TEST BANK FOR KELTNER’S PSYCHIATRIC NURSING, 9TH
ss ss ss ss ss ss
EDITION BY DEBBIE STEELE ALL CHAPTERS (1-36) |A+
ss ss ss ss ss ss ss ss
ULTIMATE GUIDE 2025 ss ss ss
Chapter 01: Me, Meds, Milieu
ss ss ss ss
Steele: Keltner’s Psychiatric Nursing, 9th Edition
ss ss ss ss ss
MULTIPLE CHOICE ss
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
the psychiatric setting. What is the nurse recruiter‘s best response?
ss ss ss ss ss ss ss ss ss ss
a. ―The nurse primarily serves in a supportive role to members of the health care
ss ss ss ss ss ss ss ss ss ss ss ss ss
delivery team.‖ ss
b. ―The multidisciplinary approach eliminates the need to clearly define the
ss ss ss ss ss ss ss ss ss
responsibilities of nursing in such a setting.‖ ss ss ss ss ss ss
c. ―Nursing actions are identified by the institution that distinguishes nursing
ss ss ss ss ss ss ss ss ss
from ss
other mental health professions.‖ ss ss ss
d. ―Nursing offers unique contributions to the psychotherapeutic management of
ss ss ss ss ss ss ss ss
psychiatric patients.‖ ss
ANS: s s D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
ss ss ss ss ss ss ss ss ss ss
team define the professional responsibilities of its members but rather utilizes their unique
ss ss ss ss ss ss ss ss ss ss ss ss ss
skills to provide holistic care. Ideally, all team members support each other and have
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
functions within the team.
ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
2. Which component of the nursing process will the nurse focus upon to address
ss ss ss ss ss ss ss ss ss ss ss ss
ss the responsibility to match individual patient needs with appropriate services?
ss ss ss ss ss ss ss ss ss
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: s s C
Proper assessment is critical for being able to determine the appropriate level of services
ss ss ss ss ss ss ss ss ss ss ss ss ss
that will provide optimal care while considering patient input and at the lowest cost.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Planning and implementation utilizes the assessment data to identify and execute actions
ss ss ss ss ss ss ss ss ss ss ss ss
(treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of
ss ss ss ss ss ss ss ss ss ss ss ss
the treatment plan.
ss ss ss
, DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Assessment MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
ss ss ss ss ss ss ss ss
hallucinations and walks about the unit, muttering. Which nursing action demonstrates
ss ss ss ss ss ss ss ss ss ss ss
the nurse‘s understanding of effective psychotherapeutic management of this client?
ss ss ss ss ss ss ss ss ss ss
a. Discussing the disease process of schizophrenia with the client and their
ss ss ss ss ss ss ss ss ss ss
domestic ss
partner
b. Minimizing contact between this patient and other patients to assure a stress-
ss ss ss ss ss ss ss ss ss ss ss
free
milieu
c. Administering PRN medication when first observing the evidence that the client ss ss ss ss ss ss ss ss ss ss
may be hallucinating ss ss
d. Independently determining that behavior modification is appropriate to ss ss ss ss ss ss ss
decrease ss
the client‘s paranoid thoughts
ss ss ss
ANS: s s A
An understanding of psychopathology is the foundation on which the three components of
ss ss ss ss ss ss ss ss ss ss ss ss
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
ss ss ss ss ss ss ss ss ss ss
basis for understanding psychopharmacology and milieu management. Minimizing contact
ss ss ss ss ss ss ss ss ss
between the patient and others and administering PRN medication indiscriminately are
ss ss ss ss ss ss ss ss ss ss ss
nontherapeutic interventions. Using behavior modification to decrease the frequency of
ss ss ss ss ss ss ss ss ss ss
hallucinations would need to be incorporated into the plan of care by the care team.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
ss ss ss ss ss ss ss ss ss ss ss
Which intervention is critical in assuring long-term, effective client care as described
ss ss ss ss ss ss ss ss ss ss ss ss
by psychotherapeutic management?
ss ss ss
a. Involvement in group therapies ss ss ss
b. Focus of close supervision by the unit staff
ss ss ss ss ss ss ss
c. Maintaining effective communication with support system ss ss ss ss ss
d. Frequently scheduled one-on-one time with nursing staff ss ss ss ss ss ss
ANS: s s D
A critical element of psychotherapeutic management is the presence of a therapeutic
ss ss ss ss ss ss ss ss ss ss ss
nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
ss ss ss ss ss ss ss ss ss ss ss
connection. While the other options are appropriate and client centered, the nurse-client
ss ss ss ss ss ss ss ss ss ss ss ss
relation is critical in the long-term delivery of quality effective care to this client.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Psychosocial Integrity
ss ss s s ss ss ss
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
ss ss ss ss ss ss ss ss ss ss ss ss
What assessment question demonstrates the nurse‘s understanding of the resulting
ss ss ss ss ss ss ss ss ss ss
needs of the client?
ss ss ss ss
a. ―Will you have any difficulty getting your prescription refilled?‖
ss ss ss ss ss ss ss ss
b. ―Have you begun experiencing any forms of hallucinations?‖
ss ss ss ss ss ss ss
c. ―What do you expect will occur since the dosage has been reduced?‖
ss ss ss ss ss ss ss ss ss ss ss
,d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
ss ss ss ss ss ss ss ss ss ss ss ss
ANS: s s B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
return or worsening of positive symptoms such as hallucinations and delusions, and
ss ss ss ss ss ss ss ss ss ss ss ss
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
ss ss ss ss ss ss ss ss ss ss ss ss
the other options may be appropriate assessment questions, they are not directed at the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
current needs of the client which is the identification of emerging psychotic behaviors.
ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process:
ss ss s s ss
Assessment MSC: Client Needs: Physiologic Integrity
ss ss s s ss ss ss
, 6. Which statement forms the foundation upon which a nurse should base the implementation
ss ss ss ss ss ss ss ss ss ss ss ss
of psychotherapeutic management to the care of a patient with mental illness?
ss ss ss ss ss ss ss ss ss ss ss ss
a. The nurse‘s role in client care is supported by the multidisciplinary team.
ss ss ss ss ss ss ss ss ss ss ss
b. Omitting any one component will compromise the effectiveness of the
ss ss ss ss ss ss ss ss ss
ss treatment.
c. The most important element of psychotherapeutic management is drug therapy.
ss ss ss ss ss ss ss ss ss
d. A therapeutic nurse-patient relationship is the most important aspect of
ss ss ss ss ss ss ss ss ss
treatment.
ss
ANS: s s B
When one element is missing, treatment is usually compromised. No single element is
ss ss ss ss ss ss ss ss ss ss ss ss
more important than the others; however, patients‘ needs govern the application of the
ss ss ss ss ss ss ss ss ss ss ss ss ss
components and permit judicious use. The remaining options identify components of the
ss ss ss ss ss ss ss ss ss ss ss ss
psychotherapeutic management process.
ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Analysis MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
ss ss ss ss ss ss ss ss ss
a. ―You will need to frequently make decisions regarding the administration of
ss ss ss ss ss ss ss ss ss ss
PRN ss
medications to help the client manage anger.‖ ss ss ss ss ss ss
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
ss ss ss ss ss ss ss ss ss ss ss ss
responses.‖
ss
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
ss ss ss ss ss ss ss ss ss
responsibility.‖
ss
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
ss ss ss ss ss ss ss ss ss ss
should be referred to the psychiatrist.‖
ss ss ss ss ss ss
ANS: s s A
Nursing assessment and analysis of data might suggest the need for PRN medication as
ss ss ss ss ss ss ss ss ss ss ss ss ss
patient anxiety increases or psychotic symptoms become more acute. The nurse is the
ss ss ss ss ss ss ss ss ss ss ss ss ss
health team member who makes this determination. Nurses are responsible for monitoring
ss ss ss ss ss ss ss ss ss ss ss ss
drug effectiveness as well as administering medication. Nurses should assume
ss ss ss ss ss ss ss ss ss ss
responsibility for teaching patients about the side effects of medications. Nurses cannot
ss ss ss ss ss ss ss ss ss ss ss ss
alter prescribed dosages of medications unless they have prescriptive privileges.
ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Analysis MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
8. When considering environmental aspects of milieu management, which intervention has
ss ss ss ss ss ss ss ss ss
the highest priority for a client admitted after a failed suicide attempt?
ss ss ss ss ss ss ss ss ss ss ss ss
a. Sending the client‘s new medication prescriptions to the pharmacy
ss ss ss ss ss ss ss ss
b. Assigning a staff member to one-on-one observation of the client ss ss ss ss ss ss ss ss ss
c. Orienting the client to the milieu‘s public and private spaces ss ss ss ss ss ss ss ss ss
d. Having all potentially dangerous items removed from the client‘s
ss ss ss ss ss ss ss ss
belongings
ss
ANS: s s B
Milieu management provides a proactive approach to care. Safety overrides all other
ss ss ss ss ss ss ss ss ss ss ss
dimensions of the milieu. Initiation of suicide precautions are the priority for this client.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
All the remaining options are appropriate but none protect the client from the risk of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
another attempt to self-harm as effectively as one-on-one observation as part of suicide
ss ss ss ss ss ss ss ss ss ss ss ss ss
precautions.
ss
DIF: Cognitive level: Analyzing ss ss TOP: s s Nursing process: Implementation ss ss
ss ss ss ss ss ss
EDITION BY DEBBIE STEELE ALL CHAPTERS (1-36) |A+
ss ss ss ss ss ss ss ss
ULTIMATE GUIDE 2025 ss ss ss
Chapter 01: Me, Meds, Milieu
ss ss ss ss
Steele: Keltner’s Psychiatric Nursing, 9th Edition
ss ss ss ss ss
MULTIPLE CHOICE ss
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
the psychiatric setting. What is the nurse recruiter‘s best response?
ss ss ss ss ss ss ss ss ss ss
a. ―The nurse primarily serves in a supportive role to members of the health care
ss ss ss ss ss ss ss ss ss ss ss ss ss
delivery team.‖ ss
b. ―The multidisciplinary approach eliminates the need to clearly define the
ss ss ss ss ss ss ss ss ss
responsibilities of nursing in such a setting.‖ ss ss ss ss ss ss
c. ―Nursing actions are identified by the institution that distinguishes nursing
ss ss ss ss ss ss ss ss ss
from ss
other mental health professions.‖ ss ss ss
d. ―Nursing offers unique contributions to the psychotherapeutic management of
ss ss ss ss ss ss ss ss
psychiatric patients.‖ ss
ANS: s s D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
application of psychotherapeutic management. Neither the facility nor the multidisciplinary
ss ss ss ss ss ss ss ss ss ss
team define the professional responsibilities of its members but rather utilizes their unique
ss ss ss ss ss ss ss ss ss ss ss ss ss
skills to provide holistic care. Ideally, all team members support each other and have
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
functions within the team.
ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
2. Which component of the nursing process will the nurse focus upon to address
ss ss ss ss ss ss ss ss ss ss ss ss
ss the responsibility to match individual patient needs with appropriate services?
ss ss ss ss ss ss ss ss ss
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: s s C
Proper assessment is critical for being able to determine the appropriate level of services
ss ss ss ss ss ss ss ss ss ss ss ss ss
that will provide optimal care while considering patient input and at the lowest cost.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
Planning and implementation utilizes the assessment data to identify and execute actions
ss ss ss ss ss ss ss ss ss ss ss ss
(treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of
ss ss ss ss ss ss ss ss ss ss ss ss
the treatment plan.
ss ss ss
, DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Assessment MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
ss ss ss ss ss ss ss ss
hallucinations and walks about the unit, muttering. Which nursing action demonstrates
ss ss ss ss ss ss ss ss ss ss ss
the nurse‘s understanding of effective psychotherapeutic management of this client?
ss ss ss ss ss ss ss ss ss ss
a. Discussing the disease process of schizophrenia with the client and their
ss ss ss ss ss ss ss ss ss ss
domestic ss
partner
b. Minimizing contact between this patient and other patients to assure a stress-
ss ss ss ss ss ss ss ss ss ss ss
free
milieu
c. Administering PRN medication when first observing the evidence that the client ss ss ss ss ss ss ss ss ss ss
may be hallucinating ss ss
d. Independently determining that behavior modification is appropriate to ss ss ss ss ss ss ss
decrease ss
the client‘s paranoid thoughts
ss ss ss
ANS: s s A
An understanding of psychopathology is the foundation on which the three components of
ss ss ss ss ss ss ss ss ss ss ss ss
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
ss ss ss ss ss ss ss ss ss ss
basis for understanding psychopharmacology and milieu management. Minimizing contact
ss ss ss ss ss ss ss ss ss
between the patient and others and administering PRN medication indiscriminately are
ss ss ss ss ss ss ss ss ss ss ss
nontherapeutic interventions. Using behavior modification to decrease the frequency of
ss ss ss ss ss ss ss ss ss ss
hallucinations would need to be incorporated into the plan of care by the care team.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
ss ss ss ss ss ss ss ss ss ss ss
Which intervention is critical in assuring long-term, effective client care as described
ss ss ss ss ss ss ss ss ss ss ss ss
by psychotherapeutic management?
ss ss ss
a. Involvement in group therapies ss ss ss
b. Focus of close supervision by the unit staff
ss ss ss ss ss ss ss
c. Maintaining effective communication with support system ss ss ss ss ss
d. Frequently scheduled one-on-one time with nursing staff ss ss ss ss ss ss
ANS: s s D
A critical element of psychotherapeutic management is the presence of a therapeutic
ss ss ss ss ss ss ss ss ss ss ss
nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
ss ss ss ss ss ss ss ss ss ss ss
connection. While the other options are appropriate and client centered, the nurse-client
ss ss ss ss ss ss ss ss ss ss ss ss
relation is critical in the long-term delivery of quality effective care to this client.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Applying TOP: Nursing process: ss ss s s ss
Implementation MSC: Client Needs: Psychosocial Integrity
ss ss s s ss ss ss
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
ss ss ss ss ss ss ss ss ss ss ss ss
What assessment question demonstrates the nurse‘s understanding of the resulting
ss ss ss ss ss ss ss ss ss ss
needs of the client?
ss ss ss ss
a. ―Will you have any difficulty getting your prescription refilled?‖
ss ss ss ss ss ss ss ss
b. ―Have you begun experiencing any forms of hallucinations?‖
ss ss ss ss ss ss ss
c. ―What do you expect will occur since the dosage has been reduced?‖
ss ss ss ss ss ss ss ss ss ss ss
,d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
ss ss ss ss ss ss ss ss ss ss ss ss
ANS: s s B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
return or worsening of positive symptoms such as hallucinations and delusions, and
ss ss ss ss ss ss ss ss ss ss ss ss
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
ss ss ss ss ss ss ss ss ss ss ss ss
the other options may be appropriate assessment questions, they are not directed at the
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
current needs of the client which is the identification of emerging psychotic behaviors.
ss ss ss ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process:
ss ss s s ss
Assessment MSC: Client Needs: Physiologic Integrity
ss ss s s ss ss ss
, 6. Which statement forms the foundation upon which a nurse should base the implementation
ss ss ss ss ss ss ss ss ss ss ss ss
of psychotherapeutic management to the care of a patient with mental illness?
ss ss ss ss ss ss ss ss ss ss ss ss
a. The nurse‘s role in client care is supported by the multidisciplinary team.
ss ss ss ss ss ss ss ss ss ss ss
b. Omitting any one component will compromise the effectiveness of the
ss ss ss ss ss ss ss ss ss
ss treatment.
c. The most important element of psychotherapeutic management is drug therapy.
ss ss ss ss ss ss ss ss ss
d. A therapeutic nurse-patient relationship is the most important aspect of
ss ss ss ss ss ss ss ss ss
treatment.
ss
ANS: s s B
When one element is missing, treatment is usually compromised. No single element is
ss ss ss ss ss ss ss ss ss ss ss ss
more important than the others; however, patients‘ needs govern the application of the
ss ss ss ss ss ss ss ss ss ss ss ss ss
components and permit judicious use. The remaining options identify components of the
ss ss ss ss ss ss ss ss ss ss ss ss
psychotherapeutic management process.
ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Analysis MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
ss ss ss ss ss ss ss ss ss
a. ―You will need to frequently make decisions regarding the administration of
ss ss ss ss ss ss ss ss ss ss
PRN ss
medications to help the client manage anger.‖ ss ss ss ss ss ss
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
ss ss ss ss ss ss ss ss ss ss ss ss
responses.‖
ss
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
ss ss ss ss ss ss ss ss ss
responsibility.‖
ss
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
ss ss ss ss ss ss ss ss ss ss
should be referred to the psychiatrist.‖
ss ss ss ss ss ss
ANS: s s A
Nursing assessment and analysis of data might suggest the need for PRN medication as
ss ss ss ss ss ss ss ss ss ss ss ss ss
patient anxiety increases or psychotic symptoms become more acute. The nurse is the
ss ss ss ss ss ss ss ss ss ss ss ss ss
health team member who makes this determination. Nurses are responsible for monitoring
ss ss ss ss ss ss ss ss ss ss ss ss
drug effectiveness as well as administering medication. Nurses should assume
ss ss ss ss ss ss ss ss ss ss
responsibility for teaching patients about the side effects of medications. Nurses cannot
ss ss ss ss ss ss ss ss ss ss ss ss
alter prescribed dosages of medications unless they have prescriptive privileges.
ss ss ss ss ss ss ss ss ss ss
DIF: Cognitive level: Analyzing TOP: Nursing process: ss ss s s ss
Analysis MSC: Client Needs: Safe, Effective Care Environment
ss ss s s ss ss ss ss ss
8. When considering environmental aspects of milieu management, which intervention has
ss ss ss ss ss ss ss ss ss
the highest priority for a client admitted after a failed suicide attempt?
ss ss ss ss ss ss ss ss ss ss ss ss
a. Sending the client‘s new medication prescriptions to the pharmacy
ss ss ss ss ss ss ss ss
b. Assigning a staff member to one-on-one observation of the client ss ss ss ss ss ss ss ss ss
c. Orienting the client to the milieu‘s public and private spaces ss ss ss ss ss ss ss ss ss
d. Having all potentially dangerous items removed from the client‘s
ss ss ss ss ss ss ss ss
belongings
ss
ANS: s s B
Milieu management provides a proactive approach to care. Safety overrides all other
ss ss ss ss ss ss ss ss ss ss ss
dimensions of the milieu. Initiation of suicide precautions are the priority for this client.
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
All the remaining options are appropriate but none protect the client from the risk of
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
another attempt to self-harm as effectively as one-on-one observation as part of suicide
ss ss ss ss ss ss ss ss ss ss ss ss ss
precautions.
ss
DIF: Cognitive level: Analyzing ss ss TOP: s s Nursing process: Implementation ss ss
