TEST BANK for Keltners Psychiatric Nursing,
9th Edition by Debbie Steele, Verified
Chapters 1 – 36
,Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice
in thepsychiatric setting. What is the nurse recruiter‘s best response?
a. ―The nurse primarily serves in a supportive role to members of the health
care
delivery team.‖
b. ―The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing in such a setting.‖
c. ―Nursing actions are identified by the institution that distinguishes nursing
from
other mental health professions.‖
d. ―Nursing offers unique contributions to the psychotherapeutic management
of
psychiatric patients
ANS: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on
and application of psychotherapeutic management. Neither the facility nor the
multidisciplinaryteam define the professional responsibilities of its members but rather
utilizes their unique skills to provide holistic care. Ideally, all team members support
each other and have functions within the team.
DIF: Cognitive level: Analyzing TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
2. Which component of the nursing process will the nurse focus upon to
address theresponsibility to match individual patient needs with
appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C
Proper assessment is critical for being able to determine the appropriate level of
services that will provide optimal care while considering patient input and at the lowest
cost. Planning and implementation utilizes the assessment data to identify and execute
actions (treatment plan) that will provide appropriate care. Evaluation validates the
effectiveness of the treatment plan.
DIF: Cognitive level: Applying TOP: Nursing process:
AssessmentMSC: Client Needs: Safe, Effective Care Environment
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
hallucinations and walks about the unit, muttering. Which nursing action
demonstrates thenurse‘s understanding of effective psychotherapeutic management
of this client?
a. Discussing the disease process of schizophrenia with the client and their
domestic
, partner
b. Minimizing contact between this patient and other patients to assure a stress-
free
milieu
c. Administering PRN medication when first observing the evidence that the
client
may be hallucinating
d. Independently determining that behavior modification is appropriate to
decrease
the client‘s paranoid thoughts
ANS: A
An understanding of psychopathology is the foundation on which the three components
of psychotherapeutic management rest; it facilitates therapeutic communication and
provides abasis for understanding psychopharmacology and milieu management.
Minimizing contact between the patient and others and administering PRN medication
indiscriminately are nontherapeutic interventions. Using behavior modification to
decrease the frequency of hallucinations would need to be incorporated into the plan of
care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
Whichintervention is critical in assuring long-term, effective client care as described
by psychotherapeutic management?
a. Involvement in group therapies
b. Focus of close supervision by the unit staff
c. Maintaining effective communication with support
system
d. Frequently scheduled one-on-one time with nursing staff
ANS: D
A critical element of psychotherapeutic management is the presence of a therapeutic
nurse-patient relationship. One-on-one time with nursing staff will help in establishing
thisconnection. While the other options are appropriate and client centered, the nurse-
client relation is critical in the long-term delivery of quality effective care to this client.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Psychosocial Integrity
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
What assessment question demonstrates the nurse‘s understanding of the resulting
needs of theclient?
a. ―Will you have any difficulty getting your prescription refilled?‖
b. ―Have you begun experiencing any forms of hallucinations?‖
c. ―What do you expect will occur since the dosage has been reduced?‖
d. ―What can I do to help you manage this reduction in haloperidol
therapy?‖
ANS: B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
return or worsening of positive symptoms such as hallucinations and delusions, and
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
the other options may be appropriate assessment questions, they are not directed at the
, current needs ofthe client which is the identification of emerging psychotic behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AssessmentMSC: Client Needs: Physiologic Integrity
6. Which statement forms the foundation upon which a nurse should base the
implementation ofpsychotherapeutic management to the care of a patient with mental
illness?
a. The nurse‘s role in client care is supported by the multidisciplinary team.
b. Omitting any one component will compromise the effectiveness of the
treatment.
c. The most important element of psychotherapeutic management is drug
therapy.
d. A therapeutic nurse-patient relationship is the most important aspect of
treatment.
ANS: B
When one element is missing, treatment is usually compromised. No single element is
more important than the others; however, patients‘ needs govern the application of the
componentsand permit judicious use. The remaining options identify components of
the psychotherapeutic management process.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
7. Which statement most accurately describes a nurse‘s role regarding
psychopharmacology?
a. ―You will need to frequently make decisions regarding the administration of
PRN
medications to help the client manage anger.‖
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective
patient responses.‖
c. ―Nurses administers medications while evaluating drug effectiveness is a
medical responsibility.‖
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
should be referred to the psychiatrist.‖
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as
patient anxiety increases or psychotic symptoms become more acute. The nurse is the
health team member who makes this determination. Nurses are responsible for
monitoring drug effectiveness as well as administering medication. Nurses should
assume responsibility for teaching patients about the side effects of medications. Nurses
cannot alter prescribed dosagesof medications unless they have prescriptive privileges.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
8. When considering environmental aspects of milieu management, which intervention
has thehighest priority for a client admitted after a failed suicide attempt?
a. Sending the client‘s new medication prescriptions to the pharmacy
b. Assigning a staff member to one-on-one observation of the client
c. Orienting the client to the milieu‘s public and private spaces
d. Having all potentially dangerous items removed from the client‘s
belongings
ANS: B
9th Edition by Debbie Steele, Verified
Chapters 1 – 36
,Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice
in thepsychiatric setting. What is the nurse recruiter‘s best response?
a. ―The nurse primarily serves in a supportive role to members of the health
care
delivery team.‖
b. ―The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing in such a setting.‖
c. ―Nursing actions are identified by the institution that distinguishes nursing
from
other mental health professions.‖
d. ―Nursing offers unique contributions to the psychotherapeutic management
of
psychiatric patients
ANS: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on
and application of psychotherapeutic management. Neither the facility nor the
multidisciplinaryteam define the professional responsibilities of its members but rather
utilizes their unique skills to provide holistic care. Ideally, all team members support
each other and have functions within the team.
DIF: Cognitive level: Analyzing TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
2. Which component of the nursing process will the nurse focus upon to
address theresponsibility to match individual patient needs with
appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C
Proper assessment is critical for being able to determine the appropriate level of
services that will provide optimal care while considering patient input and at the lowest
cost. Planning and implementation utilizes the assessment data to identify and execute
actions (treatment plan) that will provide appropriate care. Evaluation validates the
effectiveness of the treatment plan.
DIF: Cognitive level: Applying TOP: Nursing process:
AssessmentMSC: Client Needs: Safe, Effective Care Environment
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
hallucinations and walks about the unit, muttering. Which nursing action
demonstrates thenurse‘s understanding of effective psychotherapeutic management
of this client?
a. Discussing the disease process of schizophrenia with the client and their
domestic
, partner
b. Minimizing contact between this patient and other patients to assure a stress-
free
milieu
c. Administering PRN medication when first observing the evidence that the
client
may be hallucinating
d. Independently determining that behavior modification is appropriate to
decrease
the client‘s paranoid thoughts
ANS: A
An understanding of psychopathology is the foundation on which the three components
of psychotherapeutic management rest; it facilitates therapeutic communication and
provides abasis for understanding psychopharmacology and milieu management.
Minimizing contact between the patient and others and administering PRN medication
indiscriminately are nontherapeutic interventions. Using behavior modification to
decrease the frequency of hallucinations would need to be incorporated into the plan of
care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
Whichintervention is critical in assuring long-term, effective client care as described
by psychotherapeutic management?
a. Involvement in group therapies
b. Focus of close supervision by the unit staff
c. Maintaining effective communication with support
system
d. Frequently scheduled one-on-one time with nursing staff
ANS: D
A critical element of psychotherapeutic management is the presence of a therapeutic
nurse-patient relationship. One-on-one time with nursing staff will help in establishing
thisconnection. While the other options are appropriate and client centered, the nurse-
client relation is critical in the long-term delivery of quality effective care to this client.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Psychosocial Integrity
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
What assessment question demonstrates the nurse‘s understanding of the resulting
needs of theclient?
a. ―Will you have any difficulty getting your prescription refilled?‖
b. ―Have you begun experiencing any forms of hallucinations?‖
c. ―What do you expect will occur since the dosage has been reduced?‖
d. ―What can I do to help you manage this reduction in haloperidol
therapy?‖
ANS: B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
return or worsening of positive symptoms such as hallucinations and delusions, and
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
the other options may be appropriate assessment questions, they are not directed at the
, current needs ofthe client which is the identification of emerging psychotic behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AssessmentMSC: Client Needs: Physiologic Integrity
6. Which statement forms the foundation upon which a nurse should base the
implementation ofpsychotherapeutic management to the care of a patient with mental
illness?
a. The nurse‘s role in client care is supported by the multidisciplinary team.
b. Omitting any one component will compromise the effectiveness of the
treatment.
c. The most important element of psychotherapeutic management is drug
therapy.
d. A therapeutic nurse-patient relationship is the most important aspect of
treatment.
ANS: B
When one element is missing, treatment is usually compromised. No single element is
more important than the others; however, patients‘ needs govern the application of the
componentsand permit judicious use. The remaining options identify components of
the psychotherapeutic management process.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
7. Which statement most accurately describes a nurse‘s role regarding
psychopharmacology?
a. ―You will need to frequently make decisions regarding the administration of
PRN
medications to help the client manage anger.‖
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective
patient responses.‖
c. ―Nurses administers medications while evaluating drug effectiveness is a
medical responsibility.‖
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
should be referred to the psychiatrist.‖
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as
patient anxiety increases or psychotic symptoms become more acute. The nurse is the
health team member who makes this determination. Nurses are responsible for
monitoring drug effectiveness as well as administering medication. Nurses should
assume responsibility for teaching patients about the side effects of medications. Nurses
cannot alter prescribed dosagesof medications unless they have prescriptive privileges.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
8. When considering environmental aspects of milieu management, which intervention
has thehighest priority for a client admitted after a failed suicide attempt?
a. Sending the client‘s new medication prescriptions to the pharmacy
b. Assigning a staff member to one-on-one observation of the client
c. Orienting the client to the milieu‘s public and private spaces
d. Having all potentially dangerous items removed from the client‘s
belongings
ANS: B
