Nursing 2230 Mental Health Quiz 3 Chapters 12, 13, 14, 15, 20- Keiser University
Mental Health Quiz 3
Chapters 12, 13, 14, 15, 20
Chapter 12 Milieu
... [Show More] Therapy - The Therapeutic Community
1. An angry client on an inpatient unit approaches a nurse, stating, Someone took my lunch! People need to
respect others, and you need to do something about this now! The nurses response should be guided by which
basic assumption of milieu therapy?
A. Conflict should be avoided at all costs on inpatient psychiatric units.
B. Conflict should be resolved by the nursing staff.
C. Every interaction is an opportunity for therapeutic intervention.
D. Conflict resolution should be addressed only during group therapy.
The nurses response should be guided by the basic assumption that every interaction is an opportunity for
therapeutic intervention. The nurse can utilize milieu therapy to effect behavioral change and improve
psychological health and functioning.
2. A client on an inpatient unit angrily states to a nurse, Peter is not cleaning up after himself in the community
bathroom. You need to address this problem. Which is the appropriate nursing response?
A. Ill talk to Peter and present your concerns.
B. Why are you overreacting to this issue?
C. You should bring this to the attention of your treatment team.
D. I can see that you are angry. Lets discuss ways to approach Peter with your concerns.
The most appropriate nursing response involves restating the clients feeling and developing a plan with the
client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity
for therapeutic intervention to improve communication and relationship-development skills.
3. A newly admitted client asks, Why do we need a unit schedule? Im not going to these groups. Im here to get
some rest. Which is the most appropriate nursing reply?
A. Group therapy provides the opportunity to learn and practice new coping skills.
B. Group therapy is mandatory. All clients must attend.
C. Group therapy is optional. You can go if you find the topic helpful and interesting.
D. Group therapy is an economical way of providing therapy to many clients concurrently.
The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping
skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity
for therapeutic intervention.
4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during
hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the
home environment?
A. Peer pressure
B. Structured programming
C. Visitor restrictions
D. Mandated activities
The milieu, or therapeutic community, provides the client with structured programming that may be missing in
the home environment. The therapeutic community provides a structured schedule of activities in which
interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to
personal problems and focus groups.
5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration?
A. Encourage clients to request their medications at the appropriate times.
B. Refuse to administer medications unless clients request them at the appropriate times.
C. Allow the clients to determine appropriate medication times.
D. Take medications to the clients bedside at the appropriate times.
The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the
appropriate times. Nurses are responsible for the management of medication administration on inpatient
psychiatric units; however, nurses must work with clients to foster independence and provide experiences that
would foster increased self-esteem.
6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What
should the nurse identify as an appropriate group topic?
A. Dream analysis
B. Creative cooking
C. Paint by number
D. Stress management
The nurse should identify that teaching clients about stress management is an appropriate education group topic.
Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to
assess a clients learning readiness. Other topics for education groups include medical diagnoses, side effects of
medications, and the importance of medication compliance.
7. What is the best rationale for including the clients family in therapy within the inpatient milieu?
A. To structure a program of social and work-related activities
B. To facilitate discharge from the hospital
C. To provide a concrete demonstration of caring
D. To encourage the family to model positive behaviors
The nurse should include the clients family in therapy within the inpatient milieu to facilitate discharge from the
hospital. Family members are invited to participate in some therapy groups and to share meals with the client in
the communal dining room. Family involvement may also serve to prevent the client from becoming too
dependent on the therapeutic environment.
8. How does a democratic form of self-government in the milieu contribute to client therapy?
A. By setting punishments for clients who violate the community rules
B. By dealing with inappropriate behaviors as they occur
C. By setting community expectations wherein all clients are treated on an equal basis
D. By interacting with professional staff members to learn about therapeutic interventions
A democratic form of self-government in the milieu contributes to client therapy by setting the expectation that
all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving
aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and
clients. All individuals have input.
9. A client has undergone psychological testing. With which member of the interdisciplinary team should a
nurse collaborate to review these results?
A. The psychiatrist
B. The psychiatric social worker
C. The clinical psychologist
D. The clinical nurse specialist
The nurse should consult with the clinical psychologist to review psychological testing results for the client.
Clinical psychologists can administer, interpret, and evaluate psychological tests to assist in the diagnostic
process.
10. In the role of milieu manager, which activity should the nurse prioritize?
A. Setting the schedule for the daily unit activities
B. Evaluating clients for medication effectiveness
C. Conducting therapeutic group sessions
D. Searching newly admitted clients for hazardous objects
The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others
is the priority. Nurses are responsible for ensuring that the clients safety and physiological needs are met within
the milieu.
11. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals
are typically included as members of the interdisciplinary treatment team in psychiatry? Select all that apply.
A. Respiratory therapist
B. Occupational therapist
C. Recreational therapist
D. Social worker
E. Mental health technician
The typical interdisciplinary treatment team in a psychiatric inpatient setting consists of a psychiatrist,
psychiatric nurse, psychiatric social worker, music therapist, dietician, psychologist, occupational therapist,
recreational therapist, art therapist, mental health technician, and chaplain. Other disciplines may be included on
the basis of resources available in a particular hospital setting and individual patient needs.
12. Which of the following are accurate descriptors of a therapeutic community? Select all that apply.
A. The unit schedule includes unlimited free time for personal reflection.
B. Unit responsibilities are assigned according to client capabilities.
C. A flexible schedule is determined by client needs.
D. The individual is the sole focus of therapy.
E. A democratic form of government exists.
In a therapeutic community the unit responsibilities are assigned according to client capability, and a democratic
form of government exists. Therapeutic communities are structured and provide therapeutic interventions that
focus on communication and relationship-development skills.
Chapter 13 Crisis Intervention
1. A mother is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave
the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of
crisis?
A. This type of crisis is precipitated by unexpected external stressors.
B. This type of crisis is precipitated by preexisting psychopathology.
C. This type of crisis is precipitated by an acute response to an external situational stressor.
D. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.
The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that
overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred
to services that can provide assistance.
2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time
student and works 8 hours at night to support his family. He states, I cant function any longer under all this
stress. Which type of crisis is the client experiencing?
A. Maturational/developmental crisis
B. Psychiatric emergency crisis
C. Anticipated life transition crisis
D. Traumatic stress crisis
The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric
emergencies occur when crisis situations result in severe impairment, incompetence, or inability to assume
personal responsibility.
3. A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite.
The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What correctly written long-term
outcome is realistic in addressing this clients crisis?
A. The client will change his or her type A personality traits to more adaptive ones by week 1.
B. The client will list five positive self-attributes.
C. The client will examine how childhood events led to an overachieving orientation.
D. The client will return to previous adaptive levels of functioning by week 6.
The nurse should identify that a realistic long-term outcome for this client would be to return to previous
adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect
the immediacy of the situation. To be correctly written, an outcome must be client-centered, specific,
measurable, realistic, and contain a time frame.
4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of
state that she planned to also attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is
the correctly written priority nursing diagnosis for this client?
A. Ineffective coping R/T situational crisis AEB powerlessness
B. Anxiety R/T fear of failure
C. Risk for self-directed violence R/T hopelessness
D. Risk for low self-esteem R/T loss events AEB suicidal ideations
The priority nursing diagnosis for this client is Risk for self-directed violence R/T hopelessness. Nurses should
prioritize diagnoses and outcomes on the basis of potential safety risk to the client and/or others. Nursing
diagnoses should be correctly written to include evidence if actual and no evidence if the diagnosis is
determined to be potential.
5. After threatening to jump off a bridge, a client is brought to an emergency department by police. To assess for
suicide potential, which question should a nurse ask first?
A. Are you currently thinking about harming yourself?
B. Why do you want to harm yourself?
C. Have you thought about the consequences of your actions?
D. Who is your emergency contact person?
The nurse should first assess the client for current suicidal thoughts to minimize risk of harm and provide
appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team should
prioritize safety by assessing the client for thoughts of self-harm.
6. An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor.
Which intervention should a nurse prioritize to address this behavior?
A. Initiate forced medication protocol.
B. Help the client to explore the source of anger.
C. Ignore the act to avoid reinforcing the behavior.
D. With staff support and a show of solidarity, set firm limits on the behavior.
The most appropriate nursing intervention is to set firm limits on the behavior. Pushing food onto the floor does
not warrant forced medication because the behavior is not a direct safety concern. Exploring the source of anger
may be appropriate after the client has gained emotional control. Ignoring the act may further upset the client
and does not reinforce appropriate behavior.
7. A college student who was nearly raped while jogging completes a series of appointments with a rape crisis
nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have
been met?
A. Youve really been helpful. Can I count on you for continued support?
B. I dont work out anymore.
C. Im really glad I didnt go home. It would have been hard to come back.
D. I carry mace when I jog. It makes me feel safe and secure.
The nurse should evaluate that the client who has developed adaptive coping strategies has achieved the goals
of crisis intervention.
8. A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell
my house and move away. Which nursing reply is most appropriate?
A. Im confident you know whats best for you.
B. This may not be the best time for you to make such an important decision.
C. Your children will be terribly disappointed.
D. Tell me why you want to make this change.
During crisis intervention, the nurse should guide the client through a problem-solving process. The nurse
should help the individual confront the source of the problem, encourage the individual to discuss changes he or
she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be
changed. The nurse should also assist the client in determining whether any changes are realistic and if timing
of change is appropriate. This response encourages the client to think through what may be an impulsive
decision.
9. An inpatient client with a known history of violence suddenly begins to pace. Which client behavior should
alert a nurse to escalating anger and aggression?
A. The client requests prn medications.
B. The client has a tense facial expression and body language.
C. The client refuses to eat lunch.
D. The client sits in group therapy with back to peers.
The nurse should assess that tense facial expressions and body language may indicate that a clients anger is
escalating. The nurse should conduct a thorough assessment of the clients past and current violent behaviors and
develop interventions for de-escalation.
10. What is the best nursing rationale for holding a debriefing session with clients and staff after clients have
witnessed a peer being taken down after a violent outburst?
A. To reinforce unit rules with the client population
B. To create protocols for the future release of tensions associated with anger
C. To process feelings and concerns related to the witnessed intervention
D. To discuss the client problems that led to inappropriate expressions of anger
The nurse should determine that the purpose for holding a debriefing session with clients and staff after clients
have witnessed a peer being taken down after a violent outburst is to process feelings and concerns related to
the witnessed intervention.
11. Which of the following nursing statements and/or questions represent appropriate communication to assess
an individual in crisis? Select all that apply.
A. Tell me what happened.
B. What coping methods have you used, and did they work?
C. Describe to me what your life was like before this happened.
D. Lets focus on the current problem.
E. Ill assist you in selecting functional coping strategies.
In the assessment phase, the nurse should gather information regarding the precipitating stressor and the
resulting crisis. Focusing on the current problem and selecting functional coping strategies are nursing
interventions rather than assessments.
12. Which of the following are effective interventions that a nurse should utilize when caring for an inpatient
client who expresses anger inappropriately? Select all that apply.
A. Maintain a calm demeanor.
B. Clearly delineate the consequences of the behavior.
C. Use therapeutic touch to convey empathy.
D. Set limits on the behavior.
E. Teach the client to avoid I statements related to expression of feelings.
The nurse should determine that when working with an inpatient client who expresses anger inappropriately, it
is important to maintain a calm demeanor, clearly define the consequences, and set limits on the behavior. The
use of therapeutic touch may not be appropriate and could escalate the clients anger.
Chapter 14 Assertiveness Training
1. During a psychoeducational group on assertiveness training, a client asks, Why do we need to learn about this
stuff? Which is the most appropriate nursing reply?
A. Because your doctor requires you to attend this group.
B. Being assertive is the ability to stand up for yourself while respecting the rights of others.
C. Assertiveness training teaches you how to ask for what you want, when you want it.
D. Assertive people place the needs and rights of others before their own.
Assertiveness training assists people to maintain their own self-respect and meet their needs while respecting
the rights of others.
2. Two clients are roommates on an inpatient psychiatric unit. At breakfast, client A, who had been missing her
gold locket, notices client B wearing it. Which should a nurse recognize as a nonassertive or passive behavioral
response from client A?
A. Client A ignores the situation.
B. Client A discusses the situation with her nurse and develops a plan of action.
C. Client A immediately approaches client B and pulls the necklace off her neck.
D. Client A offers to wash client Bs clothes and accidentally spills bleach in the water.
By ignoring the situation, client A avoids conflict, denies her feelings, and does not assertively resolve the
problem. This is an example of nonassertive behavior.
3. A client on an inpatient unit is angry with a peer. During lunch, when the peer is not looking, the client spits
into his soup. How would the nurse document this interaction?
A. Client is displaying assertive behaviors.
B. Client is displaying aggressive behaviors.
C. Client is displaying passive behaviors.
D. Client is displaying passiveaggressive behaviors.
This response is passiveaggressive. The clients anger is expressed indirectly by spitting in the soup when the
peer is not looking.
4. A client continually waits more than an hour before being seen at the mental health clinic. The client
approaches the nurse and states, When I have to wait for more than an hour to be seen, I feel like my time is not
important. The nurse recognizes this as what type of behavior?
A. Aggressive behavior
B. Assertive behavior
C. Passiveaggressive behavior
D. Passive behavior
This response is assertive. The client is openly expressing feelings and attempting to correct a stressful
situation.
5. During an assertiveness training group, a client admits to aggressive behaviors. The client asks for
suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply?
A. Several techniques, including meditation and progressive muscle relaxation, appear helpful.
B. Theres not much that can be done about aggressive behavior because of biological responses.
C. Certain types of medications have been proven effective in promoting assertive communication.
D. There are several techniques, including I statements, role playing, and thought stopping, that can help
promote assertive behaviors and decrease aggressive behaviors.
These techniques promote assertive behaviors and would help diminish aggressive responses.
6. During an assertiveness training group, a nurse suggests using I statements. The group questions the
usefulness of this communication technique. Which explanation by the nurse is most appropriate?
A. When I statements are used, opinions are communicated without blaming others.
B. When I statements are used, anger is displaced by using indirect means.
C. When I statements are used, responsibility for ones behavior is attributed to another.
D. When I statements are used, eye contact is promoted.
I statements clearly state ones feelings and needs without blaming or demeaning others.
7. While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example
of an I statement. Which of the following statements is the best example of this assertive communication
technique?
A. I would like to know why you came home late without calling me.
B. I hate it when you think you can just come home late without calling anyone to let them know where you are.
C. I feel angry when you come home late without calling.
D. I think you dont care about me, because if you did, youd call me if you were planning on coming home late.
This response clearly states feelings about a situation without blaming another.
8. After vying for a nurse management position, nurse A is chosen over nurse B. When nurse manager A calls
for staff meetings, nurse B is chronically late or absent. Nurse B is exhibiting which type of behavior?
A. Passive
B. Assertive
C. Aggressive
D. Passiveaggressive
This response is passiveaggressive. The colleague is expressing anger indirectly by being late or absent from the
meetings. [Show Less]