Deck 20: Introduction to Milieu Management

Question 1

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?

A) Connection
B) Exploration
C) Structure
D) Balance

Answer 1

Balance

Question 2

In a therapeutic environment, which norm exists?

A) Opportunities for self-expression that relieve stress
B) Expectations for socially acceptable behavior
C) The behaviors most people display daily
D) Shared experiences among patients

Answer 2

Expectations for socially acceptable behavior

Question 3

Which nursing action best supports maintenance of a therapeutic environment?

A) Creating therapeutic relationships with patients
B) Providing purposeful structured activities
C) Maintaining patient records and care plans
D) Administering medication

Answer 3

Creating therapeutic relationships with patients

Question 4

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

A) Balance
B) Structure
C) Accountability
D) Risk management

Question 5

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?

A) Norms
B) Safety
C) Balance
D) Structure

Question 6

Which element of therapeutic environmental management has the highest priority?

A) Clearly establishing norms and designating limits
B) Scheduling purposeful activities throughout the day
C) Creating an environment of psychological and physical safety
D) Promoting a balance between patient dependence and independence

Question 7

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

A) Orientation programs detail safety issues and precautions.
B) Patients' room doors remain open during hours of sleep.
C) Safety precautions are simple and apply commonsense behaviors.
D) Patients' personal belongings are kept in secure areas under staff control.

Question 8

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

A) Visitor badges
B) Identification badges for employees
C) Telephones located in enclosed booths
D) Requiring patients to wear hospital-issue clothing
E) Guidelines for staff interaction with media representatives

Question 9

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?

A) Norms
B) Safety
C) Structure
D) Limit-setting

Question 10

The framework of schedules, rules, and activities around which a therapeutic environment revolves is related to which associated term?

A) Structure
B) Balance
C) Norms
D) Safety

Question 11

A nurse plans ways to promote patient safety and security. A proactive approach would include which intervention?

A) Restricting psychotic patients' rights
B) Enforcing consequences of limit-setting
C) Setting limits when a patient acts out aggressively
D) Clearly communicating expectations for patients' behavior

Question 12

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

A) An involuntarily hospitalized patient insists on being discharged.
B) Two patients are found kissing in an obscure area of the unit.
C) A patient with suicidal ideation asks to leave the unit.
D) A depressed patient seeks daily telephone privileges.

Question 13

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?

A) Balance
B) Limit-setting
C) A therapeutic environment
D) Establishing behavioral norms

Question 14

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?

A) Balance
B) Limit-setting
C) Personal control
D) Environmental modification

Question 15

Which adjective best characterizes custodial care?

A) Paternalistic
B) Beneficent
C) Essential
D) Safe

Question 16

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?

A) Norms
B) Safety
C) Balance
D) Structure

Question 17

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

A) Independence is best gained in increments.
B) Independence is a fundamental right of all patients.
C) Independence jeopardizes safety in an inpatient setting.
D) Dependence is a characteristic of most persons with mental illness.

Question 18

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

A) "My unit uses behavior modification to enhance patients' social skills."
B) "My unit allows patients to test new behaviors in a secure environment."
C) "My unit helps patients deal with childhood issues by providing a safe setting."
D) "My unit allows patients to deal with personal issues without interpersonal stressors."

Question 19

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

A) Helping a depressed patient to inventory personal flaws
B) Assisting a patient to change clothes after an episode of incontinence
C) Allowing an anxious patient to pace in isolation and without interruptions
D) Requiring a restrained patient to remain silent until restraints are removed

Question 20

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

A) A 4:1 patient-to-staff ratio
B) Private rooms for all patients
C) Use of a therapeutic milieu treatment model
D) Telephones for private patient conversations

Question 21

Which research findings about the therapeutic environment of an inpatient psychiatric unit have implications for nursing practice? (Select all that apply.)

A) Patients valued interactions with other patients.
B) Patients perceived other patients as dissimilar from self.
C) Hospitalization interferes with planning for the future.
D) Patients failed to experience bonding with other patients.
E) Hospitalization creates feelings of safety from self-destructiveness.

Question 22

Which statements indicate that a patient understands the unit norms? (Select all that apply.)

A) "I need quiet time after art therapy today."
B) "I will not yell during the community meeting."
C) "I realize that I need help with my problems."
D) "I will show up on time to take my medication."
E) "I will talk to staff if I get angry instead of punching somebody."