TEST BANK FOR PSYCHIATRIC
NURSING BY NORMAN L KELTNE
DEBBIE STEELE EDITION 8TH
EDITION
Test Bank for Psychiatric Nursing by Norman L. Keltner and Debbie Steele, 8th Edition
Chapter 01: Psychotherapeutic Management
1. A newly licensed asks a nursing recruiter for a description of nursing practice in the psychiatric
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."
Answer: D
Rationale: Professional role overlap cannot be denied; however, nursing is unique in its focus on and
application of psychotherapeutic management. Neither the facility nor the multidisciplinary team 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.
2. Which component of the nursing process will the nurse focus upon to address the responsibility to
match individual patient needs with appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
Answer: C
Rationale: 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.
3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations and
walks about the unit, muttering. Which nursing action demonstrates the nurse'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
Answer: A
Rationale: An understanding of psychopathology is the foundation on which the three components of
psychotherapeutic management rest; it facilitates therapeutic communication and provides a basis 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.
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
intervention 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
Answer: D
Rationale: 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 this connection. 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.
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 the client?
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?"
Answer: B
Rationale: 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 of the client; the identification of
emerging psychotic behaviors.
6. Which statement forms the foundation upon which a nurse should base the implementation of
psychotherapeutic 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.
Answer: B
Rationale: 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 components and
permit judicious use. The remaining options identify components of the psychotherapeutic management
process.
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."
Answer: A
Rationale: 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 dosages of medications unless they have
prescriptive privileges.
8. When considering environmental aspects of milieu management, which intervention has the
highest 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
Answer: B
Rationale: Milieu management provides a proactive approach to care. Safety overrides all other
dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All the
remaining options are appropriate but none protect the client from the risk of another attempt to self-
harm as effectively as one-on-one observation as part of suicide precautions.
9. The implementation of which unit policy directed at milieu balance would reflect a need for
reconsideration on the part of the treatment team?
a. All clients will receive verbal and written information explaining unit rules.
b. Unit clients will engage in all unit activities to assure interaction with both staff and other clients.
c. All clients will be uniformly expected to present themselves in a nonviolent manner to both staff and
other clients.
d. At times of unit stress, client will return to their rooms.
Answer: B
Rationale: The situation described suggests a milieu in which patients have no time for planned
therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining options address
unit norms, limit setting, and environmental modifications that are reasonable and will contribute to a
therapeutic milieu.
10. Which intervention should the nurse implement when focusing on communicating therapeutically
with a client?
a. Explaining to the client why they will need to ask for a razor
b. Providing the client with options to help achieve smoking cessation
c. Encouraging the client to identify personal stressors
d. Assuring the client that they can receive telephone call on the unit telephone
NURSING BY NORMAN L KELTNE
DEBBIE STEELE EDITION 8TH
EDITION
Test Bank for Psychiatric Nursing by Norman L. Keltner and Debbie Steele, 8th Edition
Chapter 01: Psychotherapeutic Management
1. A newly licensed asks a nursing recruiter for a description of nursing practice in the psychiatric
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."
Answer: D
Rationale: Professional role overlap cannot be denied; however, nursing is unique in its focus on and
application of psychotherapeutic management. Neither the facility nor the multidisciplinary team 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.
2. Which component of the nursing process will the nurse focus upon to address the responsibility to
match individual patient needs with appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
Answer: C
Rationale: 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.
3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations and
walks about the unit, muttering. Which nursing action demonstrates the nurse'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
Answer: A
Rationale: An understanding of psychopathology is the foundation on which the three components of
psychotherapeutic management rest; it facilitates therapeutic communication and provides a basis 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.
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
intervention 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
Answer: D
Rationale: 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 this connection. 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.
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 the client?
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?"
Answer: B
Rationale: 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 of the client; the identification of
emerging psychotic behaviors.
6. Which statement forms the foundation upon which a nurse should base the implementation of
psychotherapeutic 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.
Answer: B
Rationale: 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 components and
permit judicious use. The remaining options identify components of the psychotherapeutic management
process.
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."
Answer: A
Rationale: 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 dosages of medications unless they have
prescriptive privileges.
8. When considering environmental aspects of milieu management, which intervention has the
highest 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
Answer: B
Rationale: Milieu management provides a proactive approach to care. Safety overrides all other
dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All the
remaining options are appropriate but none protect the client from the risk of another attempt to self-
harm as effectively as one-on-one observation as part of suicide precautions.
9. The implementation of which unit policy directed at milieu balance would reflect a need for
reconsideration on the part of the treatment team?
a. All clients will receive verbal and written information explaining unit rules.
b. Unit clients will engage in all unit activities to assure interaction with both staff and other clients.
c. All clients will be uniformly expected to present themselves in a nonviolent manner to both staff and
other clients.
d. At times of unit stress, client will return to their rooms.
Answer: B
Rationale: The situation described suggests a milieu in which patients have no time for planned
therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining options address
unit norms, limit setting, and environmental modifications that are reasonable and will contribute to a
therapeutic milieu.
10. Which intervention should the nurse implement when focusing on communicating therapeutically
with a client?
a. Explaining to the client why they will need to ask for a razor
b. Providing the client with options to help achieve smoking cessation
c. Encouraging the client to identify personal stressors
d. Assuring the client that they can receive telephone call on the unit telephone
