Videbeck: Psychiatric-Mental Health Nursing Chapter 4: Treatment Settings and Therapeutic Programs

The nurse is caring for a forensic client scheduled for discharge. Which mental health principle is most influential in recovery after discharge?

Stigma

An awareness to identify the need for providing culturally competent mental health care for the client can promote which treatment goal?

Successful community rehabilitation

Community mental health can be best described as:

treating the community as client.

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 ongoing self-reflection and self-awareness.

Which client is suitable for psychiatric transitional care services?

An individual being discharged from hospital with residual symptoms of mania

Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness?

Assertive community treatment

Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model?

Case management

The most diverse role for the nurse within community based psychiatric mental health care would most probably be what?

Case manager

The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions?

Coordination of care

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.

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?

Criteria for admission to inpatient care have become legally regulated.

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.

1)Public inquiries to reactionary events in those with mental disorders 2) Criticism about the criminalization of the mentally ill 3) More inpatient mental health treatment needed for offenders

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

4

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 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

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

Which best defines a community support system in relation to mental illness?

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

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

A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use?

Ability to provide services in a variety of locations

Which is the most restrictive setting in the continuum?

Acute inpatient hospitalization

A nurse working in a psychiatric hospital is talking to new graduates. While orienting them to the unit, the nurse informs the graduates that some clients need care in stabilization in the emergency department before coming to the unit for treatment. Which types of clients does the nurse say need this acute care first? (Select all that apply.)

Clients with suicidal thoughts Clients with homicidal thoughts Clients with acute psychoses Clients who are extremely confused Clients who need acute detoxification

Initiatives that strive to strengthen the coordination of care involves cooperation and what?

Collaboration

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-based residential services

Which would not be considered an impediment to successful discharge planning?

Compliance with the therapeutic regimen

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.

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

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

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

Empowerment

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

Which would the nurse include when developing the discharge plan for a client with a mental illness? Select all that apply.

Explain all instructions for after-care in detail. Provide the client with a written list of instructions Review emergency telephone numbers with the client

The greatest impact case management has had on mental health care is that it has caused what?

Has increased client access to appropriate mental health care

The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship?

Health teaching

One essential component of a community support system is having a case manager. The role of the case manager is to do what?

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 providing which services?

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

Which goal for an individual client is consistent with the overall objectives of community support service programs?

The client's functional ability will improve.

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

Assertive Community Treatment (ACT) reduces the use of which type of service?

In-patient Hospital

Which statement is true concerning clients with dual diagnoses?

Integrated care is preferred over split care for the separate diagnoses

Which statement accurately describes the clubhouse model of community-based mental health rehabilitation?

It exists to promote rehabilitation alliance.

Which is accurate regarding assertive community treatment (ACT)?

It offers intensive community-based services.

Which is often more predictive of the client's success than the characteristics of his or her illness?

Living environment

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what?

Maintenance of the therapeutic environment

Which areas of discharge planning are important to ensuring client safety? Select all that apply.

Medication education Food-drug interactions Special diet instructions

The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse?

Members receive mental health treatment from providers in the community.

The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what?

Mental illness

During a psychiatric-mental health rotation, the nurse is asked to participate in medication administration. Which would be the nurse's responsibility in the role of the psychiatric nurse?

Monitoring the effectiveness, associated side effects, and potential health concern associated with medications

When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet?

Nurse

Which statement regarding those with serious and persistent mental illness (SPMI) is correct?

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

Which type of setting is used for clients who continue to need supervision but not long-term admission?

Partial (day) hospitalization

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

Which mental health treatment setting is not a residential treatment setting?

Partial hospitalization programs

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

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.)

Physiologic status Psychological status Mental status Relationship status

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?

Pressures to reduce health care costs associated with inpatient care

Which are benefits of client education? Select all that apply.

Prevention of complications Reduction of hospital readmissions Promotion of involvement

A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply.

Prevention of relapse Stabilization Symptom reduction

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

The nurse is demonstrating de-escalation techniques on an aggressive client in a forensic setting. Which is the best explanation of this technique?

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?

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

Which type of care provides periodic relief to caregivers of a mentally ill client?

Respite residential care

One major reason that clients with mental disorders are rehospitalized is what?

Resurfacing of acute symptoms

The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue?

Risk assessment

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

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 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

The ultimate goal of the treatment plan in inpatient care settings is what?

Stabilize the client

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

Support

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

A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what?

Symptom stabilization

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.

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

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

The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization?

The number of persons with mental illness in prison has increased

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

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

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

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ...

collaborative mental health care.

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:

psychosocial rehabilitation model.

When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness:

spend more time in jail.