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Basic psychosocial needs do not change because a person is homeless. The first step in caring for health care needs is establishing rapport. Once a trusting relationship is established, the nurse pursues other interventions.

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

REF: Pages 32-10, 37 (Box 32-2) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. “They will not let me drink. They have many rules in the shelter.” b. “I feel comfortable here. Nobody bothers me.” c. “Those shots make my arm very sore.” d. “Those people watch me a lot.”

20. A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement?

ANS: B

Evaluation of a patient’s progress is made based on patient satisfaction with the new health status and the health care team’s estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being “bothered” by others denotes improvement in the patient’s condition. The other options suggest that the patient is in danger of relapse.

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

REF: Pages 32-6, 22, 23

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation a. The case manager can modify traditional psychotherapy. b. With one coordinator of services, resources can be more efficiently used. c. The case manager can focus on social skills training and esteem building. d. Case managers bring groups of patients together to discuss common problems.

21. For patients diagnosed with SMI, what is the major advantage of case management?

ANS: B

The case manager coordinates the care and multiple referrals that so often confuse the seriously mentally ill patient and the patient’s family. Case management promotes efficient use of services. The other options are lesser advantages or are irrelevant.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 32-12, 13, 15 (Vignette)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. “We make this referral to continue eligibility for federal funding.” b. “Are you concerned that we’re trying to make your child too independent?” c. “If you think the program would be detrimental, we can postpone it for a time.” d. “Most patients are capable of employment at some level, competitive or supported.”

22. The parent of a seriously mentally ill adult asks the nurse, “Why are you making a referral to a vocational rehabilitation program? My child won’t ever be able to hold a job.” Which is the nurse’s best reply?

ANS: D

Studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment. They also demonstrate significant improvement in assertiveness and work behaviors as well as decreased depression.

PTS: 1

DIF: Cognitive Level: Apply (Application)

REF: Pages 32-18, 19

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, “That’s not my problem.”

23. A consumer at a rehabilitative psychosocial program says to the nurse, “People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered.” How should the nurse respond?

ANS: A

Consumer-run programs range from informal “clubhouses,” which offer socialization and recreation, to competitive businesses, such as snack bars or janitorial services, which provide needed services and consumer employment while encouraging independence and building vocational skills. Consumers engage in problem solving under the leadership of staff. See related audience response question.

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

REF: Pages 32-20, 33 (Table 32-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A person diagnosed with a SMI living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.)

a. Persons with SMI are more likely to be violent.

b. SMI persons are more likely to commit crimes than to be the victims of crime.

c. Impaired judgment and social skills can provoke hostile or assaultive behavior.

d. Lower incomes force SMI persons to live in high-crime areas, increasing risk.

e. SMI persons experience higher rates of sexual assault and victimization than others.

f. Criminals may believe SMI persons are less likely to resist or testify against them.

ANS: C, D, E, F

Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses. See related audience response question.

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

REF: Pages 32-2, 8, 24

TOP: Nursing Process: Planning/Implementation