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Psych Chapter 4
Which type of setting is used for clients who continue to need supervision but not long-term admission? Acute care Partial (day) hospitalization Voluntary commitment Nursing home - Partial (day) hospitalization When comparing homeless people without mental illness to homeless people with mental illness, homeless people with mental illness: spend less time in shelters spend more time in jail have more contact with family members face fewer barriers to employment. - spend more time in jail. Which best defines a community support system in relation to mental illness? A network of 12-step programs and support groups A network that helps to meet the needs of people with mental illness and to realize their potential without unnecessary isolation A system of interventions designed to affect macrosystem variables that discriminate against people with 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 One essential component of a community support system is having a case manager. The role of the case manager is to do what? Visit the client's home and provide mental health care Provide mental health counseling and prescribe appropriate medications. Help the individual make informed choices and ensure timely access to needed assistance. Ensure that the client is complying with orders written by a health care provider. - Help the individual make informed choices and ensure timely access to needed assistance. 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.
The lifestyle of the incarcerated client is solitary. Clients are transferred frequently to other forensic institutions. Nurses often transgress professional boundaries with the clients. - Clients commonly struggle with trusting others. Which client may be the most appropriate candidate for telepsychiatry? A client with bipolar disorder who has been admitted to the hospital during a manic episode A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health 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 Which is accurate regarding assertive community treatment (ACT)? It is designed to help those with intellectual disability. It provides day treatment programs only. It uses a high staff-to-client ratio. It offers intensive community-based services. - It offers intensive community-based services. 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 Partial hospitalization Acute inpatient care Intensive outpatient program - Respite residential care 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? Ensuring a sustainable living situation Nutritional therapies Drug abuse prevention Spiritual aspects of care - Ensuring a sustainable living situation Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... collaborative mental health care. partial hospitalization programs. inpatient psychiatric units.
Intellectual disabilities are not considered as a possible dual diagnosis 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 - Integrated care is preferred over split care for the separate diagnoses The Fountain House in New York developed the clubhouse model in the 1940s. Which is an important characteristic of a clubhouse? Membership is time limited. The clubhouse is run by staff members. Members live at the clubhouse. Members receive mental health treatment from providers in the community. - Members receive mental health treatment from providers in the community. The forensic nurse is assessing a client with new onset of hallucinations and agitation in a police station. Which finding is most consistent with mentally ill clients in the criminal justice system? Risk of violence Re-offense with incarceration Increased number of crimes Danger of self-harm - Risk of violence The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization? One million people in correctional facilities have mental illness. Male offenders receive more treatment than do female offenders. The number of persons with mental illness in prison has increased. The justice and correctional systems work together to improve care. - The number of persons with mental illness in prison has increased. What was the original purpose for developing the role of the case manager in community- based care? To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions To relieve already-burdened psychiatrists from having to make home visits to critically mentally ill clients To reduce stress on the emergency system (ie, ambulances, 911 services), which were increasingly being taxed by mentally ill individuals and their families To provide more comprehensive mental health psychotherapy to clients who were homebound - To allow the case manager to coordinate the various functions (housing, work-ups, social contacts, mental health treatment, etc.) that would address the needs of the mentally ill client within the community and reduce inpatient admissions
The greatest impact case management has had on mental health care is that it has caused what? Has affected public awareness of mental health care needs A focus on an illness, not a health paradigm Has increased client access to appropriate mental health care Has stimulated an interest in professional mental health careers - Has increased client access to appropriate mental health care Which statement accurately describes the clubhouse model of community-based mental health rehabilitation? It exists to promote rehabilitation alliance. Focus is on illness, not health. Staff ultimately makes decisions about treatment. Taking prescribed drugs is a condition to participation. - It exists to promote rehabilitation alliance. Which would not be considered an impediment to successful discharge planning? Noncompliance with medications Alcohol and drug abuse Criminal or violent behavior Compliance with the therapeutic regimen - Compliance with the therapeutic regimen Which best describes the scope of what community support services provide? Crisis intervention assistance and referral Mental health counseling and medication management A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation Help with instrumental activities of daily living, such as money management, transportation, and employment opportunities - A wide range of services, from health care and education to housing arrangements, employment counseling, and rehabilitation 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 address the needs of adults with mental illness and increase their ability to function To teach the community about mental illness in order to prevent stigma To increase the community's acceptance of individuals with mental illness To ensure that clients comply with their medication regimens to prevent relapse - To address the needs of adults with mental illness and increase their ability to function The client is a 32-year-old diagnosed with bipolar disorder. The client attends group therapy for 6 hours a day and then returns home to the client's residence. In which setting would the client receive this type of care?
Medication education Payment of care Social status Special diet instructions - Food-drug interactions Medication education Special diet instructions When clients are admitted to inpatient psychiatric settings, which member of the health care team is often the first whom they meet? Social worker Case manager Nurse Psychiatrist - Nurse A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? Maintenance of the therapeutic environment Therapy that does not include medication Inclusion of both art therapy and psychotherapy A multidisciplinary approach - Maintenance of the therapeutic environment 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? Apply religious beliefs to patient care. Apply the nurse's morals and values to everyone. Conduct thorough physical assessments of clients. Conduct ongoing self-reflection and self-awareness. - Conduct ongoing self-reflection and self-awareness. 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? Recovery center Respite residential care Psychosocial rehabilitation Assertive community treatment (ACT) - Respite residential care Which would be most important for the nurse to do in order to maximize client adherence with the discharge plan? Partnering with the client from the beginning Telling the client to adhere to the plan Encouraging the client to ask for help
Monitoring the client continuously - Partnering with the client from the beginning The nurse is conducting an admission assessment on a client in a forensic setting. Which is a priority care issue? Recovery oriented care Conditional release plan Discussion of crimes Risk assessment - Risk assessment The nurse is planning care for a mentally ill client in a forensic setting. The nurse-client relationship is influenced most during which stage? Working Self-awareness Orientation Termination - Working 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? Identifying and meeting the client's health and human service needs Contacting and maintaining relationships with the client's various service providers Facilitating reimbursement and coverage by the client's private and public insurances 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 Which mental health treatment setting is not a residential treatment setting? Respite Adult foster care Group homes Partial hospitalization programs - Partial hospitalization programs 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 will gain insight into the causes of the client's mental illness. The client's functional ability will improve. - The client's functional ability will improve. Which program provides comprehensive, highly individualized consumer services to those with severe and persistent mental illness?
Encourage the parents to participate in the client's care Provide intensive monitoring of the client at home Provide crisis intervention services when needed - Provide an alternative for inpatient admission The nurse is caring for a group of individuals with mental health disorders in an outpatient clinic. Which client is most likely to be referred to transitional care mental health services? A client with school phobia and anxiety A client with depression who is responding to treatment A client with schizophrenia and diabetes A client with oppositional defiant disorder - A client with schizophrenia and diabetes Individuals may need assistance with the coordination of care and community service programs related to what? The number of hospital-based services available to clients Changes of service providers over time The complexity of access to the community service programs available The number of choices of available services for specific diagnostic categories - The complexity of access to the community service programs available The goal of respite services as a prevention strategy includes what? 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 Promoting a service to assist individuals with mental illness to achieve independent living - Preventing unnecessary long-term hospitalizations due to burnout of informal caregivers 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? Improved financial status Provision of the most restrictive environment Level of functioning Emphasis on wellness - Level of functioning Coordination of care uses services that enable individualized care. Which type of service is also known as the "broker" model? Case management Crisis intervention Respite residential care Partial hospitalization - Case management
The mental health nurse must be alert for changes in the client psychosocial status and therefore must do which assessment frequently? (Select all that apply.) Financial status Relationship status Psychological status Physiologic status Mental status - Physiologic status Psychological status Mental status Relationship status 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. Arrange for financial resources required for the treatment. 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. Help the caregivers to cope with stress related to the illness of the client. - 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. 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 43-year-old recovering from acute psychoses 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 42-year-old who would like to enter marriage counseling A nursing student is preparing for a debate with another student about e-mental health. Which would the nurse include to support its use? Ensured quality of care Improvement in therapeutic relationship 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 A client is in need of a family-like environment with a high level of support. Which would be most appropriate?
Medicaid funding for those with mental illness has optimized patient care for poor individuals. 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. - Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. 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 Inadequate financial resources for private mental health care services An inability to leave the home due to chronic physical, psychosocial, or medical problems Lack of family support to assist in care - An inability to leave the home due to chronic physical, psychosocial, or medical problems 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 During milieu therapy, nurses offer positive feedback and praise for appropriate behaviors. These actions are essential to which concept of milieu therapy? Structure Containment Support Validation - Support The nurse working in a psychiatric facility has learned that people with substance use disorders are also at increased risk for what? Diabetes Mental illness Disorders of the pancreas Hypertension - Mental illness
Clients admitted to a psychiatric unit may be frightened, angry, and paranoid; it may be difficult for a nurse to establish good rapport under these circumstances. Often they also fear being bullied or attacked. What is a nursing priority at this time? Complete an admission history. Inquire about their food allergies and preferences. Inform clients that everything will be fine. Ensure safety. - Ensure safety. 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 additional funding that may not be afforded by the institution. It requires an open space for conducting therapy sessions. It requires the nurse to be available for care for the client all the time. - It requires clients to have longer lengths of stay. 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. Periodic prognostic tests. Training to perform activities of daily living. Development of social skills. Stabilization of symptoms. Treatment for comorbid conditions. - Training to perform activities of daily living. Development of social skills. Stabilization of symptoms. Which are core skill areas that must be implemented by any effective team member of an interdisciplinary team? Select all that apply. Communication skills Risk assessment and risk management skills Ability to work independently Interpersonal skills Teamwork skills - Interpersonal skills Teamwork skills Communication skills Risk assessment and risk management skills Which is the most restrictive setting in the continuum? Residential care
Self-help groups 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? Containment Validation Involvement Structure - Structure 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? Increased federal and state funding for psychiatric home care Pressures to reduce health care costs associated with inpatient care Improved pharmacological treatments for major depression Research suggesting that inpatient psychiatric treatment is less effective than previously believed - Pressures to reduce health care costs associated with inpatient care 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? Individualized care for additional inpatient stays Cost savings Consistent third-party reimbursement Improved access to less costly services - Improved access to less costly services The approach of the services provided to facilitate recovery for individuals must be based on which aspect? Reintegration Empowerment Partnership Consultation - Empowerment The most diverse role for the nurse within community based psychiatric mental health care would most probably be what? Crisis intervention nurse Outpatient clinic nurse Case manager Inpatient nurse - Case manager
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? In-house psychiatric unit Psychiatric specialty unit Outpatient psychiatric care General medical floor - In-house psychiatric unit 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? Primary Tertiary Chronic Secondary - Tertiary What are some of the goals of psychiatric rehabilitation? Select all that apply. Increased independence Increased involvement in treatment decisions Increased hospital admissions Recovery from mental illness Personal growth - Recovery from mental illness Personal growth Increased independence Increased involvement in treatment decisions 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? Recovery center Self-help group Supported employment Relapse prevention after care - Recovery center Which would not be an element of a community support system? Case management responsible for helping the client to make informed choices about care Provision of individual psychotherapy in the home if needed Adequate mental health care Identification of at-risk populations -
The nurse is caring for a group of clients in a partial hospitalization program. The nurse would most likely be involved in which activity? Facilitating a drug abuse prevention group Educating clients on menu planning and grocery shopping Providing spiritually related interventions Teaching about the nutritional content of canned foods - Educating clients on menu planning and grocery shopping A client with a psychiatric disorder is considering joining a clubhouse with other clients who have mental disorders. The client asks the nurse to explain what services the clubhouses provide. Which response by the nurse would be most accurate? "They are open 24 hours a day to provide care and support for the clubhouse members." "They are run entirely by psychiatric mental health nurses." "They are predominately run by psychiatric clients with minimal assistance from mental health staff." "Their primary focus is on providing ongoing intensive psychotherapy for clients in a group setting." - "They are predominately run by psychiatric clients with minimal assistance from mental health staff." An awareness to identify the need for providing culturally competent mental health care for the client can promote which treatment goal? A greater sense of belonging Successful community rehabilitation Physical wellness Boundary violations nurse-patient relationships - Successful community rehabilitation A psychiatric-mental health nurse is engaged in crisis intervention. The nurse would expect to focus on which area? Select all that apply. Social skills training Stabilization Symptom reduction Behavioral therapy Prevention of relapse - Stabilization Symptom reduction Prevention of relapse Which community activity is an example of tertiary prevention in a community that experienced a massive fire? Hospital personnel reviewed their emergency response plans and made changes. City officials installed warning signals in remote areas where no warning signals were heard. Mental health professionals offered educational programs on effective coping strategies.
A master plan was formulated for what to do in case of another fire. - A master plan was formulated for what to do in case of another fire. 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 will be able to make continual moves and readjust as needed. The client may have co-morbid medical illnesses which could be treated there. The client will be able function independently. The client may have persistent psychiatric symptoms. - The client will be able function independently. 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? Stress management education Social skills training Relapse prevention Illness education - Social skills training 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 Supervised living services Community-based residential services - Community-based residential services Case management has been proposed as a cost-effective model of psychiatric care for mentally ill clients. Which describes the goal of case management? Short-term inpatient, crisis stabilization, and community referral A return to the practice of institutionalizing chronically ill clients Increased use of psychotropic medication to stabilize psychotic behavior quickly Infrequent use of partial hospitalization and increased use of inpatient treatment - Short-term inpatient, crisis stabilization, and community referral 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? Determine the client's ability to function safely in public Request that a personality profile be performed to better understand the client's behavior. Involve an interdisciplinary team in the client's community care
