,1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the
c c c c c c c c c c c c c c c
psychiatric setting. What is the nurse recruiter‘s best response?
c c c c c c c c c
a. ―The nurse primarily serves in a supportive role to members of the health care
c c c c c c c c c c c c c
delivery team.‖ c
b. ―The multidisciplinary approach eliminates the need to clearly define the
c c c c c c c c c
responsibilities of nursing in such a setting.‖ c c c c c c
c. ―Nursing actions are identified by the institution that distinguishes nursing from
c c c c c c c c c c
other mental health professions.‖ c c c
d. ―Nursing offers unique contributions to the psychotherapeutic management of
c c c c c c c c
psychiatric patients.‖ c
ANS: D c
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
c c c c c c c c c c c c c c
capplication of psychotherapeutic management. Neither the facility nor the multidisciplinary
c c c c c c c c c
team define the professional responsibilities of its members but rather utilizes their unique
c c c c c c c c c c c c c
cskills to provide holistic care. Ideally, all team members support each other and have
c c c c c c c c c c c c c
cfunctions within the team. c c c
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation c c c c c
MSC: Client Needs: Safe, Effective Care Environment
c c c c c c c
2. Which component of the nursing process will the nurse focus upon to address the
c c c c c c c c c c c c c
responsibility to match individual patient needs with appropriate services?
c c c c c c c c c
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C c
Proper assessment is critical for being able to determine the appropriate level of services that
c c c c c c c c c c c c c c
will provide optimal care while considering patient input and at the lowest cost. Planning and
c c c c c c c c c c c c c c c
implementation utilizes the assessment data to identify and execute actions (treatment plan)
c c c c c c c c c c c c
that will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
c c c c c c c c c c c c c
DIF: Cognitive level: Applying TOP: Nursing process: Assessment c c c c c
MSC: Client Needs: Safe, Effective Care Environment
c c c c c c c
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
c c c c c c c c
hallucinations and walks about the unit, muttering. Which nursing action demonstrates the
c c c c c c c c c c c c
nurse‘s understanding of effective psychotherapeutic management of this client?
c c c c c c c c c
a. Discussing the disease process of schizophrenia with the client and their domestic
c c c c c c c c c c c
partner
b. Minimizing contact between this patient and other patients to assure a stress-free
c c c c c c c c c c c
milieu
c. Administering PRN medication when first observing the evidence that the client c c c c c c c c c c
, may be hallucinating
c c
d. Independently determining that behavior modification is appropriate to decrease c c c c c c c c
the client‘s paranoid thoughts
c c c
ANS: A c
An understanding of psychopathology is the foundation on which the three components of
c c c c c c c c c c c c
psychotherapeutic management rest; it facilitates therapeutic communication and provides a
c c c c c c c c c c
basis for understanding psychopharmacology and milieu management. Minimizing contact
c c c c c c c c c
between the patient and others and administering PRN medication indiscriminately are
c c c c c c c c c c c
nontherapeutic interventions. Using behavior modification to decrease the frequency of
c c c c c c c c c c
hallucinations would need to be incorporated into the plan of care by the care team.
c c c c c c c c c c c c c c c
DIF: Cognitive level: Applying TOP: Nursing process: Implementation c c c c c
MSC: Client Needs: Safe, Effective Care Environment
c c c c c c c
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
c c c c c c c c c c c c
intervention is critical in assuring long-term, effective client care as described by
c c c c c c c c c c c c
cpsychotherapeutic management? c
a. Involvement in group therapies c c c
b. Focus of close supervision by the unit staff c c c c c c c
c. Maintaining effective communication with support system c c c c c
d. Frequently scheduled one-on-one time with nursing staff c c c c c c
ANS: D c
A critical element of psychotherapeutic management is the presence of a therapeutic
c c c c c c c c c c c
nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
c c c c c c c c c c c
connection. While the other options are appropriate and client centered, the nurse-client
c c c c c c c c c c c c
relation is critical in the long-term delivery of quality effective care to this client.
c c c c c c c c c c c c c c
DIF: Cognitive level: Applying TOP: Nursing process: Implementation c c c c c
MSC: Client Needs: Psychosocial Integrity
c c c c c
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
c c c c c c c c c c c c c
assessment question demonstrates the nurse‘s understanding of the resulting needs of the
c c c c c c c c c c c c
client?
c
a. ―Will you have any difficulty getting your prescription refilled?‖
c c c c c c c c
b. ―Have you begun experiencing any forms of hallucinations?‖
c c c c c c c
c. ―What do you expect will occur since the dosage has been reduced?‖
c c c c c c c c c c c
d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
c c c c c c c c c c c c
ANS: B c
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
c c c c c c c c c c c c c c c
cpsychosis as well as for a lessening of side effects. Dosage decrease might lead to the return
c c c c c c c c c c c c c c c c
cor worsening of positive symptoms such as hallucinations and delusions, and negative
c c c c c c c c c c c
csymptoms such as blunted affect, social withdrawal, and poor grooming. While the other
c c c c c c c c c c c c
coptions may be appropriate assessment questions, they are not directed at the current needs of
c c c c c c c c c c c c c c
the client which is the identification of emerging psychotic behaviors.
c c c c c c c c c c
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment c c c c c
MSC: Client Needs: Physiologic Integrity
c c c c c
, 6. Which statement forms the foundation upon which a nurse should base the implementation of
c c c c c c c c c c c c c
psychotherapeutic management to the care of a patient with mental illness?
c c c c c c c c c c c
a. The nurse‘s role in client care is supported by the multidisciplinary team.
c c c c c c c c c c c
b. Omitting any one component will compromise the effectiveness of the treatment.
c c c c c c c c c c
c. The most important element of psychotherapeutic management is drug therapy.
c c c c c c c c c
d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
c c c c c c c c c c
ANS: B c
When one element is missing, treatment is usually compromised. No single element is more
c c c c c c c c c c c c c
important than the others; however, patients‘ needs govern the application of the components
c c c c c c c c c c c c c
and permit judicious use. The remaining options identify components of the
c c c c c c c c c c c
psychotherapeutic management process.
c c c
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis c c c c c
MSC: Client Needs: Safe, Effective Care Environment
c c c c c c c
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
c c c c c c c c c
a. ―You will need to frequently make decisions regarding the administration of PRN
c c c c c c c c c c c
medications to help the client manage anger.‖ c c c c c c
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
c c c c c c c c c c c c
responses.‖
c
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
c c c c c c c c c
responsibility.‖
c
d. ―To best assure appropriate response, a patient‘s questions about drug therapy
c c c c c c c c c c
should be referred to the psychiatrist.‖
c c c c c c
ANS: A c
Nursing assessment and analysis of data might suggest the need for PRN medication as
c c c c c c c c c c c c c
patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
c c c c c c c c c c c c c c
team member who makes this determination. Nurses are responsible for monitoring drug
c c c c c c c c c c c c
effectiveness as well as administering medication. Nurses should assume responsibility for
c c c c c c c c c c c
teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
c c c c c c c c c c c c c
of medications unless they have prescriptive privileges.
c c c c c c c
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis c c c c c
MSC: Client Needs: Safe, Effective Care Environment
c c c c c c c
8. When considering environmental aspects of milieu management, which intervention has the
c c c c c c c c c c
highest priority for a client admitted after a failed suicide attempt?
c c c c c c c c c c c
a. Sending the client‘s new medication prescriptions to the pharmacy
c c c c c c c c
b. Assigning a staff member to one-on-one observation of the client c c c c c c c c c
c. Orienting the client to the milieu‘s public and private spaces c c c c c c c c c
d. Having all potentially dangerous items removed from the client‘s belongings
c c c c c c c c c
ANS: B c
Milieu management provides a proactive approach to care. Safety overrides all other
c c c c c c c c c c c
cdimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
c c c c c c c c c c c c c c
the remaining options are appropriate but none protect the client from the risk of another
c c c c c c c c c c c c c c c
cattempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
c c c c c c c c c c c c
DIF: Cognitive level: Analyzing c c TOP: Nursing process: Implementation c c c
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