Chapter 4- Treatment Settings week 1 & 2

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

A

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 must be able to provide his or her own transportation daily. The client is able to return home each day. 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.

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 seek legal counsel. To access all personal possessions.

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.

Least Restrictive Environment

Treatment options are presented in order of acuteness, beginning with those in the least restrictive environment, that is, the setting that provides the necessary care while allowing the greatest personal freedom.

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 Medicare Medicaid Private pay

Private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.

recovery

Process of change through which individuals improve their health and wellness, live a self- directed life and strive to reach their full potential.

clinical pathways

case management tools used to communicate the standardized, interdisciplinary plan of care for a particular group of patients; care guidelines and outcomes are specified for each day of the patient's stay

Assertive Community Treatment (ACT)

community-based programs that provide many of the services that are necessary for successful community living; includes case management, problem-solving, social skills training, support, teaching on a 24/7 basis

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

d

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

d

decompensation

failure of a system so healthcare worker professional refers the patient to a higher level of care.

Elopement

leaving before being discharged

Stabilization

resolution of immediate crisis

psychiatric case management

service to assist patients in finding housing or obtaining entitlements

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? "We will help you make decisions that will keep you safe." "I am going to help you shower, so you will not smell so bad." "Your pocket knife and nail clippers will be kept in the nurses' station." "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.

milieu

(n.) the setting, surroundings, environment

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work A 30-year-old accountant who has developed symptoms of depression 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 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 Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). 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.

Prevention

A distinct concept in the healthcare literature is that of treatment based on a public health model that takes a community approach to prevention. Primary- prevents Secondary-screenings tertiary- prevent the progression

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

A patient being discharged from an inpatient alcohol rehabilitation unit PHP is for patients 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 patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient 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 patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as

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

A, b, d, e

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

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 the client to have a screening for prostate cancer Notifying the family that the client will require a wheelchair when discharged Providing the client with organizations that help defray the cost of prescribed drug Arranging for respite care when the client's family needs to attend an out-of-state affair

Arranging for the client to have a screening for prostate cancer The goal of managed care 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

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

B

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

B, c, e

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 Bedroom and dining areas with locked windows to prevent jumping Double-locked doors to prevent escaping from the unit Platform beds to prevent crush injuries

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.DIF: Cognitive Level: Apply (Application)

Triage

Determining the severity of problem and the urgency of response

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 patients who are convicted criminals sentenced to home confinement. Care is provided to clients in unconventional settings. Care is provided by a preferred provider for a large HMO. The patients are provided for by a clinical specialist with the visiting nurse service

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 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 Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.

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

D

What is the primary advantage of using a case manager when considering the planning and implementation of client care? Increases collaborative practice. Enhances resource management. Increases client satisfaction with care. 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. Voluntarily admitted clients are generally allowed additional privileges. Rules and behavioral limits are flexibly enforced. 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.

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 Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients

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

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.

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

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

Continuum of psychiatric-mental healthcare

Movement is fluid and can go in either direction. Patients discharged from the most acute levels of care (hospitalization) may need intensive services to maintain initial gains. Failure to follow up increases likelihood of rehospitalization.

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

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.

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? Opportunity to act out fears and frustrations Providing a safe place to practice coping skills Meeting their physical as well as emotional needs 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? Visiting a homeless shelter to provide mental health screenings for its clients Discussing the need for proper nutrition with a depressed new mother Providing stress reduction seminars at the local senior center 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.

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

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.

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

a

patient centered medical home

a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand

stigma

a mark of disgrace associated with a particular circumstance, quality, or person.

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

b