TEST BANK FOR PSYCHIATRIC NURSING 8TH EDITION BY NORMAN L. KELTNER, DEBBIE STEELE ISBN: | COMPLETE ALL CHAPTERS | UPDATED

TEST BANK FOR PSYCHIATRIC NURSING 8TH EDITION BY NORMAN L. KELTNER, DEBBIE STEELE ISBN: 516 | COMPLETE ALL CHAPTERS | UPDATED . 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.” 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 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. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 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 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: Assessment MSC: Client Needs: Safe, Effective Care Environment 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 NU RS IN GT B.CO M 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 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. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 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 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. 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?” 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 of the client; the identification of emerging psychotic behaviors. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Physiologic Integrity NU RS IN GT B.CO M 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. 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 components and permit judicious use. The remaining options identify components of the psychotherapeutic management process. DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis MSC: 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 dosages of medications unless they have prescriptive privileges. DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis MSC: Client Needs: Safe, Effective Care Environment 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 ANS: B 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. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation NU RS IN GT B.CO M MSC: Client Needs: Safe, Effective Care Environment 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. ANS: B 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. DIF: Cognitive level: Evaluating TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 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 ANS: C A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient relationship. An example of such communication is providing the client with an opportunity to safely identify personal stressors. The remaining options address safety, balance, and norms associated with their care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 11. During the risk assessment phase of care for a psychiatric patient, what is the nurse’s primary goal? a. Making an initial assessment b. Confirming the patient’s problem c. Assessing potential dangerousness to self or others d. Determining the level of supervision needed for the patient ANS: C Risk assessment involves looking at dangerousness to self or others, the degree of disability, and whether or not the individual is acutely psychotic to determine the feasibility of community-based care versus hospital-based care. Risk assessment usually follows the initial assessment. Confirmation of the patient’s problem is not part of the risk assessment protocol. Arranging entry into the mental health system will follow risk assessment if the patient is assessed as needing service. DIF: Cognitive level: Applying TOP: Nursing process: Assessment NU RS IN GT B.CO M MSC: Client Needs: Safe, Effective Care Environment 12. Risk assessment for a patient shows these findings: schizophrenia but not currently; not a danger to self or others; lives in parents’ home. Which decision regarding placement on the continuum of care is appropriate? a. Hospitalize the patient. b. Discharge the patient from the system. c. Refer the patient to outpatient services. d. Refer the patient to self-help resources in the community. ANS: C Referral should be made to the least restrictive, most effective, and most cost-conscious source of services. Because the patient is not a danger to self or others, hospitalization is not needed. However, follow-up as an outpatient would be more appropriate than referral to a self-help group, in which structure might be lacking, or discharge from the system. DIF: Cognitive level: Applying TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 13. A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take it anymore. Do you?” The most effective reply that the nurse could make is based on which psychotherapeutic management model? a. Psychopathology b. Milieu management c. Psychopharmacology d. Therapeutic nurse-patient relationship ANS: C Concerns about medication voiced by patients require the nurse to have knowledge about psychotherapeutic drugs to make helpful responses. The nurse-patient relationship component is based on use of self. Milieu management is concerned with the environment of care. Psychopathology provides foundational knowledge of mental disorders but would be less relevant in framing a response to the patient than knowledge of psychopharmacology. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity 14. A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take it anymore. Do you?” What is the nurse’s best response? a. “I wonder why you think that.” b. “Tell me how the medication makes you feel.” c. “One must never stop taking medication.” d. “You need to discuss this with your psychiatrist.” ANS: B As part of the psychopharmacology component of psychotherapeutic management, the responsibility of the nurse is to gather data about patients’ responses to medication and to be alert for side and adverse effects of the medication. The other responses are tangential to the real issue. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Physiologic Integrity NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 15. The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has a permanent disorder and will have many hospitalizations in the future. I wonder how I will be able to raise our children alone.” The nurse’s reply should be based on which form of nursing knowledge? a. Psychopathology b. Milieu management c. Psychopharmacology d. Nursing relationship therapy ANS: A An understanding of psychopathology will enable the nurse to communicate reassurance to the spouse regarding the treatment of panic attacks in an outpatient setting. None of the other options has psychotherapeutic knowledge of psychiatric disorders as its focus. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 16. Which observation during morning rounds should receive a nurse’s priority attention? a. Breakfast is late being served. b. A sink is leaking, leaving water on the bathroom floor. c. The daily schedule has not been posted on the unit bulletin board. d. A small group of patients is complaining that one patient turned down the TV volume. ANS: B Safety is the component of therapeutic milieu management that takes priority over the other components. A patient could be injured if he or she slipped and fell. The other problems do not pose a threat to patient safety. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 17. A community mental health nurse assessing a person with a psychiatric disorder, should refer this person to services based on which basic concept? a. Focus on interventions is on the least costly initially. b. Initial interventions are the least restrictive. c. Initial interventions offer a form of psychoeducation. d. Rapid symptom stabilization is the primary goal. ANS: B The concept of least restrictive treatment environment preserves individual rights to freedom. Many patients are healthy enough to receive community-based treatment. Hospitalization is reserved for short periods when patients are assessed as being a danger to self or others. Cost is a consideration but is of lesser concern than safety. All facets of the continuum should offer psychoeducation as needed by patients and families. Some aspects of the care continuum are more concerned with a patient’s need for symptom stabilization than others (e.g., hospitals versus psychiatric rehabilitation programs). The outcome of symptom stabilization is not a need for some patients, so it is not a correct answer. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 18. An acutely psychotic patient is restricted to an inpatient unit. This intervention demonstrates that which milieu element has been adapted? a. Norms b. Balance c. Therapy d. Psychopathology ANS: B Balance refers to negotiating the line between dependence and independence. The more psychotic the individual, the less independence he or she can usually handle safely. Unit restriction with careful supervision by staff helps compensate for lack of patient judgment. Norms refers to behavioral expectations for patients. Therapy is provided by advanced-practice nurses or others with advanced education and so is not an element of milieu management. Psychopathology is not considered an environmental element. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 19. An individual diagnosed with schizophrenia has a history of medication nonadherence. When inpatient psychiatric care is not indicated, which service is the preferred referral? a. Primary care b. Outpatient counseling c. Apartment residential living d. A group home with 24-hour supervision ANS: D Although inpatient hospitalization is unnecessary, the individual requires an environment in which medication compliance can be fostered. In this case, the group home would provide the best alternative. The other options do not provide adequate supervision. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 20. A patient diagnosed with bipolar disorder has stabilized and is being discharged from the hospital. The patient will live independently at home but lacks social skills and transportation. Which referral would be most appropriate? a. A group home b. A self-help group c. A day treatment program d. Assertive community treatment (ACT) ANS: D Assertive community treatment (ACT) provides intensive supervision, which includes assistance with medications and transportation that would support the goal of minimizing future hospitalizations. A group home is unnecessary, because the patient will reside at home. A day treatment program would provide a therapeutic program directed toward symptoms, but the patient’s symptoms have stabilized so this service is not indicated. A self-help group would not provide the intensity of service this patient needs. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 21. A patient diagnosed with long-standing bipolar disorder comes to the mental health center. The patient says, “I lost my job and home. Now, I eat in soup kitchens and sleep at a shelter. I am so depressed that I thought about jumping from a railroad bridge into a river.” Which factor has priority for the nurse who determines the appropriate level of care? a. Long-standing bipolar disorder b. Risk for suicide c. Homelessness d. Lack of income ANS: B Risk assessment shows the patient to have suicidal thoughts, and a plan for the suicide that is highly lethal, executable, and with low potential for rescue. The other factors do not have as great an effect on the determination of the level of services needed since they are less related to acute safety. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 22. When explaining risk assessment, the nurse would indicate that the highest priority for admission to hospital-based care is associated with which goal? a. Safety of self and others b. Minimal confusion and disorientation c. Successful withdrawal from harmful substances d. Management of medical illness complicating a psychiatric disorder ANS: A The highest priority is safety. In the other situations, threats to safety might or might not exist. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 23. What explanation regarding the unit milieu would be most important for the nurse to give to a newly admitted patient? a. “Your behavior will be carefully monitored during your hospital stay.” b. “Unit activities will help you cope with immediate needs and stressors.” c. “You will be given enough medication to bring your symptoms under control.” d. “I will be gathering information about you to plan your care and your discharge.” ANS: B This choice best reflects the purpose of milieu management in psychotherapeutic management as demonstrated through unit activities. Stating that behavior will be monitored creates suspicion. Discussing medication administration is a psychopharmacology issue and is not pertinent to unit milieu. Stating that assessment will take place is not directly related to milieu. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 24. Referral to a psychiatric extended-care facility would be most appropriate for which of the following patients? a. An adult with generalized anxiety disorder b. A severely depressed 70-year-old retiree NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M c. A patient with personality disorder who frequently self-mutilates d. A severely ill person with schizophrenia who is regressed and withdrawn ANS: D Extended care often serves those with severe and persistent mental illness and those with a combination of psychiatric and medical illnesses. The patient demonstrating the signs and symptoms described in the correct option is at risk for developing psychotic behaviors that increases the risk for self and other directed harm. Patients with anxiety disorders can be referred to outpatient services. Severely depressed patients would need more intensive care, as would a self-mutilating individual. DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis MSC: Client Needs: Safe, Effective Care Environment MULTIPLE RESPONSE 1. What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community-based care? (Select all that apply.) a. Need for PRN medication b. Severity of the patient’s illness c. Need for structured formal therapy d. Presence of suicidal or homicidal ideation e. Amount of supervision required by the patient ANS: B, D, E The decision tree for the continuum of care calls for the assessment of severity of the illness, the presence or absence of suicidal or homicidal ideation, whether or not the disability is so great that the patient is unable to provide for his or her own basic needs, and the amount of supervision required for patient safety. The frequency of need for PRN medication and the need for structured formal therapy are not considerations mentioned in the decision tree. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 2. Which intervention demonstrates that a nurse is functioning within the scope of psychotherapeutic management? (Select all that apply.) a. Structuring meaningful unit activities b. Administering electroconvulsive therapy c. Encouraging a patient to express feelings d. Interpreting the results of psychological testing e. Assessing a patient for medication side effects ANS: A, C, E Milieu management, patient communication, and medication administration are all within the scope of nursing practice. Electroconvulsive therapy is a medical treatment and, therefore, should be administered by a physician. Psychological testing is interpreted by a psychologist. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M Chapter 03: Legal Issues Keltner: Psychiatric Nursing, 8th Edition MULTIPLE CHOICE 1. Considering the M’Naghten Rule, what information is most important for the nurse to document when caring for a patient who will soon be tried on murder charges? a. The patient’s participation in treatment planning b. The patient’s comments about commission of the crime c. Examples of behaviors that support psychiatric diagnoses d. The patient’s perceptions of the need for hospitalization and treatment ANS: B The M’Naghten Rule states that to be held legally accountable for his or her actions, a person with mental illness must be able to understand the nature and implications of the crime. Although each of the options refers to data that should be documented, the patient’s comments about the crime would be of most importance to the trial. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 2. When discussing the precedent established in Wyatt v. Stickney with nursing students, the nurse demonstrates an accurate understanding or the decision by focusing on what factor? a. Intellectualization of the client’s condition b. About the client’s rights to adequate treatment c. Minimizing the client’s risk of being coerced into treatment d. Risks created by a request for immediate discharge from the facility ANS: B Wyatt v. Stickney was a case in which the court ruled that patients had the right to adequate treatment while hospitalized. Intellectualizing is a defense mechanism. Right to refuse treatment and commitment issues were not the focus of Wyatt v. Stickney. DIF: Cognitive level: Evaluating TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 3. A patient shouts, “I’m holding you responsible for mistreatment based on Rogers v. Orkin.” The nurse should review past care related to what focus? a. Loss of privileges b. Inability to make phone calls c. Medication administration d. Involuntary hospitalization ANS: C Rogers v. Orkin was a case in which the court ruled that nonviolent patients could not be forced to take medication. It did not have implications related to hospitalization or application of patient privileges. DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 4. To help preserve patients’ rights to freedom from restraint and seclusion, the most important interventions that the nurse can use are based on which intervention? a. Therapeutic management of the patient’s needs b. Reality-based communication to minimize cognitive disorientation c. Confidentiality of all documentation associated with the patient d. Effective use of ancillary personnel to monitor the patient ANS: A Attention to the nurse-patient relationship, the therapeutic milieu, and principles of pharmacologic management can reduce the need for restrictive measures. The other options are important aspects of care but do not relate directly to the use of restraint and seclusion. DIF: Cognitive level: Planning TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 5. A nurse finds a mental health care directive in the medical record of a patient experiencing psychosis. The directive prohibits the prescription of specific medications. Considering the patient’s impaired function, what is the nurse’s primary responsibility regarding medication administration? a. Ensure that the directives are respected in treatment planning. b. Review the directive with the patient to ensure that it is current. c. Alert the prescribing psychiatrist of the directive. d. Discuss the revision of the directive with the patient’s guardian or power of attorney. ANS: A Advance directives for psychiatric care given by competent patients are considered binding and should be respected in planning treatment. The patient is not currently capable of making such decisions due to the psychosis. The decision cannot be rescinded if it was appropriately arrived at a time when the patient was cognitive. Alerting the current prescribing psychiatrist is appropriate, but it is not the primary nursing responsibility at this time. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 6. A patient constantly disrupts activities on an inpatient unit. Which action would place the nurse at risk of being quality of assault? a. Threatening to rescind the patient’s weekend pass b. Placing the patient in seclusion c. Refusing to medicate the patient as prescribed d. Pushing the patient out of the day room ANS: A Assault is defined as an act that creates a reasonable apprehension of harmful or offensive contact to another without consent of the other. The nurse has threatened the patient thus risking the risk of assault. Battery is unwanted touching such as pushing. Negligence is failure to do what is reasonably prudent under the circumstances such as not providing prescribed medications. False imprisonment is associated with unwarranted seclusion. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 7. A patient tells the nurse, “When I get out, I’m going to get even with a lot of people.” With respect to the nurse’s duty to warn, what priority action should the nurse take? a. Discuss the consequences of such actions with the client. b. Notify local law enforcement officials of the threat. c. Warn close relatives and significant other as required by law. d. Document and discuss the threat with the clinical team. ANS: D The Tarasoff ruling specifies that a specific threat to a readily identifiable person or persons must be made. In this situation, the threat is nonspecific. The prudent action is to document and discuss with the clinical team to determine the need for providing a warning to third parties and to notify the police. While discussing the consequences of acting on the threat is not inappropriate, it is not the priority intervention required. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 8. A cognitively impaired psychiatric patient has been a court appointed guardian. What the nurse is appropriate in seeking the opinion of the guardian regarding what matter? a. The patient’s need for a winter coat b. Accompanying the patient on an outing off of facility grounds c. Addressing the patient’s financial issues d. TA change in needed treatment ANS: D Guardians make decisions on behalf of the patient related to their well-being. Being consulted about treatment planning is an appropriate area for a guardian’s input. None of the other options are directly associated with the role of a guardian. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 9. A patient tells the nurse, “I still have suicidal thoughts, but don’t tell anyone because I am supposed to be discharged today.” Select the nurse’s best course of action. a. Have the patient sign a “no suicide” contract. b. Respect the patient’s request related to confidentiality. c. Inform the health care provider and other team members. d. Search the patient’s belongings for potentially hazardous items. ANS: C Patient right to confidentiality never includes keeping important clinical information secret, especially information related to patient safety. Patients should be informed that all relevant information will be shared with the health care team. None of the other options sufficiently address the safety issue presented by a patient who expresses suicidal thoughts. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 10. Which nurse is at risk of being guilty of committing a legal tort? a. The primary nurse who does not complete the plan of care for a patient within 24 hours of the patient’s admission. b. An advanced-practice nurse who recommends that a patient who is dangerous to NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M self and others be involuntarily hospitalized. c. A nurse who suggests that a patient’s admission status be changed from involuntary to voluntary after the patient’s hallucinations subside. d. A nurse who gives a PRN dose of an antipsychotic drug to a patient to prevent violent acting out because the unit is short staffed. ANS: D A tort is a civil wrong demonstrated by a person who violates the legal rights of another. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding a patient; thus false imprisonment is a possible charge. The other options do not exemplify a tort since considering the situations described, no patient right has been violated. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 11. A crisis team led by a psychiatric nurse assesses a patient with a history of paranoid schizophrenia who is standing on the lawn shouting, “Don’t come near me. People are poisoning my water.” Which statement made to the police officer accurately identifies the patient’s immediate needs? a. “We’ve identified that this patient requires immediate emergency care.” b. “This patient will require a hearing to implement a long-term commitment.” c. “Please arrange for a probable-cause hearing for this patient.” d. “This patient meets the criteria for short-term observation and treatment. ANS: A Individuals who are deemed to be dangerous to self, dangerous to others as is possible with this patient, or those who are gravely disabled can be detained involuntarily for evaluation and emergency treatment for a specified period of time (often for 72 hours). Long-term commitment might be unnecessary. A probable-cause hearing is needed only for short-term observation and treatment. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 12. Which individual would be the most likely candidate to require at court appointed guardian? a. A patient diagnosed with panic attacks b. A patient who frequently refuses medication c. A patient with frequent admissions for drug abuse d. A patient diagnosed with chronic, paranoid schizophrenia ANS: D Guardians or conservators are appointed by the courts to manage the affairs of mentally ill individuals found to be incompetent and unable to manage their own affairs appropriately. A patient diagnosed with chronic, paranoid schizophrenia would be in need of a conservator or guardian, whereas the other individuals would more likely be judged competent since their diagnoses are not necessarily chronic in nature or as likely to impair rational thinking. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M 13. An involuntarily admitted inpatient diagnosed with paranoid schizophrenia repeatedly calls the local mayor. The patient verbally abuses the person who answers the phone as well as the mayor. Select the most appropriate initial nursing intervention to help manage this behavior. a. Document the behavior and inform the patient that their phone privileges could be revoked. b. Include the patient in a social skills building group. c. Suspend the patient’s phone privileges temporarily, and document the reason. d. Ask the patient advocate to review the limits of the patient’s rights with the patient. ANS: C The patient requires a consequence for unacceptable behavior. The nurse should document that the patient’s calls violated the rights of others, thus providing a basis for temporary suspension of the right to make phone calls to the mayor’s office. Allowing continued calls violates the rights of others. It might require several days for the advocate to meet with the patient. Social skill building is valuable but doesn’t address the immediate behavior. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 14. A nurse in a community mental health center receives a call asking for information about a patient. Under which condition can the nurse release information to the caller? a. The caller is related to the patient. b. The psychiatrist approves the request. c. The caller is a mental health professional. d. The patient has given written consent for release of information. ANS: D Patient information is privileged. Information cannot be released without consent signed by the patient. None of the other conditions meet that criteria. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 15. A patient backs into a corner of the room and shouts at the nurse, “Stay away from me.” What is the nurse’s best initial nursing intervention in this situation? a. Obtain an order for seclusion. b. Administer a PRN antipsychotic drug. c. Call for assistance to physically restrain the patient. d. Talk to the patient in a calm, nonthreatening manner. ANS: D Verbal intervention provides the least restrictive alternative in this situation. Verbal intervention might halt escalation and prevent the need for medication or the use of restraint or seclusion. Seclusion, restraint, and medication usage are all more restrictive than verbal intervention. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 16. A patient was restrained after assaulting a staff member. Which nursing measure has priority? a. Assess the patient for comfort needs every 15 minutes. b. Maintain constant supervision of the patient. NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M c. Administer a sedating medication after applying the restraints. d. Distract the patient at frequent intervals while restraints are in use. ANS: B Restrained patients must be constantly observed, with documentation of physical safety and comfort interventions occurring at 15-minute intervals. Medication may be administered, but this is not the priority action. Distraction is not an effective technique to use when a patient is in restraints, because minimal stimulation is preferred. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 17. Which patient behavior should be considered when evaluating the need for an involuntary commitment for psychiatric treatment? a. Noncompliant with the treatment regimen b. Engaging in the selling and distribution of illegal drugs c. Verbalizing the threat to “eliminate anyone who comes near me” d. Living on the streets ANS: C Involuntary commitment protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization since there is not direct threat of harm to self or to others. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effective Care Environment 18. A patient who is admitted involuntarily with a diagnosis of bipolar disorder, manic phase, refuses a prescribed dose of lithium. The nurse assembles a show of force and intimidates the patient into taking the medication. What is a likely an outcome of this action for the patient? a. A lessening of mania b. Grounds for a civil suit against the nurse for assault c. Grounds to sue the hospital for false imprisonment d. Improved nurse-patient relationship ANS: B A nurse who forces a patient to accept treatment or take medication in a nonemergency situation against the patient’s wishes can be found liable for assault (threatening) and battery (nonconsenting touching) in civil court, even if the nurse had the best interest of the patient in mind. Such action would not serve to improve the nurse-patient relationship. Diminished symptoms of mania are not likely to be related to a single dose of lithium. The scenario does not describe the conditions of false imprisonment. Actions taken in the best interest of the patient that violate the patient’s rights are cause for civil action. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 19. To reduce the risk of a lawsuit based on false imprisonment, mental health nurses must give the highest priority to which intervention? a. Educating patients about unit protocols b. Providing adequate treatment during hospitalization NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M c. Selecting the least restrictive treatment environment that will be effective d. Ensuring that patients have probable-cause hearings within 24 hours of admission ANS: C Treating a patient in the least restrictive environment that will be effective lessens the threat of the patient bringing civil suit for false imprisonment. In the least restrictive environment, the disruption to patient rights is minimized. Providing information about unit rules and providing adequate treatments are of less immediate importance than ensuring the least restrictive alternative. Probable-cause hearings are necessary only in certain cases. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment 20. How many violations of Medicare and Medicaid guidelines are evident in this documentation? Patient assaulted nurse in hall at 1730. Staff provided verbal intervention, but patient continued to strike out. Patient placed in seclusion at 1745. Observation instituted at hourly intervals. Order received from physician at 1930. Patient sleeping soundly at 2100. Patient released from seclusion at 2230 and returned to own room. a. Two b. Three c. Four d. Five ANS: D Constant observation of a secluded individual is necessary, with attention given at frequent intervals for safety and comfort interventions. No mention is made of providing fluids or bathroom privileges. Seclusion requires a written order posted within 1 hour. Seclusion must be terminated when patient behavior permits. If the patient is calm enough to sleep, the need for seclusion should be re-evaluated. The patient should be debriefed after the seclusion. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 21. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate to a patient diagnosed with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop, stop. I don’t want to take that medicine anymore. I hate the side effects.” What action should the nurse take? a. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.” b. Proceed with the injection but explain to the patient that there are medications that may help reduce the unpleasant side effects. c. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.” d. Notify other staff to report to the room for a show of force, and proceed with the injection, using restraint if necessary. ANS: A NURSINGTB.COM Psychiatric Nursing 8th Edition Keltner Test Bank NU RS IN GT B.CO M The nurse, as an advocate and educator, should seek more information about the patient’s decision and should not force the medication. Patients with mental illness retain their civil rights unless there is clear, cogent, and convincing evidence of dangerousness. The patient in this situation presents no evidence of dangerousness. It is not reasonable to promise a reduction in side effects without first discussing them, nor is it appropriate to pressure the patient into taking the medication. The medication cannot be given without the patient’s informed consent. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 22. A nurse engaging in which behavior demonstrates a need for addition education regarding the release of patient information without expressed written consent? a. Providing the estimated date of discharge to the patient’s employer b. Documenting the patient’s daily behaviors during hospitalization c. Discussing the patient’s history with other team members during care planning d. Documenting in the medical record the date and circumstances information was released to the court system ANS: A Release of information to individuals or entities without patient authorization violates the patient’s right to privacy. Documentation is a nursing responsibility and both the treatment care team and the court have the right to access such information. DIF: Cognitive level: Evaluating TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 23. An adolescent hospitalized after a violent physical outburst tells the nurse, “I’m going to kill my parents, but you can’t tell them.” Select the nurse’s initial response. a. “You’re right. Federal law requires me to keep information private.” b. “Those kinds of threats will make your hospitalization last much longer.” c. “You really should share this thought with your psychiatrist.” d. “I am required to talk to the treatment team about your threats.” ANS: D Breach of nurse-patient confidentiality does not pose a legal dilemma for nurses in these circumstances, because a team approach to delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should know that the team may have to warn the patient’s parents of the risk for harm. Considering this information, none of the other options is accurate. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 24. A patient’s insurance will not pay for continuing hospitalization at a private facility, so the family considers transferring the patient to a public psychiatric hospital. They express concern that the patient will “never get any treatment.” Select the nurse’s most helpful reply to their concern. a. “Under the law, treatment must be provided. Hospitalization without treatment violates patients’ rights.”