Test #4 - Chapter 4
The nurse works for a psychiatric-mental health facility that utilizes traditional milieu therapy. Which stage of milieu therapy allows for control and limitation of maladaptive behaviors including yelling and screaming?
Structure
Which client is suitable for psychiatric transitional care services?
An individual being discharged from hospital with residual symptoms of mania
A nurse is caring for a client with severe and persistent mental illness. As a case manager, what interventions should the nurse do for the client? Select all that apply.
Arrange for financial resources required for the treatment. Teach caregivers about behavior modifications required to manage the client. Help the caregivers to cope with stress related to the illness of the client. Refer the client to other community mental health services that would be beneficial for the client.
Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness?
Assertive community treatment
Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model?
Case management
The most diverse role for the nurse within community based psychiatric mental health care would most probably be what?
Case manager
A client was diagnosed with bipolar I disorder several years ago. After occasional inpatient admissions surrounding manic episodes over the past few years, the client has been receiving outpatient psychiatric services for the past 12 months. The client's care providers, however, are concerned that these outpatient services are not meeting the client's needs. Which service would best fit this client's needs at this time?
A day-treatment program
A client with mental illness is being discharged to a group home. The discharge planning nurse is helping the family to make the transition. The discharge planning nurse is least responsible for what related to the client's discharge?
Chart review for inadequacies
The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions?
Coordination of care
Which is an example of secondary prevention in the forensic setting?
Crisis intervention
A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier?
Clients commonly struggle with trusting others.
A nursing instructor informs a class that the trend in the United States today is to receive treatment without institutional-based intervention. What else is true concerning mental health care today?
Criteria for admission to inpatient care have become legally regulated.
The introduction of psychotropic medications occurred in which decade?
1950s
How does the rate of suicide among active and veteran military personnel compare to that of the civilian population?
2 times higher
Which mental health clients is most likely to frequently present in the emergency department in hospital?
A 34-year-old person diagnosed with an amphetamine addiction who has overdosed
A nursing instructor is teaching a class about transitional psychiatric care. The instructor determines that additional education is needed when the class identifies which client as appropriate for this care?
A 42-year-old who would like to enter marriage counseling
Psychiatric home care would be inappropriate for which individual?
A 42-year-old who would like to enter marriage counseling
Which client would be most likely to qualify for psychiatric care in a long-term care setting?
A client who has multiple sclerosis and a history of depression
Which client may be the most appropriate candidate for telepsychiatry?
A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health
Which best defines a community support system in relation to mental illness?
A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation
A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use?
Ability to provide services in a variety of locations
Which is the most restrictive setting in the continuum?
Acute inpatient hospitalization
A client has threatened to kill the client's spouse, and it is not anticipated that this crisis will resolve itself. The client is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which as the focus of care?
Acute symptom stabilization
Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what?
An inability to leave the home due to chronic physical, psychosocial, or medical problems
A client with a mental illness is receiving supportive housing during a 24-hour period on an ongoing basis. Which type service is the client most likely receiving?
Community-based residential services
Which would not be considered an impediment to successful discharge planning?
Compliance with the therapeutic regimen
A client with psychiatric illness is referred to the day treatment program. Which services should the nurse include while teaching the client about the program? Select all that apply.
Development of social skills. Stabilization of symptoms. Training to perform activities of daily living.
The nurse is reviewing a client's history, which reveals that the client is participating in a psychiatric rehabilitation program. The nurse understands that which is the goal of this program?
Empower clients to achieve the highest level of functioning possible
The approach of the services provided to facilitate recovery for individuals must be based on which aspect?
Empowerment
The client is a 46-year-old who is being admitted to a psychiatric-mental health facility. The client is angry, defensive, and paranoid. Which is the nurse's priority?
Ensuring client and personal safety
The greatest impact case management has had on mental health care is that it has caused what?
Has increased client access to appropriate mental health care
The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship?
Health teaching
A psychiatric client's nurse case manager best explains to the family that case management will facilitate the client's transition back into the community by providing which services?
Identifying and meeting the client's health and human service needs
A young client with severe depression and signs of hopelessness is seen in the emergency department of a large community hospital. The physician determines the need for a psychiatric consult. After the consult, the care team determines that the client is in need of hospitalization. Where should the nurse expect this client to be admitted?
In-house psychiatric unit
A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus?
Improved access to less costly services
Which goal for an individual client is consistent with the overall objectives of community support service programs?
The client's functional ability will improve.
Assertive Community Treatment (ACT) reduces the use of which type of service?
In-patient Hospital
Which statement is true concerning clients with dual diagnoses?
Integrated care is preferred over split care for the separate diagnoses
A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize?
Intensive treatment that prepares the client to live in the community
Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply.
Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills
Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply.
Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills
The nurse working in a psychiatric institution is researching treatment systems that facilitate effective learning. The nurse believes that effective milieu therapy cannot be practiced in today's institutional settings. What disadvantage related to milieu therapy may have led the nurse to believe this?
It requires clients to have longer lengths of stay.
A psychiatric-mental health nurse is working as a case manager. The nurse understands that the quality of case management is measured by outcomes that result from what?
Level of functioning
A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what?
Maintenance of the therapeutic environment
Which areas of discharge planning are important to ensuring client safety? Select all that apply.
Medication education Food-drug interactions Special diet instructions
The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse?
Members receive mental health treatment from providers in the community.
The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what?
Mental illness
Which statement regarding those with serious and persistent mental illness (SPMI) is correct?
Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.
Despite family members' concerns, a client has been discharged home after a recent suicide attempt and a diagnosis of major depression. Which phenomenon has been identified as contributing to reduced lengths of hospital stays in recent years?
Pressures to reduce health care costs associated with inpatient care
Which type of setting is used for clients who continue to need supervision but not long-term admission?
Partial (day) hospitalization
The client is a 54-year-old who is addicted to drugs and alcohol. Which setting would be best for an individual in need of support to minimize the risk of repeat hospitalizations?
Partial hospitalization program
Which mental health treatment setting is not a residential treatment setting?
Partial hospitalization programs
Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan?
Partnering with the client from the beginning
The goal of respite services as a prevention strategy includes what?
Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers
Which are functions of assertive community treatment? Select all that apply.
Promotes continuity of outpatient care Reduces inpatient service use Increases the stability of people with serious mental illnesses
One goal of transitional care in mental health care is what?
Provide an alternative for inpatient admission
A group of nursing students are learning about the history of forensic nursing. Which reason best explains the development of this nursing speciality? Select all that apply.
Public inquiries to reactionary events in those with mental disorders Criticism about the criminalization of the mentally ill More inpatient mental health treatment needed for offenders
A client with a mental illness is receiving care which includes counseling, mentoring, and support from individuals who are successfully dealing with their illness and training in daily living. The client is also receiving interventions related to illness self-management. The client is involved with which type of psychosocial rehabilitation?
Recovery center
What are some of the goals of psychiatric rehabilitation? Select all that apply.
Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions
Which are functions of assertive community treatment? Select all that apply.
Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses
The parents of a young adult diagnosed with schizophrenia are providing care for the client in their home. During a home visit, the parents state, "It's been so difficult taking care of our child. We need a break. But our child needs constant supervision." Which would be appropriate for the nurse to suggest?
Respite residential care
One major reason that clients with mental disorders are rehospitalized is what?
Resurfacing of acute symptoms
The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue?
Risk assessment
The forensic nurse is assessing a client with new onset of hallucinations and agitation in a police station. Which finding is most consistent with mentally ill clients in the criminal justice system?
Risk of violence
Which is considered the priority care for clients receiving inpatient care?
Safety
A county in Florida was just devastated by a Category 4 hurricane. Community mental health nurses have been sent to the area to provide crisis intervention. What type of prevention strategy is this?
Secondary
The case manager makes a home visit to the client's household and finds that the client has become psychotic in the prior 3 days and has bolted himself in the his room. The case manager works to encourage the client to come out and calls the ambulance to take the client to the emergency department. At what level of prevention is the case manager working?
Secondary
Which intervention represents tertiary prevention for mental illness?
Self-help groups
A client is referred to a psychosocial rehabilitation program. When explaining this type of care to the client, what would the nurse emphasize?
Services that promote the client's reintegration into the community
A client is to be admitted to an inpatient psychiatric unit on an involuntary basis because the client has threatened to kill the client's spouse. The nurse should explain to the client's family members that the primary focus of the client's hospitalization is what?
Stabilize acute symptoms
A group of nursing students is reviewing information about settings of care along the range of community care services for mental health. The students demonstrate a need for further review when they identify which as an important component of intensive outpatient programs?
Social skills training
During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy?
Support
The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is what?
Symptom acuity does not require psychiatric hospitalization
A client is receiving crisis stabilization in an inpatient facility. The nurse would focus care on what?
Symptom stabilization
A client with a psychiatric illness is being discharged from the hospital. What does the nurse include in the discharge teaching to help prevent relapse in the client? Select all that apply.
Symptoms of the psychiatric illness Establishment of a daily routine for the client Schedule for follow-up treatment
A client with a psychiatric illness is being discharged from the hospital. What does the nurse include in the discharge teaching to help prevent relapse in the client? Select all that apply.
Symptoms of the psychiatric illness Establishment of a daily routine for the client Schedule for follow-up treatment
A patient scheduled to be released from prison in 1 month has been assigned a case manager and has been meeting with her 3 times a week. This is an example of which level of prevention?
Tertiary
The nurse is advising the caregiver of a client to encourage the client to join an evolving consumer household. What may be the reason for the nurse to give this advice to the caregiver?
The client will be able function independently.
Individuals may need assistance with the coordination of care and community service programs related to what?
The complexity of access to the community service programs available
A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expanded role for forensic nursing that is expected in the future?
The fact that there are high rates of mental illness among the populations of jails and prisons
The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization?
The number of persons with mental illness in prison has increased.
A client is in need of a family-like environment with a high level of support. Which would be most appropriate?
Therapeutic foster care
A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community?
Upon admission to the inpatient setting
What was the original purpose for developing the role of the case manager in community-based care?
To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions
The nurse is planning care for a mentally ill client in a forensic setting. The nurse-client relationship is influenced most during which stage?
Working
Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ...
collaborative mental health care.
A community mental health model program that incorporates membership responsibility in maintaining and advancing the program and social/recreational, vocational, residential, and educational services is called:
psychosocial rehabilitation model.
