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A man tells the nurse, 'All my life, I have felt and acted like a woman while living in a man's body. For the past year, I have lived and dressed as a woman. I changed jobs to protect my new identity.' Which request is the patient likely to make to the health care provider?
- A. Can you refer me for psychological testing?'
- B. Will you prescribe hormonal therapy?'
- C. Will you alter my medical records?'
- D. What should I tell my parents?'
Correct Answer: B
Rationale: Before sexual reassignment surgery, the step that follows living as a member of the other sex is hormone therapy. The patient's decision to live as a woman makes this a natural request. Psychological testing occurs before sexual reassignment surgery, often after hormone therapy has begun. The patient has likely told his parents by this point.
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A patient diagnosed with severe and persistent mental illness lives independently. This patient often has command hallucinations and shouts warnings to neighbors. After a short hospitalization, the patient's landlord says, 'You can't come back here. You cause too much trouble.' What problem is the patient experiencing?
- A. Grief
- B. Stigmatization
- C. Recidivism
- D. Lack of insurance parity
Correct Answer: B
Rationale: The inability to obtain shelter because of negative attitudes about mental illness is an example of stigmatization. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as the patient's problem. Recidivism refers to repetition of a previous offense. Insurance parity is not relevant to this scenario.
Before working with patients regarding sexual concerns, what is a prerequisite for providing nonjudgmental care?
- A. Sympathy
- B. Assertiveness training
- C. Sexual self-awareness
- D. Effective communication
Correct Answer: C
Rationale: Only when a nurse has accepted his or her own feelings and values related to sexuality can he or she provide fully nonjudgmental care to a patient. If the nurse is uncomfortable, the patient might misinterpret discomfort as disapproval. The distractors are not prerequisites.
A nurse cares for a patient diagnosed with paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors?
- A. Stimulants
- B. Erectile dysfunction medication
- C. Atypical antipsychotic medication
- D. Mood stabilizer
Correct Answer: D
Rationale: Pharmacological treatment typically involves medications that reduce impulsive or compulsive behavior, such as antidepressants, naltrexone, antipsychotics, mood stabilizers, or medications that interfere with the production of sexual hormones in order to reduce sexual urges. The other medications are not indicated for this disorder.
Which statements most clearly indicate that the speaker views mental illness with stigma?
- A. Everyone is a little bit crazy.'
- B. If people with mental illness would go to church, their problems would be solved with faith.'
- C. Many mental illnesses are genetically transmitted. It is 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 expect the government to take care of everything they need.'
Correct Answer: A,B,E
Rationale: Statements that trivialize mental illness ('Everyone is a little bit crazy'), suggest simplistic solutions ('go to church'), or stereotype individuals as lazy reflect stigmatizing attitudes. The other statements acknowledge the biological and situational factors of mental illness without judgment, indicating a lack of stigma.
A patient diagnosed with schizophrenia tells the community mental health nurse, 'I threw away my pills because they interfere with God's voice.' The nurse identifies what as the likely cause of the patient's ineffective management of the medication regimen?
- A. Inadequate discharge planning
- B. Poor therapeutic alliance with clinicians
- C. Impaired reasoning secondary to schizophrenia
- D. Dislike of the side effects of antipsychotic medications
Correct Answer: C
Rationale: The patient's ineffective management of the medication regimen is most closely related to impaired reasoning abilities. The patient believes in being an exalted person who hears God's voice, rather than an individual with a serious mental illness who needs medication to control symptoms. Data do not suggest that any of the other factors often relate to medication nonadherence.