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Test Bank Varcarolis Foundations of Psychiatric Mental Health Nursing, 7th Edition Margaret Jordan Halter

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Chapter 04: Settings for Psychiatric Care

MULTIPLE CHOICE

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

ANS: A
Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Page 74-75 TOP: Nursing Process: Assessment
MSC: Client Needs: Safe, Effective Care Environment

2. A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager’s most appropriate action.
a. Postpone the patient’s discharge from the hospital.
b. Contact the landlord who evicted the patient to further discuss the situation.
c. Arrange a temporary place for the patient to stay until new housing can be arranged.
d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.

ANS: C
The case manager should intervene by arranging temporary shelter for the patient until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 69-72 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment

3. Select the example of tertiary prevention.
a. Helping a person diagnosed with a serious mental illness learn to manage money
b. Restraining an agitated patient who has become aggressive and assaultive
c. Teaching school-age children about the dangers of drugs and alcohol
d. Genetic counseling with a young couple expecting their first child

ANS: A
Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 70 TOP: Nursing Process: Implementation
MSC: Client Needs: Health Promotion and Maintenance

4. A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance 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:
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.

ANS: C
Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 73-76 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment

5. 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:
a. coordinating care of patients.
b. management of milieu safety.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.

ANS: B
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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Page 75-77 TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment

6. The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient:
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 haloperidol (Haldol).
d. who is a new parent and hears voices saying, “Smother your baby.”

ANS: D
Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 74-75 TOP: Nursing Process: Assessment
MSC: Client Needs: Safe, Effective Care Environment

7. A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initial action.
a. Explore ways to help the patient stop smoking.
b. Report the situation to the manager of the shelter.
c. Assess the patient’s weight; determine foods and amounts eaten.
d. Arrange hospitalization for the patient in order to formulate a new treatment plan.

ANS: C
Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 69-70 TOP: Nursing Process: Assessment
MSC: Client Needs: Physiological Integrity

8. A nurse surveys medical records. Which finding signals a violation of patients’ rights?
a. A patient was not allowed to have visitors.
b. A patient’s belongings were searched at admission.
c. A patient with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a patient was assaultive toward a staff member.

ANS: A
The patient has the right to have visitors. Inspecting patients’ belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 74-76 (Box 4-3) TOP: Nursing Process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment

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

ANS: A
The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient’s legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.

PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: Page 74-76 (Box 4-3) TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment

10. Clinical pathways are used in managed care settings to:
a. stabilize aggressive patients.
b. identify obstacles to effective care.
c. relieve nurses of planning responsibilities.
d. streamline the care process and reduce costs.

ANS: D
Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: Page 75-76 TOP: Nursing Process: Implementation
MSC: Client Needs: Safe, Effective Care Environment

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