NUR 1211C Chapter Notes - Chapter 1: Therapeutic Community, Structured Programming

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Published on 8 Jun 2020
1. A man diagnosed with alcohol use disorder experiences his first relapse. During his AA meeting, another group
member states, "I relapsed three times, but now I have been sober for 15 years." Which of Yalom's curative factors
does this illustrate?
a. Instillation of hope
i. Rationale: This scenario is an example of the curative group factor of instillation of hope. This occurs
when members observe the progress of others in the group with similar problems and begin to
believe that their personal problems can also be resolved.
2. An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior
should alert the nurse to escalating anger and aggression?
a. The client has a tense facial expression and body language.
i. Rationale: The nurse should assess that tense facial expressions and body language may indicate
that a client's anger is escalating.
3. Which member of the Interdisciplinary Team (IDT) manages the therapeutic milieu on a 24-hour basis?
a. Psychiatric Nurse
i. In the hospital, nurses are generally the only members of the IDT team who spend time with the
clients on a 24-hour basis and they assume responsibility for management of the therapeutic milieu.
4. Crises occur when an individual:
a. experiences a stressor and perceives coping strategies to be ineffective.
i. Rationale: A crisis occurs when an individual is exposed to a precipitating stressor. Their problem-
solving techniques do not relieve the stressor, anxiety increases and if resolution does not occur, the
person reaches a breaking point.
5. 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?
a. On inpatient units, every interaction is an opportunity for therapeutic intervention.
i. Rationale: The nurse's response should be guided by the basic assumption that every interaction is
an opportunity for therapeutic intervention.
6. Which of the following conditions promote a therapeutic community? (Select all that apply)
a. Unit responsibilities are assigned according to client capabilities.
b. A democratic form of government exists.
i. Rationale: A therapeutic community is promoted when unit responsibilities are assigned according
to client capability and when a democratic form of government exists.
7. 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. Structured programming
i. 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.
8. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the
exchange and excuses both of the clients from the group. Which leadership style has the nurse demonstrated?
a. Autocratic
i. Rationale: The autocratic leader will take charge, dictate the direction of the group and persuade
others that their ideas are superior.
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