Test Bank - Keltners Psychiatric Nursing, 9th Edition (Steele, 2024), Chapter 1-36 | All Chapters Latest Update 2024
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Keltners Psychiatric Nursing, 9th Edition
(Steele), Chapters 1 - 36 | All ChaptersTest
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Chapter 01: Med, Meds, Milieu
Keltner: Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly licensed asks a nursing recruiter for a description of nursing practice in
thepsychiatric setting. What is the nurse recruiter‘s best response?
a. ―The nurse primarily serves in a supportive role to members of the health care
delivery team.‖
b. ―The multidisciplinary approach eliminates the need to clearly define the
responsibilities of nursing in such a setting.‖
c. ―Nursing actions are identified by the institution that distinguishes nursing fro
m
other mental health professions.‖
d. ―Nursing offers unique contributions to the psychotherapeutic management of
psychiatric patients.‖
ANSWER: D
Professional role overlap cannot be denied; however, nursing is unique in its focus on and
application of psychotherapeutic management. Neither the facility nor the multidisciplinar
yteam define the professional responsibilities of its members but rather utilizes their uniq
ue skills to provide holistic care. Ideally, all team members support each other and have f
unctions within the team.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effecti
ve Care Environment
,2. Which component of the nursing process will the nurse focus upon to address
theresponsibility to match individual patient needs with appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANSWER: C
Proper assessment is critical for being able to determine the appropriate level of services t
hat will provide optimal care while considering patient input and at the lowest cost. Planni
ng and implementation utilizes the assessment data to identify and execute actions (treatm
ent plan) that will provide appropriate care. Evaluation validates the effectiveness of the tre
atment plan.
DIF: Cognitive level: Applying
TOP: Nursing process: Assessment MSC: Client Needs: Safe, Effecti
ve Care Environment
3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinatio
nsand walks about the unit, muttering. Which nursing action demonstrates the nurse‘s un
derstanding of effective psychotherapeutic management of this client?
a. Discussing the disease process of schizophrenia with the client and their domesti
c
partner
b. Minimizing contact between this patient and other patients to assure a stress free
milieu
c. Administering PRN medication when first observing the evidence that the client
, may be hallucinating
d. Independently determining that behavior modification is appropriate to decrease
the client‘s paranoid thoughts
ANSWER: A
An understanding of psychopathology is the foundation on which the three components of p
sychotherapeutic management rest; it facilitates therapeutic communication and provides aba
sis for understanding psychopharmacology and milieu management. Minimizing contact bet
ween the patient and others and administering PRN medication indiscriminately are nonther
apeutic interventions. Using behavior modification to decrease the frequency of hallucinatio
ns would need to be incorporated into the plan of care by the care team.
DIF: Cognitive level: Applying
TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effecti
ve Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Wh
ich intervention is critical in assuring long-
term, effective client care as described by psychotherapeutic management?
a. Involvement in group therapies
b. Focus of close supervision by the unit staff
c. Maintaining effective communication with support system
d. Frequently scheduled one-on-one time with nursing staff
ANSWER: D
A critical element of psychotherapeutic management is the presence of a therapeutic
nurse-patient relationship. One-on-
one time with nursing staff will help in establishing this connection. While the other optio
ns are appropriate and client centered, the nurse-client relation is critical in the long-
term delivery of quality effective care to this client.
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. W
hat assessment question demonstrates the nurse‘s understanding of the resulting needs
of the client?
a. ―Will you have any difficulty getting your prescription refilled?‖
b. ―Have you begun experiencing any forms of hallucinations?‖
c. ―What do you expect will occur since the dosage has been reduced?‖
d. ―What can I do to help you manage this reduction in haloperidol therapy?
‖
ANSWER: B
It will be necessary for the nurse to assess for exacerbation of the patient‘s symptoms of
psychosis as well as for a lessening of side effects. Dosage decrease might lead to the ret
urn or worsening of positive symptoms such as hallucinations and delusions, and negative
symptoms such as blunted affect, social withdrawal, and poor grooming. While the other
options may be appropriate assessment questions, they are not directed at the current nee
ds ofthe client; the identification of emerging psychotic behaviors.
, 6. Which statement forms the foundation upon which a nurse should base the implementatio
n ofpsychotherapeutic management to the care of a patient with mental illness?
a. The nurse‘s role in client care is supported by the multidisciplinary team.
b. Omitting any one component will compromise the effectiveness of the treatment.
c. The most important element of psychotherapeutic management is drug therapy.
d. A therapeutic nurse-
patient relationship is the most important aspect of treatment.
ANSWER: B
When one element is missing, treatment is usually compromised. No single element is m
ore important than the others; however, patients‘ needs govern the application of the com
ponentsand permit judicious use. The remaining options identify components of the psyc
hotherapeutic management process.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Analysis MSC: Client Needs: Safe, Effecti
ve Care Environment
7. Which statement most accurately describes a nurse‘s role regarding psychopharmacology?
a. ―You will need to frequently make decisions regarding the administration of PRN
medications to help the client manage anger.‖
b. ―It‘s a nursing responsibility to adjust a medication dose to assure effective patien
t responses.‖
c. ―Nurses administers medications while evaluating drug effectiveness is a medical
responsibility.‖
d. ―To best assure appropriate response, a patient‘s questions about drug therapy sh
ould be referred to the psychiatrist.‖
ANSWER: A
Nursing assessment and analysis of data might suggest the need for PRN medication as p
atient anxiety increases or psychotic symptoms become more acute. The nurse is the healt
h team member who makes this determination. Nurses are responsible for monitoring drug
effectiveness as well as administering medication. Nurses should assume responsibility fo
r teaching patients about the side effects of medications. Nurses cannot alter prescribed do
sagesof medications unless they have prescriptive privileges.
DIF: Cognitive level: Analyzing
TOP: Nursing process: Analysis MSC: Client Needs: Safe, Effecti
ve Care Environment
8. When considering environmental aspects of milieu management, which intervention has
thehighest priority for a client admitted after a failed suicide attempt?
a. Sending the client‘s new medication prescriptions to the pharmacy
b. Assigning a staff member to one-on-one observation of the client
c. Orienting the client to the milieu‘s public and private spaces
d. Having all potentially dangerous items removed from the client‘s belonging
s
ANSWER: B
Milieu management provides a proactive approach to care. Safety overrides all other dim
ensions of the milieu. Initiation of suicide precautions are the priority for this client. All t
he remaining options are appropriate but none protect the client from the risk of another
attempt to self-harm as effectively as one-on-
one observation as part of suicide precautions.
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