Deck 4: Psychiatric Mental Health Nursing in Acute Care Settings

Question 1

A nurse inspects an inpatient psychiatric unit and finds that exits are free from obstruction,no one is smoking,the janitor's closet is locked,and sharp objects are used under staff supervision.These observations relate to:

A) management of milieu safety.
B) coordinating care of patients.
C) management of the interpersonal climate.
D) use of therapeutic intervention strategies.

Answer 1

management of milieu safety.

Question 2

A nurse surveys medical records.Which finding signals a violation of patients' rights?

A) No treatment plan present in record.
B) Patients' belongings were searched at admission.
C) Physical restraint was used to prevent harm to self.
D) A patient with suicidal ideation was placed on 1:1 continuous observation.

Answer 2

No treatment plan present in record.

Question 3

The nurse records this entry in a patient's progress notes:
Patient escorted to unit by ER nurse at 2130.Patient's clothing was dirty.In interview room,patient sat with hands over face,sobbing softly.Did not acknowledge nurse or reply to questions.After several minutes,abruptly arose,ran to window,and pounded.Shouted repeatedly,"Let me out of here." Verbal intervention unsuccessful.Order for stat dose 2 mg haloperidol PO obtained;medication administered at 2150.By 2215,patient stopped shouting and returned to sit wordlessly in chair.Patient placed on one-to-one observation.
How should this documentation be evaluated?

A) Uses unapproved abbreviations
B) Contains subjective material
C) Too brief to be of value
D) Excessively wordy
E) Meets standards

Answer 3

Meets standards

Question 4

A nurse receives three phone calls regarding a newly admitted patient.
The psychiatrist wishes complete an assessment interview.
The medical doctor wants to perform a physical examination.
The patient's attorney wants an appointment with the patient.
The nurse schedules the activities for the patient.Which role has the nurse fulfilled?

A) Advocate
B) Case manager
C) Milieu manager
D) Provider of care

Question 5

The patients below present in the emergency department.The psychiatric unit has one bed available.Which patient should be admitted? The patient:

A) feeling anxiety and a sad mood after separation from a spouse of 10 years.
B) who self-inflicted a superficial cut on the forearm after a family argument.
C) experiencing dry mouth and tremor related to haloperidol (Haldol).
D) who is a parent and hears voices saying,"Smother your baby."

Question 6

At age 19,an individual developed a serious mental illness.Symptoms continued for 2 years despite treatment,and the individual is unable to work.For which resource should this individual apply?

A) Social Security Disability Insurance
B) Veterans Administration benefits
C) Supplemental Security Income
D) Welfare

Question 7

A patient was hospitalized for a reaction to a psychotropic medication.A new medication was prescribed,and the patient was monitored for 24 hours.During pre-discharge planning,the case manager learned that the patient received a notice of eviction on the day of admission.Select the most appropriate action for the case manager.

A) Cancel the patient's discharge from the hospital.
B) Contact the landlord who evicted the patient to further discuss the situation.
C) Arrange a temporary place for the patient to stay until new housing can be arranged.
D) Determine whether the adverse medication reaction was artificial,because the patient had nowhere to live.

Question 8

Which principle takes priority when addressing a behavioral crisis in an inpatient setting?

A) Resolve the crisis with the least restrictive intervention possible.
B) Rights of an individual patient are superseded by the rights of the majority of patients.
C) Swift intervention is justified to maintain the integrity of a therapeutic milieu.
D) Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.

Question 9

The unit secretary receives a phone call from the health insurer for a hospitalized patient.The caller seeks information about the patient's projected length of stay.How should the secretary handle the request?

A) Obtain the information from the patient's medical record,and relay it to the caller.
B) Inform the caller that all information about patients is confidential.
C) Refer the request for information to the patient's case manager.
D) Refer the request to the psychiatrist.

Question 10

Which scenario best depicts a behavioral crisis? A patient is:

A) curled up in a corner of the bathroom,wrapped in a towel.
B) crying hysterically after receiving a phone call from a family member.
C) performing push-ups in the middle of the hall,forcing others to walk around.
D) waving fists,cursing,and shouting threats at a nurse who offered PRN medication.

Question 11

Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:

A) present a clear danger to self or others.
B) are noncompliant with medication at home.
C) have limited support systems in the community.
D) develop new symptoms during the course of an illness.

Question 12

A student nurse prepares to administer oral medication to a patient with major depression,but the patient refuses.The student nurse should:

A) tell the patient,"Refusing medication is not permitted.You are required to take it."
B) tell the patient,"I'll get an unsatisfactory grade if I don't give you the medication."
C) ask the patient's reason for refusing the medication,and report to the staff nurse.
D) document the patient's refusal of the medication without further comment.

Question 13

The case manager plans to discuss the treatment plan with a patient's family.Select the case manager's first action.

A) Obtain the patient's permission for the exchange of information.
B) Support the discussion with examples of the patient's behavior.
C) Obtain a court order to release this clinical information.
D) Ask the psychologist to conduct the discussion.

Question 14

A patient was admitted after being brought to the hospital by police after a fight with a roommate.The patient told the nurse,"My roommate cast a spell by looking at me intently,so I fought to protect myself." The patient admits stopping prescribed antipsychotic medication a week ago when the prescription needed refill.Which outcome should the nurse working in a managed behavioral health inpatient unit select for this patient?

A) The patient will express feelings of self-control within 48 hours.
B) A trusting relationship with the nurse will be developed within 5 days.
C) A high level of ease with other patients will be reported within 1 week.
D) The patient will agree to placement in a new residence within 3 weeks.

Question 15

Which aspect of direct care is an experienced,inpatient psychiatric nurse most likely to provide for a patient?

A) Hygiene assistance
B) Diversional activities
C) Assistance with job hunting
D) Building assertiveness skills

Question 16

Clinical pathways are used in managed care settings to:

A) stabilize aggressive patients.
B) identify obstacles to effective care.
C) relieve nurses of planning responsibilities.
D) streamline the care process and save money.

Question 17

A bank teller worked 8 years and then developed a serious mental illness.Symptoms have continued for 2 years despite treatment.This individual is unable to return to work,but the spouse is employed and able to support the family financially.For which resource should this individual apply?

A) Social Security Disability Insurance
B) Veterans Administration benefits
C) Supplemental Security Income
D) Welfare

Question 18

A patient with schizophrenia had an exacerbation related to medication noncompliance.During 4 days of hospitalization,medication was resumed.The patient's thought processes are now more organized,and discharge is planned.The patient's family is upset and tells the nurse,"It's too soon for discharge.We will just go through all this again." The nurse should:

A) call the psychiatrist to explain the discharge rationale.
B) explain that health insurance will not pay for a longer stay.
C) call security to handle the disturbance,and escort the family off the unit.
D) explain that the patient will continue to improve if medication is taken regularly.

Question 19

An interdisciplinary health care team met 12 hours after an adolescent was hospitalized following a suicide attempt.What result can be expected from this meeting?

A) A treatment plan will be determined.
B) The nurse will assume the surrogate parent role.
C) The need for placement outside the home will be assessed.
D) The team will request a court-appointed advocate for the patient.

Question 20

When responding to a patient who has agitated,hostile behavior during a community meeting,the initial action the nurse should take is to:

A) follow the treatment plan.
B) place the patient in seclusion.
C) offer an antianxiety medication.
D) permit the angry outburst if no harmful behavior is threatened.

Question 21

A psychiatric nurse discusses rules of the therapeutic milieu and patients' rights with a newly admitted patient.Which rights should be included? (Select all that apply. )
The right to:

A) have visitors.
B) confidentiality.
C) a private room.
D) complain about inadequate care.
E) select the nurse assigned to their care.

Question 22

A nurse can best address factors of critical importance to successful community treatment,including making assessments relative to: (Select all that apply. )

A) housing adequacy and stability.
B) income adequacy and stability.
C) family and other support systems.
D) early psychosocial development.
E) substance abuse history and current use.

Question 23

The health care team at an inpatient psychiatric facility drafts these criteria for admission.Which criteria should be included in the final version of the admission policy? (Select all that apply. )

A) Clear risk of danger to self or others.
B) Adjustment needed for doses of psychotropic medication.
C) Detoxification from long-term heavy alcohol consumption needed.
D) Respite for caregivers of persons with serious and persistent mental illness.
E) Failure of community-based treatment,demonstrating need for intensive treatment.

Question 24

A patient usually watches television all day,seldom going out in the community or socializing with others.The patient says,"I just don't know what to do with my free time." Which member of the treatment team would be most helpful to this patient?

A) Psychologist
B) Social worker
C) Recreational therapist
D) Occupational therapist

Question 25

A nurse performed these actions while caring for patients in an inpatient psychiatric setting.
1)Removed cuticle scissors from a suicidal patient.
2)Helped a patient make an appointment with an attorney.
3)In patient's presence,opened a package mailed to patient.
4)Remained within arm's length of patient with homicidal ideation.
5)Permitted a patient with psychosis to refuse oral psychotropic medication.
Which action violated patients' rights? (Select all that apply. )

A) none
B) 1
C) 2
D) 3
E) 4