TEST BANK FOR KELTNERS PSYCHIATRIC
NURSING 9TH EDITION BY DEBBIE STEELE ALL
CHAPTERS INCLUDED.
Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
• A newly licensed nurse 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.‖
ANS: 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
• 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
ANS: 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
• An adult diagnosed with paranoid schizophrenia frequently 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
ANS: 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
• 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
ANS: 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
• 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?‖
ANS: 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 which is the identification of emerging psychotic
behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
Assessment MSC: Client Needs: Physiologic Integrity
• 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.
ANS: 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
• 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 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
• 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
ANS: 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
• 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.
ANS: 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
NURSING 9TH EDITION BY DEBBIE STEELE ALL
CHAPTERS INCLUDED.
Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
• A newly licensed nurse 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.‖
ANS: 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
• 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
ANS: 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
• An adult diagnosed with paranoid schizophrenia frequently 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
ANS: 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
• 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
ANS: 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
• 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?‖
ANS: 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 which is the identification of emerging psychotic
behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process:
Assessment MSC: Client Needs: Physiologic Integrity
• 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.
ANS: 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
• 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 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
• 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
ANS: 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
• 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.
ANS: 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
