TEST BANK: PSYCHIATRIC NURSING, 7TH EDITION BY KELTNER

Chapter 01: Me, Meds, Milieu MULTIPLE CHOICE 1. Select the best description of nursing practice in the psychiatric setting. a. The nurse primarily serves in a supportive role to other members of the team. b. The multidisciplinary approach eliminates the need to clearly define the responsibilities of nursing. c. Clearly differentiated nursing actions have been identified that distinguish nursing from other professions. d. Although professional role overlap exists, nursing offers unique contributions to psychotherapeutic management. ANS: D Professional role overlap cannot be denied; however, nursing is unique in its focus on and application of psychotherapeutic management. Psychiatric social workers do not have expertise in physical care. Ideally, all team members support each other. DIF: Cognitive level: Applying REF: p. 3 TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment 2. The primary element required to match individual patient needs with appropriate services is proper: 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 will provide the patient with optimal care at the lowest cost. The decision tree for the continuum of care establishes this fact. DIF: Cognitive level: Understanding REF: p. 7 TOP: Nursing process: Assessment MSC: NCLEX: Safe, Effective Care Environment 3. An adult with paranoid schizophrenia is hospitalized. This patient has frequent auditory hallucinations and walks about the unit, muttering. To use psychotherapeutic management effectively, it is most important for the nurse to: a. understand the disease process of schizophrenia. b. minimize contact between this patient and other patients. c. administer PRN medication before interacting with the patient. d. use behavior modification to decrease the frequency of hallucinations. ANS: AAn 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. DIF: Cognitive level: Applying REF: pp. 1-2 TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment 4. A depressed adult is hospitalized after a suicide attempt. The patient receives an antidepressant medication, is closely supervised, attends a variety of group therapies and activities, watches television during free time, and talks to visitors in the evening. Which additional intervention is needed in the patient‘s care? a. Milieu therapy b. Adequate drug therapy c. Increased contact with significant others d. Meaningful communication with nursing staff ANS: D Two of the three elements of psychotherapeutic management are present: psychopharmacology and milieu management. There is no evidence that the psychotherapeutic nurse–patient relationship exists. Maintaining contact with significant others is not considered an element of the psychotherapeutic management model. DIF: Cognitive level: Applying REF: pp. 1-2 TOP: Nursing process: Planning MSC: NCLEX: Psychosocial Integrity 5. A patient attends outpatient programs at a community mental health center and meets with the primary nurse regularly. Last week, the patient‘s haloperidol (Haldol) dose was reduced from 5 mg to 2 mg daily to decrease side effects. The nurse will need to monitor changes in: a. the activity schedule at the center. b. the nature of the patient‘s symptoms. c. attention given to the patient by other staff. d. balance among psychotherapeutic management elements. ANS: B It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of psychosis as well as for an amelioration 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. DIF: Cognitive level: Applying REF: p. 2 TOP: Nursing process: Assessment MSC: NCLEX: Physiologic Integrity 6. Which guideline should a nurse use when applying the components of psychotherapeutic management to the care of a patient with mental illness? a. The nurse‘s role in milieu management is secondary to that of social work. b. Omitting any one component usually will result in less effective 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.