Question 1

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

Accepted Answer

Assisting a patient to change clothes after an episode of incontinence saves embarrassment for the patient, which contributes to a positive self-concept. Requiring a restrained patient to remain silent implies punishment rather than use of an external control until they are able to regain control. The other options are not therapeutic and do not promote psychologic safety.

Question 2

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

Accepted Answer

Balance is the process of gradually allowing independent behaviors in a dependent situation. Independence must be gained in increments to avoid overwhelming the patient. The distracters are false, since they do not describe the basis of balance.

Question 3

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

Accepted Answer

Structure refers to the physical environment, regulations, and daily schedule of classes and groups provided in a treatment setting. Structure provides the base on which the other elements are built.

Question 4

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

Accepted Answer

The unit described in the correct answer provides a broad therapeutic focus for providing corrective experiences that helps patients recover. The distracters are too narrow in their therapeutic scope.

Question 5

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

The patient is violating the rights of others by being allowed to give unsolicited discourses and exert pressure on others. Balance is lacking when patients are not protected from the symptom expression of other patients.

Question 6

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

Accepted Answer

Norms are defined as specific expectations of behavior that pervade a setting. They are intended to promote community living through socially acceptable behaviors. The other explanations are not as comprehensive as the correct answer.

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

Psychologic safety is violated when one patient is allowed to harass another. Staff must set limits to protect the vulnerable patient. Norms, balance, and structure refer to other elements of the environment.

Question 8

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

Accepted Answer

Proactive is the key word in this question. Communicating clear rules for expected behavior from the beginning reinforces norms and structure, and encourages self-responsibility. The other options are reactive.

Question 9

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

Norms establish expectations that promote safety and trust in a therapeutic environment through sanctioning of socially appropriate behaviors. The other elements cannot be assessed as related to the scenario.

Question 10

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 therapeutic environment requires creation of corrective learning experiences to promote a therapeutic atmosphere. Limit-setting, balance, and norms are individual elements of the therapeutic environment and are answers that are too narrow.

Question 11

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

Limit-setting provides a patient with a clear explanation of the acceptability or unacceptability of a behavior. Limit-setting reinforces norms and encourages the milieu concept of responsibility for self. The other options are not applicable.

Question 12

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

Accepted Answer

JCAHO standards require agencies to provide an orientation program that addresses safety issues. The other options are not part of the standards of this accrediting agency.

Question 13

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

Structure refers to the physical environment, regulations, and daily schedule of classes and groups provided. The unit activities will provide an opportunity for the nurse to interface with the patient to develop a trusting relationship. The other treatment environment elements are important but are of lower priority for this patient.

Question 14

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

Accepted Answer

JCAHO environment-of-care standards stipulate that telephones must be available to allow patients to conduct private conversations. The other options are not specified in JCAHO standards.

Question 15

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

Accepted Answer

JCAHO standards mandate clothing suitable for the clinical environment, but they do not require patients to wear hospital-issue clothing. The other answers comply with standards.

Question 16

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

Accepted Answer

By definition, the element of structure includes the schedule of planned therapeutic activities and groups. Balance refers to dependence-independence behaviors. Accountability and risk management are not identified elements of the therapeutic environment.

Question 17

Which nursing action best supports maintenance of a therapeutic environment?

Accepted Answer

A therapeutic environment requires nurses to be active and willing to engage in therapeutic relationships with patients. These relationships support patients' development of coping and problem-solving skills. Maintaining records, administering medications, and providing activities are important in the therapeutic environment, but to a lesser extent than meaningful nurse-patient interactions.

Question 18

Which element of therapeutic environmental management has the highest priority?

Accepted Answer

Safety is the most basic milieu element and therefore is of highest priority. Norms often contribute to safety. Activities and balance are other important milieu elements but are of lower priority.

Question 19

Which adjective best characterizes custodial care?

Accepted Answer

Custodial care focuses on activities of daily living, hygiene, nutrition, elimination, and safety needs rather than supporting patients to develop skills for self-care. Staff members decide what is best for patients.

Question 20

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

Accepted Answer

Limits should be set on acting-out behavior, self-destructive acts, physical aggressiveness, sexual behavior, lack of compliance, use of illicit substances, and elopement. The correct answer is an example of sexual behavior. The distracters depict instances in which a therapeutic response is indicated from the nurse but not necessarily limit-setting.

Quiz 20: Introduction to Milieu Management