Advanced Psychiatric Mental Health Care of Adults and Older Adults (D346)

Correct Answer

A. Less restrictive settings are available now to care for individuals with mental illness.

Explanation

The primary reason that individuals with mental illness are no longer kept in state institutions is the development of less restrictive settings, such as community-based care and outpatient services. These alternatives provide a more supportive environment for individuals to receive treatment while living in their communities, promoting recovery and integration into society. This approach aligns with the principle of deinstitutionalization, which aims to reduce reliance on large institutions.

Why other options are wrong

B. There are fewer persons with mental illness, so less hospital beds are needed.

This is not accurate. While the prevalence of mental illness has remained relatively consistent, the shift away from institutional care is due to a change in treatment philosophy and the availability of community-based services, not a decrease in the number of individuals with mental illness.

C. Most people with mental illness are still in psychiatric institutions.

This is incorrect. Most people with mental illness today are treated in community settings or outpatient facilities, not in large psychiatric institutions. The trend has been toward less restrictive care environments.

D. Psychiatric institutions violated patients' rights.

While there were instances of abuse and mistreatment in psychiatric institutions, this response does not fully capture the reason for the shift. The main reason for moving away from institutional care is the availability of better community-based alternatives that offer more effective and humane care.

Correct Answer

B. To manage withdrawal from substances

Explanation

Detoxification in psychiatric nursing primarily focuses on safely managing the withdrawal symptoms that occur when a person stops using a substance, such as drugs or alcohol. It involves medically supervised care to ensure that the individual undergoes the detoxification process in a safe and controlled environment. This helps to minimize risks, alleviate withdrawal symptoms, and prevent complications associated with substance withdrawal, paving the way for further treatment of mental health disorders.

Why other options are wrong

A. To provide therapy for mental health disorders

Detoxification is not aimed at providing therapy for mental health disorders, but rather at managing physical withdrawal symptoms. While it is a step in the treatment process, it is not intended to address psychological or therapeutic needs, which are handled separately through therapy and counseling after detoxification is complete.

C. To conduct psychiatric evaluations

Psychiatric evaluations are typically performed to assess the mental health condition of a patient, not as part of the detoxification process. While evaluations are important in determining the overall care plan, detoxification focuses on the physical aspects of substance withdrawal rather than on conducting psychiatric assessments.

D. To prescribe medication for mental health issues

Detoxification is not specifically aimed at prescribing medication for mental health issues. The primary goal of detoxification is to manage withdrawal symptoms. Medication for mental health conditions may be prescribed after detoxification, but it is not the focus of the detox process itself

Correct Answer

B. Being sensitive to patients' and families' needs

Explanation

Building a therapeutic relationship in psychiatric nursing requires sensitivity to the individual needs of both patients and their families. A key component of this approach is establishing trust, showing empathy, and engaging in active listening. Nurses who are sensitive to these needs can help alleviate anxiety, encourage open communication, and promote collaboration in treatment planning, which ultimately leads to more effective care and better outcomes for the patient.

Why other options are wrong

A. Providing medication immediately

While medication may be an essential part of treatment, providing medication immediately is not the core method for building a therapeutic relationship. A relationship based solely on medication administration does not foster the emotional connection and trust necessary for effective psychiatric care. Building rapport and understanding through human interaction is key to a therapeutic relationship.

C. Conducting group therapy sessions

Group therapy sessions are usually led by licensed therapists or counselors, not psychiatric nurses. While psychiatric nurses may be present in group therapy, they typically do not lead these sessions. The primary focus of nurses is on individual patient care and ensuring that therapeutic relationships are nurtured on a personal level, outside of group settings.

D. Focusing solely on clinical assessments

Clinical assessments are important, but focusing solely on them misses the broader goal of building a therapeutic relationship. A nurse must engage with patients beyond assessments to offer emotional support, encourage trust, and create an environment in which the patient feels heard and respected.

Correct Answer

B. Arranging follow-up appointments with community mental health services and discussing coping strategies with the patient.

Explanation

A successful transition from inpatient to community care requires a comprehensive approach that includes both practical and emotional support. By arranging follow-up appointments and discussing coping strategies, the nurse ensures continuity of care and helps the patient develop the necessary skills to manage anxiety in everyday situations. This approach not only addresses the patient’s medical needs but also supports their ongoing recovery in the community by ensuring they have access to resources and guidance.

Why other options are wrong

A. Providing the patient with a list of medications to take after discharge.

While providing a medication list is important, it alone does not guarantee a successful transition. Follow-up appointments and coping strategies are just as crucial to support the patient’s mental health and help them integrate back into the community.

C. Recommending that the patient avoid social interactions to reduce anxiety.

Encouraging avoidance of social interactions can reinforce anxiety and prevent the patient from developing effective coping skills. Exposure to social situations in a controlled and supportive manner is essential for helping patients overcome their fears and build confidence in managing anxiety.

D. Focusing solely on the patient's medical history without considering their social support system.

Focusing only on medical history without considering the patient’s social support system would overlook a critical aspect of recovery. Social support plays a significant role in mental health recovery, and a well-rounded discharge plan must address both medical and social needs.

Correct Answer

B. Implementing community-based mental health programs and increasing access to outpatient services.

Explanation

Community-based mental health programs and increased access to outpatient services provide a more accessible and sustainable way to address the needs of the large population experiencing mental health challenges. This approach allows for early intervention, support in familiar environments, and ongoing care, which can help prevent the escalation of mental health issues. It also improves accessibility for individuals who may not require inpatient care but still need support and treatment. Community programs can provide resources such as counseling, peer support, and mental health education, all of which are critical in addressing the widespread nature of mental health challenges.

Why other options are wrong

A. Increasing funding for inpatient care only.

This is not sufficient on its own, as not all individuals with mental health disorders require inpatient care. A focus solely on inpatient services may lead to overburdening facilities and not addressing the full spectrum of care that is needed, particularly for those who can benefit from outpatient services or community-based programs.

C. Focusing solely on reducing stigma without providing additional resources.

While reducing stigma is important, it is not enough by itself to meet the needs of individuals facing mental health challenges. Without the necessary resources, such as access to care and treatment programs, stigma reduction efforts may not result in meaningful changes for those in need of mental health support.

D. Limiting mental health services to urban areas where the majority of the population resides.

This would exacerbate inequalities, as people living in rural or remote areas may have less access to mental health services. Limiting services to urban areas would ignore the needs of a significant portion of the population who may face additional barriers to access, such as geographical isolation or lack of transportation.

Correct Answer

C. The thorough and consistent delivery of care among all providers

Explanation

Continuity of care refers to the process of ensuring that a patient's care is well-coordinated across all healthcare providers and settings, from initial contact through to treatment and recovery. It involves maintaining consistent communication and comprehensive care plans to ensure that no gaps or redundancies occur in treatment. This approach helps improve outcomes and reduce the risk of errors. It focuses on consistency and comprehensive care delivery across various stages of the treatment process, often involving multiple healthcare professionals and settings.

Why other options are wrong

A. Ensuring that the same care provider is responsible for treating a patient until admission to the hospital

This option only addresses a small part of continuity of care and does not encompass the entire process. Continuity of care includes the delivery of consistent care, not just the responsibility of a single provider before admission.

B. Ensuring that once a particular treatment is started it is not stopped

While continuity of care includes following through on treatments, it is more about coordinated and consistent care across all providers, rather than the idea that treatments should never be stopped.

D. The proper documentation of the care provided to a patient

Proper documentation is an important aspect of continuity of care, but continuity itself focuses on the delivery of consistent and coordinated care among all providers, not just the documentation.

Correct Answer

C. The development of anti-psychotics and budget cuts

Explanation

The policy of deinstitutionalization was heavily influenced by the development of effective antipsychotic medications in the 1950s and 1960s, which made it possible for individuals with mental health conditions to live in community settings rather than large psychiatric hospitals. However, the movement was also influenced by budget cuts to mental health services, which led to the closure of many state hospitals without the creation of sufficient community care alternatives. As a result, many individuals with mental health conditions were discharged without proper community support, contributing to homelessness and a lack of adequate care.

Why other options are wrong

A. The signing of the Mental Health Systems Act by Jimmy Carter to fund more community health centers

This option is incorrect because while the Mental Health Systems Act of 1980 was aimed at improving mental health services, it occurred after the major phase of deinstitutionalization in the 1960s and 1970s. Deinstitutionalization was more directly influenced by the developments of antipsychotic drugs and the accompanying budget cuts during the earlier period.

B. Lobotomies and electroshock falling out of favor with the public

This option is incorrect because while the decline of practices like lobotomies and electroshock therapy contributed to shifts in mental health care, it was not the primary driver of deinstitutionalization. The main factors were the advent of antipsychotic medications and the financial pressures that led to the closing of institutions.

D. The development of anti-psychotics and the creation of Medicaid and Medicare

This option is partially correct in recognizing the development of antipsychotics but is less accurate because the creation of Medicaid and Medicare was not directly linked to the impetus for deinstitutionalization. While these programs helped provide coverage for some individuals with mental health conditions, the main driving factors for deinstitutionalization were antipsychotic drugs and the financial constraints that led to budget cuts.

Correct Answer

C. Initiate a treatment plan that includes both therapy and medication to address the symptoms early.

Explanation

Secondary mental health care focuses on early detection and intervention for mental health conditions. In this case, the community health nurse should take immediate action to initiate a treatment plan that includes therapy and medication, as early intervention can prevent the progression of depression. By addressing the symptoms early, the nurse can help reduce the severity of the disorder and promote better long-term outcomes for the patient. The nurse should act promptly rather than waiting for the condition to worsen, which is key in secondary care.

Why other options are wrong

A. Refer the patient to a psychiatrist for immediate hospitalization.

Referral to a psychiatrist for hospitalization may not be necessary at this early stage of depression, especially if the symptoms are not severe. Secondary care typically aims to address mental health conditions before they escalate to a point where hospitalization is required. Immediate hospitalization is usually reserved for cases of severe or acute mental health crises, not for early signs of depression.

B. Implement a wait-and-see approach to monitor the patient's symptoms.

A wait-and-see approach is not appropriate in secondary mental health care, as early intervention is critical to preventing the condition from worsening. Monitoring the symptoms without taking proactive steps could result in a delay in treatment, potentially allowing the depression to intensify. Early treatment, including therapy and medication, is essential to managing symptoms before they become more severe.

D. Educate the patient about the stigma associated with mental health disorders.

While educating patients about the stigma associated with mental health is important, it is not the primary action in response to early signs of depression. The nurse's immediate course of action should focus on providing the patient with the necessary treatment, such as therapy and medication, to address the symptoms. Education about stigma can be included as part of a broader care plan, but the priority should be addressing the patient's mental health needs.

Correct Answer

B. Anxiety, shame, and reluctance to share information

Explanation

When patients are admitted to psychiatric units, they often experience feelings of anxiety, shame, and reluctance to share personal information. This is because psychiatric admissions can trigger fears of stigma, vulnerability, and loss of control. Many patients may feel apprehensive about discussing their mental health openly, fearing judgment or misunderstanding. Recognizing and addressing these emotions is important in providing compassionate and effective care.

Why other options are wrong

A. Euphoria, excitement, and relief

While some patients may feel relief at receiving care, it is rare for individuals to experience euphoria or excitement upon admission to a psychiatric unit. Most patients are there because of distress, and entering a psychiatric facility often brings feelings of fear, confusion, or shame, rather than positive emotions like euphoria or excitement.

C. Indifference, boredom, and confusion

Although confusion can be a response to being in an unfamiliar and potentially overwhelming environment, indifference and boredom are not typical emotional reactions to psychiatric admissions. Most patients are anxious and concerned about their situation, so indifference is not usually a common emotional response at this stage.

D. Anger, frustration, and denial

Anger and frustration can occur in some patients, particularly those who are involuntarily admitted, but they are not the most common emotional responses for all patients. Denial may also be present, but it is more likely to manifest later in the treatment process, especially if the patient is struggling to accept their diagnosis or the need for treatment. Anxiety and shame are more common initial responses.