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What is meant by the term revolving door effect in mental health care?
- A. An overall reduction in incidence of severe mental illness
- B. Shorter and more frequent hospital stays for persons with severe and persistent mental illness
- C. Flexible treatment settings for mentally ill
- D. Most effective and least expensive treatment settings
Correct Answer: B
Rationale: The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization.
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A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions?
- A. Tells the client about personal events and interests
- B. Discusses the anxious feelings with the instructor
- C. Assumes that the client's unwillingness to talk to a student nurse is a personal insult or failure
- D. Builds rapport with the patient before asking personal questions
- E. Consults the instructor if a shocking situation arises
- F. Gravitates to clients that the student may know personally
Correct Answer: B,D,E
Rationale: Listening carefully, showing genuine interest, and caring about the client are extremely important rather than speaking about oneself. The student must deal with his or her own anxiety about approaching a stranger to talk about very sensitive and personal issues. Student nurses should not see the client's unwillingness to talkಸ�ದtalk to a student nurse as a personal insult or behavior. Being available and willing to listen are often all it takes to begin a significant interaction with someone. Questions involving personal matters should not be the first thing a student says to the client. These issues usually arise after some trust and rapport have been established. The nursing instructor and staff are always available to assist if the client is shocking or distressing to the student. If the student recognizes someone he or she knows, it is usually best for the student to talk with the client and reassure him or her about confidentiality.
The major problems with large state institutions are:
- A. Attendants were accused of abusing the residents.
- B. Stigma associated with residence in an insane asylum.
- C. Clients were geographically isolated from family and community.
- D. Increasing financial costs to individual residents.
Correct Answer: A,C
Rationale: Clients were often far removed from the local community, family, and friends because state institutions were usually in rural or remote settings. Stigma and financial costs were not identified as major problems.
Which is a positive aspect of treating clients with mental illness in a community-based care?
- A. You will not be allowed to go out with your friends while in the program.
- B. You will have to have supervision when you want to go anywhere else in the community.
- C. You will be able to live in your own home while you still see a therapist regularly.
- D. You will have someone in your home at all times to ask questions if you have any concerns.
Correct Answer: C
Rationale: Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs.
Which would be a reason for a student nurse to use the DSM?
- A. Identifying the medical diagnosis
- B. Treat clients
- C. Evaluate treatments
- D. Understand the reason for the admission and the nature of psychiatric illnesses.
Correct Answer: D
Rationale: Although student nurses do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis, treating, and evaluating treatments are not a part of the nursing process.
A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes
- A. Medical management of symptoms.
- B. Daily psychotherapy.
- C. Constant staff supervision.
- D. Psychological stabilization.
Correct Answer: A
Rationale: Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting.