Chapter 14: Recovery and Psychiatric Rehabilitation My Nursing Test Banks

Chapter 14: Recovery and Psychiatric Rehabilitation

Test Bank

MULTIPLE CHOICE

1. A psychiatric nurse whose area of practice is tertiary prevention of mental illness is asked to describe the focus of this type of practice. The nurse can best describe it as:

a.

enriching the understanding of mental illness.

b.

preventing mental illness from occurring initially.

c.

limiting disability related to an episode of mental illness.

d.

increasing community awareness of the symptoms of mental illness.

ANS: C

Psychiatric rehabilitation is the process of helping the person return to the highest possible level of functioning by focusing on the limiting of illness-caused disability.

DIF: Cognitive Level: Comprehension REF: Text Page: 199

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. When asked to explain how psychiatric rehabilitation under the tertiary prevention model differs from the traditional medical model, the nurses response should stress that the focus of tertiary prevention is on:

a.

disease as opposed to the coping continuum.

b.

learning to receive treatment in institutional settings.

c.

health and wellness and not just symptoms of disease.

d.

proper diagnosis and appropriate medications to treat disorders.

ANS: C

In traditional medical rehabilitation, the focus is on disease, illness, and symptoms. Psychiatric rehabilitation focuses on wellness and health, not symptoms.

DIF: Cognitive Level: Comprehension REF: Text Page: 200

TOP: Nursing Process: Planning|Nursing Process: Implementation

MSC: NCLEX: Health Promotion and Maintenance

3. Under the recovery model, a nurse is more likely to work with a patient with a psychiatric disorder:

a.

in a decision-making partnership.

b.

by prescribing appropriate treatment.

c.

with the assumption the patient is curable.

d.

from the position of expecting compliance.

ANS: A

The patient-helper relationship in psychiatric rehabilitation is an adult-to-adult relationship that is more egalitarian and promotes choices and empowerment, whereas the traditional medical model uses an expert-to-patient relationship.

DIF: Cognitive Level: Application REF: Text Pages: 200-201

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. A patient has been treated for a mental disorder on an outpatient basis. Function has deteriorated and the patient is hospitalized in an inpatient unit; a nurse will now implement the recovery model by:

a.

comparing patient deficits to original baseline.

b.

identifying and reinforcing patient strengths.

c.

reviewing the patients former treatment plan for updates.

d.

reconsidering expectations when the patient is discharged.

ANS: B

Although deficits are assessed, implementation focuses on the reinforcement of identified strengths.

DIF: Cognitive Level: Application REF: Text Page: 203

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. A nurse notes that a patient voices shame and socially isolates. The nurse will most likely interpret this behavior as:

a.

unrelated to serious mental illness.

b.

likely representing learned behaviors.

c.

associated with secondary symptoms of serious mental illness.

d.

a coincidental response that has little relationship to the illness.

ANS: C

Secondary symptoms of mental illness are caused by a persons response to the illness or its treatment (e.g., loneliness and social isolation).

DIF: Cognitive Level: Application REF: Text Page: 201

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

6. Which statement regarding the self-perception of the mentally ill regarding community acceptance is supported by research?

a.

Many feel stigmatized and alienated.

b.

Most feel well accepted and supported.

c.

The majority are intensely angry and hostile.

d.

Most are more concerned with their primary symptoms.

ANS: A

The Vellenga study identified several themes related to secondary symptoms: stigmatization, alienation, loss of relationships and vocational opportunities, distress caused by the effects of the illness, acceptance of self as having a mental illness, and the need for acceptance by others.

DIF: Cognitive Level: Comprehension REF: Text Pages: 201-202

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. At a community meeting, a homeowner states, I dont want mentally ill people in the neighborhood. Theyre dangerous! The community mental health nurse should respond:

a.

Former patients need care and concern, not stigmatization.

b.

I sincerely believe your fears and concerns are really unfounded.

c.

The way you act toward former patients will determine how they act toward you.

d.

Our residents are more apt to be withdrawn and timid than aggressive or violent.

ANS: D

The nurses response should be aimed at dispelling the myth that mentally ill patients are dangerous and continue to be dangerous after discharge.

DIF: Cognitive Level: Application REF: Text Page: 202

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. A psychiatric nurse is assessing the family and home of a patient who is being discharged within the next few days from an inpatient unit. The assessment component with the highest priority is:

a.

how the family members will make changes to meet the needs of the patient.

b.

the attitudes and feelings of family members toward the mentally ill member.

c.

how family members will cope with the responsibility of caring for the patient.

d.

who will be responsible for helping the client with his or her activities of daily living (ADLs).

ANS: B

The priority assessment is to determine the familys understanding and acceptance of the patient and the patients mental illness. The remaining options are all of lesser priority since they are all based on the familys ability and willingness to support the patient.

DIF: Cognitive Level: Application REF: Text Pages: 204-205

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. Which daily stressors would an unemployed 24-year-old diagnosed with chronic depression who lives on a family farm most likely experience?

a.

Housing, school, and work problems

b.

Money problems, loneliness, and boredom

c.

Florid symptoms, odd dress, and bizarre behavior

d.

Sexual, anger management, and medication problems

ANS: B

Daily hassles are concerns, worries, and events that disrupt daily life and well-being. The hassles of most frequent concern are money, loneliness, boredom, crime, past, present, and future accomplishments, communication problems, and physical health.

DIF: Cognitive Level: Application REF: Text Page: 201

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

10. A nurse is assessing the community living skills of a 28-year-old patient. The nurse ascertains that the patient has poor personal hygiene and has never assumed responsibility or management of any aspect of self-care. Based on the data, the nurse makes the assessment that the patient:

a.

has low readiness for function in the community.

b.

will be too much of a burden to live in a foster setting.

c.

is too psychotic to be considered for community placement.

d.

requires stabilization to profit from psychiatric rehabilitation.

ANS: A

The only conclusion that can be drawn based on the assessment data is that the patient currently has low readiness to function in the community.

DIF: Cognitive Level: Analysis REF: Text Page: 203

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Health Promotion and Maintenance

11. The family burden associated with having a mentally ill family member is evidenced by:

a.

decreased family stress and conflict.

b.

family members blaming each other for the illness.

c.

increased understanding and acceptance of the illness.

d.

too little time, energy, and money given to the ill member.

ANS: B

Usual assessment findings are increased family stress and conflict, a tendency of members to blame each other for the illness, difficulty understanding or accepting the illness, tension during family gatherings, and disproportionate family time, energy, or money expended on the ill member.

DIF: Cognitive Level: Comprehension REF: Text Page: 204

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

12. To ensure complete data regarding family social support needs, the nurse should consider seeking information relating to which four categories?

a.

Anger quotient, resiliency, flexibility, and guilt

b.

Financial, dependency, worry, and involvement

c.

Emotional, feedback, cognitive, and instrumental

d.

Diagnosis, treatment, relapse prediction, and violence potential

ANS: C

Norbeck and associates identified four categories of support needs as emotional support, feedback support exemplified by affirmation, cognitive or informational support, and instrumental support exemplified by resources and respite.

DIF: Cognitive Level: Application REF: Text Page: 204

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

13. A patient in a psychiatric rehabilitation program says, I feel so guilty because my family gives me so much and I have so little to give in return. What is the nurses most therapeutic reply?

a.

Your family feels good about giving to you.

b.

Remember that, and show them you are grateful.

c.

Following your treatment plan and helping with household tasks are ways you can give back.

d.

You can help most by keeping your feelings to yourself and not burdening the family when you feel upset.

ANS: C

Patients, too, can contribute to and provide support for their families by helping with household tasks, showing concern for others, thanking the family for their help, sharing positive personal characteristics such as sense of humor, caring for themselves by following the treatment plan, and giving others peace of mind by communicating how they are feeling.

DIF: Cognitive Level: Application REF: Text Page: 204

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. The most effective way for a nurse working in psychiatric rehabilitation to gain firsthand knowledge about a community agency is to:

a.

query patients who have used the services of the agency.

b.

go to the agency with someone who is requesting services.

c.

read the description in a community social services directory.

d.

go to the agency pretending to be someone who needs services.

ANS: B

The best knowledge is that which is gained firsthand by observing how the agency responds to a patient in need of services. It would be unethical to pretend to be someone who is in need of services.

DIF: Cognitive Level: Application REF: Text Page: 205

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

15. A patient diagnosed with major affective disorder expresses concern to a nurse about how to spend time after discharge. The patient states, I dont want to just sit at home alone but Im a little afraid of how others will respond to me. The nurse should suggest:

a.

Just try to get out and meet people.

b.

You should really take it easy when you get home.

c.

Try taking a course at your local community college.

d.

Consider going to a consumer-run psychosocial program.

ANS: D

Consumer-run psychosocial programs offer various levels of service, from drop-in socialization centers to a full range of rehabilitative services. The patient will be able to become involved in meaningful social and vocational activities.

DIF: Cognitive Level: Application REF: Text Page: 208

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

16. In a recovery treatment program, staff members are assigned to spend time with psychiatric patients who are in crisis in the community rather than hospitalizing the patient. Staff members help patients learn to meet real-world demands. Such a program typifies:

a.

respite care.

b.

foster home care.

c.

halfway housing.

d.

training in community living.

ANS: D

Training in community living averts hospitalization. It allows for the assessment of patient skills and the establishment of realistic collaborative goals. Staff contact is reduced as patient function improves.

DIF: Cognitive Level: Comprehension REF: Text Page: 208

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

17. Effective programs are essential for families of patients with severe mental illness. Which components should be included to enhance a programs effectiveness?

a.

Education and empowerment

b.

Political support and education

c.

Financial support and a large membership

d.

Empowerment and the participation of political figures

ANS: A

Effective programs for families of people with serious mental illnesses focus on empowerment and education.

DIF: Cognitive Level: Application REF: Text Page: 211

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

18. A patient who dropped out of college when diagnosed with schizophrenia repeatedly states, I want to get a job. I can work. Which statement made by the nurse would be the most therapeutic in facilitating the patients need to be more productive?

a.

If you return to school and get a degree you can graduate from college and get a better job in 5 or 6 years.

b.

School will be stressful. Lets just look at the classified ads and find something you are capable of doing right now.

c.

You could return to school by taking courses where class size is small; this would help your self-esteem and allow you to be more independent.

d.

Work part-time and go back to school part-time; youll get a good job when you finish a degree.

ANS: C

Education that is offered in a supportive environment can increase self-esteem, improve job qualifications, and encourage some people to pursue higher education.

DIF: Cognitive Level: Application REF: Text Page: 210

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

19. A 27-year-old diagnosed with schizophrenia lives at home with both parents. A nurse is helping the family become better prepared to work with their child. Which nursing intervention would be most beneficial?

a.

Having the family members remind the patient often about appointments and the schedule of daily activities

b.

Helping the family members with scheduling regular daily activities and suggesting the family members allow the patient privacy and personal space

c.

Suggesting that family members spend as much time as possible with the patient and continuously reassure the patient that he or she will never be left alone

d.

Suggesting that a family member help the patient plan activities of daily living (ADLs) and make sure that all family members understand the need for vigilance with the patient

ANS: B

There are several common trouble spots in family life that can be anticipated. Learning ways to handle these troublesome areas empowers the family by giving them a sense of control over their lives. Some of these trouble spots include mechanics of everyday life, including the need for privacy and control over personal space, keeping a regular schedule, television usage, money management, grooming, alcohol and drug use, and a need for relatives to remember to take care of themselves. The remaining options do not support the patient in achieving self-reliance.

DIF: Cognitive Level: Application REF: Text Page: 211

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. A nurse is conducting a workshop on family skill building. All participants have a family member with severe mental illness living in their household. Which method should be used to present coping skills to the participants?

a.

Have a rehabilitation counselor facilitate the family-centered learning workshop.

b.

Present a skill and allow participants to give feedback on the usefulness of the skill for their family member.

c.

Arrange for the workshop presenter to be someone who has a family member diagnosed with serious and persistent mental illness.

d.

Have someone who has experience with in-home care for the mentally ill present a talk and question-and-answer session at the workshop.

ANS: C

Family education has become a primary nursing intervention when providing rehabilitative services to relatives of people with severe mental illness. Nurses have established workshops for family members that have been well received and have helped families cope with the challenges presented by the mental illness. Programming for these workshops can include information and skill-building exercises. The experiences of the more seasoned family members can be particularly helpful because they can share their successes and failures in using various coping strategies and provide needed social support.

DIF: Cognitive Level: Application REF: Text Pages: 211-212

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. In addition to the psychiatric nurse, which professional would be considered a multidisciplinary rehabilitative treatment team member in a community mental health center? (Select all that apply.)

a.

Psychologist

b.

Pharmacist

c.

Social worker

d.

Psychiatrist

e.

Employment specialist

ANS: A, C, D, E

Rehabilitative psychiatric nursing takes place in the context of a multidisciplinary treatment team. Other team members may include psychiatrists, psychologists, social workers, occupational therapists, rehabilitation counselors, case managers, consumer team members, family advocates, employment specialists, and job coaches. Pharmacists are not necessarily focused on rehabilitative services.

DIF: Cognitive Level: Comprehension REF: Text Page: 200

TOP: Nursing Process: N/A

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. To promote positive outcomes, nurses in psychiatric rehabilitation practices should be skilled in: (Select all that apply.)

a.

teaching the patient living skills.

b.

actively listening to patient complaints.

c.

assisting the patient in developing his or her strengths.

d.

helping patients accept their own disabilities.

e.

accessing the appropriateness of environmental support.

ANS: A, C, E

These interventions are the basis of practice in psychiatric nursing rehabilitation. Active listening is not unique to rehabilitation. Acceptance is not the preferred attitude.

DIF: Cognitive Level: Application REF: Text Page: 205

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

3. All recovery programs should be evaluated regularly to ensure: (Select all that apply.)

a.

accountability.

b.

cost effectiveness.

c.

relevancy of services.

d.

geographical service area.

e.

appropriate grant funding.

ANS: A, B, C

Program evaluation is conducted to inform administrators about the relevance and cost effectiveness of the services they offer. Program evaluation is evolving as program funders and the public demand greater accountability from service providers.

DIF: Cognitive Level: Comprehension REF: Text Pages: 212-213

TOP: Nursing Process: Evaluation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

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