Test Bank for Keltner’s Psychiatric
Nursing, 9th Edition 2026 | Study
Guide, Practice Questions, Answers,
Rationales & Exam Review
Unit I: The Basics
Questions 1–30
1. A nurse is reviewing the historical evolution of psychiatric nursing. Which of the
following events is credited with shifting the locus of care for the mentally ill from
institutions to the community?
A) The development of chlorpromazine in the 1950s
B) The publication of the Diagnostic and Statistical Manual of Mental Disorders
(DSM)
C) The deinstitutionalization movement of the 1960s
D) The establishment of the National Institute of Mental Health
Correct Answer: C
Rationale: The deinstitutionalization movement of the 1960s, fueled by
the advent of psychotropic medications, federal legislation, and a growing belief
in community-based care, resulted in the discharge of large numbers of patients
from state psychiatric hospitals to community settings. While chlorpromazine (A)
made community management more feasible, it was the policy and social
movement (C) that directly shifted the locus of care. The DSM (B) standardized
diagnosis but did not drive the shift, and NIMH (D) funded research but was not
the primary driver of deinstitutionalization.
2. A patient tells the nurse, "I don't believe in taking medications. I think prayer
and meditation are all I need." Which of the following responses by the nurse best
demonstrates cultural competence?
,A) "You need to take your medication or you will never get better."
B) "Your beliefs are important. Let's talk about how we can include your spiritual
practices while also following your treatment plan."
C) "Medication is the only evidence-based treatment for your condition."
D) "I will document that you are refusing treatment."
Correct Answer: B
Rationale: Cultural competence involves recognizing and respecting the
patient's spiritual and cultural beliefs while collaboratively integrating them into
the plan of care. Response B acknowledges the patient's beliefs and opens a
dialogue about combining spiritual practices with prescribed treatment. Response
A is dismissive and authoritarian. Response C is factually incorrect—many
conditions have non-pharmacological evidence-based treatments—and dismisses
the patient's values. Response D is premature and does not engage the patient in
shared decision-making.
3. Which of the following best describes the concept of milieu therapy as defined
in Keltner's model?
A) The use of physical restraints to control patient behavior
B) The purposeful manipulation of the environment to promote therapeutic
outcomes
C) A form of individual psychotherapy conducted in a group setting
D) The administration of psychotropic medications in a structured setting
Correct Answer: B
Rationale: Milieu therapy, as described in Keltner's three-pronged
approach, refers to the purposeful use of the treatment environment—including
its structure, activities, and social interactions—to promote therapeutic
outcomes. It is not about restraint (A), group psychotherapy (C), or medication
administration (D), though these may occur within a therapeutic milieu.
,4. A nurse is caring for a patient who has been admitted involuntarily. The patient
asks, "Why am I being held here against my will?" Which legal principle should
guide the nurse's response?
A) Patients admitted involuntarily have no right to refuse treatment.
B) Involuntary admission requires that the patient poses a danger to self or others
or is gravely disabled.
C) Involuntary admission can be initiated by any family member without a court
order.
D) Patients admitted involuntarily lose all civil rights upon admission.
Correct Answer: B
Rationale: Involuntary commitment laws vary by state, but the common
constitutional requirement is that a person must pose a danger to self or others
or be unable to care for basic needs (gravely disabled) to be held against their
will. Patients do not lose all rights (D), and family members cannot unilaterally
initiate commitment without legal procedures (C). Patients retain the right to
refuse treatment in many circumstances, though this may be overridden in
emergencies (A).
5. A nurse is conducting a spiritual assessment. Which question is most
appropriate to include?
A) "Do you believe in God?"
B) "What gives your life meaning and purpose?"
C) "Which religion do you practice?"
D) "Do you attend religious services regularly?"
Correct Answer: B
Rationale: A spiritual assessment should explore the patient's sources of
meaning, purpose, hope, and connection, which may or may not be religious.
Asking "What gives your life meaning and purpose?" (B) is open-ended and
inclusive. Asking about belief in God (A), religious affiliation (C), or service
attendance (D) may be appropriate follow-ups but are narrower and can alienate
patients who are not religious or whose spirituality is expressed differently.
, 6. A patient with a history of chronic mental illness is being discharged to the
community. Which of the following is the most important factor in preventing
relapse?
A) The patient's willingness to attend all scheduled appointments
B) The availability of a supportive family member
C) Consistent medication adherence
D) The patient's level of insight into their illness
Correct Answer: C
Rationale: Consistent medication adherence is the single most important
factor in preventing relapse for most chronic psychiatric disorders, particularly
schizophrenia and bipolar disorder. While appointment attendance (A), family
support (B), and insight (D) all contribute to recovery, none is as directly linked to
relapse prevention as medication adherence. Nonadherence is the leading cause
of relapse and rehospitalization.
7. A nurse is reviewing the psychobiologic bases of behavior. Which
neurotransmitter is most closely associated with the positive symptoms of
schizophrenia?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) Gamma-aminobutyric acid (GABA)
Correct Answer: B
Rationale: The dopamine hypothesis posits that positive symptoms of
schizophrenia (hallucinations, delusions, disorganized thinking) are related to
excessive dopaminergic activity in mesolimbic pathways. Serotonin (A) is
implicated in mood and anxiety disorders. Norepinephrine (C) is involved in
arousal, attention, and mood. GABA (D) is the primary inhibitory neurotransmitter
and is associated with anxiety and seizure disorders.
Nursing, 9th Edition 2026 | Study
Guide, Practice Questions, Answers,
Rationales & Exam Review
Unit I: The Basics
Questions 1–30
1. A nurse is reviewing the historical evolution of psychiatric nursing. Which of the
following events is credited with shifting the locus of care for the mentally ill from
institutions to the community?
A) The development of chlorpromazine in the 1950s
B) The publication of the Diagnostic and Statistical Manual of Mental Disorders
(DSM)
C) The deinstitutionalization movement of the 1960s
D) The establishment of the National Institute of Mental Health
Correct Answer: C
Rationale: The deinstitutionalization movement of the 1960s, fueled by
the advent of psychotropic medications, federal legislation, and a growing belief
in community-based care, resulted in the discharge of large numbers of patients
from state psychiatric hospitals to community settings. While chlorpromazine (A)
made community management more feasible, it was the policy and social
movement (C) that directly shifted the locus of care. The DSM (B) standardized
diagnosis but did not drive the shift, and NIMH (D) funded research but was not
the primary driver of deinstitutionalization.
2. A patient tells the nurse, "I don't believe in taking medications. I think prayer
and meditation are all I need." Which of the following responses by the nurse best
demonstrates cultural competence?
,A) "You need to take your medication or you will never get better."
B) "Your beliefs are important. Let's talk about how we can include your spiritual
practices while also following your treatment plan."
C) "Medication is the only evidence-based treatment for your condition."
D) "I will document that you are refusing treatment."
Correct Answer: B
Rationale: Cultural competence involves recognizing and respecting the
patient's spiritual and cultural beliefs while collaboratively integrating them into
the plan of care. Response B acknowledges the patient's beliefs and opens a
dialogue about combining spiritual practices with prescribed treatment. Response
A is dismissive and authoritarian. Response C is factually incorrect—many
conditions have non-pharmacological evidence-based treatments—and dismisses
the patient's values. Response D is premature and does not engage the patient in
shared decision-making.
3. Which of the following best describes the concept of milieu therapy as defined
in Keltner's model?
A) The use of physical restraints to control patient behavior
B) The purposeful manipulation of the environment to promote therapeutic
outcomes
C) A form of individual psychotherapy conducted in a group setting
D) The administration of psychotropic medications in a structured setting
Correct Answer: B
Rationale: Milieu therapy, as described in Keltner's three-pronged
approach, refers to the purposeful use of the treatment environment—including
its structure, activities, and social interactions—to promote therapeutic
outcomes. It is not about restraint (A), group psychotherapy (C), or medication
administration (D), though these may occur within a therapeutic milieu.
,4. A nurse is caring for a patient who has been admitted involuntarily. The patient
asks, "Why am I being held here against my will?" Which legal principle should
guide the nurse's response?
A) Patients admitted involuntarily have no right to refuse treatment.
B) Involuntary admission requires that the patient poses a danger to self or others
or is gravely disabled.
C) Involuntary admission can be initiated by any family member without a court
order.
D) Patients admitted involuntarily lose all civil rights upon admission.
Correct Answer: B
Rationale: Involuntary commitment laws vary by state, but the common
constitutional requirement is that a person must pose a danger to self or others
or be unable to care for basic needs (gravely disabled) to be held against their
will. Patients do not lose all rights (D), and family members cannot unilaterally
initiate commitment without legal procedures (C). Patients retain the right to
refuse treatment in many circumstances, though this may be overridden in
emergencies (A).
5. A nurse is conducting a spiritual assessment. Which question is most
appropriate to include?
A) "Do you believe in God?"
B) "What gives your life meaning and purpose?"
C) "Which religion do you practice?"
D) "Do you attend religious services regularly?"
Correct Answer: B
Rationale: A spiritual assessment should explore the patient's sources of
meaning, purpose, hope, and connection, which may or may not be religious.
Asking "What gives your life meaning and purpose?" (B) is open-ended and
inclusive. Asking about belief in God (A), religious affiliation (C), or service
attendance (D) may be appropriate follow-ups but are narrower and can alienate
patients who are not religious or whose spirituality is expressed differently.
, 6. A patient with a history of chronic mental illness is being discharged to the
community. Which of the following is the most important factor in preventing
relapse?
A) The patient's willingness to attend all scheduled appointments
B) The availability of a supportive family member
C) Consistent medication adherence
D) The patient's level of insight into their illness
Correct Answer: C
Rationale: Consistent medication adherence is the single most important
factor in preventing relapse for most chronic psychiatric disorders, particularly
schizophrenia and bipolar disorder. While appointment attendance (A), family
support (B), and insight (D) all contribute to recovery, none is as directly linked to
relapse prevention as medication adherence. Nonadherence is the leading cause
of relapse and rehospitalization.
7. A nurse is reviewing the psychobiologic bases of behavior. Which
neurotransmitter is most closely associated with the positive symptoms of
schizophrenia?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) Gamma-aminobutyric acid (GABA)
Correct Answer: B
Rationale: The dopamine hypothesis posits that positive symptoms of
schizophrenia (hallucinations, delusions, disorganized thinking) are related to
excessive dopaminergic activity in mesolimbic pathways. Serotonin (A) is
implicated in mood and anxiety disorders. Norepinephrine (C) is involved in
arousal, attention, and mood. GABA (D) is the primary inhibitory neurotransmitter
and is associated with anxiety and seizure disorders.
