Chapter301:3Me,3Meds,3Milieu
Steele:3Keltner’s3Psychiatric3Nursing,39th3Edition
MULTIPLE3CHOICE
1. A3newly3licensed3nurse3asks3a3nursing3recruiter3for3a3description3of3nursing3practice3in3th
e3psychiatric3setting.3What3is3the3nurse3recruiter‘s3best3response?
a. ―The3nurse3primarily3serves3in3a3supportive3role3to3members3of3the3health3care
delivery3team.‖
b. ―The3multidisciplinary3approach3eliminates3the3need3to3clearly3define3the
responsibilities3of3nursing3in3such3a3setting.‖
c. ―Nursing3actions3are3identified3by3the3institution3that3distinguishes3nursing3fro
m
other3mental3health3professions.‖
d. ―Nursing3offers3unique3contributions3to3the3psychotherapeutic3management3of
psychiatric3patients.‖
ANS:3 D
Professional3role3overlap3cannot3be3denied;3however,3nursing3is3unique3in3its3focus3on3and3a
pplication3of3psychotherapeutic3management.3Neither3the3facility3nor3the3multidisciplinary3te
am3define3the3professional3responsibilities3of3its3members3but3rather3utilizes3their3unique3ski
lls3to3provide3holistic3care.3Ideally,3all3team3members3support3each3other3and3have3functions
3within3the3team.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
2. Which3component3of3the3nursing3process3will3the3nurse3focus3upon3to3address3th
e3responsibility3to3match3individual3patient3needs3with3appropriate3services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS:3 C
Proper3assessment3is3critical3for3being3able3to3determine3the3appropriate3level3of3services3that
3will3provide 3optimal 3care3while 3considering3patient 3input3and3at3the3lowest 3cost.3Planning3an
d3implementation3utilizes3the3assessment3data3to3identify3and3execute3actions3(treatment3plan
)3that3will3provide3appropriate3care.3Evaluation3validates3the3effectiveness3of3the3treatment3pl
an.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Assessment3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
3. An3adult3diagnosed3with3paranoid3schizophrenia3frequently3experiences3auditory3hallucin
ations3and3walks3about3the3unit,3muttering.3Which3nursing3action3demonstrates3the3nurse‘
s3understanding3of3effective3psychotherapeutic3management3of3this3client?
, a. Discussing3the3disease3process3of3schizophrenia3with3the3client3and3their3domesti
c
partner
b. Minimizing3contact3between3this3patient3and3other3patients3to3assure3a3stress-free
milieu
c. Administering3PRN3medication3when3first3observing3the3evidence3that3the3client
may3be3hallucinating
d. Independently3determining3that3behavior3modification3is3appropriate3to3decrease
the3client‘s3paranoid3thoughts
ANS:3 A
An3understanding3of3psychopathology3is3the3foundation3on3which3the3three3components3of3p
sychotherapeutic3management3rest;3it3facilitates3therapeutic3communication3and3provides3a3b
asis3for3understanding3psychopharmacology3and3milieu3management.3Minimizing3contact3be
tween3the3patient3and3others3and3administering3PRN3medication3indiscriminately3are3nonther
apeutic3interventions.3Using3behavior3modification3to3decrease3the3frequency3of3hallucinatio
ns3would3need3to3be3incorporated3into3the3plan3of3care3by3the3care3team.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
4. An3adult3diagnosed3with3chronic3depression3is3hospitalized3after3a3suicide3attempt.3Whic
h3intervention3is3critical3in3assuring3long-
term,3effective3client3care3as3described3by3psychotherapeutic3management?
a. Involvement3in3group3therapies
b. Focus3of3close3supervision3by3the3unit3 staff
c. Maintaining3effective3communication3with3support3system
d. Frequently3scheduled3one-on-one3time3with3nursing3staff
ANS:3 D
A3critical3element3of3psychotherapeutic3management3is3the3presence3of3a3therapeutic
nurse-patient3relationship.3One-on-
one3time3with3nursing3staff3will3help3in3establishing3this3connection.3While3the3other3options3
are3appropriate3and3client3centered,3the3nurse-client3relation3is3critical3in3the3long-
term3delivery3of3quality3effective3care3to3this3client.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Psychosocial3
Integrity
5. A3patient‘s3haloperidol3dosage3was3reduced323weeks3ago3to3decrease3side3effects.3What
3assessment3question3demonstrates3the3nurse‘s3understanding3of3the3resulting3needs3of3t
he3client?
a. ―Will3you3have3any3difficulty3getting3your3prescription3refilled?‖
b. ―Have3you3begun3experiencing3any3forms3of3hallucinations?‖
c. ―What3do3you3expect3will3occur3since3the3dosage3has3been3reduced?‖
d. ―What3can3I3do3to3help3you3manage3this3reduction3in3haloperidol3therapy?‖
ANS:3 B
It3will3be3necessary3for3the3nurse3to3assess3for3exacerbation3of3the3patient‘s3symptoms3of3ps
ychosis3as3well3as3for3a3lessening3of3side3effects.3Dosage3decrease3might3lead3to3the3return3o
,r3worsening3of3positive3symptoms3such3as3hallucinations3and3delusions,3and3negative3sympt
oms3such3as3blunted3affect,3social3withdrawal,3and3poor3grooming.3While3the3other3options3
may3be3appropriate3assessment3questions,3they3are3not3directed3at3the3current3needs3of3the3cli
ent3which3is3the3identification3of3emerging3psychotic3behaviors.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Assessment3MSC:3 Client3Needs:3Physiologic3I
ntegrity
, 6. Which3statement3forms3the3foundation3upon3which3a3nurse3should3base3the3implementation3
of3psychotherapeutic3management3to3the3care3of3a3patient3with3mental3illness?
a. The3nurse‘s3role3in3client3care3is3supported3by3the3multidisciplinary3team.
b. Omitting3any3one3component3will3compromise3the3effectiveness3of3the3treatment.
c. The3most3important3element3of3psychotherapeutic3management3is3drug3therapy.
d. A3therapeutic3nurse-
patient3relationship3is3the3most3important3aspect3of3treatment.
ANS:3 B
When3one3element3is3missing,3treatment3is3usually3compromised.3No3single3element3is3more
3important 3than3the3others; 3however,3patients‘3needs3govern3the3application3of3the3component
s3and3permit3judicious3use.3The3remaining3options3identify3components3of3the3psychotherape
utic3management3process.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Analysis3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
7. Which3statement3 most3accurately3describes3a3nurse‘s3role3regarding3psychopharmacology?
a. ―You3will3need3to3frequently3make3decisions3regarding3the3administration3of3PRN
medications3to3help3the3client3manage3anger.‖
b. ―It‘s3a3nursing3responsibility3to3adjust3a3medication3dose3to3assure3effective3patien
t3responses.‖
c. ―Nurses3administers3medications3while3evaluating3drug3effectiveness3is3a3medical3
responsibility.‖
d. ―To3best3assure3appropriate3response,3a3patient‘s3questions3about3drug3therap
y3should 3be 3referred 3to 3the 3psychiatrist.‖
ANS:3 A
Nursing3assessment3and3analysis3of3data3might3suggest3the3need3for3PRN3medication3as3pati
ent3anxiety3increases3or3psychotic3symptoms3become3more3acute.3The3nurse3is3the3health3tea
m3member3who3makes3this3determination.3Nurses3are3responsible3for3monitoring3drug3effecti
veness3as3well3as3administering3medication.3Nurses3should3assume3responsibility3for3teachin
g3patients3about3the3side3effects3of3medications.3Nurses3cannot3alter3prescribed3dosages3of3m
edications3unless3they3have3prescriptive3privileges.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Analysis3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
8. When3considering3environmental3aspects3of3milieu3management,3which3intervention3has3th
e3highest3priority3for3a3client3admitted3after3a3failed3suicide3attempt?
a. Sending3the3client‘s3new3medication3prescriptions3to3the3pharmacy
b. Assigning3a3staff3member3to3one-on-one3observation3of3the3client
c. Orienting3the3client3to3the3milieu‘s3public3and3private3spaces
d. Having3all3potentially3dangerous3items3removed3from3the3client‘s3belongings
ANS:3 B
Milieu3management3provides3a3proactive3approach3to3care.3Safety3overrides3all3other3dimens
ions3of3the3milieu.3Initiation3of3suicide3precautions3are3the3priority3for3this3client.3All3the3rem
aining3options3are3appropriate3but3none3protect3the3client3from3the3risk3of3another3attempt3to
3self-harm 3as3effectively3as3one-on-one3observation3as3part3of3suicide3precautions.
DIF: Cognitive3level:3Analyzing TOP:3 Nursing3process:3Implementation
Steele:3Keltner’s3Psychiatric3Nursing,39th3Edition
MULTIPLE3CHOICE
1. A3newly3licensed3nurse3asks3a3nursing3recruiter3for3a3description3of3nursing3practice3in3th
e3psychiatric3setting.3What3is3the3nurse3recruiter‘s3best3response?
a. ―The3nurse3primarily3serves3in3a3supportive3role3to3members3of3the3health3care
delivery3team.‖
b. ―The3multidisciplinary3approach3eliminates3the3need3to3clearly3define3the
responsibilities3of3nursing3in3such3a3setting.‖
c. ―Nursing3actions3are3identified3by3the3institution3that3distinguishes3nursing3fro
m
other3mental3health3professions.‖
d. ―Nursing3offers3unique3contributions3to3the3psychotherapeutic3management3of
psychiatric3patients.‖
ANS:3 D
Professional3role3overlap3cannot3be3denied;3however,3nursing3is3unique3in3its3focus3on3and3a
pplication3of3psychotherapeutic3management.3Neither3the3facility3nor3the3multidisciplinary3te
am3define3the3professional3responsibilities3of3its3members3but3rather3utilizes3their3unique3ski
lls3to3provide3holistic3care.3Ideally,3all3team3members3support3each3other3and3have3functions
3within3the3team.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
2. Which3component3of3the3nursing3process3will3the3nurse3focus3upon3to3address3th
e3responsibility3to3match3individual3patient3needs3with3appropriate3services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS:3 C
Proper3assessment3is3critical3for3being3able3to3determine3the3appropriate3level3of3services3that
3will3provide 3optimal 3care3while 3considering3patient 3input3and3at3the3lowest 3cost.3Planning3an
d3implementation3utilizes3the3assessment3data3to3identify3and3execute3actions3(treatment3plan
)3that3will3provide3appropriate3care.3Evaluation3validates3the3effectiveness3of3the3treatment3pl
an.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Assessment3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
3. An3adult3diagnosed3with3paranoid3schizophrenia3frequently3experiences3auditory3hallucin
ations3and3walks3about3the3unit,3muttering.3Which3nursing3action3demonstrates3the3nurse‘
s3understanding3of3effective3psychotherapeutic3management3of3this3client?
, a. Discussing3the3disease3process3of3schizophrenia3with3the3client3and3their3domesti
c
partner
b. Minimizing3contact3between3this3patient3and3other3patients3to3assure3a3stress-free
milieu
c. Administering3PRN3medication3when3first3observing3the3evidence3that3the3client
may3be3hallucinating
d. Independently3determining3that3behavior3modification3is3appropriate3to3decrease
the3client‘s3paranoid3thoughts
ANS:3 A
An3understanding3of3psychopathology3is3the3foundation3on3which3the3three3components3of3p
sychotherapeutic3management3rest;3it3facilitates3therapeutic3communication3and3provides3a3b
asis3for3understanding3psychopharmacology3and3milieu3management.3Minimizing3contact3be
tween3the3patient3and3others3and3administering3PRN3medication3indiscriminately3are3nonther
apeutic3interventions.3Using3behavior3modification3to3decrease3the3frequency3of3hallucinatio
ns3would3need3to3be3incorporated3into3the3plan3of3care3by3the3care3team.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
4. An3adult3diagnosed3with3chronic3depression3is3hospitalized3after3a3suicide3attempt.3Whic
h3intervention3is3critical3in3assuring3long-
term,3effective3client3care3as3described3by3psychotherapeutic3management?
a. Involvement3in3group3therapies
b. Focus3of3close3supervision3by3the3unit3 staff
c. Maintaining3effective3communication3with3support3system
d. Frequently3scheduled3one-on-one3time3with3nursing3staff
ANS:3 D
A3critical3element3of3psychotherapeutic3management3is3the3presence3of3a3therapeutic
nurse-patient3relationship.3One-on-
one3time3with3nursing3staff3will3help3in3establishing3this3connection.3While3the3other3options3
are3appropriate3and3client3centered,3the3nurse-client3relation3is3critical3in3the3long-
term3delivery3of3quality3effective3care3to3this3client.
DIF: Cognitive3level:3Applying
TOP:3 Nursing3process:3Implementation3MSC:3 Client3Needs:3Psychosocial3
Integrity
5. A3patient‘s3haloperidol3dosage3was3reduced323weeks3ago3to3decrease3side3effects.3What
3assessment3question3demonstrates3the3nurse‘s3understanding3of3the3resulting3needs3of3t
he3client?
a. ―Will3you3have3any3difficulty3getting3your3prescription3refilled?‖
b. ―Have3you3begun3experiencing3any3forms3of3hallucinations?‖
c. ―What3do3you3expect3will3occur3since3the3dosage3has3been3reduced?‖
d. ―What3can3I3do3to3help3you3manage3this3reduction3in3haloperidol3therapy?‖
ANS:3 B
It3will3be3necessary3for3the3nurse3to3assess3for3exacerbation3of3the3patient‘s3symptoms3of3ps
ychosis3as3well3as3for3a3lessening3of3side3effects.3Dosage3decrease3might3lead3to3the3return3o
,r3worsening3of3positive3symptoms3such3as3hallucinations3and3delusions,3and3negative3sympt
oms3such3as3blunted3affect,3social3withdrawal,3and3poor3grooming.3While3the3other3options3
may3be3appropriate3assessment3questions,3they3are3not3directed3at3the3current3needs3of3the3cli
ent3which3is3the3identification3of3emerging3psychotic3behaviors.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Assessment3MSC:3 Client3Needs:3Physiologic3I
ntegrity
, 6. Which3statement3forms3the3foundation3upon3which3a3nurse3should3base3the3implementation3
of3psychotherapeutic3management3to3the3care3of3a3patient3with3mental3illness?
a. The3nurse‘s3role3in3client3care3is3supported3by3the3multidisciplinary3team.
b. Omitting3any3one3component3will3compromise3the3effectiveness3of3the3treatment.
c. The3most3important3element3of3psychotherapeutic3management3is3drug3therapy.
d. A3therapeutic3nurse-
patient3relationship3is3the3most3important3aspect3of3treatment.
ANS:3 B
When3one3element3is3missing,3treatment3is3usually3compromised.3No3single3element3is3more
3important 3than3the3others; 3however,3patients‘3needs3govern3the3application3of3the3component
s3and3permit3judicious3use.3The3remaining3options3identify3components3of3the3psychotherape
utic3management3process.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Analysis3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
7. Which3statement3 most3accurately3describes3a3nurse‘s3role3regarding3psychopharmacology?
a. ―You3will3need3to3frequently3make3decisions3regarding3the3administration3of3PRN
medications3to3help3the3client3manage3anger.‖
b. ―It‘s3a3nursing3responsibility3to3adjust3a3medication3dose3to3assure3effective3patien
t3responses.‖
c. ―Nurses3administers3medications3while3evaluating3drug3effectiveness3is3a3medical3
responsibility.‖
d. ―To3best3assure3appropriate3response,3a3patient‘s3questions3about3drug3therap
y3should 3be 3referred 3to 3the 3psychiatrist.‖
ANS:3 A
Nursing3assessment3and3analysis3of3data3might3suggest3the3need3for3PRN3medication3as3pati
ent3anxiety3increases3or3psychotic3symptoms3become3more3acute.3The3nurse3is3the3health3tea
m3member3who3makes3this3determination.3Nurses3are3responsible3for3monitoring3drug3effecti
veness3as3well3as3administering3medication.3Nurses3should3assume3responsibility3for3teachin
g3patients3about3the3side3effects3of3medications.3Nurses3cannot3alter3prescribed3dosages3of3m
edications3unless3they3have3prescriptive3privileges.
DIF: Cognitive3level:3Analyzing
TOP:3 Nursing3process:3Analysis3MSC:3 Client3Needs:3Safe,3Effectiv
e3Care3Environment
8. When3considering3environmental3aspects3of3milieu3management,3which3intervention3has3th
e3highest3priority3for3a3client3admitted3after3a3failed3suicide3attempt?
a. Sending3the3client‘s3new3medication3prescriptions3to3the3pharmacy
b. Assigning3a3staff3member3to3one-on-one3observation3of3the3client
c. Orienting3the3client3to3the3milieu‘s3public3and3private3spaces
d. Having3all3potentially3dangerous3items3removed3from3the3client‘s3belongings
ANS:3 B
Milieu3management3provides3a3proactive3approach3to3care.3Safety3overrides3all3other3dimens
ions3of3the3milieu.3Initiation3of3suicide3precautions3are3the3priority3for3this3client.3All3the3rem
aining3options3are3appropriate3but3none3protect3the3client3from3the3risk3of3another3attempt3to
3self-harm 3as3effectively3as3one-on-one3observation3as3part3of3suicide3precautions.
DIF: Cognitive3level:3Analyzing TOP:3 Nursing3process:3Implementation
