Nokea
A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following?
- A. Housing adequacy and stability
- B. Income adequacy and stability
- C. Family and other support systems
- D. Early psychosocial development
- E. Substance abuse history and current use
Correct Answer: A,B,C,E
Rationale: Early psychosocial developmental history is less relevant to successful outcomes in the community than the assessments listed in the other options. If a patient is homeless or fears homelessness, focusing on other treatment issues is impossible. Sufficient income for basic needs and medication is necessary. Adequate support is a requisite to community placement. Substance abuse undermines medication effectiveness and interferes with community adjustment.
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A patient tells the nurse at the clinic, 'I haven't been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and don't want them to ask me about the pills.' What is the nurse's most appropriate intervention?
- A. Investigate the possibility of once-daily dosing of the antidepressant.
- B. Suggest to the patient to take the medication when no one is watching.
- C. Explain how taking each dose of medication on time relates to health maintenance.
- D. Add the following nursing diagnosis to the plan of care: ineffective therapeutic regimen management, related to lack of knowledge.
Correct Answer: A
Rationale: Investigating the possibility of once-daily dosing of the antidepressant has the highest potential for helping the patient achieve compliance. Many antidepressants can be administered by once-daily dosing, a plan that increases compliance. Explaining how taking each dose of medication on time relates to health maintenance is reasonable but would not achieve the goal; it does not address the issue of stigma. The self-conscious patient would not be comfortable doing this. A better nursing diagnosis would be related to social stigma. The question asks for an intervention, not analysis.
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.
A patient hurriedly tells the community mental health nurse, 'Everything's a disaster! I can't concentrate. My disability check didn't come. My roommate moved out, and I can't afford the rent. My therapist is moving away. I feel like I'm coming apart.' What should be the immediate focus of nursing care?
- A. Assisting with the clarification of personal values
- B. Helping the patient cope with feelings of abandonment
- C. Assisting with the management of anxiety that may lead to psychological disequilibrium
- D. Facilitating the clarification of the patient's misperceptions of the environment
Correct Answer: C
Rationale: Subjective and objective data suggest the patient is experiencing anxiety caused by multiple threats to security needs; therefore, interventions will focus on assisting the patient to cope with anxiety. While the patient may have feelings of abandonment, this is only one aspect of the anxiety. Data are not present to suggest the patient's personal values are unclear or that the patient is misperceiving the environment.
What is an example of a lack of parity in health care delivery today?
- A. Payment for psychiatric health care is not equal to that of physical health care.
- B. Medicare is provided for only those 65 years of age and older.
- C. There is a sufficient need for mental health care providers.
- D. Most psychiatric care is provided on an outpatient basis.
Correct Answer: A
Rationale: Financing psychiatric care has been complicated by lack of parity, or equal payment for physical as compared to psychiatric disorders. None of the other options relate to parity.
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.