Professional Documents
Culture Documents
Multiple Choice
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 nurse’s
response should be guided by which basic assumption of milieu therapy?
1. Conflict should be avoided at all costs on inpatient psychiatric units.
2. Conflict should be resolved by the nursing staff.
3. On inpatient units, every interaction is an opportunity for therapeutic intervention.
4. Conflict resolution should only be addressed during group therapy.
ANS: 3
Rationale: The nurse’s response should be guided by the basic assumption that every interaction
is an opportunity for therapeutic intervention. The nurse can use milieu therapy to effect
behavioral change and improve psychological health and functioning.
2. A client on an inpatient unit angrily says 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?
1. “I’ll talk to Peter and present your concerns.”
2. “Why are you overreacting to this issue?”
3. “You should bring this to the attention of your treatment team.”
4. “I can see that you are angry. Let’s discuss ways to approach Peter with your concerns.”
ANS: 4
Rationale: The most appropriate nursing response involves restating the client’s feeling and
developing a plan with the client to solve the problem. According to Skinner, every interaction 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? I’m not going to these
groups. I’m here to get some rest.” Which is the most appropriate nursing response?
1. “The purpose of group therapy is to learn and practice new coping skills.”
2. “Group therapy is mandatory. All clients must attend.”
3. “Group therapy is optional. You can go if you find the topic helpful and interesting.”
4. “Group therapy is an economical way of providing therapy to many clients concurrently.”
ANS: 1
Rationale: The nurse should explain to the client that the purpose of group therapy is to learn and
practice new coping skills. The client owns his or her environment and can make decisions to
attend group or not.
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?
1. Peer pressure
2. Structured programming
3. Visitor restrictions
4. Mandated activities
ANS: 2
Rationale: 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. Time is also devoted to personal problems and focus groups.
ANS: 1
Rationale: 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, but nurses must work with clients to encourage self-
reliance and responsibility, which may result in independent decision-making, leading to
medication adherence.
ANS: 4
Rationale: 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 client’s learning readiness. Other topics
for education groups include medical diagnoses, side effects of medications, and the importance
of medication adherence.
7. What is the best rationale for including family in the client’s therapy within the inpatient
milieu?
1. To structure a program of social and work-related activities
2. To facilitate discharge from hospitalization
3. To provide a concrete demonstration of caring
4. To encourage the family to model positive behaviors
ANS: 2
Rationale: The nurse should include the client’s 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.
ANS: 3
Rationale: 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.
ANS: 3
Rationale: The nurse should consult with the clinical psychologist to obtain psychological testing
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?
1. Setting the schedule for the daily unit activities
2. Evaluating clients for medication effectiveness
3. Conducting therapeutic group sessions
4. Searching newly admitted clients for hazardous objects
ANS: 4
Rationale: The milieu manager should search newly admitted clients for hazardous objects.
Safety of the client and others always takes priority. Nurses are responsible for ensuring that the
client’s safety and physiological needs are met.
Multiple Response
11. A nurse attends an interdisciplinary team meeting regarding a newly admitted client. Which
of the following individuals are typically included as members of the interdisciplinary treatment
team in psychiatry? (Select all that apply.)
1. Respiratory therapist and psychiatrist
2. Occupational therapist and psychologist
3. Recreational therapist and art therapist.
4. Social worker and hospital volunteer
5. Mental health technician and chaplain
ANS: 2, 3, 5
Rationale: The interdisciplinary treatment team in psychiatry consists of a psychologist,
occupational therapist, recreational therapist, art therapist, mental health technician, and
chaplain. In addition, a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist,
psychodramatist, and dietitian also participate in the interdisciplinary treatment team.
Respiratory therapists and hospital volunteers are not included in the interdisciplinary treatment
team in psychiatry.
12. Which of the following conditions promote a therapeutic community? (Select all that apply.)
1. The unit schedule includes unlimited free time for personal reflection.
2. Unit responsibilities are assigned according to client capabilities.
3. A flexible schedule is determined by client needs.
4. The individual is the sole focus of therapy.
5. A democratic form of government exists.
ANS: 2, 5
Rationale: A therapeutic community is promoted when 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.
13. A scientific structuring of the environment in order to effect behavioral changes and to
improve the psychological health and functioning of the individual is defined as
________________________ therapy.
ANS: milieu
Rationale: Milieu therapy is defined as a scientific structuring of the environment in order to
effect behavioral changes and to improve the psychological health and functioning of the
individual. The goal of milieu therapy is to manipulate the environment so that all aspects of the
client’s hospital experience are considered therapeutic.
— Tule sinä nyt vaan pois Törömäeltä mansikasta, niin saat kuulla
tarkkaan miten teemme!
Ristian sai eloa Järvituittuun. Kun hän oli seisonut jokaisella kylän
kynnysvierellä, sanonut sanottavansa, kumarrellut kutsunsa
tehokkaiksi ja hävinnyt metsätöllilleen, alkoi Järvituitun taloissa
naisten vieraissa-pistäytyminen, ylimääräinen kahvinjuontiraivo ja
päivittelevä nauru.
*****
— No — mitä katselet?
— Ohhoh!
— Kuulkaa nyt, kun isä neuvoo teitä! Jos milloin on maitoa paljon
eikä ole kellaria, niin täytyy kannuun laskea konnikainen, se pitää
maidon kylmänä eikä laske piimiintymään.
— Hei!
*****