Chapter 33: Hospital-Based Psychiatric Nursing Care My Nursing Test Banks

Chapter 33: Hospital-Based Psychiatric Nursing Care

Test Bank

MULTIPLE CHOICE

1. When a partial-hospitalization patient is assessed as possibly having suicidal ideations, the treatment plan will focus on:

a.

stabilization.

b.

institutionalization.

c.

symptom remission.

d.

diagnostic evaluation.

ANS: A

Stabilization is sought and then treatment continues in the community. Diagnostic evaluation already would have been performed, and institutionalization (an unwanted passive dependency that develops with long hospital stays) is not an appropriate outcome.

DIF: Cognitive Level: Comprehension REF: Text Page: 640

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

2. Which nursing intervention has priority when assisting a patient who has been transported to the hospital admissions unit by police for wandering barefoot and naked on the street in freezing weather?

a.

Establishing trust in the one-to-one, nurse-patient relationship

b.

Performing a rapid multidisciplinary physical assessment

c.

Contacting family for permission to treat the patient

d.

Determining why the patient removed all clothing

ANS: B

When patients are severely confused and unable to care for themselves because of maladaptive coping, the multidisciplinary team will perform a rapid diagnostic evaluation, medicate to calm the patient as needed, and escort a patient to the inpatient unit. There, the goals will include stabilization with safety concerns at the forefront of the discharge planning (which starts with admission).

DIF: Cognitive Level: Analysis REF: Text Page: 640

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. Which nursing action would best promote the psychiatric stabilization of a patient who is both confused and agitated when found wandering barefoot in freezing weather?

a.

Place the patient on frequent observation to assess both overall status and potential for harm.

b.

Anticipate the inclusion of medication therapy in the patients therapeutic plan of care.

c.

Interview the patient to obtain information regarding the identification of family and/or caregiver.

d.

Notify social services that the patient will be in need of both physical and social support resources.

ANS: A

The priority nursing intervention for such a patient on the inpatient unit would include measures that prevent harm to self or others.

DIF: Cognitive Level: Analysis REF: Text Page: 640

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. The activity room is severely damaged while the nurse is addressing an emergency on the inpatient unit. Which communication by the nurse to the entire milieu would be the most therapeutic when the destruction is first discovered?

a.

This room is off-limits for 2 weeks. I am struggling with this intolerable behavior and sorely disappointed in everyone involved.

b.

This behavior is representative of a real problem with the units milieu. Lets discuss it as you all help put the room back in its original order.

c.

People must be really angry. Everyone who was involved must help undo the damage immediately and then discuss the reasons for the behavior.

d.

It seems that there is a great deal of negative feelings in this group today. We need to share feelings regarding the problem while we all clean up the room.

ANS: D

Physically destructive behavior is a response that is derived from an unspoken anger or fear. The most therapeutic communication for the situation is the one that validates and supports the underlying feeling but sets limits on the maladaptive action taken. The nurses task is to help the destructive patients learn more adaptive ways to deal with anger, such as verbalization. Disparagement reflects the nurses anger, and humiliation is aggressive to patients and nontherapeutic. Enlisting everyone to help clean up is the most therapeutic option, because it promotes cohesion and may encourage patients who did not do the damage to speak up and voice their anger at the offenders for spoiling their activity room. Peer input is always very effective.

DIF: Cognitive Level: Application REF: Text Page: 643

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. During a group session, a flirtatious patient with mania shares that several patients and the nurse have bodies that are really nice. The most therapeutic response from the nurse would be:

a.

Please go to your room. Youre being inappropriate to me and the other patients.

b.

I know your thoughts are very rapid right now. Lets walk to your room where you can take a 30-minute time-out.

c.

Were you aware before you spoke that what you just said would offend me and the other patients on the unit very much?

d.

Do not speak to me or others like this. Would you like to take this opportunity to apologize to me and the other patients?

ANS: B

When patients are inappropriate and intrusive on the unit, the nurse will want to protect the patient (who will probably be embarrassed when his or her thinking clears), other inpatients, and self. The most therapeutic intervention is one that distracts the patient and enlists cooperation for a time-out before escalation of the behavior occurs. As the patients mental status clears, the nurses sensitivity to the patient will foster trust in the therapeutic relationship.

DIF: Cognitive Level: Analysis REF: Text Page: 642

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. Which intervention by the nurse is most therapeutic when a patient loses a pool game on the unit and begins acting aggressively?

a.

Having the other unit staff present to demonstrate both a unified presence as well as a show of force

b.

Saying to the patient, Accompany me to your room so we can talk about what triggered your anger.

c.

Stating, The rules here are for everyone. If you cannot control your temper, you may need to leave the dayroom.

d.

Setting limits on the behavior immediately, in front of other patients, to help communicate that the unit rules apply to everyone

ANS: B

It is important to communicate to the patient in a way that helps the patient view the inappropriate behavior from others viewpoints, to observe the catalysts that trigger the behavior, and to view adaptive alternatives. Confrontation can escalate aggression on the unit and is nontherapeutic in that it can promote a regressive struggle between the nurse and the patient.

DIF: Cognitive Level: Analysis REF: Text Page: 643

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. A patient who displays dependent tendencies follows the nurse around the unit and repeatedly asks, What do you think I should do, nurse? Which is the nurses most therapeutic response?

a.

You need to think for yourself. I cant do that for you.

b.

Instead of asking me what to do, you should be practicing decision making yourself.

c.

One of the things Ive observed is your dependency on me. Lets discuss why you fear making your own decisions.

d.

Lets discuss your seeming discomfort regarding decision making when we meet today in group. In the meantime, think about why you feel you need my help.

ANS: D

Working with dependency strivings is a difficult task and one that requires patience and understanding from the nurse. The most therapeutic nursing intervention is the one that encourages mutual problem solving.

DIF: Cognitive Level: Analysis REF: Text Page: 643

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. When the nursing staff from the incoming and outgoing shifts has open report on the inpatient unit, which concept underlies this approach?

a.

Proletarian milieu

b.

Democratic society

c.

Egalitarian community

d.

Therapeutic community

ANS: D

Open report is a good example of the therapeutic community recommended by Maxwell Jones in 1953.

DIF: Cognitive Level: Comprehension REF: Text Page: 642

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. A patient has contracted to be allowed to walk about outside after meals with staff supervision. When the patient begins to make a habit of asking if its time to go outside well before meals, the nurse should:

a.

provide the patient with a paper of hourly times to be clocked by the patient and initialed by the staff to indicate when its time to go outside.

b.

firmly state to the patient, 15 minutes after youre done eating, someone will come to find you so the two of you can go outside.

c.

say, with empathy, to the patient, It is very difficult to wait patiently for something you really want like going outside.

d.

instruct the patient to stand at the door of the unit after eating each meal.

ANS: A

Steps to support patients to be more independent need to be carefully weighed with regard for safety, readiness, and capacity for inner control. By checking the time the outside break is due and allowing the patient to clock the time rather than totally removing independence, the nurse is improving the patients orientation and socialization skills and reducing the amount of dependence and potentially intrusive behavior by the patient.

DIF: Cognitive Level: Analysis REF: Text Page: 643

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. A patient shares with a nurse, I dont seem to be sleeping any better since I came here. Which nursing intervention will the nurse implement initially?

a.

Comparing the patients admission and current sleeping patterns

b.

Giving the patient a warm glass of milk at bedtime

c.

Teaching relaxation techniques to the patient

d.

Starting a running program for the patient

ANS: A

The first step is to assess the patients complaint of sleeplessness. Patients often perceive that they sleep less than they do. Although the other techniques suggested may promote sleep, they would be implemented only if the nurses assessment confirmed the patients complaint of sleeplessness.

DIF: Cognitive Level: Application REF: Text Page: 645

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. A patient with a history of chronic alcohol abuse and impaired cognitive function has been successfully taught to interpret a community bus schedule. The nurse should now be confident that the patient would benefit from attending:

a.

a community resource group in the day hospital.

b.

a substance abuse group on an outpatient basis.

c.

a life skills group at the outpatient clinic.

d.

Alcoholics Anonymous at the YMCA.

ANS: A

Community resource groups are assigned on the basis of the patients learning needs. Topics in the group may be provided on a rotating basis to assist patients to use community resources, including the public library, social services, and other agencies. Skills such as reading a newspaper or telephone book are also topics that may be shared. Patients in the group also often share their problem-solving skills about pertinent issues.

DIF: Cognitive Level: Application REF: Text Page: 646

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

12. Which statement made by a nurse manager to personnel working short-staffed best reflects an understanding of the importance of safe unit staffing?

a.

If you cannot find sufficient staff, I will have to leave this unit, because it is unsafe and someone could be hurt.

b.

I cannot safely manage this unit with such a small staff. When can I expect you to send additional staffing to help?

c.

If you dont provide extra staffing immediately, I will quit and report this situation to The Joint Commission (TJC).

d.

In order to ensure unit safety I will need additional staff. I am limiting care to priority needs only until you meet that need. My written report will document my actions.

ANS: D

An assertive nurse describes the unit situation, asks clearly for what is needed, and describes interim behavior or the consequence. TJC clearly states the staffing patterns that constitute safe standards of care.

DIF: Cognitive Level: Analysis REF: Text Pages: 644-645

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

13. Which of these patients is the most appropriate candidate for assignment to a crisis bed? A patient who:

a.

is found inebriated and claims to be king of the universe.

b.

shows a store clerk a knife after being refused use of the stores restroom.

c.

has a history of violent outbursts and has been recently evicted from his or her home.

d.

is known to have bipolar disorder who expresses a need to be hospitalized for the winter.

ANS: B

Lethality assessment is the primary reason for using a crisis bed in the hospital. Although the other patients described would seem to benefit from hospitalization, crisis beds are used for patients who are suicidal and homicidal.

DIF: Cognitive Level: Application REF: Text Page: 640

TOP: Nursing Process: Assessment

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

14. The multidisciplinary team is meeting to discuss discharge planning with the family of a patient who recently attempted suicide. Which statement by a family member might constitute criteria for delaying discharge?

a.

The patients spouse says, Ill be taking long weekends from now on so well not be apart so much.

b.

The patients daughter asks, Do I keep it a secret that I miscarried my baby the day of the attempt?

c.

The patients son says, If everyone thinks Im going to make a fuss over this, theyre wrong.

d.

The patients father says, What can we do to make sure this doesnt happen again?

ANS: B

From the time the patient is admitted, discharge planning begins. Discharge occurs when the patient is stabilized. If information that is highly volatile and a likely trigger is uncovered, this might be a consideration for delaying discharge until the patient is informed, the response to the information is assessed, coping skills are evaluated, and additional supports can be provided.

DIF: Cognitive Level: Application REF: Text Pages: 646-647

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

15. A patient has just received information regarding the goals of a partial-hospitalization program. Which statement best indicates patient understanding?

a.

I think that the partial-hospitalization program will provide a good interim rest for me.

b.

The partial-hospitalization program will be a good support to me as I adjust to the stress of being back home.

c.

I know that partial hospitalization seems like a small step, but it will prevent readmission to the hospital.

d.

Im looking forward to the partial-hospitalization program, because I can gather my thoughts there and think about what I want to do.

ANS: B

Partial hospitalization provides a highly structured and organized treatment plan that is comprehensive and individualized for its patients. Treatment plans include group therapy; education for patient and family members regarding, among other topics, stress management; and other treatments to promote continuing stabilization and intermediate-term treatment.

DIF: Cognitive Level: Application REF: Text Pages: 641-642

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

16. A young adult patient is alienated by others who are offended by the patients poor hygiene and body odor. Which nursing intervention should occur first for this patient?

a.

Assessing the patients understanding of good hygiene practices

b.

Assigning the patient a scheduled shower and personal grooming time

c.

Instructing the patient regarding the need for daily showering and shampooing

d.

Having two mental health workers shower and dress the patient every morning

ANS: D

Poor hygiene in any patient is a concern. A few of the variables that may be affecting the situation are physical illness associated with this age (e.g., yeast infections, sexually transmitted diseases, urinary tract infections), sociocultural factors, and gender-related issues. The first step in identifying a problem is to explore the underlying knowledge and factors that contribute to it and then to work with the patient to solve the problem. The other answers, such as teaching or mandating grooming, should be used only after a nonjudgmental assessment has been performed.

DIF: Cognitive Level: Application REF: Text Page: 645

TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance

17. A nurse observes that a patient diagnosed with bipolar disorder who has left the seclusion room is soiled with feces. Which nursing intervention would be most likely to encourage a patient to comply with bathing?

a.

Say to the patient, We are going to help you to bathe and freshen up.

b.

Say to the patient, Would you like to clean up and change your clothes?

c.

Do nothing until the patient has enough personal control to realize the need.

d.

Return the patient to the room and reorient him or her to the bathroom and clean clothing.

ANS: A

Successful nursing approaches for disorganized patients include reassuring them and working with them to reduce the degree to which their behaviors inhibit therapeutic processes. Analyzing the extent to which fecal smearing interferes with successful functioning (Maslows hierarchy) and promoting optimal adaptation constitute primary nursing strategies for such a patient. Passivity implies approval or insensitivity. Therapeutic use of self, that is, asking how you would be able to problem solve when so soiled, is a therapeutic approach to deciding nursing action. The correct option provides anticipatory guidance, which is an effective teaching approach for all patients.

DIF: Cognitive Level: Application REF: Text Pages: 644-645

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

18. A nurse would determine that medication teaching was most successful for a patient starting on lithium (Lithobid) if the patient stated:

a.

I will discontinue my medication if I experience any fine hand tremors.

b.

I know that I will need to reduce exercising to only three times per week.

c.

I will need to get regular blood levels drawn while Im on my medication.

d.

I will continue my medication unless I get sick and catch a very bad cold.

ANS: C

Patients on lithium usually start lithium with blood levels drawn three times per week and then monthly. When the patient is on maintenance medication, the psychiatrist may extend the testing of the blood levels to every 3 to 6 months.

DIF: Cognitive Level: Application REF: Text Page: 646

TOP: Nursing Process: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. In order to best demonstrate the broad scope of practice knowledge and expertise required for contemporary psychiatric nursing a nurse must:

a.

possess experience in both inpatient and outpatient psychiatric settings.

b.

effectively manage and implement all aspects of individualized patient care.

c.

demonstrate sensitivity to the need for cost savings and short-stay care.

d.

provide patient education in a manner that reflects caring and individual needs.

ANS: B

The scope of contemporary psychiatric nursing practice requires knowledge and expertise in three broad areas: managing the therapeutic milieu, implementing caregiving activities, and integrating and coordinating care delivery. All psychiatric nurses, regardless of education or experience, engage in these activities every day.

DIF: Cognitive Level: Comprehension REF: Text Page: 642

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

20. Which is the initial nursing care intervention for a nurse admitting a patient recently discharged from an inpatient unit into a partial-hospitalization program?

a.

Confirming the telephone numbers of all family members listed as approved contacts

b.

Identifying the patients food preferences to best ensure proper nutrition as well as adequate intake

c.

Asking the patient to identify any sources of anxiety they are experiencing related to the program

d.

Educating the patient to the time and place of the unit activities included in their therapeutic plan of care

ANS: C

Support includes the staffs conscious efforts to help patients feel better and improve their self-esteem. It is the unconditional acceptance of the patient, whatever his or her circumstances. The function of support is to help patients feel comfortable and secure and reduce their anxiety. It may take many forms, but it falls under the general heading of paying attention to the patient.

DIF: Cognitive Level: Application REF: Text Page: 643

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21. In order to best address the educational needs of a patient diagnosed with cognitive impairment, the teaching plan should incorporate which strategy?

a.

Repetition of both the information and practice opportunities

b.

Use of music therapy for reducing anxiety while learning

c.

Providing specific patient-focused instructions for attainment of outcomes

d.

Asking the patient to verbally repeat the information using his or her own words

ANS: A

When barriers have been identified, particular strategies can be incorporated into the teaching plan to help the patient retain and use the information. As with any learner, but especially for the cognitively impaired patient, repeating the information, presenting information in ways that engage multiple sensory avenues, and providing opportunities for practice and feedback promote learning for psychiatric patients.

DIF: Cognitive Level: Application REF: Text Page: 646

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

22. A nurse is facilitating a teaching group for family members of patients with schizophrenia. A focus of the group will be the monitoring of medication administration and side effects. Priority teaching for this focus will concentrate on:

a.

minimizing the physical complications related to medication side effects.

b.

identifying methods to manage and control the patients psychotic behavior.

c.

using tactics proven to be effective in the prevention of patient noncompliance.

d.

recognizing the signs and symptoms of potential medication-related side effects.

ANS: D

Patient and family teaching education programs are necessary to prepare family/caregivers for the complex responsibilities that they will face. The recognition of potential side effects has priority among the given options. The remaining options are all valid teaching topics but are not as directly related to the monitoring of medication administration and side effects as is the correct option.

DIF: Cognitive Level: Application REF: Text Page: 646

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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