Varcarolis Chapter 32
The role of a case manager working with severely and persistently mentally ill clients who are homeless would include which intervention? A. Coordinate needed services B. Administer medication C. Teach the clients to function independently D. Ensure that the clients are not re-hospitalized
Answer: A Community mental health services are designed to provide outreach and case management for severely mentally ill persons who are homeless. A team approach is used to gain access to clients 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 client need and to foster client self-care. The role of the case manager does not include any of the other options.
Which statement is true of the relationship between serious mental illnesses (SMIs) and substance abuse? A. Of those diagnosed with SMI, substance abuse is high B. Substance abuse occurs at approximately the same rate as in the general population C. Substance abuse rarely occurs within this population D. Smoking has declined in this population at the same rate as the general public
Answer: A Comorbid substance abuse occurs in 30% of those with SMI. It may be a form of self-medication, countering the dysphoria or other symptoms caused by illness or its treatment (e.g., the sedation caused by one's medications) or a maladaptive response to boredom. Nicotine use has always been higher in the population of those with SMI and is not declining as it has been in the general population. Substance abuse contributes to comorbid physical health problems, reduced quality of life, incarceration, relapse, and reduced effectiveness of medications. Substance abuse in those with SMI is higher than in the general population. Smoking has not declined in this population at the same rate as for the general public.
The term dual diagnosis refers to having a severe mental illness and what other dysfunctional behavior? A. A substance abuse problem B. Medication noncompliance C. HIV infection D. A personality disorder
Answer: A Dual diagnosis is the term used to identify a client with severe mental illness and a substance abuse problem. Both problems must be treated if the client is to be successfully rehabilitated. None of the other options reflect an accurate description of the term dual diagnosis.
Serious mental illness (SMI) affects how many adults in the United States? A. 11 million B. 8 Million C. 4 Million D. 1 million
Answer: A SMI affects about 11.4 million adults in the United States. The other options are incorrect percentages.
The clinical nurse specialist should suggest which cognitive intervention initially for a client experiencing auditory hallucinations? A. Initiating a distracting technique B. Giving as-needed medication anxiety C. Seclusion when escalation begins D. Physical restraints when the client is disruptive
Answer: A Strategies have been successfully applied 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. The remaining options should only be considered when less restrictive interventions, like distraction, prove to be ineffective and the client is at risk for injury to self or to others.
Which interventions and/or goals related to planning for discharge of a client diagnosed with a serious mental illness (SMI) would support the recovery model of care? A. Interventions will focus on the client's stated wish for independent living B. Care plan interventions will focus on medication adherence C. The clients' parents will receive education on how to manage the patient's deficits D. Attending groups that teach how to cope with one's present illness
Answer: A The recovery model is patient centered, instills hope and empowerment, emphasizes the person and the future, encourages independence and self-determination, and focuses on achieving goals of the patient's choosing and meaningful living. The National Alliance on Mental Illness (NAMI) and the President's New Freedom Commission on Mental Health (2003) both support the recovery model of care rather than the rehabilitation model, which focuses on the illness and the present. The other options all follow the rehabilitation model, focusing on the illness.
An issue for severely and persistently mentally ill clients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this problem? A. Use client empowerment techniques to increase client autonomy B. Shift follow-up from social workers to the ACT model C. Develop tools to predict relapse and assess the potential for violence D. Discontinue antipsychotics that cause untoward side effects
Answer: B Adequate monitoring of medication effects by the community-based health care provider is often difficult but more achievable when the client is being monitored by the assertive community treatment (ACT) model. None of the other options present an effective remedy for this problem.
Which statement best reflects the way clients who are severely and persistently mentally ill generally perceive how others in the community see them? A. A large number are intensely hostile toward others B. Many feel stigmatized and alienated C. Most feel under-supported by family and friends D. The majority are incapable of such self-reflective thought
Answer: B Studies have shown that many clients experience stigmatization, alienation, loss of relationships, and loss of vocational opportunities. While some clients may have the perceptions described in the other options, none are as generally expressed as feeling stigmatized and alienated.
A client who has been prescribed an antipsychotic medication comes to the clinic 3 days after a scheduled visit and demonstrates evidence of restlessness and agitation. He states, "My medicine ran out, and I didn't remember where to get more." The client's case manager should initially implement which intervention to support medication adherence? A. Arrange for the client to get to the nearest emergency department for treatment B. Arrange for a dose of the client's medication immediately C. Arrange to have the client's nursing care plan reflect the need for a medication change D. Arrange for the client to see his psychiatrist as soon as the psychiatrist has an open appointment
Answer: B The role of the case manager is to coordinate access to psychiatric treatment, housing, rehabilitation or work setting, socialization, and medical care. The client's immediate need for medication is best addressed by arranging for an immediate dose. None of the other options addresses the client's needs as effectively.
A 20-year-old Amish client was diagnosed with paranoid schizophrenia 1 year ago who lives with his parents. When the nurse attempts to educate him about his diagnosis and the need for medication, the client persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to describe this response? A. Religiosity B. Apathy C. Anosognosia D. Resistance
Answer: C Anosognosia is the inability to recognize one's deficits as a result of one's illness. In serious mental illnesses (SMIs), 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 resistive 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 being preoccupied with religion at this time.
Which statement by a young client diagnosed with a severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? A. "I hate having my thought so messed up all the time." B. "I am looking for a job washing dishes at a diner." C. "I hear that marijuana helps calm you down." D. "I like to watch cartoons every morning."
Answer: C Clients with mental illness should receive information about the dangerous negative impact of using illegal drugs. None of the other options suggest situations that are unsafe for the client.
Severely mentally ill (SMI) clients often express a strong desire to be employed. According to the evidence-based research, what is the most effective model of employment for these clients? A. Vocational rehabilitation B. A placement program of rehabilitation C. Supported employment D. Productive employment
Answer: C In the past, vocational rehabilitation programs required extensive evaluation procedures and training before attempting job placement. However, these programs were unsuccessful at helping severely mentally ill clients to maintain jobs. Research efforts have identified a more productive model called supported employment.
Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization? A. Assertiveness and condor B. Fearfulness and paranoia C. Passivity and dependance D. Anger and aggression
Answer: C Medical paternalism, in which the health care provider made all decisions for patients with serious mental illnesses (SMIs), was pervasive at the time of common institutionalization for mental illness. As a result, patients became dependent on the services and structure of institutions and unable to function independently outside such institutions. It was difficult to distinguish whether behaviors such as regression were the result of the illness or institutionalization. The other options are incorrect regarding the common resulting behavior of institutionalized patients.
A client 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 others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis to address the client's concerns? A. Acute confusion B. Risk for activity intolerance C. Social isolation D. Impaired comfort
Answer: C Social isolation is aloneness experienced by the individual and perceived as imposed by others. None of the other options would be supported by the information provided in the question.
The goal of a nurse working in psychiatric rehabilitation would be to help clients in the community achieve which outcome? A. Live comfortably in a psychiatric treatment facility B. Learn to live with dependency C. Cope more effectively with their symptoms D. Complete mental health
Answer: C The long-term outcomes of rehabilitation for severely mentally ill clients include the concepts of illness management and recovery. Illness management refers to the focus in the early stage of treatment that assists the client to gain control over symptoms. Clients are taught to collaborate with professionals in mental health treatment, reduce susceptibility to relapse, and cope more effectively with symptoms. Complete mental health is not always achievable.
The mother of a client with severe, persistent schizophrenia tells the nurse, "My child has slipped so far away from me over the past few years. We really don't have a relationship anymore. I miss my child terribly." The nursing diagnosis that best describes the mother's feelings using which term? A. Ineffective coping B. Caregiver role strain C. Grieving D. Powerlessness
Answer: C The mother is mourning the loss of her son as she formerly knew him. Grief is a common experience for families with mentally ill members. The statement does not support any of the other options.
The nurse working with a client diagnosed with severe and persistent mental illness will implement rehabilitation principles by concentrating on which intervention? A. Considering the need to lower expectations periodically B. Reviewing earlier treatment plans for errors C. Assessment on the client's deficits D. Reinforcing the client's strengths
Answer: D Although deficits are assessed and addressed, implementation of rehabilitation is dependent on reinforcement of identified client strengths. None of the remaining options is fundamental to the rehab process.
Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia? A. "We have taught him to use the bus so we do not have to drive him everywhere." B. "We give positive recognition to him whenever he does even simple things well." C. "We watch him closely of signs of illness associated with relapse." D. "We always reprimand him whenever his behavior is bothersome."
Answer: D An important need of families caring for the severely and persistently mentally ill is psychoeducation to help them understand the disease process. Families need to be prepared to meet the many concerns related to safety, communication, medication compliance, and symptom management. Family interventions are now considered an evidence-based practice, with research showing improved outcomes of decreased relapses and rehospitalizations for clients whose families participate. The only negative approach to the client and his/her needs is reflected in the option that suggests reprimanding when bothersome.
