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c. Tertiary

ANS: B

An emergency department nurse would generally see patients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 4-16, 17

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

18. The nurse assigned to ACT should explain the program’s treatment goal as a. assisting patients to maintain abstinence from alcohol and other substances of abuse. b. providing structure and a therapeutic milieu for mentally ill patients whose symptoms require stabilization. c. maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness. d. providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

ANS: D

An ACT program provides intensive community services to persons with serious, persistent mental illness who live in the community but require aggressive services to prevent repeated hospitalizations.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 4-12, 13

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

19. Which scenario best depicts a behavioral crisis? A patient is a. waving fists, cursing, and shouting threats at a nurse. b. curled up in a corner of the bathroom, wrapped in a towel. c. crying hysterically after receiving a phone call from a family member. d. performing push-ups in the middle of the hall, forcing others to walk around.

ANS: A

This behavior constitutes a behavioral crisis because the patient is threatening harm to another individual. Intervention is called for to defuse the situation. The other options speak of behaviors that may require intervention of a less urgent nature because the patients in question are not threatening harm to self or others.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-23, 24

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. Determine an appropriate location for the conference. b. Support the discussion with examples of the patient’s behavior. c. Obtain the patient’s permission for the exchange of information. d. Determine which family members should participate in the conference.

20. The case manager plans to discuss the treatment plan with a patient’s family. Select the case manager’s first action.

ANS: C

The case manager must respect the patient’s right to privacy, which extends to discussions with family. Talking to family members is part of the case manager’s role. Actions identified in the distracters occur after the patient has given permission.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 4-10, 13, 49 (Box 4-3) TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist

21. A patient usually watches television all day, seldom going out in the community or socializing with others. The patient says, “I don’t know what to do with my free time.” Which member of the treatment team would be most helpful to this patient?

ANS: C

Recreational therapists help patients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other patient services. Social workers focus on the patient’s support system.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 4-49 (Box 4-3) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity a. The patient’s spouse will mark dates for prescription refills on the family calendar. b. The nurse will obtain prescription refills every 90 days and deliver to the patient. c. The patient will call the nurse weekly to discuss medication-related issues. d. The patient will report to the clinic for medication follow-up every week.

22. A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient’s spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.

ANS: A

The nurse should use the patient’s support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as medication is taken as prescribed.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 4-17, 40 (Table 4-1)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. With the patient’s consent, contact resources to provide medications without charge temporarily. b. Arrange a bed in a local homeless shelter with nightly on-site supervision. c. Hospitalize the patient until the symptoms have stabilized. d. Ask the patient, “Do you feel like I am a traitor?”

23. A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, “Only a traitor would make me go to the hospital.” Select the nurse’s best initial intervention.

ANS: A

Hospitalization may damage the nurse–patient relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 71 | Pages 4-17, 18, 40 (Table 4-1)

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Medication follow-up b. Teaching parenting skills c. Substance abuse counseling d. Making a referral for family therapy

24. Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention?

ANS: B

Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. The distracters represent secondary or tertiary prevention activities.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-10, 11, 16, 17, 49 (Box 4-3)

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. The attitude of significant others toward the patient b. Nutrition services in the patient’s neighborhood c. The level of trust between the patient and nurse d. The availability of transportation to the clinic

25. A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a patient with a history of medication nonadherence. For this plan to be successful, which factor will be of critical importance?