Varcarolis Ch. 32: Serious Mental Illness
Questions and Correct Answers
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. - correct answers:b. dependency caused by
institutionalization.
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. - correct answers:c. anosognosia.
The patient scenario describes anosognosia, the inability to recognize ones deficits due to ones 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) - correct answers:c. Assertive Community Treatment (ACT)
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 patients 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. - correct answers:d. lack of insight associated with the
illness.
The patients nonadherence is most closely related to lack of insight into his illness. The patient believes
he is an exalted personage who hears Gods 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
patients nonadherence, the correct response is most likely.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
Questions and Correct Answers
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. - correct answers:b. dependency caused by
institutionalization.
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. - correct answers:c. anosognosia.
The patient scenario describes anosognosia, the inability to recognize ones deficits due to ones 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) - correct answers:c. Assertive Community Treatment (ACT)
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 patients 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. - correct answers:d. lack of insight associated with the
illness.
The patients nonadherence is most closely related to lack of insight into his illness. The patient believes
he is an exalted personage who hears Gods 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
patients nonadherence, the correct response is most likely.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
