Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
Test Bank – Keltner’s Psychiatric Nursing, 10th
Edition (Steele) | Verified Q&A | ISBN
9781975239152
Chapter 01: Me, Meds, Milieu
MULTIPLE CHOICE
1. A newly licensed nurse 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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
b. Evaluation
c. Assessment
d. Implementati
on
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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 frequently 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
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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 which is the identification of emerging psychotic behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
Assessment MSC: Client Needs: Physiologic Integrity
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
, Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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.‖
| ISBN 9781975239152
Test Bank – Keltner’s Psychiatric Nursing, 10th
Edition (Steele) | Verified Q&A | ISBN
9781975239152
Chapter 01: Me, Meds, Milieu
MULTIPLE CHOICE
1. A newly licensed nurse 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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
b. Evaluation
c. Assessment
d. Implementati
on
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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 frequently 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
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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 which is the identification of emerging psychotic behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
Assessment MSC: Client Needs: Physiologic Integrity
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
,Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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
, Test Bank – Keltner’s Psychiatric Nursing, 10th Edition (Steele) | Verified Q&A
| ISBN 9781975239152
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.‖
