,Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
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?
―The nurse primarily serves in a supportive role to members of the health
care delivery team.‖
―The multidisciplinary approach eliminates the need to clearly define
the responsibilities of nursing in such a setting.‖
―Nursing actions are identified by the institution that distinguishes nursing
from other mental health professions.‖
―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
Which component of the nursing process will the nurse focus upon to address the
responsibility to match individual patient needs with appropriate services?
Planning
Evaluation
Assessment
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
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?
, Discussing the disease process of schizophrenia with the client and their domestic
partner
Minimizing contact between this patient and other patients to assure a stress-free
milieu
Administering PRN medication when first observing the evidence that the client
may be hallucinating
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
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?
Involvement in group therapies
Focus of close supervision by the unit staff
Maintaining effective communication with support system
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
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?
―Will you have any difficulty getting your prescription refilled?‖
―Have you begun experiencing any forms of hallucinations?‖
―What do you expect will occur since the dosage has been reduced?‖
―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
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?
The nurse‘s role in client care is supported by the multidisciplinary team.
Omitting any one component will compromise the effectiveness of the treatment.
The most important element of psychotherapeutic management is drug therapy.
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
Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
―You will need to frequently make decisions regarding the administration of
PRN medications to help the client manage anger.‖
―It‘s a nursing responsibility to adjust a medication dose to assure effective
patient responses.‖
―Nurses administers medications while evaluating drug effectiveness is a
medical responsibility.‖
―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
When considering environmental aspects of milieu management, which intervention has
the highest priority for a client admitted after a failed suicide attempt?
Sending the client‘s new medication prescriptions to the pharmacy
Assigning a staff member to one-on-one observation of the client
Orienting the client to the milieu‘s public and private spaces
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
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
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?
―The nurse primarily serves in a supportive role to members of the health
care delivery team.‖
―The multidisciplinary approach eliminates the need to clearly define
the responsibilities of nursing in such a setting.‖
―Nursing actions are identified by the institution that distinguishes nursing
from other mental health professions.‖
―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
Which component of the nursing process will the nurse focus upon to address the
responsibility to match individual patient needs with appropriate services?
Planning
Evaluation
Assessment
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
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?
, Discussing the disease process of schizophrenia with the client and their domestic
partner
Minimizing contact between this patient and other patients to assure a stress-free
milieu
Administering PRN medication when first observing the evidence that the client
may be hallucinating
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
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?
Involvement in group therapies
Focus of close supervision by the unit staff
Maintaining effective communication with support system
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
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?
―Will you have any difficulty getting your prescription refilled?‖
―Have you begun experiencing any forms of hallucinations?‖
―What do you expect will occur since the dosage has been reduced?‖
―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
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?
The nurse‘s role in client care is supported by the multidisciplinary team.
Omitting any one component will compromise the effectiveness of the treatment.
The most important element of psychotherapeutic management is drug therapy.
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
Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
―You will need to frequently make decisions regarding the administration of
PRN medications to help the client manage anger.‖
―It‘s a nursing responsibility to adjust a medication dose to assure effective
patient responses.‖
―Nurses administers medications while evaluating drug effectiveness is a
medical responsibility.‖
―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
When considering environmental aspects of milieu management, which intervention has
the highest priority for a client admitted after a failed suicide attempt?
Sending the client‘s new medication prescriptions to the pharmacy
Assigning a staff member to one-on-one observation of the client
Orienting the client to the milieu‘s public and private spaces
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
