Deck 29: Living With Recurrent and Persistent Mental Illness

Question 1

Many people brought before a criminal court have mental illness, have committed minor offences, and are off medications. The judge consults the nurse at the local community mental health centre for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate?

A) "Sometimes a little time in jail makes people rethink what they've been doing and puts them back on the right track."
B) "Sentencing such people to participate in treatment instead of incarcerating them has been shown to reduce repeat offences."
C) "Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication."
D) "Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help."

Answer 1

"Sentencing such people to participate in treatment instead of incarcerating them has been shown to reduce repeat offences."

Question 2

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the etiology of the patient's ineffective management of the medication regime as which of the following?

A) Inadequate discharge planning
B) Poor therapeutic alliance with clinicians
C) Dislike of antipsychotic medication side effects
D) Lack of insight secondary to the schizophrenia

Answer 2

Lack of insight secondary to the schizophrenia

Question 3

A patient diagnosed with a serious mental illness died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question?

A) "A certain number of people die young from undetected diseases, and it's just one of those sad things that sometimes happen."
B) "Mentally ill people tend to die much younger than others, perhaps because they struggle to maintain their health, often smoke more, or are overweight."
C) "We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death."
D) "We are all surprised. The patient had been doing so well and saw the nurse every other week."

Answer 3

"Mentally ill people tend to die much younger than others, perhaps because they struggle to maintain their health, often smoke more, or are overweight."

Question 4

The sibling of a patient diagnosed with a serious mental illness asks why a case manager has been assigned. The nurse's reply should cite which of the following as the major advantage of the use of case management?

A) "The case manager can modify traditional psychotherapy for patients so that it is more flexible."
B) "Case managers coordinate services and help with accessing them, making sure the patient's needs are met."
C) "The case manager can focus on social skills training and esteem building in the real world where the patient lives."
D) "Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money."

Question 5

A nurse's neighbour says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" Select the nurse's best response.

A) "The Schizophrenia Society of Canada offers a family education series that you might find helpful."
B) "Since your sister is noncompliant, perhaps it's time for her to be changed to injectable medication."
C) "You have done all you can. Now it's time to put yourself first and move on with your life."
D) "You cannot help her. Would it be better for you to discontinue your relationship?"

Question 6

A homeless patient diagnosed with a serious mental illness became suspicious and delusional. Depot antipsychotic medication began, and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement?

A) "They will not let me drink. They have many rules in the shelter."
B) "I take the bus each week to buy my own groceries."
C) "Those shots make my arm very sore."
D) "Those people watch me a lot."

Question 7

Serious mental illness is characterized as which of the following?

A) Any mental illness of more than 2 weeks' duration
B) A major long-term mental illness marked by significant functional impairments
C) A mental illness accompanied by physical impairment and severe social problems
D) A major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities

Question 8

Which service would be expected to provide resources 24 hours a day, 7 days a week, if needed, for persons with serious mental illness?

A) Clubhouse model
B) Cognitive Behavioural Therapy (CBT)
C) Assertive Community Treatment (ACT)
D) Cognitive Enhancement Therapy (CET)

Question 9

A person diagnosed with a serious mental illness enters a shelter for the homeless. Which intervention should be the nurse's initial priority?

A) Find supported employment.
B) Develop a therapeutic alliance.
C) Administer prescribed medication.
D) Teach appropriate health care practices.

Question 10

A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action.

A) Involve the patient's case manager to provide crisis intervention.
B) Send the patient to a homeless shelter until housing can be arranged.
C) Arrange for a short inpatient admission and begin discharge planning.
D) Explain that one must have active psychiatric symptoms to be admitted.

Question 11

An outpatient diagnosed with schizophrenia attends programming at a community mental health centre. The patient says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely benefit this patient?

A) "You need your medicine. Your schizophrenia will get worse without it."
B) "Do you want to be hospitalized again? You must take your medication."
C) "I would like you to come to the medication education group every Thursday."
D) "I noticed that when you take the medicine, you have been able to hold the job you wanted."

Question 12

An outpatient diagnosed with schizophrenia 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 which of the following?

A) Poor alliance with clinicians
B) Inadequate discharge planning
C) Dislike of medication adverse effects
D) Lack of insight associated with the illness

Question 13

Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness who is homeless?

A) Insomnia
B) Substance abuse
C) Chronic low self-esteem
D) Impaired environmental interpretation syndrome

Question 14

An adult diagnosed with a serious mental illness says, "I do not need help with money management. I have excellent ideas about investments." This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating which of the following?

A) Rationalization
B) Identification
C) Anosognosia
D) Projection

Question 15

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

A) Teach appropriate health maintenance and prevention practices.
B) Educate the patient about the importance of treatment adherence.
C) Help the patient obtain employment in a local sheltered workshop.
D) Interact regularly and supportively without trying to change the patient.

Question 16

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

A) Patients learn to improve their attention and concentration.
B) Group leaders provide support without challenging patients to change.
C) Complex interpersonal skills are taught by breaking them into simpler behaviours.
D) Patients learn social skills by practising them in a supported employment setting.

Question 17

A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health centre, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community?

A) Administer a second-generation antipsychotic to help negative symptoms.
B) Use a quick-dissolving medication formulation to reduce "cheeking."
C) Prescribe a long-acting intramuscular antipsychotic medication.
D) Involve the patient in decisions about which medication is best.

Question 18

A family discusses the impact of having a seriously mentally ill member. Insurance partially covered treatment expenses, but the family spent much of their savings for care. The patient's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful?

A) Acknowledge their concerns and consult with the treatment team about ways to bring the patient's symptoms under better control.
B) Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.
C) Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families.
D) Educate the family about caregiver burden and ways to help the patient become more independent.

Question 19

A patient living independently had command hallucinations to shout warnings to neighbours. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the patient experiencing?

A) Grief
B) Stigma
C) Homelessness
D) Nonadherence

Question 20

After 5 years in a psychiatric hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires persistent direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behaviour as the probable result of which of the following?

A) Side effects of antipsychotic medications
B) Dependency caused by institutionalization
C) Cognitive deterioration from schizophrenia
D) Stress associated with acclimation to the community

Question 21

For patients diagnosed with serious mental illness, what is the major advantage of case management?

A) The case manager can modify traditional psychotherapy.
B) With one coordinator of services, resources can be more efficiently used.
C) The case manager can focus on social skills training and esteem building.
D) Case managers bring groups of patients together to discuss common problems.

Question 22

An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability cheques. Now I'm bored and don't have any friends." Where should the nurse refer the patient?

A) Psychoeducational classes
B) Vocational rehabilitation
C) Social skills training
D) A homeless shelter
E) Crisis intervention

Question 23

A consumer at a rehabilitative psychosocial program says to the nurse, "People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered." How should the nurse respond?

A) Encourage the consumer to discuss it at a meeting with everyone.
B) Hire a professional cleaning service to clean the restrooms.
C) Address the complaint at the next staff meeting.
D) Tell the consumer, "That's not my problem."

Question 24

The parent of a seriously mentally ill adult asks the nurse, "Why are you making a referral to a vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

A) "We make this referral to continue eligibility for federal funding."
B) "Are you concerned that we're trying to make your child too independent?"
C) "If you think the program would be detrimental, we can postpone it for a time."
D) "Most patients are capable of employment at some level, competitive or supported."

Question 25

Which statements most clearly indicate that the speaker views mental illness with stigma?

A) "We are all a little bit crazy."
B) "If people with mental illness would go to church, their problems would be solved."
C) "Many mental illnesses are genetically transmitted. It's no one's fault that the illness occurs."
D) "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people."
E) "People with mental illness are lazy. They get government disability cheques instead of working."

Question 26

A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health centre. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse?

A) Discourage potentially stressful activities such as groups or volunteer work.
B) Develop plans that will help the patient remember what to do in a crisis.
C) Help the patient identify and anticipate events that are likely to be overwhelming.
D) Encourage health-promoting activities such as exercise and getting adequate rest.
E) Accompany the patient to a support group meeting.