Chapter 32 - Serious Mental Illness

Question 1

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This client now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of what factor?

a. side effects of antipsychotic medications.
b. dependency caused by institutionalization.
c. cognitive deterioration from schizophrenia.
d. stress associated with acclimation to the community.

Answer 1

b. dependency caused by institutionalization.

Question 2

An adult diagnosed with a serious mental illness (SMI) says, “I do not need help with money management. I have excellent ideas about investments.” This client usually does not have money to buy groceries by the middle of the month. The nurse assesses the client as demonstrating what defense mechanism?

a. rationalization.
b. identification.
c. anosognosia.
d. projection.

Answer 2

c. anosognosia.

Question 3

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness (SMI)?

a. Clubhouse model
b. Cognitive-behavioral therapy (CBT)
c. Assertive community treatment (ACT)
d. Cognitive enhancement therapy (CET)

Answer 3

c. Assertive community treatment (ACT)

Question 4

An outpatient diagnosed with schizophrenia tells the nurse, “I am here to save the world. I threw away the pills because they make God go away.” What does the nurse suspect is the client’s reason for medication nonadherence?

a. poor alliance with clinicians.
b. inadequate discharge planning.
c. dislike of medication side effects.
d. thought disturbances associated with the illness.

Answer 4

d. thought disturbances associated with the illness.

Question 5

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The client says, “I threw away the pills because they keep me from hearing God.” Which response by the nurse would most likely to benefit this client?

a. “You need your medicine. Your schizophrenia will get worse without it.”
b. “Do you want to be hospitalized again? You must take your medication.”
c. “I would like you to come to the medication education group every Thursday.”
d. “I noticed that when you take the medicine, you are able to keep the job you wanted.”

Answer 5

d. “I noticed that when you take the medicine, you are able to keep the job you wanted.”

Question 6

A homeless individual diagnosed with serious mental illness (SMI) and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team’s initial focus?

a. Teach appropriate health maintenance and prevention practices.
b. Educate the client about the importance of treatment adherence.
c. Help the client obtain employment in a local sheltered workshop.
d. Interact regularly and supportively without trying to change the client

Answer 6

d. Interact regularly and supportively without trying to change the client

Question 7

A hospitalized client diagnosed with schizophrenia has a history of multiple relapses. The client usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the client transitions from hospital to community?

a. Administer a second-generation antipsychotic to help negative symptoms.
b. Use a quick-dissolving medication formulation to reduce “cheeking.”
c. Prescribe a long-acting intramuscular antipsychotic medication.
d. Involve the client in decisions about which medication is best.

Answer 7

d. Involve the client in decisions about which medication is best.

Question 8

The sibling of a client who was diagnosed with a serious mental illness (SMI) asks why a case manager has been assigned. Which nurse’s reply best cites the major advantage of the use of case management?

a. “The case manager can modify traditional psychotherapy for homeless clients so that it is more flexible.”
b. “Case managers coordinate services and help with accessing them, making sure the client’s needs are met.”
c. “The case manager can focus on social skills training and esteem building in the real world where the client lives.”
d. “Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money.”

Answer 8

b. “Case managers coordinate services and help with accessing them, making sure the client’s needs are met.”

Question 9

A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The client’s sibling says, “My parents have no time for me.” The parents are concerned that when they are older, there will be no one to care for the client. Which response by the nurse would be most helpful?

a. Acknowledge their concerns and consult with the treatment team about ways to bring the client’s symptoms under better control.
b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families.
d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the client become more independent.

Answer 9

d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the client become more independent.

Question 10

A client diagnosed with a serious mental illness (SMI) lives independently and attends a psychosocial rehabilitation program. The client presents at the emergency department seeking hospitalization. The client has no acute symptoms but says, “I have no money to pay my rent or refill my prescription.” What is the nurse’s best action?

a. Involve the client’s case manager to provide crisis intervention.
b. Send the client to a homeless shelter until housing can be arranged.
c. Arrange for a short in-client admission and begin discharge planning.
d. Explain that one must have active psychiatric symptoms to be admitted.

Answer 10

a. Involve the client’s case manager to provide crisis intervention.

Question 11

The nurse wants to enroll a client with poor social skills in a training program for clients diagnosed with schizophrenia. Which description accurately describes social skills training?

a. Clients learn to improve their attention and concentration.
b. Group leaders provide support without challenging clients to change.
c. Complex interpersonal skills are taught by breaking them into simpler behaviors.
d. Clients learn social skills by practicing them in a supported employment setting.

Answer 11

c. Complex interpersonal skills are taught by breaking them into simpler behaviors.

Question 12

A client diagnosed with a serious mental illness (SMI) died suddenly at age 52. The client lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, “How could this happen?” Which response by the nurse accurately reflects research and addresses the family’s question?

a. “A certain number of people die young from undetected diseases, and it’s just one of those sad things that sometimes happen.”
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 client had been doing so well and saw the nurse every other week.”

Answer 12

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.”

Question 13

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are non-medication adherent. 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?

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.”

Answer 13

b. “Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.”

Question 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?” What is the nurse’s best response?

a. “National Alliance on Mental Illness (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?”

Answer 14

a. “National Alliance on Mental Illness (NAMI) offers a family education series that you might find helpful.”

Question 15

How is serious mental illness (SMI) characterized?

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.

Answer 15

b. a major long-term mental illness marked by significant functional impairments.

Question 16

Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness (SMI) who is homeless?

a. Insomnia
b. Substance abuse
c. Chronic low self-esteem
d. Impaired environmental interpretation syndrome

Answer 16

c. Chronic low self-esteem

Question 17

A client diagnosed with schizophrenia tells the community mental health nurse, “I threw away my pills because they interfere with God’s voice.” How should the nurse identify the etiology of the client’s ineffective management of the medication regime?

a. inadequate discharge planning.
b. poor therapeutic alliance with clinicians.
c. dislike of antipsychotic medication side effects.
d. impaired reasoning secondary to the schizophrenia.

Answer 17

d. impaired reasoning secondary to the schizophrenia.

Question 18

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

a. Grief
b. Stigma
c. Homelessness
d. Nonadherence

Answer 18

b. Stigma

Question 19

A person diagnosed with a serious mental illness (SMI) enters a shelter for the homeless. Which intervention should be the nurse’s initial priority?

a. Find supported employment.
b. Develop a trusting relationship.
c. Administer prescribed medication.
d. Teach appropriate health care practices.

Answer 19

b. Develop a trusting relationship.

Question 20

A homeless client diagnosed with a serious mental illness (SMI) became suspicious and delusional. Depot antipsychotic medication is prescribed and housing is obtained in a local shelter. One month later, which statement by the client indicates significant
improvement?

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.”

Answer 20

b. “I feel comfortable here. Nobody bothers me.”

Question 21

For clients diagnosed with serious mental illness (SMI), what is the major advantage of case management?

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 clients together to discuss common problems.

Answer 21

b. With one coordinator of services, resources can be more efficiently used.

Question 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?

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 clients are capable of employment at some level, competitive or supported.”

Answer 22

d. “Most clients are capable of employment at some level, competitive or supported.”

Question 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?

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.”

Answer 23

a. Encourage the consumer to discuss it at a meeting with everyone.

Question 24

A person diagnosed with a serious mental illness (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.

Answer 24

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.

Question 25

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.)

a. Maintain stable and consistent staff.
b. Increase the length of medication education groups.
c. Stress that without treatment, illnesses will worsen.
d. Prescribe drugs in smaller but more frequent dosages.
e. Make it easier to access prescribers and pay for drugs.
f. Require adherence in order to participate in programming.

Answer 25

a. Maintain stable and consistent staff.
e. Make it easier to access prescribers and pay for drugs.

Question 26

A person diagnosed with serious mental illness (SMI) has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.)

a. Discourage potentially stressful activities such as groups or volunteer work.
b. Develop written plans that will help the client remember what to do in a crisis.
c. Help the client identify and anticipate events that are likely to be overwhelming.
d. Encourage health-promoting activities such as exercise and getting adequate rest.
e. Accompany the client to a National Alliance on Mental Illness (NAMI) support group.

Answer 26

b. Develop written plans that will help the client remember what to do in a crisis.
c. Help the client identify and anticipate events that are likely to be overwhelming.
d. Encourage health-promoting activities such as exercise and getting adequate rest.
e. Accompany the client to a National Alliance on Mental Illness (NAMI) support group.

Question 27

A client diagnosed with serious mental illness (SMI) was living successfully in a group home but wanted an apartment. The prospective landlord said, “People like you have trouble getting along and paying their rent.” The client and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.)

a. Coach the client in ways to control symptoms effectively.
b. Seek out landlords less affected by the stigma associated with mental illness.
c. Threaten the landlord with legal action because of the discriminatory actions.
d. Encourage the client to remain in the group home until the illness is less obvious.
e. Suggest that the client list a false current address in the rental application.
f. Have the case manager meet with the landlord to provide education about mental illness.

Answer 27

a. Coach the client in ways to control symptoms effectively.
b. Seek out landlords less affected by the stigma associated with mental illness.
f. Have the case manager meet with the landlord to provide education about mental illness.

Question 28

An adult client tells the case manager, “I don’t have bipolar disorder anymore, so I don’t need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I’m bored and don’t have any friends.” Where should the nurse refer the client? (Select all that apply.)

a. Psychoeducational classes
b. Vocational rehabilitation
c. Social skills training
d. A homeless shelter
e. Crisis intervention

Answer 28

a. Psychoeducational classes
b. Vocational rehabilitation
c. Social skills training

Question 29

Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.)

a. “We are all a little bit crazy.”
b. “If people with mental illness would go to church, their problems would be solved.”
c. “Many mental illnesses are genetically transmitted. It’s no one’s fault that the illness occurs.”
d. “Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people.”
e. “People with mental illness are lazy. They get government disability checks instead of working.”

Answer 29

a. “We are all a little bit crazy.”
b. “If people with mental illness would go to church, their problems would be solved.”
e. “People with mental illness are lazy. They get government disability checks instead of working.”