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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.
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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 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.
A student nurse prepares to administer oral medication to a patient diagnosed with major depressive disorder. What should the student nurse do when the patient refuses the medication?
- A. Share with the patient, 'I'll get an unsatisfactory grade if I don't give you the medication.'
- B. Tell the patient, 'Refusing your medication is not permitted. You are required to take it.'
- C. Attempt to discuss the patient's concerns about the medication, and report to the staff nurse.
- D. Document the patient's refusal of the medication without further comment.
Correct Answer: C
Rationale: The patient has the right to refuse medication in most cases. The patient's reason for refusing should be ascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant side effects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should be reported to permit appropriate intervention.
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 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.