Chapter 32: Serious Mental Illness |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of a. side effects of antipsychotic medications. b. dependency caused by institutionalization. c. cognitive deterioration from schizophrenia. d. stress associated with acclimation to the community. ANS: B Institutions tend to impede independent functioning; for example, daily activities are planned and directed by staff; others provide meals and only at set times. Over time, patients become dependent on the institution to meet their needs and adapt to being cared for rather than caring for themselves. When these patients return to the community, many continue to demonstrate passive behaviors despite efforts to promote. Cognitive dysfunction and antipsychotic side effects can make planning and carrying out activities more difficult, but the question is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 32-3 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. An adult diagnosed with a serious mental illness (SMI) 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 a. rationalization. b. identification. c. anosognosia. d. projection. ANS: C The patient scenario describes anosognosia, the inability to recognize one‘s deficits due to one‘s illness. The patient is not projecting an undesirable thought or emotion from himself onto others. He is not justifying his behavior via rationalization and is not identifying with another. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 32-10, 19, 23, 37 (Box 32-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 3. Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI? a. Clubhouse model b. Cognitive-behavioral therapy (CBT) c. Assertive community treatment (ACT) d. Cognitive enhancement therapy (CET) ANS: C ACT involves consumers working with a multidisciplinary team that provides a comprehensive array of services. At least one member of the team is available 24 hours a day for crisis needs, and the emphasis is on treating the patient within his own environment. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 32-15, 16 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 4. 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 a. poor alliance with clinicians. b. inadequate discharge planning. c. dislike of medication side effects. d. thought disturbances associated with the illness.