Chapter 4

Question 1

In-client hospitalization for persons with mental illness is generally reserved for clients who demonstrate which characteristic?

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.

Answer 1

a. present a clear danger to self or others.

Question 2

A client was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the client received a notice of eviction immediately prior to admission. What is the case manager’s most appropriate action?

a. Postpone the client’s discharge from the hospital.
b. Contact the landlord who evicted the client to further discuss the situation.
c. Arrange a temporary place for the client to stay until new housing can be arranged.
d. Determine whether the adverse medication reaction was genuine because the client had nowhere to live.

Answer 2

c. Arrange a temporary place for the client to stay until new housing can be

Question 3

What action is an example of tertiary prevention?

a. Helping a person diagnosed with a serious mental illness learn to manage money
b. Restraining an agitated client 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

Answer 3

a. Helping a person diagnosed with a serious mental illness learn to manage money

Question 4

A client diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The client’s thoughts are now more organized, and discharge is planned. The client’s family says, “It’s too soon for discharge. We will just go through all this again.” What action should the nurse take?

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 client 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.

Answer 4

c. explain that the client will continue to improve if the medication is taken

Question 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. What do these observations relate to?

a. coordinating care of clients.
b. management of milieu safety.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.

Answer 5

b. management of milieu safety.

Question 6

The psychiatric unit has one bed available. Which client should be admitted from the emergency department? The client:

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

Answer 6

d. The client who is a new parent and hears voices saying, “Smother your baby.”

Question 7

A nurse surveying medical records would find evidence suggesting which client’s rights have been violated?

a. A client was not allowed to have visitors.
b. A client’s belongings were searched at admission.
c. A client with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a client was assaultive toward a staff member.

Answer 7

a. A client was not allowed to have visitors.

Question 8

A suspicious, socially isolated client lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. What is the community psychiatric nurse’s best initial action?

a. Exploring ways to help the client stop smoking.
b. Reporting the situation to the manager of the shelter.
c. Assessing the client’s weight; determine foods and amounts eaten.
d. Arranging hospitalization for the client in order to formulate a new treatment
plan.

Answer 8

c. Assessing the client’s weight; determine foods and amounts eaten.

Question 9

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?

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 client are superseded by the rights of the majority of clients.
d. Clients should have opportunities to regain control without intervention if the safety of others is not compromised.

Answer 9

a. Resolve the crisis with the least restrictive intervention possible.

Question 10

Clinical pathways are used in managed care settings to accomplish what?

a. stabilization of aggressive clients.
b. identifying obstacles to effective care.
c. relieving nurses of planning responsibilities.
d. streamlining the care process to reduce costs

Answer 10

d. streamlining the care process to reduce costs

Question 11

A nurse receives these three phone calls regarding a newly admitted client.

ꞏ The psychiatrist wants to complete an initial assessment.
ꞏ An internist wants to perform a physical examination.
ꞏ The client’s attorney wants an appointment with the client
.
The nurse schedules the activities for the client. Which role has the nurse fulfilled?
a. Advocate
b. Case manager
c. Milieu manager
d. Provider of care

Answer 11

b. Case manager

Question 12

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a client?

a. Hygiene assistance
b. Diversional activities
c. Assistance with job hunting
d. Building assertiveness skills

Answer 12

d. Building assertiveness skills

Question 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
c. Compassion
d. Professionalism

Answer 13

b. Autonomy

Question 14

Which client would be most appropriate to refer for assertive community treatment (ACT)?

a. One diagnosed with a phobic fear of crowded places.
b. One who experienced a single episode of major depressive disorder.
c. One who experienced a catastrophic reaction to a tornado in the community.
d. One diagnosed with schizophrenia who had four hospitalizations in the past year.

Answer 14

d. One diagnosed with schizophrenia who had four hospitalizations in the past year.

Question 15

The unit secretary receives a phone call from the health insurer for a hospitalized client. The caller seeks information about the client’s projected length of stay. How should the nurse instruct the unit secretary to handle the request?

a. Obtain the information from the client’s medical record and relay it to the caller.
b. Inform the caller that all information about clients is confidential.
c. Refer the request for information to the client’s case manager.
d. Refer the request to the health care provider.

Answer 15

c. Refer the request for information to the client’s case manager.

Question 16

What is an 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 client who assaulted a staff person

Answer 16

b. Helping school-age children identify and describe normal emotions

Question 17

Which level of prevention activities would a nurse in an emergency department employ most often?

a. Primary
b. Secondary
c. Tertiary

Answer 17

b. Secondary

Question 18

How would the nurse assigned to ACT best explain the program’s treatment goal?

a. assisting clients to maintain abstinence from alcohol and other substances of abuse.
b. providing structure and a therapeutic milieu for mentally ill clients 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.

Answer 18

d. providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

Question 19

Which scenario best depicts a behavioral crisis?

a. A client is waving fists, cursing, and shouting threats at a nurse.
b. A client is curled up in a corner of the bathroom, wrapped in a towel.
c. A client is crying hysterically after receiving a phone call from a family member.
d. A client is performing push-ups in the middle of the hall, forcing others to walk around.

Answer 19

a. A client is waving fists, cursing, and shouting threats at a nurse.

Question 20

What is the initial action of a case manager who plans to discuss the treatment plan with a client’s family?

a. Determine an appropriate location for the conference.
b. Support the discussion with examples of the client’s behavior.
c. Obtain the client’s permission for the exchange of information.
d. Determine which family members should participate in the conference.

Answer 20

c. Obtain the client’s permission for the exchange of information.

Question 21

A client usually watches television all day, seldom going out in the community or socializing with others. The client says, “I don’t know what to do with my free time.” Which member of the treatment team would be most helpful to this client?

a. Psychologist
b. Social worker
c. Recreational therapist
d. Occupational therapist

Answer 21

c. Recreational therapist

Question 22

A client diagnosed with schizophrenia has been stable for 2 months. Today the client’s spouse calls the nurse to report the client has not taken prescribed medication and is having disorganized thinking. The client forgot to refill the prescription. The nurse arranges a refill. What is the best outcome to add to the plan of care?

a. The client’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 client.
c. The client will call the nurse weekly to discuss medication-related issues.
d. The client will report to the clinic for medication follow-up every week.

Answer 22

a. The client’s spouse will mark dates for prescription refills on the family calendar.

Question 23

A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious client. The client recently lost employment and could no longer afford prescribed medications. The client says, “Only a traitor would make me go to the hospital.” What is the nurse’s best initial intervention?

a. With the client’s consent, contact resources to provide medications without charge temporarily.
b. Arrange a bed in a local homeless shelter with nightly on-site supervision.
c. Hospitalize the client until the symptoms have stabilized.
d. Ask the client, “Do you feel like I am a traitor?”

Answer 23

a. With the client’s consent, contact resources to provide medications without charge temporarily.

Question 24

Which activity is appropriate for a nurse engaged exclusively in community-based primary prevention?

a. Medication follow-up
b. Teaching parenting skills
c. Substance abuse counseling
d. Making a referral for family therapy

Answer 24

b. Teaching parenting skills

Question 25

A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a client with a history of medication nonadherence. For this plan to be successful, which factor will be of critical importance?

a. The attitude of significant others toward the client
b. Nutrition services in the client’s neighborhood
c. The level of trust between the client and nurse
d. The availability of transportation to the clinic

Answer 25

d. The availability of transportation to the clinic

Question 26

Which assessment finding for a client diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse?

a. The client receives social security disability income plus a small check from a trust fund every month.
b. The client was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.
c. The client lives in an apartment with two clients who attend partial hospitalization programs.
d. The client has a sibling who was recently diagnosed with a mental illness.

Answer 26

b. The client was absent from two of six planned Alcoholics Anonymous meetings

Question 27

The nurse should refer which of the following clients to a partial hospitalization program?
a. One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
b. One who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
c. One who spent yesterday in a supervised crisis care center and continues to have active suicidal ideation.
d. One who cannot avoid using alcohol when their spouse goes to work every morning.

Answer 27

d. One who cannot avoid using alcohol when their spouse goes to work every morning.

Question 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. What does this action by the nurse best demonstrate?

a. triage.
b. primary prevention.
c. psychosocial rehabilitation.
d. psychiatric case management.

Answer 28

b. primary prevention.

Question 29

A nurse makes an initial visit to a homebound client diagnosed with a serious mental illness. A family member offers the nurse a cup of coffee. What is the nurse’s best response?

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 clients or families.”
d. “Our agency policy prohibits me from eating or drinking in clients’ homes.”

Answer 29

a. “Thank you. I would enjoy having a cup of coffee with you.”

Question 30

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

a. Prohibited a client from using the telephone
b. In client’s presence, opened a package mailed to client
c. Remained within arm’s length of client with homicidal ideation
d. Permitted a client with psychosis to refuse oral psychotropic medicatio

Answer 30

a. Prohibited a client from using the telephone

Question 31

A nurse can best address factors of critical importance to successful community treatment by including making assessments focused on what? (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.

Answer 31

a. housing adequacy.
b. family and support systems.
c. income adequacy and stability.
e. substance abuse history and current use.

Question 32

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

Answer 32

a. Clear risk of danger to self or others
c. Detoxification from long-term heavy alcohol consumption needed
e. Failure of community-based treatment, demonstrating need for intensive treatment

Question 33

A psychiatric nurse discusses rules of the therapeutic milieu and clients’ rights with a newly admitted client. Which rights should be included? (Select all that apply.)

a. The right to have visitors.
b. The right to confidentiality.
c. The right to a private room.
d. The right to report inadequate care.
e. The right to select the nurse assigned to their care.

Answer 33

a. The right to have visitors.
b. The right to confidentiality.
d. The right to report inadequate care.

Question 34

Which statements by clients diagnosed with a serious mental illness best demonstrate that the case manager has established an effective long-term relationship? (Select all that apply.)

a. “My case manager talks in language I can understand.”
b. “My case manager helps me keep track of my medication.”
c. “My case manager gives me little gifts from time to time.”
d. “My case manager looks at me as a whole person with many needs.”
e. “My case manager let me do whatever I choose without interfering.”

Answer 34

a. “My case manager talks in language I can understand.”
b. “My case manager helps me keep track of my medication.”
d. “My case manager looks at me as a whole person with many needs.”

Question 35

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

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.”

Answer 35

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.”

Question 36

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

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 clients’ rights and unsafe conditions.”
e. “Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.”

Answer 36

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.”
e. “Federal legislation and payment for treatment of mental illness has shifted the focus to community rather than institutional settings.”

Question 37

A client diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the client:
ꞏ wants to attend an activity group at the mental health outreach center.
ꞏ is worried about being able to pay for the therapy.
ꞏ does not know how to get from home to the outreach center.
ꞏ has an appointment to have blood work at the same time an activity group meets.
ꞏ wants to attend services at a church that is a half-mile from the client’s home.

Which tasks are part of the role of a community mental health nurse? (Select all that apply.)

a. Rearranging conflicting care appointments
b. Negotiating the cost of therapy for the client
c. Arranging transportation to the outreach center
d. Accompanying the client to church services weekly
e. Monitoring to ensure the client’s basic needs are met

Answer 37

a. Rearranging conflicting care appointments
c. Arranging transportation to the outreach center
e. Monitoring to ensure the client’s basic needs are met