Chapter 5: Settings for Psychiatric Care Flashcards
- Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
c. have no 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 incorrect options do not necessarily describe patients who require inpatient treatment.
- A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to:
a. cancel the patients discharge from the hospital.
b. contact the landlord who evicted the patient to discuss the situation.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
d. document that the adverse medication reaction was feigned because the patient had nowhere to live.
ANS: C
The case manager should intervene by arranging temporary shelter for the patient until suitable housing can be found. This is part of the coordination and delivery of services that falls under the case manager role. The other options are not viable alternatives.
- A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting?
a. A treatment plan will be formulated.
b. The health care provider will order neuroimaging studies.
c. The team will request a court-appointed advocate for the patient.
d. Assessment of the patients need for placement outside the home will be undertaken.
ANS: A
Treatment plans are formulated early in the course of treatment to streamline the treatment process and reduce costs. It is too early to determine the need for alternative post-discharge living arrangements. Neuroimaging is not indicated for this scenario.
- The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is needed for at least a month. The nurse should:
a. call the psychiatrist to come explain the discharge rationale.
b. explain that health insurance will not pay for a longer stay for the patient.
c. call security to handle the disturbance and escort the family off the unit.
d. explain that the patient will continue to improve if medication is taken regularly.
ANS: D
Patients no longer stay in the hospital until every vestige of a symptom disappears. The nurse must assume responsibility to advocate for the patients 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. Calling security is unnecessary. The nurse can handle this matter.
- A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These observations relate to:
a. management of milieu safety.
b. coordinating care of patients.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
ANS: A
Members of the 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 nurses concerns, are unrelated to the observations cited.
- The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who:
a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol).
b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years.
c. self-inflicted a superficial cut on the forearm after a family argument.
d. is a single parent and hears voices saying, Smother your infant.
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.
- A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should:
a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication.
b. tell the patient, Refusing your medication is not permitted. You are required to take it.
c. discuss the patients concerns about the medication, and report to the staff nurse.
d. document the patients refusal of the medication without further comment.
ANS: C
The patient has the right to refuse medication in most cases. The patients reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should be reported to permit appropriate intervention.
- A nurse surveys the medical records for violations of patients rights. Which finding signals a violation?
a. No treatment plan is present in record.
b. Patient belongings are searched at admission.
c. Physical restraint is used to prevent harm to self.
d. Patient is placed on one-to-one continuous observation.
ANS: A
The patient has the right to have a treatment plan. Inspecting a 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 that occur as a result of a mental disorder.
- Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
a. Resolve behavioral crises using the least restrictive intervention possible.
b. Rights of the majority of patients supersede the rights of individual patients.
c. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
ANS: A
The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patients legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.
- To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
a. Problem-solving skills
b. Calm and caring manner
c. Ability to cross service systems
d. Knowledge of psychopharmacology
ANS: C
A community mental health nurse must be able to work with schools, corrections facilities, shelters, health care providers, and employers. The mental health nurse working in an inpatient unit needs only to be able to work within the single setting. Problem-solving skills are needed by all nurses. Nurses in both settings must have knowledge of psychopharmacology.
- A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurses best initial action.
a. Report the situation to the manager of the shelter.
b. Tell the patient, You must stop smoking to save money.
c. Assess the patients weight; determine the foods and amounts eaten.
d. Seek hospitalization for the patient while a new plan is being formulated.
ANS: C
Assessment of biopsychosocial needs and general ability to live in the community is called for before any 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. Nurses assess before taking action. Hospitalization may not be necessary.
- A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, Im willing to take my medicine, but I forgot to get my prescription refilled. Which outcome should the nurse add to the plan of care?
a. Nurse will obtain prescription refills every 90 days and deliver them to the patient.
b. Patients spouse will mark dates for prescription refills on the family calendar.
c. Patient will report to the hospital for medication follow-up every week.
d. Patient will call the nurse weekly to discuss medication-related issues.
ANS: B
The nurse should use the patients support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary for the nurse to do if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as he or she continues to take the medications as prescribed. No patient issues except failure to obtain medication refills were identified.
- A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, Only a traitor would make me go to the hospital. Which solution is best?
a. Arrange a bed in a local homeless shelter with nightly onsite supervision.
b. Negotiate a way to provide medication so the patient can remain at home.
c. Hospitalize the patient until the symptoms have stabilized.
d. Seek inpatient hospitalization for up to 1 week.
ANS: B
Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.
- A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance?
a. Attitude of significant others toward the patient
b. Nutritional services in the patients neighborhood
c. Level of trust between the patient and the nurse
d. Availability of transportation to the clinic
ANS: D
The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, noncompliance will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.
- Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient:
a. receives Social Security disability income plus a small check from a trust fund.
b. lives in an apartment with two patients who attend day hospital programs.
c. has a sibling who is interested and active in care planning.
d. purchases and uses marijuana on a frequent basis.
ANS: D
Patients who regularly buy illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of illegal drugs on cellular brain function, promotes relapse. The remaining options do not suggest problems.
