TEST BANK - Keltners Psychiatric Nursing, 9th Edition (Steele), Chapters 1 - 36 | All Chapters Complete

Table of Contents Chapter 01 Me, Meds, Milieu 1 Chapter 02 Historical Issues 11 Chapter 03 Legal Issues 19 Chapter 04 Psychobiologic Bases of Behavior 29 Chapter 05 Cultural Issues 38 Chapter 06 Spiritual Issues 47 Chapter 07 Models for Working with Psychiatric Patients Chapter 08 Learning to Communicate Professionally 54 64 Chapter 09 Working With an Individual Patient 72 Chapter 10 Working With Groups of Patients 86 Chapter 11 Working With the Family 95 Chapter 12 Introduction to Psychotropic Drugs 103 Chapter 13 Antiparkinsonian Drugs 110 Chapter 14 Antipsychotic Drugs 118 Chapter 15 Antidepressant Drugs 128 Chapter 16 Antimanic Drugs 135 Chapter 17 Antianxiety Drugs 143 Chapter 18 Antidementia Drugs 152 Chapter 19 Alternative Preparations and Over-the-Counter Drugs 158 Chapter 20 Introduction to Milieu Management 165 Chapter 21 Variables Affecting the Therapeutic Environment Violence and Suicide 173 Chapter 22 Therapeutic Environment in Various Treatment Settings 185 Chapter 23 Introduction to Psychopathology 191 Chapter 24 Schizophrenia Spectrum and Other Psychotic Disorders 197 Chapter 25 Depressive Disorders 204 Chapter 26 Bipolar Disorders 211 Chapter 27 Anxiety-Related, Obsessive-Compulsive, Trauma- and Stressor-Related, Somatic, and Dissociative Disorders 218 Chapter 28 Neurocognitive Disorders 227 Chapter 29 Personality Disorders 236 Chapter 30 Sexual Disorders and Gender Dysphoria 245 Chapter 31 Substance Use Disorders 252 Chapter 32 Eating Disorders 261 Chapter 33 Survivors of Violence and Trauma 268 Chapter 34 Children and Adolescents 277 Chapter 35 Older Adults 284 Chapter 36 Soldiers and Veterans 291 Chapter 01: Med, Meds, Milieu Keltner: Psychiatric Nursing, 8th Edition MULTIPLE CHOICE 1. A newly licensed 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.‖ ANSWER: 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 ANSWER: 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 frequent 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 the disease process of schizophrenia with the client and their domestic partner b. Minimizing contact between this patient and other patients to assure a stress free milieu c. Administering PRN medication when first observing the evidence that the client may be hallucinating d. Independently determining that behavior modification is appropriate to decrease the client‘s paranoid thoughts ANSWER: A An 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 by the care team. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which intervention is critical in assuring long-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 ANSWER: D A critical element of psychotherapeutic management is the presence of a therapeutic nurse-patient relationship. One-on-one time with nursing staff will help in establishing this connection. While the other options are appropriate and 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: Implementation MSC: Client Needs: Psychosocial Integrity 5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessment question demonstrates the nurse‘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?‖ ANSWER: B It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of psychosis as well as for a lessening 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. While the other options may be appropriate assessment questions, they are not directed at the current needs of the client; the identification of emerging psychotic behaviors. DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Physiologic Integrity 6. Which statement forms the foundation upon which a nurse should base the implementation of psychotherapeutic management to the care of a patient with mental illness? a. The nurse‘s role in client care is supported by the multidisciplinary team. b. Omitting any one component will compromise the effectiveness of the 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. ANSWER: B When one element is missing, treatment is usually compromised. No single element is more important than the others; however, patients‘ needs govern the application of the components and permit judicious use. The remaining options identify components of the psychotherapeutic management process. DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis MSC: 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 PRN medications to help the client manage anger.‖ b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient responses.‖ c. ―Nurses administers medications while evaluating drug effectiveness is a medical responsibility.‖ d. ―To best assure appropriate response, a patient‘s questions about drug therapy should be referred to the psychiatrist.‖ ANSWER: A Nursing assessment and analysis of data might suggest the need for PRN medication as patient anxiety increases or psychotic symptoms become more acute. The nurse is the health team member who makes this determination. Nurses are responsible for monitoring drug effectiveness as well as administering medication. Nurses should assume responsibility for teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages of medications unless they have prescriptive privileges. DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis MSC: Client Needs: Safe, Effective Care Environment 8. When considering environmental aspects of milieu management, which intervention has the highest priority for a client admitted after 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 ANSWER: B Milieu management provides a proactive approach to care. Safety overrides all other dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All the remaining options are appropriate but none protect the client from the risk of another attempt to self-harm as effectively as one-on-one observation as part of suicide precautions. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment 9. The implementation of which unit policy directed at milieu balance would reflect a need for reconsideration on the part of the treatment team? a. All clients will receive verbal and written information explaining unit rules. b. Unit clients will engage in all unit activities to assure interaction with both staff and other clients. c. All clients will be uniformly expected to present themselves in a nonviolent manner to both staff and other clients. d. At times of unit stress, client will return to their rooms. ANSWER: B The situation described suggests a milieu in which patients have no time for planned therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining options address unit norms, limit setting, and environmental modifications that are reasonable and will contribute to a therapeutic milieu. DIF: Cognitive level: Evaluating TOP: Nursing process: Evaluation MSC: Client Needs: Safe, Effective Care Environment 10. Which intervention should the nurse implement when focusing on communicating therapeutically with a client? a. Explaining to the client why they will need to ask for a razor b. Providing the client with options to help achieve smoking cessation c. Encouraging the client to identify personal stressors d. Assuring the client that they can receive telephone call on the unit telephone ANSWER: C A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient relationship. An example of such communication is providing the client with an opportunity to safely identify personal stressors. The remaining options address safety, balance, and norms associated with their care. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity 11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s primary goal? a. Making an initial assessment b. Confirming the patient‘s problem c. Assessing potential dangerousness to self or others d. Determining the level of supervision needed for the patient ANSWER: C Risk assessment involves looking at dangerousness to self or others, the degree of disability, and whether or not the individual is acutely psychotic to determine the feasibility of community-based care versus hospital-based care. Risk assessment usually follows the initial assessment. Confirmation of the patient‘s problem is not part of the risk assessment protocol. Arranging entry into the mental health system will follow risk assessment if the patient is assessed as needing service. DIF: Cognitive level: Applying TOP: Nursing process: Assessment