Lone Star College System, North Harris - PSYC 1301

Chapter 33: Hospital-Based Psychiatric Nursing Care Test Bank

MULTIPLE CHOICE

1)When a partial-hospitalization patient is assessed as possibly having suicidal ideations, the treatment plan will focus on:

1. 1. stabilization.
   2. institutionalization.
   3. symptom remission.
   4. diagnostic evaluation.

2. Which nursing intervention has priority when assisting a patient who has been transported to the hospital admissions unit by police for wandering barefoot and naked on the street in freezing weather?
   1. Establishing trust in the one-to-one, nurse-patient relationship
   2. Performing a rapid multidisciplinary physical assessment
   3. Contacting family for permission to treat the patient
   4. Determining why the patient removed all clothing

3. Which nursing action would best promote the psychiatric stabilization of a patient who is both confused and agitated when found wandering barefoot in freezing weather?
   1. Place the patient on frequent observation to assess both overall status and potential for harm.
   2. Anticipate the inclusion of medication therapy in the patient’s therapeutic plan of care.
   3. Interview the patient to obtain information regarding the identification of family and/or caregiver.
   4. Notify social services that the patient will be in need of both physical and social support resources.

4. The activity room is severely damaged while the nurse is addressing an emergency on the inpatient unit. Which communication by the nurse to the entire milieu would be the most therapeutic when the destruction is first discovered?
   1. “This room is off-limits for 2 weeks. I am struggling with this intolerable behavior and sorely disappointed in everyone involved.”
   2. “This behavior is representative of a real problem with the unit’s milieu. Let’s discuss it as you all help put the room back in its original order.”
   3. “People must be really angry. Everyone who was involved must help undo the damage immediately and then discuss the reasons for the behavior.”
   4. “It seems that there is a great deal of negative feelings in this group today. We need to share feelings regarding the problem while we all clean up the room.”

5. During a group session, a flirtatious patient with mania shares that several patients and the nurse “have bodies that are really nice.” The most therapeutic response from the nurse would be:
   1. “Please go to your room. You’re being inappropriate to me and the other patients.”
   2. “I know your thoughts are very rapid right now. Let’s walk to your room where you can take a 30-minute time-out.”
   3. “Were you aware before you spoke that what you just said would offend me and the other patients on the unit very much?”
   4. “Do not speak to me or others like this. Would you like to take this opportunity to apologize to me and the other patients?”

6. Which intervention by the nurse is most therapeutic when a patient loses a pool game on the unit and begins acting aggressively?
   1. Having the other unit staff present to demonstrate both a unified presence as well as a show of force
   2. Saying to the patient, “Accompany me to your room so we can talk about what triggered your anger.”
   3. Stating, “The rules here are for everyone. If you cannot control your temper, you may need to leave the dayroom.”
   4. Setting limits on the behavior immediately, in front of other patients, to help communicate that the unit rules apply to everyone

7. A patient who displays dependent tendencies follows the nurse around the unit and repeatedly asks, “What do you think I should do, nurse?” Which is the nurse’s most therapeutic response?
   1. “You need to think for yourself. I can’t do that for you.”
   2. “Instead of asking me what to do, you should be practicing decision making yourself.”
   3. “One of the things I’ve observed is your dependency on me. Let’s discuss why you fear making your own decisions.”
   4. “Let’s discuss your seeming discomfort regarding decision making when we meet today in group. In the meantime, think about why you feel you need my help.”

8. When the nursing staff from the incoming and outgoing shifts has open report on the inpatient unit, which concept underlies this approach?
   1. Proletarian milieu
   2. Democratic society
   3. Egalitarian community
   4. Therapeutic community

9. A patient has contracted to be allowed to walk about outside after meals with staff supervision. When the patient begins to make a habit of asking if it’s time to go outside well before meals, the nurse should:
   1. provide the patient with a paper of hourly times to be clocked by the patient and initialed by the staff to indicate when it’s time to go outside.
   2. firmly state to the patient, “15 minutes after you’re done eating, someone will come to find you so the two of you can go outside.”
   3. say, with empathy, to the patient, “It is very difficult to wait patiently for something you really want like going outside.”
   4. instruct the patient to stand at the door of the unit after eating each meal.

10. A patient shares with a nurse, “I don’t seem to be sleeping any better since I came here.” Which nursing intervention will the nurse implement initially?
    1. Comparing the patient’s admission and current sleeping patterns
    2. Giving the patient a warm glass of milk at bedtime
    3. Teaching relaxation techniques to the patient
    4. Starting a running program for the patient

11. A patient with a history of chronic alcohol abuse and impaired cognitive function has been successfully taught to interpret a community bus schedule. The nurse should now be confident that the patient would benefit from attending:
    1. a community resource group in the day hospital.
    2. a substance abuse group on an outpatient basis.
    3. a life skills group at the outpatient clinic.
    4. Alcoholics Anonymous at the YMCA.

12. Which statement made by a nurse manager to personnel working short-staffed best reflects an understanding of the importance of safe unit staffing?
    1. “If you cannot find sufficient staff, I will have to leave this unit, because it is unsafe and someone could be hurt.”
    2. “I cannot safely manage this unit with such a small staff. When can I expect you to send additional staffing to help?”
    3. “If you don’t provide extra staffing immediately, I will quit and report this situation to The Joint Commission (TJC).”
    4. “In order to ensure unit safety I will need additional staff. I am limiting care to priority needs only until you meet that need. My written report will document my actions.”

13. Which of these patients is the most appropriate candidate for assignment to a crisis bed? A patient who:
    1. is found inebriated and claims to be “king of the universe.”
    2. shows a store clerk a knife after being refused use of the store’s restroom.
    3. has a history of violent outbursts and has been recently evicted from his or her home.
    4. is known to have bipolar disorder who expresses a need to be hospitalized “for the winter.”

14. The multidisciplinary team is meeting to discuss discharge planning with the family of a patient who recently attempted suicide. Which statement by a family member might constitute criteria for delaying discharge?
    1. The patient’s spouse says, “I’ll be taking long weekends from now on so we’ll not be apart so much.”
    2. The patient’s daughter asks, “Do I keep it a secret that I miscarried my baby the day of the attempt?”
    3. The patient’s son says, “If everyone thinks I’m going to make a fuss over this, they’re wrong.”
    4. The patient’s father says, “What can we do to make sure this doesn’t happen again?”

15. A patient has just received information regarding the goals of a partial-hospitalization program. Which statement best indicates patient understanding?
    1. “I think that the partial-hospitalization program will provide a good interim rest for me.”
    2. “The partial-hospitalization program will be a good support to me as I adjust to the stress of being back home.”
    3. “I know that partial hospitalization seems like a small step, but it will prevent readmission to the hospital.”
    4. “I’m looking forward to the partial-hospitalization program, because I can gather my thoughts there and think about what I want to do.”

16. A young adult patient is alienated by others who are offended by the patient’s poor hygiene and body odor. Which nursing intervention should occur first for this patient?
    1. Assessing the patient’s understanding of good hygiene practices
    2. Assigning the patient a scheduled shower and personal grooming time
    3. Instructing the patient regarding the need for daily showering and shampooing
    4. Having two mental health workers shower and dress the patient every morning

17. A nurse observes that a patient diagnosed with bipolar disorder who has left the seclusion room is soiled with feces. Which nursing intervention would be most likely to encourage a patient to comply with bathing?
    1. Say to the patient, “We are going to help you to bathe and freshen up.”
    2. Say to the patient, “Would you like to clean up and change your clothes?”
    3. Do nothing until the patient has enough personal control to realize the need.
    4. Return the patient to the room and reorient him or her to the bathroom and clean clothing.

18. A nurse would determine that medication teaching was most successful for a patient starting on lithium (Lithobid) if the patient stated:
    1. “I will discontinue my medication if I experience any fine hand tremors.”
    2. “I know that I will need to reduce exercising to only three times per week.”
    3. “I will need to get regular blood levels drawn while I’m on my medication.”
    4. “I will continue my medication unless I get sick and catch a very bad cold.”

19. In order to best demonstrate the broad scope of practice knowledge and expertise required for contemporary psychiatric nursing a nurse must:

1. 1. possess experience in both inpatient and outpatient psychiatric settings.
   2. effectively manage and implement all aspects of individualized patient care.
   3. demonstrate sensitivity to the need for cost savings and short-stay care.
   4. provide patient education in a manner that reflects caring and individual needs.

20. Which is the initial nursing care intervention for a nurse admitting a patient recently discharged from an inpatient unit into a partial-hospitalization program?
    1. Confirming the telephone numbers of all family members listed as approved contacts
    2. Identifying the patient’s food preferences to best ensure proper nutrition as well as adequate intake
    3. Asking the patient to identify any sources of anxiety they are experiencing related to the program
    4. Educating the patient to the time and place of the unit activities included in their therapeutic plan of care

21. In order to best address the educational needs of a patient diagnosed with cognitive impairment, the teaching plan should incorporate which strategy?
    1. Repetition of both the information and practice opportunities
    2. Use of music therapy for reducing anxiety while learning
    3. Providing specific patient-focused instructions for attainment of outcomes
    4. Asking the patient to verbally repeat the information using his or her own words