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Chapter 01: Med, Meds, Milieu
Keltner: Psychiatric Nursing, 9th Edition
Te
MULTIPLE CHOICE
s t
1. A newly licensed asks a nursing recruiter for a description of nursing practice in the psychiatric
the nurserecruiter’s best response?
a. “The nurse primarily serves in a supportive role to members of the
health caredelivery team.”
b. “The multidisciplinary approach eliminates the need to clearly
define theresponsibilities of nursing in such a setting.”
c. “Nursing actions are identified by the institution that distinguishes
nursing fromother mental health professions.”
d. “Nursing offers unique contributions to the psychotherapeutic
management ofpsychiatric patients.”
ANS: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and appl
management. Neither the facility nor the multidisciplinary team define the professional respons
rather utilizes their unique skills to provide holistic care. Ideally, all team members support eac
within the team.
DIF: Cognitive level: Analyzing TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
2. Which component of the nursing process will the nurse focus upon to address the responsibility
patient needswith 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 w
while considering patient input and at the lowest cost. Planning and implementation utilizes the
identify and executeactions (treatment plan) that will provide appropriate care. Evaluation valid
of the treatment plan.
DIF: Cognitive level: Applying TOP: Nursing process:
, @
ANS: A
An understanding of psychopathology is the foundation on which the three components of psyc
Te
management rest; itfacilitates therapeutic communication and provides a basis for understandin
s
and milieu management.
t
Minimizing contact between the patient and others and administering PRN medication indiscri
nontherapeutic interventions. Using behavior modification to decrease the frequency of hallucin
incorporated into the planof care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which interv
in assuringlong-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-pati
on-one timewith nursing staff will help in establishing this connection. While the other options
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:
ImplementationMSC: Client Needs: Psychosocial Integrity
5. A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessm
demonstrates thenurse’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 psycho
lessening of sideeffects. Dosage decrease might lead to the return or worsening of positive sym
hallucinations and delusions, and negative symptoms such as blunted affect, social withdrawal,
, however, patients’ needs govern the application of the components and permit judicious use. Th
@
identify components ofthe psychotherapeutic management process.
Te
s
DIF: Cognitive level: Analyzing TOP: Nursing process:
t
AnalysisMSC: 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 PRNmedications to help the client manage anger.”
b. “It’s a nursing responsibility to adjust a medication dose to assure
effectivepatient responses.”
c. “Nurses administers medications while evaluating drug effectiveness is a
medicalresponsibility.”
d. “To best assure appropriate response, a patient’s questions about drug
therapyshould be referred to the psychiatrist.”
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as patient
psychotic symptoms become more acute. The nurse is the health team member who makes this
responsible for monitoring drug effectiveness as well as administering medication. Nurses shou
for teaching patients aboutthe side effects of medications. Nurses cannot alter prescribed dosag
they have prescriptive privileges.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
8. When considering environmental aspects of milieu management, which intervention has the hig
client admittedafter 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 dimension
of suicideprecautions are the priority for this client. All the remaining options are appropriate b
from the risk of another attempt to self-harm as effectively as one-on-one observation as part of
ia
af
m
nk
ba
st
Te
@
, @
Chapter 01: Med, Meds, Milieu
Keltner: Psychiatric Nursing, 9th Edition
Te
MULTIPLE CHOICE
s t
1. A newly licensed asks a nursing recruiter for a description of nursing practice in the psychiatric
the nurserecruiter’s best response?
a. “The nurse primarily serves in a supportive role to members of the
health caredelivery team.”
b. “The multidisciplinary approach eliminates the need to clearly
define theresponsibilities of nursing in such a setting.”
c. “Nursing actions are identified by the institution that distinguishes
nursing fromother mental health professions.”
d. “Nursing offers unique contributions to the psychotherapeutic
management ofpsychiatric patients.”
ANS: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and appl
management. Neither the facility nor the multidisciplinary team define the professional respons
rather utilizes their unique skills to provide holistic care. Ideally, all team members support eac
within the team.
DIF: Cognitive level: Analyzing TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
2. Which component of the nursing process will the nurse focus upon to address the responsibility
patient needswith 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 w
while considering patient input and at the lowest cost. Planning and implementation utilizes the
identify and executeactions (treatment plan) that will provide appropriate care. Evaluation valid
of the treatment plan.
DIF: Cognitive level: Applying TOP: Nursing process:
, @
ANS: A
An understanding of psychopathology is the foundation on which the three components of psyc
Te
management rest; itfacilitates therapeutic communication and provides a basis for understandin
s
and milieu management.
t
Minimizing contact between the patient and others and administering PRN medication indiscri
nontherapeutic interventions. Using behavior modification to decrease the frequency of hallucin
incorporated into the planof care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process:
ImplementationMSC: Client Needs: Safe, Effective Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which interv
in assuringlong-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-pati
on-one timewith nursing staff will help in establishing this connection. While the other options
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:
ImplementationMSC: Client Needs: Psychosocial Integrity
5. A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessm
demonstrates thenurse’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 psycho
lessening of sideeffects. Dosage decrease might lead to the return or worsening of positive sym
hallucinations and delusions, and negative symptoms such as blunted affect, social withdrawal,
, however, patients’ needs govern the application of the components and permit judicious use. Th
@
identify components ofthe psychotherapeutic management process.
Te
s
DIF: Cognitive level: Analyzing TOP: Nursing process:
t
AnalysisMSC: 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 PRNmedications to help the client manage anger.”
b. “It’s a nursing responsibility to adjust a medication dose to assure
effectivepatient responses.”
c. “Nurses administers medications while evaluating drug effectiveness is a
medicalresponsibility.”
d. “To best assure appropriate response, a patient’s questions about drug
therapyshould be referred to the psychiatrist.”
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as patient
psychotic symptoms become more acute. The nurse is the health team member who makes this
responsible for monitoring drug effectiveness as well as administering medication. Nurses shou
for teaching patients aboutthe side effects of medications. Nurses cannot alter prescribed dosag
they have prescriptive privileges.
DIF: Cognitive level: Analyzing TOP: Nursing process:
AnalysisMSC: Client Needs: Safe, Effective Care Environment
8. When considering environmental aspects of milieu management, which intervention has the hig
client admittedafter 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 dimension
of suicideprecautions are the priority for this client. All the remaining options are appropriate b
from the risk of another attempt to self-harm as effectively as one-on-one observation as part of
