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A community member asks a nurse, 'People diagnosed with mental illnesses used to go to a state hospital. Why has that changed?' Select the nurse's accurate responses.
- A. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities.
- B. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness.
- C. National rates of mental illness have declined significantly. The need for state institutions is actually no longer present.
- D. Most psychiatric institutions were closed because of serious violations of patients' rights and unsafe conditions.
- E. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings.
Correct Answer: A,B,E
Rationale: The community is a less restrictive alternative than hospitals for the treatment of people with mental illness. Funding for treatment of mental illness remains largely inadequate but now focuses on community rather than institutional care. Antipsychotic medications improve more symptoms of mental illness; hence, management of psychiatric disorders has improved. Rates of mental illness have increased, not decreased. Hospitals were closed because funding shifted to the community. Conditions in institutions have improved.
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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 were searched at admission.
- C. Physical restraints were used to prevent harm to self.
- D. Patient is placed on one-to-one continuous observation.
Correct Answer: A
Rationale: The patient has the right to have a treatment plan. Inspecting a patient's 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.
Correct Answer: A
Rationale: 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.
A community psychiatric nurse facilitates medication adherence for a patient by having the health care provider prescribe 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 patient's neighborhood
- C. Level of trust between the patient and the nurse
- D. Availability of transportation to the clinic
Correct Answer: D
Rationale: 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.
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
Correct Answer: C
Rationale: 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.
Which assessment finding for a patient living in the community requires priority intervention by the nurse?
- 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.
Correct Answer: D
Rationale: 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.