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
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 o
management. Neither the facility nor the multidisciplinary team define the professional responsibilities
utilizes their unique skills to provide holistic care. Ideally, all team members support each other and ha
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 mat
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 prov
considering patient input and at the lowest cost. Planning and implementation utilizes the assessment d
actions (treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of the
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 walk
Which nursing action demonstrates the nurse’s understanding of effective psychotherapeutic managem
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
ANS: A
An understanding of psychopathology is the foundation on which the three components of psychothera
facilitates therapeutic communication and provides a basis for understanding psychopharmacology and
Minimizing contact between the patient and others and administering PRN medication indiscriminately
interventions. Using behavior modification to decrease the frequency of hallucinations would need to b
of care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
, 5. A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessment que
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?”
ANS: B
It will be necessary for the nurse to assess for exacerbation of the patient’s symptoms of psychosis as w
effects. Dosage decrease might lead to the return or worsening of positive symptoms such as hallucinat
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While the other optio
assessment questions, they are not directed at the current needs of the client; the identification of emerg
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 psychoth
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.
ANS: B
When one element is missing, treatment is usually compromised. No single element is more important
patients’ needs govern the application of the components and permit judicious use. The remaining opti
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.”
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as patient anxiety
symptoms become more acute. The nurse is the health team member who makes this determination. Nu
monitoring drug effectiveness as well as administering medication. Nurses should assume responsibilit
the side effects of medications. Nurses cannot alter prescribed dosages of medications unless they have
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 pr
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
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other dimensions of the
precautions are the priority for this client. All the remaining options are appropriate but none protect th
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
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 o
management. Neither the facility nor the multidisciplinary team define the professional responsibilities
utilizes their unique skills to provide holistic care. Ideally, all team members support each other and ha
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 mat
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 prov
considering patient input and at the lowest cost. Planning and implementation utilizes the assessment d
actions (treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of the
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 walk
Which nursing action demonstrates the nurse’s understanding of effective psychotherapeutic managem
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
ANS: A
An understanding of psychopathology is the foundation on which the three components of psychothera
facilitates therapeutic communication and provides a basis for understanding psychopharmacology and
Minimizing contact between the patient and others and administering PRN medication indiscriminately
interventions. Using behavior modification to decrease the frequency of hallucinations would need to b
of care by the care team.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
, 5. A patient’s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What assessment que
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?”
ANS: B
It will be necessary for the nurse to assess for exacerbation of the patient’s symptoms of psychosis as w
effects. Dosage decrease might lead to the return or worsening of positive symptoms such as hallucinat
negative symptoms such as blunted affect, social withdrawal, and poor grooming. While the other optio
assessment questions, they are not directed at the current needs of the client; the identification of emerg
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 psychoth
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.
ANS: B
When one element is missing, treatment is usually compromised. No single element is more important
patients’ needs govern the application of the components and permit judicious use. The remaining opti
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.”
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as patient anxiety
symptoms become more acute. The nurse is the health team member who makes this determination. Nu
monitoring drug effectiveness as well as administering medication. Nurses should assume responsibilit
the side effects of medications. Nurses cannot alter prescribed dosages of medications unless they have
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 pr
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
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other dimensions of the
precautions are the priority for this client. All the remaining options are appropriate but none protect th
