Test Bank for Psychiatric Nursing 8th Edition 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

              DIF: Cognitive level: Analyzing               TOP: Nursing process: Analysis

MSC: Client Needs: Safe, Effective Care Environment

MULTIPLE RESPONSE

1.      What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community-based care? (Select all that apply.)

a.        Need for PRN medication

b.        Severity of the patient’s illness

c.        Need for structured formal therapy

d.        Presence of suicidal or homicidal ideation

e.        Amount of supervision required by the patient

ANS: B, D, E

The decision tree for the continuum of care calls for the assessment of severity of the illness, the presence or absence of suicidal or homicidal ideation, whether or not the disability is so great that the patient is unable to provide for his or her own basic needs, and the amount of supervision required for patient safety. The frequency of need for PRN medication and the need for structured formal therapy are not considerations mentioned in the decision tree.

DIF: Cognitive level: Analyzing            TOP: Nursing process: Planning MSC: Client Needs: Safe, Effective Care Environment

2.      Which intervention demonstrates that a nurse is functioning within the scope of psychotherapeutic management? (Select all that apply.)

a.        Structuring meaningful unit activities

b.        Administering electroconvulsive therapy

c.        Encouraging a patient to express feelings

d.        Interpreting the results of psychological testing

e.        Assessing a patient for medication side effects

ANS: A, C, E

Milieu management, patient communication, and medication administration are all within the scope of nursing practice. Electroconvulsive therapy is a medical treatment and, therefore, should be administered by a physician. Psychological testing is interpreted by a psychologist.

              DIF:   Cognitive level: Analyzing              TOP: Nursing process: Implementation

MSC: Client Needs: Safe, Effective Care Environment