Question 1

Which adjective best characterizes custodial care?

Accepted Answer

A)   Paternalistic
B)   Beneficent
C)   Essential
D)   Safe A

Question 2

The framework of schedules, rules, and activities around which a therapeutic environment revolves is termed:

Accepted Answer

A)   structure.
B)   balance.
C)   norms.
D)   safety. A

Question 3

During a community meeting, a patient reports about having only two patient-accessible phones on the unit. Many other patients join in, all talking at the same time. The nurse requests that only one person talk at a time. The nurse's request seeks to maintain:

Accepted Answer

A)   norms.
B)   safety.
C)   balance.
D)   structure. A

Question 4

A newly admitted patient is withdrawn and does not seek out interaction with staff or patients. Nursing interventions should focus on which element of the treatment environment?

Accepted Answer

A)   Norms
B)   Safety
C)   Structure
D)   Limit-setting

Question 5

Which nursing action best supports the maintenance of psychologic safety for a patient with mental illness?

Accepted Answer

A)   Helping a depressed patient to inventory personal flaws
B)   Assisting a patient to change clothes after an episode of incontinence
C)   Allowing an anxious patient to pace in isolation and without interruptions
D)   Requiring a restrained patient to remain silent until restraints are removed

Question 6

A patient has been bumping and pushing other patients. The nurse carefully explains to the patient that such behavior is unacceptable. The nurse has provided:

Accepted Answer

A)   balance.
B)   limit-setting.
C)   personal control.
D)   environmental modification.

Question 7

The nurse leading a social skills group is engaged in managing which environmental element?

Accepted Answer

A)   Balance
B)   Structure
C)   Accountability
D)   Risk management

Question 8

During orientation the clinical nurse leader tells a novice nurse, "You will be involved in purposeful creation of corrective learning experiences for all patients so as to provide a healing atmosphere." The clinical nurse leader is explaining aspects of:

Accepted Answer

A)   balance.
B)   limit-setting.
C)   a therapeutic environment.
D)   establishing behavioral norms.

Question 9

Complete the sentence. In a therapeutic environment, norms are:

Accepted Answer

A)   opportunities for self-expression that relieve stress.
B)   expectations for socially acceptable behavior.
C)   the behaviors most people display daily.
D)   shared experiences among patients.

Question 10

A patient demonstrating manic behaviors gathered other patients in the dayroom and gave a sales talk, pressuring others to purchase shares of stock in a gold mine. Which element of a therapeutic environment is jeopardized?

Accepted Answer

A)   Connection
B)   Exploration
C)   Structure
D)   Balance

Question 11

In which instance would it be most important for the nurse to set limits?

Accepted Answer

A)   An involuntarily hospitalized patient insists on being discharged.
B)   Two patients are found kissing in an obscure area of the unit.
C)   A patient with suicidal ideation asks to leave the unit.
D)   A depressed patient seeks daily telephone privileges.

Question 12

A nurse plans ways to promote patient safety and security. A proactive approach would include:

Accepted Answer

A)   restricting psychotic patients' rights.
B)   enforcing consequences of limit-setting.
C)   setting limits when a patient acts out aggressively.
D)   clearly communicating expectations for patients' behavior.

Question 13

Which nursing action best supports maintenance of a therapeutic environment?

Accepted Answer

A)   Creating therapeutic relationships with patients
B)   Providing purposeful structured activities
C)   Maintaining patient records and care plans
D)   Administering medication

Question 14

Which aspects of the environment of a psychiatric unit comply with JCAHO environment-of -carestandards? Select all that apply.

Accepted Answer

A)   Visitor badges
B)   Identification badges for employees
C)   Telephones located in enclosed booths
D)   Requiring patients to wear hospital-issue clothing
E)   Guidelines for staff interaction with media representatives

Question 15

A psychiatric facility is "accredited by JCAHO." Which asset would be expected?

Accepted Answer

A)   A 4:1 patient-to-staff ratio
B)   Private rooms for all patients
C)   Use of a therapeutic milieu treatment model
D)   Telephones for private patient conversations

Question 16

Which statements indicate that a patient understands the unit norms? Select all that apply.

Accepted Answer

A)   "I need quiet time after art therapy today."
B)   "I will not yell during the community meeting."
C)   "I realize that I need help with my problems."
D)   "I will show up on time to take my medication."
E)   "I will talk to staff if I get angry instead of punching somebody."

Question 17

While nurses are engaged in shift change report, one patient becomes loud and aggressive. This patient verbally harasses and frightens another patient. Which element of the therapeutic environment has been jeopardized?

Accepted Answer

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

Question 18

Which element of therapeutic environmental management has the highest priority?

Accepted Answer

A)   Clearly establishing norms and designating limits
B)   Scheduling purposeful activities throughout the day
C)   Creating an environment of psychologic and physical safety
D)   Promoting a balance between patient dependence and independence

Question 19

Which research findings about the therapeutic environment of an inpatient psychiatric unit have implications for nursing practice? Select all that apply.

Accepted Answer

A)   Patients valued interactions with other patients.
B)   Patients perceived other patients as dissimilar from self.
C)   Hospitalization interferes with planning for the future.
D)   Patients failed to experience bonding with other patients.
E)   Hospitalization creates feelings of safety from self-destructiveness.

Question 20

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards mandate that:

Accepted Answer

A)   orientation programs detail safety issues and precautions.
B)   patients' room doors remain open during hours of sleep.
C)   safety precautions are simple and apply commonsense behaviors.
D)   patients' personal belongings are kept in secure areas under staff control.

Exam 20: Introduction to Milieu Management