Practice Quiz
The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which would the nurse identify as having a positive impact on the individual's mental health?
A. Not needing others for companionship
B.A family history of mental illness
C. The ability to effectively manage stress
D. Striving for total self-reliance
C. The ability to effectively manage stress
Rationale:
Individual factors influencing mental health include coping or stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness are both needed for good mental health, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologic makeup of an individual, which may have a negative impact on an individual's mental health. Total self-reliance is not possible, and striving to attain this is likely to lead to frustration and isolation.
The factor having the most influence on the current trend in treatment settings is the fact in recent years:
A.funding for community programs has been inadequate.
B.laws have enabled more people to be committed to treatment.
C.state hospitals have expanded to meet the demand.
D.community programs have been fully developed to meet treatment needs.
A.
funding for community programs has been inadequate.
Rationale: Funding has not kept pace with the need for community programs and treatment. Commitment laws have led to deinstitutionalization and fewer people receiving inpatient care. Large state hospitals emptied as a result. Treatment in the community was intended to replace much of state hospital inpatient care, but funding has been inadequate to achieve their full development.
A client made threats to harm the client's parents if they come too close to the client. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for what?
A.Confidentiality
B.Choice of providers
C.Right to freedom
D.Periodic treatment review
C.Right to freedom
Rationale: Civil commitment or involuntary hospitalization curtails the client's right to freedom (the ability to leave the hospital when he or she wishes). All other client rights, however, remain intact during an involuntary admission.
Sociocultural factors influencing mental health are those that include a person's biologic makeup, autonomy, independence, and self-esteem.
True or False
False
a safe refuge or haven offering protection at institutions where people had been whipped, beaten, and starved because they were mentally ill
asylum
What is important to know about active military or veterans when mental health is a concern
•There is a positive correlation between the number of deployments and the development of PTSD, anxiety disorders, bipolar disorder, and depression.
•In addition to the deinstitutionalization, federal legislation was passed to provide incomes for disabled persons
Supplemental Security Income (SSI) and Social Security Disability Income (SSDI).
hich is true regarding mental health and mental illness?
A.It is easy to determine if a person is mentally healthy or mentally ill.
B.In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
C.Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures.
D.Persons who engage in fantasies are mentally ill.
B. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability.
Rationale:
Mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Concepts of behavior that is acceptable and unacceptable vary widely between cultures. Consequently, mental health or illness can be difficult to discern. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness.
A client who has continuously experienced severe symptoms of schizoaffective disorder for the past 17 years is experiencing an acute psychotic episode. Which level of care is most appropriate for this client at this time?
A.Clubhouse
B.Partial hospitalization
C.Residential treatment
D.Inpatient hospital treatment
D. Inpatient hospital treatment
Rationale: Long-stay clients in an inpatient setting are people with severe and persistent mental illness who continue to require acute care services despite the current emphasis on decreased hospital stays. This client meets these criteria. Partial hospitalization is designed for patients transitioning to independent living. Residential treatment and the clubhouse model provide supervised independent living, which would be unsafe for a client whose symptoms are severe and persistent.
Which would be an example of circumstances in which a client could be subjected to involuntary hospitalization? Select all that apply.
A.When a client who has diabetes refuses to follow the prescribed diet.
B.When a client is unable to control his or her rage and is assaulting everyone around him or her.
C.When a client states that he or she intends to harm others by a deliberate act.
D.When a client does not bathe regularly or change clothes often.
E.When a client states that he or she intends to commit suicide and is making plans to do so.
B.When a client is unable to control his or her rage and is assaulting everyone around him or her.
C.When a client states that he or she intends to harm others by a deliberate act.
E.When a client states that he or she intends to commit suicide and is making plans to do so.
Rationale: Health care professionals respect the wishes of a client who does not choose to be hospitalized and treated unless clients are a danger to themselves or others (i.e., they are threatening or have attempted suicide or represent a danger to others). When a client does not bathe regularly or change clothes often, the client is neglecting his or her hygiene, but it is unlikely that this could be construed as an imminent risk of harm to self. When a client who has diabetes refuses to follow the prescribed diet, the client is acting within his or her own right to comply with the recommendations of the health care provider.
Anxiolytic medications target _______, the major inhibitory neurotransmitter in the brain.
GABA
taxonomy published by the American Psychiatric Association and revised as needed. The current edition made some major revisions and was released in 2013.
DSM-5
Rights of Clients and Legal Considerations
•Mental health patients retain all civil rights afforded to all people
•Except right to leave hospital in case of involuntary commitment.
Deinstitutionalization has lead to the “revolving door effect” meaning that
those being treated for mental illness have a shorter stay, they are often admitted more frequently
The nurse consults the DSM for what purpose?
A.To predict the client's prognosis of treatment outcomes
B.To serve as a guide for client assessment
C.To devise a plan of care for a newly admitted client
D.To document the appropriate diagnostic code in the client's medical record
B To serve as a guide for client assessment
Rationale: The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. The DSM does not provide coding for record-keeping or billing purposes.
A client with depression is admitted to an inpatient hospital unit for treatment. What type of therapy is most likely provided in this setting?
A.talk therapy.
B.leisure skills.
C.skills for daily living.
D.self-monitoring of treatment.
A.
talk therapy.
Rationale: A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between residents and staff, and milieu therapy, meaning the total environment and its effect on the client's treatment. Partial hospitalization programs teach skills for daily living. Clubhouse models provide patients opportunities for leisure activities and self-monitoring of treatment.
A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff?
A.Allowing the client to leave with community resources for follow-up care
B.Calling security and asking them to detain the client
C.Contacting the client's family to request they convince the client to stay
D.Contacting the psychiatrist for initiation of commitment proceedings
D.Contacting the psychiatrist for initiation of commitment proceedings
Rationale: If a voluntary client who is dangerous to himself or herself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take place to decide the matter. This would be a priority action because it ensures the client's safety. Security could not legally detain a client who is being treated voluntarily. Community resources would not be sufficient to ensure the client's safety, due to the imminent risk for suicide. Similarly, it would inappropriate for the care team to defer to the family because this does not ensure the client's safety if he or she does not wish to comply.
The _______ model is based on the principles of a person having a place to which they can come and return, and that offers meaningful work and relationships
clubhouse
describe the 13 areas of concern that mental health nurses focus on when caring for clients.
they also outline standards for professional performance, quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource utilization
Why would you involuntary hold a person
•Persons held without consent presenting with imminent danger to self or others
Two important mental health objectives for healthy people 2020
–Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral.
–Increase the proportion of adults with mental health disorders who receive treatment.
he goal of the 1963 Community Mental Health Centers Act was to:
A.treat people with mental illness in a humane fashion.
B.provide funds to build hospitals with psychiatric units.
C.deinstitutionalize state hospitals.
D.ensure clients' rights for the mentally ill.
C.
deinstitutionalize state hospitals.
Rationale: The 1963 Community Mental Health Centers Act initiated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of clients with mental illness from large state institutions to care based in the community. This Act did not focus on clients' rights, funding for inpatient treatment, or humane care.
Which is the priority for admission to inpatient care?
A.Withdrawal from alcohol or other drugs
B.Need for medication changes
C.Confusion or disorientation
D.Safety of self or others
D. Safety of self or others
Rationale: Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care, but the priority is safety.
Under which conditions would it be in the client's best interest for the court to appoint a conservator, or legal guardian? Select all that apply.
A.Mentally incompetent
B.Unable to provide basic needs when resources exist
C.Gravely disabled
D.Noncompliant
E.Act only on his or her own interests
A.Mentally incompetent
B.Unable to provide basic needs when resources exist
C.Gravely disabled
Rationale: The appointment of a conservator or legal guardian is a separate process from civil commitment. People who are gravely disabled; are found to be incompetent; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require appointment of a conservator. In these cases, the court appoints a person to act as a legal guardian who assumes many responsibilities for the person. An individual is not legally required to consider the interests of others; failing to do so would not provide grounds for legal guardianship. Similarly, noncompliance with treatment does not necessarily meet the criteria for appointment of a legal guardian.
______ is an unintentional tort that involves causing bodily harm by failing to do what a reasonable and prudent person would do under similar circumstances
negligence
inpatient hospital setting
•Client-centered multidisciplinary approach to brief stay
Legal guardianship would be put in place if a person had
•Grave disability
•Incompetency
•Inability to provide self with food, clothing, shelter
•Inability to act in own best interests
Two most important nursing considerations in mental health
•Symptom management
•Barriers to treatment
What is meant by the term "revolving door effect" in mental health care?
A.Most effective and least expensive treatment settings
B.An overall reduction in incidence of severe mental illness
C.Shorter and more frequent hospital stays for persons with severe and persistent mental illness
D.Flexible treatment settings for the mentally ill
C.
Shorter and more frequent hospital stays for persons with severe and persistent mental illness
Rationale: The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for the mentally ill. This phenomenon is known to be costly and inefficient. The revolving door effect does not relate to the incidence of severe mental illness; it is associated with the ongoing treatment of chronic illness.
Which is the priority inpatient care for people with severe mental illness?
A.Social skills
B.Insight into illness
C.Symptom management
D.Family issues
C.Symptom management
Rationale: Rapid assessment, stabilization of symptoms, and discharge planning are the focus of inpatient care today. Family issues, insight into illness, and social skills are important considerations but the management of the client's symptoms is prioritized because of its direct relationship with safety and recovery.
An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is:
A.inappropriate; room restriction is not treatment in the least restrictive environment.
B.appropriate; the adolescent should not have conflicts with others.
C.inappropriate; the adolescent should be offered a sedative before room restriction.
D.appropriate; room restriction is an effective behavior modification technique.
A.inappropriate; room restriction is not treatment in the least restrictive environment.
Rationale: Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. Verbal and behavioral techniques should be instituted before physical measures such as sedation, restraint, or seclusion
____ is a branch of philosophy that deals with the values of human conduct related to the rightness or wrongness of actions and to the goodness and badness of the motives and ends of these actions.
ethics
examples of residential outpatient
•Group homes
•Supervised apartments
•Board, care homes
•Adult foster care
•Crisis resolution/respite care
Goal of seclusion
•Goal: allow time for patient to regain control
Counselling role of the nurse includes
Which statement by the nurse to the client's family is true of treatment of people with mental illness in the United States today?
A.Substance abuse is effectively treated with brief hospitalization.
B.Emergency department visits by persons who are acutely disturbed are declining.
C.Financial resources are reallocated from state hospitals to community programs and support.
D.Only one in four people needing mental health services are receiving those services.
D.
Only one in four people needing mental health services are receiving those services
Rationale: Only one in four adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%.
The primary goal of a psychiatric rehabilitation program is to promote:
A.return to prior level of functioning.
B.quality of life.
C.medication compliance.
D.stabilization and management of symptoms.
B.quality of life.
Rationale: Psychiatric rehabilitation goes beyond management of symptoms and medication management to include personal growth, reintegration into the community, empowerment, increased independence, and improved quality of life. It is not a goal of psychiatric rehabilitation to return to the prior level of functioning that may have been dysfunctional. It may not be realistic for the client to completely recover from mental illness, but rehabilitation can improve the quality of life for the client.
The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller?
A."I cannot confirm or deny the existence of any client here."
B."The person you are asking for is not a client here."
C."You will need to be placed on the client's contact list before I can discuss any information with you."
D."Hold one minute while I get the client for you."
A."I cannot confirm or deny the existence of any client here."
Rationale: The protection and privacy of personal health information is regulated by the federal government through the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Protected health information is any individually identifiable health information in oral, written, or electronic form. Mental health and substance abuse records have additional special protection under the privacy rules. Requesting placement on the contact list or getting the client verifies the client's presence to the caller. Denying the client's presence affirms the client's existence whether present or not, which violates client privacy and confidentiality.
The _____ defense is used when there is argument that an individual accused of a crime is not guilty because of the inability to control actions or to understand the wrongfulness of an act.
insanity
examples of transitional care
•Peer support
•Bridging staff
Nursing liability prevention includes
•Accurately and thoroughly document all assessment data, treatments, interventions, and evaluations of client’s response to care.
Nurses role in milieu therapy
•Maintain therapeutic environment
•Teach skills
•Encourage communication
•Promote growth through role modeling
The case manager is providing an educational seminar for the nursing staff and includes objectives from Healthy People 2020. What is the priority objective for mental health?
A.Treatment of mental illness
B.Improved inpatient care
C.Primary prevention of emotional problems
D.Stress reduction and management
A.
Treatment of mental illness
Rationale: The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Improved inpatient care, primary prevention of emotional problems, and stress reduction and management are not priorities of Healthy People 2020.
client has just begun daily participation in a community-based partial hospitalization program. The client can expect the nurse and staff to assist with which treatment goals? Select all that apply.
A.Finding a better job
B.Improved family support
C.Stabilizing psychiatric symptoms
D.Learning about the illness
E.Improving activities of daily living
F.Developing social skills
C.Stabilizing psychiatric symptoms
D.Learning about the illness
E.Improving activities of daily living
F.Developing social skills
Rationale: Partial hospitalization programs are designed to help clients make a gradual transition from being inpatients to living independently and to prevent repeat admissions. In day treatment programs, clients return to home at night; evening programs are just the reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric symptoms, monitoring drug effectiveness, stabilizing living environment, improving activities of daily living, learning about the illness and how to identify symptoms, developing social skills, obtaining meaningful work in paid employment (or a volunteer position), and providing follow-up of any health concerns. Finding a better job and improving family support are not explicit goals of partial hospitalization programs, though these may be beneficial outcomes for some clients.
Which client situations urgently requires the nurse to break confidentiality and warn a third party?
A.A mother states, "Sometimes I feel like killing my kids!"
B.A jealous man states, "I am getting my gun and going to shoot my wife's lover!"
C.An abused woman states, "I have dreams that he is dead."
D.A paranoid woman states, "I'll get them before they get me."
B.A jealous man states, "I am getting my gun and going to shoot my wife's lover!"
Rationale: Mental health clinicians have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege. A person who states a specific intention to harm someone, such as stating that he is going to get his gun and go after a specific person, requires intervention because of the immediacy and specificity of the threat. Each of the other clients' statements expresses malice but not a specific, plausible plan for harm. The nurse should carefully address each statement but none would likely be grounds for breaking confidentiality.
_____ is a theory that says decisions should be based on whether or not an action is morally right, with no regard for the result or consequences
Deontology
What is the least restrictive environment
seclusion
exception to HIPPA
•Exception: Client reports intent to return and harm others upon discharge.
Goal of inpatient hospital setting
symptom stabilization
A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes ...
A.medical management of symptoms.
B.daily psychotherapy.
C.constant staff supervision.
D.psychological stabilization.
A.
medical management of symptoms
Rationale: Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting.
A client has been referred to a psychosocial rehabilitation program. When explaining the benefits of such a program, which information would the nurse include? Select all that apply.
A.Progress to recovery from mental illness
B.Continuous close monitoring of symptoms
C.Increased level of independence
D.Increased community integration
E.Greater opportunities for personal growth
F.Increased involvement in treatment decisions
A.Progress to recovery from mental illness
C.Increased level of independence
D.Increased community integration
E.Greater opportunities for personal growth
F.Increased involvement in treatment decisions
Rationale: Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Therapeutic activities or interventions are provided individually or in groups. They may include development and maintenance of daily and community-living skills, such as communication (basic language), vocational, self-care (grooming, bodily care, feeding), and social skills that help patients function in the community. Monitoring of symptoms is an important aspect of care but is not within the psychosocial rehabilitation domain.
A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although the client is not dangerous to the client or others, the client has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but the client consistently refuses "any drugs." The staff realizes that legally this client can ...
A.be coerced to accept treatment.
B.continue to refuse treatment.
C.have the client's family sign permission for treatment.
D.be committed by the client's family to receive needed treatment.
B.continue to refuse treatment.
Rationale: The client maintains the right to refuse treatment, even if it is needed, when the client is not dangerous to the self or others. If a client is able to give consent, she cannot be coerced into treatment, have the client's family sign permission for the client, or be committed by the family to receive treatment unless the client is a danger to the self or others.
_________ review firms developed a form of managed care to control the expenditure of insurance funds, requiring providers to seek approval before the delivery of care.
Utilization
what is evolving consumer household
group living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without on-site supervision from paid staff.
What is duty to warn
•exception to patient confidentiality
Patient reports intent to harm
Primary goals for partial hospitalization programs
Primary goal is to transition patients from inpatient treatment to independent living with the prevention of repeat admission.
Developing social skills
The nurse knows that mental health issues are constantly changing. Which is a standard of professional performance to keep in current practice?
A.Assessment
B.Implementation
C.Education
D.Planning
C.
Education
Rationale: Education is a standard of professional performance. Other standards of professional performance include the quality of practice, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Assessment, planning, and implementation are components of the nursing process, not standards of professional performance.
A.Progress to recovery from mental illness
C.Increased level of independence
D.Increased community integration
E.Greater opportunities for personal growth
F.Increased involvement in treatment decisions
Rationale: Goals of psychosocial rehabilitation programs include recovery from mental illness, personal growth, quality of life, community reintegration, empowerment, increased independence, decreased hospital admissions, improved social functioning, improved vocational functioning, continuous treatment, increased involvement in treatment decisions, improved physical health, and a recovered sense of self. Therapeutic activities or interventions are provided individually or in groups. They may include development and maintenance of daily and community-living skills, such as communication (basic language), vocational, self-care (grooming, bodily care, feeding), and social skills that help patients function in the community. Monitoring of symptoms is an important aspect of care but is not within the psychosocial rehabilitation domain.
A.Clubhouse model
Rationale: The clubhouse model is based on four guaranteed rights of its members, which are: a place to come to, meaningful work, meaningful relationships, and a place to return to (lifetime membership). Assertiveness community treatment has a problem-solving orientation, and staff members who are in the community attend to specific life issues of the client. Group homes are a residential form of treatment for mental illness but do not provide complete psychiatric rehabilitation. Respite housing is temporary housing for mentally ill persons and does not provide complete psychiatric rehabilitation.
Two nurses are discussing the rights of hospitalized psychiatric clients. Which statement is an error?
A.If a committed client is also found to be incompetent, the client loses the client's rights under the Patient's Bill of Rights.
B.Confidentiality allows for the disclosure of information under specific circumstances.
C.Clients can never be held against their will.
D.Privileged communication does not apply to medical records, and it can be used in court.
A.If a committed client is also found to be incompetent, the client loses the client's rights under the Patient's Bill of Rights.
Rationale: Being committed and/or incompetent does not negate the Patient's Bill of Rights. Confidentiality does allow for the disclosure of information under specific circumstances, such as to another health care provider who has a need to know, if the client specifically consents that information be shared with persons of his or her choice, or if the client threatens to harm others. Privileged communication relates to the privacy of what was discussed during therapy sessions and this can be documented in medical records and used in courts. Clients may be held against their will if they are committed to a facility for psychiatric care until they no longer pose a danger to themselves or to anyone else.
_________ management involves the use of an individual who coordinates and manages all of the care required by a client.
case
refers to the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors, at a rate four times that of the general population in an effort to contain them in some type of institution where they might receive needed treatment
criminalization of mental illness
Self-awareness includes
•Be aware of personal feelings to prevent incongruency in the care you provide
Goal for residential and transitional care
•Goal: gradual transition from inpatient to independent living.
A client with schizophrenia has been noncompliant with medications. The client requires frequent admissions to the psychiatric unit for acute psychotic episodes. What is this process called?
A.Revolving door
B.Boarding
C.Deinstitutionalization
D.Escalated admissions
A.
Revolving door
Rationale: The revolving door effect is a result of deinstitutionalization; clients are admitted more frequently for shorter stays. Boarding is when clients are kept in the emergency department until the crisis resolves or an inpatient bed is found. Admissions are usually not escalated but are recurrent.
the nurse wants the client to have some face-to-face interaction in the client's home or community. Assertive Community Treatment (ACT) is a program that can attend to the client's needs. What does this program include?
A.Provides a problem-solving orientation
B.Offers services in offices
C.Makes a wide range of referrals
D.Sets limits on mundane life issues
A. Provides a problem-solving orientation
Rationale: An ACT program has a problem-solving orientation: Staff members attend to specific life issues, no matter how mundane. ACT programs provide most services directly rather than relying on referrals to other programs or agencies, and they implement the services in the clients' homes or communities, not in offices.
When is a nurse legally obligated to breach confidentiality?
A.If threats are made to an identifiable third party.
B.When the client violates the nurse's boundaries.
C.At any time a client is threatening.
D.Whenever the client becomes aggressive.
A.If threats are made to an identifiable third party.
Rationale: The duty to warn a third party exists when a client threatens harm to that identifiable third party. Then the client's confidentiality is overridden. The seriousness, specificity and plausibility of the threat must be considered; not every threatening statement by a mental health client justifies a breach of confidentiality. Aggression and violations of boundaries must be addressed by the nurse but these actions do not meet the legal criteria for breach in confidentiality.
____ drugs are those that are used to change brain function and result in alteration in perception, mood or consciousness
psychotropic
refers to one’s duty to benefit or to promote the good of others
beneficence
The nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances.
breach of duty
Goals for rehab programs
•Reintegration into community
•Empowerment, increased independence
Which factor is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present?
A.Progress in treatment options for mentally ill persons
B.The growth of managed care
C.The current use of milieu therapy
D.Less stigma associated with mental illness
B.
The growth of managed care
Rationale: Managed care exerts cost-control measures such as recertification of admissions, utilization review, and case management—all of which have altered inpatient treatment significantly. There has been some progress in treatment options for mentally ill persons, but this has had a lesser effect on mental health inpatient hospital care than the growth of managed care. There is decreasing stigma associated with mental illness, but that is not the primary factor that has changed mental health inpatient hospital care. Milieu therapy is a long-established aspect of care and has not brought about major changes in inpatient care over the past several decades.
A nurse is meeting with the city council to advocate for mentally ill persons and the establishment of a group home in a neighborhood where the plans have been strongly opposed by the neighbors. The nurse can effectively educate the public on the realities of a group home by citing research that indicates:
A.neighborhoods that provide park areas provide children a centralized and safe place to play.
B.police surveillance will be increased to avert any violence by residents.
C.property values quickly rebound in neighborhoods that have group homes.
D.most people with mental illness do not represent a significant danger to others.
D.most people with mental illness do not represent a significant danger to others.
Rationale: Frequently, residents oppose plans to establish a group home in their neighborhood, arguing that having a group home will create a safety risk. This is not proven to be the case and the nurse should counter this misconception. Property values have not been shown to fall and there is no need for police surveillance. The availability of parks is not relevant to the establishment of a group home.
A nurse reviews a client's history and knows that in preparation for discharge planning of the client, success of planning can be impeded by which of the following? Select all that apply.
A.violent or criminal behaviors
B.alcohol and drug abuse
C.evolving community
D.inability to secure employment
E.medication non-compliance
A.violent or criminal behaviors
B.alcohol and drug abuse
E.medication non-compliance
Rationale: Adequate discharge planning is a good indicator of how successful the client's community placement will be. Impediments to successful discharge planning include alcohol and drug abuse, criminal or violent behavior, noncompliance with medications, and suicidal ideation. Employment and integration into the community are protective, not impeding, factors.
Which of the following are criteria for instituting the short-term use of restraint or seclusion? Select all that apply.
A.The client is being punished.
B.The client is physically and emotionally self-controlled.
C.The client is aggressive.
D.The client is imminently dangerous to the self or to others.
E.All other means of calming the client have been unsuccessful.
C.The client is aggressive.
D.The client is imminently dangerous to the self or to others.
E.All other means of calming the client have been unsuccessful.
Rationale: Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and dangerous to himself or herself or to others and all other means of calming the client have been unsuccessful. The nurse must frequently contact the client and reassure the client that restraint is a restorative, not a punitive, procedure. If the client is physically and emotionally self-controlled, there is no reason for the client to be restrained or secluded.
__ is a deliberate shift from institutional care to community facilities
deinstitutionalize
The breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner.
causation
is a situation in which ethical principles conflict or when there is no one clear course of action in a given situation
ethical delemma
Four guaranteed rights of members in the club house model
•A place to come to
•Meaningful work
•Meaningful relationships
A place to return to
The client feels that the client's rights have been violated. Placing a client in restraints before using other methods of intervention violates which of the client's rights?
A.Receive treatment in the least restrictive environment
B.Be treated in a timely manner
C.Receive confidential and respectful care
D.Provide informed consent
A.Receive treatment in the least restrictive environment
Rationale: The least restrictive environment means that the client must be free of restraint or seclusion unless it is necessary. Less restrictive treatments must be tried and found to be ineffective before more restrictive measures, such as restraints, can be used. It is not necessary for the client to provide informed consent for restraints to be used when appropriate. Premature use of restraints does not violate principles of informed consent. Confidentiality involves the protection of private information, not restriction of mobility. Restraints would violate the client's autonomy, not the timeliness of treatment.
A.Receive treatment in the least restrictive environment
Rationale: The least restrictive environment means that the client must be free of restraint or seclusion unless it is necessary. Less restrictive treatments must be tried and found to be ineffective before more restrictive measures, such as restraints, can be used. It is not necessary for the client to provide informed consent for restraints to be used when appropriate. Premature use of restraints does not violate principles of informed consent. Confidentiality involves the protection of private information, not restriction of mobility. Restraints would violate the client's autonomy, not the timeliness of treatment.
C.The nurse did not breach duty.
Rationale: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client. The nurse did not breach this duty by the nursing actions and in fact maintained the client's safety, which is the nurse's highest duty. The client did experience loss of autonomy from being restrained but this is legally justifiable if the client's safety was jeopardized if not restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.
C.The nurse did not breach duty.
Rationale: For a malpractice suit to be successful, the client or family needs to prove the following four elements: (1) Duty: a legally recognized relationship (i.e., physician to client, nurse to client) existed. The nurse had a duty to the client, meaning that the nurse was acting in the capacity of a nurse. (2) Breach of duty: the nurse (or physician) failed to conform to standards of care, thereby breaching or failing the existing duty. The nurse did not act as a reasonable, prudent nurse would have acted in similar circumstances. (3) Injury or damage: the client suffered some type of loss, damage, or injury. (4) Causation: the breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse had acted in a reasonable, prudent manner. The nurse did have a duty to the client. The nurse did not breach this duty by the nursing actions and in fact maintained the client's safety, which is the nurse's highest duty. The client did experience loss of autonomy from being restrained but this is legally justifiable if the client's safety was jeopardized if not restrained. Since there was no breach of duty, there was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.
C.no documentation of benefits of treatment or treatment options
Rationale: A client has the right to be informed of the benefits of treatment and treatment options. Inspecting client belongings is performed as a safety measure. Clients have the right to a safe environment. Clients have the right to be protected against the possible impulse to harm oneself that occurs as a result of a mental disorder and to be monitored 1:1.
Marx, Test, and Stein (1973) developed the concept of ______ community treatment programs that provide intense, problem-solving–oriented approaches to community-based treatment for those with mental illnesses.
assertive
is the requirement to do no harm to others either intentionally or unintentionally
Nonmaleficence
is the requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital into the community.
mandatory outpatient treatment
ACT is?
•Direct provision of service rather than referral
One of most effective approaches for treatment of persons with mental illness. Developed in Madison Wisconsin in 1973.