,Chapter j 01: j Me, j Meds, j Milieu
Steele: j Keltner’s j Psychiatric j Nursing, j 9th j Edition
MULTIPLE j CHOICE
1. A j newly j licensed nurse j asks j a j nursing j recruiter j for j a j description j of
j
j nursing jpractice j in j the j psychiatric j setting. j What j is j the j nurse
j recruiter‘s j best j response?
a. ―The jnurse jprimarily jserves j in j a jsupportive jrole jto jmembers jof jthe
N
jhealth j care
delivery j team.‖
b. ―The j multidisciplinary j approach j eliminates j the j need j to j clearly jdefine
j the jresponsibilities j of j nursing j in j such j a j setting.‖
c. ―Nursing j actions j are j identified j by j the j institution j that j distinguishes
jnursing j from
other j mental j health j professions.‖
d. ―Nursing j offers j unique j contributions j to j the j psychotherapeutic
j management jof
psychiatric j patients.‖
ANS: D
Professional j role j overlap j cannot j be j denied; j however, j nursing j is j unique j in
j its j focus jon j and j application j of j psychotherapeutic j management. j Neither j the
j facility j nor j the jmultidisciplinary j team j define j the j professional j responsibilities
j of j its j members j but jrather j utilizes j their j unique j skills j to j provide j holistic
j care. j Ideally, j all j team j members j support j each j other j and j have j functions
j within j the j team.
DIF: Cognitive j level: j Analyzing TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Safe, j Effective j Care
j Environment
2. Which j component of j the j nursing j process j will j the j nurse j focus
j
j upon j to jaddress j the j responsibility j to j match j individual j patient
j needs j with jappropriate j services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C
Proper j assessment j is j critical j for j being j able j to j determine j the j appropriate
j level j of jservices j that j will j provide j optimal j care j while j considering j patient
j input j and j at j the jlowest j cost. j Planning j and j implementation j utilizes j the
j assessment j data j to j identify jand j execute j actions j (treatment j plan) j that j will
j provide j appropriate j care. j Evaluation jvalidates j the j effectiveness j of j the j treatment
j plan.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
, Assessment j MSC: Client j Needs: j Safe, j Effective j Care j Environment
3. An j adult j diagnosed j with j paranoid j schizophrenia j frequently j experiences
j auditory jhallucinations j and j walks j about j the j unit, j muttering. j Which j nursing
j action jdemonstrates j the j nurse‘s j understanding j of j effective
j psychotherapeutic jmanagement j of j this j client?
a. Discussing j the j disease j process j of j schizophrenia j with j the j client j and
j their jdomestic
partner
b. Minimizing j contact j between j this j patient j and j other j patients j to
j assure j a jstress-free
milieu
c. Administering j PRN j medication j when j first j observing j the j evidence j that
j the j client
may j be j hallucinating
d. Independently jdetermining j that j behavior j modification j is j appropriate j to
jdecrease
the j client‘s j paranoid j thoughts
ANS: A
An j understanding j of j psychopathology j is j the j foundation j on j which j the j three
j components j of j psychotherapeutic j management j rest; j it j facilitates j therapeutic
j communication j and j provides j a j basis j for j understanding j psychopharmacology j and
j milieu jmanagement. j Minimizing j contact j between j the j patient j and j others j and
j administering jPRN j medication j indiscriminately j are j nontherapeutic j interventions.
j Using j behavior jmodification j to j decrease j the j frequency j of j hallucinations
j would j need j to j be jincorporated j into j the j plan j of j care j by j the j care j team.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Safe, j Effective j Care
j Environment
4. An j adult diagnosed j with j chronic j depression j is j hospitalized j after j a
j
j suicide jattempt. j Which j intervention j is j critical j in j assuring j long-term,
j effective j client jcare j as j described j by j psychotherapeutic j management?
a. Involvement j in j group j therapies
b. Focus j of j close j supervision j by j the j unit j j staff
c. Maintaining j effective j communication j with j support
jsystem
d. Frequently j scheduled j one-on-one j time j with
j nursing jstaff
ANS: D
A j critical j element j of j psychotherapeutic j management j is j the j presence j of j a
therapeutic jnurse-patient j relationship. j One-on-one j time j with j nursing j staff j will
j
j help j in j establishing jthis j connection. j While j the j other j options j are
j appropriate j and j client j centered, j the jnurse-client j relation j is j critical j in j the
j long-term j delivery j of j quality j effective j care
to j this j client.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Psychosocial j Integrity
5. A j patient‘s j haloperidol j dosage j was j reduced j 2 j weeks j ago j to j decrease j side
, effects. j What j assessment j question j demonstrates j the j nurse‘s j understanding j of
j the jresulting j needs j of j the j client?
a. ―Will j you j have j any j difficulty j getting j your j prescription
j refilled?‖
b. ―Have j you j begun j experiencing j any j forms j of j hallucinations?‖
c. ―What j do j you j expect j will j occur j since j the j dosage j has j been
N N
j reduced?‖
d. ―What jcan jI jdo j to jhelp j you j manage jthis jreduction jin jhaloperidol
N
jtherapy?‖
ANS: B
It will j be j necessary j for j the j nurse j to j assess j for j exacerbation j of j the
j
j patient‘s jsymptoms j of j psychosis j as j well j as j for j a j lessening j of j side
j effects. j Dosage jdecrease j might j lead j to j the j return j or j worsening j of
j positive j symptoms j such j as jhallucinations j and j delusions, j and j negative
j symptoms j such j as j blunted j affect, j social jwithdrawal, j and j poor j grooming.
j While j the j other j options j may j be j appropriate jassessment j questions, j they j are
j not j directed j at j the j current j needs j of j the j client j which jis j the
j identification j of j emerging j psychotic j behaviors.
DIF: Cognitive j level: j Analyzing TOP: Nursing jprocess:
jAssessment j MSC: Client j Needs: j Physiologic j Integrity
Steele: j Keltner’s j Psychiatric j Nursing, j 9th j Edition
MULTIPLE j CHOICE
1. A j newly j licensed nurse j asks j a j nursing j recruiter j for j a j description j of
j
j nursing jpractice j in j the j psychiatric j setting. j What j is j the j nurse
j recruiter‘s j best j response?
a. ―The jnurse jprimarily jserves j in j a jsupportive jrole jto jmembers jof jthe
N
jhealth j care
delivery j team.‖
b. ―The j multidisciplinary j approach j eliminates j the j need j to j clearly jdefine
j the jresponsibilities j of j nursing j in j such j a j setting.‖
c. ―Nursing j actions j are j identified j by j the j institution j that j distinguishes
jnursing j from
other j mental j health j professions.‖
d. ―Nursing j offers j unique j contributions j to j the j psychotherapeutic
j management jof
psychiatric j patients.‖
ANS: D
Professional j role j overlap j cannot j be j denied; j however, j nursing j is j unique j in
j its j focus jon j and j application j of j psychotherapeutic j management. j Neither j the
j facility j nor j the jmultidisciplinary j team j define j the j professional j responsibilities
j of j its j members j but jrather j utilizes j their j unique j skills j to j provide j holistic
j care. j Ideally, j all j team j members j support j each j other j and j have j functions
j within j the j team.
DIF: Cognitive j level: j Analyzing TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Safe, j Effective j Care
j Environment
2. Which j component of j the j nursing j process j will j the j nurse j focus
j
j upon j to jaddress j the j responsibility j to j match j individual j patient
j needs j with jappropriate j services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C
Proper j assessment j is j critical j for j being j able j to j determine j the j appropriate
j level j of jservices j that j will j provide j optimal j care j while j considering j patient
j input j and j at j the jlowest j cost. j Planning j and j implementation j utilizes j the
j assessment j data j to j identify jand j execute j actions j (treatment j plan) j that j will
j provide j appropriate j care. j Evaluation jvalidates j the j effectiveness j of j the j treatment
j plan.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
, Assessment j MSC: Client j Needs: j Safe, j Effective j Care j Environment
3. An j adult j diagnosed j with j paranoid j schizophrenia j frequently j experiences
j auditory jhallucinations j and j walks j about j the j unit, j muttering. j Which j nursing
j action jdemonstrates j the j nurse‘s j understanding j of j effective
j psychotherapeutic jmanagement j of j this j client?
a. Discussing j the j disease j process j of j schizophrenia j with j the j client j and
j their jdomestic
partner
b. Minimizing j contact j between j this j patient j and j other j patients j to
j assure j a jstress-free
milieu
c. Administering j PRN j medication j when j first j observing j the j evidence j that
j the j client
may j be j hallucinating
d. Independently jdetermining j that j behavior j modification j is j appropriate j to
jdecrease
the j client‘s j paranoid j thoughts
ANS: A
An j understanding j of j psychopathology j is j the j foundation j on j which j the j three
j components j of j psychotherapeutic j management j rest; j it j facilitates j therapeutic
j communication j and j provides j a j basis j for j understanding j psychopharmacology j and
j milieu jmanagement. j Minimizing j contact j between j the j patient j and j others j and
j administering jPRN j medication j indiscriminately j are j nontherapeutic j interventions.
j Using j behavior jmodification j to j decrease j the j frequency j of j hallucinations
j would j need j to j be jincorporated j into j the j plan j of j care j by j the j care j team.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Safe, j Effective j Care
j Environment
4. An j adult diagnosed j with j chronic j depression j is j hospitalized j after j a
j
j suicide jattempt. j Which j intervention j is j critical j in j assuring j long-term,
j effective j client jcare j as j described j by j psychotherapeutic j management?
a. Involvement j in j group j therapies
b. Focus j of j close j supervision j by j the j unit j j staff
c. Maintaining j effective j communication j with j support
jsystem
d. Frequently j scheduled j one-on-one j time j with
j nursing jstaff
ANS: D
A j critical j element j of j psychotherapeutic j management j is j the j presence j of j a
therapeutic jnurse-patient j relationship. j One-on-one j time j with j nursing j staff j will
j
j help j in j establishing jthis j connection. j While j the j other j options j are
j appropriate j and j client j centered, j the jnurse-client j relation j is j critical j in j the
j long-term j delivery j of j quality j effective j care
to j this j client.
DIF: Cognitive j level: j Applying TOP: Nursing j process:
jImplementation j MSC: Client j Needs: j Psychosocial j Integrity
5. A j patient‘s j haloperidol j dosage j was j reduced j 2 j weeks j ago j to j decrease j side
, effects. j What j assessment j question j demonstrates j the j nurse‘s j understanding j of
j the jresulting j needs j of j the j client?
a. ―Will j you j have j any j difficulty j getting j your j prescription
j refilled?‖
b. ―Have j you j begun j experiencing j any j forms j of j hallucinations?‖
c. ―What j do j you j expect j will j occur j since j the j dosage j has j been
N N
j reduced?‖
d. ―What jcan jI jdo j to jhelp j you j manage jthis jreduction jin jhaloperidol
N
jtherapy?‖
ANS: B
It will j be j necessary j for j the j nurse j to j assess j for j exacerbation j of j the
j
j patient‘s jsymptoms j of j psychosis j as j well j as j for j a j lessening j of j side
j effects. j Dosage jdecrease j might j lead j to j the j return j or j worsening j of
j positive j symptoms j such j as jhallucinations j and j delusions, j and j negative
j symptoms j such j as j blunted j affect, j social jwithdrawal, j and j poor j grooming.
j While j the j other j options j may j be j appropriate jassessment j questions, j they j are
j not j directed j at j the j current j needs j of j the j client j which jis j the
j identification j of j emerging j psychotic j behaviors.
DIF: Cognitive j level: j Analyzing TOP: Nursing jprocess:
jAssessment j MSC: Client j Needs: j Physiologic j Integrity
