Ch 4 - Treatment Settings
Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? Private insurance Private pay Medicare Medicaid
Private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways clients pay for their needed mental health services.
What function is shared by advanced practice and general practice psychiatric nurses? Admitting privileges Membership on a multidisciplinary team Offers consultation services Prescriptive authority
Membership on a multidisciplinary team Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.
Which criterion must be met to refer a client to a partial hospitalization program? The client is hospitalized at night in an inpatient setting. The client is able to return home each day. The client must be able to provide his or her own transportation daily. The clients are all recovering from an addiction.
The client is able to return home each day. Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.
A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? "Your pocketknife and nail clippers will be kept in the nurses' station." "I am going to help you shower, so you will not smell so bad." "We will help you make decisions that will keep you safe." "You will be having a number of tests to help us learn about your condition."
"I am going to help you shower, so you will not smell so bad." Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.
Which of the following clients meets the criteria for an involuntary admission to a psychiatric mental health unit? A 76-year-old retired librarian who is experiencing memory loss and some confusion at times A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road A 30-year-old accountant who has developed symptoms of depression A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work
A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road Inpatient involuntary admission is reserved for clients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic client). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.
Which of the following clients would be appropriate to refer to a partial hospitalization program (PHP)? A depressed client with a suicidal plan Jeff, who has mild depression symptoms and is starting outpatient therapy A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs A client being discharged from an inpatient alcohol rehabilitation unit
A client being discharged from an inpatient alcohol rehabilitation unit PHP is for clients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This client would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This client can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A client exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.
The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. Implementation of a more flexible work schedule for staff A client and family members attend counseling sessions together at a neighborhood clinic Improved reimbursement for services provided in the community
A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. A primary goal of ACT is working intensely with the client in the community to prevent rehospitalization. The other options are not goals of ACT.
Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? The right to refuse treatment is no longer guaranteed. All rights remain intact. All rights are temporarily suspended. Only rights that do not involve decision making remain intact.
All rights remain intact. The hospitalized client is not a convicted criminal thus all civil rights remain intact.
The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? Arranging for respite care when the client's family needs to attend an out-of-state affair Providing the client with organizations that help defray the cost of prescribed drug Notifying the family that the client will require a wheelchair when discharged Arranging for the client to have a screening for prostate cancer
Arranging for the client to have a screening for prostate cancer The goal of managed care directed by a case manager is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.
Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? Break-away closet bars to prevent hanging Double-locked doors to prevent escaping from the unit Platform beds to prevent crush injuries Bedroom and dining areas with locked windows to prevent jumping
Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.
When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? The clients who are convicted criminals sentenced to home confinement. Care is provided to clients in unconventional settings. The clients are provided for by a clinical specialist with the visiting nurse service. Care is provided by a preferred provider for a large HMO.
Care is provided to clients in unconventional settings. Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.
In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? Knowledge of both national and local political activism Creative problem-solving and intervention skills The ability to cross service systems An awareness of own cultural and personal values
Creative problem-solving and intervention skills Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.
What is the primary advantage of using a case manager when considering the planning and implementation of client care? Enhances resource management. Increases client satisfaction with care. Increases collaborative practice. Promotes evidence-based psychiatric nursing.
Enhances resource management. Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.
A therapeutic inpatient milieu will include which characteristic? It provides for the client's safety and comfort. Rules and behavioral limits are flexibly enforced. Voluntarily admitted clients are generally allowed additional privileges. Staff provide frequent and ongoing negative feedback to clients.
It provides for the client's safety and comfort. Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe, and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.
When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? Fostering research Providing constructive negative feedback Providing sympathetic listening Maintaining a therapeutic milieu
Maintaining a therapeutic milieu Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.
Which situation demonstrates the nurse functioning in the role of advocate? Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation Co-leading a medication education group for clients and families Providing one-to-one supervision for a client on suicide precautions
Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.
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? Nurses Chemical dependency counselors Social workers Clinical psychologists
Nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.
The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? Providing a safe place to practice coping skills Meeting their physical as well as emotional needs Opportunity to act out fears and frustrations Encouraging group communication about existing problems
Providing a safe place to practice coping skills A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.
The psychiatric community health nurse engages in secondary prevention when implementing which intervention? Providing stress reduction seminars at the local senior center Visiting a homeless shelter to provide mental health screenings for its clients Discussing the need for proper nutrition with a depressed new mother Visiting the home of a client currently displaying manic behavior
Providing stress reduction seminars at the local senior center Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.
It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? Refusal of treatment. To send and receive mail. To access all personal possessions. To seek legal counsel.
To access all personal possessions. A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.
When considering mental illness, recovery is best described to a client by which statement? A period of time when signs and symptoms are being managed Never having to visit a mental health provider again Being able to understand the nature of the diagnosed illness Working, living, and participating in the community
Working, living, and participating in the community Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.
