Steele: Keltner’s Psychiatric Nursing, 9th Edition
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MULTIPLE CHOICE Z
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in
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thepsychiatric setting. What is the nurse recruiter‘s best response?
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a. ―The nurse primarily serves in a supportive role to members of the health care
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delivery team.‖ Z
b. ―The multidisciplinary approach eliminates the need to clearly define the
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responsibilities of nursing in such a setting.‖ Z Z Z Z Z Z
c. ―Nursing actions are identified by the institution that distinguishes nursing from
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other mental health professions.‖ Z Z Z
d. ―Nursing offers unique contributions to the psychotherapeutic management of
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psychiatric patients.‖ Z
ANS: D Z
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
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Zapplication of psychotherapeutic management. Neither the facility nor the multidisciplinary
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team define the professional responsibilities of its members but rather utilizes their unique
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Zskills to provide holistic care. Ideally, all team members support each other and have
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Zfunctions within the team. Z Z Z
DIF: Cognitive level: Analyzing TOP: Nursing process: Z Z Z Z
ImplementationMSC: Client Needs: Safe, Effective Care Environment
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2. Which component of the nursing process will the nurse focus upon to address
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Ztheresponsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C Z
Proper assessment is critical for being able to determine the appropriate level of services that
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will provide optimal care while considering patient input and at the lowest cost. Planning
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and implementation utilizes the assessment data to identify and execute actions (treatment
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plan) that will provide appropriate care. Evaluation validates the effectiveness of the
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treatment plan.
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DIF: Cognitive level: Applying TOP: Nursing process: Z Z Z Z
AssessmentMSC: Client Needs: Safe, Effective Care Environment
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3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
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hallucinations and walks about the unit, muttering. Which nursing action demonstrates
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thenurse‘s understanding of effective psychotherapeutic management of this client?
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a. Discussing the disease process of schizophrenia with the client and their domestic
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partner
b. Minimizing contact between this patient and other patients to assure a stress-free
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milieu
c. Administering PRN medication when first observing the evidence that the client Z Z Z Z Z Z Z Z Z Z
, may be hallucinating
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d. Independently determining that behavior modification is appropriate to decrease
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the client‘s paranoid thoughts
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ANS: A Z
An understanding of psychopathology is the foundation on which the three components of
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psychotherapeutic management rest; it facilitates therapeutic communication and provides a
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basis for understanding psychopharmacology and milieu management. Minimizing contact
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between the patient and others and administering PRN medication indiscriminately are
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nontherapeutic interventions. Using behavior modification to decrease the frequency of
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hallucinations would need to be incorporated into the plan of care by the care team.
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DIF: Cognitive level: Applying TOP: Nursing process: Z Z Z Z
ImplementationMSC: Client Needs: Safe, Effective Care Environment
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt.
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Whichintervention is critical in assuring long-term, effective client care as described by
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psychotherapeutic management?
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a. Involvement in group therapies Z Z Z
b. Focus of close supervision by the unit staff
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c. Maintaining effective communication with support system Z Z Z Z Z
d. Frequently scheduled one-on-one time with nursing staff Z Z Z Z Z Z
ANS: D Z
A critical element of psychotherapeutic management is the presence of a therapeutic
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nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
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connection. While the other options are appropriate and client centered, the nurse-client
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relation is critical in the long-term delivery of quality effective care to this client.
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DIF: Cognitive level: Applying TOP: Nursing process: Z Z Z Z
ImplementationMSC: Client Needs: Psychosocial Integrity
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5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
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assessment question demonstrates the nurse‘s understanding of the resulting needs of
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theclient?
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a. ―Will you have any difficulty getting your prescription refilled?‖
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b. ―Have you begun experiencing any forms of hallucinations?‖
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c. ―What do you expect will occur since the dosage has been reduced?‖
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d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
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ANS: B Z
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
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Zpsychosis as well as for a lessening of side effects. Dosage decrease might lead to the
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Zreturn or worsening of positive symptoms such as hallucinations and delusions, and
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Znegative symptoms such as blunted affect, social withdrawal, and poor grooming. While the
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Zother options may be appropriate assessment questions, they are not directed at the current
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Zneeds ofthe client which is the identification of emerging psychotic behaviors.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Z Z Z Z
AssessmentMSC: Client Needs: Physiologic Integrity
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,6. Which statement forms the foundation upon which a nurse should base the implementation
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ofpsychotherapeutic management to the care of a patient with mental illness?
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a. The nurse‘s role in client care is supported by the multidisciplinary team.
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b. Omitting any one component will compromise the effectiveness of the treatment.
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c. The most important element of psychotherapeutic management is drug therapy.
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d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
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ANS: B Z
When one element is missing, treatment is usually compromised. No single element is more
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important than the others; however, patients‘ needs govern the application of the
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componentsand permit judicious use. The remaining options identify components of the
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psychotherapeutic management process.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Z Z Z Z
AnalysisMSC: Client Needs: Safe, Effective Care Environment
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7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
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a. ―You will need to frequently make decisions regarding the administration of PRN
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medications to help the client manage anger.‖ Z Z Z Z Z Z
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
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responses.‖
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c. ―Nurses administers medications while evaluating drug effectiveness is a medical
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responsibility.‖
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d. ―To best assure appropriate response, a patient‘s questions about drug therapy
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should be referred to the psychiatrist.‖
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ANS: A Z
Nursing assessment and analysis of data might suggest the need for PRN medication as
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patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
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team member who makes this determination. Nurses are responsible for monitoring drug
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effectiveness as well as administering medication. Nurses should assume responsibility for
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teaching patients about the side effects of medications. Nurses cannot alter prescribed
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dosagesof medications unless they have prescriptive privileges.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Z Z Z Z
AnalysisMSC: Client Needs: Safe, Effective Care Environment
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8. When considering environmental aspects of milieu management, which intervention has
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thehighest priority for a client admitted after a failed suicide attempt?
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a. Sending the client‘s new medication prescriptions to the pharmacy
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b. Assigning a staff member to one-on-one observation of the client
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c. Orienting the client to the milieu‘s public and private spaces
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d. Having all potentially dangerous items removed from the client‘s belongings
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ANS: B Z
Milieu management provides a proactive approach to care. Safety overrides all other
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Zdimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
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the remaining options are appropriate but none protect the client from the risk of another
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Zattempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
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DIF: Cognitive level: Analyzing Z Z TOP: Nursing process: ImplementationZ Z Z
, MSC: Client Needs: Safe, Effective Care Environment
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9. The implementation of which unit policy directed at milieu balance would reflect a need
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Z forreconsideration on the part of the treatment team?
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a. All clients will receive verbal and written information explaining unit rules.
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b. Unit clients will engage in all unit activities to assure interaction with both staff
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and other clients.
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c. All clients will be uniformly expected to present themselves in a nonviolent
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manner to both staff and other clients.
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d. At times of unit stress, client will return to their rooms.
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ANS: B Z
The situation described suggests a milieu in which patients have no time for planned
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therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining
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options address unit norms, limit setting, and environmental modifications that are
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reasonable and willcontribute to a therapeutic milieu.
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DIF: Cognitive level: Evaluating TOP: Nursing process: Z Z Z Z
EvaluationMSC: Client Needs: Safe, Effective Care Environment
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10. Which intervention should the nurse implement when focusing on
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communicatingtherapeutically with a client?
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a. Explaining to the client why they will need to ask for a razor Z Z Z Z Z Z Z Z Z Z Z Z
b. Providing the client with options to help achieve smoking cessation
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c. Encouraging the client to identify personal stressors Z Z Z Z Z Z
d. Assuring the client that they can receive telephone call on the unit telephone
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ANS: C Z
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient
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relationship. An example of such communication is providing the client with an opportunity
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to safely identify personal stressors. The remaining options address safety, balance, and
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normsassociated with their care.
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DIF: Cognitive level: Applying TOP: Nursing process: Z Z Z Z
ImplementationMSC: Client Needs: Psychosocial Integrity
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11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s
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Zprimarygoal? Z
a. Making an initial assessment Z Z Z
b. Confirming the patient‘s problem Z Z Z
c. Assessing potential dangerousness to self or others Z Z Z Z Z Z
d. Determining the level of supervision needed for the patient Z Z Z Z Z Z Z Z
ANS: C Z
Risk assessment involves looking at dangerousness to self or others, the degree of
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disability, and whether or not the individual is acutely psychotic to determine the
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feasibility of community-based care versus hospital-based care. Risk assessment usually
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follows the initialassessment. Confirmation of the patient‘s problem is not part of the risk
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assessment protocol. Arranging entry into the mental health system will follow risk
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assessment if the patient is assessed as needing service.
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DIF: Cognitive level: Applying Z Z TOP: Nursing process: Assessment
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