PREP U CHPT 4
As technology develops and becomes increasingly accessible
, traditional face-to-face communication can be replaced with technological interactions. Any communication over the internet must be secure to maintain confidentiality. Hospital firewalls can be useful in establishing these connections. Some commonly used platforms for online communication, such as Facebook, cannot meet the standards for security and confidentiality and should not be used when communicating with clients. Phone and video conferencing are increasingly popular, especially in remote areas where the land or the isolation of the clinic constitutes barriers to the development of a therapeutic relationship.
The client will resume previous level of functioning.
A 22-year-old client with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client self-describes as "very social and doing well in school." Which of the following long-term treatment goals is best suited for this client?
Which mental health clients is most likely to frequently present in the emergency department in hospital?
A 34-year-old person diagnosed with an amphetamine addiction who has overdosed is most likely to be seen as a participant of the acute care hospitals "revolving door" phenomena. Due to the chronic and complex nature of dual diagnosis clients, frequent hospital presentations are common and treatment can be challenging.
To address the needs of adults with mental illness and increase their ability to function
A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems?
primary
A case manager is working with a parent whose child has schizophrenia. The parent reports sadness, frequent crying, and fatigue. The case manager works with the parent to establish some scheduled rest, relaxation, and respite from caring for the child. At which level of prevention is the case manager working with the parent?
Acute symptom stabilization
A client has threatened to kill the client's spouse, and it is not anticipated that this crisis will resolve itself. The client is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which as the focus of care?
Therapeutic foster care
A client is in need of a family-like environment with a high level of support. Which would be most appropriate?
therapeutic foster care
A client is in need of a family-like environment with a high level of support. Which would be most appropriate?
Symptom stabilization
A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what?
Services that promote the client's reintegration into the community
A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize?
stabilize acute symptoms
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?
a day treatment program
A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time?
Which client may be the most appropriate candidate for telepsychiatry?
A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health
Community-based residential services
A client with a mental illness is receiving supportive housing during a 24-hour period on an ongoing basis. Which type service is the client most likely receiving?
Development of social skills. Stabilization of symptoms. Training to perform activities of daily living.
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?
Development of social skills. Stabilization of symptoms. Training to perform activities of daily living
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.
The fact that there are high rates of mental illness among the populations of jails and prisons
A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future?
A healthcare organization is increasing the use of telecommunication to reach clients located in remote areas. Which avenue should the nurse question before establishing a therapeutic relationship with a client?
Which best defines a community support system in relation to mental illness?
A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation
Improved access to less costly services
A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus?
Partial hospitalization programs
A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding by identifying which type as providing the most intensive outpatient nursing care?
Maintenance of the therapeutic environment
A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what?
A 42-year-old who would like to enter marriage counseling
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?
Ability to provide services in a variety of locations
A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use?
tertiary prevention
A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention?
Identifying and meeting the client's health and human service needs
A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services?
level of functioning
A psychiatric-mental health nurse is working as a case manager. The nurse understands that the quality of case management is measured by outcomes that result from what?
1
Advocacy is a primary prevention.
Successful community rehabilitation
An awareness to identify the need for providing culturally competent mental health care for the client can promote which treatment goal?
Which client is suitable for psychiatric transitional care services?
An individual being discharged from hospital with residual symptoms of mania
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?
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
ensure safety
Clients admitted to a psychiatric unit may be frightened, angry, and paranoid; it may be difficult for a nurse to establish good rapport under these circumstances. Often they also fear being bullied or attacked. What is a nursing priority at this time?
case management
Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model?
2
Crisis intervention is considered secondary prevention.
Pressures to reduce health care costs associated with inpatient care
Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years?
support
During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy?
hope, empowerment, choice, and responsibility.
In order to facilitate recovery for individuals, family, groups, or communities, the approach of the services or supports provided must be founded on the principles of
true
In the continuum of care, the nursing process is similar to the coordination of care for psychiatric clients.
The complexity of access to the community service programs available
Individuals may need assistance with the coordination of care and community service programs related to what?
collaborative mental health care
Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ...
assertive community treatment
Intensive treatment that prepares the client to live in the community reflects the focus of
Which is the most restrictive setting in the continuum?
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.
Resurfacing of acute symptoms
One major reason that clients with mental disorders are rehospitalized is what?
Which statement regarding those with serious and persistent mental illness (SPMI) is correct?
Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.
goal of respite care
Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers
concept of milieu therapy
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.
The quality of case management is measured by outcomes that result from what?
Quality is assessed by measuring client outcomes that result from the services, such as level of functioning, community integration, and client satisfaction with the services provided. In the community, the case manager works with clients on a broad range of issues from accessing needed medical and psychiatric services to carrying out activities of daily living. Quality of case management is not measured by improved financial status or provision of the most restrictive environment. Continuum of care spans from illness to wellness states.
3
Rehabilitation and case management are tertiary preventions.
Members receive mental health treatment from providers in the community.
The Fountain House in New York developed the model in the 1940s. Which is an important characteristic of a clubhouse?
empowerment
The approach of the services provided to facilitate recovery for individuals must be based on which aspect?
primary prevention
The case manager is assisting the parent with health promotion needs in order to maintain the parent's current health status and prevent deterioration due to stressors in the parent's life.
Has increased client access to appropriate mental health care
The greatest impact case management has had on mental health care is that it has caused what?
1950
The introduction of psychotropic medications occurred in which decade?
case manager
The most diverse role for the nurse within community based psychiatric mental health care would most probably be what?
partnering with client form the start
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.
hospitalization
The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is that their symptomology does not require psychiatric
Symptom acuity does not require psychiatric hospitalization
The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what?
The client will be able function independently.
The nurse is advising the caregiver of a client to encourage the client to join an evolving consumer household. What may be the reason for the nurse to give this advice to the caregiver?
stigma
The nurse is caring for a forensic client scheduled for discharge. Which mental health principle is most influential in recovery after discharge?
ensuring a sustainable living situation
The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what?
Empower clients to achieve the highest level of functioning possible
The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program?
mental illness
The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what?
respite residential care
The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest?
coordination of care
The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions?
cause for early discharge
There is tremendous pressure to reduce the escalating costs of health care, a trend that has often resulted in early discharge and reduced average lengths of stay. This trend toward shorter inpatient courses of care is not a result of the ineffectiveness of inpatient care or improved drug treatments and publicly funded programs.
What was the original purpose for developing the role of the case manager in community-based care?
To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions
why case managers were created
To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions
acute symptom stabilization
When a client is admitted to an inpatient facility during a crisis, the focus of care is stabilization of the acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days. The client is in crisis, so rehabilitative services would be inappropriate.
nurse
When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet?
spend more time in jail
When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness:
spent more time in jail
When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness:
Communication skills Interpersonal skills Teamwork skills Risk assessment and risk management skills
Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team?
A client who has multiple sclerosis and a history of depression
Which client would be most likely to qualify for psychiatric care in a long-term care setting?
The client's functional ability will improve.
Which goal for an individual client is consistent with the overall objectives of community support service programs?
crisis intervention
Which is an example of secondary prevention in the forensic setting?
Acute inpatient hospitalization
Which is the most restrictive setting in the continuum?
acute inpatient hospitalization
Which is the most restrictive setting in the continuum?
partial hospitalization program,
Which mental health treatment setting is not a residential treatment setting?
Assertive community treatment
Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness?
Partial hospitalization
Which service aims to achieve client stabilization without hospitalization or a reduced length of inpatient care?
It exists to promote rehabilitation alliance.
Which statement accurately describes the clubhouse model of community-based mental health rehabilitation?
Partnering with the client from the beginning
Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan?
Residential services provide
a place for people to reside during a 24-hour period, or any portion of the day on an ongoing basis. Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously.
Community-based residential services provide
a place for people to reside during a 24-hour period, or any portion of the day, on an ongoing basis. Peer support services are provided by mental health consumers who have experienced symptom remission and are actively involved in their own recovery from mental illness. Supportive housing include personal care homes, board-and-care homes, therapeutic foster care, and supervised apartments. These range from highly supervised congregate settings to independent apartments.
the core skill areas that are needed to function as effective team member of
an interdisciplinary team include interpersonal skills, such as tolerance, patience, and understanding; humanity, such as warmth, acceptance, empathy, genuineness, and nonjudgmental attitude; knowledge base about mental disorders, symptoms, and behavior; communication skills; personal qualities, such as consistency, assertiveness, and problem-solving abilities; teamwork skills, such as collaborating, sharing, and integrating; and risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.
Day-treatment programs are ideal for clients who
are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care.
Respite residential care
can provide short-term necessary housing for the client and periodic relief for the caregivers.
psychosocial rehabilitation or psychiatric rehab program
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.
The evolving consumer household
is a group-living situation in which the client fulfills their own responsibilities and functions without on-site supervision from paid staff. This requires the client to function as an independent individual. Clients with persistent mental illness should not be referred to this facility. Co-morbid medical illnesses are not treated in an evolving consumer household. The purpose of the evolving consumer household is to ensure the client does not need to make continual moves and readjust to new living situations. The evolving consumer household is a permanent living arrangement and eliminates the problem of relocation.
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.
Nursing care in a partial hospitalization program
is the most intensive of all the outpatient mental health care settings. Partial hospitalization is a type of outpatient program that provides services to persons with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning, who cannot function autonomously on a daily basis, or who do not pose imminent danger to themselves or others.
the goal of community support service program
is to enable those with severe mental illness to remain in the community and function as independently as possible.
cyber therapy
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.
day treatment program
or (partial hospitalization) provides services for mentally ill clients such as developing social skills, stabilizing psychiatric symptoms, and improving the skills required for activities of daily living. These programs do not perform prognostic testing for mentally ill clients. Services for treating comorbid medical illnesses are not provided in this program.
intensive outpatient programs
provide frequent monitoring and social support within a therapeutic milieu to enable the client to remain connected to the community.
outpatient detoxification
provides detoxification services for alcohol and drugs in an outpatient setting.
homeless people who are mentally ill
spend more time in jail. They are homeless longer, spend more time in shelters, have fewer contacts with family, and face greater barriers to employment.
A short-term treatment that serves
the client in an immediate but short-term crisis is 23-hour observation. This treatment is used for acute trauma, such as rape and alcohol/narcotic detoxification, and for individuals with Axis II personality disorders who present with self-injurious behaviors.
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.
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.
Partial hospitalization programs are designed
to help the client make a gradual transition from being inpatients to having independence and to prevent repeat admissions.
managed care aims
to increase access to care and provide the most appropriate level of services in the least restrictive environment. Efforts focus on providing more outpatient and alternative treatment programs and avoiding costly inpatient hospitalizations. When properly conducted and administered, managed care allows clients better access to quality services while using health care dollars wisely.
The 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.
partial hospitalization programs
were developed to complement inpatient mental health care and outpatient services and to provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning.