Question 1

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

Accepted Answer

The statement "Independence is best gained in increments" provides a basis for the nurse to promote a balanced therapeutic environment. While independence is important, it must be balanced with safety and the patient's level of functioning. Incremental gains in independence can help the patient feel empowered and build confidence, while still maintaining safety and appropriate levels of support.

Question 2

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 is a milieu-related concept. This includes creating a healing atmosphere and purposeful corrective learning experiences for patients. Limit-setting and establishing behavioral norms are also aspects of creating a therapeutic environment, but balance is not specifically mentioned in this statement.

Question 3

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 promotes dignity, respect, and comfort. This can help maintain the patient's psychological safety by avoiding humiliation and embarrassment. The other options may potentially harm the patient's psychological safety. Helping a depressed patient to inventory personal flaws may exacerbate feelings of worthlessness and hopelessness. Allowing an anxious patient to pace in isolation and without interruptions may reinforce maladaptive coping behaviors and social isolation. Requiring a restrained patient to remain silent until restraints are removed may increase anxiety and disempowerment.

Question 4

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 that promotes patient safety and security. This helps patients understand what is expected of them and can prevent situations where patients become agitated or aggressive. Restricting patients' rights, enforcing consequences of limit-setting, and setting limits when a patient acts out aggressively are reactive approaches and may not be effective in preventing incidents from occurring.

Question 5

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 nurse's request for only one person to talk at a time is an effort to maintain norms, which are the expected behaviors and rules that help create a therapeutic environment.

Question 6

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 known as structure in a therapeutic environment.

Question 7

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

Accepted Answer

JCAHO standards emphasize the importance of orientation programs that detail safety issues and precautions to ensure a safe environment for both patients and staff.

Question 8

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 where clear boundaries are set to promote safety and appropriate behavior. By explaining to the patient that pushing and bumping other patients is unacceptable, the nurse is setting limits and reinforcing appropriate behavior.

Question 9

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

Accepted Answer

Option B most clearly describes a therapeutic environment because it emphasizes providing a secure environment where patients can safely explore and test new behaviors, which is a fundamental aspect of therapeutic settings.

Question 10

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

Accepted Answer

Setting limits is crucial in this scenario to maintain professional boundaries and ensure the safety and well-being of all patients in the unit.

Question 11

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

Safety has been jeopardized as the patient's aggressive behavior is causing fear and intimidation in another patient, which could lead to physical harm or injury.

Question 12

In a therapeutic environment, which norm exists?

Accepted Answer

In a therapeutic environment, it is essential to have expectations for socially acceptable behavior. This provides structure and a sense of safety for all participants. Other norms may also exist, such as opportunities for self-expression and shared experiences, but the primary norm is the expectation of appropriate behavior.

Question 13

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 as it sets the foundation for all other interventions and helps patients feel secure enough to participate in activities and engage in the therapeutic process. Without a sense of safety, patients may be too anxious or overwhelmed to benefit from the other elements of the therapeutic environment.

Question 14

Which nursing action best supports maintenance of a therapeutic environment?

Accepted Answer

Creating therapeutic relationships with patients is essential for maintaining a therapeutic environment.

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

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 is crucial for a withdrawn patient as it provides a predictable and secure environment, which can help in engaging them gradually and reducing their anxiety about the unknown, thereby encouraging interaction.

Question 17

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

Accepted Answer

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

Question 18

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

Accepted Answer

The nurse leading a social skills group is engaged in managing the structure of the group, which includes setting the tone, rules, expectations, and activities for the group to promote positive social interaction among its members. The other choices (A, C, D) are important aspects of nursing practice but are not directly related to managing a social skills group.

Question 19

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

Accepted Answer

The answer of Which aspects of the environment of a...

Question 20

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 answer of A patient demonstrating manic behaviors gathered other...

Quiz 20: Introduction to Milieu Management