Nokea
To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
- A. Problem-solving skills
- B. Calm and caring manner
- C. Ability to cross service systems
- D. Knowledge of psychopharmacology
Correct Answer: C
Rationale: A community mental health nurse must be able to work with schools, corrections facilities, shelters, health care providers, and employers. The mental health nurse working in an inpatient unit needs only to be able to work within the single setting. Problem-solving skills are needed by all nurses. Nurses in both settings must have knowledge of psychopharmacology.
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The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, 'It's too soon for discharge. Hospitalization is needed for at least a month.' The nurse should implement what intervention?
- A. Call the psychiatrist to come explain the discharge rationale.
- B. Explain that health insurance will not pay for a longer stay for the patient.
- C. Notify security to handle the disturbance and escort the family off the unit.
- D. Explain that the patient will continue to improve if medication is taken regularly.
Correct Answer: D
Rationale: Patients no longer stay in a hospital until all evidence of a symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handle this matter.
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.
Which assessment finding for a patient living in the community requires priority intervention by the nurse?
- A. Receives Social Security disability income plus a small check from a trust fund.
- B. Lives in an apartment with two patients who attend day hospital programs.
- C. Has a sibling who is interested and active in care planning.
- D. Purchases and uses marijuana on a frequent basis.
Correct Answer: D
Rationale: Patients who regularly buy illegal substances often become medication noncompliant. Medication noncompliance, along with the disorganizing influence of illegal drugs on cellular brain function, promotes relapse. The remaining options do not suggest problems.
A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under staff supervision. These observations relate to what nursing responsibility?
- A. Management of milieu safety
- B. Coordinating care of patients
- C. Management of the interpersonal climate
- D. Use of therapeutic intervention strategies
Correct Answer: A
Rationale: Members of the nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to the observations cited.
Which patient would a nurse refer to partial hospitalization?
- A. One who spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
- B. One who is experiencing agoraphobia and panic episodes and who would benefit from psychoeducation for relaxation therapy.
- C. One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
- D. One who states, 'I'm not sure I can avoid using alcohol when my spouse goes to work every morning.'
Correct Answer: D
Rationale: This patient could profit from the structure and supervision provided by spending the day at the partial hospitalization program. During the evening, at night, and on weekends, the spouse could assume supervision responsibilities. The patient who is actively suicidal needs inpatient hospitalization. The patient in need of psychoeducation can be referred to home care. The patient who reports regularly for blood tests and clinical follow-up can continue on the same plan.