eBay:testbanks_and_xanax

b. “Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight.” c. “We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death.” d. “We are all surprised. The patient had been doing so well and saw the nurse every other week.”

ANS: B

The family is in distress. Because they do not understand his death, they are less able to accept it and seek specific information to help them understand what happened. Persons with SMI die an average of 25 years prematurely. Contributing factors include failing to provide for their own health needs (e.g., forgetting to take medicine), inability to access or pay for care, higher rates of smoking, poor diet, criminal victimization, and stigma. The most accurate answer indicates that seriously mentally ill people are at much higher risk of premature death for a variety of reasons. Staff would not have been surprised that the patient died prematurely, and they would not attribute his death to random, undetected medical problems. Although the cause of death will not be reliably established until the autopsy, this response fails to address the family’s need for information.

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

REF: Pages 32-2, 6 to 8 TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity a. “Sometimes a little time in jail makes a person rethink what they’ve been doing and puts them back on the right track.” b. “Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.” c. “Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication.” d. “Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help.”

13. Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?

ANS: B

Research supports the use of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to the loss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving the mental health of mentally ill persons than was expected.

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

REF: Pages 32-19, 20

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. “NAMI offers a family education series that you might find helpful.” b. “Since your sister is noncompliant, perhaps it’s time for her to be changed to injectable medication.” c. “You have done all you can. Now it’s time to put yourself first and move on with your life.” d. “You cannot help her. Would it be better for you to discontinue your relationship?”

14. A nurse’s neighbor says, “My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?” Select the nurse’s best response.

ANS: A

NAMI offers a family education series that assists with the stress caregivers and other family members often experience. The nurse should not give advice about injectable medication or encourage the family member to give up on the patient.

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

REF: Pages 32-5, 40 (Box 32-4)

MSC: Client Needs: Psychosocial Integrity

15. SMI is characterized as

TOP: Nursing Process: Implementation a. any mental illness of more than 2 weeks’ duration. b. a major long-term mental illness marked by significant functional impairments. c. a mental illness accompanied by physical impairment and severe social problems. d. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

ANS: B

“Serious mental illness” has replaced the term “chronic mental illness.” Global impairments in function are evident, particularly social. Physical impairments may be present. SMI can be treated, but remissions and exacerbations are part of the course of the illness.

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

REF: Pages 32-1, 2

TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance a. Insomnia b. Substance abuse c. Chronic low self-esteem d. Impaired environmental interpretation syndrome

16. Which nursing diagnosis is likely to apply to an individual diagnosed with a SMI who is homeless?

ANS: C

Many individuals with SMI do not live with their families and become homeless. Life on the street or in a shelter has a negative influence on the individual’s self-esteem, making this nursing diagnosis one that should be considered. Substance abuse is not an approved North American Nursing Diagnosis Association (NANDA)-International diagnosis. Insomnia may be noted in some patients but is not a universal problem. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not seen in a majority of the homeless.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 32-22, 33 (Table 32-1)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Nursing Diagnosis/Analysis

17. A patient diagnosed with schizophrenia tells the community mental health nurse, “I threw away my pills because they interfere with God’s voice.” The nurse identifies the etiology of the patient’s ineffective management of the medication regime as eBay: testbanks_and_xanax a. inadequate discharge planning. b. poor therapeutic alliance with clinicians. c. dislike of antipsychotic medication side effects. d. impaired reasoning secondary to the schizophrenia.

ANS: D

The patient’s ineffective management of the medication regime is most closely related to impaired reasoning associated with the thought disturbances of schizophrenia. The patient believes in being an exalted personage who hears God’s voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of the other factors often related to medication nonadherence.

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

REF: Pages 32-10, 33 (Table 32-1), 37 (Box 32-2)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity a. Grief b. Stigma c. Homelessness d. Nonadherence

18. A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, “You cause too much trouble.” What problem is the patient experiencing?

ANS: B

The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as a patient problem. Data do not suggest that the patient is actually homeless. See relationship to audience response question.

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

REF: Pages 32-7, 8 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Find supported employment. b. Develop a trusting relationship. c. Administer prescribed medication. d. Teach appropriate health care practices.

19. A person diagnosed with a SMI enters a shelter for the homeless. Which intervention should be the nurse’s initial priority?

ANS: B