Psychiatric Mental Health Nursing in Community Settings Flashcards
- Select the response that is an 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 counselling with a young couple expecting their first child
ANS: A
Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counselling and teaching school-age children about substance abuse and dependence are examples of primary prevention.
- 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 is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.
- A nurse receives the following three phone calls regarding a community patient.
* The psychiatrist wants to complete a follow-up assessment.
* An internist wants to schedule 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
Case managers design individually tailored treatment services for patients and track outcomes of care. The new case management includes assessing patient needs, developing a plan for service, linking the patient with necessary services, monitoring the effectiveness of services, and advocating for the patient as needed. Nurses 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.
- 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
ANS: B
A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.
- A patient with which of the following diagnoses would be most appropriate to refer for assertive community treatment (ACT)?
a.A phobic fear of crowded places.
b.A single episode of major depression.
c.A catastrophic reaction to a tornado in the community.
d.Schizophrenia and four hospitalizations in the past year.
ANS: D
Assertive community treatment (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.
- Select the response that 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 patient who assaulted a staff person
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 secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention.
- 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.
- The nurse assigned to assertive community treatment (ACT) should explain the program’s treatment goal as which of the following?
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 assertive community treatment (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.
- 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 behaviour.
c.Obtain the patient’s permission for the exchange of information.
d.Determine which family members should participate in the conference.
ANS: C
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, with the patients consent. Actions identified in the distracters occur after the patient has given permission.
- 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.
- A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, “Only a traitor would make me go to the hospital.” Select the nurse’s best initial intervention.
a.Collaborate with the patient to 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 patient until the symptoms have stabilized.
d.Ask the patient, “Do you feel like I am a traitor?”
ANS: A
Hospitalization may damage the nurse–patient relationship, even if it provides an opportunity for rapid stabilization. The treatment outcome is to stabilize and improve the patients’ level of functioning in the community. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.
- 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 counselling
d.Making a referral for family therapy
ANS: B
Primary prevention activities are directed to healthy populations to provide information for developing skills that promote mental health. The distracters represent secondary or tertiary prevention activities.
- A psychiatrist prescribed depot injections every 3 weeks at the clinic for a patient with a history of medication noncompliance. For this plan to be successful, which factor will be of critical importance?
a.The attitude of significant others toward the patient
b.Nutrition services in the patient’s neighbourhood
c.The level of trust between the patient and nurse
d.The 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, nonadherence 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 in the community deserves priority intervention by the psychiatric nurse?
a.The patient receives provincial disability income plus a small cheque from a trust fund every month.
b.The patient was absent from three of six planned Alcoholics Anonymous meetings in the past 2 weeks.
c.The patient lives in an apartment with two patients who attend partial hospitalization programs.
d.The patient has a sibling who was recently diagnosed with a mental illness.
ANS: B
Patients who use alcohol or illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of substances on cellular brain function, promotes relapse. The distracters do not suggest problems.
- The nurse should refer which of the following patients to a partial hospitalization program?
a.A patient who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
b.A patient who needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
c.A patient who spent yesterday in a supervised crisis care centre and continues to have active suicidal ideation.
d.A patient who states, “I’m not sure I can avoid using alcohol when my spouse goes to work every morning.”
ANS: D
This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume responsibility for supervision. A suicidal patient needs inpatient hospitalization. The other patients can be served in the community or with individual visits.
