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VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Chapter 04: Treatment Settings Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. Inpatient hospitalization for persons with mental illness is generally reserved for patients who a. present a clear danger to self or others. b. are noncompliant with medication at home. c. have limited support systems in the community. d. develop new symptoms during the course of an illness. ANS: A Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 4-18 to 20 TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment 2. A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager’s most appropriate action. NURSINGTB.COM a. Postpone the patient’s discharge from the hospital. b. Contact the landlord who evicted the patient to further discuss the situation. c. Arrange a temporary place for the patient to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live. ANS: C The case manager should intervene by arranging temporary shelter for the patient until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-10, 40 (Table 4-1) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 3. Select the example of tertiary prevention. a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated patient who has become aggressive and assaultive c. Teaching school-age children about the dangers of drugs and alcohol d. Genetic counseling with a young couple expecting their first child ANS: A

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-16, 17 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 4. A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient’s thoughts are now more organized and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” The nurse should a. ask the case manager to arrange a transfer to a long-term care facility. b. notify hospital security to handle the disturbance and escort the family off the unit. c. explain that the patient will continue to improve if the medication is taken regularly. d. contact the health care provider to meet with the family and explain the discharge rationale. ANS: C Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter. NURSINGTB.COM

PTS: REF: TOP: MSC:

1 DIF: Cognitive Level: Apply (Application) Pages 4-18, 40 (Table 4-1), 48 (Box 4-2) Nursing Process: Implementation Client Needs: Safe, Effective Care Environment

5. A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to a. coordinating care of patients. b. management of milieu safety. c. management of the interpersonal climate. d. use of therapeutic intervention strategies. ANS: B Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse’s concerns, are unrelated to the observations cited. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 4-23, 24 TOP: Nursing Process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 6. The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. b. c. d.

feeling anxiety and a sad mood after separation from a spouse of 10 years. who self-inflicted a superficial cut on the forearm after a family argument. experiencing dry mouth and tremor related to taking antipsychotic medication. who is a new parent and hears voices saying, “Smother your baby.”

ANS: D Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 4-20 TOP: Nursing Process: Assessment MSC: Client Needs: Safe, Effective Care Environment 7. A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initial action. a. Explore ways to help the patient stop smoking. b. Report the situation to the manager of the shelter. c. Assess the patient’s weight; determine foods and amounts eaten. d. Arrange hospitalization for the patient in order to formulate a new treatment plan. ANS: C Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. The rule isNURSINGTB.COM to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-9, 17, 18 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 8. A nurse surveys medical records. Which finding signals a violation of patients’ rights? a. A patient was not allowed to have visitors. b. A patient’s belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member. ANS: A The patient has the right to have visitors. Inspecting patients’ belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self. 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 9. Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

a. Resolve the crisis with the least restrictive intervention possible. b. Swift intervention is justified to maintain the integrity of a therapeutic milieu. c. Rights of an individual patient are superseded by the rights of the majority of patients. d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised. ANS: A The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient’s legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-21, 23, 24, 48 (Box 4-2) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. Clinical pathways are used in managed care settings to a. stabilize aggressive patients. b. identify obstacles to effective care. c. relieve nurses of planning responsibilities. d. streamline the care process and reduce costs. ANS: D Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are NURSINGTB.COM responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 4-23 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 11. A nurse receives these three phone calls regarding a newly admitted patient. • The psychiatrist wants to complete an initial assessment. • An internist wants to perform a physical examination. • The patient’s attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a. Advocate b. Case manager c. Milieu manager d. Provider of care ANS: B Nurses on psychiatric units routinely coordinate patient services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the patient’s behalf. The role of milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the patient.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 4-10, 13, 49 (Box 4-3) TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 12. Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient? a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills ANS: D Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social worker or vocational therapist. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-10, 11, 49 (Box 4-3) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 13. Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a. Kindness b. Autonomy NURSINGTB.COM c. Compassion d. Professionalism ANS: B A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 4-17 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 14. Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed with a. a phobic fear of crowded places. b. a single episode of major depressive disorder. c. a catastrophic reaction to a tornado in the community. d. schizophrenia and four hospitalizations in the past year. ANS: D ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distracters identify mental health problems of a more episodic nature. PTS:

1

DIF:

Cognitive Level: Apply (Application)

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

REF: Pages 4-12, 13 TOP: Nursing Process: Planning MSC: Client Needs: Safe, Effective Care Environment 15. The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient’s projected length of stay. How should the nurse instruct the unit secretary to handle the request? a. Obtain the information from the patient’s medical record and relay it to the caller. b. Inform the caller that all information about patients is confidential. c. Refer the request for information to the patient’s case manager. d. Refer the request to the health care provider. ANS: C The case manager usually confers with insurers and provides the treatment team with information about available resources. The unit secretary should be mindful of patient confidentiality and should neither confirm that the patient is an inpatient nor disclose other information. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-10, 13, 49 (Box 4-3) TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 16. Select the example of primary prevention. a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill patient who assaulted a staff person NURSINGTB.COM

ANS: B Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill patient who assaulted a staff person is a secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 4-16, 17 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance 17. Which level of prevention activities would a nurse in an emergency department employ most often? a. Primary b. Secondary 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.

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

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. NURSINGTB.COM 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 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 20. The case manager plans to discuss the treatment plan with a patient’s family. Select the case manager’s first action. 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. ANS: C

VARCAROLIS FOUNDATIONS OF PSYCHIATRIC MENTAL HEALTH NURSING 8TH EDITION HALTER TEST BANK

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 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? a. Psychologist b. Social worker c. Recreational therapist d. Occupational therapist 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 NURSINGTB.COM 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. 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.

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 23. A community mental health nurse has worked for months to establish a relationship with a delus...