University of San Francisco - NURS 320

Chapter 01: Med, Meds, Milieu

Keltner: Psychiatric Nursing, 8th Edition

MULTIPLE CHOICE

1)A newly licensed asks a nursing recruiter for a description of nursing practice in the psychiatric setting. What is the nurse recruiter’s best response?

1. 1. “The nurse primarily serves in a supportive role to members of the health care delivery team.”
   2. “The multidisciplinary approach eliminates the need to clearly define the responsibilities of nursing in such a setting.”
   3. “Nursing actions are identified by the institution that distinguishes nursing from other mental health professions.”
   4. “Nursing offers unique contributions to the psychotherapeutic management of psychiatric patients.”

2. Which component of the nursing process with nurse focus upon to address the responsibility to match individual patient needs with appropriate services?
   1. Planning
   2. Evaluation
   3. Assessment
   4. Implementation

3. An adult diagnosed with paranoid schizophrenia frequent experiences auditory hallucinations and walks about the unit, muttering. Which nursing action demonstrates the nurse’s understanding of effective psychotherapeutic management of this client?
   1. Discussing the disease process of schizophrenia with the client and their domestic partner
   2. Minimizing contact between this patient and other patients to assure a stress free milieu
   3. Administering PRN medication when first observing the evidence that the client

may be hallucinating

1. 4. Independently determining that behavior modification is appropriate to decrease the client’s paranoid thoughts

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?
   1. Involvement in group therapies
   2. Focus of close supervision by the unit staff
   3. Maintaining effective communication with support system
   4. Frequently scheduled one-on-one time with nursing staff

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?
   1. “Will you have any difficulty getting your prescription refilled?”
   2. “Have you begun experiencing any forms of hallucinations?”
   3. “What do you expect will occur since the dosage has been reduced?”
   4. “What can I do to help you manage this reduction in haloperidol therapy?”

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?
   1. The nurse’s role in client care is supported by the multidisciplinary team.
   2. Omitting any one component will compromise the effectiveness of the treatment.
   3. The most important element of psychotherapeutic management is drug therapy.
   4. A therapeutic nurse-patient relationship is the most important aspect of treatment.

7. Which statement most accurately describes a nurse’s role regarding psychopharmacology?
   1. “You will need to frequently make decisions regarding the administration of PRN medications to help the client manage anger.”
   2. “It’s a nursing responsibility to adjust a medication dose to assure effective patient responses.”
   3. “Nurses administers medications while evaluating drug effectiveness is a medical responsibility.”
   4. “To best assure appropriate response, a patient’s questions about drug therapy should be referred to the psychiatrist.”

8. When considering environmental aspects of milieu management, which intervention has the highest priority for a client admitted after a failed suicide attempt?
   1. Sending the client’s new medication prescriptions to the pharmacy
   2. Assigning a staff member to one-on-one observation of the client
   3. Orienting the client to the milieu’s public and private spaces
   4. Having all potentially dangerous items removed from the client’s belongings

9. The implementation of which unit policy directed at milieu balance would reflect a need for reconsideration on the part of the treatment team?
   1. All clients will receive verbal and written information explaining unit rules.
   2. Unit clients will engage in all unit activities to assure interaction with both staff and other clients.
   3. All clients will be uniformly expected to present themselves in a nonviolent manner to both staff and other clients.
   4. At times of unit stress, client will return to their rooms.

10. Which intervention should the nurse implement when focusing on communicating therapeutically with a client?
    1. Explaining to the client why they will need to ask for a razor
    2. Providing the client with options to help achieve smoking cessation
    3. Encouraging the client to identify personal stressors
    4. Assuring the client that they can receive telephone call on the unit telephone

11. During the risk assessment phase of care for a psychiatric patient, what is the nurse’s primary goal?
    1. Making an initial assessment
    2. Confirming the patient’s problem
    3. Assessing potential dangerousness to self or others
    4. Determining the level of supervision needed for the patient

12. Risk assessment for a patient shows these findings: schizophrenia but not currently; not a danger to self or others; lives in parents’ home. Which decision regarding placement on the continuum of care is appropriate?
    1. Hospitalize the patient.
    2. Discharge the patient from the system.
    3. Refer the patient to outpatient services.
    4. Refer the patient to self-help resources in the community.

13. A patient tells the nurse, “This medicine makes me feel weird. I don’t think I should take it anymore. Do you?” The most effective reply that the nurse could make is based on which psychotherapeutic management model?
    1. Psychopathology
    2. Milieu management
    3. Psychopharmacology
    4. Therapeutic nurse-patient relationship

14. A patient tells the nurse, “This medication makes me feel weird. I don’t think I should take it anymore. Do you?” What is the nurse’s best response?
    1. “I wonder why you think that.”
    2. “Tell me how the medication makes you feel.”
    3. “One must never stop taking medication.”
    4. “You need to discuss this with your psychiatrist.”

15. The spouse of a patient with panic attacks tells the nurse, “I am afraid my husband has a permanent disorder and will have many hospitalizations in the future. I wonder how I will be able to raise our children alone.” The nurse’s reply should be based on which form of nursing knowledge?
    1. Psychopathology
    2. Milieu management
    3. Psychopharmacology
    4. Nursing relationship therapy

16. Which observation during morning rounds should receive a nurse’s priority attention?
    1. Breakfast is late being served.
    2. A sink is leaking, leaving water on the bathroom floor.
    3. The daily schedule has not been posted on the unit bulletin board.
    4. A small group of patients is complaining that one patient turned down the TV volume.

17. A community mental health nurse assessing a person with a psychiatric disorder, should refer this person to services based on which basic concept?
    1. Focus on interventions is on the least costly initially.
    2. Initial interventions are the least restrictive.
    3. Initial interventions offer a form of psychoeducation.
    4. Rapid symptom stabilization is the primary goal.

18. An acutely psychotic patient is restricted to an inpatient unit. This intervention demonstrates that which milieu element has been adapted?
    1. Norms
    2. Balance
    3. Therapy
    4. Psychopathology

19. An individual diagnosed with schizophrenia has a history of medication nonadherence. When inpatient psychiatric care is not indicated, which service is the preferred referral?
    1. Primary care
    2. Outpatient counseling
    3. Apartment residential living
    4. A group home with 24-hour supervision

20. A patient diagnosed with bipolar disorder has stabilized and is being discharged from the hospital. The patient will live independently at home but lacks social skills and transportation. Which referral would be most appropriate?
    1. A group home
    2. A self-help group
    3. A day treatment program
    4. Assertive community treatment (ACT)

21. A patient diagnosed with long-standing bipolar disorder comes to the mental health center.

The patient says, “I lost my job and home. Now, I eat in soup kitchens and sleep at a shelter. I am so depressed that I thought about jumping from a railroad bridge into a river.” Which factor has priority for the nurse who determines the appropriate level of care?

1. 1. Long-standing bipolar disorder
   2. Risk for suicide
   3. Homelessness
   4. Lack of income

22. When explaining risk assessment, the nurse would indicate that the highest priority for admission to hospital-based care is associated with which goal?
    1. Safety of self and others
    2. Minimal confusion and disorientation
    3. Successful withdrawal from harmful substances
    4. Management of medical illness complicating a psychiatric disorder

23. What explanation regarding the unit milieu would be most important for the nurse to give to a newly admitted patient?
    1. “Your behavior will be carefully monitored during your hospital stay.”
    2. “Unit activities will help you cope with immediate needs and stressors.”
    3. “You will be given enough medication to bring your symptoms under control.”
    4. “I will be gathering information about you to plan your care and your discharge.”

24. Referral to a psychiatric extended-care facility would be most appropriate for which of the following patients?
    1. An adult with generalized anxiety disorder
    2. A severely depressed 70-year-old retiree