Chapter 4: PrepU
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. Nurses often transgress professional boundaries with the clients. The lifestyle of the incarcerated client is solitary. Clients are transferred frequently to other forensic institutions.
Clients commonly struggle with trusting others. Explanation: Recurring themes of power and control, negotiation, and trust building dominate therapeutic interventions in this setting; clients have, in varying degrees, learned to adapt to an environment that rewards distrust, manipulation, and deceit. The criminal history, frequent diagnoses of antisocial and borderline personality disorder, and aggressive interpersonal style of many forensic clients can evoke strong emotional responses, and countertransference and splitting reactions are common.
The approach of the services provided to facilitate recovery for individuals must be based on which aspect? Partnership Reintegration Consultation Empowerment
Empowerment Explanation: In order to facilitate recovery for individuals, family, groups, or communities, the approach of the services or supports provided must be founded on the principles of hope, empowerment, choice, and responsibility.
A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Therapy that does not include medication Maintenance of the therapeutic environment Inclusion of both art therapy and psychotherapy A multidisciplinary approach
Maintenance of the therapeutic environment Explanation: Milieu therapy is also known as the maintenance of the therapeutic environment.
A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding by identifying which type as providing the most intensive outpatient nursing care? Rehabilitation programs Crisis intervention programs Outpatient detoxification programs Partial hospitalization programs
Partial hospitalization programs Explanation: Nursing care in a partial hospitalization program is the most intensive of all the outpatient mental health care settings. Partial hospitalization is a type of outpatient program that provides services to persons with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning, who cannot function autonomously on a daily basis, or who do not pose imminent danger to themselves or others.
What are some of the goals of psychiatric rehabilitation? Select all that apply. Recovery from mental illness Increased independence Personal growth Increased hospital admissions Increased involvement in treatment decisions
Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions Explanation: Psychiatric rehabilitation aims at promoting the recovery process of clients with a mental illness. Goals include helping the client recover from mental illness, facilitating personal growth, and increasing client independence and participation in treatment decision-making. These activities, as a result, decrease the number of hospital admissions due to mental illness.
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 Acute inpatient care Partial hospitalization Intensive outpatient program
Respite residential care Explanation: Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers. This would be the most appropriate suggestion in this case and would provide the client with the least restrictive environment. -Partial hospitalization programs (PHP) provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning, who cannot function autonomously on a daily basis, or who do not pose imminent danger to themselves or others. This would be appropriate if the client was experiencing any of these, but the major concern here is giving the parents some relief. -Acute inpatient care is the most restrictive and is reserved for acutely ill clients. -Intensive outpatient programs (IOP) focus on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. This client requires constant supervision.
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 Tertiary Primary Interventional
Secondary Explanation: Secondary prevention focuses on interventions that identify mental health problems early and reduce the duration and prevalence of mental illness. Examples for community mental health nurses include conducting screening surveys that focus on identifying mental illness in people within schools or the community, referring clients for mental health treatment, and providing crisis intervention to a community that has encountered a natural or man-made disaster. me: Primary: interventions designed to prevent the onset or future incidence of a specific problem Secondary: an early intervention that decreases the prevalence of a specific problem. Tertiary: treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed.
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? Involvement Containment Structure Validation
Structure Explanation: Traditional milieu therapy consists of containment, support, validation, structure, and involvement. Structure within inpatient settings assists in the control and limitation of maladaptive behaviors, such as yelling, screaming, and cursing that may accompany aggressive outbursts. stages of Milieu therapy: ...
The introduction of psychotropic medications occurred in which decade? 1970s 1940s 1960s 1950s
1950s Explanation: The introduction of psychotropic medication occurred in the 1950s.
The nurse is caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity? Teaching about the nutritional content of canned foods Educating clients on menu planning and grocery shopping Facilitating a drug abuse prevention group Providing spiritually related interventions
Educating clients on menu planning and grocery shopping Explanation: The partial hospitalization program emphasizes social skills and basic living skills training. Planning menus and shopping for groceries are examples of these types of skills. A drug abuse prevention group would be appropriate for a relapse prevention after-care program.
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 Outpatient care Acute care hospital Long-term hospitalization
Partial hospitalization program Explanation: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. This is not the primary goal of long-term hospitalization, an acute care hospital, or outpatient care.
One goal of transitional care in mental health care is what? Provide an alternative for inpatient admission Provide crisis intervention services when needed Provide intensive monitoring of the client at home Encourage the parents to participate in the client's care
Provide an alternative for inpatient admission Explanation: The two goals of transitional mental health care are to increase the functionality of the client within the home and to provide an alternative for inpatient admission.
Which would not be an element of a community support system? Provision of individual psychotherapy in the home if needed Case management responsible for helping the client to make informed choices about care Identification of at-risk populations Adequate mental health care
Provision of individual psychotherapy in the home if needed Explanation: Community support involves assistance with daily functioning and coordination of health care. Psychotherapy is provided by a licensed mental health professional.
Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... psychosocial rehabilitation programs. partial hospitalization programs. inpatient psychiatric units. collaborative mental health care.
collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.
Funding agencies determine clients' eligibility for psychiatric home care nursing services. Services will be reimbursed if documentation reflects what? Safety issues as a result of physical, psychosocial, or medical problems An inability to leave the home due to chronic physical, psychosocial, or medical problems Lack of family support to assist in care Inadequate financial resources for private mental health care services
An inability to leave the home due to chronic physical, psychosocial, or medical problems Explanation: Criteria for homebound status include: an inability to leave home alone because of physical, psychosocial, or medical problems; a need for assistance and taxing effort to leave home; and infrequent short absences from home only for medical or certain types of personal needs.
Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? (SPMI) Fairweather treatment Community living treatment Clubhouse treatment Assertive community treatment
Assertive community treatment Explanation: Assertive community treatment (ACT) is a service delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program, but it is a direct provider of highly individualized consumer services. me: associate ACT with SPMI
Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness? Clubhouse treatment Assertive community treatment (ACT) Fairweather treatment Community living treatment
Assertive community treatment (ACT) Explanation: Assertive community treatment (ACT) is a service delivery model that provides comprehensive, locally based treatment to people with serious and persistent mental illness. Unlike other community-based programs, ACT is not a linkage or brokerage case-management program, but it is a direct provider of highly individualized consumer services.
Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Crisis intervention Partial hospitalization Case management Respite residential care
Case management Explanation: Coordinated care is often accomplished through a case management service model in which a case manager locates services, links the patient with them, and then monitors the patient's receipt of these services. This type of case management is referred to as the "broker" model. Crisis intervention, partial hospitalization, and respite residential care are not known as the "broker" model.
Initiatives that strive to strengthen the coordination of care involves cooperation and what? Individualization Promptness Collaboration Duplication
Collaboration Explanation: Coordination of care is the integration of appropriate services so that individualized care is provided. Coordination of care requires collaborative and cooperative relationships among many services, including primary care, public health, mental health, social services, housing, education, and criminal justice, to name a few. Appropriate services are those that are tailored to address a client's strengths and weaknesses, cultural context, service preferences, and recovery goals, including referral to community resources and liaisons with others (e.g., physician, health care organizations, community services). Several agencies could be involved, but when care is coordinated, a person's needs are met without duplication of services.
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 supportive housing Peer support services Community-based residential services Supervised living services
Community-based residential services Explanation: Community-based residential services provide a place for people to reside during a 24-hour period, or any portion of the day, on an ongoing basis. -Peer support services are provided by mental health consumers who have experienced symptom remission and are actively involved in their own recovery from mental illness. Supportive housing include personal care homes, board-and-care homes, therapeutic foster care, and supervised apartments. These range from highly supervised congregate settings to independent apartments.
Which would not be considered an impediment to successful discharge planning? Criminal or violent behavior Alcohol and drug abuse Noncompliance with medications Compliance with the therapeutic regimen
Compliance with the therapeutic regimen Explanation: Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.
A forensic nurse working in a prison must view all clients as people who deserve respect and professionalism. What should the nurse do to enforce this viewpoint? Conduct thorough physical assessments of clients. Apply the nurse's morals and values to everyone. Apply religious beliefs to patient care. Conduct ongoing self-reflection and self-awareness.
Conduct ongoing self-reflection and self-awareness. Explanation: Nurses who are successful in forensic nursing view clients as people who deserve respect and professionalism. Being able to adopt a therapeutic role requires ongoing self-reflection and self-awareness.
The same principles that define the nursing process are at work within the provision of community based mental health services through which interventions? Casefinder model of care Coordination of care Discharge planning process Reintegration process
Coordination of care Explanation: In the continuum of care, the nursing process is similar to the coordination of care for psychiatric clients.
Which is an example of secondary prevention in the forensic setting? Advocacy Crisis intervention Case management Rehabilitation
Crisis intervention Explanation: Crisis intervention is considered secondary prevention. Rehabilitation and case management are tertiary preventions. Advocacy is a primary prevention.
Which would be an appropriate intervention to help a client regain, maintain, or improve psychological well-being? -Teach problem solving, stress reduction, coping, and proper interpersonal communication skills. -Teach the client and family ways to avoid detection of mental illness to prevent stigma in the community. -Provide 24-hour mental health care counseling to a client and family. -Bring medication to a client on a daily basis to ensure the client takes medication.
Teach problem solving, stress reduction, coping, and proper interpersonal communication skills. Explanation: A general intervention directed toward achieving the goals of psychiatric home care nursing includes: helping clients and family members or caregivers learn skills of problem solving, stress reduction, coping, and proper interpersonal communication; helping clients and family members or caregivers understand mental illness and how to monitor signs of relapse, medication effects, and medication side effects; providing respite and community resources to family members and caregivers; and coordinating and integrating clients' medical, social, spiritual, vocational, and other community-based services, as well as teaching clients and families to do so.
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? Secondary Primary Chronic Tertiary
Tertiary Explanation: Case management is an example of tertiary prevention in the forensic setting. From the book: "Examples include primary prevention, such as stress management education; secondary prevention, such as early identification of potential mental health problems; and tertiary prevention, such as monitoring and coordinating rehabilitation services for the mentally ill."
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? Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living Empower clients to achieve the highest level of functioning possible Carefully detox from alcohol and substance abuse
Empower clients to achieve the highest level of functioning possible Explanation: Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. -In-home detoxification promotes careful detoxification from alcohol and substances. -The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. -Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions.
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 may have co-morbid medical illnesses which could be treated there. The client will be able to make continual moves and readjust as needed. The client will be able function independently. The client may have persistent psychiatric symptoms.
The client will be able function independently. Explanation: The evolving consumer household is a group-living situation in which the client fulfills their own responsibilities and functions without on-site supervision from paid staff. This requires the client to function as an independent individual. Clients with persistent mental illness should not be referred to this facility. Co-morbid medical illnesses are not treated in an evolving consumer household. The purpose of the evolving consumer household is to ensure the client does not need to make continual moves and readjust to new living situations. The evolving consumer household is a permanent living arrangement and eliminates the problem of relocation.
A 22-year-old client with a history of a recent suicide attempt is being treated for depression. Prior to becoming depressed, the client self-describes as "very social and doing well in school." Which of the following long-term treatment goals is best suited for this client? The client will not injure himself. The client will resume previous level of functioning. The client's symptoms will be reduced. The client will show interest in social and leisure activities.
The client will resume previous level of functioning. Explanation: The aim now is for clients to recover or to experience a remission and be restored to pre-illness functioning in various domains, such as occupationally, socially, and educationally.
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 Carefully detox from alcohol and substance abuse Promote the ability of clients with serious mental illness to live within the community Provide self-help groups and training in daily living
Empower clients to achieve the highest level of functioning possible Explanation: Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues while addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. In-home detoxification promotes careful detoxification from alcohol and sbstances. The Assertive Community Treatment (ACT) model helps individuals with serious mental illness live in the community. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions.
Which goal for an individual client is consistent with the overall objectives of community support service programs? The client will experience fewer symptoms. The client will move from a group housing arrangement to independent living. The client's functional ability will improve. The client will gain insight into the causes of the client's mental illness.
The client's functional ability will improve. Explanation: The goal of community support service programs is to enable those with severe mental illness to remain in the community and function as independently as possible.
The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what? Spiritual aspects of care Nutritional therapies Ensuring a sustainable living situation Drug abuse prevention
Ensuring a sustainable living situation Explanation: A client's living environment affects his or her level of functioning, rate of reinstitutionalization, and duration of the remaining time in the community setting. Finding a quality living situation requires ensuring sustainability of the placement as this minimizes the possibility of future hospitalization due to decompensation of mental status.
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 Changes of service providers over time The number of choices of available services for specific diagnostic categories The number of hospital-based services available to clients
The complexity of access to the community service programs available Explanation: Due to the complexity of access to the community service programs that are available, individuals and families may require assistance with the coordination of their care, services, and supports.
A healthcare organization is increasing the use of telecommunication to reach clients located in remote areas. Which avenue should the nurse question before establishing a therapeutic relationship with a client? telephone calls videoconferencing Facebook software with firewalls
Facebook Explanation: As technology develops and becomes increasingly accessible, traditional face-to-face communication can be replaced with technological interactions. Any communication over the internet must be secure to maintain confidentiality. Hospital firewalls can be useful in establishing these connections. Some commonly used platforms for online communication, such as Facebook, cannot meet the standards for security and confidentiality and should not be used when communicating with clients. Phone and video conferencing are increasingly popular, especially in remote areas where the land or the isolation of the clinic constitutes barriers to the development of a therapeutic relationship.
Which type of residential setting may care for one to three clients in a family-like atmosphere, including meals and social activities with the family? Halfway houses Foster homes Group homes Independent living
Foster homes Explanation: Adult foster homes may care for one to three clients in a family-like atmosphere, including meals and social activities with the family.
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 The number of choices of available services for specific diagnostic categories Changes of service providers over time The number of hospital-based services available to clients
The complexity of access to the community service programs available Explanation: Due to the complexity of access to the community service programs that are available, individuals and families may require assistance with the coordination of their care, services, and supports. (this is the best answer)
The greatest impact case management has had on mental health care is that it has caused what? A focus on an illness, not a health paradigm Has stimulated an interest in professional mental health careers Has affected public awareness of mental health care needs Has increased client access to appropriate mental health care
Has increased client access to appropriate mental health care Explanation: Case management has increased client access to appropriate mental health services and offers availability of a choice of providers based on the type of care required.
The nurse is planning care for clients in a forensic setting. Which supports a trusting nurse-client relationship? Health teaching Conducting exercise sessions Personal conduct Maintaining boundaries
Health teaching Explanation: Providing the client with information and guidance on healthy living and maintaining health supports the development of a trusting relationship. Examples include health teaching such as reminding clients about appointments and teaching about medications and side effects. A non-judgmental approach and attitude will help create a trusting, respectful relationship. Clients should be treated equally by listening and keeping commitments. Conducting exercise sessions is not the responsibility of the nurse, and is not considered an activity of daily living in the forensic setting,
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? Facilitating reimbursement and coverage by the client's private and public insurances Contacting and maintaining relationships with the client's various service providers Identifying and meeting the client's health and human service needs Prescribing nursing care directed toward managing the client's acute and chronic health problems
Identifying and meeting the client's health and human service needs Explanation: Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual client's health and human service needs.
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 Consistent third-party reimbursement Cost savings Individualized care for additional inpatient stays
Improved access to less costly services Explanation: Managed care aims to increase access to care and provide the most appropriate level of services in the least restrictive environment. Efforts focus on providing more outpatient and alternative treatment programs and avoiding costly inpatient hospitalizations. When properly conducted and administered, managed care allows clients better access to quality services while using health care dollars wisely.
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? Psychiatric specialty unit Outpatient psychiatric care In-house psychiatric unit General medical floor
In-house psychiatric unit Explanation: Many large hospitals have psychiatric services and, when a patient is in need of treatment, will transfer him or her to the in-house psychiatric unit. The general hospital psychiatric setting is primarily for acute treatment with the main goal of stabilization.
Assertive Community Treatment (ACT) reduces the use of which type of service? Community based Detoxification Crisis intervention In-patient Hospital
In-patient Hospital Explanation: ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.
Which statement is true concerning clients with dual diagnoses? Integrated care is preferred over split care for the separate diagnoses Clients will dual diagnoses generally receive adequate treatment for both mental health issues Few mentally ill individuals have a confirmed dual disagoses Intellectual disabilities are not considered as a possible dual diagnosis
Integrated care is preferred over split care for the separate diagnoses Explanation: Dual diagnosis most often refers to clients with a mental illness as well as a substance abuse diagnosis. The term may also refer to clients with a mental illness and a developmental or intellectual disability diagnosis. Clients with dual diagnoses are often more difficult to treat due to more complicated problems posed by two different diagnoses. They tend to have higher rates of nonadherence to treatment and poorer long-term outcomes. Integrated care rather than split or isolated care for the separate diagnoses is recommended
Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply. Risk assessment and risk management skills Teamwork skills Ability to work independently Communication skills Interpersonal skills
Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills Explanation: The core skill areas that are needed to function as an effective team member of an interdisciplinary team include interpersonal skills, such as tolerance, patience, and understanding; humanity, such as warmth, acceptance, empathy, genuineness, and nonjudgmental attitude; knowledge base about mental disorders, symptoms, and behavior; communication skills; personal qualities, such as consistency, assertiveness, and problem-solving abilities; teamwork skills, such as collaborating, sharing, and integrating; and risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.
The nurse is advocating for the most effective and comprehensive treatment plan for a client with bipolar disorder. The client is being held in the forensic unit of the hospital because the client has been convicted of theft. Recognizing that many factors influence the client's treatment and health maintenance after discharge, the nurse plans to do what? Refer aftercare planning to the patient's parole officer Involve an interdisciplinary team in the client's community care Request that a personality profile be performed to better understand the client's behavior. Determine the client's ability to function safely in public
Involve an interdisciplinary team in the client's community care Explanation: Regardless of the treatment setting, rehabilitation program, or population, an interdisciplinary team approach is most useful in dealing with the multifaceted problems of clients with mental illness. The nurse can demonstrate advocating for the most effective and comprehensive treatment plan for this client by bringing together an interdisciplinary team for the client's ongoing community care. me: forensic= relating to a crime
Which is accurate regarding assertive community treatment (ACT)? It provides day treatment programs only. It uses a high staff-to-client ratio. It is designed to help those with intellectual disability. It offers intensive community-based services.
It offers intensive community-based services. Explanation: The ACT model is a multidisciplinary clinical team that provides nearly 24-hour, intensive community-based services. ACT typically has a low staff-to-client ratio (1 to 100). It helps individuals with serious mental illness live in the community.
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 many states now require all prison inmates to be assessed by a mental nurse daily The fact that most crimes are committed by people who have mental illness The fact that there are high rates of mental illness among the populations of jails and prisons The fact that people with mental illness are the most common victims of crime
The fact that there are high rates of mental illness among the populations of jails and prisons Explanation: Forensic nursing is expected to become one of the fastest growing nursing specialties of the 21st century because recent studies have noted the high rates of mental illness in jails and prisons. People with mental illness are not responsible for most crimes. They are vulnerable to crime, but this fact does not underlie the growth of forensic nursing.
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. It requires the nurse to be available for care for the client all the time. It requires additional funding that may not be afforded by the institution. It requires an open space for conducting therapy sessions.
It requires clients to have longer lengths of stay. Explanation: Milieu therapy refers to the method of therapy where the clients take part in group sessions and have client-to-client interactions. This therapy required longer length of stay in the hospital as new clients were paired with clients that had been in the hospital for a period of time. With the advent of managed health care in the 1990s, the length of hospital stays decreased significantly. Open space is not a requirement for this therapy. As this milieu therapy involves interactions between clients, the nurse is not required to be present during the entire session. This form of therapy is least expensive as it just involves communication between clients.
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? Provision of the most restrictive environment Improved financial status Level of functioning Emphasis on wellness
Level of functioning Explanation: Quality is assessed by measuring client outcomes that result from the services, such as level of functioning, community integration, and client satisfaction with the services provided. In the community, the case manager works with clients on a broad range of issues from accessing needed medical and psychiatric services to carrying out activities of daily living. Quality of case management is not measured by improved financial status or provision of the most restrictive environment. Continuum of care spans from illness to wellness states.
Which areas of discharge planning are important to ensuring client safety? Select all that apply. Special diet instructions Medication education Payment of care Social status Food-drug interactions
Medication education Food-drug interactions Special diet instructions Explanation: Medication education, food-drug interactions, drug-drug interactions, and special diet instructions (if applicable) are extremely important in ensuring client safety. Ability to pay for care and social status are not directly related to patient safety.
The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? Members live at the clubhouse. Membership is time limited. The clubhouse is run by staff members. Members receive mental health treatment from providers in the community.
Members receive mental health treatment from providers in the community. Explanation: Members are encouraged and assisted to use psychiatric services, which are usually local clinics or private practitioners. Membership is not time limited. The clubhouse is run entirely by patients with psychiatric illnesses with minimal assistance from mental health professionals. Generally, members do not live in the clubhouse.
The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what? Hypertension Diabetes Disorders of the pancreas Mental illness
Mental illness Explanation: People with substance use disorders are at increased risk for mental illness.
When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Nurse Psychiatrist Social worker Case manager
Nurse Explanation: When clients are admitted to inpatient psychiatric settings, nurses often are the first health care providers they meet. Beginning with admission, nurses begin to form rapport with clients and initiate the assessment phase of care.
Which statement regarding those with serious and persistent mental illness (SPMI) is correct? Reinstitutionalization has resulted in many individuals being committed to mental hospitals and asylums. Supplemental Security Income provides enough money for those with mental illness to pay for a home, food, and medication. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. Medicaid funding for those with mental illness has optimized patient care for poor individuals.
Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. Explanation: Reliance on Supplemental Security Income as the major source of financial support allows little opportunity for choices. The average monthly stipend barely meets their rent payments. Unlike the early institutions that housed those with mental illness in hospitals and asylums, the current reinstitutionalization is in both hospitals and jails. Medicaid funding, although limited in noninstitutional settings, remains the primary source for poor people, including most people with SPMI. The result has been inappropriate admissions to nursing facilities and other institutions so that clients can receive appropriate care. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.
Which type of setting is used for clients who continue to need supervision but not long-term admission? Voluntary commitment Partial (day) hospitalization Acute care Nursing home
Partial (day) hospitalization Explanation: Partial (day) hospitalization programs are for clients who continue to need supervision but not long-term admission.
Which service aims to achieve client stabilization without hospitalization or a reduced length of inpatient care? Respite residential care 23-hour observation Partial hospitalization Residential services
Partial hospitalization Explanation: Partial hospitalization programs were developed to complement inpatient mental health care and outpatient services and to provide treatment to clients with acute psychiatric symptoms who are experiencing a decline in social or occupational functioning. -A short-term treatment that serves the client in an immediate but short-term crisis is 23-hour observation. This treatment is used for acute trauma, such as rape and alcohol/narcotic detoxification, and for individuals with Axis II personality disorders who present with self-injurious behaviors. -Residential services provide a place for people to reside during a 24-hour period, or any portion of the day on an ongoing basis. Sometimes families of a person with mental illness who lives at home may be unable to provide care continuously. -Respite residential care can provide short-term necessary housing for the client and periodic relief for the caregivers.
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 Outpatient care Long-term hospitalization Acute care hospital
Partial hospitalization program (PHP) Explanation: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. This is not the primary goal of long-term hospitalization, an acute care hospital, or outpatient care.
Which mental health treatment setting is not a residential treatment setting? Adult foster care Respite Group homes Partial hospitalization programs
Partial hospitalization programs Explanation: Partial hospitalization programs are designed to help the client make a gradual transition from being inpatients to having independence and to prevent repeat admissions. The remaining options are all settings that are associated with long-term living arrangements.
Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? Encouraging the client to ask for help Partnering with the client from the beginning Telling the client to adhere to the plan Monitoring the client continuously
Partnering with the client from the beginning Explanation: The nurse can optimize discharge plan compliance by partnering with the client from the first encounter. Because clients with mental illnesses may have limited cognitive abilities and residual motivational and anxiety problems, the nurse should explain in detail all after-care plans and instructions to the client.
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? Improved pharmacological treatments for major depression Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Research suggesting that inpatient psychiatric treatment is less effective than previously believed
Pressures to reduce health care costs associated with inpatient care Explanation: There is tremendous pressure to reduce the escalating costs of health care, a trend that has often resulted in early discharge and reduced average lengths of stay. This trend toward shorter inpatient courses of care is not a result of the ineffectiveness of inpatient care or improved drug treatments and publicly funded programs.
The goal of respite services as a prevention strategy includes what? Promoting a service to assist individuals with mental illness to achieve independent living Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Identifying clients who are unable to continue living in their present circumstances Targeting the chronic population of individuals requiring daily monitoring of their behavior and medication adherence
Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers Explanation: The goals of respite programs are to prevent unnecessary long-term care placements and hospitalizations due to informal caregiver burnout.
A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply. Stabilization Behavioral therapy Social skills training Prevention of relapse Symptom reduction
Prevention of relapse Stabilization Symptom reduction Explanation: Crisis intervention is a type of short-term care that focuses on stabilization, symptom reduction, and prevention of relapse requiring inpatient services. Crisis intervention does not focus on behavioral therapy or social skills training.
A 54-year-old with severe and persistent mental illness and has been referred to a community support system. What is the basic philosophy behind community support systems? To teach the community about mental illness in order to prevent stigma To address the needs of adults with mental illness and increase their ability to function To ensure that clients comply with their medication regimens to prevent relapse To increase the community's acceptance of individuals with mental illness
To address the needs of adults with mental illness and increase their ability to function Explanation: A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion. This basic philosophy of care is meant to address humanely the needs of adults with serious and persistent mental illness, which limits their ability to function in the primary areas of daily living.
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? Once the client experiences an exacerbation of symptoms When requested by the client's health maintenance organization (HMO) When the client and/or client's family advocates for such a review Upon admission to the inpatient setting
Upon admission to the inpatient setting Explanation: It is important that a client's mental health benefits be reviewed during the discharge planning process, which should always aim to begin at the client's admission to the inpatient unit.
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? Supported employment Recovery center Self-help group Relapse prevention after care
Recovery center Explanation: Recovery centers assist in the mental health consumer's journey towards recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions. Self-help groups include Alcoholics Anonymous and Narcotics Anonymous. Relapse prevention after care focuses on preventing relapse of symptoms. Supported employment services assist individuals to find work and assess their skills, attitudes, behaviors, and interests relevant to work.
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 Increases the likelihood of relapse Decreases availability of services
Reduces inpatient service use Promotes continuity of outpatient care Increases the stability of people with serious mental illnesses Explanation: Assertive community treatment reduces inpatient service use, promotes continuity of outpatient care, and increases the stability of people with serious mental illness. Assertive community treatment does not increase the likelihood of relapse or decrease the availability of services.
Which type of care provides periodic relief to caregivers of a mentally ill client? Crisis stabilization Respite residential care Partial hospitalization Acute inpatient care
Respite residential care Explanation: Sometimes family members of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers.
The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend? Respite residential care Recovery center Assertive community treatment (ACT) Psychosocial rehabilitation
Respite residential care Explanation: Sometimes the family of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers. The ACT model is a multidisciplinary clinical team approach providing 24-hour, intensive community-based services. The ACT model helps individuals with serious mental illness live in the community. Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues, all while addressing their medical and residential needs. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions, such as Wellness Recovery Action Planning (WRAP).
One major reason that clients with mental disorders are rehospitalized is what? Need for close supervision by medical personnel Severe side effects of antipsychotic agents Resurfacing of acute symptoms Diagnosis of comorbid diseases
Resurfacing of acute symptoms Explanation: One major reason that clients with mental disorders are rehospitalized is the relapse of mental illness and substance abuse.
The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue? Risk assessment Discussion of crimes Recovery oriented care Conditional release plan
Risk assessment Explanation: Risk assessment is an important determination to maintain the safety of the client and others. The data obtained in the risk assessment, including the client's known history, habits, legal status, and triggers, are used to develop an individualized treatment plan. In some institutions, risk assessment determines the type of facility for the client. Discussion of crimes is not appropriate because it may block the development of an effective therapeutic relationship. Conditional release plans are reserved for those individuals who have been stabilized and are not considered a danger. Recovery oriented care is important, but begins after the development of an individualized treatment plan to help the individual maintain optimal mental health after discharge.
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 Tertiary Rehabilitative Primary
Secondary Explanation: The client is experiencing an acute exacerbation of the client's illness. Me: primary- ID stressors secondary- ID symptoms tertiary- case manager
Which intervention represents tertiary prevention for mental illness? Education for adolescents about substance abuse Self-help groups Depression screening Crisis intervention
Self-help groups Explanation: Tertiary prevention is the final level of prevention. Its focus is rehabilitation and ways to minimize residual effects for people who have encountered mental health problems. Examples include social skills training, vocational rehabilitation, self-help groups, systems of care and wraparound for children and families, and sufficient residential and independent living services. Crisis intervention is a secondary intervention me: Primary: interventions designed to prevent the onset or future incidence of a specific problem Secondary: an early intervention that decreases the prevalence of a specific problem. (crisis prevention) Tertiary: treatment designed to improve quality of life and reduce the symptoms after a disease or disorder has developed. (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? Intensive treatment that prepares the client to live in the community Services that promote the client's reintegration into the community Detoxification services for alcohol and drugs in an outpatient setting Frequent monitoring within a therapeutic milieu for relapse prevention
Services that promote the client's reintegration into the community Explanation: Psychosocial rehabilitation or psychiatric rehabilitation programs focus on reintegrating people with psychiatric disabilities into the community through work, education, and social avenues while also addressing their medical and residential needs. The goal is to empower clients to achieve the highest level of functioning possible. -Intensive treatment that prepares the client to live in the community reflects the focus of assertive community treatment. -Outpatient detoxification provides detoxification services for alcohol and drugs in an outpatient setting. -Intensive outpatient programs provide frequent monitoring and social support within a therapeutic milieu to enable the client to remain connected to the community.
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 Stress management education Relapse prevention Illness education
Social skills training Explanation: The primary focus of intensive outpatient programs is on stabilization and relapse prevention for highly vulnerable individuals who function autonomously on a daily basis. The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs (PHPs), but whereas PHPs emphasize social skills training, intensive outpatient programs teach clients about stress management, illness, medication, and relapse prevention
A nurse is describing the differences between a partial hospitalization program and an intensive outpatient program. Which would the nurse describe as the emphasis of partial hospitalization programs? Social skills training Relapse prevention Illness medication Stress management
Social skills training Explanation: The treatment activities of the intensive outpatient program are similar to those offered in partial hospitalization programs, but whereas partial hospitalization programs (PHPs) emphasize social skills training, intensive outpatient programs (IOPs) educate clients on stress management, illness, medication, and relapse prevention.
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? Provide rehabilitative services Provide long-term therapy Stabilize acute symptoms Provide 24-hour supervision
Stabilize acute symptoms Explanation: The focus of a crisis stabilization stay is to stabilize the client's acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days and has a symptom-based indication for hospital admission.
During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy? Containment Structure Support Validation
Support Explanation: Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. -Containment involves the provision of basic needs: food, shelter, safety, and security. -Validation begins with the first interaction between the nurse and client. -Structure within inpatient settings assists in the control and limitation of maladaptive behaviors.
During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy? Validation Support Containment Structure
Support Explanation: Providing support is essential to a positive nurse-client relationship. Nurses offer clients encouragement, praise, and positive feedback. -Containment involves the provision of basic needs: food, shelter, safety, and security. -Validation begins with the first interaction between the nurse and client. -Structure within inpatient settings assists in the control and limitation of maladaptive behaviors (like screaming and yelling)
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. 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. Make provisions for the client to get admitted in short-term residential therapy. Arrange for financial resources required for the treatment.
-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. Explanation: Case management is an important role of the nurse. As a case manager, the nurse acts as a liaison between the client and community resources and third-party payers. The nurse should help the client to identify resources that would help reduce the financial burden on the client's caregivers. The nurse should also refer the client to other mental health services that would be beneficial to the client. Teaching about behavioral strategies to manage the client is indicative of the nurse's role as a teacher. Helping the caregivers to cope with stress related to the illness of the client is indicative of the nurse's role as a counselor. The client has severe and persistent mental illness; therefore, instead of getting the client admitted in short-term residential therapy, the nurse should arrange to admit the client for long-term institutionalization.
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. Training to perform activities of daily living. Periodic prognostic tests. Treatment for comorbid conditions. Development of social skills. Stabilization of symptoms.
-Development of social skills. -Stabilization of symptoms. -Training to perform activities of daily living. Explanation: Day treatment program (partial hospitalization, PHP) provides services for mentally ill clients such as developing social skills, stabilizing psychiatric symptoms, and improving the skills required for activities of daily living. These programs do not perform prognostic testing for mentally ill clients. Services for treating comorbid medical illnesses are not provided in this program.
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 Treatment plan can be completed in less than 3 months Family home can be returned to each evening Diagnosis interferes with employability
Symptom acuity does not require psychiatric hospitalization Explanation: The nurse explains that the primary criterion for enrollment in a day treatment program for clients with eating disorders is that their symptomology does not require psychiatric hospitalization. The other options do not describe the primary criterion for enrollment in a day treatment program.
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. Criticism about the criminalization of the mentally ill Increasing numbers of incarcerated individuals with mental disorders More inpatient mental health treatment needed for offenders Demand for better health care for offenders with mental disorders Public inquiries to reactionary events in those with mental disorders
-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 Explanation: In 1995, the ANA recognized forensic nursing as a specialty for these reasons: (a) the public began to question how offenders with mental disorders were receiving treatment; (b) the public began criticizing the criminalization of those with mental illness that led to a (c) demand for better health care for offenders with mental disorders. These answers not only help define the specialty, but relate to the mental health goals for Healthy People 2020. The remaining answer choices relate to singular issues for clients within the specialty, not the development of the specialty itself.
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. Schedule for follow-up treatment Diet plan that would benefit the client Side effects related to the medications Establishment of a daily routine for the client Symptoms of the psychiatric illness
-Symptoms of the psychiatric illness -Establishment of a daily routine for the client -Schedule for follow-up treatment Explanation: Relapse prevention is an important component of discharge planning. The nurse should teach the symptoms of the illness, plan the client's daily routine, and arrange schedule for follow-up treatment and referrals. Teaching about diet would not help to prevent relapse in the client. Similarly, side effects related to the medications would also not help to prevent relapse in the client.
The population that is mentally ill is arrested and prosecuted at a rate that is how many times that of the general population? 3 2 5 4
4 Explanation: The mentally ill population is arrested and prosecuted at four times the rate of the general population.
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 68-year-old person diagnosed with early stage Alzheimer's disease with a second degree burn on the hand. A 26-year-old person diagnosed with obsessive-compulsive disorder experiencing an asthmatic attack A 16-year-old person diagnosed with borderline personality disorder and an infected wrist laceration
A 34-year-old person diagnosed with an amphetamine addiction who has overdosed Explanation: A 34-year-old person diagnosed with an amphetamine addiction who has overdosed is most likely to be seen as a participant of the acute care hospitals "revolving door" phenomena. Due to the chronic and complex nature of dual diagnosis clients, frequent hospital presentations are common and treatment can be challenging. A 26-year-old person diagnosed with obsessive-compulsive disorder experiencing an asthmatic attack, a 16-year-old person diagnosed with borderline personality disorder and an infected wrist laceration, and a 68-year-old person diagnosed with early stage Alzheimer's disease with a second degree burn on the hand are not likely to be qualified in this way.
Psychiatric home care would be inappropriate for which individual? A 42-year-old who would like to enter marriage counseling A 52-year-old with AIDS A 34-year-old with severe and persistent mental illness A 43-year-old suffering from acute psychoses
A 42-year-old who would like to enter marriage counseling Explanation: Psychiatric home health care services are appropriate for different age groups, clients with acute psychoses, clients with serious and persistent mental illness, and clients with AIDS.
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 A 52-year-old with AIDS dementia A 34-year-old with severe and persistent mental illness A 43-year-old recovering from acute psychoses
A 42-year-old who would like to enter marriage counseling Explanation: Transitional psychiatric care is appropriate for different age groups. Individuals who most benefit from in-home mental health care include clients with chronic, persistent mental illness or clients with mental illness and comorbid medical conditions that require ongoing monitoring.
Which client would be most likely to qualify for psychiatric care in a long-term care setting? A client who has a diagnosis of bipolar disorder and is an intravenous heroin user A client who has schizophrenia and who is estranged from the client's family A client who has multiple sclerosis and a history of depression A client with a recent history of suicide attempts who is scheduled to begin electroshock therapy
A client who has multiple sclerosis and a history of depression Explanation: Individuals may receive psychiatric care in a long-term care setting unless they require specialized services such as substance abuse counseling, electroshock therapy, or intense individual or group psychotherapy. A lack of family support is not an admission criterion for long-term care.
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 A client with bipolar disorder who has been admitted to the hospital during a manic episode A client who has been brought to the emergency department because of acute psychosis An inpatient who is on visual checks every 15 minutes as a suicide precaution
A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health Explanation: Cybertherapy may be most appropriate for persons who do not qualify for therapeutic intervention but who are motivated for treatment. Acute illnesses are not likely to be effectively treated by this method.
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? Admission to a long-term care facility A day-treatment program Subacute care Rehabilitative care
A day-treatment program Explanation: Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care.
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 Rehabilitative care Subacute care Admission to a long-term care facility
A day-treatment program Explanation: Day-treatment programs are ideal for clients who are not dysfunctional enough to require psychiatric hospitalization but need more structured and intensive treatment than traditional outpatient services alone can provide. This client is unlikely to meet the admission criteria for long-term care or subacute care and is unlikely to benefit from rehabilitative care. Me: Day treatment is more intensive than outpatient programs (PHP and IOP)
Which best defines a community support system in relation to mental illness? -An organized system of group housing arrangements designed to support the deinstitutionalization of the mentally ill -A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation -A network of 12-step programs and support groups -A system of interventions designed to affect macrosystem variables that discriminate against people with mental illness
A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation Explanation: A community support system is a network of people committed to helping a vulnerable population meet its needs and reach its potentials without unnecessary isolation or exclusion.
Which best describes the scope of what community support services provide? -A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation -Crisis intervention assistance and referral -Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities -Mental health counseling and medication management
A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Explanation: A community support system creates and delivers community-based care to a specific population that traditionally required long-term hospitalization. It includes a range of services: health care, mental health care, rehabilitation, social networks, housing arrangements, and educational and employment opportunities.
A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Improvement in therapeutic relationship Ensured quality of care Ability to provide services in a variety of locations Ability to provide high-intensive services for many mental illnesses
Ability to provide services in a variety of locations Explanation: E-mental health services can be delivered in a variety of locations, such as schools, places of employment, and clinics. Although the use of e-mental health applications is increasing, concerns have been expressed about using the Internet for the delivery of mental health care. Difficulties may occur in developing a therapeutic client-provider relationship via the Internet. There are concerns about the ability to ensure the quality of online mental health interventions. Client privacy and confidentiality may be compromised in a web-based, e-mental health application. In addition, the Internet is often not available to subpopulations of clients with chronic and severe mental illnesses who require high-intensity services, such as those diagnosed with schizophrenia.
Which is the most restrictive setting in the continuum? Acute inpatient hospitalization Partial hospitalization Crisis intervention Residential care
Acute inpatient hospitalization Explanation: Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.
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? 24-hour supervision Acute symptom stabilization Rehabilitative services Long-term therapy
Acute symptom stabilization Explanation: When a client is admitted to an inpatient facility during a crisis, the focus of care is stabilization of the acute symptoms through medications and behavioral interventions. This type of care usually lasts fewer than 7 days. The client is in crisis, so rehabilitative services would be inappropriate.
Which client is suitable for psychiatric transitional care services? Adolescent with conduct disorder who took an overdose of alprazolam Paralyzed Vietnam veteran who is experiencing increasing respiratory difficulties and chronic infections An individual being discharged from hospital with residual symptoms of mania Schizophrenic woman found living under the freeway
An individual being discharged from hospital with residual symptoms of mania Explanation: A homebound individual with bipolar illness who is having subacute symptoms would be the perfect candidate for home care services. The paralyzed veteran, the adolescent who took an overdose, and the schizophrenic woman under the freeway should receive home care due to the acuity of their situations.
The most diverse role for the nurse within community based psychiatric mental health care would most probably be what? Case manager Crisis intervention nurse Inpatient nurse Outpatient clinic nurse
Case manager Explanation: The nurse as case manager probably is the most diverse role within the psychiatric continuum.
Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... collaborative mental health care. partial hospitalization programs. psychosocial rehabilitation programs. inpatient psychiatric units.
collaborative mental health care. Explanation: Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.
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: Fairweather Lodge model. community worker model. community living model. psychosocial rehabilitation model.
psychosocial rehabilitation model (PRM) Explanation: Psychosocial rehabilitation focuses on client rehabilitation in a normal daily environment using the strengths, skills, and community supports. The focus is empowering the person with serious mental illness to become a contributing member of the community within a supportive setting.
