chapter 4

Which tasks are part of the role of a community mental health nurse

-Rearranging conflicting care appointments -Arranging transportation to the outreach center -Monitoring to ensure the patients basic needs are met

A person in the community asks, People with mental illnesses went to state hospitals in earlier times. Why has that changed? Select the nurses accurate responses.

-Science has made significant improvements in drugs for mental illness, so now many persons may live in their communities. -Theres now a better selection of less restrictive treatment options available in communities to care for people with mental illness. -Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.

A nurse surveys medical records. Which finding signals a violation of patients rights?

A patient was not allowed to have visitors.

A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case managers most appropriate action.

Arrange a temporary place for the patient to stay until new housing can be arranged.

A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurses best initial action.

Assess the patients weight; determine foods and amounts eaten

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room?

Autonomy

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient?

Building assertiveness skills

A nurse receives these three phone calls regarding a newly admitted patient. The psychiatrist wants to complete an initial assessment. An internist wants to perform a physical examination. The patients attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled

Case manager

The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy?

Clear risk of danger to self or others Detoxification from long-term heavy alcohol consumption needed Failure of community-based treatment, demonstrating need for intensive treatment

A Category V tornado hits a community, destroying many homes and businesses. Which nursing intervention would best demonstrate compassion and caring?

Encouraging persons to describe their memories and feelings about the event

Select the example of tertiary prevention.

Helping a person diagnosed with a serious mental illness learn to manage money

Select the example of primary prevention.

Helping school-age children identify and describe normal emotions

The case manager plans to discuss the treatment plan with a patients family. Select the case managers first action.

Obtain the patients permission for the exchange of information.

Which statements most clearly reflect the stigma of mental illness?

People claim mental illness so they can get disability checks. Mental illness results from the breakdown of American families. If people with mental illness went to church, their symptoms would vanish.

A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients rights?

Prohibited a patient from using the telephone

A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, I dont know what to do with my free time. Which member of the treatment team would be most helpful to this patient?

Recreational therapist

The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patients projected length of stay. How should the nurse instruct the unit secretary to handle the request?

Refer the request for information to the patients case manager.

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?

Resolve the crisis with the least restrictive intervention possible

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention?

Teaching parenting skills

A nurse makes an initial visit to a homebound patient diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. Select the nurses best response.

Thank you. I would enjoy having a cup of coffee with you.

A health care provider prescribed depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. For this plan to be successful, which factor will be of critical importance?

The availability of transportation to the clinic

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patients spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.

The patients spouse will mark dates for prescription refills on the family calendar.

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, Only a traitor would make me go to the hospital. Select the nurses best initial intervention.

With the patients consent, contact resources to provide medications without charge temporarily

A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should:

ensure that the directive is respected in treatment planning.

A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patients thoughts are now more organized, and discharge is planned. The patients family says, Its too soon for discharge. We will just go through all this again. The nurse should:

explain that the patient will continue to improve if the medication is taken regularly.

A psychiatric nurse discusses rules of the therapeutic milieu and patients rights with a newly admitted patient. Which rights should be included?

have visitors confidentiality complain about inadequate care

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to

housing adequacy. family and support systems. income adequacy and stability substance abuse history and current use

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitors closet is locked. These observations relate to:

management of milieu safety.

Inpatient hospitalization for persons with mental illness is generally reserved for patients who:

present a clear danger to self or others

The nurse assigned to assertive community treatment (ACT) should explain the programs treatment goal as:

providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed with:

schizophrenia and four hospitalizations in the past year.

Which level of prevention activities would a nurse in an emergency department employ most often?

secondary

The nurse should refer which of the following patients to a partial hospitalization program? A patient who:

states, Im not sure I can avoid using alcohol when my spouse goes to work every morning.

Clinical pathways are used in managed care settings to:

streamline the care process and reduce costs.

Which statements by patients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship? My case manager:

talks in language I can understand. helps me keep track of my medication. looks at me as a whole person with many needs.

Which assessment finding for a patient in the community deserves priority intervention by the psychiatric nurse? The patient:

was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.

Which scenario best depicts a behavioral crisis? A patient is

waving fists, cursing, and shouting threats at a nurse.

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient:

who is a new parent and hears voices saying, Smother your baby.