Chapter m01:mMe,mMeds,mMilieu
Steele:mKeltner’smPsychiatric mNursing,m9thmEdition
MULTIPLEmCHOICE
1. A mnewlymlicensed mnursemasksmamnursingmrecruitermformamdescriptionmof mnursingmpracticemin mt
hempsychiatricmsetting.mWhat mismthemnursemrecruiter‘smbest mresponse?
a. ―Themnursemprimarilymserves minma msupportive mrolemtommembers mof mthemhealthmcare
deliverymteam.‖
b. ―Themmultidisciplinarymapproachmeliminatesmthemneed mtomclearlymdefinemthe
responsibilitiesmof mnursingminmsuchmamsetting.‖
c. ―Nursingmactionsmaremidentifiedmbymtheminstitutionmthat mdistinguishesmnursingmfro
m
othermmentalmhealthmprofessions.‖
d. ―Nursingmoffersmuniquemcontributionsmtomthempsychotherapeuticmmanagement mof
psychiatricmpatients.‖
ANS:m D
Professionalmrolemoverlapmcannot mbemdenied;mhowever,mnursingmismuniquem inmitsmfocusmonmand m
applicationmof mpsychotherapeuticmmanagement.mNeithermthemfacilitymnormthemmultidisciplinarym
teammdefinemthemprofessionalmresponsibilitiesmof mitsmmembersmbut mrathermutilizes mtheirmuniquem
skillsmtomprovidemholisticmcare.mIdeally,mallmteammmembersmsupport meach mothermand mhavemfuncti
onsmwithinmthemteam.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
2. Whichmcomponent mof mthemnursingmprocessmwillmthemnursemfocusmuponmtomaddressmt
hemresponsibilitymtommatchmindividualmpatient mneedsmwithmappropriatemservices?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS:m C
Propermassessment mismcriticalmformbeingmablemtomdeterminemthemappropriatemlevelmof mservicesmth
at mwillmprovidemoptimalmcaremwhilemconsideringmpatient minput mand mat mthemlowest mcost.mPlanning
mand mimplementationmutilizesmthemassessment mdatamtomidentifymand mexecutemactionsm(treatment m
plan)mthat mwillmprovidemappropriatemcare.mEvaluationmvalidatesmthemeffectivenessmof mthemtreatme
nt mplan.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mAssessmentmMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
3. Anmadult mdiagnosed mwithmparanoid mschizophreniamfrequentlymexperiencesmauditorymhalluci
nationsmand mwalksmabout mthemunit,mmuttering.mWhichmnursingmactionmdemonstratesmthemnurs
e‘smunderstandingmof meffectivempsychotherapeuticmmanagement mof mthismclient?
, a. Discussingmthemdiseasemprocessmof mschizophreniamwithmthemclient mand mtheirmdomest
ic
partner
b. Minimizingmcontact mbetweenmthismpatient mand mothermpatientsmtomassuremamstress-
free
milieu
c. AdministeringmPRN mmedicationmwhenmfirst mobservingmthemevidencemthat mthemclient
maymbemhallucinating
d. Independentlymdeterminingmthat mbehaviormmodificationmismappropriatemtomdecreas
e
themclient‘smparanoid mthoughts
ANS:m A
Anmunderstandingmof mpsychopathologymismthemfoundationmonmwhichmthemthreemcomponentsmof m
psychotherapeuticmmanagement mrest;mit mfacilitatesmtherapeuticmcommunicationmand mprovidesma
mbasismformunderstandingmpsychopharmacology mand mmilieummanagement.mMinimizingmcontact
mbetweenmthempatient mand mothersmand madministeringmPRN mmedicationmindiscriminatelymaremno
ntherapeuticminterventions.mUsingmbehaviormmodificationmtomdecreasemthemfrequencymof mhalluc
inationsmwould mneed mtombemincorporated mintomthemplanmof mcarembymthemcaremteam.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
4. Anmadult mdiagnosed mwithmchronicmdepressionmismhospitalized maftermamsuicidemattempt.mWhi
chminterventionmismcriticalminmassuring mlong-
term,meffectivemclient mcaremasmdescribed mbympsychotherapeuticmmanagement?
a. Involvement minmgroupmtherapies
b. Focusmof mclosemsupervisionmbymthemunit mstaff
c. Maintainingmeffectivemcommunicationmwithmsupport msyste
m
d. Frequentlymscheduled mone-on-onemtimemwithmnursingmstaff
ANS:m D
A mcriticalmelement mof mpsychotherapeuticmmanagement mismthempresencemof mamtherapeutic
nurse-patient mrelationship.mOne-on-
onemtimemwithmnursingmstaff mwillmhelpminmestablishingmthism connection.mWhilemthemothermoption
smaremappropriatemand mclient mcentered,mthemnurse-client mrelationmismcriticalminmthem long-
termmdeliverymof mqualitymeffectivemcaremtomthismclient.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mPsychosocialm
Integrity
5. A mpatient‘smhaloperidolmdosagemwasmreduced m2mweeksmagomtomdecreasemsidemeffects.mWha
t massessment mquestionmdemonstratesmthemnurse‘smunderstandingmof mthemresultingmneedsmof m
themclient?
a. ―Willmyoumhavemanymdifficultymgettingmyourmprescriptionmrefilled?‖
b. ―Havemyoumbegunmexperiencingmanymformsmof mhallucinations?‖
c. ―What mdomyoumexpect mwillmoccurmsincemthemdosagemhasmbeenmreduced?‖
d. ―What mcanmI mdomtomhelpmyoummanagemthismreductionminmhaloperidolmtherapy
?‖
,ANS:m B
It mwillmbemnecessarymformthemnursemtomassessmformexacerbationmof mthempatient‘smsymptomsmof mp
sychosismasmwellmasmformamlesseningmof msidemeffects.mDosagemdecreasemmight mlead mtomthemreturn
mormworseningmof mpositivemsymptomsmsuchmasmhallucinationsmand mdelusions,mand mnegativemsy
mptomsmsuchmasmblunted maffect,msocialmwithdrawal,mand mpoormgrooming.mWhilemthemothermopti
onsmmaymbemappropriatemassessment mquestions,mtheymaremnot mdirected mat mthemcurrent mneedsmof mt
hemclient mwhichmismthemidentificationmof memergingmpsychoticmbehaviors.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAssessmentmMSC:m ClientmNeeds:mPhysiologicmI
ntegrity
, 6. Whichmstatement mformsmthemfoundationmuponmwhichmamnursemshould mbasemthemimplementationm
of mpsychotherapeuticmmanagement mtomthemcaremof mampatient mwithmmentalmillness?
a. Themnurse‘smroleminmclient mcarem ismsupported mbymthemmultidisciplinarymteam.
b. Omittingmanymonemcomponent mwillmcompromisemthemeffectivenessmof mthemtreatment
.
c. Themmost mimportant melement mof mpsychotherapeuticmmanagement mismdrugmtherapy.
d. Amtherapeuticmnurse-
patient mrelationshipmismthemmost mimportant maspect mof mtreatment.
ANS:m B
Whenmonemelement mismmissing,mtreatment mismusuallymcompromised.mNomsinglemelement mis mmor
emimportant mthanmthemothers;mhowever,mpatients‘mneedsmgovernmthemapplicationmof mthemcompon
entsmand mpermit mjudiciousmuse.mThemremainingmoptionsm identifymcomponentsmof mthempsychothe
rapeuticmmanagement mprocess.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAnalysismMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
7. Whichmstatement mmost maccuratelymdescribesmamnurse‘smrolemregardingmpsychopharmacology?
a. ―Youmwillmneed mtomfrequentlymmakemdecisionsmregardingmthemadministrationmof mPR
N
medicationsmtomhelpmthemclient mmanagemanger.‖
b. ―It‘smamnursingmresponsibilitymtomadjust mammedicationmdosemtomassuremeffectivempatie
nt mresponses.‖
c. ―Nursesmadministersmmedicationsmwhilemevaluatingmdrugmeffectivenessmismammedical
mresponsibility.‖
d. ―Tombest massuremappropriatemresponse,mampatient‘smquestions mabout mdrugmthera
pymshould mbemreferred mtomthe mpsychiatrist.‖
ANS:m A
Nursingmassessment mand manalysismof mdatammight msuggest mthemneed mformPRN mmedicationmasmpat
ient manxietymincreasesmormpsychoticmsymptomsmbecomem morem acute.mThemnursem ismthemhealthmt
eammmembermwhommakesmthismdetermination.mNursesmaremresponsiblemform monitoringmdrugmeff
ectivenessmasmwellmasmadministeringmmedication.mNursesmshould massumemresponsibilitymformtea
chingmpatientsmabout mthemsidemeffectsmof mmedications.mNursesmcannot maltermprescribed mdosagesm
of mmedicationsmunlessmtheymhavemprescriptivemprivileges.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAnalysismMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
8. Whenmconsideringmenvironmentalmaspectsmof mmilieummanagement,mwhichminterventionmhasmt
hemhighest mprioritymformamclient madmitted maftermamfailed msuicidemattempt?
a. Sendingmthemclient‘smnew mmedicationmprescriptionsmtomthempharmacy
b. Assigningmamstaff mmembermtomone-on-onemobservationmof mthemclient
c. Orientingmthemclient mtomthemmilieu‘smpublicmand mprivatemspaces
d. Havingmallmpotentiallymdangerousmitemsmremoved mfrommthemclient‘smbelonging
s
ANS:m B
Milieummanagement mprovidesmamproactivemapproachmtomcare. mSafetymoverridesmall mothermdimen
sionsmof mthemmilieu.mInitiationmof msuicidemprecautionsmaremthemprioritymformthismclient.mAllmthemr
emainingmoptionsmaremappropriatembut mnonemprotect mthemclient mfrommthemriskmof manothermattem
pt mtomself-harmmasmeffectivelymasmone-on-onemobservationmasmpart mof msuicidemprecautions.
Steele:mKeltner’smPsychiatric mNursing,m9thmEdition
MULTIPLEmCHOICE
1. A mnewlymlicensed mnursemasksmamnursingmrecruitermformamdescriptionmof mnursingmpracticemin mt
hempsychiatricmsetting.mWhat mismthemnursemrecruiter‘smbest mresponse?
a. ―Themnursemprimarilymserves minma msupportive mrolemtommembers mof mthemhealthmcare
deliverymteam.‖
b. ―Themmultidisciplinarymapproachmeliminatesmthemneed mtomclearlymdefinemthe
responsibilitiesmof mnursingminmsuchmamsetting.‖
c. ―Nursingmactionsmaremidentifiedmbymtheminstitutionmthat mdistinguishesmnursingmfro
m
othermmentalmhealthmprofessions.‖
d. ―Nursingmoffersmuniquemcontributionsmtomthempsychotherapeuticmmanagement mof
psychiatricmpatients.‖
ANS:m D
Professionalmrolemoverlapmcannot mbemdenied;mhowever,mnursingmismuniquem inmitsmfocusmonmand m
applicationmof mpsychotherapeuticmmanagement.mNeithermthemfacilitymnormthemmultidisciplinarym
teammdefinemthemprofessionalmresponsibilitiesmof mitsmmembersmbut mrathermutilizes mtheirmuniquem
skillsmtomprovidemholisticmcare.mIdeally,mallmteammmembersmsupport meach mothermand mhavemfuncti
onsmwithinmthemteam.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
2. Whichmcomponent mof mthemnursingmprocessmwillmthemnursemfocusmuponmtomaddressmt
hemresponsibilitymtommatchmindividualmpatient mneedsmwithmappropriatemservices?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS:m C
Propermassessment mismcriticalmformbeingmablemtomdeterminemthemappropriatemlevelmof mservicesmth
at mwillmprovidemoptimalmcaremwhilemconsideringmpatient minput mand mat mthemlowest mcost.mPlanning
mand mimplementationmutilizesmthemassessment mdatamtomidentifymand mexecutemactionsm(treatment m
plan)mthat mwillmprovidemappropriatemcare.mEvaluationmvalidatesmthemeffectivenessmof mthemtreatme
nt mplan.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mAssessmentmMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
3. Anmadult mdiagnosed mwithmparanoid mschizophreniamfrequentlymexperiencesmauditorymhalluci
nationsmand mwalksmabout mthemunit,mmuttering.mWhichmnursingmactionmdemonstratesmthemnurs
e‘smunderstandingmof meffectivempsychotherapeuticmmanagement mof mthismclient?
, a. Discussingmthemdiseasemprocessmof mschizophreniamwithmthemclient mand mtheirmdomest
ic
partner
b. Minimizingmcontact mbetweenmthismpatient mand mothermpatientsmtomassuremamstress-
free
milieu
c. AdministeringmPRN mmedicationmwhenmfirst mobservingmthemevidencemthat mthemclient
maymbemhallucinating
d. Independentlymdeterminingmthat mbehaviormmodificationmismappropriatemtomdecreas
e
themclient‘smparanoid mthoughts
ANS:m A
Anmunderstandingmof mpsychopathologymismthemfoundationmonmwhichmthemthreemcomponentsmof m
psychotherapeuticmmanagement mrest;mit mfacilitatesmtherapeuticmcommunicationmand mprovidesma
mbasismformunderstandingmpsychopharmacology mand mmilieummanagement.mMinimizingmcontact
mbetweenmthempatient mand mothersmand madministeringmPRN mmedicationmindiscriminatelymaremno
ntherapeuticminterventions.mUsingmbehaviormmodificationmtomdecreasemthemfrequencymof mhalluc
inationsmwould mneed mtombemincorporated mintomthemplanmof mcarembymthemcaremteam.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
4. Anmadult mdiagnosed mwithmchronicmdepressionmismhospitalized maftermamsuicidemattempt.mWhi
chminterventionmismcriticalminmassuring mlong-
term,meffectivemclient mcaremasmdescribed mbympsychotherapeuticmmanagement?
a. Involvement minmgroupmtherapies
b. Focusmof mclosemsupervisionmbymthemunit mstaff
c. Maintainingmeffectivemcommunicationmwithmsupport msyste
m
d. Frequentlymscheduled mone-on-onemtimemwithmnursingmstaff
ANS:m D
A mcriticalmelement mof mpsychotherapeuticmmanagement mismthempresencemof mamtherapeutic
nurse-patient mrelationship.mOne-on-
onemtimemwithmnursingmstaff mwillmhelpminmestablishingmthism connection.mWhilemthemothermoption
smaremappropriatemand mclient mcentered,mthemnurse-client mrelationmismcriticalminmthem long-
termmdeliverymof mqualitymeffectivemcaremtomthismclient.
DIF: Cognitivemlevel:mApplying
TOP:m Nursingmprocess:mImplementation mMSC:m ClientmNeeds:mPsychosocialm
Integrity
5. A mpatient‘smhaloperidolmdosagemwasmreduced m2mweeksmagomtomdecreasemsidemeffects.mWha
t massessment mquestionmdemonstratesmthemnurse‘smunderstandingmof mthemresultingmneedsmof m
themclient?
a. ―Willmyoumhavemanymdifficultymgettingmyourmprescriptionmrefilled?‖
b. ―Havemyoumbegunmexperiencingmanymformsmof mhallucinations?‖
c. ―What mdomyoumexpect mwillmoccurmsincemthemdosagemhasmbeenmreduced?‖
d. ―What mcanmI mdomtomhelpmyoummanagemthismreductionminmhaloperidolmtherapy
?‖
,ANS:m B
It mwillmbemnecessarymformthemnursemtomassessmformexacerbationmof mthempatient‘smsymptomsmof mp
sychosismasmwellmasmformamlesseningmof msidemeffects.mDosagemdecreasemmight mlead mtomthemreturn
mormworseningmof mpositivemsymptomsmsuchmasmhallucinationsmand mdelusions,mand mnegativemsy
mptomsmsuchmasmblunted maffect,msocialmwithdrawal,mand mpoormgrooming.mWhilemthemothermopti
onsmmaymbemappropriatemassessment mquestions,mtheymaremnot mdirected mat mthemcurrent mneedsmof mt
hemclient mwhichmismthemidentificationmof memergingmpsychoticmbehaviors.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAssessmentmMSC:m ClientmNeeds:mPhysiologicmI
ntegrity
, 6. Whichmstatement mformsmthemfoundationmuponmwhichmamnursemshould mbasemthemimplementationm
of mpsychotherapeuticmmanagement mtomthemcaremof mampatient mwithmmentalmillness?
a. Themnurse‘smroleminmclient mcarem ismsupported mbymthemmultidisciplinarymteam.
b. Omittingmanymonemcomponent mwillmcompromisemthemeffectivenessmof mthemtreatment
.
c. Themmost mimportant melement mof mpsychotherapeuticmmanagement mismdrugmtherapy.
d. Amtherapeuticmnurse-
patient mrelationshipmismthemmost mimportant maspect mof mtreatment.
ANS:m B
Whenmonemelement mismmissing,mtreatment mismusuallymcompromised.mNomsinglemelement mis mmor
emimportant mthanmthemothers;mhowever,mpatients‘mneedsmgovernmthemapplicationmof mthemcompon
entsmand mpermit mjudiciousmuse.mThemremainingmoptionsm identifymcomponentsmof mthempsychothe
rapeuticmmanagement mprocess.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAnalysismMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
7. Whichmstatement mmost maccuratelymdescribesmamnurse‘smrolemregardingmpsychopharmacology?
a. ―Youmwillmneed mtomfrequentlymmakemdecisionsmregardingmthemadministrationmof mPR
N
medicationsmtomhelpmthemclient mmanagemanger.‖
b. ―It‘smamnursingmresponsibilitymtomadjust mammedicationmdosemtomassuremeffectivempatie
nt mresponses.‖
c. ―Nursesmadministersmmedicationsmwhilemevaluatingmdrugmeffectivenessmismammedical
mresponsibility.‖
d. ―Tombest massuremappropriatemresponse,mampatient‘smquestions mabout mdrugmthera
pymshould mbemreferred mtomthe mpsychiatrist.‖
ANS:m A
Nursingmassessment mand manalysismof mdatammight msuggest mthemneed mformPRN mmedicationmasmpat
ient manxietymincreasesmormpsychoticmsymptomsmbecomem morem acute.mThemnursem ismthemhealthmt
eammmembermwhommakesmthismdetermination.mNursesmaremresponsiblemform monitoringmdrugmeff
ectivenessmasmwellmasmadministeringmmedication.mNursesmshould massumemresponsibilitymformtea
chingmpatientsmabout mthemsidemeffectsmof mmedications.mNursesmcannot maltermprescribed mdosagesm
of mmedicationsmunlessmtheymhavemprescriptivemprivileges.
DIF: Cognitivemlevel:mAnalyzing
TOP:m Nursingmprocess:mAnalysismMSC:m ClientmNeeds:mSafe,mEffecti
vemCaremEnvironment
8. Whenmconsideringmenvironmentalmaspectsmof mmilieummanagement,mwhichminterventionmhasmt
hemhighest mprioritymformamclient madmitted maftermamfailed msuicidemattempt?
a. Sendingmthemclient‘smnew mmedicationmprescriptionsmtomthempharmacy
b. Assigningmamstaff mmembermtomone-on-onemobservationmof mthemclient
c. Orientingmthemclient mtomthemmilieu‘smpublicmand mprivatemspaces
d. Havingmallmpotentiallymdangerousmitemsmremoved mfrommthemclient‘smbelonging
s
ANS:m B
Milieummanagement mprovidesmamproactivemapproachmtomcare. mSafetymoverridesmall mothermdimen
sionsmof mthemmilieu.mInitiationmof msuicidemprecautionsmaremthemprioritymformthismclient.mAllmthemr
emainingmoptionsmaremappropriatembut mnonemprotect mthemclient mfrommthemriskmof manothermattem
pt mtomself-harmmasmeffectivelymasmone-on-onemobservationmasmpart mof msuicidemprecautions.
