Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. 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?
a. ―The nurse primarily serves in a supportive role to members of the health care
delivery team.‖
b. ―The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing in such a setting.‖
c. ―Nursing actions are identified by the institution that distinguishes nursing from
other mental health professions.‖
d. ―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
,2. Which component of the nursing process will the nurse focus upon to address the
responsibility to match individual patient needs with 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
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
3. 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?
,a. Discussing mthe mdisease mprocess mof mschizophrenia mwith mthe mclient mand mtheir
domestic mpartner
m
b. Minimizing mcontact mbetween mthis mpatient mand mother mpatients mto massure ma mstress-
free mmilieu
c. Administering mPRN mmedication mwhen mfirst mobserving mthe mevidence mthat mthe
mclient
, may mbe mhallucinating
d. Independently mdetermining mthat mbehavior mmodification mis mappropriate mto
mdecrease mthe mclient‘s mparanoid mthoughts
ANS: mA
An munderstanding mof mpsychopathology mis mthe mfoundation mon mwhich mthe mthree mcomponents
mof mpsychotherapeutic mmanagement mrest; mit mfacilitates mtherapeutic mcommunication mand
mprovides ma mbasis mfor munderstanding mpsychopharmacology mand mmilieu mmanagement.
mMinimizing mcontact mbetween mthe mpatient mand mothers mand madministering mPRN mmedication
mindiscriminately mare mnontherapeutic minterventions. mUsing mbehavior mmodification mto
mdecrease mthe mfrequency mof mhallucinations mwould mneed mto mbe mincorporated minto mthe mplan mof
mcare mby mthe mcare mteam.
DIF: Cognitive mlevel: mApplying TOP: mNursing mprocess:
mImplementation mMSC: mClient mNeeds: mSafe, mEffective mCare mEnvironment
4. An madult mdiagnosed mwith mchronic mdepression mis mhospitalized mafter ma msuicide mattempt.
m Which mintervention mis mcritical min massuring mlong-term, meffective mclient mcare mas
m described mby mpsychotherapeutic mmanagement?
a. Involvement min mgroup mtherapies
b. Focus mof mclose msupervision mby mthe munit mstaff
c. Maintaining meffective mcommunication mwith msupport
msystem
d. Frequently mscheduled mone-on-one mtime mwith mnursing
mstaff
ANS: mD
A mcritical melement mof mpsychotherapeutic mmanagement mis mthe mpresence mof ma mtherapeutic
nurse-patient mrelationship. mOne-on-one mtime mwith mnursing mstaff mwill mhelp min mestablishing
mthis mconnection. mWhile mthe mother moptions mare mappropriate mand mclient mcentered, mthe mnurse-
client mrelation mis mcritical min mthe mlong-term mdelivery mof mquality meffective mcare mto mthis mclient.
DIF: Cognitive mlevel: mApplying TOP: mNursing mprocess:
mImplementation mMSC: mClient mNeeds: mPsychosocial mIntegrity
5. A mpatient‘s mhaloperidol mdosage mwas mreduced m2 mweeks mago mto mdecrease mside meffects.
mWhat massessment mquestion mdemonstrates mthe mnurse‘s munderstanding mof mthe mresulting
mneeds mofmthe mclient?
a. ―Will myou mhave manymdifficultymgetting myour mprescription mrefilled?‖
b. ―Have m you mbegun mexperiencing many mforms mof mhallucinations?‖
c. ―What mdo myou mexpect mwill moccur msince mthe mdosage mhas mbeen mreduced?‖
d. ―What mcan mImdo mto mhelp myou mmanage mthis mreduction min mhaloperidol
mtherapy?‖
ANS: mB
It mwill mbe mnecessary mfor mthe mnurse mto massess mfor mexacerbation mof mthe mpatient‘s msymptoms
mof mpsychosis mas mwell mas mfor ma mlessening mof mside meffects. mDosage mdecrease mmight mlead mto
mthe mreturn mor mworsening mof mpositive msymptoms msuch mas mhallucinations mand mdelusions, mand
mnegative msymptoms msuch mas mblunted maffect, msocial mwithdrawal, mand mpoor mgrooming.
mWhile mthe mother moptions mmay mbe mappropriate massessment mquestions, mthey mare mnot mdirected
mat mthe mcurrent mneeds mof mthe mclient mwhich mis mthe midentification mof memerging mpsychotic
mbehaviors.
DIF: Cognitive mlevel: mAnalyzing TOP: mNursing mprocess:
mAssessment mMSC: mClient mNeeds: mPhysiologic mIntegrity
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. 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?
a. ―The nurse primarily serves in a supportive role to members of the health care
delivery team.‖
b. ―The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing in such a setting.‖
c. ―Nursing actions are identified by the institution that distinguishes nursing from
other mental health professions.‖
d. ―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
,2. Which component of the nursing process will the nurse focus upon to address the
responsibility to match individual patient needs with 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
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
3. 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?
,a. Discussing mthe mdisease mprocess mof mschizophrenia mwith mthe mclient mand mtheir
domestic mpartner
m
b. Minimizing mcontact mbetween mthis mpatient mand mother mpatients mto massure ma mstress-
free mmilieu
c. Administering mPRN mmedication mwhen mfirst mobserving mthe mevidence mthat mthe
mclient
, may mbe mhallucinating
d. Independently mdetermining mthat mbehavior mmodification mis mappropriate mto
mdecrease mthe mclient‘s mparanoid mthoughts
ANS: mA
An munderstanding mof mpsychopathology mis mthe mfoundation mon mwhich mthe mthree mcomponents
mof mpsychotherapeutic mmanagement mrest; mit mfacilitates mtherapeutic mcommunication mand
mprovides ma mbasis mfor munderstanding mpsychopharmacology mand mmilieu mmanagement.
mMinimizing mcontact mbetween mthe mpatient mand mothers mand madministering mPRN mmedication
mindiscriminately mare mnontherapeutic minterventions. mUsing mbehavior mmodification mto
mdecrease mthe mfrequency mof mhallucinations mwould mneed mto mbe mincorporated minto mthe mplan mof
mcare mby mthe mcare mteam.
DIF: Cognitive mlevel: mApplying TOP: mNursing mprocess:
mImplementation mMSC: mClient mNeeds: mSafe, mEffective mCare mEnvironment
4. An madult mdiagnosed mwith mchronic mdepression mis mhospitalized mafter ma msuicide mattempt.
m Which mintervention mis mcritical min massuring mlong-term, meffective mclient mcare mas
m described mby mpsychotherapeutic mmanagement?
a. Involvement min mgroup mtherapies
b. Focus mof mclose msupervision mby mthe munit mstaff
c. Maintaining meffective mcommunication mwith msupport
msystem
d. Frequently mscheduled mone-on-one mtime mwith mnursing
mstaff
ANS: mD
A mcritical melement mof mpsychotherapeutic mmanagement mis mthe mpresence mof ma mtherapeutic
nurse-patient mrelationship. mOne-on-one mtime mwith mnursing mstaff mwill mhelp min mestablishing
mthis mconnection. mWhile mthe mother moptions mare mappropriate mand mclient mcentered, mthe mnurse-
client mrelation mis mcritical min mthe mlong-term mdelivery mof mquality meffective mcare mto mthis mclient.
DIF: Cognitive mlevel: mApplying TOP: mNursing mprocess:
mImplementation mMSC: mClient mNeeds: mPsychosocial mIntegrity
5. A mpatient‘s mhaloperidol mdosage mwas mreduced m2 mweeks mago mto mdecrease mside meffects.
mWhat massessment mquestion mdemonstrates mthe mnurse‘s munderstanding mof mthe mresulting
mneeds mofmthe mclient?
a. ―Will myou mhave manymdifficultymgetting myour mprescription mrefilled?‖
b. ―Have m you mbegun mexperiencing many mforms mof mhallucinations?‖
c. ―What mdo myou mexpect mwill moccur msince mthe mdosage mhas mbeen mreduced?‖
d. ―What mcan mImdo mto mhelp myou mmanage mthis mreduction min mhaloperidol
mtherapy?‖
ANS: mB
It mwill mbe mnecessary mfor mthe mnurse mto massess mfor mexacerbation mof mthe mpatient‘s msymptoms
mof mpsychosis mas mwell mas mfor ma mlessening mof mside meffects. mDosage mdecrease mmight mlead mto
mthe mreturn mor mworsening mof mpositive msymptoms msuch mas mhallucinations mand mdelusions, mand
mnegative msymptoms msuch mas mblunted maffect, msocial mwithdrawal, mand mpoor mgrooming.
mWhile mthe mother moptions mmay mbe mappropriate massessment mquestions, mthey mare mnot mdirected
mat mthe mcurrent mneeds mof mthe mclient mwhich mis mthe midentification mof memerging mpsychotic
mbehaviors.
DIF: Cognitive mlevel: mAnalyzing TOP: mNursing mprocess:
mAssessment mMSC: mClient mNeeds: mPhysiologic mIntegrity
