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A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest assisting the patient and family to cope with the stigma of mental illness as well as provide support and education?
- A. American Psychiatric Association (APA)
- B. National Alliance on Mental Illness (NAMI)
- C. Community Mental Health Centers (CMHCs)
- D. Programs of Assertive Community Treatment (PACT)
Correct Answer: B
Rationale: Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. The organization also offers patient and family support and education about living with mental illness. Community Mental Health Centers (CMHCs) are government agencies that provide outpatient services to persons diagnosed with SPMI. The APA is the professional organization of psychiatrists. Programs of Assertive Community Treatment (PACT) use a treatment team approach to improve symptom management and quality of life for persons diagnosed with SPMI.
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An adult diagnosed with attention-deficit/hyperactivity disorder (ADHD) says, 'I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job.' The nurse managing care should consider suggesting what intervention?
- A. Aversive therapy to extinguish negative behaviors.
- B. Cognitive therapy to help address internalized beliefs.
- C. Group therapy to allow comparison of feelings with others.
- D. Vocational counseling to identify needed occupational skills.
Correct Answer: B
Rationale: Cognitive therapy and knowledge of ADHD will make it possible for the patient to reframe the past and present in a more positive and realistic light and to challenge internalized false beliefs about self this improving self-image. Aversive therapy would not be useful for the patient. Group therapy may be valuable later to allow for the testing of new coping behaviors in a safe environment. Vocational counseling can help the patient explore suitable career options while pursuing treatment.
A nurse prepares a plan of care for a patient diagnosed with adult attention-deficit/hyperactivity disorder (ADHD). Which intervention should be included?
- A. Remind the patient of priorities and deadlines.
- B. Teach work-related skills such as basic computer literacy.
- C. Establish penalties for failing to organize and prioritize tasks.
- D. Give encouragement and strategies for managing and organizing.
Correct Answer: D
Rationale: The nurse's major responsibilities lie with encouraging the patient to learn and use necessary skills, assisting the patient to stay on task. The nurse is not an ever-present taskmaster or disciplinarian. The nurse does not teach work-related skills; vocational staff members assume those types of tasks.
The parent of an adult diagnosed with severe and persistent mental illness asks the nurse, 'Why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job.' Which is the nurse's best reply?
- A. We made this referral to maintain eligibility for federal funding.'
- B. Are you concerned that we're trying to make your child too independent?'
- C. If you think the program would be detrimental, we can postpone it for a time.'
- D. Most patients are capable of employment at some level, competitive or supported.'
Correct Answer: D
Rationale: Studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment; also, they demonstrate significant improvement in assertiveness and work behaviors, as well as decreased depression, and improved self-esteem and socialization.
A patient tells the nurse, 'My sexual functioning is normal when my partner wears lace. Without it, I'm not interested in sex.' This comment evidences which sexual disorder?
- A. Exhibitionism
- B. Voyeurism
- C. Pedophilia
- D. Fetishism
Correct Answer: D
Rationale: A person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality, to be sexually satisfied. Exhibitionism refers to exposing one's genitalia publicly. Voyeurism refers to viewing others in intimate situations. Pedophilia refers to the preference for having sexual relations with a child.
For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management?
- A. Modification of traditional psychotherapy
- B. Efficient access and use of resources
- C. Focus on social skills training and self-esteem building
- D. Bringing groups of patients together to discuss common problems
Correct Answer: B
Rationale: The case manager not only provides entrance into the system of care, but he or she also coordinates the multiple referrals that so often confuse the patient who is severely and persistently mentally ill and the patient's family. Case management promotes the efficient use of services. The other options are lesser advantages or may be irrelevant.