Chapter 8: Milieu Therapy—The Therapeutic Community

Chapter 8: Milieu Therapy—The Therapeutic Community

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____     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.

 

 

____     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.”

 

 

____     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.”

 

 

____     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

 

 

____     5.   To promote self-reliance, how should a psychiatric nurse best conduct medication administration?

1.	Encourage clients to request their medications at the appropriate times.
2.	Refuse to administer medications unless clients request them at the appropriate times.
3.	Allow the clients to determine appropriate medication times.
4.	Take medications to the clients’ bedside at the appropriate times.

 

Chapter 8: Milieu Therapy—The Therapeutic Community

Answer Section

 

MULTIPLE CHOICE

 

1. ANS:  3

Chapter: Chapter 8, Milieu Therapy—The Therapeutic Community

Objective: Identify seven basic assumptions of a therapeutic community.

Page: 172

Heading: Basic Assumptions

Integrated Processes: Nursing Process

Client Need: Psychosocial Integrity

Cognitive Level: Application [Applying]

Concept: Communication

Difficulty: Easy

 

	Feedback
1	Conflict is often hard to avoid, and at times is resolved between clients or other staff members.
2	Conflict should be resolved between clients or other staff members.
3	The nurse’s response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention.
4	Conflict resolution should be addressed as soon as it is therapeutic to the individuals involved.

 

 

PTS:   1                    CON:  Communication

 

2. ANS:  4

Chapter: Chapter 8 Milieu Therapy—The Therapeutic Community

Objective: Identify seven basic assumptions of a therapeutic community.

Page: 173

Heading: Basic Assumptions

Integrated Processes: Nursing Process

Client Need: Psychosocial Integrity

Cognitive Level: Application [Applying]

Concept: Communication

Difficulty: Easy

 

	Feedback
1	It would be inappropriate for the nurse to solve the problem for the client.
2	It would be inappropriate for the nurse to ignore the conflict.
3	The nurse should not pass the conflict off to other members of the treatment team, but should assist the client in handling it immediately.
4	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.

 

 

PTS:   1                    CON:  Communication

 

3. ANS:  1

Chapter: Chapter 8, Milieu Therapy—The Therapeutic Community

Objective: Identify seven basic assumptions of a therapeutic community.

Page: 172

Heading: Basic Assumptions

Integrated Processes: Nursing Process

Client Need: Psychosocial Integrity

Cognitive Level: Application [Applying]

Concept: Communication

Difficulty: Easy

 

	Feedback
1	The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills.
2	The client owns his or her environment and can make decisions to attend group or not.
3	Group therapy is encouraged so that the client can learn new coping skills.
4	Group therapy is important because it teaches clients how to interact with others and problem solve.

 

 

PTS:   1                    CON:  Communication

 

4. ANS:  2

Chapter: Chapter 8, Milieu Therapy—The Therapeutic Community

Objective: Discuss conditions that characterize a therapeutic community.

Page: 173

Heading: Conditions That Promote a Therapeutic Community

Integrated Processes: Nursing Process

Client Need: Psychosocial Integrity

Cognitive Level: Application [Applying]

Concept: Patient-Centered Care

Difficulty: Easy

 

	Feedback
1	The milieu does not provide peer pressure.
2	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.
3	The milieu does not provide visitor restrictions.
4	The milieu does not provide mandated activities.

 

 

PTS:   1                    CON:  Patient-Centered Care

 

5. ANS:  1

Chapter: Chapter 8, Milieu Therapy—The Therapeutic Community

Objective: Describe the role of the nurse on the interdisciplinary treatment team.

Page: 175

Heading: The Role of the Nurse in Milieu Therapy

Integrated Processes: Teaching and Learning

Client Need: Psychosocial Integrity

Cognitive Level: Application (Application)

Concept: Patient-Centered Care

Difficulty: Easy

 

	Feedback
1	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.
2	Refusing to administer medication does not promote self-reliance.
3	Allowing clients to choose medication times does not promote self-reliance.
4	Taking medications to the bedside does not promote self-reliance.

 

 

PTS:   1                    CON:  Patient-Centered Care