Chapter 01: Med, Meds, Milieu
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Keltner: Psychiatric Nursing, 8th Edition
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MULTIPLE CHOICE L
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1. A newly licensed asks a nursing recruiter for a description of nursing practice in the
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F,Tpsychiatric setting. What is the nurse recruiter‘s best response?
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a. —The nurse primarily serves in a supportive role to members of the health care L
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delivery team.‖ L
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b. —The multidisciplinary approach eliminates the need to clearly define the L
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responsibilities of nursing in such a setting.‖ F,T L L
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c. —Nursing actions are identified by the institution that distinguishes nursing from L
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other mental health professions.‖ F,T L L
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d. —Nursing offers unique contributions to the psychotherapeutic management of F,T L F,T L F,T L F,T L L
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psychiatric patients.‖ L
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ANS: F , T L D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and F,T L F,T L F,T L F,T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
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team define the professional responsibilities of its members but rather utilizes their unique
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skills to provide holistic care. Ideally, all team members support each other and have
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functions within the team.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
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Implementation MSC: Client Needs: Safe, Effective Care Environment
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2. Which component of the nursing process will the nurse focus upon to address the
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F,T responsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
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Proper assessment is critical for being able to determine the appropriate level of services that
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will provide optimal care while considering patient input and at the lowest cost. Planning
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and implementation utilizes the assessment data to identify and execute actions (treatment
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plan) that will provide appropriate care. Evaluation validates the effectiveness of the treatment
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plan.
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Assessment MSC: Client Needs: Safe, Effective Care Environment
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3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations
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F,T and walks about the unit, muttering. Which nursing action demonstrates the nurse‘s
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F,T understanding of effective psychotherapeutic management of this client?
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a. Discussing the disease process of schizophrenia with the client and their domestic F,T L F,T L F,T L F,T L L
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partner
b. Minimizing contact between this patient and other patients to assure a stress free L
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milieu
, c. Administering PRN medication when first observing the evidence that the client F,T L F, T L L
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may be hallucinating L
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d. Independently determining that behavior modification is appropriate to decrease L
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the client‘s paranoid thoughtsF,T L F,T L F,T L
ANS: F , T L A
An understanding of psychopathology is the foundation on which the three components of
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psychotherapeutic management rest; it facilitates therapeutic communication and provides a
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basis for understanding psychopharmacology and milieu management. Minimizing contact
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between the patient and others and administering PRN medication indiscriminately are
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nontherapeutic interventions. Using behavior modification to decrease the frequency of
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hallucinations would need to be incorporated into the plan of care by the care team.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
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Implementation MSC: Client Needs: Safe, Effective Care Environment
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
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F,Tintervention is critical in assuring long-term, effective client care as described by
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F,Tpsychotherapeutic management?
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a. Involvement in group therapies F, T L L
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b. Focus of close supervision by the unit staff F,TL L
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c. Maintaining effective communication with support system L
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d. Frequently scheduled one-on-one time with nursing staff L
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ANS: F , T L D
A critical element of psychotherapeutic management is the presence of a therapeutic
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nurse-patient relationship. One-on-one time with nursing staff will help in establishing this F,T L L
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connection. While the other options are appropriate and client centered, the nurse-client
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relation is critical in the long-term delivery of quality effective care to this client.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
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Implementation MSC: Client Needs: Psychosocial Integrity
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5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
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F,Tassessment question demonstrates the nurse‘s understanding of the resulting needs of the
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a. —Will you have any difficulty getting your prescription refilled?‖ L
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b. —Have you begun experiencing any forms of hallucinations?‖ F,T L L
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c. —What do you expect will occur since the dosage has been reduced?‖ F,T L L
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d. —What can I do to help you manage this reduction in haloperidol therapy?‖ F,T L L
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ANS: F , T L B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
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return or worsening of positive symptoms such as hallucinations and delusions, and
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negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
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the other options may be appropriate assessment questions, they are not directed at the current
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needs of the client; the identification of emerging psychotic behaviors.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
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Assessment MSC: Client Needs: Physiologic Integrity
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,6. Which statement forms the foundation upon which a nurse should base the implementation of
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F,T L psychotherapeutic management to the care of a patient with mental illness? F, T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L
a. The nurse‘s role in client care is supported by the multidisciplinary team.
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b. Omitting any one component will compromise the effectiveness of the treatment. F,T L L
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c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
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ANS: F , T L B
When one element is missing, treatment is usually compromised. No single element is more
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important than the others; however, patients‘ needs govern the application of the components
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and permit judicious use. The remaining options identify components of the
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psychotherapeutic management process.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
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Analysis MSC: Client Needs: Safe, Effective Care Environment
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7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
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a. —You will need to frequently make decisions regarding the administration of PRN L
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medications to help the client manage anger.‖ L
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b. —It‘s a nursing responsibility to adjust a medication dose to assure effective patient L
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responses.‖F,T L
c. —Nurses administers medications while evaluating drug effectiveness is a medical L
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responsibility.‖
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d. —To best assure appropriate response, a patient‘s questions about drug therapy should
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be referred to the psychiatrist.‖
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ANS: F , T L A
Nursing assessment and analysis of data might suggest the need for PRN medication as
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patient anxiety increases or psychotic symptoms become more acute. The nurse is the
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health team member who makes this determination. Nurses are responsible for monitoring
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drug effectiveness as well as administering medication. Nurses should assume responsibility
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for teaching patients about the side effects of medications. Nurses cannot alter prescribed
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dosages of medications unless they have prescriptive privileges.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
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Analysis MSC: Client Needs: Safe, Effective Care Environment
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8. When considering environmental aspects of milieu management, which intervention has the
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a. Sending the client‘s new medication prescriptions to the pharmacy L
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b. Assigning a staff member to one-on-one observation of the client L
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c. Orienting the client to the milieu‘s public and private spaces L
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d. Having all potentially dangerous items removed from the client‘s belongings L
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ANS: F , T L B
Milieu management provides a proactive approach to care. Safety overrides all other
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dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
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the remaining options are appropriate but none protect the client from the risk of another
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attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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, MSC: F , T L Client Needs: Safe, Effective Care Environment F,T L L
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9. The implementation of which unit policy directed at milieu balance would reflect a need for
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a. All clients will receive verbal and written information explaining unit rules.
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b. Unit clients will engage in all unit activities to assure interaction with both staff
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and other clients. F,T L F,T L F,T L
c. All clients will be uniformly expected to present themselves in a nonviolent
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manner to both staff and other clients.
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d. At times of unit stress, client will return to their rooms.
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ANS: F , T L B
The situation described suggests a milieu in which patients have no time for planned
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therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining
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options address unit norms, limit setting, and environmental modifications that are reasonable
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and will contribute to a therapeutic milieu.
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DIF: Cognitive level: Evaluating TOP: Nursing process: F,T L F,T L F , T L L
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Evaluation MSC: Client Needs: Safe, Effective Care Environment
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10. Which intervention should the nurse implement when focusing on communicating
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F,Ttherapeutically with a client?
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a. Explaining to the client why they will need to ask for a razor F,T L F,T L F,T L F,T L L
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b. Providing the client with options to help achieve smoking cessation F,T L L
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c. Encouraging the client to identify personal stressors F,T L F,T L F ,T L F,TL L
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d. Assuring the client that they can receive telephone call on the unit telephone L
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F,T F,T L F, T L F,T L F ,T L F,T L F, T L
ANS: F , T L C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient
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relationship. An example of such communication is providing the client with an opportunity
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F to safely identify personal stressors. The remaining options address safety, balance, and
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norms associated with their care.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Implementation MSC: Client Needs: Psychosocial Integrity
L
F,T F,T L F , T L F,T L F,T L F,T L
11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s primary
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a. Making an initial assessment F,T L L
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b. Confirming the patient‘s problem F,T L F,T L F,T L
c. Assessing potential dangerousness to self or others F,T L F,TL F,T L F,T L L
F,T F,T L
d. Determining the level of supervision needed for the patient L
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F L
F,T F,T L F, T L L
F,T F,T L
ANS: F , T L C
Risk assessment involves looking at dangerousness to self or others, the degree of
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F,T F,T L F,T L F,T L F,T L
disability, and whether or not the individual is acutely psychotic to determine the
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feasibility of community-based care versus hospital-based care. Risk assessment usually
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follows the initial assessment. Confirmation of the patient‘s problem is not part of the risk
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assessment protocol. Arranging entry into the mental health system will follow risk
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assessment if the patient is assessed as needing service.
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DIF: Cognitive level: Applying F,T L F,T L TOP: F , T L Nursing process: Assessment F,T L F, T L
F,T L L
F,T L
F,T L
F,T
Keltner: Psychiatric Nursing, 8th Edition
L
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F
MULTIPLE CHOICE L
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1. A newly licensed asks a nursing recruiter for a description of nursing practice in the
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F,Tpsychiatric setting. What is the nurse recruiter‘s best response?
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a. —The nurse primarily serves in a supportive role to members of the health care L
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delivery team.‖ L
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b. —The multidisciplinary approach eliminates the need to clearly define the L
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responsibilities of nursing in such a setting.‖ F,T L L
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c. —Nursing actions are identified by the institution that distinguishes nursing from L
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other mental health professions.‖ F,T L L
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d. —Nursing offers unique contributions to the psychotherapeutic management of F,T L F,T L F,T L F,T L L
F,T F,T L F,T L F,T L
psychiatric patients.‖ L
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ANS: F , T L D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and F,T L F,T L F,T L F,T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
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team define the professional responsibilities of its members but rather utilizes their unique
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skills to provide holistic care. Ideally, all team members support each other and have
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functions within the team.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Implementation MSC: Client Needs: Safe, Effective Care Environment
L
F,T F,T L F , T L F,T L F,T L F,T L F,T L F,T L
2. Which component of the nursing process will the nurse focus upon to address the
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FL F,T L F,T L F,T L L
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F,T
F,T responsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: F , T L C
Proper assessment is critical for being able to determine the appropriate level of services that
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will provide optimal care while considering patient input and at the lowest cost. Planning
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and implementation utilizes the assessment data to identify and execute actions (treatment
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plan) that will provide appropriate care. Evaluation validates the effectiveness of the treatment
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plan.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
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F
Assessment MSC: Client Needs: Safe, Effective Care Environment
L
F,T F,T L F , T L F,T L F,T L F,T L F,T L F,T L
3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations
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F,T and walks about the unit, muttering. Which nursing action demonstrates the nurse‘s
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F,T understanding of effective psychotherapeutic management of this client?
L F, T L F,T L F,T L F,T L F,T L F,T L F,T L
a. Discussing the disease process of schizophrenia with the client and their domestic F,T L F,T L F,T L F,T L L
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F F,T L L
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F F,T L F, T L F,T L F,T L
partner
b. Minimizing contact between this patient and other patients to assure a stress free L
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F,T F,T L F,T L F,T L F,T L
milieu
, c. Administering PRN medication when first observing the evidence that the client F,T L F, T L L
F,T F,T L F,T L F,T L F,T L F,T L L
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may be hallucinating L
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d. Independently determining that behavior modification is appropriate to decrease L
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F L
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the client‘s paranoid thoughtsF,T L F,T L F,T L
ANS: F , T L A
An understanding of psychopathology is the foundation on which the three components of
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psychotherapeutic management rest; it facilitates therapeutic communication and provides a
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basis for understanding psychopharmacology and milieu management. Minimizing contact
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between the patient and others and administering PRN medication indiscriminately are
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nontherapeutic interventions. Using behavior modification to decrease the frequency of
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hallucinations would need to be incorporated into the plan of care by the care team.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Implementation MSC: Client Needs: Safe, Effective Care Environment
L
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
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F,Tintervention is critical in assuring long-term, effective client care as described by
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F,Tpsychotherapeutic management?
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a. Involvement in group therapies F, T L L
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b. Focus of close supervision by the unit staff F,TL L
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c. Maintaining effective communication with support system L
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d. Frequently scheduled one-on-one time with nursing staff L
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ANS: F , T L D
A critical element of psychotherapeutic management is the presence of a therapeutic
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nurse-patient relationship. One-on-one time with nursing staff will help in establishing this F,T L L
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connection. While the other options are appropriate and client centered, the nurse-client
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relation is critical in the long-term delivery of quality effective care to this client.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Implementation MSC: Client Needs: Psychosocial Integrity
L
F,T F,T L F , T L F,T L F,T L F,T L
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
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F,Tassessment question demonstrates the nurse‘s understanding of the resulting needs of the
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F,Tclient?
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a. —Will you have any difficulty getting your prescription refilled?‖ L
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F F, T L F,T L F,T L
b. —Have you begun experiencing any forms of hallucinations?‖ F,T L L
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c. —What do you expect will occur since the dosage has been reduced?‖ F,T L L
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d. —What can I do to help you manage this reduction in haloperidol therapy?‖ F,T L L
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ANS: F , T L B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
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return or worsening of positive symptoms such as hallucinations and delusions, and
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negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
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the other options may be appropriate assessment questions, they are not directed at the current
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needs of the client; the identification of emerging psychotic behaviors.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
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F
Assessment MSC: Client Needs: Physiologic Integrity
L
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,6. Which statement forms the foundation upon which a nurse should base the implementation of
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F,T
F,T L psychotherapeutic management to the care of a patient with mental illness? F, T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L
a. The nurse‘s role in client care is supported by the multidisciplinary team.
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b. Omitting any one component will compromise the effectiveness of the treatment. F,T L L
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c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
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F,T F, T L F, T L F,TL F,T L L
,T
F
ANS: F , T L B
When one element is missing, treatment is usually compromised. No single element is more
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important than the others; however, patients‘ needs govern the application of the components
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F,T F,T L F,T L F,T L L
F,T L
,FT F,TL
and permit judicious use. The remaining options identify components of the
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psychotherapeutic management process.
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DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Analysis MSC: Client Needs: Safe, Effective Care Environment
L
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7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
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a. —You will need to frequently make decisions regarding the administration of PRN L
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medications to help the client manage anger.‖ L
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F,T F, T L F,T L
b. —It‘s a nursing responsibility to adjust a medication dose to assure effective patient L
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responses.‖F,T L
c. —Nurses administers medications while evaluating drug effectiveness is a medical L
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responsibility.‖
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d. —To best assure appropriate response, a patient‘s questions about drug therapy should
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be referred to the psychiatrist.‖
F,T L F,T L F,T L F,T L F,T L
ANS: F , T L A
Nursing assessment and analysis of data might suggest the need for PRN medication as
F,T L F,T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L
patient anxiety increases or psychotic symptoms become more acute. The nurse is the
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health team member who makes this determination. Nurses are responsible for monitoring
F,T L F,T L F,T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L
drug effectiveness as well as administering medication. Nurses should assume responsibility
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for teaching patients about the side effects of medications. Nurses cannot alter prescribed
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F,T F,T L F,T L L
F,T L
F,T F,T L F,T L F,T L L
F,T
dosages of medications unless they have prescriptive privileges.
F,T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L
DIF: Cognitive level: Analyzing TOP: Nursing process: F,T L F,T L F , T L L
,T
F
Analysis MSC: Client Needs: Safe, Effective Care Environment
L
F,T F,T L F , T L F,T L F,T L F,T L F,T L F,T L
8. When considering environmental aspects of milieu management, which intervention has the
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F L
F,T L
F,T F,T L F,T L F,T L L
F,T L
F,T
F,T L highest priority for a client admitted after a failed suicide attempt?
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a. Sending the client‘s new medication prescriptions to the pharmacy L
F,T F,TL F,T L F, T L L
F,T F,T L L
F,T L
F,T
b. Assigning a staff member to one-on-one observation of the client L
F,T F,T L F,T L F, T L F,T L F,T L L
,T
F L
F,T F,T L
c. Orienting the client to the milieu‘s public and private spaces L
F,T F,T L F,T L L
F,T F,T L F,T L F,T L F,T L F,T L
d. Having all potentially dangerous items removed from the client‘s belongings L
F,T L
,FT L
,T
F F,TL F,T L F,T L L
,T
F F,T L F, T L
ANS: F , T L B
Milieu management provides a proactive approach to care. Safety overrides all other
F,T L F,T L F,T L F, T L F,T L F,T L F,T L F,T L F,T L F,T L F,T L
dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
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,T
F F,T L F,T L L
F,T L
,FT F,T L L
F,T F,T L L
F,T L
F,T F,T L F,T L F, T L
the remaining options are appropriate but none protect the client from the risk of another
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attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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F L
F,T L
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F L
F,T L
F,T L
F,T L
F,T F,T L L
,T
F F,T L
DIF: Cognitive level: Analyzing F,T L F,T L TOP: F , T L Nursing process: Implementation L
F,T F,T L
, MSC: F , T L Client Needs: Safe, Effective Care Environment F,T L L
F,T F, T L L
F,T L
F,T
9. The implementation of which unit policy directed at milieu balance would reflect a need for
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F F,TL F,T L L
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F,T L reconsideration on the part of the treatment team? F,T L F,T L F,T L F,T L F,T L F,T L F,T L
a. All clients will receive verbal and written information explaining unit rules.
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b. Unit clients will engage in all unit activities to assure interaction with both staff
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and other clients. F,T L F,T L F,T L
c. All clients will be uniformly expected to present themselves in a nonviolent
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manner to both staff and other clients.
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d. At times of unit stress, client will return to their rooms.
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ANS: F , T L B
The situation described suggests a milieu in which patients have no time for planned
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therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining
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options address unit norms, limit setting, and environmental modifications that are reasonable
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and will contribute to a therapeutic milieu.
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DIF: Cognitive level: Evaluating TOP: Nursing process: F,T L F,T L F , T L L
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Evaluation MSC: Client Needs: Safe, Effective Care Environment
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10. Which intervention should the nurse implement when focusing on communicating
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F,Ttherapeutically with a client?
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a. Explaining to the client why they will need to ask for a razor F,T L F,T L F,T L F,T L L
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b. Providing the client with options to help achieve smoking cessation F,T L L
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c. Encouraging the client to identify personal stressors F,T L F,T L F ,T L F,TL L
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d. Assuring the client that they can receive telephone call on the unit telephone L
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ANS: F , T L C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient
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relationship. An example of such communication is providing the client with an opportunity
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F to safely identify personal stressors. The remaining options address safety, balance, and
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norms associated with their care.
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DIF: Cognitive level: Applying TOP: Nursing process: F,T L F,T L F , T L L
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F
Implementation MSC: Client Needs: Psychosocial Integrity
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11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s primary
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a. Making an initial assessment F,T L L
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b. Confirming the patient‘s problem F,T L F,T L F,T L
c. Assessing potential dangerousness to self or others F,T L F,TL F,T L F,T L L
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d. Determining the level of supervision needed for the patient L
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ANS: F , T L C
Risk assessment involves looking at dangerousness to self or others, the degree of
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disability, and whether or not the individual is acutely psychotic to determine the
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feasibility of community-based care versus hospital-based care. Risk assessment usually
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follows the initial assessment. Confirmation of the patient‘s problem is not part of the risk
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assessment protocol. Arranging entry into the mental health system will follow risk
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assessment if the patient is assessed as needing service.
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DIF: Cognitive level: Applying F,T L F,T L TOP: F , T L Nursing process: Assessment F,T L F, T L
