Test Bank for Psychiatric Nursing 8th Ed by Keltner

Test Bank for Psychiatric Nursing 8th Edition by Keltner

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. 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

 2. 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

 3. An adult diagnosed with paranoid schizophrenia frequent 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

 4. 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  

 10. Which intervention should the nurse implement when focusing on communicating therapeutically with a client?

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. An example of such

communication is providing the client with an opportunity to safely identify personal stressors. The remaining options address

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 whether or not the individual is

acutely psychotic to determine the feasibility of community-based care versus hospital-based care. Risk assessment usually follows

the initial assessment. Confirmation of the patient’s problem is not part of the risk assessment protocol. Arranging entry into the

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 self or others; lives in parents’

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 services. Because the patient is

not a danger to self or others, hospitalization is not needed. However, follow-up as an outpatient would be more appropriate than

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. Do you?” The most effective

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 psychotherapeutic drugs to make helpful

responses. The nurse-patient relationship component is based on use of self. Milieu management is concerned with the environment

of care. Psychopathology provides foundational knowledge of mental disorders but would be less relevant in framing a response to

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. Do you?” What is the

nurse’s best response?

a. “I wonder why you think that.”

b. “Tell me how the medication makes you feel.”

c. “One must never stop taking medication.”

d. “You need to discuss this with your psychiatrist.”

ANS: B

As part of the psychopharmacology component of psychotherapeutic management, the responsibility of the nurse is to gather data

about patients’ responses to medication and to be alert for side and adverse effects of the medication. The other responses are 

tangential to the real issue.

DIF: Cognitive level: Applying 

TOP: Nursing process: Implementation

MSC: Client Needs: Physiologic Integrity