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A patient diagnosed with severe and persistent mental illness who recently moved to a homeless shelter says, 'My life is out of control. I'm like a leaf at the mercy of the wind.' The nurse formulates the diagnosis Powerlessness. Outcomes will focus on which goal?
- A. Instilling hope
- B. Controlling anxiety
- C. Planning social activities
- D. Developing personal autonomy
Correct Answer: D
Rationale: Powerlessness is associated with feeling unable to control events in one's life. It is often associated with low self-esteem. The goal is to increase one's sense of autonomy. The scenario does not indicate hopelessness or anxiety. Socialization is not the primary need.
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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.
Which nursing diagnosis is likely to apply to the plan of care for a homeless individual diagnosed with severe and persistent mental illness?
- A. Insomnia
- B. Substance abuse
- C. Chronic low self-esteem
- D. Impaired environmental interpretation syndrome
Correct Answer: C
Rationale: Many individuals with severe mental illness do not live with their families and are homeless. Life on the street or in a shelter has a negative influence on the individual's self-esteem, making this nursing diagnosis one that should be considered. Insomnia may be noted in some patients but is not a universal problem. While substance abuse may be a comorbid problem, it is not an approved North American Nursing Diagnosis Association International (NANDA-I) diagnosis. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not observed in a majority of the homeless population.
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.
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.
Which economic factors are most critical to the success of discharge planning for a patient diagnosed with severe and persistent mental illness?
- A. Access to housing
- B. Individual psychotherapy
- C. Income to meet basic needs
- D. Availability of health insurance
- E. Ongoing interdisciplinary evaluation
Correct Answer: A,C,D
Rationale: The success of discharge planning requires careful attention to the patient's economic status. Access to housing is the first priority of the seriously mentally ill, and lack of income and health insurance is a barrier to effective treatment and rehabilitation. Although important aspects of ongoing care of the seriously mentally ill patient, ongoing interdisciplinary evaluation and individual psychotherapy are not economic factors.