eBay:testbanks_and_xanax

ANS: D

The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The long acting antipsychotic medication injections relieve the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, non-adherence will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.

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

REF: Pages 4-17, 18

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment

26. Which assessment finding for a patient diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse? The patient a. receives social security disability income plus a small check from a trust fund every month. b. was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks. c. lives in an apartment with two patients who attend partial hospitalization programs. d. has a sibling who was recently diagnosed with a mental illness.

ANS: B

Patients who use alcohol or illegal substances often become medication non-adherent. Medication non-adherence, along with the disorganizing influence of substances on cellular brain function, promotes relapse. The distracters do not suggest problems.

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

REF: Pages 4-5, 10

TOP: Nursing Process: Planning

MSC: Client Needs: Health Promotion and Maintenance

27. The nurse should refer which of the following patients to a partial hospitalization program? A patient who a. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. b. needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes. c. spent yesterday in a supervised crisis care center and continues to have active suicidal ideation. d. states, “I’m not sure I can avoid using alcohol when my spouse goes to work every morning.”

ANS: D

This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility for supervision. A suicidal patient needs inpatient hospitalization. The other patients can be served in the community or with individual visits.

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

REF: Pages 4-13, 14

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment

28. After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. This action by the nurse best demonstrates a. triage. b. primary prevention. c. psychosocial rehabilitation. d. psychiatric case management.

ANS: B

Tornado victims are at risk for psychiatric problems as a consequence of stress and trauma. Primary prevention occurs before any problem is manifested and seeks to reduce the incidence, or rate of new cases. Primary prevention may prevent or delay the onset of symptoms in predisposed individuals. Coping strategies and psychosocial support for vulnerable people are effective interventions in prevention. Disaster victims benefit from telling their story. Triage refers to the process of sorting out victims based on the immediacy of their needs for treatment. Psychosocial rehabilitation programs are designed to assist persons diagnosed with serious mental illness to develop living skills. Psychiatric case management refers to services to assist patients in finding housing or obtaining entitlements.

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

REF: Page 4-16 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. “Thank you. I would enjoy having a cup of coffee with you.” b. “Thank you, but I would prefer to proceed with the assessment.” c. “No, but thank you. I never accept drinks from patients or families.” d. “Our agency policy prohibits me from eating or drinking in patients’ homes.”

29. A nurse makes an initial visit to a homebound patient diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. Select the nurse’s best response.

ANS: A

Accepting refreshments or chatting informally with the patient and family represent therapeutic use of self and help to establish rapport. The distracters fail to help establish rapport.

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

REF: Pages 4-12, 17, 18 TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity a. Prohibited a patient from using the telephone b. In patient’s presence, opened a package mailed to patient c. Remained within arm’s length of patient with homicidal ideation d. Permitted a patient with psychosis to refuse oral psychotropic medication

30. A nurse performed these actions while caring for patients in an inpatient psychiatric setting. Which action violated patients’ rights?

ANS: A

The patient has a right to use the telephone. The patient should be protected against possible harm to self or others. Patients have rights to send and receive mail and be present during package inspection. Patients have rights to refuse treatment.

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

REF: Pages 4-21, 48 (Box 4-2) TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment eBay: testbanks_and_xanax

Multiple Response

1. A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to (Select all that apply) a. housing adequacy. b. family and support systems. c. income adequacy and stability. d. early psychosocial development. e. substance abuse history and current use.

ANS: A, B, C, E

Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.

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

REF: Pages 4-17, 18 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

2. The health care team at an inpatient psychiatric facility drafts these criteria for admission. Which criteria should be included in the final version of the admission policy? (Select all that apply) a. Clear risk of danger to self or others b. Adjustment needed for doses of psychotropic medication c. Detoxification from long-term heavy alcohol consumption needed d. Respite for caregivers of persons with serious and persistent mental illness e. Failure of community-based treatment, demonstrating need for intensive treatment

ANS: A, C, E

Medication doses can be adjusted on an outpatient basis. The goal of caregiver respite can be accomplished without hospitalizing the patient. The other options are acceptable, evidence-based criteria for admission of a patient to an inpatient service.

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

REF: Page 4-20 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

3. A psychiatric nurse discusses rules of the therapeutic milieu and patients’ rights with a newly admitted patient. Which rights should be included? The right to (Select all that apply) a. have visitors. b. confidentiality. c. a private room. d. complain about inadequate care. e. select the nurse assigned to their care.

ANS: A, B, D

Patients’ rights should be discussed shortly after admission. Patients have rights related to receiving/refusing visitors, privacy, filing complaints about inadequate care, and accepting/refusing treatments (including medications). Patients do not have a right to a private room or selecting which nurse will provide care.

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

REF: Pages 4-21, 48 (Box 4-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

4. Which statements by patients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship? “My case manager (Select all that apply) a. talks in language I can understand.” b. helps me keep track of my medication.” c. gives me little gifts from time to time.” d. looks at me as a whole person with many needs.” e. let me do whatever I choose without interfering.”

ANS: A, B, D

Each correct answer is an example of appropriate nursing foci: communicating at a level understandable to the patient, providing medication supervision, and using holistic principles to guide care. The distracters violate relationship boundaries or suggest a laissez faire attitude on the part of the nurse.

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

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

MSC: Client Needs: Psychosocial Integrity a. “Many mental illnesses are hereditary.” b. “Mental illness can be evidence of a brain disorder.” c. “People claim mental illness so they can get disability checks.” d. “Mental illness results from the breakdown of American families.” e. “If people with mental illness went to church, their symptoms would disappear.”

5. Which statements most clearly reflect the stigma of mental illness? (Select all that apply.)

ANS: C, D, E

Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. Many mental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mental illnesses.

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

REF: Pages 4-2 to 4

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. “Science has made significant improvements in drugs for mental illness, so now many persons may live in their communities.” b. “There’s now a better selection of less restrictive treatment options available in communities to care for people with mental illness.” c. “National rates of mental illness have declined significantly. There actually is not a need for state institutions anymore.” d. “Most psychiatric institutions were closed because of serious violations of patients’ rights and unsafe conditions.” e. “Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.”

6. A person in the community asks, “People with mental illnesses went to state hospitals in earlier times. Why has that changed?” Select the nurse’s accurate responses. (Select all that apply.)

ANS: A, B, E

The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.

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

REF: Pages 4-19, 21, 47 (Box 4-1), 48 (Box 4-2)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

7. A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the patient: a. Rearranging conflicting care appointments b. Negotiating the cost of therapy for the patient c. Arranging transportation to the outreach center d. Accompanying the patient to church services weekly e. Monitoring to ensure the patient’s basic needs are met

• wants to attend an activity group at the mental health outreach center.

• is worried about being able to pay for the therapy.

• does not know how to get from home to the outreach center.

• has an appointment to have blood work at the same time an activity group meets.

• wants to attend services at a church that is a half-mile from the patient’s home. Which tasks are part of the role of a community mental health nurse? (Select all that apply.)

ANS: A, C, E

The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement.

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

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

MSC: Client Needs: Safe, Effective Care Environment