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TEST BANK For Keltners Psychiatric Nursing, 9th Edition By Debbie Steele, Verified Chapters 1 - 36, Complete Newest Version
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TEST BANK For Keltners Psychiatric Nursing, 9th Edition By Debbie Steele, Verified Chapters 1 - 36, Complete Newest Version

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  • October 10, 2024
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Chapter 01: Me, Meds, Milieu
y y y y


Steele: Keltner’s Psychiatric Nursing, 9th Edition
y y y y y




MULTIPLE CHOICE y




1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the
y y y y y y y y y y y y y y y


psychiatric setting. What is the nurse recruiter‘s best response?
y y y y y y y y y


a. ―The nurse primarily serves in a supportive role to members of the health care
y y y y y y y y y y y y y


delivery team.‖ y


b. ―The multidisciplinary approach eliminates the need to clearly define the
y y y y y y y y y


responsibilities of nursing in such a setting.‖ y y y y y y


c. ―Nursing actions are identified by the institution that distinguishes nursing from
y y y y y y y y y y


other mental health professions.‖ y y y


d. ―Nursing offers unique contributions to the psychotherapeutic management of
y y y y y y y y


psychiatric patients.‖ y




ANS: D y


Professional role overlap cannot be denied; however, nursing is unique in its focus on and
y y y y y y y y y y y y y y


application of psychotherapeutic management. Neither the facility nor the multidisciplinary
y y y y y y y y y y


team define the professional responsibilities of its members but rather utilizes their unique
y y y y y y y y y y y y y


skills to provide holistic care. Ideally, all team members support each other and have
y y y y y y y y y y y y y y


functions within the team.
y y y y




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


Implementation MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




2. Which component of the nursing process will the nurse focus upon to address the
y y y y y y y y y y y y y


yresponsibility to match individual patient needs with appropriate services?
y y y y y y y y


a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C y


Proper assessment is critical for being able to determine the appropriate level of services that
y y y y y y y y y y y y y y


will provide optimal care while considering patient input and at the lowest cost. Planning and
y y y y y y y y y y y y y y y


implementation utilizes the assessment data to identify and execute actions (treatment plan)
y y y y y y y y y y y y


that will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
y y y y y y y y y y y y y




DIF: Cognitive level: Applying TOP: Nursing process: y y y y


Assessment MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory
y y y y y y y y


hallucinations and walks about the unit, muttering. Which nursing action demonstrates the
y y y y y y y y y y y y


nurse‘s understanding of effective psychotherapeutic management of this client?
y y y y y y y y y


a. Discussing the disease process of schizophrenia with the client and their domestic
y y y y y y y y y y y


partner
b. Minimizing contact between this patient and other patients to assure a stress-free
y y y y y y y y y y y


milieu
c. Administering PRN medication when first observing the evidence that the client y y y y y y y y y y

, may be hallucinating
y y


d. Independently determining that behavior modification is appropriate to decrease y y y y y y y y


the client‘s paranoid thoughts
y y y




ANS: A y


An understanding of psychopathology is the foundation on which the three components of
y y y y y y y y y y y y


psychotherapeutic management rest; it facilitates therapeutic communication and provides a
y y y y y y y y y y


basis for understanding psychopharmacology and milieu management. Minimizing contact
y y y y y y y y y


between the patient and others and administering PRN medication indiscriminately are
y y y y y y y y y y y


nontherapeutic interventions. Using behavior modification to decrease the frequency of
y y y y y y y y y y


hallucinations would need to be incorporated into the plan of care by the care team.
y y y y y y y y y y y y y y y




DIF: Cognitive level: Applying TOP: Nursing process: y y y y


Implementation MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
y y y y y y y y y y y y


intervention is critical in assuring long-term, effective client care as described by
y y y y y y y y y y y y


psychotherapeutic management?
y y


a. Involvement in group therapies y y y


b. Focus of close supervision by the unit staff
y y y y y y y


c. Maintaining effective communication with support system y y y y y


d. Frequently scheduled one-on-one time with nursing staff y y y y y y




ANS: D y


A critical element of psychotherapeutic management is the presence of a therapeutic
y y y y y y y y y y y


nurse-patient relationship. One-on-one time with nursing staff will help in establishing this
y y y y y y y y y y y


connection. While the other options are appropriate and client centered, the nurse-client
y y y y y y y y y y y y


relation is critical in the long-term delivery of quality effective care to this client.
y y y y y y y y y y y y y y




DIF: Cognitive level: Applying TOP: Nursing process: y y y y


Implementation MSC: Client Needs: Psychosocial Integrity
y y y y y y




5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What
y y y y y y y y y y y y y


assessment question demonstrates the nurse‘s understanding of the resulting needs of the
y y y y y y y y y y y y


client?
y


a. ―Will you have any difficulty getting your prescription refilled?‖
y y y y y y y y


b. ―Have you begun experiencing any forms of hallucinations?‖
y y y y y y y


c. ―What do you expect will occur since the dosage has been reduced?‖
y y y y y y y y y y y


d. ―What can I do to help you manage this reduction in haloperidol therapy?‖
y y y y y y y y y y y y




ANS: B y


It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
y y y y y y y y y y y y y y y


psychosis as well as for a lessening of side effects. Dosage decrease might lead to the return
y y y y y y y y y y y y y y y y y


or worsening of positive symptoms such as hallucinations and delusions, and negative
y y y y y y y y y y y y


symptoms such as blunted affect, social withdrawal, and poor grooming. While the other
y y y y y y y y y y y y y


options may be appropriate assessment questions, they are not directed at the current needs of
y y y y y y y y y y y y y y y


the client which is the identification of emerging psychotic behaviors.
y y y y y y y y y y




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


Assessment MSC: Client Needs: Physiologic Integrity
y y y y y y

,6. Which statement forms the foundation upon which a nurse should base the implementation of
y y y y y y y y y y y y y


psychotherapeutic management to the care of a patient with mental illness?
y y y y y y y y y y y


a. The nurse‘s role in client care is supported by the multidisciplinary team.
y y y y y y y y y y y


b. Omitting any one component will compromise the effectiveness of the treatment.
y y y y y y y y y y


c. The most important element of psychotherapeutic management is drug therapy.
y y y y y y y y y


d. A therapeutic nurse-patient relationship is the most important aspect of treatment.
y y y y y y y y y y




ANS: B y


When one element is missing, treatment is usually compromised. No single element is more
y y y y y y y y y y y y y


important than the others; however, patients‘ needs govern the application of the components
y y y y y y y y y y y y y


and permit judicious use. The remaining options identify components of the
y y y y y y y y y y y


psychotherapeutic management process.
y y y




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


Analysis MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
y y y y y y y y y


a. ―You will need to frequently make decisions regarding the administration of PRN
y y y y y y y y y y y


medications to help the client manage anger.‖ y y y y y y


b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patient
y y y y y y y y y y y y


responses.‖
y


c. ―Nurses administers medications while evaluating drug effectiveness is a medical
y y y y y y y y y


responsibility.‖
y


d. ―To best assure appropriate response, a patient‘s questions about drug therapy
y y y y y y y y y y


should be referred to the psychiatrist.‖
y y y y y y




ANS: A y


Nursing assessment and analysis of data might suggest the need for PRN medication as
y y y y y y y y y y y y y


patient anxiety increases or psychotic symptoms become more acute. The nurse is the health
y y y y y y y y y y y y y y


team member who makes this determination. Nurses are responsible for monitoring drug
y y y y y y y y y y y y


effectiveness as well as administering medication. Nurses should assume responsibility for
y y y y y y y y y y y


teaching patients about the side effects of medications. Nurses cannot alter prescribed dosages
y y y y y y y y y y y y y


of medications unless they have prescriptive privileges.
y y y y y y y




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


Analysis MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




8. When considering environmental aspects of milieu management, which intervention has the
y y y y y y y y y y


highest priority for a client admitted after a failed suicide attempt?
y y y y y y y y y y y


a. Sending the client‘s new medication prescriptions to the pharmacy
y y y y y y y y


b. Assigning a staff member to one-on-one observation of the client y y y y y y y y y


c. Orienting the client to the milieu‘s public and private spaces y y y y y y y y y


d. Having all potentially dangerous items removed from the client‘s belongings
y y y y y y y y y




ANS: B y


Milieu management provides a proactive approach to care. Safety overrides all other
y y y y y y y y y y y


dimensions of the milieu. Initiation of suicide precautions are the priority for this client. All
y y y y y y y y y y y y y y y


the remaining options are appropriate but none protect the client from the risk of another
y y y y y y y y y y y y y y y


attempt to self-harm as effectively as one-on-one observation as part of suicide precautions.
y y y y y y y y y y y y y




DIF: Cognitive level: Analyzing y y TOP: Nursing process: Implementationy y y

, MSC: Client Needs: Safe, Effective Care Environment
y y y y y y




9. The implementation of which unit policy directed at milieu balance would reflect a need for
y y y y y y y y y y y y y y


yreconsideration on the part of the treatment team? y y y y y y y


a. All clients will receive verbal and written information explaining unit rules.
y y y y y y y y y y


b. Unit clients will engage in all unit activities to assure interaction with both staff
y y y y y y y y y y y y y


and other clients.
y y y


c. All clients will be uniformly expected to present themselves in a nonviolent
y y y y y y y y y y y


manner to both staff and other clients.
y y y y y y y


d. At times of unit stress, client will return to their rooms.
y y y y y y y y y y




ANS: B y


The situation described suggests a milieu in which patients have no time for planned
y y y y y y y y y y y y y


therapeutic encounters with staff; hence, it is a milieu lacking balance. The remaining options
y y y y y y y y y y y y y y


address unit norms, limit setting, and environmental modifications that are reasonable and will
y y y y y y y y y y y y y


contribute to a therapeutic milieu.
y y y y y




DIF: Cognitive level: Evaluating TOP: Nursing process: y y y y


Evaluation MSC: Client Needs: Safe, Effective Care Environment
y y y y y y y y




10. Which intervention should the nurse implement when focusing on communicating
y y y y y y y y y


therapeutically with a client?
y y y y


a. Explaining to the client why they will need to ask for a razor y y y y y y y y y y y y


b. Providing the client with options to help achieve smoking cessation
y y y y y y y y y


c. Encouraging the client to identify personal stressors y y y y y y


d. Assuring the client that they can receive telephone call on the unit telephone
y y y y y y y y y y y y




ANS: C y


A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient
y y y y y y y y y y y


relationship. An example of such communication is providing the client with an opportunity
y y y y y y y y y y y y y


to safely identify personal stressors. The remaining options address safety, balance, and norms
y y y y y y y y y y y y y


associated with their care.
y y y y




DIF: Cognitive level: Applying TOP: Nursing process: y y y y


Implementation MSC: Client Needs: Psychosocial Integrity
y y y y y y




11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s primary
y y y y y y y y y y y y y y y


ygoal?
a. Making an initial assessment y y y


b. Confirming the patient‘s problem y y y


c. Assessing potential dangerousness to self or others y y y y y y


d. Determining the level of supervision needed for the patient y y y y y y y y




ANS: C y


Risk assessment involves looking at dangerousness to self or others, the degree of disability,
y y y y y y y y y y y y y


and whether or not the individual is acutely psychotic to determine the feasibility of
y y y y y y y y y y y y y y


community-based care versus hospital-based care. Risk assessment usually follows the initial
y y y y y y y y y y y


assessment. Confirmation of the patient‘s problem is not part of the risk assessment protocol.
y y y y y y y y y y y y y y


Arranging entry into the mental health system will follow risk assessment if the patient is
y y y y y y y y y y y y y y y


assessed as needing service.
y y y y




DIF: Cognitive level: Applying y y TOP: Nursing process: Assessmenty y y

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