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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: A
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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.
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.
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ANS: B
The three components listed as choices a, c, and d above work together to provide the best
treatment outcomes. 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.
DIF: Cognitive level: Applying REF: pp. 1-2 TOP: Nursing process: Planning
MSC: NCLEX: Safe, Effective Care Environment
7. Which statement most accurately describes a nurse’s role regarding psychopharmacology?
The psychiatric nurse:
a. frequently makes decisions regarding administration of PRN medications.
b. might adjust a medication dose if a patient is not responding positively.
c. administers medications but is not responsible for monitoring drug effectiveness.
d. should refer a patient’s questions about drug side and adverse effects to the
psychiatrist.
ANS: 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: Understanding REF: 2
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
8. A nurse considers environmental aspects of milieu management while planning care for a
newly admitted patient. Which element has the highest priority?
a. Norms
b. Safety
c. Balance
d. Structure
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other
dimensions of the milieu.
DIF: Cognitive level: Analyzing REF: 2 TOP: Nursing process: Planning
MSC: NCLEX: Safe, Effective Care Environment
9. When the treatment team in an inpatient psychiatric unit institutes a new unit schedule that
provides for all patients to be involved in activities continuously throughout both the day and
early evening, which element of milieu management needs reflection and reconsideration?
a. Norms
b. Balance
c. Limit setting
d. Environmental modification
ANS: B
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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. Environmental
modification is not a core element of milieu management. Data are insufficient to permit the
student to choose either the component of norms or limit setting.
DIF: Cognitive level: Analyzing REF: p. 2 TOP: Nursing process: Evaluation
MSC: NCLEX: Safe, Effective Care Environment
10. During an interaction with a patient, a nurse encourages the patient to express feelings,
identify stressors, and review coping strategies. These nursing interventions relate most to the
use of:
a. risk assessment.
b. behavior modification.
c. therapeutic communication.
d. environmental manipulation.
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse–patient
relationship. Being therapeutic does not imply that the nurse is providing therapy, a formal,
structured process. Risk assessment has a different purpose related to provision of an
appropriate level of care. Environmental manipulation is more related to milieu management
than to therapeutic use of self.
DIF: Cognitive level: Understanding REF: p. 2
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
11. During the risk assessment phase of care for a psychiatric patient, the nurse will:
a. make an initial assessment.
b. confirm the patient’s problem.
c. assess potential dangerousness to self or others.
d. determine the level of supervision needed for the patient.
ANS: 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 REF: pp. 2-3
TOP: Nursing process: Assessment MSC: NCLEX: Safe, Effective Care Environment
12. Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic at
the moment; not a danger to self or others; lives in parents’ home. Which decision regarding
placement on the continuum of care is appropriate?
a. Hospitalize the patient.
b. Discharge the patient from the system.
c. Refer the patient to outpatient services.
d. Refer the patient to self-help resources in the community.
ANS: C
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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: A
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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.
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.
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ANS: B
The three components listed as choices a, c, and d above work together to provide the best
treatment outcomes. 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.
DIF: Cognitive level: Applying REF: pp. 1-2 TOP: Nursing process: Planning
MSC: NCLEX: Safe, Effective Care Environment
7. Which statement most accurately describes a nurse’s role regarding psychopharmacology?
The psychiatric nurse:
a. frequently makes decisions regarding administration of PRN medications.
b. might adjust a medication dose if a patient is not responding positively.
c. administers medications but is not responsible for monitoring drug effectiveness.
d. should refer a patient’s questions about drug side and adverse effects to the
psychiatrist.
ANS: 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: Understanding REF: 2
TOP: Nursing process: Implementation MSC: NCLEX: Safe, Effective Care Environment
8. A nurse considers environmental aspects of milieu management while planning care for a
newly admitted patient. Which element has the highest priority?
a. Norms
b. Safety
c. Balance
d. Structure
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other
dimensions of the milieu.
DIF: Cognitive level: Analyzing REF: 2 TOP: Nursing process: Planning
MSC: NCLEX: Safe, Effective Care Environment
9. When the treatment team in an inpatient psychiatric unit institutes a new unit schedule that
provides for all patients to be involved in activities continuously throughout both the day and
early evening, which element of milieu management needs reflection and reconsideration?
a. Norms
b. Balance
c. Limit setting
d. Environmental modification
ANS: B
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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. Environmental
modification is not a core element of milieu management. Data are insufficient to permit the
student to choose either the component of norms or limit setting.
DIF: Cognitive level: Analyzing REF: p. 2 TOP: Nursing process: Evaluation
MSC: NCLEX: Safe, Effective Care Environment
10. During an interaction with a patient, a nurse encourages the patient to express feelings,
identify stressors, and review coping strategies. These nursing interventions relate most to the
use of:
a. risk assessment.
b. behavior modification.
c. therapeutic communication.
d. environmental manipulation.
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse–patient
relationship. Being therapeutic does not imply that the nurse is providing therapy, a formal,
structured process. Risk assessment has a different purpose related to provision of an
appropriate level of care. Environmental manipulation is more related to milieu management
than to therapeutic use of self.
DIF: Cognitive level: Understanding REF: p. 2
TOP: Nursing process: Implementation MSC: NCLEX: Psychosocial Integrity
11. During the risk assessment phase of care for a psychiatric patient, the nurse will:
a. make an initial assessment.
b. confirm the patient’s problem.
c. assess potential dangerousness to self or others.
d. determine the level of supervision needed for the patient.
ANS: 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 REF: pp. 2-3
TOP: Nursing process: Assessment MSC: NCLEX: Safe, Effective Care Environment
12. Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic at
the moment; not a danger to self or others; lives in parents’ home. Which decision regarding
placement on the continuum of care is appropriate?
a. Hospitalize the patient.
b. Discharge the patient from the system.
c. Refer the patient to outpatient services.
d. Refer the patient to self-help resources in the community.
ANS: C
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