Chapter 13 My Nursing Test Banks

 

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank
Chapter 13

Question 1

Type: MCSA

Which of the following treatment programs would be most appropriate for homeless clients whose judgment is severely impaired by paranoid delusions and command hallucinations due to medication and treatment nonadherence?

1. Inpatient hospital-based care

2. Mobile outreach units

3. Assertive community treatment

4. Partial hospitalization programs

Correct Answer: 1

Rationale 1: Clients who are strongly influenced by delusions or hallucinations that seriously impair judgment have a severe inability to function in almost all areas and require intense, skilled nursing care to ensure safety needs are met. This type of care can only be delivered through inpatient hospital-based care. Mobile outreach units, partial hospitalization, and assertive community treatment programs cannot provide the security and supervision necessary to ensure these clients safety.

Rationale 2: Clients who are strongly influenced by delusions or hallucinations that seriously impair judgment have a severe inability to function in almost all areas and require intense, skilled nursing care to ensure safety needs are met. This type of care can only be delivered through inpatient hospital-based care. Mobile outreach units, partial hospitalization, and assertive community treatment programs cannot provide the security and supervision necessary to ensure these clients safety.

Rationale 3: Clients who are strongly influenced by delusions or hallucinations that seriously impair judgment have a severe inability to function in almost all areas and require intense, skilled nursing care to ensure safety needs are met. This type of care can only be delivered through inpatient hospital-based care. Mobile outreach units, partial hospitalization, and assertive community treatment programs cannot provide the security and supervision necessary to ensure these clients safety.

Rationale 4: Clients who are strongly influenced by delusions or hallucinations that seriously impair judgment have a severe inability to function in almost all areas and require intense, skilled nursing care to ensure safety needs are met. This type of care can only be delivered through inpatient hospital-based care. Mobile outreach units, partial hospitalization, and assertive community treatment programs cannot provide the security and supervision necessary to ensure these clients safety.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the types of hospital-based and community-based settings in which psychiatricmental health nurses practice.

Question 2

Type: MCSA

Which of the following services are not typically offered by community mental health centers?

1. Psychoeducation groups

2. Medication management clinics

3. Vocational rehabilitation

4. Legal assistance

Correct Answer: 4

Rationale 1: Legal assistance is not a typical function of community mental health centers. Community mental health centers typically provide emergency services, medication management clinics, psychoeducation groups, vocational rehabilitation, and consultation services to hospitals, nursing homes, and primary care centers.

Rationale 2: Legal assistance is not a typical function of community mental health centers. Community mental health centers typically provide emergency services, medication management clinics, psychoeducation groups, vocational rehabilitation, and consultation services to hospitals, nursing homes, and primary care centers.

Rationale 3: Legal assistance is not a typical function of community mental health centers. Community mental health centers typically provide emergency services, medication management clinics, psychoeducation groups, vocational rehabilitation, and consultation services to hospitals, nursing homes, and primary care centers.

Rationale 4: Legal assistance is not a typical function of community mental health centers. Community mental health centers typically provide emergency services, medication management clinics, psychoeducation groups, vocational rehabilitation, and consultation services to hospitals, nursing homes, and primary care centers.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the types of hospital-based and community-based settings in which psychiatricmental health nurses practice.

Question 3

Type: MCSA

Which of the following would be considered a disadvantage of Assertive Community Treatment (ACT) programs?

1. They are expensive, sophisticated programs.

2. They include small interdisciplinary teams of staff members.

3. They control access to resources such as housing and money.

4. They reduce stress and burnout of individual case managers.

Correct Answer: 3

Rationale 1: ACT programs become actively and directly involved in many areas of the clients life and may control access to resources such as housing and money in return for adherence to medication and treatment programs through outpatient commitment. This paternalistic coercion into treatment interferes with the clients personal autonomy. ACT programs are expensive, sophisticated programs, making them difficult for some clients to afford; however, they are believed to be cost-effective because they offset still more expensive hospital episodes. Reduction of stress and burnout of individual case managers is achieved through the small interdisciplinary team management of cases and are advantages of ACT programs.

Rationale 2: ACT programs become actively and directly involved in many areas of the clients life and may control access to resources such as housing and money in return for adherence to medication and treatment programs through outpatient commitment. This paternalistic coercion into treatment interferes with the clients personal autonomy. ACT programs are expensive, sophisticated programs, making them difficult for some clients to afford; however, they are believed to be cost-effective because they offset still more expensive hospital episodes. Reduction of stress and burnout of individual case managers is achieved through the small interdisciplinary team management of cases and are advantages of ACT programs.

Rationale 3: ACT programs become actively and directly involved in many areas of the clients life and may control access to resources such as housing and money in return for adherence to medication and treatment programs through outpatient commitment. This paternalistic coercion into treatment interferes with the clients personal autonomy. ACT programs are expensive, sophisticated programs, making them difficult for some clients to afford; however, they are believed to be cost-effective because they offset still more expensive hospital episodes. Reduction of stress and burnout of individual case managers is achieved through the small interdisciplinary team management of cases and are advantages of ACT programs.

Rationale 4: ACT programs become actively and directly involved in many areas of the clients life and may control access to resources such as housing and money in return for adherence to medication and treatment programs through outpatient commitment. This paternalistic coercion into treatment interferes with the clients personal autonomy. ACT programs are expensive, sophisticated programs, making them difficult for some clients to afford; however, they are believed to be cost-effective because they offset still more expensive hospital episodes. Reduction of stress and burnout of individual case managers is achieved through the small interdisciplinary team management of cases and are advantages of ACT programs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Identify the types of hospital-based and community-based settings in which psychiatricmental health nurses practice.

Question 4

Type: MCMA

Which of the following programs are often available to mentally ill clients in community treatment settings?

Standard Text: Select all that apply.

1. Group homes

2. Halfway houses

3. Sheltered workshops

4. Day treatment centers

5. Adult day care centers

Correct Answer: 2,3,4,5

Rationale 1: Group homes. These homes provide an opportunity for clients with serious and persistent mental illness to live more independently in the community.

Rationale 2: Halfway houses. These houses provide an opportunity for mentally ill clients to transition from the hospital and become reintegrated into the community.

Rationale 3: Sheltered workshops. These workshops provide special accommodations in the workplace to clients with disabilities in the community.

Rationale 4: Day treatment centers. These centers provide structured programs throughout the day for mentally ill clients in the community.

Rationale 5: Adult day care centers. These centers provide respite for family caregivers of mentally ill or confused clients in the community.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the types of hospital-based and community-based settings in which psychiatricmental health nurses practice.

Question 5

Type: MCSA

The nurse has completed a new clients orientation to the inpatient psychiatric unit and asks if the client has any questions. Which of the following questions indicates further teaching is needed regarding the clients rights in a therapeutic environment?

1. Where do I go if I want to smoke?

2. What time does morning group start?

3. What time are meals served on the unit?

4. What happens if I refuse to attend a group activity?

Correct Answer: 4

Rationale 1: While clients can choose to refuse group activities and other forms of treatment, a complete orientation of client rights should include benefits of the treatment program and consequences associated with lack of participation. Other logistical information such as meal times, smoking areas, and morning routines are important information for the client to know, but questions such as these do not indicate a misunderstanding of rights.

Rationale 2: While clients can choose to refuse group activities and other forms of treatment, a complete orientation of client rights should include benefits of the treatment program and consequences associated with lack of participation. Other logistical information such as meal times, smoking areas, and morning routines are important information for the client to know, but questions such as these do not indicate a misunderstanding of rights.

Rationale 3: While clients can choose to refuse group activities and other forms of treatment, a complete orientation of client rights should include benefits of the treatment program and consequences associated with lack of participation. Other logistical information such as meal times, smoking areas, and morning routines are important information for the client to know, but questions such as these do not indicate a misunderstanding of rights.

Rationale 4: While clients can choose to refuse group activities and other forms of treatment, a complete orientation of client rights should include benefits of the treatment program and consequences associated with lack of participation. Other logistical information such as meal times, smoking areas, and morning routines are important information for the client to know, but questions such as these do not indicate a misunderstanding of rights.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Minimize external factors that negatively affect the degree of cohesion and involvement of clients in inpatient settings.

Question 6

Type: MCSA

Which of the following client behaviors is the best illustration of a positive response to the therapeutic environment in an inpatient ward?

1. Sitting alone in the day room working a jigsaw puzzle

2. Watching television during leisure time

3. Napping in the dayroom after lunch

4. Signing up during the community meeting for ward duties

Correct Answer: 4

Rationale 1: Participation in community life by signing up for unit or ward duties or activities indicates the client is responding positively to the therapeutic environment. Engaging in isolative activities by working a jigsaw puzzle, watching television, or napping after lunch are benign responses that do not represent client involvement in the therapeutic environment.

Rationale 2: Participation in community life by signing up for unit or ward duties or activities indicates the client is responding positively to the therapeutic environment. Engaging in isolative activities by working a jigsaw puzzle, watching television, or napping after lunch are benign responses that do not represent client involvement in the therapeutic environment.

Rationale 3: Participation in community life by signing up for unit or ward duties or activities indicates the client is responding positively to the therapeutic environment. Engaging in isolative activities by working a jigsaw puzzle, watching television, or napping after lunch are benign responses that do not represent client involvement in the therapeutic environment.

Rationale 4: Participation in community life by signing up for unit or ward duties or activities indicates the client is responding positively to the therapeutic environment. Engaging in isolative activities by working a jigsaw puzzle, watching television, or napping after lunch are benign responses that do not represent client involvement in the therapeutic environment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Minimize external factors that negatively affect the degree of cohesion and involvement of clients in inpatient settings.

Question 7

Type: MCSA

Which of the following aspects of the structural environment pose the greatest risk to client safety in the hospital setting?

1. Plastic clothes hangers in clients closets

2. Program schedules posted on bulletin boards behind glass doors

3. Potted plants in plastic containers in the day room

4. Breakaway shower rods in the clients bathrooms

Correct Answer: 2

Rationale 1: Glass doors on bulletin boards pose a risk to client safety because, if broken, the shards could be used to injure self or others. Although building features are beyond the nurses ability to influence, the nurse can make suggestions to improve the physical structure of the environment to ensure safety of all clients. Potted plants, plastic clothes hangers, and breakaway shower rods are all examples of important safety features to be considered in hospital-based care.

Rationale 2: Glass doors on bulletin boards pose a risk to client safety because, if broken, the shards could be used to injure self or others. Although building features are beyond the nurses ability to influence, the nurse can make suggestions to improve the physical structure of the environment to ensure safety of all clients. Potted plants, plastic clothes hangers, and breakaway shower rods are all examples of important safety features to be considered in hospital-based care.

Rationale 3: Glass doors on bulletin boards pose a risk to client safety because, if broken, the shards could be used to injure self or others. Although building features are beyond the nurses ability to influence, the nurse can make suggestions to improve the physical structure of the environment to ensure safety of all clients. Potted plants, plastic clothes hangers, and breakaway shower rods are all examples of important safety features to be considered in hospital-based care.

Rationale 4: Glass doors on bulletin boards pose a risk to client safety because, if broken, the shards could be used to injure self or others. Although building features are beyond the nurses ability to influence, the nurse can make suggestions to improve the physical structure of the environment to ensure safety of all clients. Potted plants, plastic clothes hangers, and breakaway shower rods are all examples of important safety features to be considered in hospital-based care.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Minimize external factors that negatively affect the degree of cohesion and involvement of clients in inpatient settings.

Question 8

Type: MCSA

A client on the inpatient psychiatric unit asks the nurse, Why is the daily schedule so full of activities and why do we have so many rules to follow? Which of the following is the best response by the nurse?

1. A daily routine helps you keep on track and organize your thoughts. The rules help people live together respectfully.

2. Clients with mental illness get too chaotic and unpredictable when they dont have a structured routine to follow.

3. Idle hands and minds are the devils playground.

4. The real world is full of rules and activities for everyone to follow.

Correct Answer: 1

Rationale 1: A routine helps clients keep on track and organize their thinking as well as their activities. Rules promote harmony and respect in a therapeutic environment. Remarks like idle minds and devils playground can be confusing and belittling to the client. References to the real world and referring to client behavior as chaotic and unpredictable imply that clients with psychiatric illness are incapable of living independently in the community and are belittling to the client as well.

Rationale 2: A routine helps clients keep on track and organize their thinking as well as their activities. Rules promote harmony and respect in a therapeutic environment. Remarks like idle minds and devils playground can be confusing and belittling to the client. References to the real world and referring to client behavior as chaotic and unpredictable imply that clients with psychiatric illness are incapable of living independently in the community and are belittling to the client as well.

Rationale 3: A routine helps clients keep on track and organize their thinking as well as their activities. Rules promote harmony and respect in a therapeutic environment. Remarks like idle minds and devils playground can be confusing and belittling to the client. References to the real world and referring to client behavior as chaotic and unpredictable imply that clients with psychiatric illness are incapable of living independently in the community and are belittling to the client as well.

Rationale 4: A routine helps clients keep on track and organize their thinking as well as their activities. Rules promote harmony and respect in a therapeutic environment. Remarks like idle minds and devils playground can be confusing and belittling to the client. References to the real world and referring to client behavior as chaotic and unpredictable imply that clients with psychiatric illness are incapable of living independently in the community and are belittling to the client as well.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Minimize external factors that negatively affect the degree of cohesion and involvement of clients in inpatient settings.

Question 9

Type: MCSA

A client admitted to the inpatient psychiatric unit after a recent suicide attempt tells the nurse, Even though suicide is against my religion, I was in so much emotional distress that I didnt think I could keep on living. Im really struggling with my spiritual conscience and dont know what I should do. Which of the following nurse responses is most appropriate?

1. It sounds like spirituality plays a significant role in your life. Tell me what beliefs are most important to you.

2. Im not very comfortable discussing religious matters. This is something you should talk to your priest or pastor about.

3. I think you should pray for forgiveness and turn all your problems over to God.

4. I hear that you are having a real struggle with your spiritual beliefs. Tell me what I can do to help.

Correct Answer: 1

Rationale 1: Asking clients to identify which spiritual beliefs are most important to them enables the nurse to reassure clients who fear that their beliefs will be challenged or minimized in a psychiatric environment. The nurse should avoid offering advice such as suggesting the client pray and turn all troubles over to God. Referring the client to a priest or pastor abdicates the nurses role in helping clients explore the importance of spiritual beliefs in their recovery. Asking clients to tell the nurse what can be done to help places the responsibility for action on the nurse rather than the client and does not encourage discussion of spiritual beliefs.

Rationale 2: Asking clients to identify which spiritual beliefs are most important to them enables the nurse to reassure clients who fear that their beliefs will be challenged or minimized in a psychiatric environment. The nurse should avoid offering advice such as suggesting the client pray and turn all troubles over to God. Referring the client to a priest or pastor abdicates the nurses role in helping clients explore the importance of spiritual beliefs in their recovery. Asking clients to tell the nurse what can be done to help places the responsibility for action on the nurse rather than the client and does not encourage discussion of spiritual beliefs.

Rationale 3: Asking clients to identify which spiritual beliefs are most important to them enables the nurse to reassure clients who fear that their beliefs will be challenged or minimized in a psychiatric environment. The nurse should avoid offering advice such as suggesting the client pray and turn all troubles over to God. Referring the client to a priest or pastor abdicates the nurses role in helping clients explore the importance of spiritual beliefs in their recovery. Asking clients to tell the nurse what can be done to help places the responsibility for action on the nurse rather than the client and does not encourage discussion of spiritual beliefs.

Rationale 4: Asking clients to identify which spiritual beliefs are most important to them enables the nurse to reassure clients who fear that their beliefs will be challenged or minimized in a psychiatric environment. The nurse should avoid offering advice such as suggesting the client pray and turn all troubles over to God. Referring the client to a priest or pastor abdicates the nurses role in helping clients explore the importance of spiritual beliefs in their recovery. Asking clients to tell the nurse what can be done to help places the responsibility for action on the nurse rather than the client and does not encourage discussion of spiritual beliefs.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Maximize the common good of all clients in a hospital setting while maintaining the privacy and autonomy of individual clients.

Question 10

Type: MCSA

A client and his wife are visiting in the day room of an inpatient psychiatric unit when a client with acute psychosis experiencing auditory hallucinations sits down next to them and begins talking to the voices. Which of the following nursing actions is most appropriate?

1. Take the client with psychosis by the hand and lead the client to another area in the day room.

2. Announce over the intercom that visiting hours are over.

3. Observe the situation and intervene only if the client with psychosis becomes aggressive.

4. Remind the client with psychosis to respect the privacy of the other client and his wife.

Correct Answer: 4

Rationale 1: The nurse needs to give instructions or directions at the level of the clients ability. Providing a verbal prompt to a client with acute psychosis who may not realize that another clients privacy is being invaded is the most appropriate proactive strategy. Waiting until aggressive behavior occurs before intervening puts the other client and his wife at risk. Physically leading the client away from the situation assumes a parental role and does not promote independent behavior. Announcing that visiting hours are over is not appropriate unless this is true, and it could confuse clients with psychosis who have auditory hallucinations.

Rationale 2: The nurse needs to give instructions or directions at the level of the clients ability. Providing a verbal prompt to a client with acute psychosis who may not realize that another clients privacy is being invaded is the most appropriate proactive strategy. Waiting until aggressive behavior occurs before intervening puts the other client and his wife at risk. Physically leading the client away from the situation assumes a parental role and does not promote independent behavior. Announcing that visiting hours are over is not appropriate unless this is true, and it could confuse clients with psychosis who have auditory hallucinations.

Rationale 3: The nurse needs to give instructions or directions at the level of the clients ability. Providing a verbal prompt to a client with acute psychosis who may not realize that another clients privacy is being invaded is the most appropriate proactive strategy. Waiting until aggressive behavior occurs before intervening puts the other client and his wife at risk. Physically leading the client away from the situation assumes a parental role and does not promote independent behavior. Announcing that visiting hours are over is not appropriate unless this is true, and it could confuse clients with psychosis who have auditory hallucinations.

Rationale 4: The nurse needs to give instructions or directions at the level of the clients ability. Providing a verbal prompt to a client with acute psychosis who may not realize that another clients privacy is being invaded is the most appropriate proactive strategy. Waiting until aggressive behavior occurs before intervening puts the other client and his wife at risk. Physically leading the client away from the situation assumes a parental role and does not promote independent behavior. Announcing that visiting hours are over is not appropriate unless this is true, and it could confuse clients with psychosis who have auditory hallucinations.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Maximize the common good of all clients in a hospital setting while maintaining the privacy and autonomy of individual clients.

Question 11

Type: MCSA

A client with chronic paranoid schizophrenia is scheduled to be discharged from the inpatient psychiatric unit in two days. The nurse is working with the clients family to develop a plan for managing psychotic symptoms and emergency behaviors after discharge. Which of the following nursing diagnoses is most appropriate?

1. Noncompliance: Medication Regimen related to paranoid ideation

2. Self-Care Deficit: Bathing/Hygiene related to irrational thought processes

3. Knowledge Deficit: Symptom Management related to inadequate understanding of disease processes

4. Risk for Violence Directed Toward Others related to delusional and persecutory thought process

Correct Answer: 3

Rationale 1: Nurses should partner with the client and family to determine a mutually agreeable plan for a safe, secure, and supportive living arrangement following discharge. This includes a plan for managing symptoms by reducing schedule demands and/or contacting the mental health team or case manager for assistance. Family members need guidance in how to recognize relapse and exacerbation of symptoms as well as what to do in an emergency situation. Noncompliance with Medications, Self-Care Deficits, and Potential for Violent Behaviors are nursing diagnoses more appropriate for clients in the inpatient setting but do not help the family prepare for challenges after discharge.

Rationale 2: Nurses should partner with the client and family to determine a mutually agreeable plan for a safe, secure, and supportive living arrangement following discharge. This includes a plan for managing symptoms by reducing schedule demands and/or contacting the mental health team or case manager for assistance. Family members need guidance in how to recognize relapse and exacerbation of symptoms as well as what to do in an emergency situation. Noncompliance with Medications, Self-Care Deficits, and Potential for Violent Behaviors are nursing diagnoses more appropriate for clients in the inpatient setting but do not help the family prepare for challenges after discharge.

Rationale 3: Nurses should partner with the client and family to determine a mutually agreeable plan for a safe, secure, and supportive living arrangement following discharge. This includes a plan for managing symptoms by reducing schedule demands and/or contacting the mental health team or case manager for assistance. Family members need guidance in how to recognize relapse and exacerbation of symptoms as well as what to do in an emergency situation. Noncompliance with Medications, Self-Care Deficits, and Potential for Violent Behaviors are nursing diagnoses more appropriate for clients in the inpatient setting but do not help the family prepare for challenges after discharge.

Rationale 4: Nurses should partner with the client and family to determine a mutually agreeable plan for a safe, secure, and supportive living arrangement following discharge. This includes a plan for managing symptoms by reducing schedule demands and/or contacting the mental health team or case manager for assistance. Family members need guidance in how to recognize relapse and exacerbation of symptoms as well as what to do in an emergency situation. Noncompliance with Medications, Self-Care Deficits, and Potential for Violent Behaviors are nursing diagnoses more appropriate for clients in the inpatient setting but do not help the family prepare for challenges after discharge.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Maximize the common good of all clients in a hospital setting while maintaining the privacy and autonomy of individual clients.

Question 12

Type: MCSA

A psychiatric home care nurse knocks on the clients door for the first time and is told by the client, Go away and leave me alone. I dont want to buy any Girl Scout cookies. What should the nurse do in this instance?

1. Leave, and try to gain admittance to the clients home tomorrow

2. Show the client identification and explain the purpose of the visit

3. Offer to give the client money to buy Girl Scout cookies

4. Call the home health agency and request a new assignment

Correct Answer: 2

Rationale 1: The psychiatric home health nurse should provide proof of identity and the reason for knocking on the clients door. Offering the client money, even to buy Girl Scout cookies, is unethical and can create an undesirable precedent for future visits. Leaving without an attempt to gain admittance at this time, or requesting a new assignment from the home health agency, would be unproductive and only serve to delay necessary treatment.

Rationale 2: The psychiatric home health nurse should provide proof of identity and the reason for knocking on the clients door. Offering the client money, even to buy Girl Scout cookies, is unethical and can create an undesirable precedent for future visits. Leaving without an attempt to gain admittance at this time, or requesting a new assignment from the home health agency, would be unproductive and only serve to delay necessary treatment.

Rationale 3: The psychiatric home health nurse should provide proof of identity and the reason for knocking on the clients door. Offering the client money, even to buy Girl Scout cookies, is unethical and can create an undesirable precedent for future visits. Leaving without an attempt to gain admittance at this time, or requesting a new assignment from the home health agency, would be unproductive and only serve to delay necessary treatment.

Rationale 4: The psychiatric home health nurse should provide proof of identity and the reason for knocking on the clients door. Offering the client money, even to buy Girl Scout cookies, is unethical and can create an undesirable precedent for future visits. Leaving without an attempt to gain admittance at this time, or requesting a new assignment from the home health agency, would be unproductive and only serve to delay necessary treatment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the specific challenges that psychiatric home care nurses face.

Question 13

Type: MCSA

The psychiatric home health nurse has made repeated attempts to make a home visit to a homebound client, only to find that the client is not at home at the scheduled time. What is the best action by the nurse?

1. Wait outside in the car until the client returns home.

2. Reevaluate the clients homebound status.

3. Call the client the day before each scheduled visit as a reminder.

4. Call the clients landlord and ask to be let into the clients home.

Correct Answer: 2

Rationale 1: Clients who are receiving psychiatric services at home must qualify for homebound status for reimbursement purposes. If clients are not at home for scheduled visits, they are no longer homebound and need alternative arrangements for services. Calling the client the day before each scheduled visit as a reminder is appropriate, but the change in homebound status must still be addressed to prevent Medicare fraud. Waiting outside the clients home is impractical and does not address the change in homebound status. The nurse should never enter the clients home without the clients permission. If foul play is suspected or the nurse fears for the clients life, the emergency response team should be called.

Rationale 2: Clients who are receiving psychiatric services at home must qualify for homebound status for reimbursement purposes. If clients are not at home for scheduled visits, they are no longer homebound and need alternative arrangements for services. Calling the client the day before each scheduled visit as a reminder is appropriate, but the change in homebound status must still be addressed to prevent Medicare fraud. Waiting outside the clients home is impractical and does not address the change in homebound status. The nurse should never enter the clients home without the clients permission. If foul play is suspected or the nurse fears for the clients life, the emergency response team should be called.

Rationale 3: Clients who are receiving psychiatric services at home must qualify for homebound status for reimbursement purposes. If clients are not at home for scheduled visits, they are no longer homebound and need alternative arrangements for services. Calling the client the day before each scheduled visit as a reminder is appropriate, but the change in homebound status must still be addressed to prevent Medicare fraud. Waiting outside the clients home is impractical and does not address the change in homebound status. The nurse should never enter the clients home without the clients permission. If foul play is suspected or the nurse fears for the clients life, the emergency response team should be called.

Rationale 4: Clients who are receiving psychiatric services at home must qualify for homebound status for reimbursement purposes. If clients are not at home for scheduled visits, they are no longer homebound and need alternative arrangements for services. Calling the client the day before each scheduled visit as a reminder is appropriate, but the change in homebound status must still be addressed to prevent Medicare fraud. Waiting outside the clients home is impractical and does not address the change in homebound status. The nurse should never enter the clients home without the clients permission. If foul play is suspected or the nurse fears for the clients life, the emergency response team should be called.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the specific challenges that psychiatric home care nurses face.

Question 14

Type: MCMA

A psychiatric home health nurse makes home visits in a neighborhood that has a high incidence of reported crimes. What reasonable safety measures should the nurse implement during home visits?

Standard Text: Select all that apply.

1. Make all visits in the daytime

2. Ask for a police escort during visits

3. Call the client before arrival at the home

4. Carry a cell phone at all times

5. Ask to be accompanied on visits by a co-worker

Correct Answer: 1,2,3,4,5

Rationale 1: Make all visits in the daytime. Never enter a crime-filled neighborhood in the dark.

Rationale 2: Ask for a police escort during visits. This is an unreasonable expectation. If the neighborhood is that dangerous, then alternative treatment should be arranged.

Rationale 3: Call the client before arrival at the home. This will ensure the client is home and assess the activities occurring in the neighborhood.

Rationale 4: Carry a cell phone at all times. Help can be called if needed.

Rationale 5: Ask to be accompanied on visits by a co-worker. There is safety and comfort in numbers.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Discuss the specific challenges that psychiatric home care nurses face.

Question 15

Type: MCSA

A nurse case manager is assigned to a client with recurring substance abuse issues. Which of the following strategies would be most important in providing care to this client?

1. Assessment and problem identification

2. Ordering psychological testing

3. Arranging for inpatient hospital care

4. Administering medications

Correct Answer: 1

Rationale 1: Assessment and problem identification is the most important strategy to develop a plan consistent with the needs of clients who have serious and persistent mental illnesses such as recurring substance abuse. The nurse case manager does not provide direct care, such as administering medications, and does not have the authority to order psychological testing unless the nurse is engaged in advanced practice. Arranging for inpatient hospital care may not be necessary, and a thorough assessment would determine if this level of care is needed.

Rationale 2: Assessment and problem identification is the most important strategy to develop a plan consistent with the needs of clients who have serious and persistent mental illnesses such as recurring substance abuse. The nurse case manager does not provide direct care, such as administering medications, and does not have the authority to order psychological testing unless the nurse is engaged in advanced practice. Arranging for inpatient hospital care may not be necessary, and a thorough assessment would determine if this level of care is needed.

Rationale 3: Assessment and problem identification is the most important strategy to develop a plan consistent with the needs of clients who have serious and persistent mental illnesses such as recurring substance abuse. The nurse case manager does not provide direct care, such as administering medications, and does not have the authority to order psychological testing unless the nurse is engaged in advanced practice. Arranging for inpatient hospital care may not be necessary, and a thorough assessment would determine if this level of care is needed.

Rationale 4: Assessment and problem identification is the most important strategy to develop a plan consistent with the needs of clients who have serious and persistent mental illnesses such as recurring substance abuse. The nurse case manager does not provide direct care, such as administering medications, and does not have the authority to order psychological testing unless the nurse is engaged in advanced practice. Arranging for inpatient hospital care may not be necessary, and a thorough assessment would determine if this level of care is needed.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Coordinate a clients care with a wide diversity of providers in a complex mental health system by incorporating the principles of the case management role.

Question 16

Type: MCSA

The nurse case manager is participating in a treatment team meeting where members are discussing treatment options for a client with a history of medication and treatment nonadherence. The clients health insurance plan does not cover the cost of expensive atypical antipsychotic depot medications. Which of the following is not an appropriate action by the nurse in this situation?

1. Suggesting affordable alternatives for treatment

2. Discussing possible treatment options with the client

3. Monitoring the clients response to current medication treatment

4. Enrolling the client in another health insurance plan

Correct Answer: 4

Rationale 1: Only the client can enroll in another health insurance plan. The nurse can review health insurance coverage with the client, suggest affordable alternatives for treatment, and discuss possible treatment options to help the client and treatment team make an informed decision. The nurse case manager plays an important role in evaluating and monitoring the clients current response to treatment and progress toward desired outcomes.

Rationale 2: Only the client can enroll in another health insurance plan. The nurse can review health insurance coverage with the client, suggest affordable alternatives for treatment, and discuss possible treatment options to help the client and treatment team make an informed decision. The nurse case manager plays an important role in evaluating and monitoring the clients current response to treatment and progress toward desired outcomes.

Rationale 3: Only the client can enroll in another health insurance plan. The nurse can review health insurance coverage with the client, suggest affordable alternatives for treatment, and discuss possible treatment options to help the client and treatment team make an informed decision. The nurse case manager plays an important role in evaluating and monitoring the clients current response to treatment and progress toward desired outcomes.

Rationale 4: Only the client can enroll in another health insurance plan. The nurse can review health insurance coverage with the client, suggest affordable alternatives for treatment, and discuss possible treatment options to help the client and treatment team make an informed decision. The nurse case manager plays an important role in evaluating and monitoring the clients current response to treatment and progress toward desired outcomes.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Coordinate a clients care with a wide diversity of providers in a complex mental health system by incorporating the principles of the case management role.

Question 17

Type: MCSA

The interdisciplinary treatment team is discussing appropriate strategies for a homebound client who has a history of medication nonadherence. Which of the following rationales should the nurse case manager use when a treatment team member suggests that the nurse case manager make daily home visits to administer medications?

1. My job description does not include medication administration to clients in the home.

2. My role as case manager is to remain objective and look at the whole picture. If I deliver direct care, I may lose this perspective.

3. My time is more importantly spent supervising others to provide this type of direct care.

4. My daily schedule is too full to commit this amount of time to administering medications.

Correct Answer: 2

Rationale 1: The nurse case managers role is to remain the objective, internal consultant, looking at the whole picture. When pulled into delivering the care, the case manager loses perspective and may find important issues clouded. Arguing that the case manager is too busy, too important, or that it is not in the job description does not communicate the importance of the case managers role and its unique contribution to the care team.

Rationale 2: The nurse case managers role is to remain the objective, internal consultant, looking at the whole picture. When pulled into delivering the care, the case manager loses perspective and may find important issues clouded. Arguing that the case manager is too busy, too important, or that it is not in the job description does not communicate the importance of the case managers role and its unique contribution to the care team.

Rationale 3: The nurse case managers role is to remain the objective, internal consultant, looking at the whole picture. When pulled into delivering the care, the case manager loses perspective and may find important issues clouded. Arguing that the case manager is too busy, too important, or that it is not in the job description does not communicate the importance of the case managers role and its unique contribution to the care team.

Rationale 4: The nurse case managers role is to remain the objective, internal consultant, looking at the whole picture. When pulled into delivering the care, the case manager loses perspective and may find important issues clouded. Arguing that the case manager is too busy, too important, or that it is not in the job description does not communicate the importance of the case managers role and its unique contribution to the care team.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Coordinate a clients care with a wide diversity of providers in a complex mental health system by incorporating the principles of the case management role.

Question 18

Type: MCSA

Which of the following activities is the central element that differentiates case management from other types of care?

1. Coordinating one episode of care across multiple treatment settings

2. Preventing re-hospitalization

3. Focusing treatment goals in the most restrictive setting

4. Advocating for clients requiring extensive services

Correct Answer: 1

Rationale 1: Case managers are primarily responsible for the coordination of one episode of care across the multiple settings of the care continuum. Although preventing unnecessary hospitalizations is an important goal, preventing re-hospitalization may be unrealistic. Treatment goals should be focused on providing care in least-restrictive settings. Advocating for clients requiring extensive services is not unique to the case management role.

Rationale 2: Case managers are primarily responsible for the coordination of one episode of care across the multiple settings of the care continuum. Although preventing unnecessary hospitalizations is an important goal, preventing re-hospitalization may be unrealistic. Treatment goals should be focused on providing care in least-restrictive settings. Advocating for clients requiring extensive services is not unique to the case management role.

Rationale 3: Case managers are primarily responsible for the coordination of one episode of care across the multiple settings of the care continuum. Although preventing unnecessary hospitalizations is an important goal, preventing re-hospitalization may be unrealistic. Treatment goals should be focused on providing care in least-restrictive settings. Advocating for clients requiring extensive services is not unique to the case management role.

Rationale 4: Case managers are primarily responsible for the coordination of one episode of care across the multiple settings of the care continuum. Although preventing unnecessary hospitalizations is an important goal, preventing re-hospitalization may be unrealistic. Treatment goals should be focused on providing care in least-restrictive settings. Advocating for clients requiring extensive services is not unique to the case management role.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Coordinate a clients care with a wide diversity of providers in a complex mental health system by incorporating the principles of the case management role.

Question 19

Type: MCSA

Which of the following qualifications best explains why nurses are better suited for the role of case management than social workers?

1. Nurses have broader clinical experiences with a variety of clients.

2. Nurses have thorough training in psychobiology and pharmacology.

3. Nurses have superior therapeutic communication skills.

4. Nurses have better therapeutic relationships with their clients.

Correct Answer: 2

Rationale 1: Nurses are uniquely suited to the role of case management because of their increased emphasis on psychobiology and pharmacology in helping clients cope with alterations in their mental health. Social workers have broad clinical experiences with a variety of clients but do not receive education in pharmacologic treatment regimens. Nurses and social workers are equally adept in developing relationships with clients and using therapeutic communication skills.

Rationale 2: Nurses are uniquely suited to the role of case management because of their increased emphasis on psychobiology and pharmacology in helping clients cope with alterations in their mental health. Social workers have broad clinical experiences with a variety of clients but do not receive education in pharmacologic treatment regimens. Nurses and social workers are equally adept in developing relationships with clients and using therapeutic communication skills.

Rationale 3: Nurses are uniquely suited to the role of case management because of their increased emphasis on psychobiology and pharmacology in helping clients cope with alterations in their mental health. Social workers have broad clinical experiences with a variety of clients but do not receive education in pharmacologic treatment regimens. Nurses and social workers are equally adept in developing relationships with clients and using therapeutic communication skills.

Rationale 4: Nurses are uniquely suited to the role of case management because of their increased emphasis on psychobiology and pharmacology in helping clients cope with alterations in their mental health. Social workers have broad clinical experiences with a variety of clients but do not receive education in pharmacologic treatment regimens. Nurses and social workers are equally adept in developing relationships with clients and using therapeutic communication skills.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Coordinate a clients care with a wide diversity of providers in a complex mental health system by incorporating the principles of the case management role.

Question 20

Type: MCSA

Which of the following statements regarding the impact of managed health care on the delivery of psychiatric services is true?

1. Managed mental health care has resulted in shorter, more intense psychiatric hospital stays to keep costs down.

2. Clients are admitted to hospitals in earlier stages of psychiatric illnesses.

3. Cost containment has created an entire range of ambulatory care services that are considered ineffective.

4. Shorter models for psychiatric services and outpatient treatment do not meet the lifestyle needs of clients and their employers.

Correct Answer: 1

Rationale 1: In an effort to contain costs, managed mental health care has resulted in shorter, more intense psychiatric hospital stays. As a result of managed care, clients are admitted to hospitals in later stages of disease or illness, or perhaps not admitted at all. Shorter models of psychiatric services, outpatient treatment, and ambulatory care services have been effectively created to keep costs down and meet the lifestyle needs of clients and their employers.

Rationale 2: In an effort to contain costs, managed mental health care has resulted in shorter, more intense psychiatric hospital stays. As a result of managed care, clients are admitted to hospitals in later stages of disease or illness, or perhaps not admitted at all. Shorter models of psychiatric services, outpatient treatment, and ambulatory care services have been effectively created to keep costs down and meet the lifestyle needs of clients and their employers.

Rationale 3: In an effort to contain costs, managed mental health care has resulted in shorter, more intense psychiatric hospital stays. As a result of managed care, clients are admitted to hospitals in later stages of disease or illness, or perhaps not admitted at all. Shorter models of psychiatric services, outpatient treatment, and ambulatory care services have been effectively created to keep costs down and meet the lifestyle needs of clients and their employers.

Rationale 4: In an effort to contain costs, managed mental health care has resulted in shorter, more intense psychiatric hospital stays. As a result of managed care, clients are admitted to hospitals in later stages of disease or illness, or perhaps not admitted at all. Shorter models of psychiatric services, outpatient treatment, and ambulatory care services have been effectively created to keep costs down and meet the lifestyle needs of clients and their employers.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explain how managed mental health care organizations influence the delivery of psychiatricmental health care.

Question 21

Type: MCMA

Which of the following services are typically performed by psychiatric nurses employed in managed care organizations?

Standard Text: Select all that apply.

1. Performing mental health assessments

2. Scheduling appointments for therapy

3. Providing stress management classes

4. Contacting medication prescribers to arrange for changes

5. Triaging initial requests for services

Correct Answer: 1,3,4,5

Rationale 1: Performing mental health assessments. It is part of the psychiatric nurses role to identify health care needs and plan appropriate treatment.

Rationale 2: Scheduling appointments for therapy. Scheduling appointments is not an important role of psychiatric nurses and is ineffective utilization of the nurses time and skills.

Rationale 3: Providing stress management classes. It is part of the psychiatric nurses role to promote health and decrease the incidence of illness.

Rationale 4: Contacting medication prescribers to arrange for changes. Psychiatric nurses who work for managed care organizations have an important advocacy role.

Rationale 5: Triaging initial requests for services. Acting as gatekeeper is an important role of psychiatric nurses who work in the managed care environment.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how managed mental health care organizations influence the delivery of psychiatricmental health care.

Question 22

Type: MCSA

A client with generalized anxiety disorder frequently skips weekly scheduled appointments with a primary nurse therapist in the managed care organization (MCO), showing up only when the client is feeling severely stressed. Which of the following statements best explains this behavior?

1. The client is aware that MCOs frequently double-book appointments to balance out the no-shows.

2. The client does not have transportation for scheduled appointments with the therapist.

3. MCO consumers do not have to make co-payments for missed appointments.

4. MCO consumers find it easier than non-MCO consumers to not keep scheduled appointments, partly because services are prepaid.

Correct Answer: 4

Rationale 1: Perhaps because services are prepaid, MCO consumers find it easier to skip scheduled appointments. This is sometimes referred to as DNKA (did not keep appointment). Some MCOs deal with this problem by not scheduling future appointments until the client makes co-payment for all missed appointments. Transportation problems are a frequent reason for failure to keep appointments; however, this does not seem apparent as the client is able to keep appointments when the client feels it is needed. Most clients are unaware of the scheduling practices of an MCO and do not realize the clinical and administrative importance of missing scheduled appointments.

Rationale 2: Perhaps because services are prepaid, MCO consumers find it easier to skip scheduled appointments. This is sometimes referred to as DNKA (did not keep appointment). Some MCOs deal with this problem by not scheduling future appointments until the client makes co-payment for all missed appointments. Transportation problems are a frequent reason for failure to keep appointments; however, this does not seem apparent as the client is able to keep appointments when the client feels it is needed. Most clients are unaware of the scheduling practices of an MCO and do not realize the clinical and administrative importance of missing scheduled appointments.

Rationale 3: Perhaps because services are prepaid, MCO consumers find it easier to skip scheduled appointments. This is sometimes referred to as DNKA (did not keep appointment). Some MCOs deal with this problem by not scheduling future appointments until the client makes co-payment for all missed appointments. Transportation problems are a frequent reason for failure to keep appointments; however, this does not seem apparent as the client is able to keep appointments when the client feels it is needed. Most clients are unaware of the scheduling practices of an MCO and do not realize the clinical and administrative importance of missing scheduled appointments.

Rationale 4: Perhaps because services are prepaid, MCO consumers find it easier to skip scheduled appointments. This is sometimes referred to as DNKA (did not keep appointment). Some MCOs deal with this problem by not scheduling future appointments until the client makes co-payment for all missed appointments. Transportation problems are a frequent reason for failure to keep appointments; however, this does not seem apparent as the client is able to keep appointments when the client feels it is needed. Most clients are unaware of the scheduling practices of an MCO and do not realize the clinical and administrative importance of missing scheduled appointments.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explain how managed mental health care organizations influence the delivery of psychiatricmental health care.

Question 23

Type: MCMA

Which of the following community support programs should the nurse recommend to family members of a client with severe and persistent mental illness (SPMI) who is living independently in the community?

Standard Text: Select all that apply.

1. Residential special care units

2. Hospices

3. Day treatment

4. Case management

5. Medication management

Correct Answer: 4,5

Rationale 1: Residential special care units. These units are assisted living facilities for clients with cognitive impairment caused by diseases of the Alzheimers type (DAT).

Rationale 2: Hospices. Hospices are programs for clients with end-of-life care needs and are not appropriate referrals for SPMI clients unless they have a terminal illness and less than six months to live.

Rationale 3: Day treatment programs. These programs offer groups and activities that provide for recreation and socialization and help people with SPMI function independently in the community.

Rationale 4: Case management. This management helps assure clients with SPMI access to and linkage with appropriate services to secure income and obtain other entitlements (such as health benefits) and basic resources such as food, clothing, and transportation.

Rationale 5: Medication management. This management is the mainstay of treatment programs for clients with SPMI and can reduce rates of relapse and hospital readmission.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain how managed mental health care organizations influence the delivery of psychiatricmental health care.

Kneisl, Contemporary Psychiatric-Mental Health Nursing, 3/e Test Bank

Copyright 2012 by Pearson Education, Inc.

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