Community Mental Health Nursing

Multiple Choice

1. A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act?
1. Many perspective clients did not meet criteria for mental illness diagnostic-related groups.
2. Zoning laws discouraged the development of community mental health centers.
3. States could not match federal funds to establish community mental health centers.
4. There was not a sufficient employment pool to staff community mental health centers.

ANS: 3
Rationale: A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals.

Cognitive Level: Application
Integrated Process: Evaluation

2. A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care?
1. Teaching an adolescent about pregnancy prevention
2. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication
3. Teaching a client to cook meals, make a grocery list, and establish a budget
4. Teaching a client about his or her new diagnosis of bipolar disorder

ANS: 3
Rationale: The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

Cognitive Level: Application
Integrated Process: Implementation

3. A nursing instructor is teaching about case management. What student statement indicates that learning has occurred?
1. “Case management is a method used to achieve independent client care.”
2. “Case management provides coordination of services required to meet client needs.”
3. “Case management exists mainly to facilitate client admission to needed inpatient services.”
4. “Case management is a method to facilitate physician reimbursement.”

ANS: 2
Rationale: The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames.

Cognitive Level: Application
Integrated Process: Evaluation

4. A client at the mental health clinic tells the case manager, “I can’t think about living another day, but don’t tell anyone about the way I feel. I know you are obligated to protect my confidentiality.” Which case manager response is most appropriate?
1. “The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care.”
2. “Let’s discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk.”
3. “You seem to be preoccupied with self. You should concentrate on hope for the future.”
4. “This information is secure with me because of client confidentiality.”

ANS: 1
Rationale: The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the client’s care. This case manager’s priority is to ensure client safety and to inform others on the treatment team of the client’s suicidal ideation.

Cognitive Level: Application
Integrated Process: Implementation

5. When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention?
1. Teaching assertiveness skills in order to meet assessed needs
2. Supplying the couple with guidelines related to marital seminar leadership
3. Teaching the couple about various methods of birth control
4. Counseling the couple related to open and honest communication skills

ANS: 4
Rationale: Counseling the couple related to open and honest communication skills is a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

Cognitive Level: Application
Integrated Process: Implementation

6. A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of preventive care?
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
4. Primary intervention

ANS: 1
Rationale: Providing nursing education on drug abuse to a high school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population.

Cognitive Level: Application
Integrated Process: Implementation

7. A newly admitted homeless client diagnosed with schizophrenia states, “I have been living in a cardboard box for two weeks. Why did the government let me down?” Which is an appropriate nursing response?
1. “Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless.”
2. “Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia.”
3. “Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success.”
4. “Your discharge from the state hospital was based on presumed family support, and this was not forthcoming.”

ANS: 3
Rationale: The most accurate nursing response is to explain to the client that the resources were not available to make transitioning out of a state hospital a success. There are several factors that are thought to contribute to homelessness among the mentally ill: deinstitutionalization, poverty, lack of affordable housing, lack of affordable health care, domestic violence, and addiction disorders.

Cognitive Level: Application
Integrated Process: Implementation

8. An instructor is teaching nursing students about the difference between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization?
1. Partial hospitalization does not provide medication administration and monitoring.
2. Partial hospitalization does not use an interdisciplinary team.
3. Partial hospitalization does not offer a comprehensive treatment plan.
4. Partial hospitalization does not provide supervision 24 hours a day.

ANS: 4
Rationale: The instructor should explain that partial hospitalization does not provide supervision 24 hours a day. Partial hospitalization programs generally offer a comprehensive treatment plan formulated by an interdisciplinary team. They have proved to be an effective method of preventing hospitalization.

Cognitive Level: Application
Integrated Process: Evaluation

9. When a home health nurse administers an outpatient’s injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing?
1. Primary prevention level of care
2. Secondary prevention level of care
3. Tertiary prevention level of care
4. Case management level of care

ANS: 3
Rationale: When administering medication in an outpatient setting, the nurse is providing a tertiary prevention level of care. Tertiary prevention services are aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.

Cognitive Level: Application
Integrated Process: Implementation

10. A client diagnosed with schizophrenia is hospitalized owing to an exacerbation of psychosis related to non-adherence with antipsychotic medications. Which level of care does the client’s hospitalization reflect?
1. Primary prevention level of care
2. Secondary prevention level of care
3. Tertiary prevention level of care
4. Case management level of care

ANS: 2
Rationale: The client’s hospitalization reflects the secondary prevention level of care. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

Cognitive Level: Application
Integrated Process: Implementation

11. When attempting to provide health-care services to the homeless, what should be a realistic concern for a nurse?
1. Most individuals that are homeless reject help.
2. Most individuals that are homeless are suspicious of anyone who offers help.
3. Most individuals that are homeless are proud and will often refuse charity.
4. Most individuals that are homeless relocate frequently.

ANS: 4
Rationale: A realistic concern in the provision of health-care services to the homeless is that individuals who are homeless relocate frequently. Frequent relocation confounds service delivery and interferes with providers’ efforts to ensure appropriate care.

Cognitive Level: Application
Integrated Process: Planning

12. A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect?
1. Meningitis
2. Tuberculosis
3. Encephalopathy
4. Mononucleosis

ANS: 2
Rationale: The nurse should suspect that the homeless client has contracted tuberculosis. Tuberculosis is a growing problem among individuals who are homeless, owing to being in crowded shelters, which are ideal conditions for the spread of respiratory tuberculosis. Prevalence of alcoholism, drug addiction, HIV infection, and poor nutrition also impact the increase of contracted cases of tuberculosis.

Cognitive Level: Analysis
Integrated Process: Assessment

Multiple Response

13. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.)
1. An acutely suicidal teenager
2. A chronically mentally ill woman who has a history of medication non-adherence
3. A socially isolated older individual
4. A depressed individual who is able to contract for safety
5. A client who is hearing voices that tell the client to harm others

ANS: 2, 4
Rationale: The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication non-adherence and for a depressed individual who is able to contract for safety. Day programs (also called partial hospitalizations) are designed to prevent institutionalization or to ease the transition from inpatient hospitalization to community living.

Cognitive Level: Application
Integrated Process: Implementation

14. Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.)
1. PACT offers nationally based treatment to people with serious and persistent mental illnesses.
2. PACT is a type of case-management program.
3. The PACT team provides services 24 hours a day, 7 days a week, 365 days a year.
4. The PACT team provides highly individualized services directly to consumers.
5. PACT is a multidisciplinary team approach.

ANS: 2, 3, 4, 5
Rationale: NAMI defines PACT as a service-delivery model that provides comprehensive, locally, not nationally, based treatment to people with serious and persistent mental illnesses. PACT is a type of case-management program that provides highly individualized services directly to consumers. It is a team approach and includes members from psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. The PACT team provides these services 24 hours a day, 7 days a week, 365 days a year.

Cognitive Level: Application
Integrated Process: Assessment

15. Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.)
1. Schizophrenia
2. Body dysmorphic disorder
3. Antisocial personality disorder
4. Neurocognitive disorder
5. Conversion disorder

ANS: 1, 3, 4
Rationale: A number of studies have been conducted, primarily in large, urban areas, which have addressed the most common types of mental illness identified among homeless individuals. Schizophrenia is frequently described as the most common diagnosis. Other prevalent disorders include bipolar disorder, substance abuse and dependence, depression, personality disorders, and neurocognitive disorders.

Cognitive Level: Application
Integrated Process: Assessment

Ordered Response

16. Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan.
________ Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness
________ Services aimed at reducing the residual defects that are associated with severe and persistent mental illness
________ Services aimed at reducing the incidence of mental disorders within the population

ANS: The correct order is 2, 3, 1
Rationale: The premise of the model of public health is based largely on the concepts set forth by Gerald Caplan (1964) during the initial community mental health movement. They include primary prevention, secondary prevention, and tertiary prevention.
1. Primary prevention is aimed at reducing the incidence of mental disorders within the population.
2. Secondary prevention is aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness.
3. Tertiary prevention is aimed at providing services that reduce the residual defects that are associated with severe and persistent mental illness.

Cognitive Level: Analysis
Integrated Process: Planning

Fill-in-the-Blank

17. The ________________________ movement closed state mental hospitals and caused the discharge of individuals with mental illness.

ANS: deinstitutionalization
Rationale: The deinstitutionalization movement closed state mental hospitals and caused the discharge of individuals with mental illness. Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act (often called the Community Mental Health Centers Act) in 1963. This act called for the construction of comprehensive community health centers, the cost of which would be shared by federal and state governments. Unfortunately, many state governments did not have the capability to match the federal funds required for the establishment of these mental health centers.

Cognitive Level: Application
Integrated Process: Assessment