Chapter 31: Serious Mental Illness

Chapter 31: Serious Mental Illness

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. After 5 years in a state 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 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 585        TOP:   Nursing Process: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

2. 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:

a.	rationalization.	c.	anosognosia.
b.	identification.	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:   Page 588        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 serious mental illness?

a.	Clubhouse model
b.	Cognitive Behavioral Therapy (CBT)
c.	Assertive Community Treatment (ACT)
d.	Cognitive Enhancement Therapy (CET)

 

 

ANS:  C

Assertive community treatment (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:   Page 590-591                                  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.	lack of insight associated with the illness.

 

 

ANS:  D

The patient’s nonadherence is most closely related to lack of insight into his illness. The patient believes he is an exalted personage who hears God’s voice rather than an individual with a serious mental disorder who needs medication to control his symptoms. While the distracters may play a part in the patient’s nonadherence, the correct response is most likely.

 

PTS:   1                    DIF:    Cognitive Level: Analyze (Analysis)

REF:   Page 588        TOP:   Nursing Process: Assessment

MSC:   Client Needs: Psychosocial Integrity