Chapter 30: Community Mental Health Nursing for Patients with Severe and Persistent Mental Illness My Nursing Test Banks

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 30: Community Mental Health Nursing for Patients with Severe and Persistent Mental Illness

Test Bank

MULTIPLE CHOICE

1. In addition to excellent assessment skills and keen insight into human behavior, what additional ability is most critical to effective community mental health nursing?

a.

Attention to economical nursing practice

b.

Willingness to advocate for the patient

c.

Familiarity with local patient-focused resources

d.

Working relationship with community medical professionals

ANS: C

The role of the community mental health nurse is to help the patient to maintain his or her highest level of functioning and independence within the community. It is critical for the nurse to be familiar with the available community resources and community networks, so they can work with the multidisciplinary treatment team to help patients and their families adjust to the community. The remaining options are appropriate but are not unique to community mental health nursing and its role in facilitating the patients ability to live and function as a member of a community.

DIF: Cognitive Level: Analysis REF: Page 678

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

2. What factor had the greatest impact on the limited success of the deinstitutionalization of the mentally ill population?

a.

The initiative was never funded by the federal government.

b.

The mentally ill population found it too difficult to function autonomously.

c.

Community support systems were unprepared to provide the required services.

d.

The communities were biased against having the mentally ill living among them.

ANS: A

During deinstitutionalization, federal dollars were designated for community mental health facilities; however, the enacted legislation was never funded. The effects of the other options would have been directly related to the lack of sufficient funding.

DIF: Cognitive Level: Analysis REF: Page 678

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

3. What is the primary event that results in many eccentric individuals being initially diagnosed with a psychiatric disorder?

a.

They commit a crime and are incarcerated.

b.

They become both homeless and destitute.

c.

They are unable to meet their own physical needs.

d.

There is proof that they are a danger to themselves or others.

ANS: D

The family may describe the persons behavior as odd or eccentric without realizing or being willing to admit that the family member has a psychiatric illness that needs professional help. The family generally seeks treatment for the ill member when the behavior becomes irrational, threatening, assaultive, or self-destructive. Although the remaining options are characteristic of mental illness, they are generally not sufficient to warrant a mental illness diagnosis.

DIF: Cognitive Level: Analysis REF: Page 679

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

4. To best respect the mentally ill patients rights, no restricting intervention can be implemented without:

a.

First securing the patients informed consent

b.

Proof that the patient is a danger to self or others

c.

Initially attempting to secure the patients cooperation

d.

Securing an order from the patients psychiatric care provider

ANS: B

Mentally ill persons who are disturbed or actively psychotic are not required to obtain psychiatric treatment unless they are a threat to themselves or others. In cases where safety is a concern, informed consent is not required and actions can be approved by the care provider postintervention.

DIF: Cognitive Level: Application REF: Page 679 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

5. Which nursing intervention by a community mental health nurse demonstrates an understanding of the potential health risks that psychotropic medications present?

a.

Discussing the risk of food interactions when taking buspirone (BuSpar)

b.

Monitoring the blood glucose levels of a patient prescribed risperidone (Risperdal)

c.

Stressing the importance of using alprazolam (Xanax) only as a short-term therapy

d.

Evaluating a patients understanding of the possible weight gain resulting from escitalopram oxalate (Lexapro) therapy

ANS: B

The onset of type 2 diabetes is one of the less known side effects of commonly used antipsychotic medications. Diabetes associated with psychotropic medications has been demonstrated to be more frequent with risperidone (Risperdal).

Weight gain is a possible side effect of the antidepressant escitalopram oxalate (Lexapro). Drugs used to treat anxiety, including buspirone (BuSpar), have known food interactions such as grapefruit. Benzodiazepines, like alprazolam (Xanax), are prescribed for depression and anxiety but should not be used on a long-term basis.

DIF: Cognitive Level: Analysis REF: Page 679

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

6. Which behavior engaged in by a patient diagnosed with both schizophrenia and hepatitis C presents the community mental health nurse with the greatest need to share information ordinarily protected by the patients right to confidentiality?

a.

Engaging in unprotected sex

b.

Wearing the uniform of a police officer

c.

Expressing a real hatred for the government

d.

Stealing clothing and food from stores in the neighborhood

ANS: A

Legal and ethical issues continually challenge community mental health nurses. Nurses need to be aware of state laws that mandate patient confidentiality while sharing necessary information about a patient. For example, a nurse who learns this patient is engaging in high-risk sexual behavior needs to report such findings to the appropriate professionals in order to protect the public. The other options, although problematic, do not have this level of seriousness regarding the good of the general public.

DIF: Cognitive Level: Analysis REF: Page 680 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

7. Regarding freedom-of-choice care systems, what information must the patient receive regarding the criteria for terminating treatment of a patient with mental health disorders?

a.

Patients inability to pay for the services

b.

Aggressive behavior on the part of the patient

c.

Facility finds it uneconomical to provide the treatment

d.

Patients noncompliance with an appropriate treatment plan

ANS: D

Freedom-of-choice systems have experienced some common problems with patient care resulting in many agencies choosing not to develop treatment options for severe mental disorders because they disagree with the premise of freedom of choice. Both the provider and the patient have the freedom to make decisions; however, treatment providers in these systems have the right to refuse to treat anyone whose symptoms make that person resistant to accept treatment. The remaining options are not considered as criteria for treatment termination regarding freedom of choice.

DIF: Cognitive Level: Application REF: Page 681 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

8. Which interview question demonstrates cultural competency when conducting an admission interview for a Jewish patient being admitted for severe depression?

a.

Is there a history of depression in your family?

b.

Do you find comfort in your religious beliefs?

c.

Has been being Jewish contributed to your depression?

d.

How has your family responded to you since you have been depressed?

ANS: D

Every cultural group has traditions and beliefs about the acceptance of mental illness and the ability and willingness to trust health care providers. Members of the Jewish community generally view severe mental illness as a stigma. The other options do not directly address this culturally stigma.

DIF: Cognitive Level: Application REF: Page 681

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

9. Which intervention demonstrates cultural competency regarding the care provided an African American who is experiencing depression after the death of a child?

a.

Providing information regarding local grief support groups

b.

Assessing the patients ability to understand the grief process

c.

Encouraging family members to be present when discharge planning is discussed

d.

Consulting with the patient before discussing treatment plans with her adult children

ANS: A

African Americans are more likely to rely on family and religious groups for support. The remaining options are appropriate for all patients regardless of cultural considerations.

DIF: Cognitive Level: Application REF: Page 681

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

10. What understanding is the most critical to the delivery of effective culturally-congruent nursing care to the mentally ill patient?

a.

Willingness to learn about the cultural beliefs of the affected population

b.

Consciousness of the role cultural beliefs play regarding the acceptance of mental health nursing interventions

c.

Attentiveness to the individuals expression of cultural beliefs and reliance on the culture for various support

d.

Awareness of the biases the culturally diverse population experiences when experiencing mental illness

ANS: B

Understanding the cultural beliefs about mental illness and being sensitive to diverse ethnic and cultural groups is a critical goal for community mental health nurses since this has an immense impact on the planning and acceptance of nursing interventions. The other options, although impactful, lack the direct relationship to the patients willingness to accept and comply with mental health treatment

DIF: Cognitive Level: Analysis REF: Page 681

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

11. Which activity best reflects the role of the mental health nurse case manager?

a.

Advocating for the patient in all aspects of care

b.

Attending to the patients physical and emotional needs

c.

Acting as the leader of a patients multidisciplinary care team

d.

Assuming responsibility for maintaining the patients mental health records

ANS: C

Case management facilitates and promotes the coordination of patient care, thereby minimizing the fragmentation of treatment which is a major factor in the relapsing of the patients symptomology. The other options are roles of the case manager but they lack the attention to the basic concept of integrated, focused, and supervised care of the patient.

DIF: Cognitive Level: Analysis REF: Page 684

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

12. Which statement supports the fact that a patient diagnosed with chronic schizophrenia who is being prepared for placement in an adult family home understands the unique expectations of such an arrangement?

a.

Ill have a safe, clean place to live.

b.

Im excited about having a bedroom of my own.

c.

I will help wash dishes and sweep floors but I like doing that.

d.

I cant wait to live my life like I want to and make my own decisions.

ANS: C

Adult family homes (supportive housing programs) provide a quieter and more personal living arrangement for patients who need supervision. The patient becomes a part of the family structure and is expected to fit into the normal routines of the household performing routine tasks of daily living when appropriate. The patient may not have a private bedroom and will have only the independence they are capable of managing effectively and safely. Any placement is intended to ensure a clean, safe place to live.

DIF: Cognitive Level: Application REF: Page 686 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

13. Which intervention demonstrates the community mental health nurses understanding of the potential risks that home visits present?

a.

Calling ahead to make an appointment to visit

b.

Being sure to have access to a telephone during the actual visit

c.

Asking family members to describe the patients recent behavior

d.

Taking a small gift to give to the patients family during the visit

ANS: C

It is crucial that the nurse who is planning a home visit evaluate the potential risks of that visit before beginning the actual interventions. Risk evaluation always includes the patients history, especially current emotional and behavioral status. Calling ahead to make an appointment is standard procedure and is more directed towards respect than safety. Having access to a telephone is good practice but has little impact on minimizing risk. It is not recommended to set the expectation that the family will receive a gift with each visit.

DIF: Cognitive Level: Application REF: Page 686

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

14. Which action provides the nurse with evidence that a Hispanic patient diagnosed with schizophrenia 10 years ago is likely to continue to benefit from social support after being discharged for a psychotic break?

a.

The patients brother and sister-in-law offer suggestions concerning the support they can provide after discharge

b.

The patients mother expresses an understanding of the need for compliance with the treatment plan

c.

The familys religious leader visits the patient regularly and suggests part-time employment at the church

d.

Friends of the patient offer to provide transportation to and from therapy sessions that the patient is scheduled to attend

ANS: A

Racial and ethnic differences play a significant role in the familys response to mentally ill members. Some cultural groups are protective of the ill individual, whereas others soon become exhausted and emotionally drained with the care, dependency needs, and symptoms of the ill person. The familys continued involvement in the patients care is the most positive example of continued support. The other options are positive but lack the element of long-term active involvement with the patient.

DIF: Cognitive Level: Analysis REF: Page 682 TOP: Nursing Process: Evaluation

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which intervention is considered an essential element of a community nurses mental health home visit? Select all that apply.

a.

Documenting the patients current level of function

b.

Evaluating the patients compliance with the plan of care

c.

Ensuring that the patients family is supportive of the patient

d.

Assessing the patients ability to understand their condition

e.

Determining whether the patient has access to prescribed medication

ANS: A, B, D, E

The psychiatric nurses visit needs to include psychiatric evaluation, medication compliance, health teaching, crisis intervention, and documentation. It would not be possible for the nurse to ensure the familys support regardless of its impact on the patients prognosis.

DIF: Cognitive Level: Application REF: Page 678 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

Copyright 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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