Chapter 34: Community-Based Psychiatric Nursing Care My Nursing Test Banks

Chapter 34: Community-Based Psychiatric Nursing Care

Test Bank

MULTIPLE CHOICE

1. Which health care setting is most likely to meet the mental health care needs of an urban community?

a.

A physicians office associated with diagnostic testing located near a community shopping center

b.

A community mental health clinic with a wide range of multidisciplinary services

c.

A hospital emergency room with fast tracking and minimum patient waiting time

d.

An inpatient specialty unit located in a large urban hospital

ANS: B

According to the report from the New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (NFCMH, 2003), evidence shows that offering a full range of community-based alternatives is more effective than physician- or hospital-based or emergency-room treatment.

DIF: Cognitive Level: Comprehension REF: Text Pages: 651-652

TOP: Nursing Process: Implementation

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

2. A psychiatric nurse is focusing on the fifth area of service, based on the Community Mental Health Centers Act of 1963, when:

a.

assisting with electroconvulsive therapy (ECT) treatments.

b.

providing stress management technique classes to new mothers.

c.

assessing patients for admission into an outpatient group program.

d.

providing emergency psychiatric care to a rape victim demonstrating psychoses.

ANS: B

The goal of the fifth service of the Community Mental Health Centers Act of 1963 is consultation and education. One focus for education is primary prevention.

DIF: Cognitive Level: Application REF: Text Pages: 657-658

TOP: Nursing Process: Implementation

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

3. A community mental health center is adjusting to severe budget cuts. Which service is most likely to be considered for elimination?

a.

Toll-free suicide prevention telephone hotline services

b.

Community education regarding the risk factors of depression

c.

Transitional housing for a parent diagnosed with chronic depression

d.

Follow-up laboratory testing regarding therapeutic medication levels

ANS: B

Major amendments to the Community Mental Health Centers Act in 1975 required that community mental health centers continue to offer five areas of service. Because of the funding cuts, the services that most community mental health centers reluctantly reduce are their preventive efforts directed toward mental health education, focusing resources on the care of people with diagnosed mental illness.

DIF: Cognitive Level: Analysis REF: Text Pages: 657-658

TOP: Nursing Process: Outcome Identification

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

4. When considering mental health issues, deinstitutionalization is best demonstrated when a:

a.

patient newly diagnosed with bipolar disorder is admitted to a mental health unit for medication and therapy stabilization.

b.

patient who has been hospitalized for 5 years for persistent depression is being discharged to an outpatient program.

c.

suburban communitys shelter for its persistently mentally ill and cognitively impaired population receives renewed funding.

d.

homeless adolescent newly diagnosed with obsessive compulsive disorder (OCD) is discharged earlier than expected when a foster home becomes available.

ANS: B

Deinstitutionalization refers to the transfer of a patient hospitalized for extended periods of time to a community setting. At the mental health care system level, it refers to a shift in the focus of care from long-term institution to the community, accompanied by discharging long-term patients and avoiding unnecessary admissions.

DIF: Cognitive Level: Application REF: Text Page: 660

TOP: Nursing Process: N/A

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

5. The primary nursing responsibility of a community psychiatric nurse managing caring for patients diagnosed with serious and persistent mental illnesses residing in a group home is to conduct an ongoing:

a.

assessment of the patients life needs.

b.

evaluation of care provided for the patients.

c.

management of the funds allotted for individual patient care.

d.

oversight of all day-to-day operations of the group home and its services.

ANS: A

A systems model of community mental health operates on the philosophy that all aspects of a persons life need carebasic human needs, physical health needs, and needs for psychiatric treatment and rehabilitationif a person is to live successfully in the community. The initial step is to assess the individual patients needs.

DIF: Cognitive Level: Application REF: Text Page: 661

TOP: Nursing Process: Assessment

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

6. Which situation would be considered discrimination under the Americans with Disabilities Act?

a.

A Hispanic with poor English-speaking skills is hospitalized for possible late-onset schizophrenia.

b.

A patient hospitalized for detoxification after a drunk driving accident is not allowed to leave the unit.

c.

Staff is responsible for bathing, dressing, and feeding a patient diagnosed with mild Alzheimer disease (AD) on a daily basis.

d.

After evaluation a cognitively impaired individual diagnosed with obsessive compulsive disorder (OCD) is identified as being unemployable.

ANS: C

Institutionalizing an individual by assuming activities of daily living that they are capable of performing would be considered a denial of their ability to be independent. The remaining options do not appear to violate any patient right.

DIF: Cognitive Level: Analysis REF: Text Page: 359

TOP: Nursing Process: Assessment

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

7. An example of the primary responsibility of a nurse case manager for psychiatric patients in a residential home is to:

a.

assure each patient is bathed and clothed appropriately.

b.

conduct the units socialization group session daily.

c.

participate in the feeding of a severely depressed patient.

d.

arrange for a patient to move into a private apartment.

ANS: D

Case management involves linking the service system to the consumer and coordinating the service components so that he or she can achieve successful community living.

DIF: Cognitive Level: Application REF: Text Pages: 658-659

TOP: Nursing Process: Planning

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

8. Which intervention demonstrates effective management of two contradictory goals of case management?

a.

Arranging for outpatient patients to car pool to group meetings

b.

Assessing patients to determine who is able to shower independently

c.

Scheduling a patient to have in-home help with cooking and cleaning

d.

Helping a patient appropriately fill a personal 5-day medication container

ANS: A

With the advent of managed care, case management has come to reflect two basic but seemingly contradictory goals, increasing access to services and limiting costs. The correct option demonstrates an effective intervention that addresses these goals.

DIF: Cognitive Level: Application REF: Text Pages: 658-659

TOP: Nursing Process: Planning

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

9. A key component of focused treatment directed toward the homeless population that has been shown to be most successful is the facilitation of:

a.

nutrition in the form of finger foods left in a visible, well-lit location daily.

b.

health care services and screening through community-based free clinics.

c.

frequent and consistent staff contact through assertive but nonthreatening outreach services.

d.

access to clothing and hygiene products through community-based support networks.

ANS: C

Mental health professionals have begun to explore the use of new approaches to providing treatment, rehabilitation services, and housing to homeless people with mental illness, a population that often avoids contact with traditional mental health programs. Key components of this focused treatment approach include frequent and consistent staff contact through assertive outreach.

DIF: Cognitive Level: Application REF: Text Page: 661

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

10. Rural suicide rates:

a.

have surpassed urban suicide rates over the past 20 years.

b.

are not tracked as effectively as urban rates.

c.

cannot be determined with accuracy.

d.

are very low in the United States.

ANS: A

Rural residents face greater social stigma in regard to seeking mental health care, and basic community services such as transportation, electricity, water, and telephones that are important to providing health care may not be available. Rural suicide rates have surpassed urban suicide rates over the past 20 years.

DIF: Cognitive Level: Knowledge REF: Text Page: 662

TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity

11. When assessing a new prison inmate the correctional nurse conducts a particularly thorough mental illness screening because:

a.

the rate of serious mental illness among inmates is three to four times that of the general U.S. population.

b.

this may be the only opportunity this individual has ever had for a mental health assessment to be conducted.

c.

the prison system is prepared to deal with underlying mental health disorders that may have previously gone untreated.

d.

medication dosages being used to treat existing mental health disorders may need to be reevaluated to address the stressors of incarceration.

ANS: A

The rate of serious mental illness in the incarcerated population is about three to four times that of the general U.S. population.

DIF: Cognitive Level: Comprehension REF: Text Pages: 662-663

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

12. A community mental health nurse is often a member of a multidisciplinary Assertive Community Treatment (ACT) team. An example of a nursing intervention that focuses on the primary concentration of care for such a team is:

a.

providing medication education to all patients.

b.

volunteering to counsel homeless abused women.

c.

involving a patient in the various aspects of his or her discharge planning.

d.

conducting a support group for patients recovering from depression.

ANS: D

One of the primary concerns of the Assertive Community Treatment team is relapse prevention. All the other answers are true if needed by the individual patient, but a primary concern is to keep the individual healthy and out of an inpatient setting such as a support group.

DIF: Cognitive Level: Application REF: Text Page: 659

TOP: Nursing Process: Implementation

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

13. The National Alliance on Mental Illness (NAMI) believes that which program offers the most comprehensive treatment for severely mentally ill individuals living in the community?

a.

The multisystem therapy model

b.

The rural mental health model

c.

The Program of Assertive Community Treatment

d.

The National Mental Health Treatment Program

ANS: C

The Program of Assertive Community Treatment (PACT) is recognized by the National Alliance on Mental Illness (NAMI) as the most effective service-delivery model for community treatment of severe mental illness.

DIF: Cognitive Level: Comprehension REF: Text Pages: 659-660

TOP: Nursing Process: Planning

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

14. A community mental health nurse is conducting a home visit when the patient states, I never want to go back to that hospital again. Which response has the greatest therapeutic value in terms of appropriate assurance for the patients concerns?

a.

Its likely that you wont need to go to the hospital again if you are compliant with the plan of care we have created for you.

b.

I cant promise that you will never need to go back to the hospital, but I will work to provide the care you need here in the community.

c.

Any inpatient hospitalization that you need in the future will be very brief now that you are receiving such effective home psychiatric care.

d.

Sometimes you will need to be re-hospitalized because of your mental health disorder, but I will work with you throughout your stay in the inpatient setting.

ANS: B

Psychiatric home care is available to a broad segment of the population. Factors contributing to the development of the treatment setting include the following: continued trend of deinstitutionalization; growth of managed care, which focuses on cost, outcomes, and earlier hospital discharges; and advocacy by consumer groups to find less restrictive and more humane ways of delivering care to people with mental illness. Although the nurse cannot promise that the patient will not require future hospitalizations, reassurance that community-based care is available should provide appropriate emotional support.

DIF: Cognitive Level: Analysis REF: Text Pages: 651-652

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

15. Which statement made by a psychiatric community nurse reflects a need for further education regarding Medicare criteria for home health reimbursement for mental health services?

a.

Medicare policies have limited the growth of psychiatric home care programs.

b.

Medicare requires that the patient be incapable of independently accessing psychiatric follow-up care.

c.

A patient may be considered psychiatrically homebound by Medicare if 24-hour supervision is required.

d.

A patient must be diagnosed with a persistent mental illness before Medicare will reimburse for home services.

ANS: D

Although a patient must be diagnosed with a psychiatric disorder, it need not be considered chronic for home care services to be reimbursable.

DIF: Cognitive Level: Application REF: Text Page: 654

TOP: Nursing Process: Assessment

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

16. Which patient would benefit from in-home psychiatric nursing services?

a.

A patient with schizophrenia who still experiences hallucinations and is taking medication for treatment of the disorder

b.

A patient with chronic depression with repeated crisis hospitalizations who is currently experiencing side effects from a newly prescribed medication

c.

A patient with bipolar disorder successfully being treated with medication who also has diabetes

d.

A patient newly diagnosed with HIV who is experiencing situational depression

ANS: B

Patients with repeated inpatient or crisis-unit admissions are identified among patients who can benefit from in-home psychiatric nursing services.

DIF: Cognitive Level: Analysis REF: Text Page: 654

TOP: Nursing Process: Assessment

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

17. A psychiatric home care nurses greatest patient care challenge is:

a.

effectively assessing the home care needs of the patient.

b.

documenting care to reflect the skilled service given.

c.

providing all the attention each patient wants.

d.

evaluating family situations accurately.

ANS: B

Documentation is one of the most challenging requirements of psychiatric home care. If the nurses documentation does not reflect the skilled service given, the payment for that service can be denied by Medicare or other payers. Few guidelines are available for documentation of psychiatric home care, but standardized coding and classification systems are preferred. The psychiatric home care nurse must be very organized and detail-oriented to successfully manage the extensive and detailed paperwork.

DIF: Cognitive Level: Comprehension REF: Text Page: 656

TOP: Nursing Process: Implementation

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

18. Forensic nursing has two very different and sometimes conflicting goals. These goals are:

a.

ensuring easy identification of psychiatrically impaired inmates and protecting their right to privacy.

b.

implementing effective individualized patient care and providing protection for the community.

c.

acting as a patient advocate while remaining a representative of the judicial system.

d.

facilitating patient treatment while minimizing cost to the community.

ANS: B

The conflicting goals of forensic nursing occur as the nurse attempts to provide the patient with the most appropriate, effective mental health care while preserving the communitys safety.

DIF: Cognitive Level: Comprehension REF: Text Pages: 663-664

TOP: Nursing Process: Planning

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

MULTIPLE RESPONSE

1. The outcome that resulted from the fundamental flaw with the deinstitutionalization of mental health patients was that: (Select all that apply.)

a.

patients had to be readmitted to state hospitals because of the lack of adequate community services.

b.

there was insufficient financial support to care for the psychiatric patients at the homeless shelters currently in place.

c.

funds for services were misused since policymakers did not require adequate documentation of patient service needs.

d.

there were insufficient numbers of community health professionals available to care for the psychiatric patients who qualified for deinstitutionalization care.

e.

patients refused to seek out or accept mental health care from community-based

facilities since they were unfamiliar with them and therefore generally distrustful of them.

ANS: A, B, D

Soon after deinstitutionalization began, it became clear that policymakers had seriously miscalculated both the service needs of this population and the ability of communities to accommodate the large numbers of people with mental illness who had been discharged from the state. Often these former patients had to be readmitted to state hospitals.

DIF: Cognitive Level: Application REF: Text Page: 660

TOP: Nursing Process: Evaluation

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

2. Individuals may seek treatment for mental health disorders from their primary care provider. Which assessment questions are directed towards identifying the most common of these conditions? (Select all that apply.)

a.

Do you see yourself as a depressed individual?

b.

What is your opinion of recreational drug use?

c.

Would you consider yourself an anxious person?

d.

Is your daily routine controlled by ritual behaviors?

e.

Have you ever been told you drink too much alcohol?

ANS: A, B, C, E

The three most common problems seen in primary care are depression, anxiety, and substance abuse.

DIF: Cognitive Level: Application REF: Text Pages: 651-652

TOP: Nursing Process: Planning

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

3. Which interventions are directed toward achieving the goals of integrated health care? (Select all that apply.)

a.

The terminally ill patient is referred to a grief counselor.

b.

The homeless mentally ill patient is screened for tuberculosis.

c.

The new mother is assessed for possible postpartum depression.

d.

The diabetic patient is monitored every 3 months with an A1C test.

e.

The schizophrenic patient is provided with a yearly flu vaccination.

ANS: A, B, C, E

Truly integrated care includes people in primary care settings who have behavioral health problems being identified and treated in primary care settings if possible and people in behavioral health care settings who need routine primary care being identified and treated in behavioral health settings if possible.

DIF: Cognitive Level: Application REF: Text Page: 652

TOP: Nursing Process: Planning

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

4. Which interventions would be provided by an employee assistance program (EAP) when an employee is suspected of having an alcohol abuse problem? (Select all that apply.)

a.

A consultation with their immediate supervisor

b.

Referral to an alcohol abuse treatment program

c.

Financial help while at an alcohol treatment center

d.

Guarantee that ones job will be held until treatment is successful

e.

Evaluation of the employees need for a leave of absence from their job

ANS: A, B, E

Comprehensive EAPs have six major components including identification of problems based on job performance, consultation with supervisors, constructive confrontation, evaluation and referral, liaison with treatment providers, and substance abuse expertise. There is no guarantee of employment past a reasonable time period nor financial assistance.

DIF: Cognitive Level: Application REF: Text Pages: 653-654

TOP: Nursing Process: Planning

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

5. Which patient meets the criteria for psychiatric homebound care? (Select all that apply.)

a.

A 68-year-old whose moderate Alzheimer disease (AD) symptoms are progressing

b.

A 19-year-old who refuses to leave his room because of paranoid delusions

c.

A 45-year-old who is so persistently depressed she rarely gets out of bed

d.

A 50-year-old alcoholic who has developed cirrhosis of the liver

e.

A 35-year-old who washes his hands 25 to 35 times a day

ANS: A, B, E

Psychiatric homebound status criteria is met by individuals who are confused and/or disoriented, immobilized by depression, and experiencing paranoid delusions that interfere with safety. The other options depict individuals who are not necessarily made homebound by their symptomatology.

DIF: Cognitive Level: Application REF: Text Page: 654

TOP: Nursing Process: Planning

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

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