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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.
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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 patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, 'I'm willing to take my medicine, but I forgot to get my prescription refilled.' Which outcome should the nurse add to the plan of care?
- A. Nurse will obtain prescription refills every 90 days and deliver them to the patient.
- B. Patient's spouse will mark dates for prescription refills on the family calendar.
- C. Patient will report to the hospital for medication follow-up every week.
- D. Patient will call the nurse weekly to discuss medication-related issues.
Correct Answer: B
Rationale: The nurse should use the patient's support system to meet patient needs whenever possible. Delivery of medication by the nurse should be unnecessary if the patient or a significant other can be responsible. The patient may not need more intensive follow-up as long as he or she continues to take the medications as prescribed. No patient issues except failure to obtain medication refills were identified.
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.
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.