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./th
e./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./fro
m
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./a
pplication./of./psychotherapeutic./management../Neither./the./facility./nor./the./multidisciplinary./te
am./define./the./professional./responsibilities./of./its./members./but./rather./utilizes./their./unique./ski
lls./to./provide./holistic./care../Ideally,./all./team./members./support./each./other./and./have./functions
./within./the./team.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
2. Which./component./of./the./nursing./process./will./the./nurse./focus./upon./to./address./th
e./responsibility./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./tha
t./will./provide./optimal./care./while./considering./patient./input./and./at./the./lowest./cost../Planning./a
, nd./implementation./utilizes./the./assessment./data./to./identify./and./execute./actions./(treatment./pla
n)./that./will./provide./appropriate./care../Evaluation./validates./the./effectiveness./of./the./treatment./p
lan.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Assessment./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
3. An./adult./diagnosed./with./paranoid./schizophrenia./frequently./experiences./auditory./halluci
nations./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./domesti
c
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./decreas
e
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./a./
basis./for./understanding./psychopharmacology./and./milieu./management../Minimizing./contact./
between./the./patient./and./others./and./administering./PRN./medication./indiscriminately./are./nont
herapeutic./interventions../Using./behavior./modification./to./decrease./the./frequency./of./hallucin
ations./would./need./to./be./incorporated./into./the./plan./of./care./by./the./care./team.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
4. An./adult./diagnosed./with./chronic./depression./is./hospitalized./after./a./suicide./attempt../Whic
h./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
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./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.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Psychosocial
./Integrity
,5. A./patient‘s./haloperidol./dosage./was./reduced./2./weeks./ago./to./decrease./side./effects../Wha
t./assessment./question./demonstrates./the./nurse‘s./understanding./of./the./resulting./needs./of./t
he./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?‖
ANS:. / B
It./will./be./necessary./for./the./nurse./to./assess./for./exacerbation./of./the./patient‘s./symptoms./of./ps
ychosis./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./sym
ptoms./such./as./blunted./affect,./social./withdrawal,./and./poor./grooming../While./the./other./option
s./may./be./appropriate./assessment./questions,./they./are./not./directed./at./the./current./needs./of./the./c
lient./which./is./the./identification./of./emerging./psychotic./behaviors.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Assessment./MSC:. / Client./Needs:./Physiologic./
Integrity
, 6. Which./statement./forms./the./foundation./upon./which./a./nurse./should./base./the./implementation./o
f./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.
ANS:. / B
When./one./element./is./missing,./treatment./is./usually./compromised../No./single./element./is./mor
e./important./than./the./others;./however,./patients‘./needs./govern./the./application./of./the./compone
nts./and./permit./judicious./use../The./remaining./options./identify./components./of./the./psychother
apeutic./management./process.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Analysis./MSC:. / Client./Needs:./Safe,./Effecti
ve./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./pati
ent./anxiety./increases./or./psychotic./symptoms./become./more./acute../The./nurse./is./the./health./tea
m./member./who./makes./this./determination../Nurses./are./responsible./for./monitoring./drug./effect
iveness./as./well./as./administering./medication../Nurses./should./assume./responsibility./for./teachi
ng./patients./about./the./side./effects./of./medications../Nurses./cannot./alter./prescribed./dosages./of./
medications./unless./they./have./prescriptive./privileges.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Analysis./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
8. When./considering./environmental./aspects./of./milieu./management,./which./intervention./has./th
e./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./belonging
s
ANS:. / B
Milieu./management./provides./a./proactive./approach./to./care../Safety./overrides./all./other./dimen
sions./of./the./milieu../Initiation./of./suicide./precautions./are./the./priority./for./this./client../All./the./re
maining./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.
DIF: Cognitive./level:./Analyzing TOP:. / Nursing./process:./Implementation
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./th
e./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./fro
m
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./a
pplication./of./psychotherapeutic./management../Neither./the./facility./nor./the./multidisciplinary./te
am./define./the./professional./responsibilities./of./its./members./but./rather./utilizes./their./unique./ski
lls./to./provide./holistic./care../Ideally,./all./team./members./support./each./other./and./have./functions
./within./the./team.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
2. Which./component./of./the./nursing./process./will./the./nurse./focus./upon./to./address./th
e./responsibility./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./tha
t./will./provide./optimal./care./while./considering./patient./input./and./at./the./lowest./cost../Planning./a
, nd./implementation./utilizes./the./assessment./data./to./identify./and./execute./actions./(treatment./pla
n)./that./will./provide./appropriate./care../Evaluation./validates./the./effectiveness./of./the./treatment./p
lan.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Assessment./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
3. An./adult./diagnosed./with./paranoid./schizophrenia./frequently./experiences./auditory./halluci
nations./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./domesti
c
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./decreas
e
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./a./
basis./for./understanding./psychopharmacology./and./milieu./management../Minimizing./contact./
between./the./patient./and./others./and./administering./PRN./medication./indiscriminately./are./nont
herapeutic./interventions../Using./behavior./modification./to./decrease./the./frequency./of./hallucin
ations./would./need./to./be./incorporated./into./the./plan./of./care./by./the./care./team.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
4. An./adult./diagnosed./with./chronic./depression./is./hospitalized./after./a./suicide./attempt../Whic
h./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
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./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.
DIF: Cognitive./level:./Applying
TOP:. / Nursing./process:./Implementation./MSC:. / Client./Needs:./Psychosocial
./Integrity
,5. A./patient‘s./haloperidol./dosage./was./reduced./2./weeks./ago./to./decrease./side./effects../Wha
t./assessment./question./demonstrates./the./nurse‘s./understanding./of./the./resulting./needs./of./t
he./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?‖
ANS:. / B
It./will./be./necessary./for./the./nurse./to./assess./for./exacerbation./of./the./patient‘s./symptoms./of./ps
ychosis./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./sym
ptoms./such./as./blunted./affect,./social./withdrawal,./and./poor./grooming../While./the./other./option
s./may./be./appropriate./assessment./questions,./they./are./not./directed./at./the./current./needs./of./the./c
lient./which./is./the./identification./of./emerging./psychotic./behaviors.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Assessment./MSC:. / Client./Needs:./Physiologic./
Integrity
, 6. Which./statement./forms./the./foundation./upon./which./a./nurse./should./base./the./implementation./o
f./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.
ANS:. / B
When./one./element./is./missing,./treatment./is./usually./compromised../No./single./element./is./mor
e./important./than./the./others;./however,./patients‘./needs./govern./the./application./of./the./compone
nts./and./permit./judicious./use../The./remaining./options./identify./components./of./the./psychother
apeutic./management./process.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Analysis./MSC:. / Client./Needs:./Safe,./Effecti
ve./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./pati
ent./anxiety./increases./or./psychotic./symptoms./become./more./acute../The./nurse./is./the./health./tea
m./member./who./makes./this./determination../Nurses./are./responsible./for./monitoring./drug./effect
iveness./as./well./as./administering./medication../Nurses./should./assume./responsibility./for./teachi
ng./patients./about./the./side./effects./of./medications../Nurses./cannot./alter./prescribed./dosages./of./
medications./unless./they./have./prescriptive./privileges.
DIF: Cognitive./level:./Analyzing
TOP:. / Nursing./process:./Analysis./MSC:. / Client./Needs:./Safe,./Effecti
ve./Care./Environment
8. When./considering./environmental./aspects./of./milieu./management,./which./intervention./has./th
e./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./belonging
s
ANS:. / B
Milieu./management./provides./a./proactive./approach./to./care../Safety./overrides./all./other./dimen
sions./of./the./milieu../Initiation./of./suicide./precautions./are./the./priority./for./this./client../All./the./re
maining./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.
DIF: Cognitive./level:./Analyzing TOP:. / Nursing./process:./Implementation
