Deck 1: Me, Meds, Milieu

Question 1

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?

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.

Answer 1

Refer the patient to outpatient services.

Question 2

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?

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

Answer 2

Meaningful communication with nursing staff

Question 3

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

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.

Answer 3

Although professional role overlap exists, nursing offers unique contributions to psychotherapeutic management.

Question 4

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

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 5

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.

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."

Question 6

A community mental health nurse assesses a person with a psychiatric disorder on an initial visit. The nurse should refer this person to services on the care continuum that:

A) are the least costly.
B) are the least restrictive.
C) offer psychoeducation.
D) promote rapid symptom stabilization.

Question 7

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 the psychotherapeutic management model component of:

A) psychopathology.
B) milieu management.
C) psychopharmacology.
D) therapeutic nurse-patient relationship.

Question 8

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

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

Question 9

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

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

Question 10

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

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

Question 11

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:

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 12

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:

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

Question 13

A patient 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?

A) A group home
B) A self-help group
C) A day treatment program
D) Assertive community treatment (ACT)

Question 14

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

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 15

When inpatient psychiatric care is not indicated, an individual with schizophrenia who has a history of medication noncompliance should be referred to which service?

A) Primary care
B) Outpatient counseling
C) Apartment residential living
D) A group home with 24-hour supervision

Question 16

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?

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

Question 17

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:

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

Question 18

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:

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 19

Which statement most accurately describes a nurse's role regarding psychopharmacology? The psychiatric nurse:

A) frequently makes decisions regarding administration of PRN medications.
B) might adjust a medication dose if a patient is not responding positively.
C) administers medications but is not responsible for monitoring drug effectiveness.
D) should refer a patient's questions about drug side and adverse effects to the psychiatrist.

Question 20

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

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.

Question 21

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

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 22

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

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 23

Referral to a psychiatric extended-care facility would be most appropriate for which of the following patients?

A) An adult with generalized anxiety disorder
B) A severely depressed 70-year-old retiree
C) A patient with personality disorder who frequently self-mutilates
D) A severely ill person with schizophrenia who is regressed and withdrawn

Question 24

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

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

Question 25

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

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 26

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?

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