Exam 30: Serious Mental Illness

A patient with severe schizophrenia is seen at a community mental health center.He tells the nurse,"I am here to save the world.I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as:

A patient with paranoid schizophrenia and anosognosia has had several hospitalizations.He responds quickly to antipsychotic medication but stops taking the medication soon after discharge.Discharge planning will include follow-up at the mental health clinic,placement in a group home,and daily attendance at a psychosocial day program.Which medication strategy will most likely be used as he transitions from hospital to community?

A patient with serious mental illness who has just moved into a homeless shelter tells the nurse that his "life just got out of control." He says he could not depend on others,so he kept to himself.Then he added,"I am like a leaf at the mercy of the wind." The nurse adds the nursing diagnosis of Powerlessness to his care plan.Which entry in his chart best suggests that the treatment plan is helping with this diagnosis?

A homeless individual with severe mental illness,anosognosia,and a history of persistent treatment nonadherence is persuaded to come to the day program at the community mental health center.Which intervention should be the team's initial priority?

A patient with severe mental illness who lives independently in an apartment and attends a psychosocial rehabilitation program 4 days a week presents at the emergency department seeking admission to the inpatient psychiatric unit.The mental status examination reveals no acute symptoms of psychiatric disorder.Her chief complaint is that she has no money to pay her rent or refill her antipsychotic medication prescription.The best action for the emergency department nurse would be to:

A man with severe mental illness has difficulty with boredom,feels that attending the day program does not challenge him,and wishes to earn money.Which of the following options would be most appropriate for addressing these issues?

Which three health maintenance and promotion interventions would be most indicated and beneficial for patients with serious mental illness? Select all that apply.

A middle-class family is talking with the nurse about the impact a seriously mental ill son has had on the family.Insurance has only partially covered treatment expenses,and the family has spent much of their savings to care for him.The patient's younger sister mentions she feels lost because her parents are so focused on her brother that it seems as though they have no time for her.The parents are concerned that when the siblings move out and they themselves become aged,there will be no one to care for the patient.Which response would be most helpful?

The nurse wishes to enroll a patient with poor social skills in a training program for patients with schizophrenia.Which description accurately describes how social skills training works?

A judge notices that many of the persons brought before her criminal court are mentally ill people who have committed minor offenses,are off their medications,and who probably offended because of their illness.She consults the nurse director of the local community mental health center for guidance about how to most helpfully respond when handling such cases.Which advice from the nurse would be most appropriate?

A man with severe mental illness dies suddenly at the age of 52.He had been living successfully in the community for 5 years without a hospitalization and worked for the past 6 months in the first job he had held for more than 20 years.His family is in shock,having been caught completely by surprise by his death,and asks why this has happened.Which of the following responses accurately reflects the research on mortality and serious mental illness and best addresses the family's question?

A patient with severe schizophrenia is seen at a community mental health center.Although he continues to attend programming at the center,he tells the nurse,"I threw away the pills because they keep me from hearing God." Which of the following responses would be most likely to benefit this patient?

A patient with schizophrenia,aged 60 years,spent 5 years in a state hospital before being discharged to a community residence.The patient requires persistent direction to accomplish daily activities of living,has difficulty determining what to do with his time,and is resistant to behaving independently,expecting others to provide meals or wash his clothes.The nurse assesses this passive behavior as being the probable result of:

The brother of a patient who is seriously mentally ill asks why the patient has been assigned a case manager.The nurse's reply should cite the major advantage of the use of case management as:

A man with schizophrenia states: "I will not take medicine-there is nothing wrong with me! Why would I take medicine when I'm not sick! They only put me here because they want to steal my thoughts so they can sell them." What is this patient demonstrating?

A seriously mentally ill patient who lives in a homeless shelter has a nursing diagnosis of Powerlessness.Which intervention would best address this nursing diagnosis?

A patient,aged 30 years,tells his case manager,"I do not have bipolar disorder anymore,so I do not need the medicine and the blood tests.I was in the hospital twice for a few days a year or so ago,then I got a place to live and SSI checks.All that is wrong now is I am bored and I need to get something going." The nurse assesses the patient as demonstrating:

A severely mentally ill man neglects to pay his rent and becomes homeless,so he sleeps in 24-hour laundromats and washes in public restrooms.His SSI checks are returned as undeliverable.Without money he cannot buy food,and as a result he steals a bag of chips,leading to incarceration.Which nursing diagnosis would most likely apply?

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there.Which interventions are likely to help achieve this goal? Select all that apply.