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CHAPTER 4 PSYCH NURSING, Exams of Advanced Education

Virginia Union University (VUU)Advanced Education

CHAPTER 4 PSYCH NURSING NEW REVIEW 2025

Typology: Exams

2024/2025

Available from 12/04/2024

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CHAPTER 4 PSYCH NURSING
1. Which of the following factors is primarily responsible for the changes in inpatient hospital treatment
between the 1980s and the present?
A) Progress in treatment options for mentally ill persons
B) The growth of managed care
C) Less stigma associated with mental illness
D) The current use of milieu therapy - Ans: B Feedback:
Managed care exerts cost-control measures such as recertification of admissions, utilization review, and
case managementóall of which have altered inpatient treatment significantly. There has been some
progress in treatment options for mentally ill persons, but that is not the primary factor that has
changed mental health inpatient hospital care. There is lesser stigma associated with mental illness, but
that is not the primary factor that has changed mental health inpatient hospital care. In the 1980s, a
typical psychiatric unit emphasized milieu therapy, which required long lengths of stay because clients
with more stable conditions helped to provide structure and support for newly admitted clients with
more acute conditions.
2. The factor having the most influence on the current trend in treatment settings is the fact in recent
years,
A) funding for community programs has been inadequate.
B) laws have enabled more people to be committed to treatment.
C) state hospitals have expanded to meet the demand.
D) community programs have been fully developed to meet treatment needs. - Ans: A
Feedback:
Adequate funding has not kept pace with the need for community programs and treatment.
Commitment laws have led to deinstitutionalization. Large state hospitals emptied as a result.
Treatment in the community was intended to replace much of state hospital inpatient care, but funding
has been inadequate.
3. A patient who has continuously experienced severe symptoms of schizoaffective disorder for the past
17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this
patient at this time?
A) Partial hospitalization
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CHAPTER 4 PSYCH NURSING

  1. Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present? A) Progress in treatment options for mentally ill persons B) The growth of managed care C) Less stigma associated with mental illness D) The current use of milieu therapy - Ans: B Feedback: Managed care exerts cost-control measures such as recertification of admissions, utilization review, and case managementóall of which have altered inpatient treatment significantly. There has been some progress in treatment options for mentally ill persons, but that is not the primary factor that has changed mental health inpatient hospital care. There is lesser stigma associated with mental illness, but that is not the primary factor that has changed mental health inpatient hospital care. In the 1980s, a typical psychiatric unit emphasized milieu therapy, which required long lengths of stay because clients with more stable conditions helped to provide structure and support for newly admitted clients with more acute conditions.
  2. The factor having the most influence on the current trend in treatment settings is the fact in recent years, A) funding for community programs has been inadequate. B) laws have enabled more people to be committed to treatment. C) state hospitals have expanded to meet the demand. D) community programs have been fully developed to meet treatment needs. - Ans: A Feedback: Adequate funding has not kept pace with the need for community programs and treatment. Commitment laws have led to deinstitutionalization. Large state hospitals emptied as a result. Treatment in the community was intended to replace much of state hospital inpatient care, but funding has been inadequate.
  3. A patient who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this patient at this time? A) Partial hospitalization

B) Residential treatment C) Inpatient hospital treatment D) Clubhouse - Ans: C Feedback: Long-stay clients in an inpatient setting are people with severe and persistent mental illness who continue to require acute care services despite the current emphasis on decreased hospital stays. This population includes clients who were hospitalized before deinstitutionalization and remain hospitalized despite efforts at community placement. It also includes clients who have been hospitalized consistently for long periods despite efforts to minimize their hospital stays. Partial hospitalization is designed for patients transitioning to independent living. Residential treatment and clubhouse model provide supervised independent living.

  1. A patient with depression is admitted to an inpatient hospital unit for treatment. The type of therapy most likely provided in this setting includes A) leisure skills. B) self-monitoring of treatment. C) skills for daily living. D) talk therapy. - Ans: D Feedback: A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between residents and staff, and milieu therapy, meaning the total environment and its effect on the client's treatment. Partial hospitalization programs teach skills for daily living. Clubhouse models provide patients opportunities for leisure activities and self- monitoring of treatment.
  2. Which of the following is the highest priority for admission to inpatient care? A) Confusion or disorientation B) Need for medication changes C) Safety of self or others D) Withdrawal from alcohol or other drugs - Ans: C Feedback: Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care but the priority is safety.

Because the evolving consumer household is a permanent living arrangement, it eliminates the problem of relocation. Halfway houses usually serve as temporary placements that provide support as the clients prepare for independence. Clients who are served by respite housing are those who live in group homes or independently most of the time but have a need for ìrespiteî from their usual residences when the client experiences a crisis, feels overwhelmed, or cannot cope with problems or emotions. Independent living programs are available in many states, but may vary a great deal in regard to services provided with some agencies providing a broad range of services or shelter but few services.

  1. A patient is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually A) meet with a therapist on a weekly basis. B) resolve crises within a shorter time period. C) fulfill daily responsibilities without supervision. D) use the increased emotional support of paid staff. - Ans: C Feedback: The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without onsite supervision from paid staff.
  2. What is an important role of the nurse with regard to residents opposing plans to establish a group home or residential facility in their neighborhood? A) To provide information to correct misinformation related to stereotypes of persons with mental illnesses B) To persuade neighborhood residents that mentally ill people need safe, affordable, and desirable housing C) To provide for the safety and security of the neighborhood D) To ensure the security of persons in the group home - Ans: A Feedback: Frequently, residents oppose plans to establish a group home or residential facility in their neighborhood. They argue that having a group home will decrease their property values, and they may believe that people with mental illness are violent, will act bizarrely in public, or will be a menace to their children. These people have strongly ingrained stereotypes and a great deal of misinformation. Local residents must be given the facts, and nurses are in a position to advocate for clients by educating members of the community. The neighborhood residents who object to the establishment of a group home or residential setting may not be motivated to understand the needs of mentally ill people. It is

not the responsibility for the nurse to provide for the safety and security of the neighborhood or protect the safety and security of persons in the group home.

  1. What are the two essential components of transitional care discharge model that is used in Canada and Scotland? A) Peer support and bridging staff B) Collaboration and funding C) Relapse and hospitalization D) Poverty and entitlements - Ans: A Feedback: Two essential components of the transitional care discharge model are peer support and bridging staff. Peer support is provided by a consumer now living successfully in the community. Bridging staff refers to an overlap between hospital and community careóhospital staff do not terminate their therapeutic relationship with the client until a therapeutic relationship has been established with the community care provider. This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization. Poverty among people with mental illness is a significant barrier to maintaining housing. Mentally ill persons often rely on government entitlements for their income which forces people to have to choose continuation of the entitlement and dependence versus working inconsistently in unskilled, part-time, and low-paying jobs with no health insurance.
  2. Some residential treatment settings are transitional. This means that clients are eventually expected to A) become self-sufficient. B) find employment. C) no longer need medication. D) relocate to another setting. - Ans: D Feedback: Transitional housing is temporary; clients are expected to move to another residential setting. Clients using transitional treatment settings are not expected to become totally self-sufficient, find employment, or not be in need of medication.
  3. The primary advantage of an evolving consumer household is that clients A) are provided with adequate income to combat poverty. B) do not have to relocate as they become more independent. C) have on-site staff supervision 24 hours a day.

This model requires collaboration, administrative support, and adequate funding to effectively promote the patient's health and well-being and prevent relapse and rehospitalization.

  1. A patient has just begun daily participation in a community-based partial hospitalization program. The patient can expect the staff to assist with which of the following treatment goals? Select all that apply. A) Stabilizing psychiatric symptoms B) Finding a better job C) Improving activities of daily living D) Learning to structure time E) Improved family support F) Developing social skills - Ans: A, C, D, F Feedback: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. In day treatment programs, clients return to home at night; evening programs are just the reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric symptoms, monitoring drug effectiveness, stabilizing living environment, improving activities of daily living, learning to structure time, developing social skills, obtaining meaningful work, paid employment, or a volunteer position, and providing follow-up of any health concerns. Finding a better job and improving family support are not goals of partial hospitalization programs.
  2. A patient has just been referred to a psychosocial rehabilitation program. The nurse explains that the benefits of being involved in such a program include: Select all that apply. A) continuous monitoring of symptoms. B) increased independence. C) increased involvement in treatment decisions. D) recovery from mental illness. E) increased community integration. F) greater opportunities for personal growth. - Ans: B, D, E Feedback: Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital

admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Monitoring of symptoms and medication education are major foci of partial hospitalization programs

  1. Which type of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances? A) Clubhouse model B) Assertive community treatment C) Group homes D) Respite housing - Ans: A Feedback: The clubhouse model of psychiatric rehabilitation relies on intentional communities and rehabilitation alliances. Assertiveness community treatment (ACT) has a problem- solving orientation, and staff members who are in the community attend to specific life issues of the client. Group homes are a residential form of treatment for mental illness but do not provide complete psychiatric rehabilitation. Respite housing is temporary housing for mentally ill persons and does not provide complete psychiatric rehabilitation.
  2. Which is the orientation of assertive community treatment (ACT)? A) Setting limits on mundane life issues B) Making a wide range of referrals C) Providing services in offices D) Problem-solving orientation - Ans: D Feedback: An ACT program has a problem-solving orientation: Staff members attend to specific life issues, no matter how mundane. ACT programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices.
  3. Which of the following are advantages of a crisis resolution team or home treatment team? Select all that apply. A) It is a residential treatment setting. B) It is more likely to help a client to perceive his or her situation more accurately.

Results are positive when personal connections with case managers are established. The most recent report from the ACCESS project found frequent shifts between the street, programs, and institutions worsen the lives of the homeless. The degree of social support and employment has direct influence on quality of life.

  1. A nurse is orienting to a new position working the infirmary in the state penitentiary. When working with prisoners who are also mentally ill, the nurse examines her own attitudes. Which of the following beliefs should the nurse discuss with her supervisor before caring for incarcerated patients? A) People with mental illness are inherently violent. B) The mentally ill can get better treatment in prison than in the community. C) People with mental illness are more vulnerable to victimization when incarcerated. D) Many mentally ill would not be in prison if they were stabilized on medication. - Ans: A Feedback: Although it is true that people with major mental illnesses who do not take prescribed medication are at increased risk for being violent, most people with mental illness do not represent a significant danger to others. Criminalization of mental illness refers to the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate four times that of the general population in an effort to contain them in some type of institution where they might receive needed treatment. People with a mental illness are more likely to be the victims of violence, both in prisons and in the community.
  2. The nurse is part of a group setting up a mobile crisis service in conjunction with the local police department. Community education on which of the following this team will focus includes? A) Teaching police officers counseling skills B) Crisis counseling services to be provided in the prison system C) Educating about the dangers of the mentally ill in the community D) Assisting police officers to recognize mental illness - Ans: D Feedback: Mobile crisis services are linked to police departments. These professionals are called to the scene when police officers believe mental health issues are involved. Frequently, the mentally ill individual can be diverted to crisis counseling services or to the hospital, if needed, instead of being arrested and going to jail. Often, these same professionals provide education to police to help them recognize mental illness and perhaps change their attitude about mentally ill offenders. They do not provide direct counseling training to police officers.
  1. Which of the following are core skill areas that are needed of any effective team member of an interdisciplinary team? Select all that apply. A) Interpersonal skills B) Teamwork skills C) Communication skills D) The ability to work independently E) Risk assessment and risk management skills - Ans: A, B, C, E Feedback: 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; risk assessment and risk management skills. Members of an interdisciplinary group must work interdependently, not independently.
  2. A patient has been started on antidepressants. The interdisciplinary team member most responsible for monitoring effectiveness and side effects of this new medication is the A) pharmacist. B) psychiatrist. C) psychiatric nurse. D) psychologist - Ans: C Feedback: The nurse is also an essential team member in evaluating the effectiveness of medical treatment, particularly medications. The pharmacist has a working knowledge of medications but has limited contact with the patient. The primary function of the psychiatrist is diagnosis of mental disorders and prescription of medical treatments. The clinical psychologist practices therapy.
  3. A patient is encouraged to join in daily outdoor games with peers on the unit. The interdisciplinary team member who will monitor the patient's involvement will be the A) occupational therapist. B) recreation therapist. C) vocational rehabilitation therapist.

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.

  1. A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health-care need? A) Influencing schizophrenic patients to adhere to medication regimens B) Assisting high school students to effectively manage stress C) Coaching patients with depression to obtain employment D) Teaching parents the early signs of attention deficit disorder in children - Ans: B Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. 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.
  2. A psychiatric nurse is planning activities aimed at secondary prevention of mental illness. Which activity would be most appropriate to develop? A) Self-esteem building with a local after-school program B) Social skills training for chronic schizophrenics C) Parenthood classes at a local community center D) Depression screening in an assisted living facility - Ans: D Feedback: Nurses work to provide mental health prevention services to reduce risks to the mental health of persons, families, and communities. 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.
  3. Which element would be present in an assertive community treatment (ACT) program? A) 24-hour-a-day services B) Infrequent contact with clients C) Many clients to each staff member D) Limited length of service - Ans: A

Feedback: ACT includes a 24-hour-a-day service, many staff members for each client, in-home or community services, intense and frequent contact, and unlimited length of service.