Question 1

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

D

Question 2

In a therapeutic environment, which norm exists?

Accepted Answer

In a therapeutic environment, there is an expectation for socially acceptable behavior to create a safe and respectful space for all patients. While opportunities for self-expression and shared experiences may also exist, they are not universal norms that are always present in therapeutic environments.

Question 3

Which nursing action best supports maintenance of a therapeutic environment?

Accepted Answer

A

Question 4

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

Accepted Answer

The nurse leading a social skills group is managing the structure of the environment, such as the rules, routine, and expectations of the group.

Question 5

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

The safety element of the therapeutic environment has been jeopardized due to the patient's aggressive and verbally harassing behavior, which frightens another patient.

Question 6

Which element of therapeutic environmental management has the highest priority?

Accepted Answer

Creating an environment of psychological and physical safety is the highest priority in therapeutic environmental management. Without a sense of safety, patients cannot engage in therapeutic activities and may even become more distressed. Once safety is established, other elements such as establishing norms and scheduling purposeful activities can be addressed. Promoting patient dependence and independence is also important, but it is not the highest priority.

Question 7

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

Accepted Answer

The answer of Regarding effective milieu management, the Joint Commission...

Question 8

Which aspects of the environment of a psychiatric unit comply with JCAHO environment-of-care standards? (Select all that apply.)

Accepted Answer

JCAHO's environment-of-care standards require visitor and employee identification, privacy for telephone conversations, and other measures to protect the safety and confidentiality of patients in a psychiatric unit. Requiring patients to wear a specific type of clothing or having guidelines for staff interaction with media representatives are not specifically addressed in JCAHO's environment-of-care standards.

Question 9

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

The patient's withdrawal suggests a need for structure in the treatment environment, which can provide a sense of predictability and safety for the patient. A structured environment may include routine schedules, clear expectations, and daily activities to help engage the patient and encourage interaction with staff and other patients. While norms and limit-setting may also be important in promoting an open and supportive treatment environment, they may not be the most immediate priority for this patient. Safety is a critical concern, but it is not specifically related to addressing the patient's withdrawal.

Question 10

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

Accepted Answer

The framework of schedules, rules, and activities is often referred to as the structure of a therapeutic environment.

Question 11

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

Accepted Answer

Clearly communicating expectations for patients' behavior is a proactive approach to promoting patient safety and security. It helps patients understand the boundaries and what behavior is expected of them, ultimately reducing the risk of harm to themselves and others. Restricting rights or enforcing consequences may cause patients to act out more or feel more vulnerable, ultimately risking their safety and security. Setting limits when a patient acts out may be reactive rather than proactive.

Question 12

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

Accepted Answer

The answer of In which instance would it be most...

Question 13

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

The clinical nurse leader is describing the creation of a therapeutic environment, which involves providing a healing atmosphere for patients. This is a key aspect of the milieu-related concept, as it focuses on creating a positive and supportive environment for patients to aid in their recovery.

Question 14

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 what characteristic of a therapeutic environment?

Accepted Answer

Limit-setting is a characteristic of a therapeutic environment that helps to maintain a safe and respectful atmosphere. By explaining to the patient that their behavior is unacceptable, the nurse is setting limits and reinforcing appropriate behavior.

Question 15

Which adjective best characterizes custodial care?

Accepted Answer

Custodial care refers to care provided to assist with daily living activities rather than medical care. It often implies a paternalistic approach, where the caregiver makes decisions for the individual receiving care, similar to a parent's role.

Question 16

During a community meeting, a patient reacts negatively 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 what characteristic of a therapeutic environment?

Accepted Answer

The answer of During a community meeting, a patient reacts...

Question 17

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

Accepted Answer

Maintaining a balance between independence and dependence is important in managing a therapeutic environment. Allowing patients to gradually gain independence in increments helps them develop the skills needed to manage their mental illness and improve their overall wellbeing. Total dependence can lead to a sense of helplessness and hinder progress, while total independence can jeopardize safety and impede treatment progress. Therefore, independence should be fostered in a manner that ensures safety and supports the patient's growth and development.

Question 18

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

Accepted Answer

All of the options describe potentially therapeutic environments, but B is the most clearly identified as therapeutic because it emphasizes the importance of providing a secure environment for patients to test new behaviors. This suggests that the unit is focused on promoting growth and change in a safe and supportive way. The other options also mention important factors, like reducing stressors and addressing childhood issues, but they are less explicit in their descriptions of how the unit supports patients' well-being.

Question 19

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

Accepted Answer

Assisting a patient with a basic need such as changing clothes after an episode of incontinence can help maintain their dignity and prevent further embarrassment, which supports psychological safety. Option A can have a negative impact on psychological safety by reinforcing negative self-talk and self-blame, while option C may make the patient feel even more isolated and disregarded. Option D can be seen as punitive and may escalate the patient's distress, rather than supporting psychological safety.

Question 20

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

Accepted Answer

The answer of A psychiatric facility is "accredited by JCAHO."...

Quiz 20: Introduction to Milieu Management