Chapter 32: Serious mental illness

The nurse is caring for a patient with severe depression. What appropriate instruction does the nurse give the patient for effective treatment? 1 "Place the medication in a cool and dry place." 2 "Avoid using public transportation when traveling." 3 "Avoid doing house work like cooking and cleaning." 4 "Take a nap regularly during the day to avoid fatigue."

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

The nurse checks the medical history of a patient with severe mental illness and learns that the patient is depressed because of a relapse of the illness. Which action does the nurse initially follow to provide effective care? 1 The nurse performs crisis intervention for the patient. 2 The nurse checks the need for isolation of the patient. 3 The nurse encourages the patient to interact with his or her peers. 4 The nurse suggests that the patient adhere to his or her medication.

1 The nurse performs crisis intervention for the patient.

Which outcome is appropriate when a patient diagnosed with a serious mental illness (SMI) is employed in a clubhouse model business? Select all that apply. 1 Decreased dependency 2 Increased self-confidence 3 Decreased self-motivation 4 Improved socialization skills 5 Improved organization abilities

1 Decreased dependency 2 Increased self-confidence 4 Improved socialization skills 5 Improved organization abilities

Which interventions are characteristic of the assertive community treatment (ACT) service model? Select all that apply. 1 Development of a personalized multidisciplinary team 2 Patient is assigned a room in an ACT-managed facility. 3 Identification of a comprehensive list of needed services 4 Operation costs will be modest compared with other care models. 5 Contact with 24-hour-a-day crisis intervention personal is provided.

1 Development of a personalized multidisciplinary team 3 Identification of a comprehensive list of needed services 5 Contact with 24-hour-a-day crisis intervention personal is provided.

The nursing diagnosis of a patient is chronic low self-esteem. What are the expected nursing outcomes of this condition? Select all that apply. 1 Maintain good eye contact. 2 Exhibit insensitivity to others. 3 Talk about feelings of self-worth. 4 Keep medical care appointments. 5 Realize personally significant roles.

1 Maintain good eye contact. 3 Talk about feelings of self-worth. 5 Realize personally significant roles.

Which statement by a young patient who has severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? 1 "I like to watch cartoons every morning." 2 "I hear that marijuana helps calm you down." 3 "I am looking for a job washing dishes at a diner." 4 "I hate having my thoughts so messed up all the time."

2 "I hear that marijuana helps calm you down."

A patient suffering from serious mental illness undergoes relapse due to nonadherence to treatment. The patient does not spend responsibly and is homeless due to not paying rent regularly. Which response would be most therapeutic? 1 The patient is shifted to a community home to avoid homelessness. 2 A guardianship program is employed to manage the financial needs. 3 The patient is encouraged to live with the condition and develop social skills. 4 The case manager is advised to take more responsibility in the management of the case.

2 A guardianship program is employed to manage the financial needs

Psychiatric nurses use basic nursing interventions in all settings. The basic nursing interventions include all but which of the following? 1 Health teaching 2 Housing access 3 Crisis intervention 4 Case management

2 Housing access

Which finding indicates indirect harm to self in a patient diagnosed with a serious mental illness (SMI)? 1 Paranoia 2 Malnutrition 3 Suicidal ideation 4 Homicidal tendencies

2 Malnutrition

How will the nurse working with a patient diagnosed with severe and persistent mental illness implement rehabilitation principles? 1 Reviewing earlier treatment plans for errors 2 Focusing assessment on the patient's deficits 3 Identifying and reinforcing the patient's strengths 4 Considering the need to lower expectations periodically

3 Identifying and reinforcing the patient's strengths

. A 20-year-old male Amish patient who was diagnosed with paranoid schizophrenia one year ago and who lives with his parents is admitted to the psychiatric unit with psychosis because of nonadherence to his medication regime. When the nurse attempts to educate the patient diagnosed with paranoid schizophrenia about his diagnosis and the need for medication, the patient persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to identify the patient's behavior? 1 Apathy 2 Religiosity 3 Resistance 4 Anosognosia

4 Anosognosia

Which is the best nonpharmacologic treatment method for managing symptoms in a patient who is experiencing delusions and impaired social functioning? 1 Role play 2 Group interaction 3 Supportive psychotherapy 4 Cognitive-behavioral therapy

4 Cognitive-behavioral therapy (CBT) is effective in reducing and managing delusions and impaired social functioning in a patient with serious mental illness (SMI). CBT helps patients identify distorted thoughts and replace them with effective thinking and behavior.

An adult diagnosed with a serious mental illness has difficulty taking prescribed oral medications. This patient lives alone and says, "Some days I can't remember if I've taken my morning or nighttime medicine." Which strategy should the nurse use first to assist this patient? 1 Include the patient in medication education groups to enhance compliance. 2 Arrange for the patient to come to the clinic daily for medication administration. 3 Ask the health care provider to change this patient from oral medications to depot injections. 4 Confer with the health care provider about changing the patient to a once-daily dosing regimen.

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

A male patient diagnosed with a severe mental illness and institutionalized for most of his adult life recently has been transferred to a supervised community-based residential home that houses several other adult men. The patient is resistant to going to day therapy and has begun to socially isolate if allowed. He has apparent weight loss and has become uncooperative. What is the most likely reason for these changes? 1 Is experiencing a decreased sense of self 2 Has begun showing signs of independence 3 Is lazy now that he is not on a regular schedule 4 Has begun exhibiting a lack of desire to attend the day program

1 Is experiencing a decreased sense of self

A patient diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around the others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis? 1 Acute confusion 2 Social isolation 3 Impaired comfort 4 Risk for activity intolerance

2 Social isolation

What is a feature of the recovery model supported by the National Alliance on Mental Illness (NAMI) for management of persons with serious mental illness? 1 It focuses on the patient's strengths and abilities. 2 It improves quality of life with continuous care. 3 It emphasizes the illness and the current care. 4 It focuses on goals set by the nursing staff.

1 It focuses on the patient's strengths and abilities The recovery model supported by NAMI focuses on the strengths and abilities of the patient and how to improve them so that the patient can overcome the illness and disability. A recovery model is planned to deinstitutionalize the patients so that they can be independent and acute care is needed only during relapse. It does not provide continuous care. Its emphasis is on developing personal and social coping abilities in the person and on an improved future rather than on the illness. The focus is not on achieving goals set by the nurse or any other staff. The patient chooses the goals.

The nurse is educating a patient on the importance of establishing a meaningful life. What is considered an appropriate way of achieving a meaningful life? 1 Learning to help others or volunteering 2 Concentrating on things other than the illness 3 Properly following plans for institutionalization 4 Being punctual and well-mannered for every medical visit

1 Learning to help others or volunteering

A convicted person is found "Not Guilty by Reason of Insanity" and does not require hospitalization. What measure is taken to manage the care of the patient? 1 Supervised housing service 2 Community outreach program 3 Emergency psychiatric services 4 Cognitive enhancement therapy

1 Supervised housing service Forensic patients do not require inpatient care but require special intensive monitoring and programming in the community. Housing services are suitable for this kind of patients. These services help the individual to be self-sufficient, maintain stability, and avoid homelessness. Emergency psychiatric services help to assess emergencies and provide crisis interventions. These services may respond to psychiatric emergencies in patient residencies and jails or even on street corners. Community outreach programs are focused on homeless patients with mental illness, help in medical needs and self-care, and provide patient advocacy. Cognitive enhancement therapy stimulates the healthier parts of the brain and targets improving cognition level in patients. These therapies are not focused on persons found "Not Guilty by Reason of Insanity."

The nursing students are learning about assertive community treatment (ACT). When they are asked about it, which statement by a student conveys a proper understanding? 1 The patient is shifted to a community home to reduce homelessness. 2 ACT provides the needed range of services by a multidisciplinary team. 3 A 24-hour monitoring is absent in order to reduce dependency in patients. 4 ACT has a cheaper cost as a multidisciplinary team comes under one roof.

2 ACT provides the needed range of services by a multidisciplinary team

A patient diagnosed with serious mental illness and who lives in the community says to the nurse, "You try to be so helpful to me but I'm not worth your energy. You should spend your time helping other patients who have a chance to get well." Which nursing diagnosis applies? 1 Anxiety 2 Chronic low self-esteem 3 Disturbed thought processes 4 Personal identity disturbance

2 Chronic low self-esteem

A nurse is providing discharge education for a patient who frequently experiences hallucinations. What strategy can the nurse suggest the patient use when experiencing hallucination in public? 1 Moving to a quiet area 2 Encouraging reality testing 3 Contacting the healthcare provider 4 Taking additional medication as needed

2 Encouraging reality testing The nurse can suggest the patient use reality testing to help recognize and counter the hallucinations. This strategy enables the patient to learn to scan the public area to determine if others seem frightened. If the patient is unable to do this, he or she can learn to attribute the experience to the illness and to ignore the hallucinations. Moving to a quiet area, contacting the healthcare provider, or taking additional medication may not always be possible and do not lessen the hallucinations at the time the patient is experiencing them.

Which treatment approach is most likely to be included in the plan of a care for a patient with a SMI that needs to work on assertiveness? 1 Cognitive enhancement therapy 2 Psychoeducation group therapy 3 Use of a peer support specialist 4 Wellness and recovery action plan

2 Psychoeducation group therapy A psychotherapy approach that will assist a patient with serious mental illness to work on assertiveness is a psychoeducational group, which is useful in educating patients about mental health topics and working on communication skills. Cognitive enhancement therapy is used to challenge and strengthen functions such as focusing attention, processing, and recalling information. A wellness and recovery action plan is a psychoeducational program that empowers and trains patients in skills that promote recovery and prepare them to deal with stressors and crisis. Use of a peer support specialist involves the support from a peer who has experienced what the patient is experiencing.

An adult diagnosed with mental illness was brought by police to the emergency department. The adult was wandering in the community, wearing provocative clothing, yelling obscenities, and threatening to shoot the mayor. Which behavior most clearly meets criteria for involuntary hospitalization of this adult? 1 Yelling obscenities 2 Threats to shoot the mayor 3 Wandering in the community 4 Wearing provocative clothing

2 Threats to shoot the mayor

The goal of a nurse working in psychiatric rehabilitation would be to help patients in the community do which of the following? 1 Achieve complete mental health 2 Cope more effectively with their symptoms 3 Continue to live comfortably in a psychiatric treatment facility 4 Learn to live with dependency and be content with fewer opportunities

2 Cope more effectively with their symptoms

The primary health care provider instructs the nurse to provide day programs to a patient with severe mental illness. What appropriate action should the nurse take while conducting the day program for the patient? 1 Instruct the patient to be silent during the program. 2 Conduct the day program once a month for the patient. 3 Arrange a prevocational trainer to work with the patient. 4 Make prominent eye contact with the patient during the program.

3 Arrange a prevocational trainer to work with the patient. Day programs are designed to involve the patient in therapeutic activities to enhance socialization and to improve self-esteem. Prevocational training involves teaching the patient about the fundamentals required before one could be successfully employed, for example, how to dress, and how to interview; such training is included in prevocational training. This helps the patient to improve interpersonal skills and develop confidence. The nurse should conduct the program once or several times a week. Conducting the program once a month will not be effective because of the long gap between programs. Encouraging the patient to interact in the day programs helps in assessing the strengths and the thoughts of the patient. The program should be interactive, and the patient should be asked to actively participate. Making prominent eye contact while giving instructions can make some patients with mental illness feel uncomfortable. As a result, the patient may avoid interacting and participating in the programs.

The nurse maintains a record of regular supplies of hot meals, clothing, transportation, and mailing addresses of patients with severe mental illness. Which community service (or program) can the nurse use to perform these functions? 1 Guardianship 2 Housing services 3 Multiservice centers 4 Partial hospital programs

3 Multiservice centers There are many community services and programs for the effective treatment and care of patients with severe mental illness. Multiservice centers work in collaboration with the other services listed to supply hot meals, clothing, and mailing address to the patient. Housing services are provided to patients who have committed an offense while suffering from severe mental illness. It helps the patient to maintain stability and live independently without depending on others. In partial hospital programs, the patient is given treatment similar to that provided to an inpatient of a psychiatric ward. Patients from inpatient units are referred to partial hospitalization programs after effective treatment. These programs help to stabilize the patient within the community and their surroundings. In guardianship, a person is appointed to make treatment decisions for a patient with impaired judgment.

In the context of cognitive enhancement therapy (CET), which sentence is most appropriate to describe this method of treatment? 1 Helps to avoid homelessness 2 Focuses on thought patterns 3 Stimulates healthier areas of brain 4 Gives services to high-need persons

3 Stimulates healthier areas of brain

Severely mentally ill patients often express a strong desire to be employed. According to the evidence-based research, the most effective model of employment for these patients is which of the following? 1 Productive employment 2 Vocational rehabilitation 3 Supported employment 4 A job placement program

3 Supported employment

One of the roles of a case manager working with severely and persistently mentally ill patients who are homeless is to do which of the following? 1 Administer medication 2 Teach the patients to function independently 3 Ensure that the patients are not rehospitalized 4 Coordinate needed services and provide outreach

4 Coordinate needed services and provide outreach

An issue for severely and persistently mentally ill patients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this? 1 Discontinue antipsychotics that cause untoward side effects 2 Use patient empowerment techniques to increase patient autonomy 3 Develop tools to predict relapse and assess the potential for violence 4 Shift follow-up from social workers to the assertive community treatment (ACT) model

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