prepU CHAPTER 7
A child diagnosed with obsessive-compulsive disorder (OCD) tells the nurse, "One of the kids in my class calls me crazy." What response by the nurse best supports the child's ability to deal with the stigma of mental illness? "Did you report that to your teacher?" "Does that kind of thing happen to you often?" "What do you think made the classmate call you 'crazy'?" "How does it make you feel when someone calls you 'crazy'?"
Correct response: "How does it make you feel when someone calls you 'crazy'?" Explanation: The challenge for nurses and other clinicians is to support stigma resilience, a personal trait that means the client has the capacity to withstand or recover from significant challenges that threaten stability, viability, or development. Asking the child how the incident made them feel will provide insight into how resilient the child is. None of the other answers provide insight into how the child is emotionally handling such biased behavior.
A nurse is caring for a client who has been admitted to the hospital for treatment of manic behavior associated with a new diagnosis of bipolar disorder. Which statement made by the nurse demonstrates an attempt to incorporate the person-centered care model in this client's plan of care? "The client prefers spending as much time as possible outside walking the grounds." "The symptoms of this disorder make clients very easily agitated and aggressive." "I have scheduled the client to attend a stress management group each afternoon." "I have arranged for the client's parents to call later this evening."
Correct response: "The client prefers spending as much time as possible outside walking the grounds." Explanation: Person-centered care is an approach to healthcare that is organized around the client's health needs and expectations. Demonstrating attention to the client's preferences shows an understanding of this model. The remaining options fail to demonstrate client involvement in the decisions. Instead, they depict choices the nurse made based either on common manifestations of the diagnosed disorder or on the nurse's interpretation of the client's needs.
The charge nurse is talking with another nurse who states, "I feel like my client has no interest in his or her care and does not care that I am trying to help." Which response should the charge nurse make? "A lot of clients behave that way, but you cannot take it personally." "Do you want me to assign another nurse to the client?" "Have you tried to establish a therapeutic relationship with the client?" "Clients often behave that way when they are in pain."
Correct response: "Have you tried to establish a therapeutic relationship with the client?" Explanation: The charge nurse should ask if the nurse has tried to establish a therapeutic relationship with the client yet. Establishing this relationship helps with a feeling of connectedness for the client and promotes behavior changes needed to improve health and well-being. The other options dismiss the nurse's concerns or make assumptions about the client.
The nurse is caring for a group of clients at a substance use disorder treatment facility. Which statement would indicate a client is experiencing self-stigma? "Everytime I am outside getting fresh air I can feel people who are walking by just staring at me. I almost did not come back in." "I cannot wait to prove to my family that I am not using drugs anymore, but I know they are just going to see me as an addict forever." "I understand that I need to find a new group of friends, because my friends will keep offerring me drugs instead of helping me stay off of them." "How do I get my coworkers to understand that I have a disease and it is not a choice? Their whispers make me want to leave work and find drugs."
Correct response: "How do I get my coworkers to understand that I have a disease and it is not a choice? Their whispers make me want to leave work and find drugs." Explanation: The client statement about wanting to leave work and use drugs because of the coworkers' whispering is an indication of self-stigma. The client is internalizing the coworkers' opinions and it increases the client's symptoms of wanting to use drugs. The other statements are indications that the client is overcoming other people's opinions.
A nurse advocate led a panel discussion at a local community center addressing the needs of persons with mental illness. Which statement made by a member of the audience during the question and answer session best indicates to the nurse that the goal of advocacy was achieved? "I would like to help; tell me what I can do." "It is hard to imagine how the average person can affect such a huge problem." "I am beginning to see the homeless as people who simply need a helping hand." "The federal government needs to earmark more funds to the care of the mentally ill."
Correct response: "I am beginning to see the homeless as people who simply need a helping hand." Explanation: The goal of the advocacy movement is to challenge society's negative perception of persons with mental disorders and to gradually replace it with more realistic, empathic perceptions. Recognizing that those with a mental illness are people just like the rest of us demonstrates a more positive perception of that population. While the other statements demonstrate a willingness to help or an understanding of the scope of the needs, none demonstrates the change in perception required of this goal.
The nurse is caring for a client who was previously homeless and is now in the stage of ongoing rehabilitation as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA). The nurse recognizes achievement of the primary goal of this phase of rehabilitation when the client makes which statement? "I am relieved that I finally have a place to call home." "I like feeling better, and I want to keep this going." "I want to be part of every decision that affects my health." "I need to find a dentist that I can access reguarly."
Correct response: "I am relieved that I finally have a place to call home." Explanation: Ongoing rehabilitation is the fifth stage of the SAMHSA five-stage process. It is an open-ended phase, in which clients gradually establish an identity as no longer homeless. This stage includes an active and continuing supportive counseling relationship, participation in mental health treatment as needed, and continued participation in prevention programs as appropriate. Recognizing the need for basic services occurs during stage 1 of the process; participating in the management of one's own goals is part of stage 3; and sustaining the process of recovery occurs during stage 4.
The nurse is working with a client who was recently diagnosed with obsessive-compulsive disorder (OCD). Which statement best demonstrates that the client has been empowered to participate in the care process? "I am pretty sure that both my siblings also have OCD tendencies." "My treatment team was right to suggest I take an oral anti-anxiety medication." "I know that when I feel stressed, I am more likely to focus on my handwashing ritual." "I think I can get control of my life with the help of my family and healthcare team."
Correct response: "I know that when I feel stressed, I am more likely to focus on my handwashing ritual." Explanation: Empowering the client to engage in the care process requires that the individual is educated on health and mental health issues and approaches. The client must have the knowledge and skills to engage in a meaningful collaborative process. Recognizing when and why symptoms will increase demonstrates such knowledge. None of the other options demonstrate the insight or active engagement required for empowerment. Most of them suggest a reliance on family or the healthcare team.
The nurse is caring for a group of assigned clients. The nurse should prioritize following up with the client that makes which statement? "My spouse and I had a fight, so I have been sleeping in our camper for 2 days." "I love sleeping under the stars. I feel less stressed." "My address is my friend's house because I have been sleeping on the couch for the last 2 weeks." "I plan to make my way to a warmer state, so I will not be so cold all day."
Correct response: "I plan to make my way to a warmer state, so I will not be so cold all day." Explanation: The nurse should prioritize following up with the client who talks about being cold all day, because the statement indicates that the client is homeless and unsheltered. The other clients indicate that either they are homeless but sheltered, or that they are making choices to sleep elsewhere besides their home.
The nurse is working with several clients diagnosed with mental health disorders. Which client statements suggest that prognosis for effective management of the condition is good? Select all that apply. "I really like living with my sister; I help her by babysitting her children whenever I can." "My employer is very understanding about arranging my hours so I can keep my clinic appointments." "My support group has given me a lot of good advice about managing my symptoms and feeling positive about myself." "I am interested in getting a degree in business, and I have been talking about that with people at the local college." "I am confident that the medications I have been prescribed will keep me from experiencing a relapse of my symptoms."
Correct response: "I really like living with my sister; I help her by babysitting her children whenever I can." "My employer is very understanding about arranging my hours so I can keep my clinic appointments." "My support group has given me a lot of good advice about managing my symptoms and feeling positive about myself." Explanation: Satisfying employment, housing, and peer support are all considered critical to successful recovery from a mental health disorder. These factors contribute to the stability and support required to appropriately manage stress associated with recovery. While having a goal, such as completing a college degree, may be a positive sign, such efforts may add stress to the client's life and be destabilizing in some instances. The client's view that medication will, by itself, prevent relapse is incorrect; the client requires additional education concerning their disorder.
The nurse is caring for a client who is in stage 3 of the five-stage process in homeless rehabilitation. Which statement by the client would indicate the process is effective? "Can you explain my options for treatment?" "Will I receive supportive care after I am discharged?" "I will not let other people's opinions of me affect my recovery." "I want to learn to control my stress so I do not use drugs again."
Correct response: "I want to learn to control my stress so I do not use drugs again." Explanation: The statement about learning to control stress would demonstrate that the stages are working for the client and, with stage 3, the client participates in defining and managing goals. One of the primary focuses of the stage is skills training. The statement about other people's opinions demonstrates stigma resilience. The other two options are questions about the client's care and treatment options and do not demonstrate effective treatment.
The nurse is caring for a client who is receiving treatment for alcohol use disorder. Which statement made by the nurse best demonstrates an understanding of person-centered care for a client with this condition? "The client has a family history of alcohol abuse going back at least three generations." "I will ask the client about a preference regarding Alcoholics Anonymous meeting locations." "The client has expressed concern about being admitted to the hospital." "I will arrange for the client to attend at least two group sessions daily."
Correct response: "I will ask the client about a preference regarding Alcoholics Anonymous meeting locations." Explanation: One of the key concepts in recovery-oriented care is person-centered care, in which the person is actively involved in determining the best options for their health care circumstances instead of passively receiving a prescription for treatment. Allowing the client to select the meeting site demonstrates person-centered care. Although arranging for group sessions demonstrates appropriate planning and intervention, it does not reflect person-centered care. The client's family history and concern regarding admission are potential assessment data.
A mental health nurse is developing a plan of care for a client who is homeless. Which assessment question best demonstrates the nurse's understanding of the guiding focus of the Housing First model of client assistance? "How much work are you willing to do to get your symptoms under control?" "If you had a choice, what neighborhood would you prefer to live in?" "How long has it been since you were able to maintain employment?" "Who can you rely on for assistance when you need help with a problem?"
Correct response: "If you had a choice, what neighborhood would you prefer to live in?" Explanation: Housing First prioritizes permanent housing to people experiencing homelessness. This approach is guided by the belief that people need basic necessities like food and housing before they can attend to other issues such as recovery from a mental illness, securing a job, and developing meaningful relationships. The other assessment questions focus on different aspects of the recovery model.
The nurse is working with a client who has recently been diagnosed with schizophrenia. The client tells the nurse, "I think participating in a music therapy group would help me." When applying a person-centered approach to care, what is the nurse's best response? "Let's explore how you think music therapy will help you and where we might be able to find this type of group in the community." "Typically the most effective way to treat your illness is with antipsychotic medications. We should focus on this before other treatments." "Music therapy can be overstimulating for people with schizophrenia. It is important to avoid this type of stress while you are recovering." "I think you may be misinformed about treatment options. Is it possible that you have confused music therapy with psychotherapy?"
Correct response: "Let's explore how you think music therapy will help you and where we might be able to find this type of group in the community." Explanation: In person-centered care, the nurse helps the client make decisions about care and treatment based on facts, rather than telling the client what is best. By exploring the client's knowledge of and interest in music therapy, the nurse demonstrates that the client shares in decision making and promotes empowerment, a key component of effective person-centered care. Effective treatment for schizophrenia typically requires both pharmacological and non-pharmacological interventions, so it would be incorrect to tell the client that the treatment plan should focus exclusively on the prescribed medication. There is no evidence to support the notion that music therapy is overstimulating for individuals with schizophrenia. The nurse should not assume the client has confused music therapy with psychotherapy. As discussions take place regarding what the client hopes to achieve through music therapy, it should become clear if the client confused the two forms of therapy.
A nurse and another member of the healthcare team are discussing the plan of care for a client who was previously diagnosed with acute despression and is again seeking treatment for similiar symptoms. Which statement made by the nurse best demonstrates an understanding of the person-centered care model? "Depression is a mood disorder that generally responds well to antidepressant medication therapy." "My initial goal is to establish an effective, respectful nurse-client relationship with this client." "A reccurance of symptoms of depression can complicate the plan of care for this client." "The client is familiar with support groups; we need to talk to the client to see if attendance should be included in the plan."
Correct response: "The client is familiar with support groups; we need to talk to the client to see if attendance should be included in the plan." Explanation: Person-centered care is an approach to healthcare that is organized around health needs and expectations, rather than diseases. The client becomes a partner to the clinician, and together they decide the best approach based on the client's circumstances. The care approach is individualized; one person's care plan will look different from another's. Discussing the possibility of participating in a support group involves interaction between client and clinician, includes the client in the decision-making process, and addresses individual needs. None of the other statements depicts any involvement of the client in the decision-making process or any attempt to individualize care.
Correct response: "I really like living with my sister; I help her by babysitting her children whenever I can." "My employer is very understanding about arranging my hours so I can keep my clinic appointments." "My support group has given me a lot of good advice about managing my symptoms and feeling positive about myself." Explanation: Satisfying employment, housing, and peer support are all considered critical to successful recovery from a mental health disorder. These factors contribute to the stability and support required to appropriately manage stress associated with recovery. While having a goal, such as completing a college degree, may be a positive sign, such efforts may add stress to the client's life and be destabilizing in some instances. The client's view that medication will, by itself, prevent relapse is incorrect; the client requires additional education concerning their disorder.
Correct response: "The only reason I am not living on the streets is because my parents send me money every month." Explanation: A major barrier in accessing recovery-oriented care is poverty. A client's ability to survive on their income will depend on the availability of other resources—such as support from family, friends, and neighbors—available social services, and cost of living. The statement regarding financial assistance from parents strongly suggests the client is experiencing poverty. While the other options suggest financial difficulties, none so strongly suggests the inability to be financially stable.
The nurse is caring for a client with depression who states, "Why is there a specific model used to care for people with mental health issues." The nurse should respond with which statement? "Before the recovery model existed, people with mental health issues were abused." "The recovery model allows people with mental health issues to refuse or accept care." "The recovery model expanded to those with mental health issues to protect those clients' rights." "The recovery model was created by John Perceval because he suffered from schizophrenia."
Correct response: "The recovery model expanded to those with mental health issues to protect those clients' rights." Explanation: The recovery model initially only existed for those with substance use disorders but was then expanded to persons with mental health issues after the civil rights movement in the late 1960s. Now the recovery model is used to care for and treat persons with mental health disorders worldwide. John Perceval did not invent the recovery model, as it already existed for those with substance use disorders. Perceval wrote about his experience with schizophrenia, but it was not related to the existence of the recovery model. The recovery model does not allow clients to accept or refuse care, and there is no documentation that clients were abused prior to the recovery model expanding to those with mental health issues.
The nurse is working with a client with a diagnosis of chronic depression who has expressed a desire to become a history teacher. What question would the nurse ask that would demonstrate an understanding of the client's need to possess stigma resilience? "Has anyone else in your family been successful in completing a college degree?" "What challenges do you see yourself facing once you are enrolled in college?" "How will you secure the money you will need to attend college?" "What is it about studying history that appeals to you so much?"
Correct response: "What challenges do you see yourself facing once you are enrolled in college?" Explanation: One challenge for nurses and other clinicians is to support stigma resilience, a personal trait that means the client has the capacity to withstand or recover from significant challenges that threaten stability, viability, or development. Encouraging the client to consider the challenges ahead will help prepare to address those challenges as they occur. The remaining questions, while appropriate, are not related to resiliency.
The nurse is explaining the concept of the shared decision-making model to the spouse of a client who was involuntarily admitted for a substance use disorder. The spouse states, "Is it really a good idea to let my spouse help make decisions since this is involuntary and the decisions my spouse made to begin with is why we are here?" Which response would be mostappropriate by the nurse? "Your spouse still has rights, and this model can help improve the success of recovery." "You can make decisions for your spouse, if you become the conservator." "Do you think your spouse will try to make bad choices for treatment options, because your spouse has an addiction problem?" "The health care provider has the final say in the treatment, so your spouse will get the care needed."
Correct response: "Your spouse still has rights, and this model can help improve the success of recovery." Explanation: The best response by the nurse is to advocate for the client, explaining that the client has rights even if the client was admitted involuntarily. Also, explaining that the model can improve the client's success with recovery helps the spouse understand that this would be the best plan. The other options do not advocate for the client and/or are incorrect. The health care provider does not have the "final say," but rather the decisions are made together to facilitate the best plan of care for the client.
The nurse is planning care for a group of clients using the recovery model. Which client(s) would be appropriate for the nurse to include? Select all that apply. A client with a history of personality disorder. A client recovering from an opioid overdose. A client diagnosed with Alzheimer disease A client with an eating disorder. A client with erectyle disfunction.
Correct response: A client with a history of personality disorder. A client recovering from an opioid overdose. A client with an eating disorder. Explanation: The recovery model was initially applied to clients with substance use disorders and then expanded to include clients with mental health disorders as well. Therefore, the nurse should include the clients who have mental health disorders which would be, opioid overdose, personality disorder, and an eating disorder. Alzheimer disease and erectyle disfunction would not be appropriate diagnosis for the recovery model.
Which intervention is the best example of comprehensive advocacy for people with mental illness? Adminstration agrees to include mental health staff in planning the facility's annual community health fair. The head nurse on an Alzheimer's unit requires that a nightlight be turned on in each client room between dusk and dawn. A staff nurse requests a prescription for PRN medication for a client with a history of physical abuse toward staff. A community health nurse addresses a town council meeting regarding the need for mental health resources for individuals who are homeless.
Correct response: A community health nurse addresses a town council meeting regarding the need for mental health resources for individuals who are homeless. Explanation: Advocacy comprises various actions aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes. It is an important means of raising awareness of mental health issues. Attempting to address the needs of an at-risk population, such as a community's homeless population, is the best example of comprehensive advocacy. While the other options all attempt to address specific needs related to mental health, none is as comprehensive.
The nurse is developing the plan of care for a client with suicidal ideations using person-centered care. Which action should the nurse take? Ask if the client would feel more safe having inpatient care or making a 24-hour safe contract. Ask if the client understands what the Baker Act is. Teach the client about the benefits of a newly prescribed antidepressant medication. Teach the client about the need for one-to-one care.
Correct response: Ask if the client would feel more safe having inpatient care or making a 24-hour safe contract. Explanation: Person-centered care actively involves the client in the client's own care. This allows the client to be educated about treatment options and the disorder, so the client can make educated decisions about the care. The nurse should ask the client about safety and if the client would rather check into inpatient care in order to stay safe or if the client wants to make a contract to promise not to hurt oneself for the next 24-hours. The other options do not allow the client to participate in decision making, but rather tell the client about treatment the client will receive without the client's input.
The nurse working in the local clinic is planning to advocate for client's with substance use disorders. Which action(s) should the nurse take? Select all that apply. Attend a friendly protest for financial support. Teach family members and friends ways to prevent enabling clients with an addiction. Organize a support group for clients at the clinic. Develop free pamphlets available in the clinic that offers information about substance use. Tell clients to avoid persons who promote self-stigma.
Correct response: Attend a friendly protest for financial support. Teach family members and friends ways to prevent enabling clients with an addiction. Organize a support group for clients at the clinic. Develop free pamphlets available in the clinic that offers information about substance use. Explanation: Advocating involves raising awareness, educating, training, counseling, providing mutual help, mediating, defending, and denouncing. Attending a protest, teaching family, developing pamphlets, and organizing support groups are all ways of advocating for clients with substance use disorders. Telling a client what people to stay away from is not advocating, but rather giving advice.
The nurse is developing the care plan for a client with a substance use disorder using person-centered care. Which intervention(s) should the nurse include in the client's plan of care? Select all that apply. Refer the client for inpatient therapy. Determine if the client would prefer to have family members involved in the plan. Assess the client's willingness to participate in recovering. Provide the client with a list of a support groups available in the community. Educate the client about how addiction works in the body.
Correct response: Determine if the client would prefer to have family members involved in the plan. Assess the client's willingness to participate in recovering. Provide the client with a list of a support groups available in the community. Explanation: The nurse using person-centered care should focus on health needs and expectations instead of the disease. Educating the client about how addiction works in the body and referring the client for inpatient care are not actions that encompass person-centered care. Providing a list of support groups, assessing the client's willingness to change and providing the client the choice to include the client's family are actions that support the concept of person-centered care.
The nurse is talking with a client who states, "I do not know what to do. The health care provider gave me all the information about my options, but I know I will make the wrong choice." Which action would be most appropriate for the nurse to take? Discuss the shared decision-model of care with the client. Empower the client to make decision based on one's instincts. Notify the health care provider that a paternalistc approach would be best for the client. Discuss why the client's decision would not be the best choice.
Correct response: Discuss the shared decision-model of care with the client. Explanation: The best action by the nurse would be to discuss the shared decision-making model with the client, so that the client can still participate in making decisions, but will also allow the nurse and health care provider to make recommendations for the client. The nurse should not ask the client why, because it can make the client feel defensive. However, discussing the client's feelings about making the decision would be appropriate. Telling the client to trust the client's instinct does not necessarily decrease the client's concern for making the wrong choice. Paternalistic approach is having the nurse or health care provider make choices for the client and can lead to noncompliance of care.
The nurse is leading a support group on the mental health unit. Which action should the nurse take first? Empower each client to share as much or as little as desired within the group. Promote comfort by allowing each client to find a place to sit that makes the client comfortable with in the room. Establish a connection by greeting each client by name and thanking each for joining the group. Encourage each client to invite a peer support person to come with him or her to the group sessions.
Correct response: Establish a connection by greeting each client by name and thanking each for joining the group. Explanation: The nurse should first establish a therapeutic nurse-client relationship by trying to establish trust and a connection with the clients. Person-centered care is built on a strong nurse-client relationship. Greeting each client by name and thanking him or her for joining the group can give each client a sense of importance and belongingness. The other options would be appropriate to do after establishing a connection.
The nurse is caring for a client who identifies oneself as Jewish and requires mental health treatment for bipolar disorder. Which action by the nurse would would be most appropriate? Research the Jewish culture to find out what interventions would assist the client best. Implement person-centered care. Used the informed choice model when planning care. Facilitate empowerment so the client can receive the type of care the client prefers.
Correct response: Implement person-centered care. Explanation: The nurse should implement person-centered care because this would actively engage the client in planning interventions and the nurse can find out if the client practices Jewish culture and what the client's needs might be. Researching the culture and implementing interventions does not allow the client to choose preferences or help make decisions that are appropriate for the client. Using the informed choice model without discussing the options of using shared decision-making model and person-centered care would not be more appropriate than implementing person-centered care, which allows the client to make choices and participate in care.
The nurse is caring for a client who has a plan of care with a long-term goal of demonstrating self-management skills. Which action would best assist the client in achieving this goal? Using the informed choice model to plan the client's care. Providing resources to assist the client with employment. Including the concept of empowerment in the client's plan of care. Referring the client for peer support.
Correct response: Including the concept of empowerment in the client's plan of care. Explanation: The best action by the nurse to assist the client with achieving the goal is to include empowerment in the client's plan of care. Empowerment facilitates self-management by supporting people and communities to take control of their own health needs. The informed choice model allows the client to choose options for treatment and care after the nurse shares evidence and offers the client options. Employment is an important piece of mental health recovery, but assisting the client with resources to establish employment would not help the client achieve the goal. If the client was able to establish and maintain employment, this would be one way of the client demonstrating that the goal of self-managment was achieved. Having peer support could help the client with achieving the goal because peer support can give the client hope that if someone else can achieve self-management then so could the client. However, this would not be better than empowerment which can foster permanent changes in the client's health.
The nurse has provided care for a client using person-centered care. Which outcome should the nurse expect? Increased client satisfaction with treatment Family involvement in recovery Client able to verbalize full understanding of the disease process Client demonstration of stigma-resilience
Correct response: Increased client satisfaction with treatment Explanation: Person-centered care involves building a trusting relationship with the client, which helps improve satisfaction with treatment. Family involvment in recovery, verbalizing the disease process, and stigma-resilience are not related to the outcomes of person-centered care.
The nurse is caring for a client who wants to be included in decision making. The nurse should recommend which in the planning care process? Select all that apply. Informed choice model Shared decision-making model Paternalistic model Person-centered care Peer support
Correct response: Informed choice model Shared decision-making model Person-centered care Explanation: The nurse should include person-centered care, the informed decision model, and the shared decision-making model in the process of planning care for a client who wants to be included in decision making. The paternalistic model does not include the client in the decisions, but rather makes decisions for the client. Peer support assists the client in managing self care, but does not participate in planning care with the client.
A nurse recently attended a workshop discussing the World Health Organization's (WHO) position on the rights of persons with mentally illness. What activity could the nurse perform that would most clearly align with that position? Provide an informational presentation on the community's role in the care of mentally ill citizens. Notify the healthcare provider of a client's need for a medication change to address new symptoms. Encourage a client diagnosed with chronic anxiety disorder to attend a self-help group at the local mental health clinic. Ask a social services representative to provide a client with information regarding community services related to depression.
Correct response: Provide an informational presentation on the community's role in the care of mentally ill citizens. Explanation: WHO recognizes the need for mental health advocacy to promote the human rights of all persons with mental disorders and to reduce stigma and discrimination. Providing a presentation on the community's responsibility to its members with mental illness would address the issue of client rights. While the other activities involve advocacy, they address the needs of individual clients rather than the broader population at the center of the WHO efforts.
The nurse is caring for a client receiving treatment for acute depression. Which intervention can the nurse perform to best demonstrate a committment to providing person-centered care? Provide the client with information about the proposed antidepressant medication therapy. Encourage the client to discuss the ways that depression has affected daily life and family relationships. Accompany the client to the prescribed stress management group sessions. Arrange the medication schedule to help minimize the sedative effect of the prescribed medication.
Correct response: Provide the client with information about the proposed antidepressant medication therapy. Explanation: For a client to participate in their own care and make meaningful decisions, the individual must be educated about the disorder and treatment options and collaborate with the clinician. Providing information about the medication will assist the client in making an informed decision regarding therapy. Encouraging the client to discuss the impact of depression, accompanying the client to group sessions, and arranging the medication schedule to minimize adverse effects all support prescribed treatments; they do not aid the client in actively managing their own treatment.
The nurse is planning care using the five-stage process recommended by Substance Abuse and Mental Health Services Administration for a client who is homeless and has a mental illness. Place the following interventions in the correct order that the nurse will use when following the recommended stages. Use all options. 1Recognize the client's needs and establish a nurse-client therapeutic relationship. 2Obtain consent from the client to accept treatment and services. 3Encourage the client to participate in planning goals. 4Prepare the client for discharge and living independently in affordable housing. 5Follow-up with the client's recovery and participation in primary prevention programs.
Correct response: Recognize the client's needs and establish a nurse-client therapeutic relationship. Obtain consent from the client to accept treatment and services. Encourage the client to participate in planning goals. Prepare the client for discharge and living independently in affordable housing. Follow-up with the client's recovery and participation in primary prevention programs. Explanation: The five-stage process includes; 1. Outreach and engagement where the nurse recognizes the client's needs and establishes a nurse-client therapeutic relationship. 2. Transition to intensive care where the nurse obtains consent from the client to accept treatment and services. 3. Intensive treatment involves encouraging the client to participate in planning goals. 4. Transition from intensive care to ongoing rehabilitation where the nurse prepares the client for discharge and living independently in affordable housing. 5. Ongoing rehabilitation is the last stage that includes following-up with the client's recovery and participation in primary prevention programs.
The nurse has assisted a client with gaining employment after discharge from mental health treatment. Which action should the nurse take to best assist the client with maintaining the employment? Recommend a peer support specialist for the client. Call the client for the first 2 weeks every morning to ensure the client is going to the job. Set a date and time for a follow-up appointment that does not interfere with the client's work hours. Assist the client to gain affordable housing instead of a halfway house.
Correct response: Recommend a peer support specialist for the client. Explanation: The nurse should recommend a peer support specialist for the client who could assist the client after discharge with a plethora of services offerred by peer workers. After discharge it would be a boundary issue for the nurse to call the client every morning for 2 weeks. Affordable housing versus a halfway house could assist the client, but that should be determined on an individual basis, since some clients do better independently and others do better with shared living. Setting up a follow-up appointment outside of the client's work hours would be appropriate to not interfere with the client's employment; however, this would not be the best intervention to help the client maintain the employment.
The nurse is discharging a client from inpatient mental health treatment to a halfway house and has referred a peer support specialist to assist the client. Which has the nurse demonstrated? Stigma resilience Shared decision-making model Stage 4 of the five-stage process in homeless rehabilitation Stage 3 of the five-stage process in homeless rehabilitation
Correct response: Stage 4 of the five-stage process in homeless rehabilitation Explanation: The nurse has demonstrated stage 4 of the five-stage process in homeless rehabilitation, which is transition from intensive care to ongoing rehabilitation. Stage 3 of this model is intensive treatment. Stigma resilience is a characteristic of a client that demonstrates the ability to overcome challenges that threaten stabiliity, viability or development. The shared decision-making model occurs moreso at the beginning of treatment not at discharge. Although the client and caregivers may have made shared-decisions about the client's discharge, there is no evidence in the scenario to show that shared decision-making was used.
The nurse is screening clients for risk factors associated with limited or no access to health care. Which client should the nurse identify as having the highest risk? The 5-year-old child who lives in the city and requires treatment for leukemia. The 10-year-old child who lives on a farm and requires treatment for depression. The 23-year-old client who is a veteran and requires treatment for post-traumatic stress disorder (PTSD). The 20-year-old client who is homeless and requires treatment for diabetes mellitus.
Correct response: The 10-year-old child who lives on a farm and requires treatment for depression. Explanation: The nurse should identify the child who lives on a farm and has depression as having the highest risk for limited or no access to health care. People who live in rural areas and especially children with mental health needs have higher risks of limited to no access for care. Even the client who is homeless would be able to access care for diabetes through many services that are offerred. The veteran could receive government assisted care, and the child with leukemia could also receive free care through facilities like the Shriner's hospital.
The nurse at a local clinic is caring for the following clients. Which client should the nurse recognize as being homeless and unsheltered? The client who sleeps in a friend's car at night. The client sleeping in a sleeping bag under a tree in the park. The client who looks for coins at the beach all day and sleeps on a bench in the pavillion. The client who sleeps in a tent during the day and at night digs through trash cans for food.
Correct response: The client sleeping in a sleeping bag under a tree in the park. Explanation: The nurse should recognize the client sleeping under a tree in the park has unsheltered homelessness. The other clients all have some type of roof over them to protect them from rain or snow while they sleep. A tree would not be considered shelter.
The nurse is caring for a group of clients and wants to implement the recovery model. Which client would be appropriate for this model? The client with Parkinson disease who also has dementia. The client who had a double mastectomy. The client receiving physical therapy after having a myocardial infarction. The client with erectyle disfunction.
Correct response: The client who had a double mastectomy. Explanation: The nurse should recognize the client who had a double mastectomy will experience grief from a loss and will also experience body dysmorphic syndrome. These are both mental health issues that would benefit from the recovery model. The clientw with Parkinson disease, a myocardial infarction, and erectyle dysfunction are experiencing physiological issues not mental health issues.
The nurse is caring for a group of clients who have mental illness. Which client(s) should the nurse recognize as demonstrating stigma resilience? Select all that apply. The client with depression who was fired 1 week ago and is now applying for other jobs. The client recovering from a substance use disorder whose parent died and the client went to a bar and had drinks with a friend. The client with bipolar disorder who was evicted 2 days ago and is now staying at a shelter. The client with personality disorder whose spouse filed for divorce and the client has requested to talk with a peer support specialist. The client who has been taking prescribed antipsychotic medications for the last 5 years and lost insurance coverage and refused to ask family for assistance.
Correct response: The client with depression who was fired 1 week ago and is now applying for other jobs. The client with bipolar disorder who was evicted 2 days ago and is now staying at a shelter. The client with personality disorder whose spouse filed for divorce and the client has requested to talk with a peer support specialist. Explanation: Stigma resilience is when the client can withstand or recover from major challenges that threaten the client's stability, viability, or development. The client who went to a bar and the client who refused to ask family for assistance are not demonstrating stigma resilience. These two client's are demonstrating self-stigma, causing barriers to their own recovery. The other clients are demonstrating acts of recovering from the challenge by applying for another job, finding a shelter to stay in, and requesting a peer support specialist.
The nurse is caring for a client who wants to actively participate in the plan of care. Which action should the nurse take? Discuss the informed choice model with the client. Include the concept of empowerment when planning the client's care. Use the shared decision-making model when planning the client's care. Discuss the paternalistic model with the client.
Correct response: Use the shared decision-making model when planning the client's care. Explanation: The nurse should include use of the shared decision-making model when planning the client's care because this approach allows the individual to be an active participant in planning care. The paternalistic model does not allow active participation, it is based on the nurse/health care provider making choices that person feels are best for the client. The informed choice model allows the client to choose after the nurse/health care provider provides evidence of treatments and care and offers options to the client. However, this is not a collaborative effort, the client makes all the choices alone based on the information provided. Empowerment is a concept that is used to support clients not to collaboratively plan care with the client.
The nurse is caring for a client who has a history of several re-admissions for nonadherance to medications. Which action by the nurse would best help the client with medication adherance? Using a person-centered approach. Gaining the client's trust before informing the client about the plan of care. Asking why the client failed to adhere to the medication regimen. Including a support person from home in the client's plan of care.
Correct response: Using a person-centered approach. Explanation: The nurse should try a person-centered approach to help the client achieve medication adherance after discharge. Including a support person could be helpful, if the client prefers that, and it would be part of person-centered approach to ask the client about the preferences. It may be a good idea to assess what the reasons were for failed medication adherance in the past, but asking the client why may cause the client to feel defensive and would not be the best action. Gaining trust and establishing a therapeutic nurse-client relationship is also important and part of the person-centered approach. However, the nurse should not then go ahead and create a plan of care without the client's input.
The nurse is providing education to families of clients with chronic mental health conditions. When discussing the advantages of supportive housing, what benefit should the nurse identify? allows for holistic recovery from acute mental illness increases the use of acute psychiatric services provides easier access for police intervention serves as an inexpensive way to prevent acute mental health conditions
Correct response: allows for holistic recovery from acute mental illness Explanation: Housing is a basic necessity that provides the foundation for health needs to be met. A holistic approach to recovery that emphasizes the need to secure permanent housing reduces readmission to the hospital and reentry to street dwelling. Although supportive housing is expensive, communities are realizing that housing programs for people who are mentally ill and homeless are a good investment that can achieve long-term cost savings. The person who is safely housed is less likely to use other acute care and publicly funded services, such as shelters. Use of acute psychiatric and medical services is reduced, and the person is less likely to be arrested or incarcerated. Although supportive housing aids in the recovery process from acute mental health conditions, it does not prevent them.
The nurse is caring for a client using the person-centered approach. Which client is likely to have the best outcome using this approach? client with schizophrenia who meets regularly with the case manager to review health goals client with bipolar disorder for whom a plan of care has been developed solely by the case manager client with major depressive disorder who works with the case manager to identify alternatives to taking medication client with rape trauma syndrome who has monthly case management appointments using teleheath
Correct response: client with schizophrenia who meets regularly with the case manager to review health goals Explanation: The person-clinician partnership plans and manages mental health and health care issues, provides an opportunity for collaborative and creative thinking, and serves as a tool for gauging progress toward goals. A person-centered approach is exemplified in the scenario where the client meets with the case manager on a regular and frequent basis to ensure that the health goals in the care plan are being met. The development of the care plan by the case manager, without the collaboration of the client, depicts the paternalistic model of care. For a client with major depressive disorder, antidepressant medications will be essential to the plan of care, especially early in the client's recovery. The case manager should support the client in identifying non-pharmacological approaches to managing their condition, but these should complement medication therapy, not replace it. The person-centered approach is based on a strong, therapeutic nurse-client relationship. Infrequent and remote communication is unlikely to provide the close working relationship the client with rape trauma syndrome requires for effective person-centered care.
The nurse is caring for a client using a person-centered approach. What health behavior should expect the client to exhibit? demonstrates improved medication adherence agrees to comply with all provider decisions involves family in decision-making prioritizes long-term goals over short-term goals
Correct response: demonstrates improved medication adherence Explanation: Research on the person-centered care approach shows improved engagement in health care and medication adherence (Stanhope, Ingoglia., Schmelter, & Marcus, 2013). In this care model, clients are actively involved in determining the best options for their healthcare circumstances and no longer passively receive prescriptions for treatment of diseases. Family involvement is not an expected component of person-centered care. Both long-term and short-term goals should be established and addressed in the plan of care.
The nurse is screening a group of clients for risk factors associated with poverty. Which conditions should the nurse recognize as risk factor(s)? Select all that apply. diagnosis of schizophrenia diagnosis of depression employment without benefits clients receiving Social Security disability insurance clients who refuse peer support
Correct response: diagnosis of schizophrenia diagnosis of depression clients receiving Social Security disability insurance Explanation: The nurse should recognize that clients with schizophrenia and depression are at risk for poverty as well as clients receiving Social Security disability insurance who lack support from family, friends, and neighbors. Refusing peer support is not related to being at risk for poverty nor is a lack of benefits through the employer for an employed client. The client can always apply for benefits through other available social services and government assisted programs.
A nurse is collaborating with a peer support specialist to plan a community group for veterans in a rural setting. The nurse will emphasize that the peer support specialist can: treat individuals withdrawing from alcohol or drug use. provide care for sexually transmitted infections. direct individuals to information on affordable housing. provide education on prescribed medications.
Correct response: direct individuals to information on affordable housing. Explanation: Peer support specialists can provide links to resources, services, and support. A good example of this is when peer support workers assist individuals with identifying sources of affordable housing and help with the processes required to access such services. It is not within the scope of a peer support specialist to provide care for infections or use disorders nor to provide education on medications. An appropriate health care provider would be required to meet those needs.
The nursing student is developing a presentation on mental health advocacy. Which factors should be discussed as elements of advocacy? Select all that apply. education counseling mediation stigma access
Correct response: education counseling mediation Explanation: The concept of advocacy includes several elements such as awareness-raising; providing information, education, training, and counseling; and mutual help, mediating, defending, and denouncing. Stigma and access are not elements of advocacy, though combatting stigma and championing access to care are both examples of advocacy.
A client has been hospitalized for acute depression following an unsuccessful suicide attempt. When the client's discharge is being finalized using the informed choice model of care, the nurse expects the treatment team to: emphasize the importance of attending a support group that the team enrolled the client in. enlist the client in deciding which treatment option to implement. offer the client options for medication therapy without indicating which option they think should be implemented. determine treatment without client input because the client has exhibited dangerous and impulsive behavior.
Correct response: offer the client options for medication therapy without indicating which option they think should be implemented. Explanation: In the informed choice model, the clinicians share evidence and present options, but they offer no opinions. The client independently makes the decision from among the options presented. The shared decision-making model involves the clinicians supporting the client in making choices regarding treatment options by offering opinions. Enrolling the client in a support group without input and omitting them from the process of selecting treatment represent the paternalistic model, in which the clinician makes decisions regarding care without client input.
The nurse is developing a person-centered plan of care with a client. The nurse should expect the client to exhibit which behavior(s)? Select all that apply. participate in own health needs collaborate with healthcare provider seek education regarding health issues focus on the specifics of the disease process passively accept treatment decisions
Correct response: participate in own health needs collaborate with healthcare provider seek education regarding health issues Explanation: Person-centered care is an approach to healthcare that is organized around health needs and expectations, rather than diseases. The person, family, and community participate in and benefit from a trusted healthcare system. The cllient should not focus on individual disease or passively accept care.
The nurse is caring for a client with schizophrenia who has Type II diabetes. Which decision-making model of care is most appropriate for this client when determining sliding scale insulin? paternalistic informed choice shared decision-making empowerment
Correct response: paternalistic Explanation: Because the client is not qualified to determine sliding scale requirements for insulin, the paternalistic model, in which the decisions are made by only the clinician and given to the client, is the best choice for the described scenario. Neither the informed choice model nor the shared decision-making model is appropriate in this case. The informed choice model involves the clinician providing the client with information, but not opinions, to allow the client to make the decision; the shared decision-making model involves the clinician providing both information and opinions to allow the client to work with the clinician to reach a mutual decision. Empowerment is not a decision-making model.
The nurse is developing ideas for a community improvement project. Which project bestdemonstrates the concept of empowerment as it relates to improving health in the community? playground street lights speed bumps house numbers
Correct response: playground Explanation: Empowerment is the process of supporting people and communities to take control of their own health needs, with the goal of healthy behaviors, positive mental health, self-management of illnesses, and well-being (Grealish, et al., 2017; WHO, 2015). Empowerment facilitates client independence, self-management, and self-efficacy. By creating a playground, the community offers the opportunity for families to engage in physical and social activity; thus, it empowers them to achieve positive health outcomes. Street lights, speed bumps and house numbers all improve community safety, but they do not empower its members.
In developing and updating the plan of care for a client diagnosed with schizophrenia, the nurse has attempted to foster client empowerment. When assessing the degree of empowerment the client has achieved, the nurse will observe for the presence of what behaviors? Select all that apply. self-efficacy independence self-management medication adherence stigma resilience
Correct response: self-efficacy independence self-management Explanation: An important component of the recovery model is empowerment, the process of supporting clients to take control of their own health needs. Empowerment facilitates patient independence, self-management, and self-efficacy. Medication adherence has been shown to improve under the person-centered care model, but it is not an indication of empowerment. Similarly, while stigma resilience is a positive trait that can aid in the recovery model, its presence does not demonstrate empowerment.
A nurse is admitting a client recently diagnosed with schizophrenia. The nurse demonstrates a paternalistic approach to care by: telling the client that failure to adhere to the medication regimen will result in a longer hospital stay. asking the client what experiences with hospitalization have been in the past. providing the client with education about the hospital stay and treatment. encouraging the client to participate in unit activities whenever possible.
Correct response: telling the client that failure to adhere to the medication regimen will result in a longer hospital stay. Explanation: In the paternalistic model, clinicians make all care decisions and dictate them to the clients. As a result, clients can feel coerced into treatment. By telling the client that the consequence of not taking prescribed medications is a longer hospital stay, the nurse is giving the client an ultimatum rather than allowing the client to feel as if they have a say in their own care. Person-centered care—in which the client is an active participant in making care decisions—requires thorough education regarding health issues and treatment options as well as a strong therapeutic relationship between the client and the provider. The nurse demonstrates these aspects of person-centered care by asking the client about past experiences with hospitalization and by providing education about the upcoming hospital stay and treatment. Encouraging the client to participate in unit activities wherever possible is a supportive nursing action that is aimed at fostering empowerment, a concept related to person-centered care in which clients are encouraged and equipped to take control of their own health needs.
The nurse is screening clients for common risk factors related to homelessness. The nurse should screen for which sign(s) and/or symptom(s)? Select all that apply. withdrawal sexual abuse posttraumatic stress disorder (PTSD) mental illness sensory deprivation
Correct response: withdrawal sexual abuse posttraumatic stress disorder (PTSD) mental illness Explanation: The nurse should assess for signs and/or symptoms of PTSD, substance use or withdrawal, sexual abuse, and mental illness. Sensory deprivation is not considered a common risk factor associated with homelessness.
The nurse is caring for a patient who was recently diagnosed with schizophrenia and is now preparing for discharge. Which client statement indicates a factor that will positively influence mental health recovery? "I have a part time job waiting for me at the local diner." "I am so pleased I can depend on you to meet my needs while I recover." "I trust my care team to make all the right decisions for me." "Whether or not I get better depends on the effectiveness of my medications."
Correct response: "I have a part time job waiting for me at the local diner." Explanation: Employment is one of the most important factors that impacts mental health recovery. Employment gives individuals a sense of purpose and a reason to get up in the morning. Relying on the healthcare provider indicates the client does not feel a sense of self-efficacy or control over achieving desired health outcomes. Medication adherence is important but does not determine recovery. Paternalism is demonstrated in the statement the client makes about the care team making all the decisions for care. This is not considered a factor that contributes to mental health recovery.
The nurse is assisting in the discharge of a client who received treatment for severe anxiety associated with a diagnosis of post-traumatic stress disorder. What statement made by the client best suggests a good prognosis for symptom management? "I am sure if I do everything I have been told, I will not be hospitalized again." "I have good insurance because I have qualified for military benefits." "I am a strong person; I am sure I will be able to get better." "I understand how important it is to manage stress."
Correct response: "I have good insurance because I have qualified for military benefits." Explanation: Ongoing treatment is critical to the successful management of symptoms. Factors that contribute to whether persons with mental health disorders can receive appropriate treatment include access to insurance. While the other statements demonstrate the client's confidence and understanding of the disorder, none address the issue of ongoing treatment.
The nurse has recently reviewed plans of care with several clients. Which client statement best demonstrates the influence of the shared decision-making model on that client's plan of care? "After discussing the benefit of a halfway house with my team, I agree that moving to one will provide the support I need after completing my alcohol rehab program." "I have learned a lot about my obsessive-compulsive behaviors, and I am confident I can manage those tendencies better now." "I really hate the side effects of my antidepressant medication, but I don't think I have any other choice in the matter." "If I don't enter a rehab program, I will be unable to avoid going to prison for my drug charges."
Correct response: "After discussing the benefit of a halfway house with my team, I agree that moving to one will provide the support I need after completing my alcohol rehab program." Explanation: The shared decision-making model is an approach in which both the individual and the healthcare team are active participants in deciding on a plan of care. Clinician-client communication is at the core of the process. This model is demonstrated by the mutual agreement that a halfway house is the best treatment option following completion of the rehabilitation program. The statements regarding the inevitability of unpleasant side effects and the potential for imprisonment both suggest that the client is not taking an active role in determining the plan of care. The client's confidence in self-management of behaviors suggests empowerment but offers no indication that this was achieved using the shared decision-making model.
A mental health nurse is discussing care with the parents of a child newly diagnosed with obsessive-compulsive disorder (OCD). Which statement or question by the nurse bestdemonstrates both advocacy for this child and an attempt to minimize the stigma associated with mental illness? "I think your child would benefit from weekly individual counseling with one of our pediatric psychologists." "Would you be willing to attend a support and education group for families of children with mental health diagnoses?" "Do you think your child's teacher would be willing to have me lead an age-appropriate discussion of OCD with the class?" "The community has several resources that focus on supporting OCD clients; I will get you some information on each of them."
Correct response: "Do you think your child's teacher would be willing to have me lead an age-appropriate discussion of OCD with the class?" Explanation: Healthcare workers can play an important role in advocating for quality mental health care through participating in activities of client and family groups. They can educate communities and support access to services. Educating the client's classmates regarding OCD in an age-appropriate manner would accomplish both advocacy and stigma reduction. While the other statements represent potentially appropriate aspects of care, none address the need for stigma reduction.
The nurse is caring for a client using the recovery model. Which factors are important in achieving positive outcomes for this client? Select all that apply. housing peer support employment stigma limited access
Correct response: housing peer support employment Explanation: Housing, peer support, and employment are all integral factors components of the recovery model. Stigma and limited access to services are barriers to recovery.
A nurse at a neighborhood mental health clinic is coordinating care of clients diagnosed with post-traumatic stress disorder (PTSD). Which activities would be appropriate for the nurse to delegate to a peer support specialist volunteering at the clinic? Select all that apply. presenting information about PTSD to a group of military families assessing new clients' knowledge concerning the signs and symptoms of PTSD discussing with clients the ways that PTSD negatively affects both family and social relationships acting as group leader for a stress management group that meets at the clinic evaluating the effects of antianxiety medications prescribed to the clients
Correct response: presenting information about PTSD to a group of military families discussing with clients the ways that PTSD negatively affects both family and social relationships acting as group leader for a stress management group that meets at the clinic Explanation: Peer support specialists engage in a wide range of activities including advocacy, linkage to resources, sharing of experiences, community and relationship building, group facilitation, skill building, mentoring, and goal setting. They also may provide training, administer programs, and plan and develop groups, services, or activities. Because they can describe their mental health experiences and can explain their journey of recovery, they are especially well suited to educate the public and policymakers and can challenge negative stereotypes. Assessment and evaluation are nursing roles and cannot be delegated to peer support specialists.
