Question 1

Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room?

Accepted Answer

A)   Kindness
B)   Autonomy
C)   Compassion
D)   Professionalism B

Question 2

A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to

Accepted Answer

A)   coordinating care of patients.
B)   management of milieu safety.
C)   management of the interpersonal climate.
D)   use of therapeutic intervention strategies. B

Question 3

A nurse receives these three phone calls regarding a newly admitted patient. · The psychiatrist wants to complete an initial assessment.
· An internist wants to perform a physical examination.
· The patient's attorney wants an appointment with the patient.
The nurse schedules the activities for the patient. Which role has the nurse fulfilled?

Accepted Answer

A)   Advocate
B)   Case manager
C)   Milieu manager
D)   Provider of care B

Question 4

Which statements most clearly reflect the stigma of mental illness? (Select all that apply.)

Accepted Answer

A)   "Many mental illnesses are hereditary."
B)   "Mental illness can be evidence of a brain disorder."
C)   "People claim mental illness so they can get disability checks."
D)   "Mental illness results from the breakdown of American families."
E)   "If people with mental illness went to church, their symptoms would disappear."

Question 5

A health care provider prescribed long acting antipsychotic medication injections every 3 weeks at the clinic for a patient with a history of medication nonadherence. For this plan to be successful, which factor will be of critical importance?

Accepted Answer

A)   The attitude of significant others toward the patient
B)   Nutrition services in the patient's neighborhood
C)   The level of trust between the patient and nurse
D)   The availability of transportation to the clinic

Question 6

The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient

Accepted Answer

A)   feeling anxiety and a sad mood after separation from a spouse of 10 years.
B)   who self-inflicted a superficial cut on the forearm after a family argument.
C)   experiencing dry mouth and tremor related to taking antipsychotic medication.
D)   who is a new parent and hears voices saying, "Smother your baby."

Question 7

A nurse can best address factors of critical importance to successful community treatment by including making assessments relative to (Select all that apply)

Accepted Answer

A)   housing adequacy.
B)   family and support systems.
C)   income adequacy and stability.
D)   early psychosocial development.
E)   substance abuse history and current use.

Question 8

The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient's projected length of stay. How should the nurse instruct the unit secretary to handle the request?

Accepted Answer

A)   Obtain the information from the patient's medical record and relay it to the caller.
B)   Inform the caller that all information about patients is confidential.
C)   Refer the request for information to the patient's case manager.
D)   Refer the request to the health care provider.

Question 9

Inpatient hospitalization for persons with mental illness is generally reserved for patients who

Accepted Answer

A)   present a clear danger to self or others.
B)   are noncompliant with medication at home.
C)   have limited support systems in the community.
D)   develop new symptoms during the course of an illness.

Question 10

A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient's spouse calls the nurse to report the patient has not taken prescribed medication and is having disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a refill. Select the best outcome to add to the plan of care.

Accepted Answer

A)   The patient's spouse will mark dates for prescription refills on the family calendar.
B)   The nurse will obtain prescription refills every 90 days and deliver to the patient.
C)   The patient will call the nurse weekly to discuss medication-related issues.
D)   The patient will report to the clinic for medication follow-up every week.

Question 11

The nurse assigned to ACT should explain the program's treatment goal as

Accepted Answer

A)   assisting patients to maintain abstinence from alcohol and other substances of abuse.
B)   providing structure and a therapeutic milieu for mentally ill patients whose symptoms require stabilization.
C)   maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness.
D)   providing services for mentally ill individuals who require intensive treatment to continue to live in the community.

Question 12

Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient?

Accepted Answer

A)   Hygiene assistance
B)   Diversional activities
C)   Assistance with job hunting
D)   Building assertiveness skills

Question 13

Which assessment finding for a patient diagnosed with serious and persistent mental illness and living in the community merits priority intervention by the psychiatric nurse? The patient

Accepted Answer

A)   receives social security disability income plus a small check from a trust fund every month.
B)   was absent from two of six planned Alcoholics Anonymous meetings in the past 2 weeks.
C)   lives in an apartment with two patients who attend partial hospitalization programs.
D)   has a sibling who was recently diagnosed with a mental illness.

Question 14

Clinical pathways are used in managed care settings to

Accepted Answer

A)   stabilize aggressive patients.
B)   identify obstacles to effective care.
C)   relieve nurses of planning responsibilities.
D)   streamline the care process and reduce costs.

Question 15

A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient's thoughts are now more organized and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." The nurse should

Accepted Answer

A)   ask the case manager to arrange a transfer to a long-term care facility.
B)   notify hospital security to handle the disturbance and escort the family off the unit.
C)   explain that the patient will continue to improve if the medication is taken regularly.
D)   contact the health care provider to meet with the family and explain the discharge rationale.

Question 16

Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?

Accepted Answer

A)   Resolve the crisis with the least restrictive intervention possible.
B)   Swift intervention is justified to maintain the integrity of a therapeutic milieu.
C)   Rights of an individual patient are superseded by the rights of the majority of patients.
D)   Patients should have opportunities to regain control without intervention if the safety of others is not compromised.

Question 17

The nurse should refer which of the following patients to a partial hospitalization program? A patient who

Accepted Answer

A)   has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
B)   needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
C)   spent yesterday in a supervised crisis care center and continues to have active suicidal ideation.
D)   states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

Question 18

After a Category 5 tornado hits a community and destroys many homes and businesses, a community mental health nurse encourages victims to describe their memories and feelings about the event. This action by the nurse best demonstrates

Accepted Answer

A)   triage.
B)   primary prevention.
C)   psychosocial rehabilitation.
D)   psychiatric case management.

Question 19

The case manager plans to discuss the treatment plan with a patient's family. Select the case manager's first action.

Accepted Answer

A)   Determine an appropriate location for the conference.
B)   Support the discussion with examples of the patient's behavior.
C)   Obtain the patient's permission for the exchange of information.
D)   Determine which family members should participate in the conference.

Question 20

Which scenario best depicts a behavioral crisis? A patient is

Accepted Answer

A)   waving fists, cursing, and shouting threats at a nurse.
B)   curled up in a corner of the bathroom, wrapped in a towel.
C)   crying hysterically after receiving a phone call from a family member.
D)   performing push-ups in the middle of the hall, forcing others to walk around.

Exam 4: Treatment Settings