Deck 9: Working with an Individual Patient

Question 1

A nurse tells a patient, "I know how you feel. My spouse can be very insensitive too. I am also considering divorce." Analysis suggests that the nurse is:

A) self-disclosing inappropriately.
B) experiencing countertransference.
C) using empathy to establish trust with the patient.
D) encouraging the patient to express negative feelings.

Answer 1

self-disclosing inappropriately.

Question 2

A nurse and patient who developed a therapeutic relationship enter into the final phase of their relationship as the patient prepares for discharge. An important nursing intervention for this stage is for the nurse to:

A) provide structure and intensive support.
B) inform the patient of the progress made.
C) encourage the patient to describe goals for change.
D) discuss feelings about termination with the patient.

Answer 2

discuss feelings about termination with the patient.

Question 3

A patient says, "I went out drinking only one time last week. At least I'm trying to change." The nurse responds, "I appreciate your effort, but you agreed to abstain from alcohol completely." The nurse is:

A) using cognitive restructuring.
B) preventing manipulation.
C) showing empathy.
D) using flooding.

Answer 3

preventing manipulation.

Question 4

The nurse believes that a patient is having emotional pain. Which remark is most therapeutic?

A) "I hear how painful this is for you. I would like to help you deal with it."
B) "I'm so sorry this has happened to you. You don't deserve it."
C) "What would you like me to do to help you through this?"
D) "I don't think this is as serious as you believe it is."

Question 5

A novice nurse says, "I have more important things to do than play games with patients. These activities are not a worthwhile use of my time." Select the nurse manager's best response.

A) "Games are part of the therapeutic milieu."
B) "Patients need a break from intensive individual therapy."
C) "Informal activities help patients develop social skills and take risks."
D) "Please review material on the psychotherapeutic management model."

Question 6

Which nursing intervention will initially be most helpful for trust building with a suspicious patient?

A) Enforcing rules
B) Keeping appointments and promises
C) Agreeing not to document the patient's disclosures
D) Openly challenging unclear statements by the patient

Question 7

A patient with a history of self-mutilation says to the nurse, "I want to stop hurting myself." What is the initial step of the problem-solving process to be taken toward resolution of a patient's identified problem?

A) Deciding on a plan of action
B) Determining necessary changes
C) Considering alternative behaviors
D) Describing the problem or situation

Question 8

A patient diagnosed with schizophrenia says to the nurse, "I feel really close to you. You're the only true friend I have." Select the nurse's most therapeutic response.

A) "We are not friends. Our relationship is a professional one."
B) "I feel sure there are other friends in your life. Can you name some?"
C) "I am glad you trust me. Trust is important for the work we are doing together."
D) "Our relationship is professional, but let's explore ways to strengthen friendships."

Question 9

Which statement by a patient would the nurse interpret as willingness to collaborate in the nurse-patient relationship?

A) "I know you are here to help me, and will do whatever you tell me to do."
B) "I didn't want to deal with this at first, but I'm glad you made me face it."
C) "I realize that I have some issues that I need help resolving."
D) "I will do anything to get out of this hospital."

Question 10

A patient is hospitalized for severe depression. Knowing that the patient will be discharged after a short stay, what is the nurse's first priority?

A) Maximize the benefits of milieu management.
B) Immediately begin to explore acute patient issues.
C) Develop a goal-directed, problem-centered relationship.
D) Choose a specific theoretical model as the basis for care.

Question 11

A patient shouts at a nurse who just entered the room, "You're an incompetent fool. Leave me alone." The nurse's response should be based on which rationale?

A) The anger was created by a situation or significant person, not the nurse.
B) The reaction probably results from transference and countertransference.
C) The patient is probably reacting to fear of loss of emotional control.
D) The patient has a right to openly express negative feelings.

Question 12

A nurse and patient agree on problems to be addressed during a brief hospital stay. Which inference is correct?

A) The relationship is moving into the working stage.
B) The nurse should reinforce messages about termination.
C) The nurse needs to direct the patient to begin journaling.
D) Management of emotions must be ensured before work can continue.

Question 13

As a patient and nurse move into the working stage of a therapeutic relationship, the nurse's most beneficial statement is:

A) "I want to be helpful to you as we explore your problems and the way you express feelings."
B) "A good long-term goal for someone your age would be to develop better job-related skills."
C) "Of the problems we have discussed so far, which ones would you most like to work on at this time?"
D) "When someone gives you a compliment, I notice that you become very quiet and appear uncomfortable."

Question 14

An inpatient says, "Last time I was here, a primary nurse talked with me every day. This time, different nurses work with me. How can I make progress?" Select the nurse's best response.

A) "Your comments are interesting. With your permission I will share them with the treatment team."
B) "We are using a new system because of managed-care requirements. We are hopeful it will be effective."
C) "Shift reports, care plans, and progress notes help different nurses work with all patients toward their individual goals."
D) "It sounds like you are feeling dissatisfied with your care. After you are discharged, you will receive a form to provide feedback."

Question 15

A patient is withdrawn and avoids talking to the nurse. The best initial intervention for the nurse would be to:

A) offer to listen and help.
B) directly ask why the patient does not wish to talk.
C) involve the patient in a group activity to decrease isolation.
D) respect the patient's desire not to talk and leave the patient alone.

Question 16

A patient has identified the need for better anger management and tells the nurse, "I'm afraid that someday I might explode." The best strategy for reducing this patient's fear of losing control is to:

A) talk about these feelings openly and directly.
B) discuss feelings in general without reference to the patient.
C) avoid talking about the feelings until the patient feels comfortable.
D) reassure the patient that expressing feelings is the first step to resolving them.

Question 17

A patient playing pool with another patient throws down the pool cue and begins swearing. The nurse should initially intervene by:

A) asking other patients to leave the room.
B) calling for assistance to restrain the patient.
C) suggesting a time-out in the patient's room.
D) restating rules of the milieu related to swearing.

Question 18

A newly admitted patient tells the nurse, "The voices are bothering me." The nurse should first:

A) ignore the patient's reference to voices.
B) distract the patient from the hallucinations.
C) tell the patient that the voices do not exist.
D) seek a description of the voices and identify themes.

Question 19

Which patient behavior would require the most immediate limit-setting?

A) The patient makes self-deprecating remarks.
B) At a goal-setting meeting, the patient interrupts others to express delusions.
C) A patient shouts at a roommate, "You are perverted! You watched me undress."
D) During dinner, a patient manipulates an older adult patient to obtain a second dessert.

Question 20

Complete this goal statement for a newly admitted patient in the orientation stage. "By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate:

A) greater independence."
B) increased self-responsibility."
C) trust and rapport with two staff members."
D) ability to problem-solve one issue."

Question 21

Assessment findings by the multidisciplinary team after a patient-intake interview are used primarily to:

A) confirm ongoing discharge planning.
B) expand and confirm the initial assessment.
C) verify the appropriateness of nursing diagnoses.
D) analyze the patient's feelings about hospitalization.

Question 22

The nurse caring for a hyperactive patient should be particularly concerned about assessing:

A) physical safety.
B) emotional trauma.
C) manipulative behaviors.
D) feelings about the relationship.

Question 23

During an MSE a patient says, "I am a special messenger sent to provide the world a cure for cancer." The patient's statement indicates the presence of:

A) a phobia.
B) a delusion.
C) hypervigilance.
D) loose associations.

Question 24

As the nurse plans care for a newly admitted patient, identification of dysfunctional behaviors will provide the focus for:

A) evaluation.
B) nursing diagnosis.
C) nursing interventions.
D) outcome identification.

Question 25

A patient tells the nurse, "I was raped a month ago. Since then I've felt anxious and have been unable to talk normally to my husband. I've had frequent thoughts about cutting my wrists." What is the priority nursing concern regarding this patient?

A) The risk for self-directed violence
B) The development of rape traumatic syndrome
C) The damage that could result in poor self-esteem
D) The demonstration of signs and symptoms of acute anxiety

Question 26

A nurse considers interventions for a diabetic patient who needs to change eating habits and lose weight. The nurse will base strategies on which principle?

A) The nurse's primary responsibility is to encourage the change.
B) Patient-initiated change is more successful than imposed change.
C) For successful change, both the benefit and the risk to the patient must be high.
D) Patients value advice from nurses because of the trusting dimensions of the relationship.

Question 27

A patient hospitalized for 6 days has made little progress toward outcomes written at the time of admission. The nurse decides that the lack of progress toward goals indicates that:

A) needs for reassessment exist.
B) discharge should be delayed.
C) nursing diagnoses were incorrect.
D) nursing interventions were inadequate.

Question 28

A student grumbles to an instructor, "I do not see the value of process recordings." The best justification of a process recording is that it is a:

A) tool for analyzing communication.
B) verbatim record of a patient interview.
C) legal document that becomes part of the medical record.
D) note written at the time of a patient interview to provide information to team members.

Question 29

The nurse writing a discharge summary for a patient should include achievements as well as:

A) care plan updates.
B) a list of patient strengths.
C) effective nursing interventions.
D) outcomes that still need to be addressed.

Question 30

A psychotic patient tells the nurse, "Get away from me or I'll hit you. You're sucking the thoughts out of my head." To best de-escalate the situation, the nurse should:

A) direct the patient to a chair.
B) deny taking the patient's thoughts.
C) increase the distance between nurse and patient.
D) tell the patient, "You will be restrained if you hit me."

Question 31

A realistic outcome for a patient with situational low self-esteem who will have a short inpatient stay would be for the patient to:

A) write a list of strengths, abilities, and talents.
B) role-play with others to improve social skills.
C) replace a negative self-image with a positive one.
D) respond with positive self-esteem in all encounters.

Question 32

A patient with suicidal ideation is hospitalized. What is the priority intervention?

A) Negotiating a no-harm contract
B) Facilitating attendance at groups
C) Administering a psychotropic drug
D) Determining the precipitating situation

Question 33

Following the admission interview, a spouse of a patient asks the nurse, "Why did you ask my partner all those questions? Some of them had nothing to do with current problems." The nurse's best response is, "Those questions help us understand:

A) the patient's current status."
B) the complete family history."
C) the patient's past experiences."
D) what the patient's prognosis will be."

Question 34

Realistic short-term goals for a patient who is newly admitted to the hospital should be achievable in:

A) 1 to 2 days.
B) 4 to 6 days.
C) 1 to 2 weeks.
D) 2 to 4 weeks.

Question 35

The nurse performing a mental status examination wants to assess for hallucinations. The nurse should ask:

A) "Can you tell me where you are now?"
B) "Do you hear or see things when others don't?"
C) "Do your moods shift more than those of other people?"
D) "What would you do if you found a stamped, addressed letter on the floor?"

Question 36

A nurse says, "What step would you like to take next to resolve this issue?" The patient stands up and shouts, "You are so controlling! You want me to do everything your way." What is the likely basis of the patient's behavior?

A) Projection
B) Dissociation
C) Transference
D) Emotional catharsis

Question 37

A psychiatric aide asks, "Can you give me some examples of how we provide structure for patients?" The nurse should offer which suggestions? Select all that apply.

A) Set limits on destructive behavior.
B) Direct a patient to go to a quiet place.
C) Sit with a withdrawn, isolated patient.
D) Distract a patient who is hallucinating.
E) Help a patient contemplate needed change.

Question 38

When the nurse formulates nursing diagnoses, it is necessary to be specific in describing dysfunctional behaviors so as to:

A) select appropriate desirable behaviors for outcome criteria.
B) analyze how the patient was feeling at the time of assessment.
C) explore the context that precipitated the exacerbation of the illness.
D) determine how the illness relates to the patient's total life experience.

Question 39

Objective data obtained in an initial assessment of a patient are of particular value when:

A) the patient is too ill to participate.
B) the patient's admission is involuntary.
C) family members have admitted the patient.
D) the patient has been transferred from a subacute setting.

Question 40

Select the best outcome for a nurse to include in the care plan for a withdrawn patient who says, "I would like to have more friends." Within 3 days, the patient will:

A) be more outgoing.
B) develop greater independence.
C) participate in one group activity.
D) increase socialization with others.

Question 41

A patient tells the nurse, "I want to have sex with you." Which nursing responses are appropriate? Select all that apply.

A) "I will forget you said that."
B) "Your suggestion frightens me."
C) "You must keep your distance."
D) "Sex is not part of our relationship."
E) "We are here to work on your problems."

Question 42

A nurse plans to teach a group of patients the basics of the change process. How should the elements be sequenced for the presentation?

A) Assess the success of new behaviors.
B) Observe to gain awareness.
C) Draw conclusions about the problem.
D) Test new behaviors.
E) Determine that change is necessary.
F) None of the above.