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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.
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The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, 'It's too soon for discharge. Hospitalization is needed for at least a month.' The nurse should implement what intervention?
- A. Call the psychiatrist to come explain the discharge rationale.
- B. Explain that health insurance will not pay for a longer stay for the patient.
- C. Notify security to handle the disturbance and escort the family off the unit.
- D. Explain that the patient will continue to improve if medication is taken regularly.
Correct Answer: D
Rationale: Patients no longer stay in a hospital until all evidence of a symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handle this matter.
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 community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, 'Only a traitor would make me go to the hospital.' Which solution is best?
- A. Arrange a bed in a local homeless shelter with nightly onsite supervision.
- B. Negotiate a way to provide medication so the patient can remain at home.
- C. Hospitalize the patient until the symptoms have stabilized.
- D. Seek inpatient hospitalization for up to 1 week.
Correct Answer: B
Rationale: Hospitalization may damage the nurse-patient relationship even if it provides an opportunity for rapid stabilization. If medication can be obtained and restarted, the patient can possibly be stabilized in the home setting, even if it takes a little longer. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first because the patient is not dangerous.
A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, 'I feel the same.' Which intervention supports the nurse's assessment while preserving the patient's autonomy?
- A. Arrange for a short hospitalization.
- B. Schedule weekly clinic appointments.
- C. Refer the patient to the crisis intervention clinic.
- D. Call the family and ask them to observe the patient closely.
Correct Answer: B
Rationale: Scheduling clinic appointments at shorter intervals will give the opportunity for more frequent assessment of symptoms and allow the nurse to use early intervention. If the patient does not admit to having a crisis or problem, a referral would be useless. The remaining options may produce unreliable information, violate the patient's privacy, and waste scarce resources.
A community psychiatric nurse facilitates medication adherence for a patient by having the health care provider prescribe medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance?
- A. Attitude of significant others toward the patient
- B. Nutritional services in the patient's neighborhood
- C. Level of trust between the patient and the nurse
- D. Availability of transportation to the clinic
Correct Answer: D
Rationale: The ability of the patient to get to the clinic is of paramount importance to the success of the plan. The depot medication relieves the patient of the necessity to take medication daily, but if he or she does not receive the injection at 3-week intervals, noncompliance will again be the issue. Attitude toward the patient, trusting relationships, and nutrition are important but not fundamental to this particular problem.