Question 1

Which statement about balance provides a basis for a nurse's management of the therapeutic environment?

Accepted Answer

A)   Independence is best gained in increments.
B)   Independence is a fundamental right of all patients.
C)   Independence jeopardizes safety in an inpatient setting.
D)   Dependence is a characteristic of most persons with mental illness. A

Question 2

A nurse plans ways to promote patient safety and security. A proactive approach would include which intervention?

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 D

Question 3

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 D

Question 4

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 milieu-related concept?

Accepted Answer

A)   Balance
B)   Limit-setting
C)   A therapeutic environment
D)   Establishing behavioral norms

Question 5

Which aspects of the environment of a psychiatric unit comply with JCAHO environment-of-care standards? (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 6

In a therapeutic environment, which norm exists?

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 7

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 8

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 9

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 10

Which nursing action best supports the maintenance of psychological 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 11

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 12

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 13

Regarding effective milieu management, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards mandate that intervention?

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.

Question 14

Which adjective best characterizes custodial care?

Accepted Answer

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

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

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 17

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 psychological and physical safety
D)   Promoting a balance between patient dependence and independence

Question 18

The framework of schedules, rules, and activities around which a therapeutic environment revolves is related to which associated term?

Accepted Answer

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

Question 19

Four nurses describe their unit environments. Which description can most clearly be identified as therapeutic?

Accepted Answer

A)   "My unit uses behavior modification to enhance patients' social skills."
B)   "My unit allows patients to test new behaviors in a secure environment."
C)   "My unit helps patients deal with childhood issues by providing a safe setting."
D)   "My unit allows patients to deal with personal issues without interpersonal stressors."

Question 20

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

Exam 20: Introduction to Milieu Management