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An adult says, 'When I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job.' Which disorder is most likely?
- A. Stress intolerance disorder
- B. Generalized anxiety disorder (GAD)
- C. Borderline personality disorder
- D. Adult attention-deficit/hyperactivity disorder (ADHD)
Correct Answer: D
Rationale: Adult ADHD is usually diagnosed in early life and treated until adolescence. Treatment is often stopped because professionals think the disorder resolves itself because the hyperactive impulsive behaviors may diminish; the inattentive and disorganized behaviors tend to persist, however. Stress intolerance disorder is not found in the DSM-5. The scenario description is inconsistent with generalized anxiety disorder and borderline personality disorder.
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The manager of a health club put a hidden camera in the women's locker room and videotaped women as they showered and dressed. Which sexual dysfunction is evident?
- A. Frotteurism
- B. Exhibitionism
- C. Pedophilia
- D. Voyeurism
Correct Answer: D
Rationale: Voyeurism is the viewing of others in intimate situations such as undressing, bathing, or having sexual relations. Voyeurs are often called 'peeping Toms.' Frotteurism is touching or rubbing against a nonconsenting person to achieve sexual gratification. Exhibitionists are interested in exposing their genitals to others. Pedophiles seek sexual contact with prepubescent children.
Health maintenance and promotion efforts for patients diagnosed with severe mental illness should include education about the importance of what regular intervention?
- A. Home safety inspections
- B. Monitoring of self-care abilities
- C. Screening for cancer, hypertension, and diabetes
- D. Determination of adequacy of a patient's support system
Correct Answer: C
Rationale: Individuals diagnosed with severe and persistent mental illness have an increased prevalence of medical disorders. Patients should be taught the importance of regular visits to a primary care physician for screening for these illnesses. Home safety inspections are more often suggested for patients with physical impairments. Caregivers and family members usually evaluate self-care abilities, rather than the patient. Assessment of a patient's support system is not usually considered part of health promotion and maintenance.
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 in a homeless shelter. The priority nursing diagnosis for this patient is Powerlessness. Which intervention should be included in the plan of care?
- A. Encourage mutual goal setting.
- B. Verbally communicate empathy.
- C. Reinforce participation in activities.
- D. Demonstrate an accepting attitude.
Correct Answer: A
Rationale: Mutual goal setting is an intervention designed to promote feelings of personal autonomy and dispel feelings of powerlessness. Although it might be easier and faster for the nurse to establish a plan and outcomes, this action contributes to the patient's sense of powerlessness. Involving the patient in decision making empowers the patient and reduces feelings of powerlessness.
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.