Ch 9: Recovery Framework for Mental Health Nursing

a) "I really trust my healthcare team, so I do whatever they think is best for me" Pg. 112 Empowerment is the process of supporting people and communities to take control of their own health needs with the goal of healthy behaviors, positive mental health, self-management of illnesses, and well-being. Unquestioningly following the healthcare team's instructions suggests a lack of participation on the part of the client and, therefore, a lack of empowerment. The other statements reflect the client's opinions, goals, and actions related to understanding and managing anxiety and PTSD, so they demonstrate empowerment.

1. The nurse is teaching a client techniques for managing anxiety related to a diagnosis of post-traumatic stress disorder (PTSD). Which statement suggests to the nurse that additional teaching is required to empower the client to manage the condition? a) "I really trust my healthcare team, so I do whatever they think is best for me" b) "I will work to identify the things that trigger my anxiety" c) "I understand the impact that PTSD has on my ability to live and work productively" d) "I have been really pleased with the progress I have made toward managing my anxiety"

b) Telling the client that failure to adhere to the medication regimen will result in a longer hospital stay Pg. 110 In the paternalistic model, clinicians make all care decisions and dictate them to the clients. As a result, clients can feel coerced into treatment. By telling the client that the consequence of not taking prescribed medications is a longer hospital stay, the nurse is giving the client an ultimatum rather than allowing the client to feel as if they have a say in their own care. Person-centered care—in which the client is an active participant in making care decisions—requires thorough education regarding health issues and treatment options as well as a strong therapeutic relationship between the client and the provider. The nurse demonstrates these aspects of person-centered care by asking the client about past experiences with hospitalization and by providing education about the upcoming hospital stay and treatment. Encouraging the client to participate in unit activities wherever possible is a supportive nursing action that is aimed at fostering empowerment, a concept related to person-centered care in which clients are encouraged and equipped to take control of their own health needs.

10. A nurse is admitting a client recently diagnosed with schizophrenia. The nurse demonstrates a paternalistic approach to care by: a) Encouraging the client to participate in unit activities whenever possible b) Telling the client that failure to adhere to the medication regimen will result in a longer hospital stay c) Providing the client with education about the hospital stay and treatment d) Asking the client what experiences with hospitalization have been in the past

a) A community health nurse addresses a town council meeting regarding the need for mental health resources for individuals who are homeless Pg. 113 Advocacy comprises various actions aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes. It is an important means of raising awareness of mental health issues. Attempting to address the needs of an at-risk population, such as a community's homeless population, is the best example of comprehensive advocacy. While the other options all attempt to address specific needs related to mental health, none is as comprehensive.

11. Which intervention is the best example of comprehensive advocacy for people with mental illness? a) A community health nurse addresses a town council meeting regarding the need for mental health resources for individuals who are homeless b) A staff nurse requests a prescription for PRN medication for a client with a history of physical abuse toward staff c) The head nurse on an Alzheimer's unit requires that a nightlight be turned on in each client room between dusk and dawn d) Administration agrees to include mental health staff in planning the facility's annual community health fair

b) Housing d) Peer support e) Employment Pg. 111 Housing, peer support, and employment are all integral factors components of the recovery model. Stigma and limited access to services are barriers to recovery.

12. The nurse is caring for a client using the recovery model. Which factors are important in achieving positive outcomes for this client? Select all that apply. a) Stigma b) Housing c) Limited access d) Peer support e) Employment

b) "What challenges do you see yourself facing once you are enrolled in college?" Pg. 112 One challenge for nurses and other clinicians is to support stigma resilience, a personal trait that means the client has the capacity to withstand or recover from significant challenges that threaten stability, viability, or development. Encouraging the client to consider the challenges ahead will help prepare to address those challenges as they occur. The remaining questions, while appropriate, are not related to resiliency.

13. The nurse is working with a client with a diagnosis of chronic depression who has expressed a desire to become a history teacher. What question would the nurse ask that would demonstrate an understanding of the client's need to possess stigma resilience? a) "How will you secure the money you will need to attend college?" b) "What challenges do you see yourself facing once you are enrolled in college?" c) "Has anyone else in your family been successful in completing a college degree?" d) "What is it about studying history that appeals to you so much?"

b) "My support group has given me a lot of good advice about managing my symptoms and feeling positive about myself" c) "My employer is very understanding about arranging my hours so I can keep my clinic appointments" d) "I really like living with my sister; I help her by babysitting her children whenever I can" Pg. 111 Satisfying employment, housing, and peer support are all considered critical to successful recovery from a mental health disorder. These factors contribute to the stability and support required to appropriately manage stress associated with recovery. While having a goal, such as completing a college degree, may be a positive sign, such efforts may add stress to the client's life and be destabilizing in some instances. The client's view that medication will, by itself, prevent relapse is incorrect; the client requires additional education concerning their disorder.

14. The nurse is working with several clients diagnosed with mental health disorders. Which client statements suggest that prognosis for effective management of the condition is good? Select all that apply. a) "I am interested in getting a degree in business, and I have been talking about that with people at the local college" b) "My support group has given me a lot of good advice about managing my symptoms and feeling positive about myself" c) "My employer is very understanding about arranging my hours so I can keep my clinic appointments" d) "I really like living with my sister; I help her by babysitting her children whenever I can" e) "I am confident that the medications I have been prescribed will keep me from experiencing a relapse of my symptoms"

b) "I will ask the client about a preference regarding Alcoholics Anonymous meeting locations" Pg. 109 One of the key concepts in recovery-oriented care is person-centered care, in which the person is actively involved in determining the best options for their health care circumstances instead of passively receiving a prescription for treatment. Allowing the client to select the meeting site demonstrates person-centered care. Although arranging for group sessions demonstrates appropriate planning and intervention, it does not reflect person-centered care. The client's family history and concern regarding admission are potential assessment data.

15. The nurse is caring for a client who is receiving treatment for alcohol use disorder. Which statement made by the nurse best demonstrates an understanding of person-centered care for a client with this condition? a) "The client has a family history of alcohol abuse going back at least three generations" b) "I will ask the client about a preference regarding Alcoholics Anonymous meeting locations" c) "I will arrange for the client to attend at least two group sessions daily" d) "The client has expressed concern about being admitted to the hospital"

b) Planning Pg. 109 In person-centered care, the client is actively engaged in planning interventions based upon individual strengths and needs. The plan, which reflects the client's preferences and values, provides the structure in which the individual, in partnership with the clinician, can identify long- and short-term life goals and skills.

16. The nurse is caring for a client using the person-centered approach. In which stage of the nursing process is this approach most likely utilized? a) Assessment b) Planning c) Implementation d) Diagnosis

b) "I have not missed a day of work in over a month" Pg. 110 The aim of every intervention is recovery. Along the way, there are important interventions that focus on treating underlying illnesses that places the person in the best position to continue the recovery journey. Effective interventions are based on the person's needs, preparedness to engage, and stage of recovery. Successful outcomes of these interventions lead to engagement of other evidence-based strategies that support the journey. Absenteeism is often an indicator of poor social inclusion; therefore, the client statement "I have not missed a day of work in over a month" is an indicator that the recovery interventions included in the client's plan of care are effective. The client statements indicating insomnia, losing weight without trying, and unhappiness with the currently prescribed medication all indicate that the recovery interventions included in the client's plan of care may be ineffective, thus requiring an update to the plan of care.

17. Which client statement indicates to the nurse that the recovery interventions included in the plan of care are effective? a) "I am still experiencing significant insomnia" b) "I have not missed a day of work in over a month" c) "I am not happy with my currently prescribed medication" d) "I continue to lose weight even though I am not dieting"

c) Implement the recovery-directed care model Pg. 114 As the care paradigm shifts from nurse-directed care to recovery-oriented care with shared decision making, nurses have the opportunity to truly practice from a holistic perspective. The shared decision-making model empowers the client and is central to recovery. Peer support is an integral part of the recovery model; it can be provided concurrently with other interventions.

18. A mental health nurse is considering ways to incorporate holistic practices into client care. In what way can the nurse best practice holistic nursing? a) Use the peer support care model only when other models have failed b) Focus on the nurse-directed care model c) Implement the recovery-directed care model d) Recognize the limitations of the shared decision-making model

c) Joining a community walking group d) Setting timers as reminders for taking medication e) Completing health insurance forms independently Pg. 109 Any action the client takes independently to enhance their personal wellness and prevent or manage illness suggests empowerment. Joining a walking group for exercise and socialization opportunities, using timers to self-manage medication therapy, and completing insurance forms unaided all indicate that the client is feeling empowered. While advocacy and employment both aid in recovery, using an advocate to communicate with healthcare providers and asking the nurse for help in finding employment both indicate a reliance on others rather than the self-reliance exhibited by an empowered client.

19. The nurse is working with a client who is recovering from an acute depressive episode. The nurse judges that the client is displaying empowerment when the client reports: Select all that apply. a) Contacting an advocate to speak on their behalf with healthcare providers b) Asking the nurse for help in finding employment c) Joining a community walking group d) Setting timers as reminders for taking medication e) Completing health insurance forms independently

a) "The client prefers spending as much time as possible outside walking the grounds" Pg. 109 Person-centered care is an approach to healthcare that is organized around the client's health needs and expectations. Demonstrating attention to the client's preferences shows an understanding of this model. The remaining options fail to demonstrate client involvement in the decisions. Instead, they depict choices the nurse made based either on common manifestations of the diagnosed disorder or on the nurse's interpretation of the client's needs.

2. A nurse is caring for a client who has been admitted to the hospital for treatment of manic behavior associated with a new diagnosis of bipolar disorder. Which statement made by the nurse demonstrates an attempt to incorporate the person-centered care model in this client's plan of care? a) "The client prefers spending as much time as possible outside walking the grounds" b) "I have arranged for the client's parents to call later this evening" c) "The symptoms of this disorder make clients very easily agitated and aggressive" d) "I have scheduled the client to attend a stress management group each afternoon"

c) "Are you currently able to contribute to monthly rent payments?" Pg. 111 Section 8 federally subsidized housing units are supervised or operated by the state or city. Tenants are responsible for paying one third of their monthly income—such as payments from Social Security Disability Insurance—toward rent. None of the other questions are directly relevant to determining a client's eligibility for Section 8 housing assistance.

20. The nurse is working with a client diagnosed with a chronic mental illness who requires new housing arrangements. Which question would the nurse ask to best determine the client's eligibility for federally subsidized housing? a) "What type of housing would you prefer?" b) "When were you initially diagnosed with a chronic mental illness?" c) "Are you currently able to contribute to monthly rent payments?" d) "Do you believe you will comply with your plan of care?"

a) Poverty Pg. 112 There are several different barriers to recovery. Based on the current data for this client, the priority barrier to accessing recovery-oriented care is poverty. The current data does not support stigma, homelessness, or lack of services as priority barriers to recovery-oriented care.

21. The nurse plans care for a client who is newly diagnosed with major depressive disorder. The client states, "I recently lost my job, and I don't have much money. I had to move in with my parents when I was evicted from my apartment." Which barrier to recovery-oriented care is the priority for the nurse to address in the client's plan of care? a) Poverty b) Stigma c) Homelessness d) Lack of services

d) "How does it make you feel when someone calls you 'crazy'?" Pg. 112 The challenge for nurses and other clinicians is to support stigma resilience, a personal trait that means the client has the capacity to withstand or recover from significant challenges that threaten stability, viability, or development. Asking the child how the incident made them feel will provide insight into how resilient the child is. None of the other answers provide insight into how the child is emotionally handling such biased behavior.

22. A child diagnosed with obsessive-compulsive disorder (OCD) tells the nurse, "One of the kids in my class calls me crazy." What response by the nurse best supports the child's ability to deal with the stigma of mental illness? a) "Did you report that to your teacher?" b) "Does that kind of thing happen to you often?" c) "What do you think made the classmate call you 'crazy'?" d) "How does it make you feel when someone calls you 'crazy'?"

d) Allows for holistic recovery from acute mental illness Pg. 111 Housing is a basic necessity that provides the foundation for health needs to be met. A holistic approach to recovery that emphasizes the need to secure permanent housing reduces readmission to the hospital and reentry to street dwelling. Although supportive housing is expensive, communities are realizing that housing programs for people who are mentally ill and homeless are a good investment that can achieve long-term cost savings. The person who is safely housed is less likely to use other acute care and publicly funded services, such as shelters. Use of acute psychiatric and medical services is reduced, and the person is less likely to be arrested or incarcerated. Although supportive housing aids in the recovery process from acute mental health conditions, it does not prevent them.

23. The nurse is providing education to families of clients with chronic mental health conditions. When discussing the advantages of supportive housing, what benefit should the nurse identify? a) Increases the use of acute psychiatric services b) Serves as an inexpensive way to prevent acute mental health conditions c) Provides easier access for police intervention d) Allows for holistic recovery from acute mental illness

c) Seek education regarding health issues d) Collaborate with healthcare provider e) Participate in own health needs Pg. 109 Person-centered care is an approach to healthcare that is organized around health needs and expectations, rather than diseases. The person, family, and community participate in and benefit from a trusted healthcare system. The cllient should not focus on individual disease or passively accept care.

24. The nurse is developing a person-centered plan of care with a client. The nurse should expect the client to exhibit which behavior(s)? Select all that apply. a) Focus on the specifics of the disease process b) Passively accept treatment decisions c) Seek education regarding health issues d) Collaborate with healthcare provider e) Participate in own health needs

c) The nurse suggests, "Let's discuss how your interest in running can help you manage stress effectively" Pg. 113 In person-centered care, the client is actively engaged in planning interventions based upon individual strengths and needs. The plan, which reflects the client's preferences and values, provides the structure in which the client, in partnership with the clinician, can identify long- and short-term life goals and skills. Connecting the client's interest in running with stress management techniques engages the client in the planning of interventions based on personal preference. The other statements fail to depict the client's interests or values being incorporated into the decision-making process.

25. A nurse has been teaching a client techniques to manage the triggers that cause a relapse of symptoms associated with a diagnosis of depression. Which statement best demonstrates that the nurse has incorporated person-centered care in the teaching? a) The client says,"I have many fond memories of running with my dad before he died last year" b) The client states,"I have never liked exercising, but I suppose I could try it" c) The nurse suggests, "Let's discuss how your interest in running can help you manage stress effectively" d) The nurse states, "Exercise has been shown to be an effective way for managing daily stress"

b) Receive specialized training and certification Pg. 111 Peer support specialists are people who have been successful in their recovery and management of existing symptoms. They are trained and certified to use their experiences to help others and work with other mental health disciplines to facilitate recovery-oriented care. A chronic mental health disorder is likely to require ongoing treatment, but successful management of the disorder would not disqualify an otherwise qualified individual from the role. Age, background, and length of history are not requirements for fulfilling the role of peer support specialist.

26. A nurse is discussing the value of peer support with a client diagnosed with post-traumatic stress disorder. When describing the requirements for becoming a peer support specialist, the nurse indicates that specialists must: a) Have a 5-year or longer history of the same mental health disorder as clients b) Receive specialized training and certification c) No longer require treatment for any mental health disorder d) Be of a similar age and socioeconomic background as clients

d) "The stress management techniques I have learned have really helped me" Pg. 109 Empowerment is the process of supporting people and communities to take control of their own health needs with the goal of healthy behaviors, positive mental health, self-management of illnesses, and well-being. The client's ability to use learned methods to manage stress that can worsen depression is an indication of empowerment and control over the condition. The other statements depict a degree of reliance on others.

27. The nurse is evaluating the plan of care for a client who was hospitalized with an exacerbation of symptoms associated with a diagnosis of chronic depression. Which client statement best demonstrates to the nurse that the plan of care has empowered the client to effectively manage symptoms following discharge? a) "I feel really safe when I am here with people who care about me" b) "My family and friends have been there for me, and I know I can always depend on them" c) "Depression is a terrible feeling, but with help I hope I can manage the symptoms" d) "The stress management techniques I have learned have really helped me"

a) Self-management d) Independence e) Self-efficacy Pg. 109 An important component of the recovery model is empowerment, the process of supporting clients to take control of their own health needs. Empowerment facilitates patient independence, self-management, and self-efficacy. Medication adherence has been shown to improve under the person-centered care model, but it is not an indication of empowerment. Similarly, while stigma resilience is a positive trait that can aid in the recovery model, its presence does not demonstrate empowerment.

28. In developing and updating the plan of care for a client diagnosed with schizophrenia, the nurse has attempted to foster client empowerment. When assessing the degree of empowerment the client has achieved, the nurse will observe for the presence of what behaviors? Select all that apply. a) Self-management b) Stigma resilience c) Medication adherence d) Independence e) Self-efficacy

c) Direct individuals to information on affordable housing Pg. 111-112 Peer support specialists can provide links to resources, services, and support. A good example of this is when peer support workers assist individuals with identifying sources of affordable housing and help with the processes required to access such services. It is not within the scope of a peer support specialist to provide care for infections or use disorders nor to provide education on medications. An appropriate health care provider would be required to meet those needs.

29. A nurse is collaborating with a peer support specialist to plan a community group for veterans in a rural setting. The nurse will emphasize that the peer support specialist can: a) Treat individuals withdrawing from alcohol or drug use b) Provide education on prescribed medications c) Direct individuals to information on affordable housing d) Provide care for sexually transmitted infections

a) The client who is unemployed due to being diagnosed with schizophrenia Pg. 112 Poverty, which is defined as a lack of monetary resources, is associated with mental disorders. People with a disability such as a mental illness may qualify for government supplement and additional support through SSDI. The individual who is most likely to quality for SSDI is the client who is unemployed due to being diagnosed with schizophrenia. This mental health disorder can make gainful employment difficult; therefore, this client requires a social work consult for continued assistance. The other clients can work in some capacity; therefore, they are not likely to be eligible for SSDI at this time.

3. The nurse is providing mental health services for clients in a rural setting. Which client is most likely to quality for Social Security disability insurance (SSDI) and thus requires a social work consult? a) The client who is unemployed due to being diagnosed with schizophrenia b) The client who is employed part-time and diagnosed with anxiety c) The client who works full-time and is diagnosed with depression d) The client who is married, works from home, and is diagnosed with panic disorder

b) "Where will you be living after discharge?" Pg. 112 Since mental health services vary from state to state, it is important to determine what state the client will be residing in. While the other questions are appropriate for assessment, securing necessary services hinges foremost on what services are available where the client will be living.

30. The mental health nurse is discussing care with a client who plans to move to a different state following discharge. When discussing mental health services that will be available to the client, what assessment question will provide the nurse with the information needed initially? a) "What services do you expect to require?" b) "Where will you be living after discharge?" c) "When are you expecting to be discharged?" d) "Can you afford to pay for necessary services?"

d) "Psychoeducation is a function that only nurses can implement with clients" Pg. 110 Psychoeducation is conducted by several mental health disciplines including nurses, psychiatrists, social workers, psychologists, peer support specialists, and others; therefore, the statement "Psychoeducation is a function that only nurses can implement with clients" requires clarification from the nurse educator. Not only does psychoeducation provide knowledge and competence about the disorder but also it promotes insight into the disorders, promotes relapse prevention, and provides skills for crisis management and suicide prevention; therefore, the other statements indicate a correct understanding regarding psychoeducation.

31. Which statement regarding psychoeducation requires clarification by the nurse educator? a) "Psychoeducation promotes relapse prevention for those with substance use disorder" b) "Psychoeducation promotes client insight into the diagnosed mental health disorder" c) "Psychoeducation provides the client with skills for crisis management" d) "Psychoeducation is a function that only nurses can implement with clients"

d) "Let's explore how you think music therapy will help you and where we might be able to find this type of group in the community" Pg. 108-109 In person-centered care, the nurse helps the client make decisions about care and treatment based on facts, rather than telling the client what is best. By exploring the client's knowledge of and interest in music therapy, the nurse demonstrates that the client shares in decision making and promotes empowerment, a key component of effective person-centered care. Effective treatment for schizophrenia typically requires both pharmacological and non-pharmacological interventions, so it would be incorrect to tell the client that the treatment plan should focus exclusively on the prescribed medication. There is no evidence to support the notion that music therapy is overstimulating for individuals with schizophrenia. The nurse should not assume the client has confused music therapy with psychotherapy. As discussions take place regarding what the client hopes to achieve through music therapy, it should become clear if the client confused the two forms of therapy.

32. The nurse is working with a client who has recently been diagnosed with schizophrenia. The client tells the nurse, "I think participating in a music therapy group would help me." When applying a person-centered approach to care, what is the nurse's best response? a) "I think you may be misinformed about treatment options. Is it possible that you have confused music therapy with psychotherapy?" b) "Typically the most effective way to treat your illness is with antipsychotic medications. We should focus on this before other treatments" c) "Music therapy can be overstimulating for people with schizophrenia. It is important to avoid this type of stress while you are recovering" d) "Let's explore how you think music therapy will help you and where we might be able to find this type of group in the community"

a) "It is not a good idea to disclose my diagnosis if I want to get a new job" Pg. 111 Recovery-oriented care recognizes employment potential and provides social support for gaining meaningful employment. Factors that facilitate obtaining and maintaining employment include personal strengths, social support, accommodative work environment, disclosure, and support from mental health professionals and services. Based on this information, the client statement that indicates a need for additional teaching is "It is not a good idea to disclose my diagnosis if I want to get a new job." The other client statements indicate a correct understanding regarding obtaining and maintaining employment.

33. The nurse provides education to a client who recently lost a job due to absenteeism because of being newly diagnosed with post traumatic stress disorder (PTSD). Which client statement indicates a need for additional teaching regarding factors that facilitate obtaining and maintaining employment? a) "It is not a good idea to disclose my diagnosis if I want to get a new job" b) "Social support is essential to obtaining a job" c) "My personal strengths are important to obtaining a job" d) "It is essential that my new job has an accommodative atmosphere"

b) Playground Pg. 109 Empowerment is the process of supporting people and communities to take control of their own health needs, with the goal of healthy behaviors, positive mental health, self-management of illnesses, and well-being. Empowerment facilitates client independence, self-management, and self-efficacy. By creating a playground, the community offers the opportunity for families to engage in physical and social activity; thus, it empowers them to achieve positive health outcomes. Street lights, speed bumps and house numbers all improve community safety, but they do not empower its members.

34. The nurse is developing ideas for a community improvement project. Which project best demonstrates the concept of empowerment as it relates to improving health in the community? a) House numbers b) Playground c) Speed bumps d) Street lights

b) "It is great knowing I can make a difference in the students' lives" Pg. 111 Employment gives individuals a sense of purpose and a reason to get up in the morning. These benefits are critical in the recovery process. While all the remaining statements are positive, none are related to providing the client with purpose and a sense of achievement.

35. A client who works as a school aide is in the recovery phase of treatment for acute clinical depression. Which statement made by the client best indicates that the primary benefit of employment is being realized? a) "I see my younger self in so many of the kids" b) "It is great knowing I can make a difference in the students' lives" c) "The money I make really helps with being able to pay all my bills" d) "The teachers I work with are all really nice"

b) Current inequalities in mental health care between insured and uninsured clients would be reduced Pg. 113 Universal access to mental health services would help reduce the disparities between those who are insured and those who are not. None of the other options would be assured by universal access to mental health care services.

36. A nurse is participating in a meeting with legislators to advocate for universal access to mental health care services. What is the benefit of universal access to client care? a) All mental health services would be equally available in all areas of the country b) Current inequalities in mental health care between insured and uninsured clients would be reduced c) Clients would be in control of selecting needed mental health care services d) Healthcare would be managed exclusively by professional mental health care providers

a) An adolescent living on a farm who has discussed suicide with a friend Pg. 113 While it is estimated that over 56% of adults with a mental health disorder receive no treatment in the United States, services for children and youth are even more sparse. In addition, access to mental health care is very limited in rural areas. Healthcare providers are concentrated in urban areas, leaving rural communities without an adequate number of qualified professionals. These factors make the adolescent at greatest risk of ineffective mental health care.

37. Which client will the nurse identify has having the greatest risk for ineffective mental health care? a) An adolescent living on a farm who has discussed suicide with a friend b) A middle-age professional who reports a high level of stress at work c) A single parent living in an urban area who reports "drinking too much" d) A doctoral candidate diagnosed with manic-depression

a) Dyslexia Pg. Unrecognized learning disabilities can lead to mental health problems that culminate in dropping out of school prior to high school completion; therefore, the nurse assesses the client for dyslexia because this is a learning disability. The other options are not supported by evidence-based practice guidelines as comorbidities that should be assessed for based on the current client data.

38. The nurse provides care to a young adult client who was diagnosed with attention deficit hyperactivity disorder (ADHD) during late childhood. The client states, "I never did well in school; I dropped out before I graduated." Which comorbidity should the nurse assess the client for based on the current information? a) Dyslexia b) Panic disorder c) Hypertension d) Bipolar disorder

d) "The Affordable Care Act (ACA) resulted in an increase in the uninsured" Pg. 113 Barriers to recovery include poverty, homelessness, stigma, and lack of services. The statement that indicates a need for additional teaching regarding barrier to recovery is "The ACA resulted in an increase in the uninsured" because this act decreased the number of uninsured clients. The other statements are true regarding barriers to recovery.

39. Which statement regarding barriers to recovery indicates a need for additional teaching? a) "Access to health care in the United States is often dependent on employment" b) "Poverty can make it difficult for clients to purchase medication" c) "Public mental health care may involve long wait times for appointments" d) "The Affordable Care Act (ACA) resulted in an increase in the uninsured"

c) The nurse places a client in the seclusion room following an assault on another client Pg. 110 In the paternalistic model, healthcare decisions are made by clinicians and prescribed to clients without their input. This model is represented by the nurse's decision to place the client in seclusion to help manage unacceptable behavior. The other interventions depict either the informed choice model, in which clinicians offer options but no opinions regarding treatment, or the shared decision-making model, in which clinicians provide both options and opinions to help clients choose a course of treatment.

4. The nurse is caring for several clients admitted for treatment of mental health issues. The nurse recognizes which intervention as being based on the paternalistic model of care? a) A client and the healthcare provider discuss the available pharmacological therapies before mutually agreeing on one b) The healthcare provider explains the benefits and limitations of electroconvulsive therapy to allow the client to decide whether to undergo it c) The nurse places a client in the seclusion room following an assault on another client d) After discussing two support groups available following discharge, the nurse arranges for the client to attend the one closer to home

d) Client with schizophrenia who meets regularly with the case manager to review health goals Pg. 109 The person-clinician partnership plans and manages mental health and health care issues, provides an opportunity for collaborative and creative thinking, and serves as a tool for gauging progress toward goals. A person-centered approach is exemplified in the scenario where the client meets with the case manager on a regular and frequent basis to ensure that the health goals in the care plan are being met. The development of the care plan by the case manager, without the collaboration of the client, depicts the paternalistic model of care. For a client with major depressive disorder, antidepressant medications will be essential to the plan of care, especially early in the client's recovery. The case manager should support the client in identifying non-pharmacological approaches to managing their condition, but these should complement medication therapy, not replace it. The person-centered approach is based on a strong, therapeutic nurse-client relationship. Infrequent and remote communication is unlikely to provide the close working relationship the client with rape trauma syndrome requires for effective person-centered care.

40. The nurse is caring for a client using the person-centered approach. Which client is likely to have the best outcome using this approach? a) Client with bipolar disorder for whom a plan of care has been developed solely by the case manager b) Client with major depressive disorder who works with the case manager to identify alternatives to taking medication c) Client with rape trauma syndrome who has monthly case management appointments using teleheath d) Client with schizophrenia who meets regularly with the case manager to review health goals

d) "This approach to treatment can help people with a range of mental health problems" Pg. 108, 110 In the United States, the recovery model was initially applied only to the care of persons with substance use disorder. Recently, the recovery model application was expanded to persons with a range of mental health problems. While it is true that this expansion emerged from the consumer/survivor/ex-patient movement following the civil rights movement in the late 1960s, the nurse does not need to include this information in the education session; it would be more important to emphasize the types of mental health problems for which this approach can be helpful. Person-centered care is a key concept in the recovery model, not an alternative to it. Because the recovery is based on person-centered care, the healthcare provider is not directing the client's care. Instead, the client and the provider collaborate to mutually agree on treatment plans and goals.

5. The nurse is providing education to a group of clients regarding the recovery model for treatment of mental health issues. What information will the nurse include when teaching the clients about this approach? a) "This treatment model emerged from the consumer movement of the 1960s" b) "This option is best when the client can adhere to the directions of their healthcare provider" c) "This method of treatment is an alternative to person-centered care" d) "This approach to treatment can help people with a range of mental health problems"

c) "Do you use substances such alcohol or illicit drugs?" Pg. 112 Homelessness is stressful and coping with homelessness is challenging. Substance use disorders can be an issue. Based on the nurse's observation of track marks on the client's arms the priority question to include in the assessment is "Do you use substances such alcohol or illicit drugs?" Although all the other questions are appropriate to include in the psychosocial portion of the assessment, the current data do not indicate they are priority.

6. The nurse provides care to a client who is homeless and diagnosed with schizophrenia. The nurse notes track marks on the client's arms. Which priority question should the nurse include when conducting the psychosocial portion of the assessment? a) "Do you have family who would be willing to take you in?" b) "What is your educational background?" c) "Do you use substances such alcohol or illicit drugs?" d) "How long have you been living in your car?"

a) "After discussing the benefit of a halfway house with my team, I agree that moving to one will provide the support I need after completing my alcohol rehab program" Pg. The shared decision-making model is an approach in which both the individual and the healthcare team are active participants in deciding on a plan of care. Clinician-client communication is at the core of the process. This model is demonstrated by the mutual agreement that a halfway house is the best treatment option following completion of the rehabilitation program. The statements regarding the inevitability of unpleasant side effects and the potential for imprisonment both suggest that the client is not taking an active role in determining the plan of care. The client's confidence in self-management of behaviors suggests empowerment but offers no indication that this was achieved using the shared decision-making model.

7. The nurse has recently reviewed plans of care with several clients. Which client statement best demonstrates the influence of the shared decision-making model on that client's plan of care? a) "After discussing the benefit of a halfway house with my team, I agree that moving to one will provide the support I need after completing my alcohol rehab program" b) "If I don't enter a rehab program, I will be unable to avoid going to prison for my drug charges" c) "I have learned a lot about my obsessive-compulsive behaviors, and I am confident I can manage those tendencies better now" d) "I really hate the side effects of my antidepressant medication, but I don't think I have any other choice in the matter"

c) "I am looking forward to spending time with my family this weekend" Pg. 109 An emerging concept that is useful in collaborating with a person with mental health issues is positive mental health, experiencing more desirable health-related quality-of-life events than undesirable ones. Positive mental health can be viewed from either a biologic or psychosocial perspective. A biologic perspective of positive mental health includes having more neurotransmitter activity associated with positive affect states such as dopamine and serotonin than associated with negative emotions (e.g., anger, sadness). It can also be viewed from a psychosocial view such as spending more time in social activities than in social isolation. The statement that indicates a psychosocial perspective of positive mental health is "I am looking forward to spending time with my family this weekend." Although the client statement "I prefer to stay home and sleep these days" focuses on a psychosocial view, it is one that is associated with a negative, not positive, psychosocial perspective of mental health. The other client statements focus on positive biologic perspectives of mental health.

8. Which client statement indicates a positive psychosocial perspective of mental health? a) "I prefer to stay home and sleep these days" b) "My prescribed antidepressant will help my sadness" c) "I am looking forward to spending time with my family this weekend" d) "I hope that I have decreased feelings of anger with my new medication"

c) "The stress management techniques I have learned have really helped me" Pg. 109 Empowerment is the process of supporting people and communities to take control of their own health needs with the goal of healthy behaviors, positive mental health, self-management of illnesses, and well-being. The client's ability to use learned methods to manage stress that can worsen depression is an indication of empowerment and control over the condition. The other statements depict a degree of reliance on others.

9. The nurse is evaluating the plan of care for a client who was hospitalized with an exacerbation of symptoms associated with a diagnosis of chronic depression. Which client statement best demonstrates to the nurse that the plan of care has empowered the client to effectively manage symptoms following discharge? a) "Depression is a terrible feeling, but with help I hope I can manage the symptoms" b) "I feel really safe when I am here with people who care about me" c) "The stress management techniques I have learned have really helped me" d) "My family and friends have been there for me, and I know I can always depend on them"