1. A newly licensed 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.‖ I I ll
b. ―The multidisciplinary approach eliminates the need to clearly define the
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responsibilities of nursing in such a setting.‖ IIll IIll IIll II ll IIll IIll
c. ―Nursing actions are identified by the institution that distinguishes nursing IIll IIll IIll IIll IIll IIll IIll I I ll IIll
from I I ll
other mental health professions.‖ II ll IIll IIll
d. ―Nursing offers unique contributions to the psychotherapeutic management of IIll IIll IIll IIll IIll IIll I I ll IIll
psychiatric patients.‖ IIll
ANSWER: D IIll
Professional role overlap cannot be denied; however, nursing is unique in its focus on
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and application of psychotherapeutic management. Neither the facility nor the
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multidisciplinaryteam define the professional responsibilities of its members but rather
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utilizes their unique skills to provide holistic care. Ideally, all team members support
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each other and have functions within the team.
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DIF: Cognitive level: Analyzing TOP: Nursing process: IIll IIll I I l l IIll
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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theresponsibility to match individual patient needs with appropriate services?
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a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANSWER: C IIll
Proper assessment is critical for being able to determine the appropriate level of services
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that will provide optimal care while considering patient input and at the lowest cost.
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Planning and implementation utilizes the assessment data to identify and execute actions
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(treatment plan) that will provide appropriate care. Evaluation validates the effectiveness of
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the treatment plan.
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DIF: Cognitive level: Applying TOP: Nursing process: IIll IIll I I l l IIll
AssessmentMSC: Client Needs: Safe, Effective Care Environment
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3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory
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hallucinationsand 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 IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll
partner
b. Minimizing contact between this patient and other patients to assure a stress free IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll
milieu
c. Administering PRN medication when first observing the evidence that the client IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll
, may be hallucinating IIll IIll
d. Independently determining that behavior modification is appropriate to decrease IIll IIll IIll IIll IIll IIll IIll IIll
the client‘s paranoid thoughts
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ANSWER: A IIll
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
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abasis 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: IIll IIll I I l l IIll
ImplementationMSC: Client Needs: Safe, Effective Care Environment
IIll Il I I l l IIll IIll IIll IIll IIll
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
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by psychotherapeutic management?
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a. Involvement in group therapies IIll IIll IIll
b. Focus of close supervision by the unit staff IIll IIll IIll IIll IIll IIll I I ll
c. Maintaining effective communication with support system IIll IIll IIll IIll IIll
d. Frequently scheduled one-on-one time with nursing staff IIll IIll IIll IIll IIll IIll
ANSWER: D IIll
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 IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll
thisconnection. While the other options are appropriate and client centered, the nurse-
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client 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: IIll IIll I I l l IIll
ImplementationMSC: Client Needs: Psychosocial Integrity
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5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects.
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What assessment question demonstrates the nurse‘s understanding of the resulting
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needs of 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?‖ IIll IIll IIll IIll IIll IIll IIll
c. ―What do you expect will occur since the dosage has been reduced?‖ II ll IIll IIll IIll IIll IIll IIll IIll IIll IIll IIll
d. ―What can I do to help you manage this reduction in haloperidol II ll IIll IIll IIll II ll I I ll I I ll IIll IIll IIll IIll
therapy?‖ IIll
ANSWER: B IIll
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
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return or worsening of positive symptoms such as hallucinations and delusions, and
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negative symptoms such as blunted affect, social withdrawal, and poor grooming. While
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the other options may be appropriate assessment questions, they are not directed at the
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current needs ofthe client; the identification of emerging psychotic behaviors.
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DIF: Cognitive level: Analyzing TOP: Nursing process: IIll IIll I I l l IIll
AssessmentMSC: Client Needs: Physiologic Integrity
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