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
,10. Which intervention should the nurse implement when focusing on communicating therapeutically with
a. Explaining to the client why they will need to ask for a razor
b. Providing the client with options to help achieve smoking cessation
c. Encouraging the client to identify personal stressors
d. Assuring the client that they can receive telephone call on the unit telephone
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient relationship
communication is providing the client with an opportunity to safely identify personal stressors. The rem
safety, balance, and norms associated with their care.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
11. During the risk assessment phase of care for a psychiatric patient, what is the nurse’s primary goal?
a. Making an initial assessment
b. Confirming the patient’s problem
c. Assessing potential dangerousness to self or others
d. Determining 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 wheth
acutely psychotic to determine the feasibility of community-based care versus hospital-based care. Risk
the initial assessment. Confirmation of the patient’s problem is not part of the risk assessment protocol
mental health system will follow risk assessment if the patient is assessed as needing service.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
MSC: Client Needs: Safe, Effective Care Environment
12. Risk assessment for a patient shows these findings: schizophrenia but not currently; not a danger to sel
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
Referral should be made to the least restrictive, most effective, and most cost-conscious source of servi
not a danger to self or others, hospitalization is not needed. However, follow-up as an outpatient would
referral to a self-help group, in which structure might be lacking, or discharge from the system.
DIF: Cognitive level: Applying TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
13. A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take it anymore. D
reply that the nurse could make is based on which psychotherapeutic management model?
a. Psychopathology
b. Milieu management
c. Psychopharmacology
d. Therapeutic nurse-patient relationship
ANS: C
Concerns about medication voiced by patients require the nurse to have knowledge about psychotherap
responses. The nurse-patient relationship component is based on use of self. Milieu management is con
of care. Psychopathology provides foundational knowledge of mental disorders but would be less relev
the patient than knowledge of psychopharmacology.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
14. A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take it anymore.
, 15. The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has a permanent dis
hospitalizations in the future. I wonder how I will be able to raise our children alone.” The nurse’s repl
form of nursing knowledge?
a. Psychopathology
b. Milieu management
c. Psychopharmacology
d. Nursing relationship therapy
ANS: A
An understanding of psychopathology will enable the nurse to communicate reassurance to the spouse
panic attacks in an outpatient setting. None of the other options has psychotherapeutic knowledge of ps
focus.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
16. Which observation during morning rounds should receive a nurse’s priority attention?
a. Breakfast is late being served.
b. A sink is leaking, leaving water on the bathroom floor.
c. The daily schedule has not been posted on the unit bulletin board.
d. A small group of patients is complaining that one patient turned down the TV
volume.
ANS: B
Safety is the component of therapeutic milieu management that takes priority over the other componen
if he or she slipped and fell. The other problems do not pose a threat to patient safety.
DIF: Cognitive level: Analyzing TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
17. A community mental health nurse assessing a person with a psychiatric disorder, should refer this pers
which basic concept?
a. Focus on interventions is on the least costly initially.
b. Initial interventions are the least restrictive.
c. Initial interventions offer a form of psychoeducation.
d. Rapid symptom stabilization is the primary goal.
ANS: B
The concept of least restrictive treatment environment preserves individual rights to freedom. Many pa
receive community-based treatment. Hospitalization is reserved for short periods when patients are ass
self or others. Cost is a consideration but is of lesser concern than safety. All facets of the continuum sh
as needed by patients and families. Some aspects of the care continuum are more concerned with a pati
stabilization than others (e.g., hospitals versus psychiatric rehabilitation programs). The outcome of sy
need for some patients, so it is not a correct answer.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
18. An acutely psychotic patient is restricted to an inpatient unit. This intervention demonstrates that which
adapted?
a. Norms
b. Balance
c. Therapy
d. Psychopathology
ANS: B
Balance refers to negotiating the line between dependence and independence. The more psychotic the i
independence he or she can usually handle safely. Unit restriction with careful supervision by staff help
patient judgment. Norms refers to behavioral expectations for patients. Therapy is provided by advance
with advanced education and so is not an element of milieu management. Psychopathology is not cons
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
,10. Which intervention should the nurse implement when focusing on communicating therapeutically with
a. Explaining to the client why they will need to ask for a razor
b. Providing the client with options to help achieve smoking cessation
c. Encouraging the client to identify personal stressors
d. Assuring the client that they can receive telephone call on the unit telephone
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient relationship
communication is providing the client with an opportunity to safely identify personal stressors. The rem
safety, balance, and norms associated with their care.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
11. During the risk assessment phase of care for a psychiatric patient, what is the nurse’s primary goal?
a. Making an initial assessment
b. Confirming the patient’s problem
c. Assessing potential dangerousness to self or others
d. Determining 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 wheth
acutely psychotic to determine the feasibility of community-based care versus hospital-based care. Risk
the initial assessment. Confirmation of the patient’s problem is not part of the risk assessment protocol
mental health system will follow risk assessment if the patient is assessed as needing service.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
MSC: Client Needs: Safe, Effective Care Environment
12. Risk assessment for a patient shows these findings: schizophrenia but not currently; not a danger to sel
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
Referral should be made to the least restrictive, most effective, and most cost-conscious source of servi
not a danger to self or others, hospitalization is not needed. However, follow-up as an outpatient would
referral to a self-help group, in which structure might be lacking, or discharge from the system.
DIF: Cognitive level: Applying TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
13. A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take it anymore. D
reply that the nurse could make is based on which psychotherapeutic management model?
a. Psychopathology
b. Milieu management
c. Psychopharmacology
d. Therapeutic nurse-patient relationship
ANS: C
Concerns about medication voiced by patients require the nurse to have knowledge about psychotherap
responses. The nurse-patient relationship component is based on use of self. Milieu management is con
of care. Psychopathology provides foundational knowledge of mental disorders but would be less relev
the patient than knowledge of psychopharmacology.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Physiologic Integrity
14. A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take it anymore.
, 15. The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has a permanent dis
hospitalizations in the future. I wonder how I will be able to raise our children alone.” The nurse’s repl
form of nursing knowledge?
a. Psychopathology
b. Milieu management
c. Psychopharmacology
d. Nursing relationship therapy
ANS: A
An understanding of psychopathology will enable the nurse to communicate reassurance to the spouse
panic attacks in an outpatient setting. None of the other options has psychotherapeutic knowledge of ps
focus.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
16. Which observation during morning rounds should receive a nurse’s priority attention?
a. Breakfast is late being served.
b. A sink is leaking, leaving water on the bathroom floor.
c. The daily schedule has not been posted on the unit bulletin board.
d. A small group of patients is complaining that one patient turned down the TV
volume.
ANS: B
Safety is the component of therapeutic milieu management that takes priority over the other componen
if he or she slipped and fell. The other problems do not pose a threat to patient safety.
DIF: Cognitive level: Analyzing TOP: Nursing process: Planning
MSC: Client Needs: Safe, Effective Care Environment
17. A community mental health nurse assessing a person with a psychiatric disorder, should refer this pers
which basic concept?
a. Focus on interventions is on the least costly initially.
b. Initial interventions are the least restrictive.
c. Initial interventions offer a form of psychoeducation.
d. Rapid symptom stabilization is the primary goal.
ANS: B
The concept of least restrictive treatment environment preserves individual rights to freedom. Many pa
receive community-based treatment. Hospitalization is reserved for short periods when patients are ass
self or others. Cost is a consideration but is of lesser concern than safety. All facets of the continuum sh
as needed by patients and families. Some aspects of the care continuum are more concerned with a pati
stabilization than others (e.g., hospitals versus psychiatric rehabilitation programs). The outcome of sy
need for some patients, so it is not a correct answer.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
18. An acutely psychotic patient is restricted to an inpatient unit. This intervention demonstrates that which
adapted?
a. Norms
b. Balance
c. Therapy
d. Psychopathology
ANS: B
Balance refers to negotiating the line between dependence and independence. The more psychotic the i
independence he or she can usually handle safely. Unit restriction with careful supervision by staff help
patient judgment. Norms refers to behavioral expectations for patients. Therapy is provided by advance
with advanced education and so is not an element of milieu management. Psychopathology is not cons
