Psych Videbeck Chapter 4: Treatment Settings and Therapeutic Programs

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. Periodic prognostic tests. Training to perform activities of daily living. Development of social skills. Stabilization of symptoms. Treatment for comorbid conditions.

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

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? When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review Upon admission to the inpatient setting Once the client experiences an exacerbation of symptoms

Upon admission to the inpatient setting

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. a) Training to perform activities of daily living. b) Treatment for co-morbid conditions. c) Development of social skills. d) Periodic prognostic tests. e) Stabilization of symptoms.

a) Training to perform activities of daily living. c) Development of social skills. e) Stabilization of symptoms.

Which of the following clients is suitable for psychiatric home care services? a) Adolescent with conduct disorder who took an overdose of Xanax (alprazolam) b) Paralyzed Vietnam veteran who is experiencing increasing respiratory difficulties and chronic infections c) Schizophrenic woman found living under the freeway d) Homebound individual with bipolar illness who is exhibiting manic symptoms

d) Homebound individual with bipolar illness who is exhibiting manic symptoms

Krista is a 32-year-old woman who has bipolar disorder. She attends group therapy for 6 hours a day and then returns home to her residence. In which of the following settings would Krista receive this type of care? a) Psychiatric specialty unit b) Acute care hospitalization c) Long-term hospitalization d) Partial hospitalization program

d) Partial hospitalization program

Which of the following would be most important for the nurse to do to maximize client compliance with the discharge plan? a) Telling the client to adhere to the plan. b) Monitoring the client continuously. c) Encouraging the client to ask for help d) Partnering with the client from the beginning

d) Partnering with the client from the beginning

Which of the following goals for an individual client is consistent with the overall objectives of community support service programs? a) The client will move from a group housing arrangement to independent living. b) The client will gain insight into the causes of his mental illness. c) The client will experience fewer symptoms. d) The client's functional ability will improve.

d) The client's functional ability will improve.

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: Fairweather Lodge model. community worker model. community living model. psychosocial rehabilitation model.

psychosocial rehabilitation model (PRM) Explanation: Psychosocial rehabilitation focuses on client rehabilitation in a normal daily environment using the strengths, skills, and community supports. The focus is empowering the person with serious mental illness to become a contributing member of the community within a supportive setting.

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: Fairweather Lodge model. community living model. community worker model . psychosocial rehabilitation model.

psychosocial rehabilitation model.

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness: spend less time in shelters spend more time in jail have more contact with family members face fewer barriers to employment.

spend more time in jail.

Which of the following programs provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? a) Fairweather treatment b) Community living treatment c) Assertive community treatment d) Clubhouse treatment

c) Assertive community treatment

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. Training to perform activities of daily living. Periodic prognostic tests. Treatment for comorbid conditions. Development of social skills. Stabilization of symptoms.

-Development of social skills. -Stabilization of symptoms. -Training to perform activities of daily living. Explanation: Day treatment program (partial hospitalization, PHP) provides services for mentally ill clients such as developing social skills, stabilizing psychiatric symptoms, and improving the skills required for activities of daily living. These programs do not perform prognostic testing for mentally ill clients. Services for treating comorbid medical illnesses are not provided in this program.

The introduction of psychotropic medications occurred in which decade? 1970s 1940s 1960s 1950s

1950s Explanation: The introduction of psychotropic medication occurred in the 1950s.

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 open 24 hours a day to provide care and support for the clubhouse members." "They are run entirely by psychiatric mental health nurses." "They are predominately run by psychiatric clients with minimal assistance from mental health staff." "Their primary focus is on providing ongoing intensive psychotherapy for clients in a group setting."

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

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. 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. Make provisions for the client to get admitted in short-term residential therapy. Arrange for financial resources required for the treatment.

-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. Explanation: Case management is an important role of the nurse. As a case manager, the nurse acts as a liaison between the client and community resources and third-party payers. The nurse should help the client to identify resources that would help reduce the financial burden on the client's caregivers. The nurse should also refer the client to other mental health services that would be beneficial to the client. Teaching about behavioral strategies to manage the client is indicative of the nurse's role as a teacher. Helping the caregivers to cope with stress related to the illness of the client is indicative of the nurse's role as a counselor. The client has severe and persistent mental illness; therefore, instead of getting the client admitted in short-term residential therapy, the nurse should arrange to admit the client for long-term institutionalization.

A group of nursing students are learning about the history of forensic nursing. Which reason best explains the development of this nursing speciality? Select all that apply. Criticism about the criminalization of the mentally ill Increasing numbers of incarcerated individuals with mental disorders More inpatient mental health treatment needed for offenders Demand for better health care for offenders with mental disorders Public inquiries to reactionary events in those with mental disorders

-Public inquiries to reactionary events in those with mental disorders -Criticism about the criminalization of the mentally ill -More inpatient mental health treatment needed for offenders Explanation: In 1995, the ANA recognized forensic nursing as a specialty for these reasons: (a) the public began to question how offenders with mental disorders were receiving treatment; (b) the public began criticizing the criminalization of those with mental illness that led to a (c) demand for better health care for offenders with mental disorders. These answers not only help define the specialty, but relate to the mental health goals for Healthy People 2020. The remaining answer choices relate to singular issues for clients within the specialty, not the development of the specialty itself.

A client with a psychiatric illness is being discharged from the hospital. What does the nurse include in the discharge teaching to help prevent relapse in the client? Select all that apply. Schedule for follow-up treatment Diet plan that would benefit the client Side effects related to the medications Establishment of a daily routine for the client Symptoms of the psychiatric illness

-Symptoms of the psychiatric illness -Establishment of a daily routine for the client -Schedule for follow-up treatment Explanation: Relapse prevention is an important component of discharge planning. The nurse should teach the symptoms of the illness, plan the client's daily routine, and arrange schedule for follow-up treatment and referrals. Teaching about diet would not help to prevent relapse in the client. Similarly, side effects related to the medications would also not help to prevent relapse in the client.

The introduction of psychotropic medications occurred in which decade? 1940s 1960s 1950s 1970s

1950s

The population that is mentally ill is arrested and prosecuted at a rate that is how many times that of the general population? 4 5 2 3

4

The population that is mentally ill is arrested and prosecuted at a rate that is how many times that of the general population? 3 2 5 4

4 Explanation: The mentally ill population is arrested and prosecuted at four times the rate of the general population.

The rate of mental illness in the jailed population has been increasing faster than that of the general population. How many times higher is the rate of mental illness in the jailed population? 3 2 5 4

5 Explanation: The mentally ill population is arrested and prosecuted at five times the rate of the general population.

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: psyciatric home care d: outpatient psychiatric care

A

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

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A) Private insurance B) Medicare C) Medicaid D) Private pay

A 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.

A therapeutic inpatient milieu will include which characteristic? A) It provides for the client's safety and comfort. B) Voluntarily admitted clients are generally allowed additional privileges. C) Rules and behavioral limits are flexibly enforced. D) Staff provide frequent and ongoing negative feedback to clients.

A 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.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A) Break-away closet bars to prevent hanging B) Bedroom and dining areas with locked windows to prevent jumping C) Double-locked doors to prevent escaping from the unit D) Platform beds to prevent crush injuries

A 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.

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? A) Nurses B) Social workers C) Clinical psychologists D) Chemical dependency counselors

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

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

A 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.

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? A) Arranging for the client to have a screening for prostate cancer B) Notifying the family that the client will require a wheelchair when discharged C) Providing the client with organizations that help defray the cost of prescribed drug D) Arranging for respite care when the client's family needs to attend an out-of-state affair

A 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.

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

A The hospitalized client is not a convicted criminal thus all civil rights remain intact.

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 A 68-year-old person diagnosed with early stage Alzheimer's disease with a second degree burn on the hand. A 26-year-old person diagnosed with obsessive-compulsive disorder experiencing an asthmatic attack A 16-year-old person diagnosed with borderline personality disorder and an infected wrist laceration

A 34-year-old person diagnosed with an amphetamine addiction who has overdosed Explanation: A 34-year-old person diagnosed with an amphetamine addiction who has overdosed is most likely to be seen as a participant of the acute care hospitals "revolving door" phenomena. Due to the chronic and complex nature of dual diagnosis clients, frequent hospital presentations are common and treatment can be challenging. A 26-year-old person diagnosed with obsessive-compulsive disorder experiencing an asthmatic attack, a 16-year-old person diagnosed with borderline personality disorder and an infected wrist laceration, and a 68-year-old person diagnosed with early stage Alzheimer's disease with a second degree burn on the hand are not likely to be qualified in this way.

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 43-year-old recovering from acute psychoses A 42-year-old who would like to enter marriage counseling A 52-year-old with AIDS dementia A 34-year-old with severe and persistent mental illness

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

Psychiatric home care would be inappropriate for which individual? A 42-year-old who would like to enter marriage counseling A 52-year-old with AIDS A 34-year-old with severe and persistent mental illness A 43-year-old suffering from acute psychoses

A 42-year-old who would like to enter marriage counseling Explanation: Psychiatric home health care services are appropriate for different age groups, clients with acute psychoses, clients with serious and persistent mental illness, and clients with AIDS.

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 A 52-year-old with AIDS dementia A 34-year-old with severe and persistent mental illness A 43-year-old recovering from acute psychoses

A 42-year-old who would like to enter marriage counseling Explanation: Transitional psychiatric care is appropriate for different age groups. Individuals who most benefit from in-home mental health care include clients with chronic, persistent mental illness or clients with mental illness and comorbid medical conditions that require ongoing monitoring.

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 43-year-old recovering from acute psychoses A 52-year-old with AIDS dementia A 42-year-old who would like to enter marriage counseling A 34-year-old with severe and persistent mental illness

A 42-year-old who would like to enter marriage counseling Explanation: Transitional psychiatric care is appropriate for different age groups. Individuals who most benefit from in-home mental health care include clients with chronic, persistent mental illness or clients with mental illness and comorbid medical conditions that require ongoing monitoring.

Which client would be most likely to qualify for psychiatric care in a long-term care setting? A client who has a diagnosis of bipolar disorder and is an intravenous heroin user A client who has schizophrenia and who is estranged from the client's family A client who has multiple sclerosis and a history of depression A client with a recent history of suicide attempts who is scheduled to begin electroshock therapy

A client who has multiple sclerosis and a history of depression Explanation: Individuals may receive psychiatric care in a long-term care setting unless they require specialized services such as substance abuse counseling, electroshock therapy, or intense individual or group psychotherapy. A lack of family support is not an admission criterion for long-term care.

Which client may be the most appropriate candidate for telepsychiatry? A client with bipolar disorder who has been admitted to the hospital during a manic episode A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution

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

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 A client with bipolar disorder who has been admitted to the hospital during a manic episode A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution

A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health Explanation: Cybertherapy may be most appropriate for persons who do not qualify for therapeutic intervention but who are motivated for treatment. Acute illnesses are not likely to be effectively treated by this method.

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 school phobia and anxiety A client with depression who is responding to treatment A client with schizophrenia and diabetes A client with oppositional defiant disorder

A client with schizophrenia and diabetes

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 oppositional defiant disorder A client with school phobia and anxiety A client with schizophrenia and diabetes A client with depression who is responding to treatment

A client with schizophrenia and diabetes Explanation: Individuals most appropriate for in-home mental health care services include clients with chronic persistent mental illness or those who have a comorbid condition, such as diabetes, and require long-term monitoring.

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? Admission to a long-term care facility Subacute care A day-treatment program Rehabilitative care

A day-treatment program

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? A multidisciplinary approach Maintenance of the therapeutic environment Therapy that does not include medication Inclusion of both art therapy and psychotherapy

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

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? Admission to a long-term care facility A day-treatment program Subacute care Rehabilitative care

A day-treatment program Explanation: Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care.

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 Rehabilitative care Subacute care Admission to a long-term care facility

A day-treatment program Explanation: Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care. Me: Day treatment is more intensive than outpatient programs (PHP and IOP)

Which community activity is an example of tertiary prevention in a community that experienced a massive fire? Hospital personnel reviewed their emergency response plans and made changes. City officials installed warning signals in remote areas where no warning signals were heard. Mental health professionals offered educational programs on effective coping strategies. A master plan was formulated for what to do in case of another 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 of 12-step programs and support groups A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill

A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation

Which best defines a community support system in relation to mental illness? -An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill -A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation -A network of 12-step programs and support groups -A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness

A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation Explanation: 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.

Which best defines a community support system in relation to mental illness? An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A network of 12-step programs and support groups

A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation Explanation: 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.

Which best describes the scope of what community support services provide? Crisis intervention assistance and referral Mental health counseling and medication management A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities

A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation

Which best describes the scope of what community support services provide? -A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation -Crisis intervention assistance and referral -Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities -Mental health counseling and medication management

A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Explanation: A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities.

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 experience 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 intervention demonstrates an attempt by nursing staff to meet the goals identified by the Joint Commission as National Patient Safety Goals? (Select all that apply) a: Identifying patients using both name and date of birth before drawing blood. b: Sitting with the patient diagnosed with an eating disorder during meals c: Administering the Beck Scale on each patient at the time of admission. d: Performing a medication history assessment on each new patient. e: Using appropriate hand washing technique at all times.

A, C, D, E

Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medications at home. c. have no support systems in the community. d. develop new symptoms during the course of an illness.

ANS: A Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The incorrect options do not necessarily describe patients who require inpatient treatment.

A patient tells the nurse at the clinic, "I haven't been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and don't want them to ask me about the pills." Select the nurse's most appropriate intervention. a. Investigate the possibility of once-daily dosing of the antidepressant. b. Suggest to the patient to take the medication when no one is watching. c. Explain how taking each dose of medication on time relates to health maintenance. d. Add the following nursing diagnosis to the plan of care: Ineffective therapeutic regimen management, related to lack of knowledge.

ANS: A Investigating the possibility of once-daily dosing of the antidepressant has the highest potential for helping the patient achieve compliance. Many antidepressants can be administered by once-daily dosing, a plan that increases compliance. Explaining how taking each dose of medication on time relates to health maintenance is reasonable but would not achieve the goal; it does not address the issue of stigma. The self-conscious patient would not be comfortable doing this. A better nursing diagnosis would be related to social stigma. The question asks for an intervention, not analysis.

A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under staff supervision. These observations relate to: a. management of milieu safety. b. coordinating care of patients. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.

ANS: A Members of the nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to the observations cited.

A nurse surveys the medical records for violations of patients' rights. Which finding signals a violation? a. No treatment plan is present in record. b. Patient belongings are searched at admission. c. Physical restraint is used to prevent harm to self. d. Patient is placed on one-to-one continuous observation.

ANS: A The patient has the right to have a treatment plan. Inspecting a patient's belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self that occur as a result of a mental disorder.

Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises? a. Resolve behavioral crises using the least restrictive intervention possible. b. Rights of the majority of patients supersede the rights of individual patients. c. Swift intervention is justified to maintain the integrity of the therapeutic milieu. d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.

ANS: A The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.

A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting? a. A treatment plan will be formulated. b. The health care provider will order neuroimaging studies. c. The team will request a court-appointed advocate for the patient. d. Assessment of the patient's need for placement outside the home will be undertaken.

ANS: A Treatment plans are formulated early in the course of treatment to streamline the treatment process and reduce costs. It is too early to determine the need for alternative post-discharge living arrangements. Neuroimaging is not indicated for this scenario.

Which employer's health plan is required to include parity provisions related to mental illnesses? a. Employer with more than 50 employees b. Cancer thrift shop staffed by volunteers c. Daycare center that employs 7 teachers d. Church that employs 15 people

ANS: A Under federal parity laws, companies with more than 50 employees may not limit annual or lifetime mental health benefits unless they also limit benefits for physical illnesses.

A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following? Select all that apply. a. Housing adequacy and stability b. Income adequacy and stability c. Family and other support systems d. Early psychosocial development e. Substance abuse history and current use

ANS: A, B, C, E Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.

A community member asks a nurse, "People diagnosed with mental illnesses used to go to a state hospital. Why has that changed?" Select the nurse's accurate responses. Select all that apply. a. "Science has made significant improvements in drugs for mental illness, so now many people may live in their communities." b. "A better selection of less restrictive settings is now available in communities to care for individuals with mental illness." c. "National rates of mental illness have declined significantly. The need for state institutions is actually no longer present." d. "Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe conditions." e. "Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings."

ANS: A, B, E The community is a less restrictive alternative than hospitals for the treatment of people with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.

A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, "Only a traitor would make me go to the hospital." Which solution is best? a. Arrange a bed in a local homeless shelter with nightly onsite supervision. b. Negotiate a way to provide medication so the patient can remain at home. c. Hospitalize the patient until the symptoms have stabilized. d. Seek inpatient hospitalization for up to 1 week.

ANS: B Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.

A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, "I feel the same." Which intervention supports the nurse's assessment while preserving the patient's autonomy? a. Arrange for a short hospitalization. b. Schedule weekly clinic appointments. c. Refer the patient to the crisis intervention clinic. d. Call the family and ask them to observe the patient closely.

ANS: B Scheduling clinic appointments at shorter intervals will give the opportunity for more frequent assessment of symptoms and allow the nurse to use early intervention. If the patient does not admit to having a crisis or problem, a referral would be useless. The remaining options may produce unreliable information, violate the patient's privacy, and waste scarce resources.

A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, "I'm willing to take my medicine, but I forgot to get my prescription refilled." Which outcome should the nurse add to the plan of care? a. Nurse will obtain prescription refills every 90 days and deliver them to the patient. b. Patient's spouse will mark dates for prescription refills on the family calendar. c. Patient will report to the hospital for medication follow-up every week. d. Patient will call the nurse weekly to discuss medication-related issues.

ANS: B The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as he or she continues to take the medications as prescribed. No patient issues except failure to obtain medication refills were identified.

To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit? a. Problem-solving skills b. Calm and caring manner c. Ability to cross service systems d. Knowledge of psychopharmacology

ANS: C A community mental health nurse must be able to work with schools, corrections facilities, shelters, health care providers, and employers. The mental health nurse working in an inpatient unit needs only to be able to work within the single setting. Problem-solving skills are needed by all nurses. Nurses in both settings must have knowledge of psychopharmacology.

A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurse's best initial action. a. Report the situation to the manager of the shelter. b. Tell the patient, "You must stop smoking to save money." c. Assess the patient's weight; determine the foods and amounts eaten. d. Seek hospitalization for the patient while a new plan is being formulated.

ANS: C Assessment of biopsychosocial needs and general ability to live in the community is called for before any action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. Nurses assess before taking action. Hospitalization may not be necessary.

A patient hurriedly tells the community mental health nurse, "Everything's a disaster! I can't concentrate. My disability check didn't come. My roommate moved out, and I can't afford the rent. My therapist is moving away. I feel like I'm coming apart." Which nursing diagnosis applies? a. Decisional conflict, related to challenges to personal values b. Spiritual distress, related to ethical implications of treatment regimen c. Anxiety, related to changes perceived as threatening to psychological equilibrium d. Impaired environmental interpretation syndrome, related to solving multiple problems affecting security needs

ANS: C Subjective and objective data obtained by the nurse suggest the patient is experiencing anxiety caused by multiple threats to security needs. Data are not present to suggest Decisional conflict, Spiritual distress caused by ethical conflicts, or Impaired environmental interpretation syndrome.

A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to: a. cancel the patient's discharge from the hospital. b. contact the landlord who evicted the patient to discuss the situation. c. arrange a temporary place for the patient to stay until new housing can be arranged. d. document that the adverse medication reaction was feigned because the patient had nowhere to live.

ANS: C The case manager should intervene by arranging temporary shelter for the patient until suitable housing can be found. This is part of the coordination and delivery of services that falls under the case manager role. The other options are not viable alternatives.

A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should: a. tell the patient, "I'll get an unsatisfactory grade if I don't give you the medication." b. tell the patient, "Refusing your medication is not permitted. You are required to take it." c. discuss the patient's concerns about the medication, and report to the staff nurse. d. document the patient's refusal of the medication without further comment.

ANS: C The patient has the right to refuse medication in most cases. The patient's reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should be reported to permit appropriate intervention.

The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who: a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol). b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years. c. self-inflicted a superficial cut on the forearm after a family argument. d. is a single parent and hears voices saying, "Smother your infant."

ANS: D Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.

The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, "It's too soon for discharge. Hospitalization is needed for at least a month." The nurse should: a. call the psychiatrist to come explain the discharge rationale. b. explain that health insurance will not pay for a longer stay for the patient. c. call security to handle the disturbance and escort the family off the unit. d. explain that the patient will continue to improve if medication is taken regularly.

ANS: D Patients no longer stay in the hospital until every vestige of a symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handle this matter.

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Maintenance of the therapeutic environment Inclusion of both art therapy and psychotherapy Therapy that does not include medication A multidisciplinary approach

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

Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient: a. receives Social Security disability income plus a small check from a trust fund. b. lives in an apartment with two patients who attend day hospital programs. c. has a sibling who is interested and active in care planning. d. purchases and uses marijuana on a frequent basis.

ANS: D Patients who regularly buy illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of illegal drugs on cellular brain function, promotes relapse. The remaining options do not suggest problems.

A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance? a. Attitude of significant others toward the patient b. Nutritional services in the patient's neighborhood c. Level of trust between the patient and the nurse d. Availability of transportation to the clinic

ANS: D The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, noncompliance will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.

Which patient would a nurse refer to partial hospitalization? An individual who: a. spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal. b. because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy. c. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. d. states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

ANS: D This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume supervision responsibilities. The patient who is actively suicidal needs inpatient hospitalization. The patient in need of psychoeducation can be referred to home care. The patient who reports regularly for blood tests and clinical follow-up can continue on the same plan.

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Ensured quality of care Improvement in therapeutic relationship Ability to provide services in a variety of locations Ability to provide high-intensive services for many mental illnesses

Ability to provide services in a variety of locations

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Improvement in therapeutic relationship Ensured quality of care Ability to provide services in a variety of locations Ability to provide high-intensive services for many mental illnesses

Ability to provide services in a variety of locations Explanation: 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? Residential care Acute inpatient hospitalization Crisis intervention Partial hospitalization

Acute inpatient hospitalization

Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Partial hospitalization Crisis intervention Residential care

Acute inpatient hospitalization Explanation: 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.

Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Crisis intervention Partial hospitalization Residential care

Acute inpatient hospitalization Explanation: 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? 24-hour supervision Acute symptom stabilization Rehabilitative services Long-term therapy

Acute symptom stabilization Explanation: When a client is admitted to an inpatient facility during a crisis, the focus of care is stabilization of the acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days. The client is in crisis, so rehabilitative services would be inappropriate.

Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what? Safety issues as a result of physical, psychosocial, or medical problems Inadequate financial resources for private mental health care services An inability to leave the home due to chronic physical, psychosocial, or medical problems Lack of family support to assist in care

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

Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what? Safety issues as a result of physical, psychosocial, or medical problems An inability to leave the home due to chronic physical, psychosocial, or medical problems Lack of family support to assist in care Inadequate financial resources for private mental health care services

An inability to leave the home due to chronic physical, psychosocial, or medical problems Explanation: Criteria for homebound status include: an inability to leave home alone because of physical, psychosocial, or medical problems; a need for assistance and taxing effort to leave home; and infrequent short absences from home only for medical or certain types of personal needs.

Which client is suitable for psychiatric transitional care services? An individual being discharged from hospital with residual symptoms of mania Adolescent with conduct disorder who took an overdose of alprazolam Paralyzed Vietnam veteran who is experiencing increasing respiratory difficulties and chronic infections Schizophrenic woman found living under the freeway

An individual being discharged from hospital with residual symptoms of mania

Which client is suitable for psychiatric transitional care services? Adolescent with conduct disorder who took an overdose of alprazolam Paralyzed Vietnam veteran who is experiencing increasing respiratory difficulties and chronic infections An individual being discharged from hospital with residual symptoms of mania Schizophrenic woman found living under the freeway

An individual being discharged from hospital with residual symptoms of mania Explanation: 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.

Which criterion must be met to refer a client to a partial hospitalization program? A) The client is hospitalized at night in an inpatient setting. B) The client must be able to provide his or her own transportation daily. C) The client is able to return home each day. D) The clients are all recovering from an addiction.

C 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 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? Apply religious beliefs to patient care. Apply the nurse's morals and values to everyone. Conduct thorough physical assessments of clients. Conduct ongoing self-reflection and self-awareness.

Conduct ongoing self-reflection and self-awareness.

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? Fairweather treatment Clubhouse treatment Assertive community treatment Community living treatment

Assertive community treatment Correct response: Assertive community treatment Explanation: Assertive community treatment (ACT) is a service delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program, but it is a direct provider of highly individualized consumer services.

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. 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. Teach caregivers about behavior modifications required to manage the client. Make provisions for the client to get admitted in short-term residential therapy.

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. Explanation: Case management is an important role of the nurse. As a case manager, the nurse acts as a liaison between the client and community resources and third-party payers. The nurse should help the client to identify resources that would help reduce the financial burden on the client's caregivers. The nurse should also refer the client to other mental health services that would be beneficial to the client. Teaching about behavioral strategies to manage the client is indicative of the nurse's role as a teacher. Helping the caregivers to cope with stress related to the illness of the client is indicative of the nurse's role as a counselor. The client has severe and persistent mental illness; therefore, instead of getting the client admitted in short-term residential therapy, the nurse should arrange to admit the client for long-term institutionalization.

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. Teach caregivers about behavior modifications required to manage the client. Arrange for financial resources required for the treatment. Refer the client to other community mental health services that would be beneficial for the client. Make provisions for the client to get admitted in short-term residential therapy. Help the caregivers to cope with stress related to the illness of the client.

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.

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. Refer the client to other community mental health services that would be beneficial for the client. Arrange for financial resources required for the treatment. Make provisions for the client to get admitted in short-term residential therapy. Teach caregivers about behavior modifications required to manage the client. Help the caregivers to cope with stress related to the illness of the client.

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. Explanation: Case management is an important role of the nurse. As a case manager, the nurse acts as a liaison between the client and community resources and third-party payers. The nurse should help the client to identify resources that would help reduce the financial burden on the client's caregivers. The nurse should also refer the client to other mental health services that would be beneficial to the client. Teaching about behavioral strategies to manage the client is indicative of the nurse's role as a teacher. Helping the caregivers to cope with stress related to the illness of the client is indicative of the nurse's role as a counselor. The client has severe and persistent mental illness; therefore, instead of getting the client admitted in short-term residential therapy, the nurse should arrange to admit the client for long-term institutionalization.

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? Community living treatment Fairweather treatment Clubhouse treatment Assertive community treatment

Assertive community treatment

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? (SPMI) Fairweather treatment Community living treatment Clubhouse treatment Assertive community treatment

Assertive community treatment Explanation: Assertive community treatment (ACT) is a service delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program, but it is a direct provider of highly individualized consumer services. me: associate ACT with SPMI

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? Clubhouse treatment Assertive community treatment (ACT) Fairweather treatment Community living treatment

Assertive community treatment (ACT) Explanation: Assertive community treatment (ACT) is a service delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program, but it is a direct provider of highly individualized consumer services.

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

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

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A) Opportunity to act out fears and frustrations B) Providing a safe place to practice coping skills C) Meeting their physical as well as emotional needs D) Encouraging group communication about existing problems

B 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.

What is the primary advantage of using a case manager when considering the planning and implementation of client care? A) Increases collaborative practice. B) Enhances resource management. C) Increases client satisfaction with care. D) Promotes evidence-based psychiatric nursing.

B 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 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? A) "We will help you make decisions that will keep you safe." B) "I am going to help you shower, so you will not smell so bad." C) "Your pocket knife and nail clippers will be kept in the nurses' station." D) "You will be having a number of tests to help us learn about your condition."

B Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A) The patients who are convicted criminals sentenced to home confinement. B) Care is provided to clients in unconventional settings. C) Care is provided by a preferred provider for a large HMO. D) The patients are provided for by a clinical specialist with the visiting nurse service.

B 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.

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

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

B 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 PHP.

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 patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A) A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B) A 30-year-old accountant who has developed symptoms of depression C) 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 D) A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C 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.

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A) Visiting a homeless shelter to provide mental health screenings for its clients B) Discussing the need for proper nutrition with a depressed new mother C) Providing stress reduction seminars at the local senior center D) Visiting the home of a client currently displaying manic behavior

C 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.

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Case management Crisis intervention Respite residential care Partial hospitalization

Case management

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Crisis intervention Partial hospitalization Case management Respite residential care

Case management Explanation: 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 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 thorough physical assessments of clients. Apply the nurse's morals and values to everyone. Apply religious beliefs to patient care. Conduct ongoing self-reflection and self-awareness.

Conduct ongoing self-reflection and self-awareness. Explanation: Nurses who are successful in forensic nursing view clients as people who deserve respect and professionalism. Being able to adopt a therapeutic role requires ongoing self-reflection and self-awareness.

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Crisis intervention Respite residential care Case management Partial hospitalization

Case management Explanation: 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.

The most diverse role for the nurse within community based psychiatric mental health care would most probably be what? Crisis intervention nurse Outpatient clinic nurse Case manager Inpatient nurse

Case manager

The most diverse role for the nurse within community based psychiatric mental health care would most probably be what? Case manager Crisis intervention nurse Inpatient nurse Outpatient clinic nurse

Case manager Explanation: The nurse as case manager probably is the most diverse role within the psychiatric continuum.

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. The lifestyle of the incarcerated client is solitary. Clients are transferred frequently to other forensic institutions. Nurses often transgress professional boundaries with the clients.

Clients commonly struggle with trusting others.

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. Nurses often transgress professional boundaries with the clients. The lifestyle of the incarcerated client is solitary. Clients are transferred frequently to other forensic institutions.

Clients commonly struggle with trusting others. Explanation: 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.

Initiatives that strive to strengthen the coordination of care involves cooperation and what? Individualization Promptness Collaboration Duplication

Collaboration Explanation: Coordination of care is the integration of appropriate services so that individualized care is provided. Coordination of care requires collaborative and cooperative relationships among many services, including primary care, public health, mental health, social services, housing, education, and criminal justice, to name a few. Appropriate services are those that are tailored to address a client's strengths and weaknesses, cultural context, service preferences, and recovery goals, including referral to community resources and liaisons with others (e.g., physician, health care organizations, community services). Several agencies could be involved, but when care is coordinated, a person's needs are met without duplication of services.

A client with a mental illness is receiving supportive housing during a 24-hour period on an ongoing basis. Which type service is the client most likely receiving? Community supportive housing Peer support services Supervised living services Community-based residential services

Community-based residential services

A client with a mental illness is receiving supportive housing during a 24-hour period on an ongoing basis. Which type service is the client most likely receiving? Community supportive housing Peer support services Community-based residential services Supervised living services

Community-based residential services Explanation: Community-based residential services provide a place for people to reside during a 24-hour period, or any portion of the day, on an ongoing basis. -Peer support services are provided by mental health consumers who have experienced symptom remission and are actively involved in their own recovery from mental illness. Supportive housing include personal care homes, board-and-care homes, therapeutic foster care, and supervised apartments. These range from highly supervised congregate settings to independent apartments.

Which would not be considered an impediment to successful discharge planning? Noncompliance with medications Alcohol and drug abuse Criminal or violent behavior Compliance with the therapeutic regimen

Compliance with the therapeutic regimen

Which would not be considered an impediment to successful discharge planning? Criminal or violent behavior Alcohol and drug abuse Noncompliance with medications Compliance with the therapeutic regimen

Compliance with the therapeutic regimen Explanation: Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.

Which would not be considered an impediment to successful discharge planning? Compliance with the therapeutic regimen Alcohol and drug abuse Criminal or violent behavior Noncompliance with medications

Compliance with the therapeutic regimen Explanation: Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? Reintegration process Coordination of care Casefinder model of care Discharge planning process

Coordination of care

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? Casefinder model of care Coordination of care Discharge planning process Reintegration process

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

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? Reintegration process Discharge planning process Coordination of care Casefinder model of care

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

Which client may be the most appropriate candidate for telepsychiatry? A client with bipolar disorder who has been admitted to the hospital during a manic episode A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution

Correct response: A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health Explanation: Cybertherapy may be most appropriate for persons who do not qualify for therapeutic intervention but who are motivated for treatment. Acute illnesses are not likely to be effectively treated by this method.

Which best defines a community support system in relation to mental illness? An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A network of 12-step programs and support groups A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness

Correct response: A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation Explanation: 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.

Which best describes the scope of what community support services provide? Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Mental health counseling and medication management Crisis intervention assistance and referral

Correct response: A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Explanation: A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities.

Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Crisis intervention Residential care Partial hospitalization

Correct response: Acute inpatient hospitalization Explanation: 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 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? Provide long-term therapy Provide rehabilitative services Stabilize acute symptoms Provide 24-hour supervision

Correct response: Stabilize acute symptoms Explanation: 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.

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Crisis intervention Partial hospitalization Case management Respite residential care

Correct response: Case management Explanation: 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 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. Clients are transferred frequently to other forensic institutions. The lifestyle of the incarcerated client is solitary. Nurses often transgress professional boundaries with the clients.

Correct response: Clients commonly struggle with trusting others. Explanation: 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.

Which would not be considered an impediment to successful discharge planning? Compliance with the therapeutic regimen Criminal or violent behavior Alcohol and drug abuse Noncompliance with medications

Correct response: Compliance with the therapeutic regimen Explanation: Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.

Which is an example of secondary prevention in the forensic setting? Advocacy Rehabilitation Crisis intervention Case management

Correct response: Crisis intervention Explanation: Crisis intervention is considered secondary prevention. Rehabilitation and case management are tertiary preventions. Advocacy is a primary prevention.

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? Changes in health care reimbursement have had no effects on outcomes. Insurance and Medicaid/Medicare are lenient in regards to payment for this care. Criteria for admission to inpatient care have become legally regulated. Treatment settings for patients with mental illnesses have remained constant the last century.

Correct response: Criteria for admission to inpatient care have become legally regulated. Explanation: Treatment settings for patients with mental illnesses have undergone a paradigm shift in recent years. Changes in health care reimbursement have greatly affected the U.S. behavioral health care system. Insurances and Medicaid/Medicare have affected the level of care given to patients. Criteria for admission to inpatient care have thus become very regulated, which has led to fewer services offered.

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 Carefully detox from alcohol and substance abuse Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living

Correct response: Empower clients to achieve the highest level of functioning possible Explanation: 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 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? Drug abuse prevention Spiritual aspects of care Ensuring a sustainable living situation Nutritional therapies

Correct response: Ensuring a sustainable living situation Explanation: 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.

Which statement is true concerning clients with dual diagnoses? Few mentally ill individuals have a confirmed dual disagoses Clients will dual diagnoses generally receive adequate treatment for both mental health issues Integrated care is preferred over split care for the separate diagnoses Intellectual disabilities are not considered as a possible dual diagnosis

Correct response: Integrated care is preferred over split care for the separate diagnoses Explanation: Dual diagnosis most often refers to clients with a mental illness as well as a substance abuse diagnosis. The term may also refer to clients with a mental illness and a developmental or intellectual disability diagnosis. Clients with dual diagnoses are often more difficult to treat due to more complicated problems posed by two different diagnoses. They tend to have higher rates of nonadherence to treatment and poorer long-term outcomes. Integrated care rather than split or isolated care for the separate diagnoses is recommended

Which is accurate regarding assertive community treatment (ACT)? It offers intensive community-based services. It uses a high staff-to-client ratio. It provides day treatment programs only. It is designed to help those with intellectual disability.

Correct response: It offers intensive community-based services. Explanation: The ACT model is a multidisciplinary clinical team that provides nearly 24-hour, intensive community-based services. ACT typically has a low staff-to-client ratio. It helps individuals with serious mental illness live in the community.

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Inclusion of both art therapy and psychotherapy Maintenance of the therapeutic environment A multidisciplinary approach Therapy that does not include medication

Correct response: Maintenance of the therapeutic environment Explanation: Milieu therapy is also known as the maintenance of the therapeutic environment.

Which areas of discharge planning are important to ensuring client safety? Select all that apply. Payment of care Medication education Food-drug interactions Special diet instructions Social status

Correct response: Medication education Food-drug interactions Special diet instructions Explanation: Medication education, food-drug interactions, drug-drug interactions, and special diet instructions (if applicable) are extremely important in ensuring client safety. Ability to pay for care and social status are not directly related to patient safety.

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Psychiatrist Case manager Nurse Social worker

Correct response: Nurse Explanation: When clients are admitted to inpatient psychiatric settings, nurses often are the first health care providers they meet. Beginning with admission, nurses begin to form rapport with clients and initiate the assessment phase of care.

Which type of setting is used for clients who continue to need supervision but not long-term admission? Partial (day) hospitalization Acute care Voluntary commitment Nursing home

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

Which mental health treatment setting is not a residential treatment setting? Partial hospitalization programs Group homes Adult foster care Respite

Correct response: Partial hospitalization programs Explanation: 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? Telling the client to adhere to the plan Partnering with the client from the beginning Encouraging the client to ask for help Monitoring the client continuously

Correct response: Partnering with the client from the beginning Explanation: 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.

Which are benefits of client education? Select all that apply. Provision of basic needs Prevention of complications Reduction of hospital readmissions Promotion of involvement Development of social skills

Correct response: Prevention of complications Reduction of hospital readmissions Promotion of involvement Explanation: Client education promotes involvement, prevents complications, and reduces hospital readmissions. Education does not provide for basic needs or assist with the development of social skills.

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 Once the client experiences an exacerbation of symptoms When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review

Correct response: Upon admission to the inpatient setting Explanation: It is important that a client's mental health benefits be reviewed during the discharge planning process, which should always aim to begin at the client's admission to the inpatient unit

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? Partial hospitalization Acute inpatient care Respite residential care Intensive outpatient program

Correct response: Respite residential care Explanation: 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.

One major reason that clients with mental disorders are rehospitalized is what? Resurfacing of acute symptoms Severe side effects of antipsychotic agents Need for close supervision by medical personnel Diagnosis of comorbid diseases

Correct response: Resurfacing of acute symptoms Explanation: One major reason that clients with mental disorders are rehospitalized is the relapse of mental illness and substance abuse.

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 Stress management Illness medication Relapse prevention

Correct response: Social skills training Explanation: The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs, but whereas partial hospitalization programs emphasize social skills training, intensive outpatient programs educate clients on stress management, illness, medication, and relapse prevention.

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? Treatment settings for patients with mental illnesses have remained constant the last century. Criteria for admission to inpatient care have become legally regulated. Changes in health care reimbursement have had no effects on outcomes. Insurance and Medicaid/Medicare are lenient in regards to payment for this care.

Criteria for admission to inpatient care have become legally regulated.

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

Correct response: Support Explanation: Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. Containment involves the provision of basic needs: food, shelter, safety, and security. Validation begins with the first interaction between the nurse and client. Structure within inpatient settings assists in the control and limitation of maladaptive behaviors.

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 most crimes are committed by people who have mental illness The fact that people with mental illness are the most common victims of crime The fact that there are high rates of mental illness among the populations of jails and prisons The fact that many states now require all prison inmates to be assessed by a mental nurse daily

Correct response: The fact that there are high rates of mental illness among the populations of jails and prisons Explanation: 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.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... partial hospitalization programs. inpatient psychiatric units. psychosocial rehabilitation programs. collaborative mental health care.

Correct response: collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.

A client with mental illness is being discharged to a group home. The discharge planner is helping the family to make the transition. The discharge planner would be least likely to be responsible for which of the following as it relates to the client? a) Past medical history b) Current response to treatment c) Family support upon discharge d) Chart review for inadequacies

d) Chart review for inadequacies

Community mental health can be best described as: treating the community as client. treating mentally ill individuals in a community program. treating the client by establishing community programs for his or her needs. treating the family as client, and considering both to be within a community.

Correct response: treating the community as client. Explanation: The concept of community mental health addresses the collective mental health of all people within a particular community.

Which is an example of secondary prevention in the forensic setting? Advocacy Crisis intervention Rehabilitation Case management

Crisis intervention

Which is an example of secondary prevention in the forensic setting? Advocacy Crisis intervention Case management Rehabilitation

Crisis intervention Explanation: Crisis intervention is considered secondary prevention. Rehabilitation and case management are tertiary preventions. Advocacy is a primary prevention.

Which is an example of secondary prevention in the forensic setting? Case management Advocacy Rehabilitation Crisis intervention

Crisis intervention Explanation: Crisis intervention is considered secondary prevention. Rehabilitation and case management are tertiary preventions. Advocacy is a primary prevention.

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? Changes in health care reimbursement have had no effects on outcomes. Criteria for admission to inpatient care have become legally regulated. Insurance and Medicaid/Medicare are lenient in regards to payment for this care. Treatment settings for patients with mental illnesses have remained constant the last century.

Criteria for admission to inpatient care have become legally regulated. Explanation: Treatment settings for patients with mental illnesses have undergone a paradigm shift in recent years. Changes in health care reimbursement have greatly affected the U.S. behavioral health care system. Insurances and Medicaid/Medicare have affected the level of care given to patients. Criteria for admission to inpatient care have thus become very regulated, which has led to fewer services offered.

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: psyciatric home care d: primary care provider

D

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 to. It's none of your business."

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

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A) Refusal of treatment. B) To send and receive mail. C) To seek legal counsel. D) To access all personal possessions.

D 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.

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A) A client and family members attend counseling sessions together at a neighborhood clinic B) Implementation of a more flexible work schedule for staff C) Improved reimbursement for services provided in the community D) A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

D A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A) Knowledge of both national and local political activism B) The ability to cross service systems C) An awareness of own cultural and personal values D) Creative problem-solving and intervention skills

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

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

D 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.

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

D 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.

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 Nutritional therapies Spiritual aspects of care Drug abuse prevention

Ensuring a sustainable living situation Explanation: 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 caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity? Facilitating a drug abuse prevention group Educating clients on menu planning and grocery shopping Providing spiritually related interventions Teaching about the nutritional content of canned foods

Educating clients on menu planning and grocery shopping

The nurse is caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity? Teaching about the nutritional content of canned foods Educating clients on menu planning and grocery shopping Facilitating a drug abuse prevention group Providing spiritually related interventions

Educating clients on menu planning and grocery shopping Explanation: The partial hospitalization program emphasizes social skills and basic living skills training. Planning menus and shopping for groceries are examples of these types of skills. A drug abuse prevention group would be appropriate for a relapse prevention after-care program.

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? Carefully detox from alcohol and substance abuse Empower clients to achieve the highest level of functioning possible Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living

Empower clients to achieve the highest level of functioning possible

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? Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living Empower clients to achieve the highest level of functioning possible Carefully detox from alcohol and substance abuse

Empower clients to achieve the highest level of functioning possible Explanation: 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 substances. -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 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 Carefully detox from alcohol and substance abuse Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living

Empower clients to achieve the highest level of functioning possible Explanation: 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 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 Carefully detox from alcohol and substance abuse Provide self-help groups and training in daily living Promote the ability of clients with serious mental illness to live within the community

Empower clients to achieve the highest level of functioning possible Explanation: 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 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? Provide self-help groups and training in daily living Empower clients to achieve the highest level of functioning possible Promote the ability of clients with serious mental illness to live within the community Carefully detox from alcohol and substance abuse

Empower clients to achieve the highest level of functioning possible Explanation: 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? Reintegration Empowerment Partnership Consultation

Empowerment

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

Empowerment Explanation: In order to facilitate recovery for individuals, family, groups, or communities, the approach of the services or supports provided must be founded on the principles of hope, empowerment, choice, and responsibility.

Clients admitted to a psychiatric unit may be frightened, angry, and paranoid; it may be difficult for a nurse to establish good rapport under these circumstances. Often they also fear being bullied or attacked. What is a nursing priority at this time? Complete an admission history. Inquire about their food allergies and preferences. Inform clients that everything will be fine. Ensure safety.

Ensure safety.

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 Nutritional therapies Drug abuse prevention Spiritual aspects of care

Ensuring a sustainable living situation

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? Spiritual aspects of care Nutritional therapies Ensuring a sustainable living situation Drug abuse prevention

Ensuring a sustainable living situation Explanation: 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 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 Drug abuse prevention Nutritional therapies Spiritual aspects of care

Ensuring a sustainable living situation Explanation: 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 client is a 46-year-old who is being admitted to a psychiatric-mental health facility. The client is angry, defensive, and paranoid. Which is the nurse's priority? Ensuring client and personal safety Ensuring the client that medication will correct the client's problems Determining the client's willingness to be admitted Determining the source of the client's anger and paranoia

Ensuring client and personal safety Explanation: When clients are admitted to inpatient psychiatric settings, nurses often are the first health care providers they meet. Clients may be frightened, angry, defensive, paranoid, anxious, or despondent. Giving reminders to clients that they are safe is a nursing priority. Another priority is ensuring the safety of other clients and staff.

A healthcare organization is increasing the use of telecommunication to reach clients located in remote areas. Which avenue should the nurse question before establishing a therapeutic relationship with a client? telephone calls videoconferencing Facebook software with firewalls

Facebook Explanation: As technology develops and becomes increasingly accessible, traditional face-to-face communication can be replaced with technological interactions. Any communication over the internet must be secure to maintain confidentiality. Hospital firewalls can be useful in establishing these connections. Some commonly used platforms for online communication, such as Facebook, cannot meet the standards for security and confidentiality and should not be used when communicating with clients. Phone and video conferencing are increasingly popular, especially in remote areas where the land or the isolation of the clinic constitutes barriers to the development of a therapeutic relationship.

Which areas of discharge planning are important to ensuring client safety? Select all that apply. Food-drug interactions Medication education Payment of care Social status Special diet instructions

Food-drug interactions Medication education Special diet instructions

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? Halfway houses Independent living Foster homes Group homes

Foster homes

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? Halfway houses Foster homes Group homes Independent living

Foster homes Explanation: Adult foster homes may care for one to three clients in a family-like atmosphere, including meals and social activities with the family.

Which is accurate regarding assertive community treatment (ACT)? It provides day treatment programs only. It uses a high staff-to-client ratio. It is designed to help those with intellectual disability. It offers intensive community-based services.

It offers intensive community-based services. Explanation: The ACT model is a multidisciplinary clinical team that provides nearly 24-hour, intensive community-based services. ACT typically has a low staff-to-client ratio (1 to 100). It helps individuals with serious mental illness live in the community.

The greatest impact case management has had on mental health care is that it has caused what? Has affected public awareness of mental health care needs A focus on an illness, not a health paradigm Has increased client access to appropriate mental health care Has stimulated an interest in professional mental health careers

Has increased client access to appropriate mental health care

The greatest impact case management has had on mental health care is that it has caused what? A focus on an illness, not a health paradigm Has stimulated an interest in professional mental health careers Has affected public awareness of mental health care needs Has increased client access to appropriate mental health care

Has increased client access to appropriate mental health care Explanation: 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.

The greatest impact case management has had on mental health care is that it has caused what? A focus on an illness, not a health paradigm Has stimulated an interest in professional mental health careers Has increased client access to appropriate mental health care Has affected public awareness of mental health care needs

Has increased client access to appropriate mental health care Explanation: 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.

The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship? Health teaching Conducting exercise sessions Personal conduct Maintaining boundaries

Health teaching Explanation: Providing the client with information and guidance on healthy living and maintaining health supports the development of a trusting relationship. Examples include health teaching such as reminding clients about appointments and teaching about medications and side effects. A non-judgmental approach and attitude will help create a trusting, respectful relationship. Clients should be treated equally by listening and keeping commitments. Conducting exercise sessions is not the responsibility of the nurse, and is not considered an activity of daily living in the forensic setting,

One essential component of a community support system is having a case manager. The role of the case manager is to do what? Visit the client's home and provide mental health care Provide mental health counseling and prescribe appropriate medications. Help the individual make informed choices and ensure timely access to needed assistance. Ensure that the client is complying with orders written by a health care provider.

Help the individual make informed choices and ensure timely access to needed assistance.

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 Discharge planning from the inpatient facility Client monitoring for use of services Linkage of client with services Detoxification

Identification of services Linkage of client with services Client monitoring for use of services Explanation: Coordinated care is often accomplished through a case management service model, in which a case manager locates services, links the client with these services, and then monitors the client's receipt of these services. This type of case management is referred to as the "broker" model.

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 Contacting and maintaining relationships with the client's various service providers Facilitating reimbursement and coverage by the client's private and public insurances Prescribing nursing care directed toward managing the client's acute and chronic health problems

Identifying and meeting the client's health and human service needs

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? Facilitating reimbursement and coverage by the client's private and public insurances Contacting and maintaining relationships with the client's various service providers Identifying and meeting the client's health and human service needs Prescribing nursing care directed toward managing the client's acute and chronic health problems

Identifying and meeting the client's health and human service needs Explanation: 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 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? Contacting and maintaining relationships with the client's various service providers Facilitating reimbursement and coverage by the client's private and public insurances Prescribing nursing care directed toward managing the client's acute and chronic health problems Identifying and meeting the client's health and human service needs

Identifying and meeting the client's health and human service needs Explanation: 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? Individualized care for additional inpatient stays Cost savings Consistent third-party reimbursement Improved access to less costly services

Improved access to less costly services

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 Consistent third-party reimbursement Cost savings Individualized care for additional inpatient stays

Improved access to less costly services Explanation: 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 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 Individualized care for additional inpatient stays Cost savings Consistent third-party reimbursement

Improved access to less costly services Explanation: 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 Psychiatric specialty unit Outpatient psychiatric care General medical floor

In-house psychiatric unit

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? Psychiatric specialty unit Outpatient psychiatric care In-house psychiatric unit General medical floor

In-house psychiatric unit Explanation: Many large hospitals have psychiatric services and, when a patient is in need of treatment, will transfer him or her to the in-house psychiatric unit. The general hospital psychiatric setting is primarily for acute treatment with the main goal of stabilization.

Assertive Community Treatment (ACT) reduces the use of which type of service? In-patient Hospital Crisis intervention Detoxification Community based

In-patient Hospital

Assertive Community Treatment (ACT) reduces the use of which type of service? Community based Detoxification Crisis intervention In-patient Hospital

In-patient Hospital Explanation: 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.

Assertive Community Treatment (ACT) reduces the use of which type of service? Detoxification Community based Crisis intervention In-patient Hospital

In-patient Hospital Explanation: 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 statement is true concerning clients with dual diagnoses? Intellectual disabilities are not considered as a possible dual diagnosis Integrated care is preferred over split care for the separate diagnoses Clients will dual diagnoses generally receive adequate treatment for both mental health issues Few mentally ill individuals have a confirmed dual disagoses

Integrated care is preferred over split care for the separate diagnoses

Which statement is true concerning clients with dual diagnoses? Integrated care is preferred over split care for the separate diagnoses Clients will dual diagnoses generally receive adequate treatment for both mental health issues Few mentally ill individuals have a confirmed dual disagoses Intellectual disabilities are not considered as a possible dual diagnosis

Integrated care is preferred over split care for the separate diagnoses Explanation: Dual diagnosis most often refers to clients with a mental illness as well as a substance abuse diagnosis. The term may also refer to clients with a mental illness and a developmental or intellectual disability diagnosis. Clients with dual diagnoses are often more difficult to treat due to more complicated problems posed by two different diagnoses. They tend to have higher rates of nonadherence to treatment and poorer long-term outcomes. Integrated care rather than split or isolated care for the separate diagnoses is recommended

Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply. Communication skills Risk assessment and risk management skills Ability to work independently Interpersonal skills Teamwork skills

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

Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply. Risk assessment and risk management skills Teamwork skills Ability to work independently Communication skills Interpersonal skills

Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills Explanation: The core skill areas that are needed to function as an effective team member of an interdisciplinary team include interpersonal skills, such as tolerance, patience, and understanding; humanity, such as warmth, acceptance, empathy, genuineness, and nonjudgmental attitude; knowledge base about mental disorders, symptoms, and behavior; communication skills; personal qualities, such as consistency, assertiveness, and problem-solving abilities; teamwork skills, such as collaborating, sharing, and integrating; and risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.

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? Determine the client's ability to function safely in public Request that a personality profile be performed to better understand the client's behavior. Involve an interdisciplinary team in the client's community care Refer aftercare planning to the patient's parole officer

Involve an interdisciplinary team in the client's community care

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? Refer aftercare planning to the patient's parole officer Involve an interdisciplinary team in the client's community care Request that a personality profile be performed to better understand the client's behavior. Determine the client's ability to function safely in public

Involve an interdisciplinary team in the client's community care Explanation: Regardless of the treatment setting, rehabilitation program, or population, an interdisciplinary team approach is most useful in dealing with the multifaceted problems of clients with mental illness. The nurse can demonstrate advocating for the most effective and comprehensive treatment plan for this client by bringing together an interdisciplinary team for the client's ongoing community care. me: forensic= relating to a crime

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? It exists to promote rehabilitation alliance. Focus is on illness, not health. Staff ultimately makes decisions about treatment. Taking prescribed drugs is a condition to participation.

It exists to promote rehabilitation alliance.

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? Focus is on illness, not health. Taking prescribed drugs is a condition to participation. Staff ultimately makes decisions about treatment. It exists to promote rehabilitation alliance.

It exists to promote rehabilitation alliance. Explanation: 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 is designed to help those with intellectual disability. It provides day treatment programs only. It uses a high staff-to-client ratio. It offers intensive community-based services.

It offers intensive community-based services.

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Therapy that does not include medication Maintenance of the therapeutic environment Inclusion of both art therapy and psychotherapy A multidisciplinary approach

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

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. It requires additional funding that may not be afforded by the institution. It requires an open space for conducting therapy sessions. It requires the nurse to be available for care for the client all the time.

It requires clients to have longer lengths of stay.

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. It requires the nurse to be available for care for the client all the time. It requires additional funding that may not be afforded by the institution. It requires an open space for conducting therapy sessions.

It requires clients to have longer lengths of stay. Explanation: Milieu therapy refers to the method of therapy where the clients take part in group sessions and have client-to-client interactions. This therapy required longer length of stay in the hospital as new clients were paired with clients that had been in the hospital for a period of time. With the advent of managed health care in the 1990s, the length of hospital stays decreased significantly. Open space is not a requirement for this therapy. As this milieu therapy involves interactions between clients, the nurse is not required to be present during the entire session. This form of therapy is least expensive as it just involves communication between clients.

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? Improved financial status Provision of the most restrictive environment Level of functioning Emphasis on wellness

Level of functioning

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? Provision of the most restrictive environment Improved financial status Level of functioning Emphasis on wellness

Level of functioning Explanation: Quality is assessed by measuring client outcomes that result from the services, such as level of functioning, community integration, and client satisfaction with the services provided. In the community, the case manager works with clients on a broad range of issues from accessing needed medical and psychiatric services to carrying out activities of daily living. Quality of case management is not measured by improved financial status or provision of the most restrictive environment. Continuum of care spans from illness to wellness states.

Which is often more predictive of the client's success than the characteristics of his or her illness? Rate of reinstitutionalization Living environment Level of functioning Previous criminal record

Living environment

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Maintenance of the therapeutic environment Therapy that does not include medication Inclusion of both art therapy and psychotherapy A multidisciplinary approach

Maintenance of the therapeutic environment

Which areas of discharge planning are important to ensuring client safety? Select all that apply. Special diet instructions Medication education Payment of care Social status Food-drug interactions

Medication education Food-drug interactions Special diet instructions Explanation: Medication education, food-drug interactions, drug-drug interactions, and special diet instructions (if applicable) are extremely important in ensuring client safety. Ability to pay for care and social status are not directly related to patient safety.

Which areas of discharge planning are important to ensuring client safety? Select all that apply. Special diet instructions Food-drug interactions Social status Payment of care Medication education

Medication education Food-drug interactions Special diet instructions Explanation: Medication education, food-drug interactions, drug-drug interactions, and special diet instructions (if applicable) are extremely important in ensuring client safety. Ability to pay for care and social status are not directly related to patient safety.

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? Membership is time limited. The clubhouse is run by staff members. Members live at the clubhouse. Members receive mental health treatment from providers in the community.

Members receive mental health treatment from providers in the community.

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? Members live at the clubhouse. Membership is time limited. The clubhouse is run by staff members. Members receive mental health treatment from providers in the community.

Members receive mental health treatment from providers in the community. Explanation: 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.

The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what? Diabetes Mental illness Disorders of the pancreas Hypertension

Mental illness

The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what? Hypertension Diabetes Disorders of the pancreas Mental illness

Mental illness Explanation: People with substance use disorders are at increased risk for mental illness.

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Social worker Case manager Nurse Psychiatrist

Nurse

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Nurse Psychiatrist Social worker Case manager

Nurse Explanation: When clients are admitted to inpatient psychiatric settings, nurses often are the first health care providers they meet. Beginning with admission, nurses begin to form rapport with clients and initiate the assessment phase of care.

Which statement regarding those with serious and persistent mental illness (SPMI) is correct? Medicaid funding for those with mental illness has optimized patient care for poor individuals. Reinstitutionalization has resulted in many individuals being committed to mental hospitals and asylums. Supplemental Security Income provides enough money for those with mental illness to pay for a home, food, and medication. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.

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

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 Outpatient care Long-term hospitalization Acute care hospital

Partial hospitalization program (PHP) Explanation: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. This is not the primary goal of long-term hospitalization, an acute care hospital, or outpatient care.

Which mental health treatment setting is not a residential treatment setting? Respite Adult foster care Group homes Partial hospitalization programs

Partial hospitalization programs

Which statement regarding those with serious and persistent mental illness (SPMI) is correct? Reinstitutionalization has resulted in many individuals being committed to mental hospitals and asylums. Supplemental Security Income provides enough money for those with mental illness to pay for a home, food, and medication. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. Medicaid funding for those with mental illness has optimized patient care for poor individuals.

Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. Explanation: Reliance on Supplemental Security Income as the major source of financial support allows little opportunity for choices. The average monthly stipend barely meets their rent payments. Unlike the early institutions that housed those with mental illness in hospitals and asylums, the current reinstitutionalization is in both hospitals and jails. Medicaid funding, although limited in noninstitutional settings, remains the primary source for poor people, including most people with SPMI. The result has been inappropriate admissions to nursing facilities and other institutions so that clients can receive appropriate care. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.

Which type of service is provided to medically stable clients who do not require inpatient, residential, or home care environments? Outpatient care Crisis Intervention Crisis stabilization Detoxification

Outpatient care Explanation: Outpatient care is a level that occurs outside of the hospital or institution. Outpatient services usually are less intensive and provided to patients who do not require inpatient, residential, or home care environments.

Which type of setting is used for clients who continue to need supervision but not long-term admission? Acute care Partial (day) hospitalization Voluntary commitment Nursing home

Partial (day) hospitalization

Which type of setting is used for clients who continue to need supervision but not long-term admission? Voluntary commitment Partial (day) hospitalization Acute care Nursing home

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

Which service aims to achieve client stabilization without hospitalization or a reduced length of inpatient care? Respite residential care 23-hour observation Partial hospitalization Residential services

Partial hospitalization

Which service aims to achieve client stabilization without hospitalization or a reduced length of inpatient care? Respite residential care 23-hour observation Partial hospitalization Residential services

Partial hospitalization Explanation: Partial hospitalization programs were developed to complement inpatient mental health care and outpatient services and to provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning. -A short-term treatment that serves the client in an immediate but short-term crisis is 23-hour observation. This treatment is used for acute trauma, such as rape and alcohol/narcotic detoxification, and for individuals with Axis II personality disorders who present with self-injurious behaviors. -Residential services provide a place for people to reside during a 24-hour period, or any portion of the day on an ongoing basis. Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously. -Respite residential care can provide short-term necessary housing for the client and periodic relief for the caregivers.

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 Long-term hospitalization Acute care hospitalization Psychiatric specialty unit

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? Long-term hospitalization Acute care hospital Partial hospitalization program Outpatient 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 Outpatient care Acute care hospital Long-term hospitalization

Partial hospitalization program Explanation: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. This is not the primary goal of long-term hospitalization, an acute care hospital, or outpatient care.

A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding by identifying which type as providing the most intensive outpatient nursing care? Rehabilitation programs Crisis intervention programs Outpatient detoxification programs Partial hospitalization programs

Partial hospitalization programs Explanation: Nursing care in a partial hospitalization program is the most intensive of all the outpatient mental health care settings. Partial hospitalization is a type of outpatient program that provides services to persons 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.

Which mental health treatment setting is not a residential treatment setting? Adult foster care Respite Group homes Partial hospitalization programs

Partial hospitalization programs Explanation: 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 mental health treatment setting is not a residential treatment setting? Adult foster care Group homes Respite Partial hospitalization programs

Partial hospitalization programs Explanation: 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 Telling the client to adhere to the plan Encouraging the client to ask for help Monitoring the client continuously

Partnering with the client from the beginning

Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? Encouraging the client to ask for help Partnering with the client from the beginning Telling the client to adhere to the plan Monitoring the client continuously

Partnering with the client from the beginning Explanation: 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.

Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? Monitoring the client continuously Partnering with the client from the beginning Telling the client to adhere to the plan Encouraging the client to ask for help

Partnering with the client from the beginning Explanation: 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.) Financial status Relationship status Psychological status Physiologic status Mental status

Physiologic status Psychological status Mental status Relationship status

Individuals who are most likely to receive inpatient mental health treatment are those who meet which criteria? Cannot afford housing or are unable to maintain employment Pose a risk of harm to self or others Have a coexisting medical condition Have a condition that has not responded to medication

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

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? Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Improved pharmacological treatments for major depression Research suggesting that inpatient psychiatric treatment is less effective than previously believed

Pressures to reduce health care costs associated with inpatient care

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? Improved pharmacological treatments for major depression Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Research suggesting that inpatient psychiatric treatment is less effective than previously believed

Pressures to reduce health care costs associated with inpatient care Explanation: There is tremendous pressure to reduce the escalating costs of health care, a trend that has often resulted in early discharge and reduced average lengths of stay. This trend toward shorter inpatient courses of care is not a result of the ineffectiveness of inpatient care or improved drug treatments and publicly funded programs.

The goal of respite services as a prevention strategy includes what? Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Identifying clients who are unable to continue living in their present circumstances Targeting the chronic population of individuals requiring daily monitoring of their behavior and medication adherence Promoting a service to assist individuals with mental illness to achieve independent living

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

The goal of respite services as a prevention strategy includes what? Promoting a service to assist individuals with mental illness to achieve independent living Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Identifying clients who are unable to continue living in their present circumstances Targeting the chronic population of individuals requiring daily monitoring of their behavior and medication adherence

Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Explanation: The goals of respite programs are to prevent unnecessary long-term care placements and hospitalizations due to informal caregiver burnout.

The goal of respite services as a prevention strategy includes what? Identifying clients who are unable to continue living in their present circumstances Promoting a service to assist individuals with mental illness to achieve independent living Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Targeting the chronic population of individuals requiring daily monitoring of their behavior and medication adheren

Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Explanation: The goals of respite programs are to prevent unnecessary long-term care placements and hospitalizations due to informal caregiver burnout.

A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply. Stabilization Behavioral therapy Social skills training Prevention of relapse Symptom reduction

Prevention of relapse Stabilization Symptom reduction Explanation: Crisis intervention is a type of short-term care that focuses on stabilization, symptom reduction, and prevention of relapse requiring inpatient services. Crisis intervention does not focus on behavioral therapy or social skills training.

One goal of transitional care in mental health care is what? Provide an alternative for inpatient admission Encourage the parents to participate in the client's care Provide intensive monitoring of the client at home Provide crisis intervention services when needed

Provide an alternative for inpatient admission

One goal of transitional care in mental health care is what? Provide an alternative for inpatient admission Provide crisis intervention services when needed Provide intensive monitoring of the client at home Encourage the parents to participate in the client's care

Provide an alternative for inpatient admission Explanation: The two goals of transitional mental health care are to increase the functionality of the client within the home and to provide an alternative for inpatient admission.

Which would not be an element of a community support system? Case management responsible for helping the client to make informed choices about care Provision of individual psychotherapy in the home if needed Adequate mental health care Identification of at-risk populations

Provision of individual psychotherapy in the home if needed

Which would not be an element of a community support system? Provision of individual psychotherapy in the home if needed Case management responsible for helping the client to make informed choices about care Identification of at-risk populations Adequate mental health care

Provision of individual psychotherapy in the home if needed Explanation: Community support involves assistance with daily functioning and coordination of health care. Psychotherapy is provided by a licensed mental health professional.

A client with a mental illness is receiving care which includes counseling, mentoring, and support from individuals who are successfully dealing with their illness and training in daily living. The client is also receiving interventions related to illness self-management. The client is involved with which type of psychosocial rehabilitation? Recovery center Self-help group Supported employment Relapse prevention after care

Recovery center

A client with a mental illness is receiving care which includes counseling, mentoring, and support from individuals who are successfully dealing with their illness and training in daily living. The client is also receiving interventions related to illness self-management. The client is involved with which type of psychosocial rehabilitation? Supported employment Recovery center Self-help group Relapse prevention after care

Recovery center Explanation: Recovery centers assist in the mental health consumer's journey towards recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions. Self-help groups include Alcoholics Anonymous and Narcotics Anonymous. Relapse prevention after care focuses on preventing relapse of symptoms. Supported employment services assist individuals to find work and assess their skills, attitudes, behaviors, and interests relevant to work.

A client with a mental illness is receiving care which includes counseling, mentoring, and support from individuals who are successfully dealing with their illness and training in daily living. The client is also receiving interventions related to illness self-management. The client is involved with which type of psychosocial rehabilitation? Relapse prevention after care Recovery center Self-help group Supported employment

Recovery center Explanation: Recovery centers assist in the mental health consumer's journey towards recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions. Self-help groups include Alcoholics Anonymous and Narcotics Anonymous. Relapse prevention after care focuses on preventing relapse of symptoms. Supported employment services assist individuals to find work and assess their skills, attitudes, behaviors, and interests relevant to work.

What are some of the goals of psychiatric rehabilitation? Select all that apply. Increased independence Increased involvement in treatment decisions Increased hospital admissions Recovery from mental illness Personal growth

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

What are some of the goals of psychiatric rehabilitation? Select all that apply. Recovery from mental illness Increased independence Personal growth Increased hospital admissions Increased involvement in treatment decisions

Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions Explanation: Psychiatric rehabilitation aims at promoting the recovery process of clients with a mental illness. Goals include helping the client recover from mental illness, facilitating personal growth, and increasing client independence and participation in treatment decision-making. These activities, as a result, decrease the number of hospital admissions due to mental illness.

Which are functions of assertive community treatment? Select all that apply. Decreases availability of services Promotes continuity of outpatient care Reduces inpatient service use Increases the likelihood of relapse Increases the stability of people with serious mental illnesses

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Explanation: 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.

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 Increases the likelihood of relapse Decreases availability of services

Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Explanation: 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 nurse is demonstrating de-escalation techniques on an aggressive client in a forensic setting. Which is the <b<best</b> explanation of this technique? Increasing self-awareness of early signs of aggression Stopping dangerous behavior by pointing out unacceptable behavior Role modeling expected behavior by staff Resolution of anger in nonviolent ways

Resolution of anger in nonviolent ways

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? Recovery center Respite residential care Psychosocial rehabilitation Assertive community treatment (ACT)

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 Partial hospitalization Acute inpatient care Intensive outpatient program

Respite residential care

Which type of care provides periodic relief to caregivers of a mentally ill client? Crisis stabilization Partial hospitalization Acute inpatient care Respite residential care

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 Acute inpatient care Partial hospitalization Intensive outpatient program

Respite residential care Explanation: 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 (PHP) 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 (IOP) focus on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. This client requires constant supervision.

Which type of care provides periodic relief to caregivers of a mentally ill client? Crisis stabilization Respite residential care Partial hospitalization Acute inpatient care

Respite residential care Explanation: 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.

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 Recovery center Assertive community treatment (ACT) Psychosocial rehabilitation

Respite residential care Explanation: Sometimes the family 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. The ACT model is a multidisciplinary clinical team approach providing 24-hour, intensive community-based services. The ACT model helps individuals with serious mental illness live in the community. 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, all while addressing their medical and residential needs. 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, such as Wellness Recovery Action Planning (WRAP).

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? Acute inpatient care Intensive outpatient program Partial hospitalization Respite residential care

Respite residential care Explanation: 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.

Which type of care provides periodic relief to caregivers of a mentally ill client? Crisis stabilization Partial hospitalization Respite residential care Acute inpatient care

Respite residential care Explanation: 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.

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 Assertive community treatment (ACT) Recovery center Psychosocial rehabilitation

Respite residential care Explanation: Sometimes the family 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. The ACT model is a multidisciplinary clinical team approach providing 24-hour, intensive community-based services. The ACT model helps individuals with serious mental illness live in the community. 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, all while addressing their medical and residential needs. 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, such as Wellness Recovery Action Planning (WRAP).

One major reason that clients with mental disorders are rehospitalized is what? Diagnosis of comorbid diseases Severe side effects of antipsychotic agents Need for close supervision by medical personnel Resurfacing of acute symptoms

Resurfacing of acute symptoms

One major reason that clients with mental disorders are rehospitalized is what? Need for close supervision by medical personnel Severe side effects of antipsychotic agents Resurfacing of acute symptoms Diagnosis of comorbid diseases

Resurfacing of acute symptoms Explanation: One major reason that clients with mental disorders are rehospitalized is the relapse of mental illness and substance abuse.

One major reason that clients with mental disorders are rehospitalized is what? Resurfacing of acute symptoms Severe side effects of antipsychotic agents Need for close supervision by medical personnel Diagnosis of comorbid disease

Resurfacing of acute symptoms Explanation: One major reason that clients with mental disorders are rehospitalized is the relapse of mental illness and substance abuse.

One major reason that clients with mental disorders are rehospitalized is what? Severe side effects of antipsychotic agents Need for close supervision by medical personnel Diagnosis of comorbid diseases Resurfacing of acute symptoms

Resurfacing of acute symptoms Explanation: One major reason that clients with mental disorders are rehospitalized is the relapse of mental illness and substance abuse.

The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue? Recovery oriented care Conditional release plan Discussion of crimes Risk assessment

Risk assessment

The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue? Risk assessment Discussion of crimes Recovery oriented care Conditional release plan

Risk assessment Explanation: Risk assessment is an important determination to maintain the safety of the client and others. The data obtained in the risk assessment, including the client's known history, habits, legal status, and triggers, are used to develop an individualized treatment plan. In some institutions, risk assessment determines the type of facility for the client. Discussion of crimes is not appropriate because it may block the development of an effective therapeutic relationship. Conditional release plans are reserved for those individuals who have been stabilized and are not considered a danger. Recovery oriented care is important, but begins after the development of an individualized treatment plan to help the individual maintain optimal mental health after discharge.

The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue? Discussion of crimes Recovery oriented care Conditional release plan Risk assessment

Risk assessment Explanation: Risk assessment is an important determination to maintain the safety of the client and others. The data obtained in the risk assessment, including the client's known history, habits, legal status, and triggers, are used to develop an individualized treatment plan. In some institutions, risk assessment determines the type of facility for the client. Discussion of crimes is not appropriate because it may block the development of an effective therapeutic relationship. Conditional release plans are reserved for those individuals who have been stabilized and are not considered a danger. Recovery oriented care is important, but begins after the development of an individualized treatment plan to help the individual maintain optimal mental health after discharge.

The forensic nurse is assessing a client with new onset of hallucinations and agitation in a police station. Which finding is most consistent with mentally ill clients in the criminal justice system? Risk of violence Re-offense with incarceration Increased number of crimes Danger of self-harm

Risk of violence

Which is considered the priority care for clients receiving inpatient care? Accurate assessment Medication management Socialization Safety

Safety

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? Primary Secondary Interventional Tertiary

Secondary

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? Primary Tertiary Rehabilitative Secondary

Secondary

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 Tertiary Rehabilitative Primary

Secondary Explanation: The client is experiencing an acute exacerbation of the client's illness. Me: primary- ID stressors secondary- ID symptoms tertiary- case manager

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 Tertiary Primary Interventional

Secondary Explanation: Secondary prevention focuses on interventions that identify mental health problems early and reduce the duration and prevalence of mental illness. Examples for community mental health nurses include conducting screening surveys that focus on identifying mental illness in people within schools or the community, referring clients for mental health treatment, and providing crisis intervention to a community that has encountered a natural or man-made disaster. me: Primary: interventions designed to prevent the onset or future incidence of a specific problem Secondary: an early intervention that decreases the prevalence of a specific problem. Tertiary: treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed.

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 Family involvement to alter the emotional climate in the family and reduce stress Job skills such as interviewing techniques, resume writing, filling out job applications, and job searching Role-playing and psychodrama as well as individual, family, and group therapies

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

Which intervention represents tertiary prevention for mental illness? Education for adolescents about substance abuse Crisis intervention Self-help groups Depression screening

Self-help groups

Which intervention represents tertiary prevention for mental illness? Education for adolescents about substance abuse Self-help groups Depression screening Crisis intervention

Self-help groups Explanation: 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. Crisis intervention is a secondary intervention me: Primary: interventions designed to prevent the onset or future incidence of a specific problem Secondary: an early intervention that decreases the prevalence of a specific problem. (crisis prevention) Tertiary: treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed. (self-help groups)

A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize? Detoxification services for alcohol and drugs in an outpatient setting Intensive treatment that prepares the client to live in the community Frequent monitoring within a therapeutic milieu for relapse prevention Services that promote the client's reintegration into the community

Services that promote the client's reintegration into the community

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? Provide rehabilitative services Provide long-term therapy Stabilize acute symptoms Provide 24-hour supervision

Stabilize acute symptoms Explanation: 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.

A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize? Intensive treatment that prepares the client to live in the community Services that promote the client's reintegration into the community Detoxification services for alcohol and drugs in an outpatient setting Frequent monitoring within a therapeutic milieu for relapse prevention

Services that promote the client's reintegration into the community Explanation: 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 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 Intensive treatment that prepares the client to live in the community Detoxification services for alcohol and drugs in an outpatient setting Frequent monitoring within a therapeutic milieu for relapse prevention

Services that promote the client's reintegration into the community Explanation: 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.

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 return to the practice of institutionalizing chronically ill clients Increased use of psychotropic medication to stabilize psychotic behavior quickly Infrequent use of partial hospitalization and increased use of inpatient treatment

Short-term inpatient, crisis stabilization, and community referral

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? Stress management education Social skills training Relapse prevention Illness education

Social skills training

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 Stress management education Relapse prevention Illness education

Social skills training Explanation: The primary focus of intensive outpatient programs is on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs (PHPs), but whereas PHPs emphasize social skills training, intensive outpatient programs teach clients about stress management, illness, medication, and relapse prevention

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 Relapse prevention Illness medication Stress management

Social skills training Explanation: The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs, but whereas partial hospitalization programs (PHPs) emphasize social skills training, intensive outpatient programs (IOPs) educate clients on stress management, illness, medication, and relapse prevention.

A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply. Social skills training Stabilization Symptom reduction Behavioral therapy Prevention of relapse

Stabilization Symptom reduction Prevention of relapse

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? Provide long-term therapy Stabilize acute symptoms Provide rehabilitative services Provide 24-hour supervision

Stabilize acute symptoms

The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization? One million people in correctional facilities have mental illness. Male offenders receive more treatment than do female offenders. The number of persons with mental illness in prison has increased. The justice and correctional systems work together to improve care.

The number of persons with mental illness in prison has increased.

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? Provide rehabilitative services Stabilize acute symptoms Provide long-term therapy Provide 24-hour supervision

Stabilize acute symptoms Explanation: 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 is caring for a forensic client scheduled for discharge. Which mental health principle is most influential in recovery after discharge? Violence Stigma Homelessness Community

Stigma Explanation: Forensic patients suffer the combined effects of the stigma of mental illness and criminality. Stigma affects treatment and discharge of forensic clients as well. Stigma is paramount in the recovery for a forensic client. Community, homelessness, and violence are certainly factors, but the overriding stigma of mental illness is the greatest influence.

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? Containment Validation Involvement Structure

Structure

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? Involvement Containment Structure Validation

Structure Explanation: Traditional milieu therapy consists of containment, support, validation, structure, and involvement. Structure within inpatient settings assists in the control and limitation of maladaptive behaviors, such as yelling, screaming, and cursing that may accompany aggressive outbursts. stages of Milieu therapy: ...

An awareness to identify the need for providing culturally competent mental health care for the client can promote which treatment goal? A greater sense of belonging Successful community rehabilitation Physical wellness Boundary violations nurse-patient relationships

Successful community rehabilitation

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

Support

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

Support Explanation: Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. -Containment involves the provision of basic needs: food, shelter, safety, and security. -Validation begins with the first interaction between the nurse and client. -Structure within inpatient settings assists in the control and limitation of maladaptive behaviors.

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

Support Explanation: Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. -Containment involves the provision of basic needs: food, shelter, safety, and security. -Validation begins with the first interaction between the nurse and client. -Structure within inpatient settings assists in the control and limitation of maladaptive behaviors (like screaming and yelling)

The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what? Family home can be returned to each evening Treatment plan can be completed in less than 3 months Symptom acuity does not require psychiatric hospitalization Diagnosis interferes with employability

Symptom acuity does not require psychiatric hospitalization

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 Treatment plan can be completed in less than 3 months Family home can be returned to each evening Diagnosis interferes with employability

Symptom acuity does not require psychiatric hospitalization Explanation: The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is that their symptomology does not require psychiatric hospitalization. The other options do not describe the primary criterion for enrollment in a day treatment program.

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? Symptom stabilization Recovery Discharge planning Psychoeducation

Symptom stabilization

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? Recovery Symptom stabilization Discharge planning Psychoeducation

Symptom stabilization Explanation: When the immediate crisis does not resolve quickly, crisis stabilization is the next step. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission. The primary purpose of stabilization is control of precipitating symptoms through medications, behavioral interventions, and coordination with other agencies for appropriate after-care. The major focus of nursing care in a short-term inpatient setting is symptom management

A nurse would expect that a client experiencing which of the following would be appropriate for 23-hour observation? a) Suicidal ideation b) Paranoia c) Hallucinations d) Delusions

a) Suicidal ideation

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what? Discharge planning Recovery Psychoeducation Symptom stabilization

Symptom stabilization Explanation: When the immediate crisis does not resolve quickly, crisis stabilization is the next step. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission. The primary purpose of stabilization is control of precipitating symptoms through medications, behavioral interventions, and coordination with other agencies for appropriate after-care. The major focus of nursing care in a short-term inpatient setting is symptom management.

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. -Teach the client and family ways to avoid detection of mental illness to prevent stigma in the community. -Provide 24-hour mental health care counseling to a client and family. -Bring medication to a client on a daily basis to ensure the client takes medication.

Teach problem solving, stress reduction, coping, and proper interpersonal communication skills. Explanation: A general intervention directed toward achieving the goals of psychiatric home care nursing includes: helping clients and family members or caregivers learn skills of problem solving, stress reduction, coping, and proper interpersonal communication; helping clients and family members or caregivers understand mental illness and how to monitor signs of relapse, medication effects, and medication side effects; providing respite and community resources to family members and caregivers; and coordinating and integrating clients' medical, social, spiritual, vocational, and other community-based services, as well as teaching clients and families to do so.

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? Primary Tertiary Chronic Secondary

Tertiary

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? Secondary Primary Chronic Tertiary

Tertiary Explanation: Case management is an example of tertiary prevention in the forensic setting. From the book: "Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill."

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? The client will be able to make continual moves and readjust as needed. The client may have co-morbid medical illnesses which could be treated there. The client will be able function independently. The client may have persistent psychiatric symptoms.

The client will be able function independently.

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? The client may have co-morbid medical illnesses which could be treated there. The client will be able to make continual moves and readjust as needed. The client will be able function independently. The client may have persistent psychiatric symptoms.

The client will be able function independently. Explanation: The evolving consumer household is a group-living situation in which the client fulfills their own responsibilities and functions without on-site supervision from paid staff. This requires the client to function as an independent individual. Clients with persistent mental illness should not be referred to this facility. Co-morbid medical illnesses are not treated in an evolving consumer household. The purpose of the evolving consumer household is to ensure the client does not need to make continual moves and readjust to new living situations. The evolving consumer household is a permanent living arrangement and eliminates the problem of relocation.

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. The client's symptoms will be reduced. The client will not injure himself. The client will show interest in social and leisure activities.

The client will resume previous level of functioning.

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 not injure himself. The client will resume previous level of functioning. The client's symptoms will be reduced. The client will show interest in social and leisure activities.

The client will resume previous level of functioning. Explanation: The aim now is for clients to recover or to experience a remission and be restored to pre-illness functioning in various domains, such as occupationally, socially, and educationally.

Which goal for an individual client is consistent with the overall objectives of community support service programs? The client will experience fewer symptoms. The client will move from a group housing arrangement to independent living. The client will gain insight into the causes of the client's mental illness. The client's functional ability will improve.

The client's functional ability will improve.

Which goal for an individual client is consistent with the overall objectives of community support service programs? The client will experience fewer symptoms. The client will move from a group housing arrangement to independent living. The client's functional ability will improve. The client will gain insight into the causes of the client's mental illness.

The client's functional ability will improve. Explanation: 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 number of hospital-based services available to clients Changes of service providers over time The complexity of access to the community service programs available The number of choices of available services for specific diagnostic categories

The complexity of access to the community service programs available

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 Changes of service providers over time The number of choices of available services for specific diagnostic categories The number of hospital-based services available to clients

The complexity of access to the community service programs available Explanation: 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.

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 The number of choices of available services for specific diagnostic categories Changes of service providers over time The number of hospital-based services available to clients

The complexity of access to the community service programs available Explanation: 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. (this is the best answer)

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 many states now require all prison inmates to be assessed by a mental nurse daily The fact that there are high rates of mental illness among the populations of jails and prisons The fact that people with mental illness are the most common victims of crime The fact that most crimes are committed by people who have mental illness

The fact that there are high rates of mental illness among the populations of jails and prisons

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 many states now require all prison inmates to be assessed by a mental nurse daily The fact that most crimes are committed by people who have mental illness The fact that there are high rates of mental illness among the populations of jails and prisons The fact that people with mental illness are the most common victims of crime

The fact that there are high rates of mental illness among the populations of jails and prisons Explanation: 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.

A client is in need of a family-like environment with a high level of support. Which of the following would be most appropriate? a) Therapeutic foster care b) Supervised apartment c) Personal care home d) Board-and-care home

a) Therapeutic foster care

A client is in need of a family-like environment with a high level of support. Which would be most appropriate? Supervised apartment Personal care home Therapeutic foster care Board-and-care home

Therapeutic foster care

A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expectation of an expanded role for forensic nursing in the future? Many states now require incarcerated individuals to be frequently assessed by a mental health nurse. People with mental illness are the most common victims of crime. There are high rates of mental illness among incarcerated populations. Most crimes are committed by people who have mental illness.

There are high rates of mental illness among incarcerated populations. Explanation: 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 among the incarcerated population. 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.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? To address the needs of adults with mental illness and increase their ability to function To teach the community about mental illness in order to prevent stigma To increase the community's acceptance of individuals with mental illness To ensure that clients comply with their medication regimens to prevent relapse

To address the needs of adults with mental illness and increase their ability to function

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? To teach the community about mental illness in order to prevent stigma To address the needs of adults with mental illness and increase their ability to function To ensure that clients comply with their medication regimens to prevent relapse To increase the community's acceptance of individuals with mental illness

To address the needs of adults with mental illness and increase their ability to function Explanation: 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. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.

A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? To teach the community about mental illness in order to prevent stigma To ensure that clients comply with their medication regimens to prevent relapse To address the needs of adults with mental illness and increase their ability to function To increase the community's acceptance of individuals with mental illness

To address the needs of adults with mental illness and increase their ability to function Explanation: 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. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.

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 To relieve already-burdened psychiatrists from having to make home visits to critically mentally ill clients To reduce stress on the emergency system (ie, ambulances, 911 services), which were increasingly being taxed by mentally ill individuals and their families To provide more comprehensive mental health psychotherapy to clients who were homebound

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

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? Once the client experiences an exacerbation of symptoms When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review Upon admission to the inpatient setting

Upon admission to the inpatient setting Explanation: It is important that a client's mental health benefits be reviewed during the discharge planning process, which should always aim to begin at the client's admission to the inpatient unit.

The nurse is planning care for a mentally ill client in a forensic setting. The nurse-client relationship is influenced most during which stage? Working Self-awareness Orientation Termination

Working

Which of the following would not be considered an impediment to successful discharge planning? a) Compliance with the therapeutic regimen b) Criminal or violent behavior c) Alcohol and drug abuse d) Noncompliance with medications

a) Compliance with the therapeutic regimen

One essential component of a community support system is having a case manager. The role of the case manager is to do which of the following? a) Help the individual make informed choices and ensure timely access to needed assistance. b) Provide mental health counseling and prescribe appropriate medications. c) Ensure that the client is complying with orders written by a health care provider. d) Visit the client's home and provide mental health care.

a) Help the individual make informed choices and ensure timely access to needed assistance.

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 a) Identifying and meeting the client's health and human services needs b) Prescribing nursing care directed toward managing the client's acute and chronic health problems c) Facilitating reimbursement and coverage by the client's private and public insurances d) Contacting and maintaining relationships with the client's various service providers

a) Identifying and meeting the client's health and human services needs

What are some of the goals of psychiatric rehabilitation? Select all that apply. a) Increased independence b) Recovery from mental illness c) Increased hospital admissions d) Personal growth e) Increased involvement in treatment decisions

a) Increased independence b) Recovery from mental illness d) Personal growth e) Increased involvement in treatment decisions

Which of the following are responsibilities of the forensic nurse? Select all that apply. a) Maintenance of client confidentiality b) Working independently of colleagues c) Altering client records in conjunction with lawyers d) Anticipation of environmental consequences e) Seeking of unbiased scientific contributions

a) Maintenance of client confidentiality d) Anticipation of environmental consequences e) Seeking of unbiased scientific contributions

Which type of setting is used for clients who continue to need supervision but not long-term admission? a) Partial (day) hospitalization b) Nursing home c) Acute care d) Voluntary commitment

a) Partial (day) hospitalization

All of the following are residential treatment settings except a) Partial hospitalization programs (PHPs) b) Group homes c) Respite d) Adult foster care

a) Partial hospitalization programs (PHPs)

The nurse is evaluating the outcome of psychosocial interventions with an incarcerated client. The treatment can be said to have been effective if the client shows the ability to do what? a) Reason and shows good judgment b) Avoid future confrontations with the law c) Make amends to those harmed in the past d) Find another place to live upon release

a) Reason and shows good judgment

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness a) Spend more time in jail b) Face fewer barriers to employment c) Have more contact with family members d) Spend less time in shelters

a) Spend more time in jail

Mrs. Cairns was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, she has been receiving outpatient psychiatric services for the past 12 months. Her care providers, however, are concerned that these outpatient services are not meeting her needs, though she does not currently meet inpatient admission criteria. Mrs. Cairns may benefit from what? a) Admission to a long-term care facility b) A day-treatment program c) Subacute care d) Rehabilitative care

b) A day-treatment program

Which of the following best describes the scope of what community support services provide? a) Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities b) A wide range of services, from healthcare and education to housing arrangements, employment counseling, and rehabilitation c) Crisis intervention assistance and referral d) Mental health counseling and medication management

b) A wide range of services, from healthcare and education to housing arrangements, employment counseling, and rehabilitation

After teaching a group of nursing students about the least restrictive environment, the instructor determines that the education was successful when the group identifies which of the following as the most restrictive setting? a) Residential services b) Acute inpatient care c) In-home detoxification d) Crisis intervention

b) Acute inpatient care

A client is to receive ambulatory level three care based on which of the following assessment findings? Select all that apply. a) Client has marked impairment in areas of daily living b) Client demonstrates the ability to form and maintain relationships. c) Client requires close monitoring and support. d) Client is mildly unstable and in little danger of self-harm e) Client is experiencing moderate symptoms due to an exacerbation of the illness

b) Client demonstrates the ability to form and maintain relationships. d) Client is mildly unstable and in little danger of self-harm e) Client is experiencing moderate symptoms due to an exacerbation of the illness

Which of the following would be considered a goal for in-home mental health care? Select all that apply. a) Standardized levels of service b) Individualized, flexible service c) Segregated grouping d) Social integration e) Placement for care

b) Individualized, flexible service d) Social integration

Which of the following is true regarding the clubhouse model? a) Taking prescribed drugs in a condition to participation. b) It exists to promote rehabilitation alliance. c) Staff ultimately makes decisions about treatment. d) Focus is on illness, not health.

b) It exists to promote rehabilitation alliance.

A nurse is reviewing information about the Olmstead decision in preparation for a class presentation. The nurse is most likely preparing to discuss which of the following? a) Care coordination b) Least restrictive environment c) Recovery d) Continuum of care

b) Least restrictive environment

The Fountain House in New York developed the clubhouse model in the 1940s. Which of the following is an important characteristic of a clubhouse? a) The clubhouse is run by staff members. b) Members are expected to assist with household chores. c) Membership is time limited. d) Members live at the clubhouse.

b) Members are expected to assist with household chores.

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? a) Tertiary b) Secondary c) Interventional d) Primary

b) Secondary

Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which of the following describe(s) the focus of case management? a) Infrequent use of partial hospitalization and increased use of inpatient treatment b) Short-term inpatient, crisis stabilization, and community referral c) Increased use of psychotropic medication to stabilize psychotic behavior quickly d) Return to the practice of institutionalizing chronically ill clients

b) Short-term inpatient, crisis stabilization, and community referral

Which portion of the therapeutic milieu focuses on control and limitation of maladaptive behaviors? a) Validation b) Structure c) Support d) Containment

b) Structure

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on which of the following? a) Recovery b) Symptom stabilization c) Psychoeducation d) Discharge planning

b) Symptom stabilization

Al is a 54-year-old man with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? a) To increase the community's acceptance of individuals with mental illness b) To address the needs of adults with mental illness and increase their ability to function c) To teach the community about mental illness in order to prevent stigma d) To ensure that clients comply with their medication regimens to prevent relapse

b) To address the needs of adults with mental illness and increase their ability to function

A nurse is preparing a client for discharge to a board-and-care home. When describing this setting, which of the following would the nurse most likely include? Select all that apply. a) "You'll have transportation available to take you to your appointments. " b) "You'll live with 6 to 10 people in one house." c) "You'll have a room with up to three roommates." d) "You will have around the clock supervision and help with your medications." e) "You'll be mostly responsible for your routine daily activities like bathing and dressing."

c) "You'll have a room with up to three roommates." d) "You will have around the clock supervision and help with your medications." e) "You'll be mostly responsible for your routine daily activities like bathing and dressing."

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 of the following is the goal of this program? a) Providing self-help groups and training in daily living. b) Promote the ability of clients with serious mental illness to live within the community c) Empower clients to achieve the highest level of functioning possible d) Carefully detoxifying from alcohol and substance abuse.

c) Empower clients to achieve the highest level of functioning possible

The biggest impact managed care has on mental health care is that it a) Has stimulated an interest in professional mental health careers b) Is based on an illness, not health paradigm c) Has increased client access to appropriate mental health care d) Is affecting public awareness of mental health care needs

c) Has increased client access to appropriate mental health care

A forensic nurse is most likely to be the most significant resource when caring for which of the following populations? a) Women of low socioeconomic status b) Adolescents who are involved in crime c) Incarcerated clients d) Mentally ill clients who are voluntarily admitted

c) Incarcerated clients

Which of the following is also known as the maintenance of the therapeutic environment. a) Partial hospitalization b) Acute care c) Milieu d) Inpatient setting

c) Milieu

Susan, a case manager, is working with Mindy Jones, whose son Todd has schizophrenia. Mindy reports sadness, frequent crying, and fatigue. Susan works with her to establish some scheduled rest, relaxation, and respite from caring for her son. At which level of prevention is Susan working with Mindy? a) Rehabilitative b) Tertiary c) Primary d) Secondary

c) Primary

Which of the following types of prevention strategies would aim to stop mental disorders from ever occurring and to reduce identified cases of psychiatric disorders and disabilities within a population? a) Interventional b) Secondary c) Primary d) Tertiary

c) Primary

A group of nursing students is reviewing information about settings of care along the continuum of care for mental health. The students demonstrate a need for further review when they identify which of the following as an important component of intensive outpatient programs? a) Illness education b) Relapse prevention. c) Social skills training d) Stress management education

c) Social skills training

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... collaborative mental health care. partial hospitalization programs. inpatient psychiatric units. psychosocial rehabilitation programs.

collaborative mental health care.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... collaborative mental health care. partial hospitalization programs. psychosocial rehabilitation programs. inpatient psychiatric units.

collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... psychosocial rehabilitation programs. partial hospitalization programs. inpatient psychiatric units. collaborative mental health care.

collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... inpatient psychiatric units. collaborative mental health care. psychosocial rehabilitation programs. partial hospitalization programs.

collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.

Which of the following best defines a community support system in relation to mental illness? a) A network of 12-step programs and support groups b) A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness c) An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill d) A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation

d) A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation

Which of the following individuals has experienced the consequences of deinstitutionalization? a) A man who has been unable to obtain health insurance but who receives Medicare benefits b) A woman who has been the frequent object of stigma due to her history of psychiatric illness c) A man who was denied inpatient psychiatric treatment by his health maintenance organization (HMO) d) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure

d) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure

A nursing student is preparing for a debate with another student about E-mental health. Which of the following would the nurse include to support its use? a) Ability to provide high-intensive services for many mental illnesses. b) Ensured quality of care c) Improvement in therapeutic relationship d) Ability to provide services in a variety of locations

d) Ability to provide services in a variety of locations

Joel is a 54-year-old man who is addicted to drugs and alcohol. Which of the following settings would be best for an individual in need of acute detoxification? a) Partial hospitalization program b) Long-term hospitalization c) Outpatient care d) Acute care hospital

d) Acute care hospital

Which of the following issues has the greatest potential to affect clients receiving behavioral health home care? a) Deinstitutionalization b) Preferred provider arrangements c) Demographic changes d) Authorization of long-term home care services

d) Authorization of long-term home care services