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, Psychiatric Nursing 8th Edition Keltner Test Bank
Chapter 01: Med, Meds, Milieu
Keltner: Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly licensed asks a nursing recruiter for a description of nursing practice in the
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psychiatric setting. What is the nurse recruiter’s best response?
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a. “The nurse primarily serves in a supportive role to members of the health care
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delivery team.” T
b. “The multidisciplinary approach eliminates the need to clearly define the
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responsibilities of nursing in such a setting.” T T T T T T
c. “Nursing actions are identified by the institution that distinguishes nursing from
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other mental health professions.”
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d. “Nursing offers unique contributions to the psychotherapeutic management of
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psychiatric patients.” T
CORRECT:: D T
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
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application of psychotherapeutic management. Neither the facility nor the multidisciplinary
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team define the professional responsibilities of its members but rather utilizes their unique
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skills to provide holistic care. Ideally, all team members support each other and have
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functions within the team. T T T
DIF: Cognitive level: Analyzing TOP: Nursing process: T T T T T
Implementation MSC: Patient Needs: Safe, Effective Care Environment
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Ug pSroceNss wTill theOnurse focus upon to address the
2. Which component of the nursin T T T
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responsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
CORRECT:: C T
Proper assessment is critical for being able to determine the appropriate level of services that
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will provide optimal care while considering patient input and at the lowest cost. Planning and
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implementation utilizes the assessment data to identify and execute actions (treatment plan)
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that will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
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DIF: Cognitive level: Applying TOP: Nursing process: T T T T T
Assessment MSC: Patient Needs: Safe, Effective Care Environment
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3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations
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and walks about the unit, muttering. Which nursing action demonstrates the nurse’s
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understanding of effective psychotherapeutic management of this patient?
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a. Discussing the disease process of schizophrenia with the patient and their
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domestic partner T
b. Minimizing contact between this patient and other patients to assure a stress free
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milieu
c. Administering PRN medication when first observing the evidence that the patient T T T T T T T T T T
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, Psychiatric Nursing 8th Edition Keltner Test Bank
may be hallucinatingT T
d. Independently determining that behavior modification is appropriate to decrease T T T T T T T T T
the patient’s paranoid thoughts
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CORRECT:: A T
An understanding of psychopathology is the foundation on which the three components of
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psychotherapeutic management rest; it facilitates therapeutic communication and provides a basis T T T T T T T T T T T
for understanding psychopharmacology and milieu management. Minimizing contact between
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the patient and others and administering PRN medication indiscriminately are nontherapeutic
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interventions. Using behavior modification to decrease the frequency of hallucinations would
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need to be incorporated into the plan of care by the care team.
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DIF: Cognitive level: Applying TOP: Nursing process: T T T T T
Implementation MSC: Patient Needs: Safe, Effective Care Environment T T T T T T T
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
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intervention is critical in assuring long-term, effective patient care as described by
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psychotherapeutic management? T
a. Involvement in group therapies T T T
b. Focus of close supervision by the unit staff
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c. Maintaining effective communication with support system T T T T T
d. Frequently scheduled one-on-one time with nursing staff T T T T T T
CORRECT:: D T
A critical element of psychotherapeutic management is the presence of a therapeutic
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nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
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connection. While the other options are appropriate and patient centered, the nurse-patient
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relation is critical in the l o n g N
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- teUrm
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o f.qC
uaOliM
t y effective care to this patient.
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DIF: Cognitive level: Applying TOP: Nursing process: T T T T T
Implementation MSC: Patient Needs: Psychosocial Integrity T T T T T
5. A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
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assessment question demonstrates the nurse’s understanding of the resulting needs of the
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patient?
a. “Will you have any difficulty getting your prescription refilled?”
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b. “Have you begun experiencing any forms of hallucinations?”
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c. “What do you expect will occur since the dosage has been reduced?”
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d. “What can I do to help you manage this reduction in haloperidol therapy?”
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CORRECT:: B T
It will be necessary for the nurse to assess for exacerbation of the patient’s symptoms of
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the return or
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worsening of positive symptoms such as hallucinations and delusions, and negative symptoms
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such as blunted affect, social withdrawal, and poor grooming. While the other options may be
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appropriate assessment questions, they are not directed at the current needs of the patient; the
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identification of emerging psychotic behaviors. T T T T
DIF: Cognitive level: Analyzing TOP: Nursing process: T T T T T
Assessment MSC: Patient Needs: Physiologic Integrity
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, Psychiatric Nursing 8th Edition Keltner Test Bank
6. Which statement forms the foundation upon which a nurse should base the implementation of
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psychotherapeutic management to the care of a patient with mental illness? T T T T T T T T T T
a. The nurse’s role in patient care is supported by the multidisciplinary team.
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b. Omitting any one component will compromise the effectiveness of the treatment.
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c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
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CORRECT:: B T
When one element is missing, treatment is usually compromised. No single element is more
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important than the others; however, patients’ needs govern the application of the components
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and permit judicious use. The remaining options identify components of the
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psychotherapeutic management process. T T
DIF: Cognitive level: Analyzing TOP: Nursing process: T T T T T
Analysis MSC: Patient Needs: Safe, Effective Care Environment
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7. Which statement most accurately describes a nurse’s role regarding psychopharmacology?
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a. “You will need to frequently make decisions regarding the administration of PRN
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medications to help the patient manage anger.” T T T T T T
b. “It’s a nursing responsibility to adjust a medication dose to assure effective patient
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responses.”
c. “Nurses administers medications while evaluating drug effectiveness is a medical
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responsibility.”
d. “To best assure appropriate response, a patient’s questions about drug therapy
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should be referred to the psychiatrist.” T T T T T
CORRECT:: A T
Nursing assessment and analN URofSdIata
ysis
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NGmig
TBh.t sCuOg gMe s t the need for PRN medication as T T T T T T T T T T T
patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
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team member who makes this determination. Nurses are responsible for monitoring drug
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effectiveness as well as administering medication. Nurses should assume responsibility for
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teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
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of medications unless they have prescriptive privileges.
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DIF: Cognitive level: Analyzing TOP: Nursing process: T T T T T
Analysis MSC: Patient Needs: Safe, Effective Care Environment
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8. When considering environmental aspects of milieu management, which intervention has the
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highest priority for a patient admitted after a failed suicide attempt?
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a. Sending the patient’s new medication prescriptions to the pharmacy
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b. Assigning a staff member to one-on-one observation of the patient T T T T T T T T T
c. Orienting the patient to the milieu’s public and private spaces T T T T T T T T T
d. Having all potentially dangerous items removed from the patient’s belongings
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CORRECT:: B T
Milieu management provides a proactive approach to care. Safety overrides all other
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dimensions of the milieu. Initiation of suicide precautions are the priority for this patient. All
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the remaining options are appropriate but none protect the patient from the risk of another
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attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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DIF: Cognitive level: Analyzing T T TOP: Nursing process: ImplementationT T T
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