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A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a pre-discharge visit, the case manager learns the patient received a notice of eviction on the day of admission. What is the most appropriate intervention for the case manager to implement?
- A. Cancel the patient's discharge from the hospital.
- B. Contact the landlord who evicted the patient to discuss the situation.
- C. Arrange a temporary place for the patient to stay until new housing can be secured.
- D. Document that the patient's recovery will be hampered because of homelessness.
Correct Answer: C
Rationale: The case manager should intervene by arranging temporary shelter for the patient until suitable housing can be found. This is part of the coordination and delivery of services that falls under the case manager role. The other options are not viable alternatives.
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A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurse's best initial action.
- A. Report the situation to the manager of the shelter.
- B. Tell the patient, 'You must stop smoking to save money.'
- C. Assess the patient's weight; determine the foods and amounts eaten.
- D. Seek hospitalization for the patient while a new plan is being formulated.
Correct Answer: C
Rationale: Assessment of biopsychosocial needs and general ability to live in the community is called for before any action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. Nurses assess before taking action. Hospitalization may not be necessary.
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.
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 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 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.