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A person diagnosed with severe and persistent mental illness enters a shelter for the homeless. Which intervention should be the nurse's initial priority?
- A. Develop a relationship.
- B. Find supported employment.
- C. Administer prescribed medication.
- D. Teach appropriate health care practices.
Correct Answer: A
Rationale: Basic psychosocial needs do not change because a person is homeless. The nurse's initial priority should be establishing rapport. Once a trusting relationship is established, then the nurse can pursue other interventions.
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A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest assisting the patient and family to cope with the stigma of mental illness as well as provide support and education?
- A. American Psychiatric Association (APA)
- B. National Alliance on Mental Illness (NAMI)
- C. Community Mental Health Centers (CMHCs)
- D. Programs of Assertive Community Treatment (PACT)
Correct Answer: B
Rationale: Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. The organization also offers patient and family support and education about living with mental illness. Community Mental Health Centers (CMHCs) are government agencies that provide outpatient services to persons diagnosed with SPMI. The APA is the professional organization of psychiatrists. Programs of Assertive Community Treatment (PACT) use a treatment team approach to improve symptom management and quality of life for persons diagnosed with SPMI.
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.
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.
A man tells the nurse, 'All my life, I have felt and acted like a woman while living in a man's body. For the past year, I have lived and dressed as a woman. I changed jobs to protect my new identity.' Which request is the patient likely to make to the health care provider?
- A. Can you refer me for psychological testing?'
- B. Will you prescribe hormonal therapy?'
- C. Will you alter my medical records?'
- D. What should I tell my parents?'
Correct Answer: B
Rationale: Before sexual reassignment surgery, the step that follows living as a member of the other sex is hormone therapy. The patient's decision to live as a woman makes this a natural request. Psychological testing occurs before sexual reassignment surgery, often after hormone therapy has begun. The patient has likely told his parents by this point.
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.