services should the nurse include while teaching the client about the program? Select all that apply.

Development of social skills. Stabilization of symptoms. Training to perform activities of daily living.

Which statement is true concerning clients with dual diagnoses?

Integrated care is preferred over split care for the separate diagnoses

Which areas of discharge planning are important to ensuring client safety? Select all that apply.

Medication education Food-drug interactions Special diet instructions

Which type of setting is used for clients who continue to need supervision but not long-term admission?

Partial (day) hospitalization Partial (day) hospitalization programs are for clients who continue to need supervision but not long-term admission.

The client is a 32 year old diagnosed with bipolar disorder. The client attends group therapy for 6 hours a day and then returns home to the client's residence. In which setting would the client receive this type of care?

Partial hospitalization program

The client is a 54-year-old who is addicted to drugs and alcohol. Which setting would be best for an individual in need of support to minimize the risk of repeat hospitalizations?

Partial hospitalization program

What are some of the goals of psychiatric rehabilitation? Select all that apply.

Personal growth Increased independence Increased involvement in treatment decisions Recovery from mental illness

Individuals who are most likely to receive inpatient mental health treatment are those who meet which criteria?

Pose a risk of harm to self or others Candidates most likely to receive inpatient treatment are those who pose a risk of harm to self or others.

One goal of transitional care in mental health care is what?

Provide an alternative for inpatient admission

A community mental health model program that incorporates membership responsibility in maintaining and advancing the program and social/recreational, vocational, residential, and educational services is called:

Psychosocial rehabilitation model

Which type of care provides periodic relief to caregivers of a mentally ill client?

Respite residential care Sometimes family members of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers.

Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which describes the goal of case management?

Short-term inpatient, crisis stabilization, and community referral

A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client's family members that the primary focus of the client's hospitalization is what?

Stabilize acute symptoms The focus of a crisis stabilization stay is to stabilize the client's acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission.

The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what?

Symptom acuity does not require psychiatric hospitalization

Which would be an appropriate intervention to help a client regain, maintain, or improve psychological well-being?

Teach problem solving, stress reduction, coping, and proper interpersonal communication skills.

A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention?

Tertiary

A 47-year-old client missed 1 week of work while hospitalized with bipolar disorder. The client was placed on medication and was able to return to work. When asked, the client informed coworkers that the absence was due to influenza. What is the most likely reason the client lied about the illness?

The client feared rejection, isolation, and discrimination.

Which goal for an individual client is consistent with the overall objectives of community support service programs?

The client's functional ability will improve. The goal of community support service programs is to enable those with severe mental illness to remain in the community and function as independently as possible.

Individuals may need assistance with the coordination of care and community service programs related to what?

The complexity of access to the community service programs available Due to the complexity of access to the community service programs that are available, individuals and families may require assistance with the coordination of their care, services, and supports.

A client is in need of a family-like environment with a high level of support. Which would be most appropriate?

Therapeutic foster care

What was the original purpose for developing the role of the case manager in community-based care?

To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ...

collaborative mental health care.

Which type of residential setting may care for one to three clients in a family-like atmosphere, including meals and social activities with the family?

foster homes

The nurse is advising the caregiver of a client to encourage the client to join an evolving consumer household. What may be the reason for the nurse to give this advice to the caregiver?

function independently.

what type of setting is used for clients who continue to need supervision but not long-term admission?

partial (day) hospitalization

Which service aims to achieve client stabilization without hospitalization or a reduced length of inpatient care?

partial hospitilazation

which would not be an element of a community support system?

provision of individual psychotherapy in the home if needed

A county in Florida was just devastated by a Category 4 hurricane. Community mental health nurses have been sent to the area to provide crisis intervention. What type of prevention strategy is this?

secondary

An awareness to identify the need for providing culturally competent mental health care for the client can promote which treatment goal?

Successful community rehabilitation

Community mental health can be best described as:

treating the community as client.

Quality of case management is measured by outcomes that result from what?

Level of functioning

A client with a psychiatric disorder is considering joining a clubhouse with other clients who have mental disorders. The client asks the nurse to explain what services the clubhouses provide. Which response by the nurse would be most accurate?

"They are predominately run by psychiatric clients with minimal assistance from mental health staff."

Which client is suitable for psychiatric transitional care services?

An individual being discharged from hospital with residual symptoms of mania A homebound individual with bipolar illness who is having subacute symptoms would be the perfect candidate for home care services. The paralyzed veteran, the adolescent who took an overdose, and the schizophrenic woman under the freeway should receive home care due to the acuity of their situations.

A nurse is caring for a client with severe and persistent mental illness. As a case manager, what interventions should the nurse do for the client? Select all that apply.

Arrange for financial resources required for the treatment. Teach caregivers about behavior modifications required to manage the client. Help the caregivers to cope with stress related to the illness of the client. Refer the client to other community mental health services that would be beneficial for the client.

The most diverse role for the nurse within community based psychiatric mental health care would most probably be what?

Case manager

Which client may be the most appropriate candidate for telepsychiatry?

A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health

The nurse is caring for a group of individuals with mental health disorders in an outpatient clinic. Which client is most likely to be referred to transitional care mental health services?

A client with schizophrenia and diabetes

A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time?

A day-treatment program

A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint?

Conduct ongoing self-reflection and self-awareness.

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions?

Coordination of care In the continuum of care, the nursing process is similar to the coordination of care for psychiatric clients.

A client with mental illness is being discharged to a group home. The discharge planning nurse is helping the family to make the transition. The discharge planning nurse is least responsible for what related to the client's discharge?

Chart review for inadequacies The nurse who serves as a discharge planner coordinates all the facets of a client's admission and discharge. The nurse reviews the client's current response to treatment and past medical history and assesses what family or friend support is available once the client is ready to be discharged. Reviewing the chart for inadequacies is not a task of the discharge planner.

A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier?

Clients commonly struggle with trusting others. Recurring themes of power and control, negotiation, and trust building dominate therapeutic interventions in this setting; clients have, in varying degrees, learned to adapt to an environment that rewards distrust, manipulation, and deceit. The criminal history, frequent diagnoses of antisocial and borderline personality disorder, and aggressive interpersonal style of many forensic clients can evoke strong emotional responses, and countertransference and splitting reactions are common.

A nursing instructor informs a class that the trend in the United States today is to receive treatment without institutional-based intervention. What else is true concerning mental health care today?

Criteria for admission to inpatient care have become legally regulated.

The greatest impact case management has had on mental health care is that it has caused what?

Has increased client access to appropriate mental health care Case management has increased client access to appropriate mental health services and offers availability of a choice of providers based on the type of care required.

A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care?

A 42-year-old who would like to enter marriage counseling

Which community activity is an example of tertiary prevention in a community that experienced a massive fire?

A master plan was formulated for what to do in case of another fire.

Which best defines a community support system in relation to mental illness?

A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion.

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use?

Ability to provide services in a variety of locations E-mental health services can be delivered in a variety of locations, such as schools, places of employment, and clinics. Although the use of e-mental health applications is increasing, concerns have been expressed about using the Internet for the delivery of mental health care. Difficulties may occur in developing a therapeutic client-provider relationship via the Internet. There are concerns about the ability to ensure the quality of online mental health interventions. Client privacy and confidentiality may be compromised in a web-based, e-mental health application. In addition, the Internet is often not available to subpopulations of clients with chronic and severe mental illnesses who require high-intensity services, such as those diagnosed with schizophrenia.

Which is the most restrictive setting in the continuum?

Acute inpatient hospitalization Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.

A client has threatened to kill the client's spouse, and it is not anticipated that this crisis will resolve itself. The client is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which as the focus of care?

Acute symptom stabilization

Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what?

An inability to leave the home due to chronic physical, psychosocial, or medical problems

The nurse is caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity?

Educating clients on menu planning and grocery shopping

The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what?

Ensuring a sustainable living situation A client's living environment affects his or her level of functioning, rate of reinstitutionalization, and duration of the remaining time in the community setting. Finding a quality living situation requires ensuring sustainability of the placement as this minimizes the possibility of future hospitalization due to decompensation of mental status.

The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program?

Empower clients to achieve the highest level of functioning possible Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. In-home detoxification promotes careful detoxification from alcohol and sbstances. The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions.

The approach of the services provided to facilitate recovery for individuals must be based on which aspect?

Empowerment

Which is a primary goal of community mental health care?

Engage clients to help determine need, policy changes, and evolution of mental health programs.

Which would the nurse include when developing the discharge plan for a client with a mental illness? Select all that apply.

Explain all instructions for after-care in detail. Provide the client with a written list of instructions Review emergency telephone numbers with the client

A nurse is working as a mental health case manager. Which is included within this nurse's role? Select all that apply.

Identification of services Linkage of client with services Client monitoring for use of services

A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services?

Identifying and meeting the client's health and human service needs Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual client's health and human service needs.

A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus?

Improved access to less costly services Managed care aims to increase access to care and provide the most appropriate level of services in the least restrictive environment. Efforts focus on providing more outpatient and alternative treatment programs and avoiding costly inpatient hospitalizations. When properly conducted and administered, managed care allows clients better access to quality services while using health care dollars wisely.

A young client with severe depression and signs of hopelessness is seen in the emergency department of a large community hospital. The physician determines the need for a psychiatric consult. After the consult, the care team determines that the client is in need of hospitalization. Where should the nurse expect this client to be admitted?

In-house psychiatric unit

Assertive Community Treatment (ACT) reduces the use of which type of service?

In-patient Hospital ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.

Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply.

Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills

the nurse is advocating for the most effective and comprehensive treatment plan for a client with bipolar disorder. The client is being held in the forensic unit of the hospital because the client has been convicted of theft. Recognizing that many factors influence the client's treatment and health maintenance after discharge, the nurse plans to do what?

Involve an interdisciplinary team in the client's community care

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation?

It exists to promote rehabilitation alliance. The clubhouse model exists to promote rehabilitation alliance as a positive force in the members' lives. The focus of this model is on health. Taking prescribed drugs is not a condition for participation. Members make decisions regarding their treatment.

Which is accurate regarding assertive community treatment (ACT)?

It offers intensive community-based services.

The nurse working in a psychiatric institution is researching treatment systems that facilitate effective learning. The nurse believes that effective milieu therapy cannot be practiced in today's institutional settings. What disadvantage related to milieu therapy may have led the nurse to believe this?

It requires clients to have longer lengths of stay.

A psychiatric-mental health nurse is working as a case manager. The nurse understands that the quality of case management is measured by outcomes that result from what?

Level of functioning

Which is often more predictive of the client's success than the characteristics of his or her illness?

Living environment

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what?

Maintenance of the therapeutic environment Milieu therapy is also known as the maintenance of the therapeutic environment

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse?

Members receive mental health treatment from providers in the community. Members are encouraged and assisted to use psychiatric services, which are usually local clinics or private practitioners. Membership is not time limited. The clubhouse is run entirely by patients with psychiatric illnesses with minimal assistance from mental health professionals. Generally, members do not live in the clubhouse.

Which statement regarding those with serious and persistent mental illness (SPMI) is correct?

Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.

Which mental health treatment setting is not a residential treatment setting?

Partial hospitalization programs Partial hospitalization programs are designed to help the client make a gradual transition from being inpatients to having independence and to prevent repeat admissions. The remaining options are all settings that are associated with long-term living arrangements.

Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan?

Partnering with the client from the beginning The nurse can optimize discharge plan compliance by partnering with the client from the first encounter. Because clients with mental illnesses may have limited cognitive abilities and residual motivational and anxiety problems, the nurse should explain in detail all after-care plans and instructions to the client.

The mental health nurse must be alert for changes in the client psychosocial status and therefore must do which assessment frequently? (Select all that apply.)

Physiologic status Psychological status Mental status Relationship status

Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years?

Pressures to reduce health care costs associated with inpatient care

The goal of respite services as a prevention strategy includes what?

Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers

Which are the benefits of client education? select all that apply

Prevention of complications Reduction of hospital readmissions Promotion of involvement

A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply.

Prevention of relapse Stabilization Symptom reduction

A case manager is working with a parent whose child has schizophrenia. The parent reports sadness, frequent crying, and fatigue. The case manager works with the parent to establish some scheduled rest, relaxation, and respite from caring for the child. At which level of prevention is the case manager working with the parent?

Primary The case manager is assisting the parent with health promotion needs in order to maintain the parent's current health status and prevent deterioration due to stressors in the parent's life.

Which are functions of assertive community treatment? Select all that apply.

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Assertive community treatment reduces inpatient service use, promotes continuity of outpatient care, and increases the stability of people with serious mental illness. Assertive community treatment does not increase the likelihood of relapse or decrease the availability of services.

The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend?

Respite residential care

The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest?

Respite residential care Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers. This would be the most appropriate suggestion in this case and would provide the client with the least restrictive environment. Partial hospitalization programs provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning, who cannot function autonomously on a daily basis, or who do not pose imminent danger to themselves or others. This would be appropriate if the client was experiencing any of these, but the major concern here is giving the parents some relief. Acute inpatient care is the most restrictive and is reserved for acutely ill clients. Intensive outpatient programs focus on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. This client requires constant supervision.

The case manager makes a home visit to the client's household and finds that the client has become psychotic in the prior 3 days and has bolted himself in the his room. The case manager works to encourage the client to come out and calls the ambulance to take the client to the emergency department. At what level of prevention is the case manager working?

Secondary

Which is an appropriate description of social skills training available at a local mental health clubhouse?

Self-care skills such as learning to use a list of crisis hotline numbers or to cope with unexpected stressful situations

A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize?

Services that promote the client's reintegration into the community Psychosocial rehabilitation or psychiatric rehabilitation programs focus on reintegrating people with psychiatric disabilities into the community through work, education, and social avenues while also addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. Intensive treatment that prepares the client to live in the community reflects the focus of assertive community treatment. Outpatient detoxification provides detoxification services for alcohol and drugs in an outpatient setting. Intensive outpatient programs provide frequent monitoring and social support within a therapeutic milieu to enable the client to remain connected to the community.

A group of nursing students is reviewing information about settings of care along the range of community care services for mental health. The students demonstrate a need for further review when they identify which as an important component of intensive outpatient programs?

Social skills training

A nurse is describing the differences between a partial hospitalization program and an intensive outpatient program. Which would the nurse describe as the emphasis of partial hospitalization programs?

Social skills training

The nurse works for a psychiatric-mental health facility that utilizes traditional milieu therapy. Which stage of milieu therapy allows for control and limitation of maladaptive behaviors including yelling and screaming?

Structure

During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy?

Support

A 22-year-old client with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client self-describes as "very social and doing well in school." Which of the following long-term treatment goals is best suited for this client?

The client will resume previous level of functioning.

A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future?

The fact that there are high rates of mental illness among the populations of jails and prisons Forensic nursing is expected to become one of the fastest growing nursing specialties of the 21st century because recent studies have noted the high rates of mental illness in jails and prisons. People with mental illness are not responsible for most crimes. They are vulnerable to crime, but this fact does not underlie the growth of forensic nursing.

Which intervention represents tertiary prevention for mental illness?

self-help groups Tertiary prevention is the final level of prevention. Its focus is rehabilitation and ways to minimize residual effects for people who have encountered mental health problems. Examples include social skills training, vocational rehabilitation, self-help groups, systems of care and wraparound for children and families, and sufficient residential and independent living services.

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness:

spend more time in jail

A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community?

upon admission to the inpatient setting