Question 1

Which guideline should a nurse use when applying the components of psychotherapeutic management to the care of a patient with mental illness?

Accepted Answer

A)   The nurse's role in milieu management is secondary to that of social work.
B)   Omitting any one component usually will result in less effective 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. B

Question 2

A patient tells the nurse, "This medication makes me feel weird. I don't think I should take it anymore. Do you?" Select the nurse's best response.

Accepted Answer

A)   "I wonder why you think that."
B)   "Tell me how it makes you feel."
C)   "One must never stop taking medication."
D)   "You need to discuss this with your psychiatrist." B

Question 3

The primary element required to match individual patient needs with appropriate services is proper:

Accepted Answer

A)   planning.
B)   evaluation.
C)   assessment.
D)   implementation. C

Question 4

An adult with paranoid schizophrenia is hospitalized. This patient has frequent auditory hallucinations and walks about the unit, muttering. To use psychotherapeutic management effectively, it is most important for the nurse to:

Accepted Answer

A)   understand the disease process of schizophrenia.
B)   minimize contact between this patient and other patients.
C)   administer PRN medication before interacting with the patient.
D)   use behavior modification to decrease the frequency of hallucinations.

Question 5

During an interaction with a patient, a nurse encourages the patient to express feelings, identify stressors, and review coping strategies. These nursing interventions relate most to the use of:

Accepted Answer

A)   risk assessment.
B)   behavior modification.
C)   therapeutic communication.
D)   environmental manipulation.

Question 6

Which observation during morning rounds should receive a nurse's priority attention?

Accepted Answer

A)   Breakfast is late being served.
B)   A sink is leaking, leaving water on the bathroom floor.
C)   The daily schedule has not been posted on the unit bulletin board.
D)   A small group of patients is complaining that one patient turned down the TV volume.

Question 7

A depressed adult is hospitalized after a suicide attempt. The patient receives an antidepressant medication, is closely supervised, attends a variety of group therapies and activities, watches television during free time, and talks to visitors in the evening. Which additional intervention is needed in the patient's care?

Accepted Answer

A)   Milieu therapy
B)   Adequate drug therapy
C)   Increased contact with significant others
D)   Meaningful communication with nursing staff

Question 8

During the risk assessment phase of care for a psychiatric patient, the nurse will:

Accepted Answer

A)   make an initial assessment.
B)   confirm the patient's problem.
C)   assess potential dangerousness to self or others.
D)   determine the level of supervision needed for the patient.

Question 9

What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community-based care? Select all that apply.

Accepted Answer

A)   Need for PRN medication
B)   Severity of the patient's illness
C)   Need for structured formal therapy
D)   Presence of suicidal or homicidal ideation
E)   Amount of supervision required by the patient

Question 10

What explanation about the unit milieu would be most important for the nurse to give to a newly admitted patient?

Accepted Answer

A)   "Your behavior will be carefully monitored during your hospital stay."
B)   "Unit activities will help you cope with immediate needs and stressors."
C)   "You will be given enough medication to bring your symptoms under control."
D)   "I will be gathering information about you to plan your care and your discharge."

Question 11

Which scenarios demonstrate that a nurse is functioning within the scope of psychotherapeutic management? The nurse (select all that apply)

Accepted Answer

A)   structures meaningful unit activities.
B)   administers electroconvulsive therapy.
C)   encourages a patient to express feelings.
D)   interprets the results of psychological testing.
E)   assesses a patient for medication side effects.

Question 12

When the treatment team in an inpatient psychiatric unit institutes a new unit schedule that provides for all patients to be involved in activities continuously throughout both the day and early evening, which element of milieu management needs reflection and reconsideration?

Accepted Answer

A)   Norms
B)   Balance
C)   Limit setting
D)   Environmental modification

Question 13

A patient attends outpatient programs at a community mental health center and meets with the primary nurse regularly. Last week, the patient's haloperidol (Haldol) dose was reduced from 5 mg to 2 mg daily to decrease side effects. The nurse will need to monitor changes in:

Accepted Answer

A)   the activity schedule at the center.
B)   the nature of the patient's symptoms.
C)   attention given to the patient by other staff.
D)   balance among psychotherapeutic management elements.

Question 14

A patient 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?

Accepted Answer

A)   Long-standing bipolar disorder
B)   Risk for suicide
C)   Homelessness
D)   Lack of income

Question 15

Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic at the moment; not a danger to self or others; lives in parents' home. Which decision regarding placement on the continuum of care is appropriate?

Accepted Answer

A)   Hospitalize the patient.
B)   Discharge the patient from the system.
C)   Refer the patient to outpatient services.
D)   Refer the patient to self-help resources in the community.

Question 16

When explaining risk assessment, the nurse would indicate that the highest priority for admission to hospital-based care is:

Accepted Answer

A)   safety of self and others.
B)   confusion and disorientation.
C)   withdrawal from harmful substances.
D)   medical illness complicating a psychiatric disorder.

Question 17

Select the best description of nursing practice in the psychiatric setting.

Accepted Answer

A)   The nurse primarily serves in a supportive role to other members of the team.
B)   The multidisciplinary approach eliminates the need to clearly define the responsibilities of nursing.
C)   Clearly differentiated nursing actions have been identified that distinguish nursing from other professions.
D)   Although professional role overlap exists, nursing offers unique contributions to psychotherapeutic management.

Question 18

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 knowledge of:

Accepted Answer

A)   psychopathology.
B)   milieu management.
C)   psychopharmacology.
D)   nursing relationship therapy.

Question 19

An acutely psychotic patient is restricted to an inpatient unit. Which milieu element has been adapted?

Accepted Answer

A)   Norms
B)   Balance
C)   Therapy
D)   Psychopathology

Question 20

A nurse considers environmental aspects of milieu management while planning care for a newly admitted patient. Which element has the highest priority?

Accepted Answer

A)   Norms
B)   Safety
C)   Balance
D)   Structure

Exam 1: Me, Meds, Milieu