Chapter 32 Serious Mental Illness

Institutionalization leads to what specific type of behaviors in adults? Anger and aggression Passivity and dependence Assertiveness and candor Fearfulness and paranoia

Passivity and dependence

Which statement by a young patient who has severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? "I like to watch cartoons every morning." "I hear that marijuana helps calm you down." "I am looking for a job washing dishes at a diner." "I hate having my thoughts so messed up all the time."

"I hear that marijuana helps calm you down."

The nurse is caring for a patient with severe depression. What appropriate instruction does the nurse give the patient for effective treatment? "Place the medication in a cool and dry place." "Avoid using public transportation when traveling." "Avoid doing house work like cooking and cleaning." "Take a nap regularly during the day to avoid fatigue."

"Place the medication in a cool and dry place."

A workshop was conducted for police officials by the American Psychiatric Nurses Association. The nurses discussed the criminal offenses committed by mentally ill patients. Which statement about patients with severe mental illness is appropriate? "The patients are not impulsive; they remain calm and neutral." "Patients with severe mental illness are involved in violent crimes." "Advocates believe that imprisonment of the patient will deter the crime." "The patients despair and become overstressed because of imprisonment."

"The patients despair and become overstressed because of imprisonment."

A person with serious mental illness (SMI) lives in a "parallel universe" separate from "normals" (the name used to describe people who have no mental illness). What causes this condition? Poor quality of life because of SMI Violent behavior and related threat Intoxication due to substance abuse Organic changes in the patient's brain

Poor quality of life because of SMI

Serious mental illness (SMI) affects how many people in the United States? 4% of the population 1% of the population 30% of the population 10% to 15% of the population

4% of the population

A patient suffering from serious mental illness undergoes relapse due to nonadherence to treatment. The patient does not spend responsibly and is homeless due to not paying rent regularly. Which response would be most therapeutic? The patient is shifted to a community home to avoid homelessness. A guardianship program is employed to manage the financial needs. The patient is encouraged to live with the condition and develop social skills. The case manager is advised to take more responsibility in the management of the case.

A guardianship program is employed to manage the financial needs

The case manager determines that the patient diagnosed with schizophrenia would profit from a structured environment and having simple responsibilities. Which community resource could provide this? Inpatient hospitalization Partial hospitalization Supportive group therapy A psychosocial rehabilitation program

A psychosocial rehabilitation program

The nursing students are learning about assertive community treatment (ACT). When they are asked about it, which statement by a student conveys a proper understanding? The patient is shifted to a community home to reduce homelessness. ACT provides the needed range of services by a multidisciplinary team. A 24-hour monitoring is absent in order to reduce dependency in patients. ACT has a cheaper cost as a multidisciplinary team comes under one roof.

ACT provides the needed range of services by a multidisciplinary team

Which treatment approach is most likely to be included in the plan of a care for a patient with a SMI that needs to work on assertiveness? Cognitive enhancement therapy Psychoeducation group therapy Use of a peer support specialist Wellness and recovery action plan

Psychoeducation group therapy

When caring for a patient with a serious mental illness (SMI), what intervention can improve adherence to treatment? Actively manage side effects of the drug. Check the patient's mouth for hidden pills. Use short-acting forms of the medication. Reprimand when the patient is nonadherent.

Actively manage side effects of the drug.

What are the most likely negative outcomes for an individual diagnosed with a serious mental illness (SMI) who has been incarcerated for illness-related behaviors? Select all that apply. Acute depression Loss of employment Exacerbation of symptoms Eviction from present housing Contraction of a communicable disease

Acute depression Loss of employment Exacerbation of symptoms Eviction from present housing

A 20-year-old male Amish patient who was diagnosed with paranoid schizophrenia one year ago and who lives with his parents is admitted to the psychiatric unit with psychosis because of nonadherence to his medication regime. When the nurse attempts to educate the patient diagnosed with paranoid schizophrenia about his diagnosis and the need for medication, the patient persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to identify the patient's behavior? Apathy Religiosity Resistance Anosognosia

Anosognosia (inability to recognize one's deficits as a result of one's illness)

The primary health care provider instructs the nurse to provide day programs to a patient with severe mental illness. What appropriate action should the nurse take while conducting the day program for the patient? Instruct the patient to be silent during the program. Conduct the day program once a month for the patient. Arrange a prevocational trainer to work with the patient. Make prominent eye contact with the patient during the program.

Arrange a prevocational trainer to work with the patient.

A nurse preparing an education plan includes a component designed to help the patient access and use community supports. The nurse can consider the educational component successful when the patient does which of the following? Identifies stressful events Remains medication compliant Can discuss early signs of relapse Arranges to attend a money management workshop

Arranges to attend a money management workshop

A nurse is planning discharge care for a patient with serious mental illness experiencing multiple hospitalizations over the past year. Which evidence-based approach will provide the most support for the patient after discharge? Family support and services Community outreach programs Cognitive behavioral therapy (CBT) Assertive community treatment (ACT)

Assertive community treatment (ACT)

A patient with a long history of schizophrenia lives alone in the community. The patient complains of increasing depression and says, "My parents will never be proud of me like they are of my brothers and sisters." What is the highest priority nursing intervention? Assess the patient for suicidal ideation and intent Suggest the patient attend a community support group Confer with the patient's family regarding recent behavioral changes Assess the patient's compliance with the prescribed antipsychotic medication regimen

Assess the patient for suicidal ideation and intent

A patient diagnosed with serious mental illness and who lives in the community says to the nurse, "You try to be so helpful to me but I'm not worth your energy. You should spend your time helping other patients who have a chance to get well." Which nursing diagnosis applies? Anxiety Chronic low self-esteem Disturbed thought processes Personal identity disturbance

Chronic low self-esteem

A patient with severe mental illness says to the nurse, "I haven't been successful in any job interview; I will not attend any job interviews from now on." What appropriate diagnosis should the nurse make based on the patient's response? Social isolation Caregiver role strain Chronic low self-esteem Impaired social interaction

Chronic low self-esteem

Which is the best nonpharmacologic treatment method for managing symptoms in a patient who is experiencing delusions and impaired social functioning? Role play Group interaction Supportive psychotherapy Cognitive-behavioral therapy

Cognitive-behavioral therapy

An adult diagnosed with a serious mental illness has difficulty taking prescribed oral medications. This patient lives alone and says, "Some days I can't remember if I've taken my morning or nighttime medicine." Which strategy should the nurse use first to assist this patient? Include the patient in medication education groups to enhance compliance. Arrange for the patient to come to the clinic daily for medication administration. Ask the health care provider to change this patient from oral medications to depot injections. Confer with the health care provider about changing the patient to a once- daily dosing regimen.

Confer with the health care provider about changing the patient to a once- daily dosing regimen.

The nurse suspects that a patient is not taking pills but hiding the pills and later throwing them away. What can be done to ensure the medication reaches the patient's system? Confront the patient. Mix the pills with food. Force the patient to swallow. Converse for several minutes.

Converse for several minutes.

One of the roles of a case manager working with severely and persistently mentally ill patients who are homeless is to do which of the following? Administer medication Teach the patients to function independently Ensure that the patients are not rehospitalized Coordinate needed services and provide outreach

Coordinate needed services and provide outreach

The goal of a nurse working in psychiatric rehabilitation would be to help patients in the community do which of the following? Achieve complete mental health Cope more effectively with their symptoms Continue to live comfortably in a psychiatric treatment facility Learn to live with dependency and be content with fewer opportunities

Cope more effectively with their symptoms

Which outcome is appropriate when a patient diagnosed with a serious mental illness (SMI) is employed in a clubhouse model business? Select all that apply. Decreased dependency Increased self-confidence Decreased self-motivation Improved socialization skills Improved organization abilities

Decreased dependency Increased self-confidence Improved socialization skills Improved organization abilities

Which interventions are characteristic of the assertive community treatment (ACT) service model? Select all that apply. Development of a personalized multidisciplinary team Patient is assigned a room in an ACT-managed facility. Identification of a comprehensive list of needed services Operation costs will be modest compared with other care models. Contact with 24-hour-a-day crisis intervention personal is provided.

Development of a personalized multidisciplinary team Identification of a comprehensive list of needed services Contact with 24-hour-a-day crisis intervention personal is provided.

An adult diagnosed with schizophrenia lives independently but has difficulty with money management. The patient often does not have adequate funds to pay rent, buy groceries, and purchase prescribed medications. Which nursing action is most therapeutic? Arrange group home placement for the patient rather than independent living. Discuss with the patient appointment of a guardian to assure that funds are available for rent, medications, and other basic needs. Hold the patient responsible for results of poor decisions by allowing periods of homelessness because of money mismanagement. Help the patient to set up a savings account at a local bank and deposit 10% of each month's income in the account for future expenses.

Discuss with the patient appointment of a guardian to assure that funds are available for rent, medications, and other basic needs.

The nurse, working with a patient in the partial hospitalization program, seeks advice from the psychiatric clinical nurse specialist to help a patient who has auditory hallucinations. The clinical nurse specialist most likely would suggest which of the following cognitive interventions for this patient? Distracting technique Seclusion when escalation begins Giving as-needed medication for anxiety Physical restraints when the patient is disruptive

Distracting technique

How can a nurse advocate for consumers with serious mental illness in the community? Select all that apply. Educating law enforcement Expanding community treatment Encouraging deinstitutionalization Promoting trans-institutionalization Assisting in establishing mental health courts

Educating law enforcement Expanding community treatment Assisting in establishing mental health courts

A nurse is providing discharge education for a patient who frequently experiences hallucinations. What strategy can the nurse suggest the patient use when experiencing hallucination in public? Moving to a quiet area Encouraging reality testing Contacting the healthcare provider Taking additional medication as needed

Encouraging reality testing

The nurse administers oral antipsychotic medication to a patient diagnosed with serious mental illness (SMI). Which nursing action best promotes medication compliance as well as an effective nurse-patient relationship? Integrating treatment adherence with nursing goals Conducting mouth checks to find hidden medication Breaking up doses throughout the day on a predicable schedule Engaging the patient in conversation directly after medication administration

Engaging the patient in conversation directly after medication administration

How will the nurse working with a patient diagnosed with severe and persistent mental illness implement rehabilitation principles? Reviewing earlier treatment plans for errors Focusing assessment on the patient's deficits Identifying and reinforcing the patient's strengths Considering the need to lower expectations periodically

Identifying and reinforcing the patient's strengths

A male patient diagnosed with a severe mental illness and institutionalized for most of his adult life recently has been transferred to a supervised community-based residential home that houses several other adult men. The patient is resistant to going to day therapy and has begun to socially isolate if allowed. He has apparent weight loss and has become uncooperative. What is the most likely reason for these changes? Is experiencing a decreased sense of self Has begun showing signs of independence Is lazy now that he is not on a regular scheduleHas begun exhibiting a lack of desire to attend the day program

Is experiencing a decreased sense of self

What is a feature of the recovery model supported by the National Alliance on Mental Illness (NAMI) for management of persons with serious mental illness? It focuses on the patient's strengths and abilities. It improves quality of life with continuous care. It emphasizes the illness and the current care. It focuses on goals set by the nursing staff.

It focuses on the patient's strengths and abilities.

The nurse is learning about supportive psychotherapy. What are the advantages of supportive psychotherapy? It sets short-term recovery goals. It employs social skills training as a feature. It is informal and enhances the therapeutic alliance. It uses advanced computer programs to treat the patient.

It is informal and enhances the therapeutic alliance.

Which statement concerning the stigma associated with serious mental illnesses (SMIs) is true? Select all that apply. It results in discrimination and social isolation. Hospitalization protects those diagnosed with SMI. It is based on a lack of knowledge regarding this type of illness. People diagnosed with SMI don't become violent if they are left alone. Access of the patient with SMI to necessary health services is interfered with.

It results in discrimination and social isolation. It is based on a lack of knowledge regarding this type of illness. Access of the patient with SMI to necessary health services is interfered with.

The nurse is educating a patient on the importance of establishing a meaningful life. What is considered an appropriate way of achieving a meaningful life? Learning to help others or volunteering Concentrating on things other than the illness Properly following plans for institutionalization Being punctual and well-mannered for every medical visit

Learning to help others or volunteering

The nursing diagnosis of a patient is chronic low self-esteem. What are the expected nursing outcomes of this condition? Select all that apply. Maintain good eye contact. Exhibit insensitivity to others. Talk about feelings of self-worth. Keep medical care appointments. Realize personally significant roles.

Maintain good eye contact Talk about feelings of self-worth Realize personally significant roles

Which finding indicates indirect harm to self in a patient diagnosed with a serious mental illness (SMI)? Paranoia Malnutrition Suicidal ideation Homicidal tendencies

Malnutrition

The nurse finds that a patient with severe mental illness also has substance abuse. The primary health care provider prescribes a medication for treating substance abuse. Which drug does the nurse anticipate in the patient's prescription? Methadone Carbamazepine Acetaminophen Dextroamphetamine

Methadone

The nurse maintains a record of regular supplies of hot meals, clothing, transportation, and mailing addresses of patients with severe mental illness. Which community service (or program) can the nurse use to perform these functions? Guardianship Housing services Multiservice centers Partial hospital programs

Multiservice centers

A patient diagnosed with serious mental illness lives in the community. The patient says to the nurse, "I want to get a job. My disability check is not enough money for me to live on." What is the nurse's best action? Help the patient to apply for additional disability benefits. Assist the patient to prepare a resume and arrange references. Refer the patient to participate in a prevocational training group. Remind the patient that employment could jeopardize current disability eligibility.

Refer the patient to participate in a prevocational training group.

During the follow-up visits by a patient with serious mental illness, the nurse suspects nonadherence. What causes the nurse to suspect this in the patient? Select all that apply. Several unused medications Missed appointments Inability to express concerns Inappropriate social behavior Worsening of the symptoms

Several unused medications Missed appointments Worsening of symptoms

An issue for severely and persistently mentally ill patients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this? Discontinue antipsychotics that cause untoward side effects Use patient empowerment techniques to increase patient autonomy Develop tools to predict relapse and assess the potential for violence Shift follow-up from social workers to the assertive community treatment (ACT) model

Shift follow-up from social workers to the assertive community treatment (ACT) model

A patient diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around the others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis? Acute confusion Social isolation Impaired comfort Risk for activity intolerance

Social isolation

The nurse conducting a group session provides patients the opportunity to role play in a job interview situation. Which evidence-based treatment approach is the nurse using? Social skills training Vocational rehabilitation Supportive employment model Cognitive enhancement therapy

Social skills training

Patients with serious mental illness (SMI) deal with many social problems. What is the most difficult problem faced by these patients? Lack of mental health care coverage Acceptance of assistance from others Poor understanding of the disease process Stigma resulting in discrimination and isolation

Stigma resulting in discrimination and isolation

In the context of cognitive enhancement therapy (CET), which sentence is most appropriate to describe this method of treatment? Helps to avoid homelessness Focuses on thought patterns Stimulates healthier areas of brain Gives services to high-need persons

Stimulates healthier areas of brain

A convicted person is found "Not Guilty by Reason of Insanity" and does not require hospitalization. What measure is taken to manage the care of the patient? Supervised housing service Community outreach program Emergency psychiatric services Cognitive enhancement therapy

Supervised housing service

Severely mentally ill patients often express a strong desire to be employed. According to the evidence-based research, the most effective model of employment for these patients is which of the following? Productive employment Vocational rehabilitation Supported employment A job placement program

Supported employment

The nurse includes the recovery model in the treatment plan of a patient with a serious mental illness. Which appropriate action does the nurse follow while caring for this patient? The nurse emphasizes the present illness of the patient. The nurse focuses on the existing strengths of the patient. The nurse focuses on the dysfunction and disabilities of the patient. The nurse encourages the patient to accept assistance from the staff.

The nurse focuses on the existing strengths of the patient.

The nurse checks the medical history of a patient with severe mental illness and learns that the patient is depressed because of a relapse of the illness. Which action does the nurse initially follow to provide effective care? The nurse performs crisis intervention for the patient. The nurse checks the need for isolation of the patient. The nurse encourages the patient to interact with his or her peers. The nurse suggests that the patient adhere to his or her medication.

The nurse performs crisis intervention for the patient.

A patient with a serious mental illness gives an advance directive during a period of remission. What does this action indicate? The patient is adamant about the way he or she wants to be treated. The patient lacks faith in the treatment protocol and health care programs. The patient directs the future management of therapy if patient's judgment is impaired. The patient allows the primary care provider to make all decisions about managing the therapy.

The patient directs future management of therapy if patient's judgement is impaired

The nurse is performing an assessment of a patient with serious mental illness. The nurse documents that the patient has impaired verbal communication. Which appropriate symptom does the nurse find in the patient? The patient has difficulty expressing thoughts. The patient maintains eye contact while interacting. The patient has social discomfort when interacting. The patient is preoccupied with his or her own thoughts.

The patient has difficulty expressing thoughts.

The nurse diagnoses a patient with severe mental illness as having impaired social interaction. What outcome shown by the patient indicates effective treatment? The patient expresses feelings of self-worth. The patient starts discussing the prescribed treatment. The patient starts cooperating with others in group tasks. The patient starts sharing his or her feelings on spirituality.

The patient starts cooperating with others in group tasks

Why is there a requirement for integrating mental and physical health care into a single setting? The mental health care provider can calm a violent patient easily. The patient's description of a serious symptom may be misunderstood. The insurance coverage can be easily obtained when both are integrated. The health care provider can treat both mental and physical illness with ease.

The patient's description of a serious symptom may be misunderstood.

A serious mental illness (SMI) patient who has undergone a serious battering comes to the facility for nursing care. What makes people with SMI more vulnerable to being victimized? Select all that apply. They live in high-crime neighborhoods. They get punished for their violent behaviors. They fake injuries to gain some advantages. They lack self-esteem and are likely to be victimized. They have impaired judgment and interpersonal skills.

They live in high-crime neighborhoods. They lack self-esteem and are likely to be victimized. They have impaired judgment and interpersonal skills.

An adult diagnosed with mental illness was brought by police to the emergency department. The adult was wandering in the community, wearing provocative clothing, yelling obscenities, and threatening to shoot the mayor. Which behavior most clearly meets criteria for involuntary hospitalization of this adult? Yelling obscenities Threats to shoot the mayor Wandering in the community Wearing provocative clothing

Threats to shoot the mayor

What is a popular misconception about the seriously mentally ill? Violent and aggressive Usually abandoned by their families Generally given the care they require Likely to experience periods of remission

Violent and aggressive