Ch. 5: Mental Health Care in the Community

A nurse is working in a crisis intervention unit. The nurse would most likely be involved with which activities? Select all that apply. A) Administering medications B) Assessing short-term interventions C) Facilitating referrals for services D) Providing 23-hour observation E) Stabilizing the crisis

A) Administering medications B) Assessing short-term interventions C) Facilitating referrals for services Crisis intervention treatment—a specialized, short-term, goal-directed therapy for those in acute distress—is brief, usually lasting fewer than 6 hours. Key nursing roles include assessment of short-term therapeutic interventions and medication administration. Nurses also facilitate referrals for admission to the hospital or for outpatient services. The use of 23-hour observation is a short-term treatment that serves the client in immediate but short-term crisis. This type of care admits individuals to an inpatient setting for as long as 23 hours, during which time services are provided at a less-than-acute care level. When the immediate crisis does not resolve quickly, crisis stabilization is the next step. This type of care usually lasts fewer than seven days and has a symptom-based indication for hospital admission.

A psychiatric-mental health nurse is reviewing the medical records of several clients. The nurse determines that in-home mental health care would be of most benefit for which clients? Select all that apply. A) Client with chronic schizophrenia B) Client with chronic major depression and heart failure C) Client experiencing an acute crisis D) Client who is to undergo alcohol detoxification E) Client with anxiety receiving medication therapy

A) Client with chronic schizophrenia B) Client with chronic major depression and heart failure Although in-home mental health care may be prescribed for any individual with a mental illness, individuals who most benefit from in-home mental health care include clients with chronic, persistent mental illness, such as chronic schizophrenia or clients with mental illness and comorbid medical conditions, such as chronic depression and heart failure, that require ongoing monitoring. A person who will be detoxing from alcohol may be eligible for in-home detoxification if the client's withdrawal symptoms are mild and a family member is present at all times.

20. A psychiatric-mental health nurse is providing in-home mental health care to a client. The nurse provides direct care and case management to the client to achieve which goal? Select all that apply. A) Reduce hospital stays B) Improve client's ability to function C) Reduce the number of medications prescribed D) Increase family involvement in care E) Improve standardization of care

A) Reduce hospital stays B) Improve client's ability to function With in-home mental health care, direct client care and case management skills are used to decrease hospital stays and increase the functionality of the client within the home, not reduce the number of medications prescribed or increase the standardization of care. Family involvement may or may not increase with in-home mental health care.

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? A) Social skills training B) Stress management C) Illness medication D) Relapse prevention

A) Social skills training The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs. However, partial hospitalization programs emphasize social skills training, intensive outpatient programs educate clients on stress management, illness, medication, and relapse prevention.

When describing the continuum of care for mental health, which would the nurse identify as the primary goal? A) Coordination of care B) Care in the least restrictive environment C) Case management D) Crisis care

B) Care in the least restrictive environment The primary goal of the continuum of care is to provide treatment that allows clients to achieve the highest level of functioning in the least restrictive environment. The continuum of care requires coordination of care, including case management, but this is not the primary goal. Crisis care is one aspect of the continuum of care.

A psychiatric-mental health nurse has evaluated a client and determines that the client needs additional services. The nurse sends the client to another setting to obtain these services. Which action is the nurse demonstrating? A) Transfer B) Referral C) Discharge planning D) Assessment

B) Referral The nurse is making a referral. Referral involves sending an individual from one clinician to another or from one service setting to another for care or consultation. Transfer involves formally shifting responsibility for the care of an individual from one clinician to another or from one care unit to another. Discharge planning is a procedure that occurs when a client leaves a health care facility to ensure that the client has all of the resources needed to function as independently as possible. Assessment refers to the evaluation of the client's status to determine areas of need.

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

B) Services that promote the client's reintegration into the community 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 nurse is providing in-home mental health care and determines that the care is effective when the client demonstrates which response? A) A need for continued intensive monitoring in the home B) A need for crisis intervention services on an ongoing basis C) A decrease in admission frequency to inpatient psychiatric hospitals D) A dependence on parents to participate in the client's care

C) A decrease in admission frequency to inpatient psychiatric hospitals The two goals of in-home transitional mental health care are to increase the functionality of the client within the home and to decrease the number of inpatient hospitalizations. A need for continued in-home monitoring or crisis intervention indicates that additional care is needed. Dependency on parents for care suggests that the client is not increasing his or her functionality within the home.

3. A client who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The client continues to need routine psychiatric services. The nurse anticipates that this client will most likely be referred to what care setting? A) A partial hospitalization program B) An in-home mental health care C) An intensive outpatient program D) A crisis center in the community

C) An intensive outpatient program The nurse would expect that the client would be referred to an intensive outpatient program that focuses on stabilization and relapse prevention for highly vulnerable people who function autonomously on a daily basis. These programs are designed for individuals who have returned to work or school, yet they continue to need frequent monitoring and support within a therapeutic milieu. The treatment activities are similar to partial hospitalization programs, but whereas partial hospitalization programs emphasize social skills training, intensive outpatient programs teach clients about stress management, illness, medication, and relapse prevention. In-home mental health care is used for clients who can live at home but find that outpatient care does not meet their treatment needs. A crisis center in the community provides care for those in acute distress.

When working within the continuum of care, which process occurs first? A) Referral B) Transfer C) Assessment D) Discharge planning

C) Assessment Regardless of the setting or the situation, the nurse conducts an assessment at the point of first client contact. The individual's needs are then matched to the most appropriate setting, service, or program that will meet those needs. If a client is admitted for services, the nurse also begins discharge planning upon the first admission.

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 the plan to the family, the nurse would identify which as the focus of care? A) Long-term therapy B) Rehabilitative services C) Crisis stabilization D) 24-hour supervision

C) Crisis stabilization When a client is admitted to an inpatient facility during a crisis, the focus of care is crisis stabilization, which includes control of precipitating symptoms through medications, behavioral interventions, and coordination with other agencies for appropriate aftercare. This type of care usually lasts fewer than 7 days. The client is in crisis, so rehabilitative services would be inappropriate. When treating aggressive or violent patients, the nurse implements the appropriate use of seclusion and restraints according to facility policy.

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

C) Educating clients on menu planning and grocery shopping 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.

A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which topic would the nurse include as the main focus? A) Cost savings B) Consistent third-party reimbursement C) Improved access to less costly services D) Individualized care for additional inpatient stays

C) Improved access to less costly services 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.

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? A) Partial hospitalization B) Acute inpatient care C) Respite residential care D) Intensive outpatient program

C) Respite residential care 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 vuln

A nurse is working with a client who is recovering from alcohol abuse. The client mentions participating in a 12-step recovery program. The nurse identifies this as which type of service? A) Partial hospitalization B) Outpatient detoxification C) Self-help group D) Supported employment

C) Self-help group Twelve-step programs are examples of self-help groups. Partial hospitalization programs (PHPs) were developed to complement inpatient mental health care and outpatient services, and 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. It is a time-limited, ambulatory, active treatment program that offers therapeutically intensive, coordinated, and structured clinical services within a stable milieu. Outpatient detoxification is a specialized form of partial hospitalization for clients requiring medical supervision. Supported employment services assist individuals to find work.

A psychiatric-mental health nurse is reviewing the medical record of a client diagnosed with a mental illness. The client is receiving care while living with a family who has been specially trained to handle mental illness. The nurse identifies this situation as which type of alternative housing? A) Personal care home B) Board-and-care home C) Therapeutic foster care D) Supervised apartment

C) Therapeutic foster care Therapeutic foster care is indicated for clients in need of a family-like environment and a high level of support. This level of care actually places clients in residences of families specially trained to handle individuals with mental illnesses. Personal care homes operate within houses in the community. Usually, 6 to 10 people live in one house with a health care attendant providing 24-hour supervision to assist with medication monitoring or other minor activities, including transportation to appointments, meals, and self-care skills. Board-and-care homes provide 24-hour supervision and assistance with medications, meals, and some self-care skills. In a supervised apartment setting, individuals live in their own apartments, usually alone or with one roommate, and are responsible for all household chores and self-care.

The nurse is working as part of the interdisciplinary staff of a psychiatric inpatient facility. The staff is developing discharge plans for a client who requires alternative housing arrangements. The client will be referred to a personal care home. When explaining this housing arrangement to the client, which statement would the nurse include? A) "You'll be living with a family in their home, and the family will help supervise and support you." B) "You'll be living in an apartment wi

D) "You'll be living in a house with about 6 to 10 other people, and a health care attendant will provide 24-hour supervision." Personal care homes usually serve 6 to 10 clients in one house, with a health care attendant providing 24-hour supervision to assist with medication monitoring or other minor activities, including transportation to appointments. Board-and-care homes provide 24-hour supervision and assistance with medication, meals, and some self-care skills (and may house 50 to 15 people in one location). Therapeutic foster care involves the client living in the residence of families specially trained to handle individuals with mental illnesses, and the family provides supervision, structure, and support for the client living with them. A supervised apartment allows the client to live in his or her own apartment, either alone or with a roommate, and the client is responsible for all household chores and self-care. A staff member stops by each apartment routinely to eval

A client diagnosed 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? A) Peer support services B) Community supportive housing C) Supervised living services D) Community-based residential services

D) Community-based residential services 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 includes personal care homes, board-and-care homes, therapeutic foster care, and supervised apartments. These range from highly supervised congregate settings to independent apartments.

A psychiatric-mental health nurse is working with a local self-help group in the community. Which role would the nurse most likely fulfill? A) Direct care provider B) Counselor C) Mentor D) Consultant

D) Consultant In self-help groups, the nurse would most likely be asked to serve as a consultant. Counseling, mentoring, and support are provided by individuals with alcohol or drug dependence who successfully abstain from substance use.

The nurse is employed by a long-term residential treatment center that provides care to a variety of clients with chronic mental disorders. Which role would the nurse primarily assume when working with these clients? A) Therapist B) Medication administrator C) Mediator D) Educator

D) Educator Nurses in long-term residential facilities provide basic psychiatric nursing care with a focus on psychoeducation, basic social skills training, aggression management, activities of daily living management, and group living.