Quiz: Chapter 31, Serious Mental Illness
A 20-year-old male Amish patient who was diagnosed with paranoid schizophrenia one year ago and who lives with his parents is admitted to the psychiatric unit with psychosis because of nonadherence to his medication regime. When the nurse attempts to educate the patient diagnosed with paranoid schizophrenia about his diagnosis and the need for medication, the patient persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to identify the patient's behavior? 1 Anosognosia 2 Resistance 3 Apathy 4 Religiosity
1. Anosognosia is the inability to recognize one's deficits as a result of one's illness. In serious mental illness (SMI), the brain—the organ one needs to have insight and make good decisions—is the organ that is diseased. An illness that makes one unable to recognize that illness can understandably cause one to be resistant to treatment. Although the patient may be resistant to treatment, it does not best describe the patient's denial of the illness. Apathy is lack of caring. Nothing in the scenario depicts the patient as being preoccupied with religion at this time.
The nurse is teaching a group of nursing students about approaches to treating patients with severe mental illness. Which response by a student indicates effective learning regarding functions of assertive community treatment (ACT)? 1 "Treating patients in their environment reduces inpatient admission." 2 "Treating patients with symptoms of delusions reduces impaired social functions." 3 "Crisis intervention is provided from 9 am to 9 pm to patients with severe mental illness." 4 "Patients are involved in group exercises, which are meant to test their attention and memory."
1. Evidence-based treatment approaches can be used as an adjuvant treatment for patients with severe mental illness. ACT is given to patients who cannot avail themselves of the treatment because of low income and/or lack of awareness. A group of health care professionals form a team to provide the patient with complete care and treatment in their environment, and hospitalization is not required. The treatment of delusions and dementia is emphasized in cognitive and behavioral therapy, which focus on the thought processes of the patient to identify disoriented thinking and negative self-talk. In ACT, one of the members of the team is always available to provide 24-hour crisis intervention to the patient. In cognitive enhancement therapy, patients are given group exercises to improve their attention and memory.
The nurse finds that a patient with severe mental illness also has substance abuse. The primary health care provider prescribes a medication for treating substance abuse. Which drug does the nurse anticipate in the patient's prescription? 1 Methadone (Dolophine) 2 Carbamazepine (Tegretol) 3 Acetaminophen (Tylenol)) 4 Dextroamphetamine (Dexedrine)
1. Substance abuse can be seen in patients with severe mental illness. These patients are prescribed detoxification drugs such as methadone (Dolophine), a synthetic opioid drug. It is used to reduce opioid dependency in patients who have substance abuse. Carbamazepine (Tegretol) is an antiepileptic drug used to treat epilepsy. Acetaminophen (Tylenol) is prescribed to relieve pain such as headaches and backaches. Dextroamphetamine (Dexedrine) is a central nervous system stimulant prescribed to enhance alertness and wakefulness in the patient.
A patient with a long history of schizophrenia lives alone in the community. The patient complains of increasing depression and says, "My parents will never be proud of me like they are of my brothers and sisters." What is the highest priority nursing intervention? 1 Assess the patient for suicidal ideation and intent 2 Suggest the patient attend a community support group 3 Confer with the patient's family regarding recent behavioral changes 4 Assess the patient's compliance with the prescribed antipsychotic medication regimen
1. Suicide occurs 12 times more frequently in persons with serious mental illness (SMI). Persons with SMIs often experience profound feelings of loss regarding their current life and future. These losses can lead to grief that, along with the chronicity of the illness and its impact on daily life, can contribute to despair and depression. A community support group, conferring with the patient's family, and assessing the patient's compliance with medication are not the nurse's first priority.
A popular misconception about the seriously mentally ill is that they are 1 Violent and aggressive 2 Generally given the care they require 3 Likely to experience periods of remission 4 Usually abandoned by their families
1. The seriously mentally are much more likely to be victims of violence than perpetrators of aggressive behavior. That the mentally ill are generally given the care they require, are likely to experience periods of remission, and usually are abandoned by their families are not true statements.
One of the roles of a case manager working with severely and persistently mentally ill patients who are homeless is to 1 Administer medication 2 Coordinate needed services and provide outreach 3 Ensure that the patients are not rehospitalized 4 Teach the patients to function independently
2. Community mental health services are designed to provide outreach and case management for severely mentally ill persons who are homeless. Patient participation in the program is voluntary. Community outreach programs send professional and nonprofessional workers into streets, parks, temporary shelters, bus stations, soup kitchens, and anywhere else the mentally ill may be found. A team approach is used to gain access to patients and connect them with the various services available to meet their needs. The role of the outreach worker is to be an advocate in all areas of patient need and to foster patient self-care. The role of the case manager does not include administering medication, ensuring that the patients are not rehospitalized, or teaching patients to function independently.
A patient diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around the others in the group home. It's better when I just stay by myself." The nurse should consider the nursing diagnosis of 1 Acute confusion 2 Social isolation 3 Risk for activity intolerance 4 Impaired comfort
2. Social isolation is aloneness experienced by the individual and perceived as imposed by others.
The nursing students are learning about Assertive Community Treatment (ACT). When they are asked about it, which statement by a student conveys a proper understanding? 1 A 24-hour monitoring is absent in order to reduce dependency in patients. 2 The patient is shifted to a community home to reduce homelessness. 3 ACT provides the needed range of services by a multidisciplinary team. 4 ACT has a cheaper cost as a multidisciplinary team comes under one roof.
3. A multidisciplinary team is involved in ACT. The patients do not have to visit the different departments separately. Rather, they get the needed care by one multidisciplinary team. A 24-hour monitoring by a person is available in ACT to handle any crisis situations. The patients get treatment in their own environment, which is meant to improve the quality of life without shifting the patients anywhere else. ACT program rates are high, but in the long run it cuts the costs needed for other care.
A male patient diagnosed with a severe mental illness and institutionalized for most of his adult life recently has been transferred to a supervised community-based residential home that houses several other adult men. The patient is resistant to going to day therapy and has begun to socially isolate if allowed. He has an apparent weight loss and has become uncooperative. The most likely reason for these changes is that he 1 Has begun exhibiting a lack of desire to attend the day program 2 Is lazy now that he is not on a regular schedule 3 Is experiencing a decreased sense of self 4 Has begun showing signs of independence
3. Before deinstitutionalization of the severely mentally ill beginning in 1975, psychiatric hospitals were the long-term residences for many people. Medical paternalism was a pervasive philosophical stance at that time. The health care approach to severely mentally ill persons was that of making all their decisions. Patients became institutionalized, that is, they could not think independently and lost the ability to problem solve. Much of a person's behavior became a combination of the disease process and the decreased sense of self that resulted from the lack of autonomy.
Psychiatric nurses use basic nursing interventions in all settings. The basic nursing interventions include all but which of the following? 1 Health teaching 2 Crisis intervention 3 Case management 4 Housing access
4. Nurses encounter the severely mentally ill in the acute psychiatric setting, community treatment, and medical-surgical units and clinics. All psychiatric nurses use the following basic interventions with these patients: crisis intervention, psychobiological intervention, health teaching for patients and families, counseling, case management, milieu therapy, promotion of self-care activities, and psychiatric rehabilitation.
Patients with serious mental illness (SMI) deal with many social problems. What is the most difficult problem faced by these patients? 1 Lack of mental health care coverage 2 Acceptance of assistance from others 3 Poor understanding of the disease process 4 Stigma resulting in discrimination and isolation
4. Patients with serious mental illness are discriminated against and isolated from normal people. Such social stigma is due to a lack of understanding of the diseases and certain assumptions about the patients. Some insurance providers may limit mental health coverage. However, this is an economic challenge and not a social problem faced by patients with SMI. Patients are encouraged to do their own daily activities and often do not get assistance from others. People may have a stigma against these patients. The patients themselves also avoid seeking assistance because of poor self-image and social isolation. Due to illness the patients show a reduced power of understanding. They have little knowledge of their illnesses. Normal people do not understand patients with SMI as these patients are unable to express themselves well.
The nurse, working with a patient in the partial hospitalization program, seeks advice from the psychiatric clinical nurse specialist to help a patient who has auditory hallucinations. The clinical nurse specialist most likely would suggest which of the following cognitive interventions for this patient? 1 Seclusion when escalation begins 2 Physical restraints when the patient is disruptive 3 Distracting technique 4 Giving as-needed medication for anxiety
Strategies have been applied successfully to treat hallucinations, delusions, and negative symptoms, making cognitive interventions an evidence-based practice. For example, distraction techniques can be taught when auditory hallucinations occur, such as listening to music or humming.
