Test Bank for Keltner’s Psychiatric Nursing, 9th Edition by Debbie Steele
Chapter 01: Me, Meds, Milieu
Steele: Keltner’s Psychiatric Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly licensed nurse asks a nursing recruiter for a description of nursing practice in the psychiatric
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 from
other mental health professions.‖
d. ―Nursing offers unique contributions to the psychotherapeutic management of
psychiatric patients.‖
ANS: 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 multidisciplinary team define the professional
responsibilities of its members but rather utilizes their unique skills to provide holistic care. Ideally, all team
members support each other and have functions within the team.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
2. Which component of the nursing process will the nurse focus upon to address the responsibility
to match individual patient needs with appropriate services?
a. Planning
b. Evaluation
c. Assessment
d. Implementation
ANS: C
Proper assessment is critical for being able to determine the appropriate level of services that will provide
optimal care while considering patient input and at the lowest cost. Planning and implementation utilizes the
assessment data to identify and execute actions (treatment plan) that will provide appropriate care. Evaluation
validates the effectiveness of the treatment plan.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
MSC: Client Needs: Safe, Effective Care Environment
3. An adult diagnosed with paranoid schizophrenia frequently experiences auditory hallucinations and walks
about the unit, muttering. Which nursing action demonstrates the nurse‘s understanding of effective
psychotherapeutic management of this client?
a. Discussing the disease process of schizophrenia with the client and their domestic
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
, Test Bank for Keltner’s Psychiatric Nursing, 9th Edition by Debbie Steele
ANS: A
An understanding of psychopathology is the foundation on which the three components of psychotherapeutic
management rest; it facilitates therapeutic communication and provides a basis for understanding
psychopharmacology and milieu management. Minimizing contact between the patient and others and
administering PRN medication indiscriminately are nontherapeutic interventions. Using behavior modification to
decrease the frequency of hallucinations 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, Effective Care Environment
4. An adult diagnosed with chronic depression is hospitalized after a suicide attempt. Which 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
ANS: 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 options are appropriate and client centered, the nurse-client relation is critical in the long-term
delivery of quality effective care to this client.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. A patient‘s haloperidol dosage was reduced 2 weeks ago to decrease side effects. What 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?‖
ANS: 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 return 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 needs of the client which is the identification of emerging psychotic behaviors.
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment
MSC: Client Needs: Physiologic Integrity
, Test Bank for Keltner’s Psychiatric Nursing, 9th Edition by Debbie Steele
6. Which statement forms the foundation upon which a nurse should base the implementation of
psychotherapeutic 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.
ANS: B
When one element is missing, treatment is usually compromised. No single element is more important than
the others; however, patients‘ needs govern the application of the components and permit judicious use. The
remaining options identify components of the psychotherapeutic management process.
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis
MSC: Client Needs: Safe, Effective 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 patient 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 should be
referred to the psychiatrist.‖
ANS: A
Nursing assessment and analysis of data might suggest the need for PRN medication as patient anxiety
increases or psychotic symptoms become more acute. The nurse is the health team member who makes this
determination. Nurses are responsible for monitoring drug effectiveness as well as administering medication.
Nurses should assume responsibility for teaching patients about the side effects of medications. Nurses cannot
alter prescribed dosages of medications unless they have prescriptive privileges.
DIF: Cognitive level: Analyzing TOP: Nursing process: Analysis
MSC: Client Needs: Safe, Effective Care Environment
8. When considering environmental aspects of milieu management, which intervention has the highest 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 belongings
ANS: B
Milieu management provides a proactive approach to care. Safety overrides all other dimensions of the milieu.
Initiation of suicide precautions are the priority for this client. All the 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.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
, Test Bank for Keltner’s Psychiatric Nursing, 9th Edition by Debbie Steele
MSC: Client Needs: Safe, Effective Care Environment
9. The implementation of which unit policy directed at milieu balance would reflect a need for reconsideration
on the part of the treatment team?
a. All clients will receive verbal and written information explaining unit rules.
b. Unit clients will engage in all unit activities to assure interaction with both staff and other
clients.
c. All clients will be uniformly expected to present themselves in a nonviolent manner to both
staff and other clients.
d. At times of unit stress, client will return to their rooms.
ANS: B
The situation described suggests a milieu in which patients have no time for planned therapeutic encounters
with staff; hence, it is a milieu lacking balance. The remaining options address unit norms, limit setting, and
environmental modifications that are reasonable and will contribute to a therapeutic milieu.
DIF: Cognitive level: Evaluating TOP: Nursing process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
10. Which intervention should the nurse implement when focusing on communicating therapeutically
with a client?
a. Explaining to the client why they will need to ask for a razor
b. Providing the client with options to help achieve smoking cessation
c. Encouraging the client to identify personal stressors
d. Assuring the client that they can receive telephone call on the unit telephone
ANS: C
A nurse uses therapeutic communication techniques as part of the therapeutic nurse-patient relationship. An
example of such communication is providing the client with an opportunity to safely identify personal stressors.
The remaining options address safety, balance, and norms associated with their care.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
11. During the risk assessment phase of care for a psychiatric patient, what is the nurse‘s primary goal?
a. Making an initial assessment
b. Confirming the patient‘s problem
c. Assessing potential dangerousness to self or others
d. Determining the level of supervision needed for the patient
ANS: C
Risk assessment involves looking at dangerousness to self or others, the degree of disability, and whether or
not the individual is acutely psychotic to determine the feasibility of community-based care versus hospital-
based care. Risk assessment usually follows the initial assessment. Confirmation of the patient‘s problem is not
part of the risk assessment protocol. Arranging entry into the mental health system will follow risk
assessment if the patient is assessed as needing service.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment
