C HAPTER 32: S ERIOUS M ENTAL I LLNESS
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. A client diagnosed with a serious mental illness (SMI) died suddenl y at
age 52. The client lived in the community for 5 years without relapse and
held supported employment the past 6 months. The distressed famil y asks,
“How could this happen?” Which response by the nurse accuratel y reflects
research and addresses the famil y’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. “Mentall y ill people tend to die much younger than others, perhaps
because they do not take as good care of their health, 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 client had been doing so well and saw the
nurse every other week.”
ANS: B
The famil y is in distress. Because they do not understand his death,
they are less able to accept it and seek specific information to help
them understand what happened. Persons with SMI die an average of 25
years prematurel y. Contributing factors include failing t o provide for
their own health needs (e.g., forgetting to take medicine), inabilit y to
, access or pay for care, higher rates of smoking, poor diet, criminal
victimization, and stigma. The most accurate answer indicates that
seriousl y mentall y ill people are at much higher risk of premature
death for a variet y of reasons. Staff would not have been surprised that
the client died prematurel y, and they would not attribute his death to
random, undetected medical problems. Although the cause of death will
not be reliabl y established until the autopsy, this response fails to
address the famil y’s need for information.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Implementation MSC: Client
Needs: Physiological Integrit y
2. Many persons br ought before a criminal court have mental illness, have
committed minor offenses, and are non -medication adherent. The judge
consults the nurse at the local communit y mental health center for
guidance about how to respond when handling such cases. Which ad vice
from the nurse would be most appropriate?
a. “Sometimes a little time in jail makes a person rethink what they’ve
been doing and puts them back on the right track.”
b. “Sentencing such persons to participate in treatment instead of
incarcerating them has be en shown to reduce repeat offenses.”
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.”
ANS: B
, Research supports the use of special mental health courts that can
sentence mentall y ill persons to treatment instead of jail. Jail exposes
vulnerable mentall y ill persons to criminals, victimizat ion, and high
levels of stimulation and stress. Incarceration can also interrupt
eligibilit y for benefits or lead to the loss of housing and often provides
lower-qualit y mental health treatment in other settings. Recidivism
rates for both mentally ill and non-mentally ill offenders are relativel y
high, so it does not appear that incarceration necessaril y leads people
to behave more appropriatel y. In addition, a criminal record can leave
them more desperate and with fewer options after release. Research
indicates that outpatient commitment is less effective at improving the
mental health of mentall y ill persons than was expected.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Planning MSC: Client Needs:
Safe, Effective Care Envir onment
3. A nurse’s neighbor 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?” What is the nurse’s be st response?
a. “National Alliance on Mental Illness (NAMI) offers a famil y
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 i t’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?”
ANS: A
Halter: Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: A
Clinical Approach, 9th Edition
MULTIPLE CHOICE
1. A client diagnosed with a serious mental illness (SMI) died suddenl y at
age 52. The client lived in the community for 5 years without relapse and
held supported employment the past 6 months. The distressed famil y asks,
“How could this happen?” Which response by the nurse accuratel y reflects
research and addresses the famil y’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. “Mentall y ill people tend to die much younger than others, perhaps
because they do not take as good care of their health, 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 client had been doing so well and saw the
nurse every other week.”
ANS: B
The famil y is in distress. Because they do not understand his death,
they are less able to accept it and seek specific information to help
them understand what happened. Persons with SMI die an average of 25
years prematurel y. Contributing factors include failing t o provide for
their own health needs (e.g., forgetting to take medicine), inabilit y to
, access or pay for care, higher rates of smoking, poor diet, criminal
victimization, and stigma. The most accurate answer indicates that
seriousl y mentall y ill people are at much higher risk of premature
death for a variet y of reasons. Staff would not have been surprised that
the client died prematurel y, and they would not attribute his death to
random, undetected medical problems. Although the cause of death will
not be reliabl y established until the autopsy, this response fails to
address the famil y’s need for information.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Implementation MSC: Client
Needs: Physiological Integrit y
2. Many persons br ought before a criminal court have mental illness, have
committed minor offenses, and are non -medication adherent. The judge
consults the nurse at the local communit y mental health center for
guidance about how to respond when handling such cases. Which ad vice
from the nurse would be most appropriate?
a. “Sometimes a little time in jail makes a person rethink what they’ve
been doing and puts them back on the right track.”
b. “Sentencing such persons to participate in treatment instead of
incarcerating them has be en shown to reduce repeat offenses.”
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.”
ANS: B
, Research supports the use of special mental health courts that can
sentence mentall y ill persons to treatment instead of jail. Jail exposes
vulnerable mentall y ill persons to criminals, victimizat ion, and high
levels of stimulation and stress. Incarceration can also interrupt
eligibilit y for benefits or lead to the loss of housing and often provides
lower-qualit y mental health treatment in other settings. Recidivism
rates for both mentally ill and non-mentally ill offenders are relativel y
high, so it does not appear that incarceration necessaril y leads people
to behave more appropriatel y. In addition, a criminal record can leave
them more desperate and with fewer options after release. Research
indicates that outpatient commitment is less effective at improving the
mental health of mentall y ill persons than was expected.
PTS: 1 DIF: Cognitive Level: Appl y (Application)
TOP: Nursing Process: Planning MSC: Client Needs:
Safe, Effective Care Envir onment
3. A nurse’s neighbor 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?” What is the nurse’s be st response?
a. “National Alliance on Mental Illness (NAMI) offers a famil y
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 i t’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?”
ANS: A
