Mental Health - Ch 4: Treatment Settings, Mental Health-Chapter 4: Treatment Settings and Therapeutic Programs, NUR444 PrepU Ch.4, Psychiatric - Chp 4

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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.

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.

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.

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.

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.

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

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.

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

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

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.

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.

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.

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.

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.

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

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.

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 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 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.

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 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

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."

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.

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.

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.

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? 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.

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 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.

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.

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.

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 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.

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.

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

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.

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? 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

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."

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

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 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

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 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

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.

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.

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.

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? 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? 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.

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.

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 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 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.

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 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? 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 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 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.

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.

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).

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? 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.

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.

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.

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

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 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.

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

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 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 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.

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

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

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."

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

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 ... 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

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.

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