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Varcarolis Ch. 5 Settings for Psychiatric Care

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Varcarolis Ch. 5 Settings for Psychiatric Care Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medications at home. c. hav...

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  • August 16, 2024
  • 10
  • 2024/2025
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Varcarolis Ch. 5 Settings for Psychiatric Care
Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is
generally reserved for patients who:

a. present a clear danger to self or others.

b. are noncompliant with medications at home.

c. have no support systems in the community.

d. develop new symptoms during the course of an illness. ✔️a. present a clear danger to self or others.



Hospitalization is justified when the patient is a danger to self or others, has dangerously
decompensated, or needs intensive medical treatment. The incorrect options do not necessarily
describe patients who require inpatient treatment.



A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24
hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on
the day of admission. The most appropriate intervention for the case manager is to:

a. cancel the patients discharge from the hospital.

b. contact the landlord who evicted the patient to discuss the situation.

c. arrange a temporary place for the patient to stay until new housing can be arranged.

d. document that the adverse medication reaction was feigned because the patient had nowhere to live.
✔️c. arrange a temporary place for the patient to stay until new housing can be arranged.



The case manager should intervene by arranging temporary shelter for the patient until suitable housing
can be found. This is part of the coordination and delivery of services that falls under the case manager
role. The other options are not viable alternatives.



A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide
attempt. Members of the team report their assessments. What outcome can be expected from this
meeting?

a. A treatment plan will be formulated.

b. The health care provider will order neuroimaging studies.

c. The team will request a court-appointed advocate for the patient.

, d. Assessment of the patients need for placement outside the home will be undertaken. ✔️a. A
treatment plan will be formulated.



Treatment plans are formulated early in the course of treatment to streamline the treatment process
and reduce costs. It is too early to determine the need for alternative post-discharge living
arrangements. Neuroimaging is not indicated for this scenario.



The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The
patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more
organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is
needed for at least a month. The nurse should:

a. call the psychiatrist to come explain the discharge rationale.

b. explain that health insurance will not pay for a longer stay for the patient.

c. call security to handle the disturbance and escort the family off the unit.

d. explain that the patient will continue to improve if medication is taken regularly. ✔️d. explain that
the patient will continue to improve if medication is taken regularly.



Patients no longer stay in the hospital until every vestige of a symptom disappears. The nurse must
assume responsibility to advocate for the patients right to the least restrictive setting as soon as the
symptoms are under control and for the right of citizens to control health care costs. The health care
provider will use the same rationale. Shifting blame will not change the discharge. Calling security is
unnecessary. The nurse can handle this matter.



A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is
smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These
observations relate to:

a. management of milieu safety.

b. coordinating care of patients.

c. management of the interpersonal climate.

d. use of therapeutic intervention strategies. ✔️a. management of milieu safety.



Members of the nursing staff are responsible for all aspects of milieu management. The observations
mentioned in this question directly relate to the safety of the unit. The other options, although part of
the nurses concerns, are unrelated to the observations cited.

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