Ch 32 Questions

A client diagnosed with a serious mental illness (SMI) died suddenly at age 52. The client lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question?

"Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight."

The parent of a seriously mentally ill adult asks the nurse, "Why are you making a referral to a vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

"Most clients are capable of employment at some level, competitive or supported."

A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" What is the nurse's best response?

"National Alliance on Mental Illness (NAMI) offers a family education series that you might find helpful."

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are non-medication adherent. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?

"Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses."

A client diagnosed with a serious mental illness (SMI) lives independently and attends a psychosocial rehabilitation program. The client presents at the emergency department seeking hospitalization. The client has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." What is the nurse's best action?

Involve the client's case manager to provide crisis intervention.

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.)

Maintain stable and consistent staff. Make it easier to access prescribers and pay for drugs.

The sibling of a client who was diagnosed with a serious mental illness (SMI) asks why a case manager has been assigned. Which nurse's reply best cites the major advantage of the use of case management?

"Case managers coordinate services and help with accessing them, making sure the client's needs are met."

A homeless client diagnosed with a serious mental illness (SMI) became suspicious and delusional. Depot antipsychotic medication is prescribed and housing is obtained in a local shelter. One month later, which statement by the client indicates significant improvement?

"I feel comfortable here. Nobody bothers me."

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The client says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this client?

"I noticed that when you take the medicine, you are able to keep the job you wanted."

Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.)

"We are all a little bit crazy." "If people with mental illness would go to church, their problems would be solved." "People with mental illness are lazy. They get government disability checks instead of working."

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness (SMI)?

Assertive community treatment (ACT)

A homeless individual diagnosed with serious mental illness (SMI) and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team's initial focus?

Interact regularly and supportively without trying to change the client.

Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness (SMI) who is homeless?

Chronic low self-esteem

A client diagnosed with serious mental illness (SMI) was living successfully in a group home but wanted an apartment. The prospective landlord said, "People like you have trouble getting along and paying their rent." The client and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.)

Coach the client in ways to control symptoms effectively. Seek out landlords less affected by the stigma associated with mental illness. Have the case manager meet with the landlord to provide education about mental illness.

The nurse wants to enroll a client with poor social skills in a training program for clients diagnosed with schizophrenia. Which description accurately describes social skills training?

Complex interpersonal skills are taught by breaking them into simpler behaviors.

A hospitalized client diagnosed with schizophrenia has a history of multiple relapses. The client usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the client transitions from hospital to community?

Involve the client in decisions about which medication is best.

A person diagnosed with a serious mental illness (SMI) enters a shelter for the homeless. Which intervention should be the nurse's initial priority?

Develop a trusting relationship.

A person diagnosed with serious mental illness (SMI) has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.)

Develop written plans that will help the client remember what to do in a crisis. Help the client identify and anticipate events that are likely to be overwhelming. Encourage health-promoting activities such as exercise and getting adequate rest. Accompany the client to a National Alliance on Mental Illness (NAMI) support group.

A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The client's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the client. Which response by the nurse would be most helpful?

Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the client become more independent.

A consumer at a rehabilitative psychosocial program says to the nurse, "People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered." How should the nurse respond?

Encourage the consumer to discuss it at a meeting with everyone.

A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.)

Impaired judgment and social skills can provoke hostile or assaultive behavior. Lower incomes force SMI persons to live in high-crime areas, increasing risk. SMI persons experience higher rates of sexual assault and victimization than others. Criminals may believe SMI persons are less likely to resist or testify against them.

An adult client tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the client? (Select all that apply.)

Psychoeducational classes Vocational rehabilitation Social skills training

A client living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the client was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the client experiencing?

Stigma

For clients diagnosed with serious mental illness (SMI), what is the major advantage of case management?

With one coordinator of services, resources can be more efficiently used.

How is serious mental illness (SMI) characterized?

a major long-term mental illness marked by significant functional impairments.

An adult diagnosed with a serious mental illness (SMI) says, "I do not need help with money management. I have excellent ideas about investments." This client usually does not have money to buy groceries by the middle of the month. The nurse assesses the client as demonstrating what defense mechanism?

anosognosia.

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This client now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of what factor?

dependency caused by institutionalization.

A client diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." How should the nurse identify the etiology of the client's ineffective management of the medication regime?

impaired reasoning secondary to the schizophrenia.

An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." What does the nurse suspect is the client's reason for medication nonadherence?

thought disturbances associated with the illness.