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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.
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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.
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.
How is severe and persistent mental best characterized?
- A. Mental illness with longer than 2 weeks' duration.
- B. Major ongoing mental illness marked by significant functional impairments.
- C. Mental illness accompanied by physical impairment and severe social problems.
- D. Major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.
Correct Answer: B
Rationale: Severe mental illness' has replaced the phrase 'chronic mental illness.' Global impairments in function are evident, including social skills. Physical impairments may or may not be present. Severe mental illness can be treated, but remissions and exacerbations are part of the course of the illness. The distractors fail to effectively address the issue of functional impairment.
The treatment team believes medication will help a patient diagnosed with adult attention-deficit/hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed?
- A. Benzodiazepines
- B. Stimulants
- C. Antipsychotics
- D. Anxiolytics
Correct Answer: B
Rationale: Stimulants, such as methylphenidate and amphetamines, provide the basis for treatment of both adult and childhood ADHD. They are the most commonly used medications; therefore, the nurse could expect the health care provider to prescribe a drug in this class. None of the other drugs listed as options have proved useful in the treatment of ADHD.
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.