Chapter 4,8,9 Mental Health
What are the 4 elements of psychiatric homecare medicare requires to reimburse
1) homebound status 2) presence of psychiatric diagnosis 3) Need for the skills of a psychiatric RN 4) Plan of care developed under physician orders
What are the 5 characteristics of PCMH
1. patient centered- unique to the person 2. Comprehensive care- all levels of mental health addressed 3. coordination of care- broader health system 4. Improved access- not limited to 9-5 5. Systems approach- evidence based care
A nurse surveying medical records would find evidence suggesting which client's rights have been violated? A) A client was not allowed to have visitors. B)A client's belongings were searched at admission. C)A client with suicidal ideation was placed on continuous observation. D) Physical restraint was used after a client was assaultive toward a staff member.
A) A client was not allowed to have visitors.
What action is an example of tertiary prevention? A) Helping a person diagnosed with a serious mental illness learn to manage money B) Restraining an agitated client who has become aggressive and assaultive C) Teaching school-age children about the dangers of drugs and alcohol D) Genetic counseling with a young couple expecting their first child
A) Helping a person diagnosed with a serious mental illness learn to manage money - Tertiary prevention involves services addressing residual impairments, with goal of improved functioning. Restraint is secondary prevention Substance abuse education for children is primary prevention
Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? A) Resolve the crisis with the least restrictive intervention possible. B) Swift intervention is justified to maintain the integrity of a therapeutic milieu. C) Rights of an individual client are superseded by the rights of the majority of clients. D) Clients should have opportunities to regain control without intervention if the safety of others is not compromised.
A) Resolve the crisis with the least restrictive intervention possible. -The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the client's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the client threatens harm to self.
In-client hospitalizations for people with mental illness is typically reserved for pt's who demonstrate which characteristic? A) present a clear danger to self or others. B) are noncompliant with medication at home. C) have limited support systems in the community. D) develop new symptoms during the course of an illness.
A) present a clear danger to self or others.
When a patient says, "I've done a lot of cheating and manipulating in my relationships.", what nonjudgmental response should the nurse provide? A. "How do you feel about that?" b."I am glad that you realize this." c."That's not a good way to behave." d."Have you outgrown that type of behavior?"
A. "How do you feel about that?" - ask pt to reflect on their feelings about their actions does not imply any judgement
A patient says, "Please don't share information about me with the other people." How should the nurse respond? A) I will not share information with your family or friends without your permission, but I will share information about you with other staff." B) "A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know." C) "It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others." D) "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us."
A. "I will not share information with your family or friends without your permission, but I will share information about you with other staff." - A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Other staff needs to know pertinent data.
A nurse makes an initial visit to a homebound client diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. What is the nurse's best response? A. "Thank you. I would enjoy having a cup of coffee with you." B. "Thank you, but I would prefer to proceed with the assessment." C. "No but thank you. I never accept drinks from clients or families." D. "Our agency policy prohibits me from eating or drinking in clients' homes."
A. "Thank you. I would enjoy having a cup of coffee with you." - Accepting refreshments or talking informally with patient and family represent therapeutic use of self and help to establish rapport.
What is the best explanation a nurse can give to the family of a mentally ill patient regarding how a nurse-patient relationship differs from social relationships? A. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." b."The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented." c."The focus of the relationship is socialization. Mutual needs are met, and feelings are shared openly." d."The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other."
A. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient."
Which statement shows a nurse has empathy for a patient who made a suicide attempt? A. "You must have been very upset when you tried to hurt yourself." b."It makes me sad to see you going through such a difficult experience." c."If you tell me what is troubling you, I can help you solve your problems." d."Suicide is a drastic solution to a problem that may not be such a serious matter."
A. "You must have been very upset when you tried to hurt yourself." - empathy permits the nurse to see an event from patients perspective, understand pt feelings THE INNCORRECT RESPONSES ARE NURSE'S FEELINGS RATHER THAN PATIENTS... SYMPATHETIC IS A NO
Which benefits are most associated with use of telehealth technologies? (Select all that apply.) A. Cost savings for clients b.Maximize care management c.Access to services for clients in rural areas d.Prompt reimbursement by third-party payers e.Rapid development of trusting relationships with clients
A. Cost savings for clients b.Maximize care management c.Access to services for clients in rural areas
A nurse performed these actions while caring for clients in an inpatient psychiatric setting. Which action violated clients' rights? A. Prohibited a client from using the telephone B. In client's presence, opened a package mailed to client C. Remained within arm's length of client with homicidal ideation D. Permitted a client with psychosis to refuse oral psychotropic medication
A. Prohibited a client from using the telephone -The patient has the right to use the phone; the patient should be protected against possible harm to self or others. Patient's have the right to send and receive mail and be present during package inspection. Patients have the right to refuse treatment
A client diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the client: · wants to attend an activity group at the mental health outreach center. · is worried about being able to pay for the therapy. · does not know how to get from home to the outreach center. · has an appointment to have blood work at the same time an activity group meets. · wants to attend services at a church that is a half-mile from the client's home. Which tasks are part of the role of a community mental health nurse? (Select all that apply.) A. Rearranging conflicting care appointments B. Negotiating the cost of therapy for the client C. Arranging transportation to the outreach center D. Accompanying the client to church services weekly E. Monitoring to ensure the client's basic needs are met
A. Rearranging conflicting care appointments C. Arranging transportation to the outreach center E. Monitoring to ensure the client's basic needs are met -These answers reflect coordinating the role of the community psychiatric nurse case manager. -Accompanying the patient to church and negotiating cost of therapy are not interventions the nurse would partake in.
Which technique will best communicate to a client that the nurse is interested in listening? A. Restating a feeling or thought the pt has expressed B. Asking a direction question, "Did you feel angry" C. Making judgement about the patient's problem D. Saying "I understand what you're saying"
A. Restating a feeling or thought the pt has expressed - restating allows the pt to validate the nurses understanding of what has been said. This is an active listening technique. -- Close ended questions "Did you feel angry" ask for information rather than understanding
A nurse can best address factors of critical importance to successful community treatment by including making assessments focused on what? (Select all that apply.) A. housing adequacy. B. family and support systems. C. income adequacy and stability. D. early psychosocial development. E. substance abuse history and current use.
A. housing adequacy. B. family and support systems. C. income adequacy and stability. E. substance abuse history and current use. -Early psychosocial development are less relevant to successful outcomes in the community than the other options. -If a client is homeless or fears homelessness, focusing on other treatment issues is impossible -Sufficient income for basic needs and medication is necessary. -Adequate support is a requisite to community placement. -Substance abuse undermines medication effectiveness & interferes with community adjustment
Who is legally able to conduct talk therapy?
Advanced practice registered nurses
Which treatment center works intensively with patients in their homes or in agencies, hospitals, and clinics—whatever settings patients find themselves in, assist patients with creative problem solving and intervention
Assertive Community Treatment
What are common goals of talk therapy?
Assist patient with problem solving, help patient examine self defeating behaviors and help them find alternatives, promote self-care
What type of prevention are restraints? A) Primary B) Secondary C) Tertiary
B) secondary
A nurse receives these three phone calls regarding a newly admitted client. · The psychiatrist wants to complete an initial assessment. · An internist wants to perform a physical examination. · The client's attorney wants an appointment with the client. The nurse schedules the activities for the client. Which role has the nurse fulfilled? a.Advocate b.Case manager c.Milieu manager d.Provider of care
B. Case manager - nurses serve as case managers
After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. What does this action by the nurse best demonstrate? A. Triage B. Primary prevention C. Psychosocial rehabilitation D. Psychiatric case management
B. Primary prevention -Tornado victims are at risk for psychiatric problems due to stress and trauma. -Primary prevention occurs before any problem is manifested; seeks to reduce incidence, or rate of new cases. Primary prevention may prevent or delay the onset of sx in predisposed individuals. Disaster victims benefit from telling their story. - Triage refers to the process of sorting out victims based on emergent needs for treatment. - Psychosocial groups are designed to assist people diagnosed with serious mental illness to develop living skills. - Psychiatric case management refers to services to assist patient in finding housing or obtaining entitlements
A client of color says to a Caucasian nurse, "There's no sense talking about how I feel. You wouldn't understand because you live in a white world." What is the nurse's best action ? A. Explain, "Yes, I do understand. Everyone goes through the same experiences." B. Say, "Please give an example of something you think I wouldn't understand." C. Reassure the client that nurses interact with people from all cultures. D. Change the subject to one that is less emotionally disturbing.
B. Say, "Please give an example of something you think I wouldn't understand." - have pt give specifics instead of globally will help nurse understand pt perspective.
A client was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the client received a notice of eviction immediately prior to admission. What is the case manager's most appropriate action? A) Postpone the client's discharge from the hospital. B) Contact the landlord who evicted the client to further discuss the situation. C) Arrange a temporary place for the client to stay until new housing can be arranged. D) Determine whether the adverse medication reaction was genuine because the client had nowhere to live.
C) Arrange a temporary place for the client to stay until new housing can be arranged
A suspicious, socially isolated client lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. What is the community psychiatric nurse's best initial action? A) Exploring ways to help the client stop smoking. B) Reporting the situation to the manager of the shelter. C) Assessing the client's weight; determine foods and amounts eaten. D) Arranging hospitalization for the client in order to formulate a new treatment plan.
C) Assessing the client's weight; determine foods and amounts eaten. - Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters.
A client diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The client's thoughts are now more organized, and discharge is planned. The client's family says, "It's too soon for discharge. We will just go through all this again." What action should the nurse take? A) ask the case manager to arrange a transfer to a long-term care facility. B) notify hospital security to handle the disturbance and escort the family off the unit. C) explain that the client will continue to improve if the medication is taken regularly. D) contact the health care provider to meet with the family and explain the discharge rationale.
C) explain that the client will continue to improve if the medication is taken regularly.
After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? A. The patient's reactions toward nurse appear to be realistic and appropriate B. The patient states "Talking to you feels like talking to my parents" C. "The nurse feels unusually happy when the patient's mood begins to lift" D. The nurse develops a trusting relationship with the patient
C. "The nurse feels unusually happy when the patient's mood begins to lift" - strong positive or negative emotions toward patient or over identifying with patient indicate possible countertransference and then seek supervision.
A client tells the nurse, "I don't think I'll ever get out of here." What is the nurse's most therapeutic response? A. "Don't talk that way. Of course, you will leave here!" B. "Keep up the good work, and you certainly will." C. "You don't think you're making progress?" D. "Everyone feels that way sometimes"
C. "You don't think you're making progress?" - the nurse is reflecting on the comment, issues are easier to identify. -- saying everyone feels that way could minimize pt's feelings. - all other options are false hope
A client discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? A. What are the common elements here B. Tell me again about your experiences C. Am I correct in my understanding of that D. Tell me everything from the beginning
C. Am I correct in my understanding of that - permits clarification to ensure nurse and pt are sharing same understanding
Termination of a therapeutic nurse-patient relationship has been successful when the nurse engages in what activity? A. Avoids upsetting the patient by shifting focus to other patients before the discharge. B. Gives the patient a personal telephone number and permission to call after discharge. C. Discusses with the patient changes that happened during the relationship and evaluates outcomes. d. Offers to meet the patient for coffee and conversation three times a week after discharge.
C. Discusses with the patient changes that happened during the relationship and evaluates outcomes. - this helps validate the experience for the patient, helps with closure. If termination is not discussed the pt could experience abandonment
As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, "Thank you for helping mend my broken heart." Which is the nurse's best response? A. Accepting gifts violates the policies and procedures of the facility." b."I'm glad you feel so much better now. Thank you for the beautiful necklace." c."I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope." d."Helping people is what nursing is all about. It's rewarding to me when patients recognize how hard we work."
C. I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope."
"The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services. There is a broader treatment of care including home services, as well as improved access- patients are not limited to M-F 9-5" is which treatment setting? A. Partial Hospitalization Program B. Intensive Outpatient Program C. Patient Centered Medical Home D. Community Mental Health Centers
C. Patient Centered Medical Home - Community mental health centers provide emergency services, community/home based services, out-patient services across a lifespan.
Which principle should guide the nurse in determining the extent of silence to use during client interview sessions? A. A nurse is responsible for breaking silences. B. Clients withdraw if silences are prolonged. C. Silence can provide meaningful moments for reflection. D. Silence helps clients know that what they said was understood.
C. Silence can provide meaningful moments for reflection. - this gives opportunity to contemplate what has been transpired, and formulate ideas
What is the initial action of a case manager who plans to discuss the treatment plan with a client's family? a.Determine an appropriate location for the conference. b.Support the discussion with examples of the client's behavior. c.Obtain the client's permission for the exchange of information. d.Determine which family members should participate in the conference.
C.Obtain the client's permission for the exchange of information. - must respect patients right to privacy, extends discussion with family.
The unit secretary receives a phone call from the health insurer for a hospitalized client. The caller seeks information about the client's projected length of stay. How should the nurse instruct the unit secretary to handle the request? a.Obtain the information from the client's medical record and relay it to the caller. b.Inform the caller that all information about clients is confidential. c.Refer the request for information to the client's case manager. d.Refer the request to the health care provider.
C.Refer the request for information to the client's case manager. - The case manager usually confers with insurers and provides the treatment team with information about available resources. The unit secretary should be mindful of client confidentiality and should neither confirm that the client is an inpatient nor disclose other information.
Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a client? A) Hygiene assistance B) Diversional activities C) Assistance with job hunting D)Building assertiveness skills
D) Building assertiveness skills - Assertiveness training relies on the counseling and psychoeducational skills of the nurse.
Which client would be most appropriate to refer for assertive community treatment (ACT)? A) .One diagnosed with a phobic fear of crowded places. B) One who experienced a single episode of major depressive disorder. C) One who experienced a catastrophic reaction to a tornado in the community. D) One diagnosed with schizophrenia who had four hospitalizations in the past year.
D) One diagnosed with schizophrenia who had four hospitalizations in the past year. - ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distractors identify mental health problems of a more episodic nature.
The psychiatric unit has one bed available. Which client should be admitted from the emergency department? A) The client feeling anxiety and a sad mood after separation from a spouse of 10 years. B) The client who self-inflicted a superficial cut on the forearm after a family argument. C) The client experiencing dry mouth and tremor related to taking antipsychotic medication. D) The client who is a new parent and hears voices saying, "Smother your baby."
D) The client who is a new parent and hears voices saying, "Smother your baby." - risk of patient danger to self or others. The other patients have issues that can be dealt with less restrictive alternatives
Clinical pathways are used in managed care settings to accomplish what? A) stabilization of aggressive clients. B) identifying obstacles to effective care. C)relieving nurses of planning responsibilities. D) streamlining the care process to reduce costs.
D) streamlining the care process to reduce costs. - Guidelines for assessments, interventions, treatments, and outcomes as a designated timeline for accomplishment.
The nurse should refer which of the following clients to a partial hospitalization program? A. One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. B. One who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. C. One who spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. D, One who cannot avoid using alcohol when their spouse goes to work every morning.
D, One who cannot avoid using alcohol when their spouse goes to work every morning. - Patient could benefit from structure and supervision provided at the partial hospitalization program. - In the evening, nights, and on weekends, spouse can take over responsibilities for supervision. - A suicidal patient needs inpatient hospitalization
A nurse interacts with a newly hospitalized client. Which of the nurse's comments applies the communication technique of "offering self?" A. "I've also had traumatic life experiences. Maybe it would help if I told you about them." B."Why do you think you had so much difficulty adjusting to this change in your life?" C."I hope you will feel better after getting accustomed to how this unit operates." D. "I'd like to sit with you for a while to help you get comfortable talking to me."
D. "I'd like to sit with you for a while to help you get comfortable talking to me." - used in the orientation phase of nurse-patient relationship. The other response is an example of offering hope
Which treatment center provides therapy, family therapies, medication prescription and management, emergency services, outpatient services, continument of treatment and management? A. Partial Hospitalization Program B. Intensive Outpatient Program C. Patient Centered Medical Home D. Community Mental Health Centers
D. Community Mental Health Centers
A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, "I really need to talk to you." What action should nurse take? A. Invite the interrupting patient to join in the session with the current patient. B. Tell the interrupting patient, "I am not available to talk with you at the present time." C. End the unproductive session with the current patient and spend time with the interrupting patient. D. Tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."
D. Tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."
What refers to the patient's inability to leave home on their own due to physical or mental conditions?
Homebound
What is the function of a social worker in a mental-health facility? Do they counsel?
No. They assist patient to find resources- look for housing, a doctor.
What are main concepts for nurse patient relationship?
Patient centered care dignity and respect information sharing patient and family participation Collab with policy and program Clear and appropriate boundaries
What is the center of focus in PCMH
Patient centered- comprehensive care, can help manage other medical disorders
Stages of nurse-patient relationship
Pre Interaction: Explore feelings, fears, analyze own personal strengths and limits, gather data about patient Orientation: determine why patient sought help, establish trust, acceptance, open communication, formulate contract under mutual understanding, explore patient thoughts, feelings, and actions, identify patient problems, define goals with patient Working: explore stressors, instruct constructive coping, overcome resistance behavior Termination: Establish reality of separation, renew progress of therapy, and attainment of goals, explore feelings of rejection, loss, sadness and anger and related behaviors
Which phase of the nurse-patient relationship reviews patient chart and reviews report on patient? A. Pre Orientation B. Orientation C. Working phase D. Termination phase
Pre-orientation
What is the least restrictive and most preferred environment of mental health care
Primary care
What do nurses do in community mental health centers?
Provide med administration, mental health education to help individuals continue treatment
Psychiatrist vs. Psychologist; which one prescribes and which one conduct psychological testing
Psychiatrists prescribe medications for psychiatric sx; Psychologists conduct psychological testing
Which specialized psychiatric care providers can prescribe medications?
Psychiatrists, advanced practice psychiatric nurses, and physician assistants.
What therapy is "talk therapy" based off?
Psychotherapy
Secondary prevention
REDUCING prevalence of psych disorders
Primary Prevention
Takes place before any problem manifests. - may prevent or delay the onset of sx - coping strategies and psychosocial support for vulnerable young people- effective in preventing mood & anxiety disorders
What is the problem with intensive outpatient programs?
They are only M-F; leaving the person without care or intervention for 2 days
Why are patient centered medical homes beneficial?
They are patient centered; taking into account the person as a whole.
Tertiary Prevention
Treatment of disease, preventing relapse, rehabilitation. - in case of major depressive disorder, the aim to avoid losing job, prevent suicide
What is the goal of emergency care?
Triage and stabilization situation. - who would get seen 1st? Someone who is going to commit suicide or homicide
Which phase of nurse-patient relationship do behavioral changes begin to take place A. Pre Orientation B. Orientation C. Working phase D. Termination phase
Working phase
Which statements by clients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship? (Select all that apply.) a."My case manager talks in language I can understand." b."My case manager helps me keep track of my medication." c."My case manager gives me little gifts from time to time." d."My case manager looks at me as a whole person with many needs." e."My case manager let me do whatever I choose without interfering."
a."My case manager talks in language I can understand." b."My case manager helps me keep track of my medication." d."My case manager looks at me as a whole person with many needs."
Which scenario best depicts a behavioral crisis? a.A client is waving fists, cursing, and shouting threats at a nurse. b.A client is curled up in a corner of the bathroom, wrapped in a towel. c.A client is crying hysterically after receiving a phone call from a family member. d.A client is performing push-ups in the middle of the hall, forcing others to walk around.
a.A client is waving fists, cursing, and shouting threats at a nurse. - crisis because pt is threatening another individual
A psychiatric nurse discusses rules of the therapeutic milieu and clients' rights with a newly admitted client. Which rights should be included? (Select all that apply.) a.The right to have visitors. b.The right to confidentiality. c.The right to a private room. d.The right to report inadequate care. e.The right to select the nurse assigned to their care.
a.The right to have visitors. b.The right to confidentiality d. The right to report inadequate care. -Patient's rights should be discussed shortly after admission. Patients have the right to refuse visitors, privacy, filing complaints about inadequate care, and accepting/ refusing treatment (including meds). Patients do not have the "right" to a private room or selecting the nurse that will provide care.
A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious client. The client recently lost employment and could no longer afford prescribed medications. The client says, "Only a traitor would make me go to the hospital." What is the nurse's best initial intervention? a.With the client's consent, contact resources to provide medications without charge temporarily. b.Arrange a bed in a local homeless shelter with nightly on-site supervision. c.Hospitalize the client until the symptoms have stabilized. d.Ask the client, "Do you feel like I am a traitor?"
a.With the client's consent, contact resources to provide medications without charge temporarily. -Hospitalization may damage the nurse-client relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the client may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help clients who are unable to afford their medications.
Difference between psychotherapy and psychoanalyzing
analyzing the feeling for the reason of the behavior, looking at the history of it is psychoanalyzing Looking at the emotion, and why the patient feels the way they do in current day- not looking at root of problem and how they will approach the feeling moving forward is psychotherapy.
A client diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is most therapeutic? A. "Let's talk about something other than the CIA." b."It sounds like you're concerned about your privacy." c."The CIA is prohibited from operating in health care facilities." d."You have lost touch with reality, which is a symptom of your illness."
b."It sounds like you're concerned about your privacy." - do not challenge pt's beliefs, even if they are unrealistic. this will loosen trust between pt and nurse
Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a.Kindness b.Autonomy c.Compassion d.Professionalism
b.Autonomy - A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.
What is an example of primary prevention? a.Assisting a person diagnosed with a serious mental illness to fill a pill-minder b.Helping school-age children identify and describe normal emotions c.Leading a psychoeducational group in a community care home d. Medicating an acutely ill client who assaulted a staff person
b.Helping school-age children identify and describe normal emotions - preventing health problems from occurring
Which level of prevention activities would a nurse in an emergency department employ most often? a.Primary b.Secondary c.Tertiary
b.Secondary -An emergency department nurse would generally see clients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities.
Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention? a.Medication follow-up b.Teaching parenting skills c.Substance abuse counseling d.Making a referral for family therapy
b.Teaching parenting skills - directed to healthy populations to provide information for developing skills that promote mental health
What action should a nurse take to demonstrate genuineness with a patient diagnosed with schizophrenia? A) Restate what the patient says. b.Use congruent communication strategies. c.Use self-revelation in patient interactions. d.Consistently interpret the patient's behaviors.
b.Use congruent communication strategies. - Genuineness is a desirable characteristic involving awareness of one's own feelings as they arise and the ability to communicate them when appropriate. The incorrect options are undesirable in a therapeutic relationship.
A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. What do these observations relate to? a.coordinating care of clients. b.management of milieu safety. c.management of the interpersonal climate. d.use of therapeutic intervention strategies.
b.management of milieu safety. -
Which behavior shows that a nurse values autonomy? The nurse: a. suggests one-on-one supervision for a patient who has suicidal thoughts. b. informs a patient that the spouse will not be in during visiting hours. c. discusses options and helps the patient weigh the consequences. d. sets limits on a patient's romantic overtures toward the nurse.
c. discusses options and helps the patient weigh the consequences.
A patient says, "I'm still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?" What is the nurse's best response? A. "Why are you asking me when you're able to speak for yourself?" b."I will be glad to address it when I see your doctor later today." c."That's a good topic for you to discuss with your doctor." d."Do you think you can't speak to a doctor?"
c."That's a good topic for you to discuss with your doctor."
What behaviors will the patient demonstrate as desirable outcomes for the orientation stage of a nurse-patient relationship? A. Self-responsibility and autonomy. b.A greater sense of independence. c.Rapport and trust with the nurse. d.Resolved transference. - Rapport defines as: emotional connection of counselor and patient
c.Rapport and trust with the nurse. - rapport and trust is necessary before the relationship can progress to the working phase
During which phase of the nurse-patient relationship can the nurse anticipate that the patient's identified issues will be explored and resolved? A. Preorientation b.Orientation c.Working d.Termination
c.Working
During which phase of the nurse-patient relationship can the nurse anticipate that the patient's identified issues will be explored and resolved? A. Pre-orientation b.Orientation c.Working d.Termination
c.Working - the nurse strives to assist pt in making connections among dysfunctional behaviors, thinking, and emotions and offers support while coping mechanisms are tried.
A client says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response should the nurse use to clarify the client's comment? A. "It sounds as though you were uncomfortable with the content of your dream." b."I understand what you're saying. Bad dreams leave me feeling tired, too." c."So you feel as though you did not get enough quality sleep last night?" d."Can you give me an example of what you mean by 'stoned'?"
d."Can you give me an example of what you mean by 'stoned'?" - this technique is clarification- examine reason of pt's statement.
Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship? A. "I don't have any problems." b."It is so difficult for me to talk about problems." c."I don't know how it will help to talk to you about my problems." d."I want to find a way to deal with my anger without becoming violent."
d."I want to find a way to deal with my anger without becoming violent." - demonstrates willingness to make changes in behavior
A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should take what action? a. Suppress the angry feelings. b.Express the anger openly and directly with the patient. c.Ask the nurse manager to assign the patient to another nurse. d.Discuss the anger with a clinician during a supervisory session.
d.Discuss the anger with a clinician during a supervisory session. - objectivity is threatened by strong positive or negative feelings
How would the nurse assigned to ACT best explain the program's treatment goal? a.assisting clients to maintain abstinence from alcohol and other substances of abuse. b.providing structure and a therapeutic milieu for mentally ill clients whose symptoms require stabilization. c.maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness. d.providing services for mentally ill individuals who require intensive treatment to continue to live in the community.
d.providing services for mentally ill individuals who require intensive treatment to continue to live in the community. - ACT program provides intensive community services with people with serious, persistent mental Illness
What does a psychiatric-mental health APRN do in psychiatric care?
diagnosing psychiatric conditions, prescribing psychotropic medications and conducting psychotherapy
What do community mental health centers provide?
emergency services, community/home services, outpatient services
Patient Centered Medical Home
mix between psychiatric homecare and community mental hental centers. - help take medications, and give them structure
What is the role of psychiatric registered nurses in psychiatric homecare
provide evaluation, therapy, and teaching
What is the importance of a well-managed milieu
sense of security and help promote healing
Who assists the patient prepare a support system that will promote mental health upon discharge from the hospital.
social worker
Why might PCPs have an important role in psychiatric care>
their treatment feels familiar, and might reduce "stigma"
