Varcarolis Mental Health Chapter 4
Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? A) Private insurance B) Medicare C) Medicaid D) Private pay
A Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services.
A therapeutic inpatient milieu will include which characteristic? A) It provides for the client's safety and comfort. B) Voluntarily admitted clients are generally allowed additional privileges. C) Rules and behavioral limits are flexibly enforced. D) Staff provide frequent and ongoing negative feedback to clients.
A Because the acuity level on inpatient units is high, nurses are responsible for ensuring that the environment is safe and that elopement and self-harm opportunities are minimized. The other choices are undesirable characteristics of a therapeutic milieu.
Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A) Break-away closet bars to prevent hanging B) Bedroom and dining areas with locked windows to prevent jumping C) Double-locked doors to prevent escaping from the unit D) Platform beds to prevent crush injuries
A Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.
In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? A) Nurses B) Social workers C) Clinical psychologists D) Chemical dependency counselors
A Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients.
When considering mental illness, recovery is best described to a client by which statement? A) Working, living, and participating in the community B) Never having to visit a mental health provider again C) Being able to understand the nature of the diagnosed illness D) A period of time when signs and symptoms are being managed
A Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.
The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? A) Arranging for the client to have a screening for prostate cancer B) Notifying the family that the client will require a wheelchair when discharged C) Providing the client with organizations that help defray the cost of prescribed drug D) Arranging for respite care when the client's family needs to attend an out-of-state affair
A The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care.
Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? A) All rights remain intact. B) Only rights that do not involve decision making remain intact. C) The right to refuse treatment is no longer guaranteed. D) All rights are temporarily suspended.
A The hospitalized client is not a convicted criminal thus all civil rights remain intact.
The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? A) Opportunity to act out fears and frustrations B) Providing a safe place to practice coping skills C) Meeting their physical as well as emotional needs D) Encouraging group communication about existing problems
B A therapeutic milieu can serve as a real-life training ground for learning about the self and practicing communication and coping skills in preparation for a return to the community. The other options are considered components of a therapeutic milieu.
What is the primary advantage of using a case manager when considering the planning and implementation of client care? A) Increases collaborative practice. B) Enhances resource management. C) Increases client satisfaction with care. D) Promotes evidence-based psychiatric nursing.
B Case management coordinates and monitors the effectiveness of services appropriate for the client. While the other options are true statements, none describes the primary advantage of the case manager model of health care delivery.
A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? A) "We will help you make decisions that will keep you safe." B) "I am going to help you shower, so you will not smell so bad." C) "Your pocket knife and nail clippers will be kept in the nurses' station." D) "You will be having a number of tests to help us learn about your condition."
B Every client has the right to be treated with dignity. This statement is demeaning. All of the other statements support the client's rights.
When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? A) The patients who are convicted criminals sentenced to home confinement. B) Care is provided to clients in unconventional settings. C) Care is provided by a preferred provider for a large HMO. D) The patients are provided for by a clinical specialist with the visiting nurse service.
B Mobile mental health units travel throughout the community, seeing clients on their own "turf," such as in shelters, on street corners, in homes, and at factories.
When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? A) Fostering research B) Maintaining a therapeutic milieu C) Providing sympathetic listening D) Providing constructive negative feedback
B Nursing is the discipline primarily responsible for maintenance of a therapeutic milieu, an environment that serves as a real-life training ground for learning about self and practicing communication and coping skills in preparation for a return to the community outside the hospital. While the remaining options are nursing responsibilities, none has the priority of maintaining a therapeutic milieu.
Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A) A depressed patient with a suicidal plan B) A patient being discharged from an inpatient alcohol rehabilitation unit C) A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs D) Jeff, who has mild depression symptoms and is starting outpatient therapy
B PHP is for patients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This patient would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This patient can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A patient exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.
Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A) A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B) A 30-year-old accountant who has developed symptoms of depression C) A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road D) A 76-year-old retired librarian who is experiencing memory loss and some confusion at times
C Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.
Which criterion must be met to refer a client to a partial hospitalization program? A) The client is hospitalized at night in an inpatient setting. B) The client must be able to provide his or her own transportation daily. C) The client is able to return home each day. D) The clients are all recovering from an addiction.
C Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society. None of the remaining options are true statements regarding partial hospitalization programs.
The psychiatric community health nurse engages in secondary prevention when implementing which intervention? A) Visiting a homeless shelter to provide mental health screenings for its clients B) Discussing the need for proper nutrition with a depressed new mother C) Providing stress reduction seminars at the local senior center D) Visiting the home of a client currently displaying manic behavior
C Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Early identification of problems, screening, and prompt and effective treatment are hallmarks of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.
It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? A) Refusal of treatment. B) To send and receive mail. C) To seek legal counsel. D) To access all personal possessions.
D A client has the right to keep personal belongings unless they are dangerous. Items such as sharp objects, glass containers, and medication are usually removed from the client's possession and kept in a locked area to be used by the client under supervision or returned at discharge. The remaining options are civil rights afforded to all clients.
The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A) A client and family members attend counseling sessions together at a neighborhood clinic B) Implementation of a more flexible work schedule for staff C) Improved reimbursement for services provided in the community D) A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.
D A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT.
In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? A) Knowledge of both national and local political activism B) The ability to cross service systems C) An awareness of own cultural and personal values D) Creative problem-solving and intervention skills
D Creative problem-solving and intervention skills are the hallmark of care provided by the ACT team.
Which situation demonstrates the nurse functioning in the role of advocate? A) Providing one-to-one supervision for a client on suicide precautions B) Co-leading a medication education group for clients and families C) Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation D) Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days
D In the inpatient setting, case managers on the hospital team communicate daily or weekly with the client's insurer and provide the treatment team guidance regarding the availability of resources. In the community, multiple levels of intervention are available within case management service, ranging from daily assistance with medications to ongoing resolution of housing and financial issues.
What function is shared by advanced practice and general practice psychiatric nurses? A) Prescriptive authority B) Admitting privileges C) Offers consultation services D) Membership on a multidisciplinary team
D Nurses at both levels are expected to collaborate with multidisciplinary teams; only the advanced practice nurse has prescriptive authority and admitting privileges and can provide consultation.
