,1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the
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psychiatric 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.‖ l
b. ―The multidisciplinary approach eliminates the need to clearly define the
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responsibilities of nursing in such a setting.‖ l l l l l l
c. ―Nursing actions are identified by the institution that distinguishes nursing froml l l l l l l l l l
other mental health professions.‖ l l l
d. ―Nursing offers unique contributions to the psychotherapeutic management of l l l l l l l l
psychiatric patients.‖ l
ANS: D l
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
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application 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 skills
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to provide holistic care. Ideally, all team members support each other and have functions within
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the team.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation l l l l l
MSC: Client Needs: Safe, Effective Care Environment
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2. Which component of the nursing process will the nurse focus upon to address the
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responsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C l
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 and
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implementation utilizes the assessment data to identify and execute actions (treatment plan) that
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will provide appropriate care. Evaluation validates the effectiveness of the treatment plan.
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DIF: Cognitive level: Applying TOP: Nursing process: Assessment l l l l l
MSC: 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 the
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nurse‘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 l l l l l l l l l l l
partner
b. Minimizing contact between this patient and other patients to assure a stress-free l l l l l l l l l l l
milieu
c. Administering PRN medication when first observing the evidence that the client l l l l l l l l l l
, may be hallucinating l l
d. Independently determining that behavior modification is appropriate to decrease l l l l l l l l
the client‘s paranoid thoughts
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ANS: A l
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: Implementation l l l l l
MSC: Client Needs: Safe, Effective Care Environment
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4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which
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intervention 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 l l l
b. Focus of close supervision by the unit staff l l l l l l l
c. Maintaining effective communication with support system l l l l l
d. Frequently scheduled one-on-one time with nursing staff l l l l l l
ANS: D l
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 relation
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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: Implementation l l l l l
MSC: 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 the
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client?
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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?‖ l l l l l l l
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 l
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
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psychosis as well as for a lessening of side effects. Dosage decrease might lead to the return or
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worsening of positive symptoms such as hallucinations and delusions, and negative symptoms
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such as blunted affect, social withdrawal, and poor grooming. While the other options may be
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appropriate assessment questions, they are not directed at the current needs ofthe client which is
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the identification of emerging psychotic behaviors.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment l l l l l
MSC: Client Needs: Physiologic Integrity
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, 6. Which statement forms the foundation upon which a nurse should base the implementation of
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psychotherapeutic 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 l
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 components
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and permit judicious use. The remaining options identify components of the psychotherapeutic
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management process.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis l l l l l
MSC: 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.‖ l l l l l l
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 should
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be referred to the psychiatrist.‖
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ANS: A l
Nursing assessment and analysis of data might suggest the need for PRN medication as patient
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anxiety increases or psychotic symptoms become more acute. The nurse is the health team
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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 dosagesof
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medications unless they have prescriptive privileges.
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DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis l l l l l
MSC: Client Needs: Safe, Effective Care Environment
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8. When considering environmental aspects of milieu management, which intervention has the
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highest 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 l l l l l l l l l
c. Orienting the client to the milieu‘s public and private spaces l l l l l l l l l
d. Having all potentially dangerous items removed from the client‘s belongings
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ANS: B l
Milieu management provides a proactive approach to care. Safety overrides all other
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dimensions of the milieu. Initiation of suicide precautions are the priority for this client. Allthe
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remaining options are appropriate but none protect the client from the risk of another attempt to
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self-harm as effectively as one-on-one observation as part of suicide precautions.
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DIF: Cognitive level: Analyzing l l TOP: Nursing process: Implementation l l l
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