Which of the following factors contribute to the movement of patients out of large state institutions and into community-based mental health treatment? Select all that apply.
States desire to save money by moving the patients to the community, where the federal government would pick up more of the cost.
The growing availability of generous mental health insurance coverage gave more patients the ability to seek private care in the community.
A system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment.
The Community Mental Health Centers Act of 1963 required states to develop and offer care in community-based treatment programs.
Patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive setting.
New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.
Levels of prevention strategies prominent in outpatient psychiatric care consist of primary prevention, secondary prevention, and [blank_start]tertiary[blank_end] prevention.
Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications?
Help Anna to understand her illness and share in decisions about her care.
Advise Anna that if she stops her medications, her doctor will hospitalize her.
Arrange for Anna to receive daily home care so that her use of medications is monitored.
Discourage Anna from focusing on side effects and other excuses for stopping her pills.
A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has?
Provide emotional support and encourage him to contact his family to see if they can help him arrange and pay for inpatient care.
Advise him that hospitals serve all persons regardless of their ability to pay, and immediately contact a Mobile Crisis team or accompany him to the nearest hospital emergency department.
Help him apply for Medicaid coverage, arrange for him to be monitored by family and friends, and once Medicaid coverage is in place, take him to an emergency room for evaluation.
Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.
Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? Select all that apply.
Interact frequently with both individuals and groups on the unit.
Attempt to introduce patients with similar backgrounds to each other to form social bonds for after discharge.
Initiate and support group interactions via therapeutic groups and activities.
Provide and encourage opportunities to practice social and other life skills.
Collaborate with housekeeping to provide a safe, pleasant environment.
Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.
The criteria for admission to an inpatient psychiatric unit is that the patient:
refuses to comply with the treatment team in regard to medication, counseling, living situation, or substance abuse abstinence.
is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm.
refuses all psychotropic medication.
is court-ordered by a judge specializing in mental health.
The primary advantage of using a case manager is to
increase collaborative practice.
enhance resource management.
increase client satisfaction with care.
promote evidence-based psychiatric nursing.
Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by
Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true?
All rights remain intact.
Only rights that do not involve decision making remain intact.
The right to refuse treatment is no longer guaranteed.
All rights are temporarily suspended.
It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to
send and receive mail.
seek legal counsel.
access all personal possessions.
For the psychiatric client, the greatest negative aspect of the multidisciplinary treatment team approach to care is that it
is an expensive treatment model.
can increase anxiety in the newly admitted client.
requires the client to answer the same questions repeatedly.
puts demands on the client's time and energy.
An ongoing, crucial responsibility of nurses working on an inpatient psychiatric unit is
maintaining a therapeutic milieu.
providing constructive negative feedback.
Which is a characteristic of a therapeutic inpatient milieu?
It provides for the client's safety and comfort.
Voluntarily admitted clients are generally allowed additional privileges.
Rules and behavioral limits are flexibly enforced.
Staff provide frequent and ongoing negative feedback to clients.
In an attempt to provide both safety and client comfort, psychiatric units generally have
a varied client menu served on non-breakable plastic dinnerware.
comfortable seating that is well padded but secured to the floor.
bedrooms that resemble hotel rooms but with specific safety features.
a dayroom that has audiovisual equipment and is visible from the nurses' station.
Which would NOT be considered a crisis on a psychiatric unit?
Mr. R reports chest pain after eating a spicy lunch.
Ms. T cannot speak and is holding her hands up to her neck.
Mr. S demonstrates anger that escalates to physical assault.
Mr. U reports hearing voices telling him to hit others.
The community mental health movement was least influenced by
the advent of antipsychotic medications.
increasing public awareness of the poor care given in some large psychiatric hospitals.
the proliferation of federal entitlement programs, making it possible to move the mentally ill out of hospitals.
the increasingly larger numbers of advanced practice nurses prepared to care for the mentally ill in the community.
Which attribute would be least helpful for a community mental health nurse to have?
Ability to cross service systems
Which assessment information is uniquely important to the mental health client receiving outpatient care?
Mental status examination results
The client's strengths and deficits
Housing adequacy and stability
The presenting problem and referring party
The major difference between the psychiatric nursing assessment performed for a client who is hospitalized and for a client who will be treated in the community is
for the latter, the general assessment must be expanded.
for the latter, the nursing focus is primarily on the mental status examination.
for the former, the general assessment must be reimbursement based.
for the former, the nursing focus is limited to the client's willingness to accept treatment.
Which need is the highest priority for a seriously and persistently ill client living in the community?
Access to medication
Socialization and diversion
Independent decision making
Engaging in meaningful work
A function shared by advanced practice and general practice psychiatric nurses is
provision of consultation services.
collaboration with a multidisciplinary team.
In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care?
Chemical dependency counselors
Although mental illness still carries a stigma, acceptance has improved over the past 40 years, partly due to
better control of symptoms through drug therapy.
public screenings that are well advertised in the community.
community psychiatric nursing programs that provide in-home care.
acknowledgment of personal mental health issues by well-known people.
Which criterion must be met to refer a client to a partial hospitalization program?
The client is hospitalized at night in an inpatient setting.
The client must be able to provide his or her own transportation daily.
The client is able to return home each day.
The client is able to care for his or her own physical and psychological needs.
A nurse says, "I work with a mobile mental health unit." The listener can assume that the nurse
works with patients who are incarcerated.
sees clients in unconventional settings.
is a preferred provider for a large HMO.
is a clinical specialist with the visiting nurse service.
Which activity best exemplifies the focus for a case manager?
Arranging for rapid assessment of a newly hospitalized client
Providing a comprehensive client social history to the treatment team
Writing a report describing best practices in care for clients with depression
Gathering data for a research study concerning side effects of a new medication
Which situation demonstrates the nurse functioning in the role of advocate?
Providing one-to-one supervision for a client on suicide precautions
Co-leading a medication education group for clients and families
Attending an inservice education program to obtain recertification in cardiopulmonary resuscitation
Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days
The case manager is demonstrating an understanding of the primary goals of managed care when
arranging for the client to have a screening for prostate cancer.
notifying the family that the client will require a wheelchair when discharged.
providing the client with organizations that help defray the cost of prescribed drug.
arranging for respite care when the client's family needs to attend an out-of-state affair.
A client admitted to the behavioral health unit with a diagnosis of schizophrenia tells the nurse that she does not wish to see her husband if he visits. The nurse tells the client's husband that
his wife has the right to refuse visitors if she wishes.
he is welcome to visit but may receive a cool reception.
the client's plan of care calls for limiting visitors for 2 days.
the client is acutely psychotic and not responsible for her present behavior.
A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse states:
"We will help you make decisions that will keep you safe."
"I am going to help you shower, so you will not smell so bad."
"Your pocket knife and nail clippers will be kept in the nurses' station."
"You will be having a number of tests to help us learn about your condition."
Which symptomatology has priority for admission to an inpatient behavioral health unit?
Severe anxiety and feeling as though one is suffocating
Profound grieving over the recent death of one's identical twin
Hearing voices that proclaim one to be "the exalted ruler of the universe"
History of seizures and an elevated lithium level
A novice nurse is assigned to manage the milieu when there is a behavioral crisis with a client in the dining room. The nurse shows a lack of understanding of crisis management when
requiring that all clients go in their rooms.
moving clients from the dining room to the day room/solarium.
encouraging the clients to express their reactions to the incident.
reassuring clients that staff will handle the agitated client.
The nurse who provides therapeutic milieu management supports the clients best by
allowing them to act out their fears and frustrations.
providing a safe place for them to practice coping skills.
meeting their physical as well as emotional needs.
encouraging them to talk about their problems with others.
A chronically ill client was readmitted when symptoms of the illness exacerbated. The client lives alone and has few outside activities. To best prepare the client for discharge, the nurse will focus on
improving client-family relationships.
placing the client in a sheltered workshop.
psychoeducation to promote medication compliance.
involving the client in daily visits to a psychosocial club.
On a hospital inpatient unit, the nurse manager primary responsible is to
assure the safety of both clients and staff on the unit.
assist the client to prepare a support system by the time of discharge.
provide medication therapy for the patients on the unit.
help the inpatient community remain supportive of each other.
When preparing an education program focused on the history of the community mental health movement in the United States, the nurse includes the fact that
use of community settings began after World War II with the discharge of large numbers of veterans with mental illness.
the shift from care in psychiatric hospitals to community mental health centers began in the 1960s.
movement of services out of hospitals and into the community is a baby-boomer phenomenon that began in the 1980s.
the community mental health movement is an outgrowth of managed care's response to rising health care costs beginning in the 1990s.
In order to be most affective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess
knowledge of both national and local political activism.
the ability to cross service systems.
an awareness of own cultural and personal values.
creative problem-solving and intervention skills.
When asked to explain what a psychosocial rehabilitation program is, the nurse responds best when sharing
"The concept started in the 1960s and provides psychiatric care for those without private insurance."
"The individual program can provide medication, therapies, and social services for the mentally ill."
"Referrals from inpatient and intensive outpatient facilities are provided with long-term care that focuses on desired goals."
"It is a multidisciplinary team approach that is composed of nurses, psychiatrics, social workers, and psychologists."
When mental health care is provided for in a community setting, goal setting is
client-directed and focused on the individual's expressed wishes.
society-driven and focused on returning the client into the social community.
determined by the care provider and focused on cost-effective measures.
negotiated by both client and staff and focused on long-term functioning.
The psychiatric community health nurse engages in primary prevention when
visiting a homeless shelter to provide crisis intervention for its clients.
discussing the need for proper nutrition with a depressed new mother.
providing stress reduction seminars at the local senior center.
visiting the home of a client currently displaying manic behavior.
In 1963 the Community Mental Health Centers Act was signed with the primary purpose of
having mental health care services funded by the federal government while provided by state government.
providing mental health care to the uninsured in an economical reasonable manner.
providing mental health care on an outpatient basis in order to maintain the client as a member of an established community.
assuring all Americans of the mental health care services they need and/or desire.
A community mental health nurse is assigned to a mobile mental health care unit in a locale where the majority of the population are newly immigrated Vietnamese. The measure that will best help the nurse initially plan and implement culturally sensitive care for clients is
arranging for the services of an interpreter and cultural consultant.
reading about the predominant health beliefs held by members of Asian cultures.
attempting to place self in the position of being an unassimilated member of a culture.
treating clients in the same manner that clients of any culture would find satisfying.
An example of deinstitutionalization would include
providing a recovering alcoholic with transportation to nightly AA meetings.
discharging a stabilized psychotic client to a transitional halfway house.
psychiatric in-home visits for a new mother experiencing post-partum depression.
conducting regular depression screening at a local homeless shelter.
The community mental health nurse recognizes that the mentally ill population will require
frequent assessment for physical illness both acute and chronic in nature.
continuous supervision in order to assure that their physical needs are met.
government assistance in the form of health insurance and housing.
legal assistance to ensure they retain their civic rights.
A community mental health nurse is responsible for medication management for clients. Which general approach can be anticipated to yield the best results?
Empowering clients to be responsible for medication compliance
Providing frequent oversight by nurse of daily medication ingestion
Establishing a system in which client support figures oversee medications
Scheduling monthly blood tests to determine serum levels of prescribed medications
There is one bed on a locked psychiatric unit. Which of the following patients is appropriate for involuntary admission?
Jill, aged 23 years, a college student who has developed symptoms of anxiety and is missing classes and work
Michael, aged 30 years, an accountant who has developed symptoms of depression
Mia, aged 26 years, a kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road
Rose, aged 76 years, a retired librarian who is experiencing memory loss and some confusion at times
Which of the following structural safety precautions is most important to prevent the most common type of inpatient suicides?
Break-away closet bars to prevent hanging
Bedroom and dining areas with locked windows to prevent jumping
Double-locked doors to prevent escaping from the unit
Platform beds to prevent crush injuries
Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)?
Ramon, who is suicidal with a plan
Marty, a substance abuser who is being discharged from an inpatient alcohol rehabilitation unit
Ellen, who stopped taking her antipsychotic medication and is decompensated and not caring for herself
Jeff, who has mild depression symptoms and is starting outpatient therapy
George W. Bush's New Freedom Commission on Mental Health's report emphasized that mental illness is not a hopeless life sentence but a condition from which people can recover. Recovery, which is still the number 1 goal, could be described as:
the ability to work, live, and participate in the community.
never having to visit a mental health provider again.
a short-term journey that leaves people better able to cope with symptoms.
a long-term journey over the individual's life span.
One primary goal and benefit of Assertive Community Treatment (ACT) is:
forming closer relationships with the patient's family.
more flexible work schedule for staff.
more reimbursement to staff for services provided.
In the DSM-5, a major change in how culture is viewed within each disorder is that:
issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes.
issues related to culture and mental illness are markedly absent in the discussion of each disorder.
it is noted that it is impossible for health practitioners to be expected to be culturally aware with the increasing diversity of the United States.
issues related to culture and mental illness are less important than previously thought in diagnostic criteria.
Julio is a 31-year-old patient who comes to your mental health out-patient clinic. Which of the following would alert you to the potential for somatization?
Julio states, "I have been feeling sad for weeks."
Julio shows you bottles of medication he has been prescribed for anxiety.
Julio presents with concerns involving headaches, dizziness, and fatigue.
Julio states, "I have been sleeping all the time."
You are caring for Maria, a patient who states that she has "ghost sickness." Which is the appropriate nursing response?
"I have no idea what 'ghost sickness' is."
"How does 'ghost sickness' make you feel?"
"'Ghost sickness' is not listed in the manual of psychiatric disorders."
"Let's talk about why you believe in evil spirits?"
Which nursing actions demonstrate cultural competence? Select all that apply.
Planning mealtime around the patient's prayer schedule
Advising a patient to visit with the hospital chaplain
Researching foods that a lacto-ovo-vegetarian patient will eat
Providing time for a patient's spiritual healer to visit
Ordering standard meal trays to be delivered three times daily
The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate?
Patient will visit with spiritual healer once weekly.
Patient will experience rebalance of yin-yang by discharge.
Patient will identify sources that increase "cold wind" within 24 hours of admission.
Patient will contact "singer" to provider healing ritual within 3 days of admission.
Which statement best explains the term "worldview"?
Beliefs and values held by people of a given culture about what is good, right, and normal.
Ideas derived from the major health care system of the culture about what causes illness.
Cultural norms about how, when, and to whom illness symptoms may be displayed.
Valuing one's beliefs and customs over those of another group.
When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called
According to the Western scientific view of health, illness is the result of
Which healing practice is least used in the Western health system of healing practices?
Targeted cellular destruction
Restoring lost balance or harmony
Exclusive use of Western psychological theories by nurses making client assessments will result in
a high level of care for all clients.
standardization of nomenclature for psychiatric disorders.
inadequate assessment of clients of diverse cultures.
greater ease in selecting appropriate treatment interventions.
Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of
biased assessment tools.
insensitive interviewing techniques.
lack of the availability of cultural translators.
People who have an indigenous worldview
see themselves as spiritual and believe that they are linked with all other living things.
focus on the articulation of individual needs and ideas.
view the self as an extension of cosmic energy that is repeatedly reborn.
are concerned with being part of a harmonious community.
In the Eastern tradition, disease is believed to be caused by
fluctuations in opposing forces.
adoption of Western beliefs.
Deviation from cultural expectations is considered by members of the cultural group as a demonstration of
lack of self-will.
variation from tradition.
A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client
has a major mental illness.
is expressing a culture-bound illness.
requires hospitalization to protect the neighbor.
will probably not respond to Western medical treatment.
The Eastern world view can be identified by the belief that
one's identify is found in individuality.
holds responsibility to family as central.
time waits for no one.
disease is a lack of harmony with the environment.
Which idea held by the nurse would best promote the provision of culturally competent care?
Western biomedicine is one several established healing systems.
Some individuals will profit from use of both Western and folk healing practices.
Use of cultural translators will provide valuable information into health-seeking behaviors.
Need for spiritual healing is a concept that crosses cultural boundaries.
When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects
Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces?
The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports
increased somatic expressions of distress.
disruption of energy balance.
appeasement of the spirits.
The nurse assesses the wellness beliefs and values of a client from another culture best when asking
"What do you think is making you ill?"
"When did you first feel ill?"
"How can I help you get better?"
"Did you do something to cause the illness?"
Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture?
"Is there someone in your community who usually cures your illness?"
"What usually helps people who have the same type of illness you have?"
"What questions would you like to ask about your condition?"
"What sorts of stress are you presently experiencing?"
Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to
power and control.
assimilation and conformity.
The psychiatric nurse planning and implementing care for culturally diverse clients should understand
political power theory.
The question that would give data of least value to the assessment of family dynamics is
"What changes have occurred recently at work?"
"Are your wife and children conforming to your expectations?"
"Are you experiencing stress associated with conforming to family expectations?"
"Do you expect others to shun or avoid you because you are seeing a therapist?"
A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms?
"So, ethnicity refers to having the same life goals whereas culture refers to race."
"So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes."
"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values."
"So, ethnicity refers to race, and culture refers to having the same worldview."
Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure?
Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace.
Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them.
Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance.
Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate.
Which of the following best explains the concept of cultural competence?
Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care.
Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States.
Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices.
Nurses must take continuing education classes on culture in the process of becoming culturally competent.
Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting:
You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (Select all that apply.)
"You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply."
"I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English."
"Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English."
"What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture."
"Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known."