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A patient says, 'I often make careless mistakes and have trouble staying focused. Sometimes it's hard to listen to what someone is saying. I have problems putting things in the right order and often lose equipment.' Which problem should the nurse document?
- A. Inattention
- B. Impulsivity
- C. Hyperactivity
- D. Social impairment
Correct Answer: A
Rationale: Inattention refers to the failure to stay focused. A number of the other problems are the result of failure to pay attention, which contributes to problems with organization. Impulsivity refers to acting without thinking through the consequences. Hyperactivity refers to excessive motor activity. Social impairment refers to the failure to use appropriate social skills.
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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.
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.
An adult patient tells the case manager, 'I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends.' Which resources should the nurse suggest for the patient?
- A. Psychoeducation classes
- B. Vocational rehabilitation
- C. Social skills training
- D. Homeless shelter
- E. Crisis intervention
Correct Answer: A,B,C
Rationale: The patient does not understand the illness and the need for adhering to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. Work gives meaning and purpose to life; vocational rehabilitation can assist with this aspect of care. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with severe mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking down each skill into small verbal and nonverbal components. The patient presently has a home and does not require the services of a homeless shelter. The nurse case manager functions in the role of crisis stabilizer, so no related referral is needed.
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.
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.