Test Bank for Keltner’s Psychiatric n n n n n
nNursing, 9th Edition by Debbie Steele n n n n n n
|Chapter1-36 |All Chapters n n n n
Chapter 01: Me, Meds, Milieu
n n n n
Steele: Keltner’s Psychiatric Nursing, 9th Edition
n n n n n
MULTIPLE CHOICE n
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the
n n n n n n n n n n n n n n n
psychiatric setting. What is the nurse recruiter‘s best response?
n n n n n n n n n
a. ―The nurse primarily serves in a supportive role to members of the health care
n n n n n n n n n n n n n
delivery team.‖
n n
b. ―The multidisciplinary approach eliminates the need to clearly define the
n n n n n n n n n
responsibilities of nursing in such a setting.‖
n n n n n n n
c. ―Nursing actions are identified by the institution that distinguishes nursing from
n n n n n n n n n n
other mental health professions.‖
n n n n
d. ―Nursing offers unique contributions to the psychotherapeutic management of
n n n n n n n n
psychiatric patients.‖
n n
ANS: D n
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
n n n n n n n n n n n n n n
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
n n n n n n n n n n
team define the professional responsibilities of its members but rather utilizes their unique
n n n n n n n n n n n n n
skills to provide holistic care. Ideally, all team members support each other and have
n n n n n n n n n n n n n n
functions within the team.
n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
2. Which component of the nursing process will the nurse focus upon to address the
n n n n n n n n n n n n n
responsibility to match individual patient needs with appropriate services?
n n n n n n n n n
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C n
Proper assessment is critical for being able to determine the appropriate level of services that
n n n n n n n n n n n n n n
will provide optimal care while considering patient input and at the lowest cost. Planning and
n n n n n n n n n n n n n n n
implementation utilizes the assessment data to identify and execute actions (treatment plan)
n n n n n n n n n n n n
that will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Assessment n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
n n n n n n n n
hallucinations and walks about the unit, muttering. Which nursing action demonstrates the
n n n n n n n n n n n n
nurse‘s understanding of effective psychotherapeutic management of this client?
n n n n n n n n n
,a. Discussing the disease process of schizophrenia with the client and their domestic
n n n n n n n n n n n
partner
n
b. Minimizing contact between this patient and other patients to assure a stress-free
n n n n n n n n n n n
milieu
n
c. Administering PRN medication when first observing the evidence that the client
n n n n n n n n n n
, may be hallucinating
n n
d. Independently determining that behavior modification is appropriate to decrease n n n n n n n n
n the client‘s paranoid thoughts
n n n
ANS: A n
An understanding of psychopathology is the foundation on which the three components of
n n n n n n n n n n n n
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
n n n n n n n n n n
basis for understanding psychopharmacology and milieu management. Minimizing contact
n n n n n n n n n
between the patient and others and administering PRN medication indiscriminately are
n n n n n n n n n n n
nontherapeutic interventions. Using behavior modification to decrease the frequency of
n n n n n n n n n n
hallucinations would need to be incorporated into the plan of care by the care team.
n n n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Implementation n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
n n n n n n n n n n n n
intervention is critical in assuring long-term, effective client care as described by
n n n n n n n n n n n n
psychotherapeutic management?
n n
a. Involvement in group therapies n n n
b. Focus of close supervision by the unit staff
n n n n n n n
c. Maintaining effective communication with support system n n n n n
d. Frequently scheduled one-on-one time with nursing staff n n n n n n
ANS: D n
A critical element of psychotherapeutic management is the presence of a therapeutic
n n n n n n n n n n n
nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
n n n n n n n n n n n
connection. While the other options are appropriate and client centered, the nurse-client
n n n n n n n n n n n n
relation is critical in the long-term delivery of quality effective care to this client.
n n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Implementation n n n n n
MSC: Client Needs: Psychosocial Integrity
n n n n n
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
n n n n n n n n n n n n n
assessment question demonstrates the nurse‘s understanding of the resulting needs ofthe
n n n n n n n n n n n n
client?
n
a. ―Will you have any difficulty getting your prescription refilled?‖
n n n n n n n n
b. ―Have you begun experiencing any forms of hallucinations?‖
n n n n n n n
c. ―What do you expect will occur since the dosage has been reduced?‖
n n n n n n n n n n n
d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
n n n n n n n n n n n n
ANS: B n
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
n n n n n n n n n n n n n n n
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the return
n n n n n n n n n n n n n n n n n
or worsening of positive symptoms such as hallucinations and delusions, and negative
n n n n n n n n n n n n
symptoms such as blunted affect, social withdrawal, and poor grooming. While the other
n n n n n n n n n n n n n
options may be appropriate assessment questions, they are not directed at the current needs of
n n n n n n n n n n n n n n n
the client which is the identification of emerging psychotic behaviors.
n n n n n n n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment n n n n n
MSC: Client Needs: Physiologic Integrity
n n n n n
, 6. Which statement forms the foundation upon which a nurse should base the implementationof
n n n n n n n n n n n n
psychotherapeutic management to the care of a patient with mental illness?
n n n n n n n n n n n
a. The nurse‘s role in client care is supported by the multidisciplinary team.
n n n n n n n n n n n
b. Omitting any one component will compromise the effectiveness of the treatment.
n n n n n n n n n n
c. The most important element of psychotherapeutic management is drug therapy.
n n n n n n n n n
d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
n n n n n n n n n n
ANS: B n
When one element is missing, treatment is usually compromised. No single element is more
n n n n n n n n n n n n n
important than the others; however, patients‘ needs govern the application of the components
n n n n n n n n n n n n n
and permit judicious use. The remaining options identify components of the
n n n n n n n n n n n
psychotherapeutic management process.
n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
n n n n n n n n n
a. ―You will need to frequently make decisions regarding the administration of PRN
n n n n n n n n n n n
medications to help the client manage anger.‖
n n n n n n n
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
n n n n n n n n n n n n
responses.‖
n
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
n n n n n n n n n
responsibility.‖
n
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
n n n n n n n n n n
should be referred to the psychiatrist.‖
n n n n n n
ANS: A n
Nursing assessment and analysis of data might suggest the need for PRN medication as
n n n n n n n n n n n n n
patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
n n n n n n n n n n n n n n
team member who makes this determination. Nurses are responsible for monitoring drug
n n n n n n n n n n n n
effectiveness as well as administering medication. Nurses should assume responsibility for
n n n n n n n n n n n
teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
n n n n n n n n n n n n n
of medications unless they have prescriptive privileges.
n n n n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
8. When considering environmental aspects of milieu management, which intervention has the
n n n n n n n n n n
highest priority for a client admitted after a failed suicide attempt?
n n n n n n n n n n n
a. Sending the client‘s new medication prescriptions to the pharmacy
n n n n n n n n
b. Assigning a staff member to one-on-one observation of the client n n n n n n n n n
c. Orienting the client to the milieu‘s public and private spaces
n n n n n n n n n
d. Having all potentially dangerous items removed from the client‘s belongings
n n n n n n n n n
ANS: B n
Milieu management provides a proactive approach to care. Safety overrides all other
n n n n n n n n n n n
dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
n n n n n n n n n n n n n n n
the remaining options are appropriate but none protect the client from the risk of another
n n n n n n n n n n n n n n n
attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
n n n n n n n n n n n n n
DIF: Cognitive level: Analyzing n n TOP: Nursing process: Implementationn n n
nNursing, 9th Edition by Debbie Steele n n n n n n
|Chapter1-36 |All Chapters n n n n
Chapter 01: Me, Meds, Milieu
n n n n
Steele: Keltner’s Psychiatric Nursing, 9th Edition
n n n n n
MULTIPLE CHOICE n
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the
n n n n n n n n n n n n n n n
psychiatric setting. What is the nurse recruiter‘s best response?
n n n n n n n n n
a. ―The nurse primarily serves in a supportive role to members of the health care
n n n n n n n n n n n n n
delivery team.‖
n n
b. ―The multidisciplinary approach eliminates the need to clearly define the
n n n n n n n n n
responsibilities of nursing in such a setting.‖
n n n n n n n
c. ―Nursing actions are identified by the institution that distinguishes nursing from
n n n n n n n n n n
other mental health professions.‖
n n n n
d. ―Nursing offers unique contributions to the psychotherapeutic management of
n n n n n n n n
psychiatric patients.‖
n n
ANS: D n
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
n n n n n n n n n n n n n n
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
n n n n n n n n n n
team define the professional responsibilities of its members but rather utilizes their unique
n n n n n n n n n n n n n
skills to provide holistic care. Ideally, all team members support each other and have
n n n n n n n n n n n n n n
functions within the team.
n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
2. Which component of the nursing process will the nurse focus upon to address the
n n n n n n n n n n n n n
responsibility to match individual patient needs with appropriate services?
n n n n n n n n n
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C n
Proper assessment is critical for being able to determine the appropriate level of services that
n n n n n n n n n n n n n n
will provide optimal care while considering patient input and at the lowest cost. Planning and
n n n n n n n n n n n n n n n
implementation utilizes the assessment data to identify and execute actions (treatment plan)
n n n n n n n n n n n n
that will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Assessment n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
n n n n n n n n
hallucinations and walks about the unit, muttering. Which nursing action demonstrates the
n n n n n n n n n n n n
nurse‘s understanding of effective psychotherapeutic management of this client?
n n n n n n n n n
,a. Discussing the disease process of schizophrenia with the client and their domestic
n n n n n n n n n n n
partner
n
b. Minimizing contact between this patient and other patients to assure a stress-free
n n n n n n n n n n n
milieu
n
c. Administering PRN medication when first observing the evidence that the client
n n n n n n n n n n
, may be hallucinating
n n
d. Independently determining that behavior modification is appropriate to decrease n n n n n n n n
n the client‘s paranoid thoughts
n n n
ANS: A n
An understanding of psychopathology is the foundation on which the three components of
n n n n n n n n n n n n
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
n n n n n n n n n n
basis for understanding psychopharmacology and milieu management. Minimizing contact
n n n n n n n n n
between the patient and others and administering PRN medication indiscriminately are
n n n n n n n n n n n
nontherapeutic interventions. Using behavior modification to decrease the frequency of
n n n n n n n n n n
hallucinations would need to be incorporated into the plan of care by the care team.
n n n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Implementation n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
n n n n n n n n n n n n
intervention is critical in assuring long-term, effective client care as described by
n n n n n n n n n n n n
psychotherapeutic management?
n n
a. Involvement in group therapies n n n
b. Focus of close supervision by the unit staff
n n n n n n n
c. Maintaining effective communication with support system n n n n n
d. Frequently scheduled one-on-one time with nursing staff n n n n n n
ANS: D n
A critical element of psychotherapeutic management is the presence of a therapeutic
n n n n n n n n n n n
nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
n n n n n n n n n n n
connection. While the other options are appropriate and client centered, the nurse-client
n n n n n n n n n n n n
relation is critical in the long-term delivery of quality effective care to this client.
n n n n n n n n n n n n n n
DIF: Cognitive level: Applying TOP: Nursing process: Implementation n n n n n
MSC: Client Needs: Psychosocial Integrity
n n n n n
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
n n n n n n n n n n n n n
assessment question demonstrates the nurse‘s understanding of the resulting needs ofthe
n n n n n n n n n n n n
client?
n
a. ―Will you have any difficulty getting your prescription refilled?‖
n n n n n n n n
b. ―Have you begun experiencing any forms of hallucinations?‖
n n n n n n n
c. ―What do you expect will occur since the dosage has been reduced?‖
n n n n n n n n n n n
d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
n n n n n n n n n n n n
ANS: B n
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
n n n n n n n n n n n n n n n
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the return
n n n n n n n n n n n n n n n n n
or worsening of positive symptoms such as hallucinations and delusions, and negative
n n n n n n n n n n n n
symptoms such as blunted affect, social withdrawal, and poor grooming. While the other
n n n n n n n n n n n n n
options may be appropriate assessment questions, they are not directed at the current needs of
n n n n n n n n n n n n n n n
the client which is the identification of emerging psychotic behaviors.
n n n n n n n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment n n n n n
MSC: Client Needs: Physiologic Integrity
n n n n n
, 6. Which statement forms the foundation upon which a nurse should base the implementationof
n n n n n n n n n n n n
psychotherapeutic management to the care of a patient with mental illness?
n n n n n n n n n n n
a. The nurse‘s role in client care is supported by the multidisciplinary team.
n n n n n n n n n n n
b. Omitting any one component will compromise the effectiveness of the treatment.
n n n n n n n n n n
c. The most important element of psychotherapeutic management is drug therapy.
n n n n n n n n n
d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
n n n n n n n n n n
ANS: B n
When one element is missing, treatment is usually compromised. No single element is more
n n n n n n n n n n n n n
important than the others; however, patients‘ needs govern the application of the components
n n n n n n n n n n n n n
and permit judicious use. The remaining options identify components of the
n n n n n n n n n n n
psychotherapeutic management process.
n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
n n n n n n n n n
a. ―You will need to frequently make decisions regarding the administration of PRN
n n n n n n n n n n n
medications to help the client manage anger.‖
n n n n n n n
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
n n n n n n n n n n n n
responses.‖
n
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
n n n n n n n n n
responsibility.‖
n
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
n n n n n n n n n n
should be referred to the psychiatrist.‖
n n n n n n
ANS: A n
Nursing assessment and analysis of data might suggest the need for PRN medication as
n n n n n n n n n n n n n
patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
n n n n n n n n n n n n n n
team member who makes this determination. Nurses are responsible for monitoring drug
n n n n n n n n n n n n
effectiveness as well as administering medication. Nurses should assume responsibility for
n n n n n n n n n n n
teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
n n n n n n n n n n n n n
of medications unless they have prescriptive privileges.
n n n n n n n
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis n n n n n
MSC: Client Needs: Safe, Effective Care Environment
n n n n n n n
8. When considering environmental aspects of milieu management, which intervention has the
n n n n n n n n n n
highest priority for a client admitted after a failed suicide attempt?
n n n n n n n n n n n
a. Sending the client‘s new medication prescriptions to the pharmacy
n n n n n n n n
b. Assigning a staff member to one-on-one observation of the client n n n n n n n n n
c. Orienting the client to the milieu‘s public and private spaces
n n n n n n n n n
d. Having all potentially dangerous items removed from the client‘s belongings
n n n n n n n n n
ANS: B n
Milieu management provides a proactive approach to care. Safety overrides all other
n n n n n n n n n n n
dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
n n n n n n n n n n n n n n n
the remaining options are appropriate but none protect the client from the risk of another
n n n n n n n n n n n n n n n
attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
n n n n n n n n n n n n n
DIF: Cognitive level: Analyzing n n TOP: Nursing process: Implementationn n n
