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:

Accepted Answer

Brief self-disclosure is used to help the patient clarify specific issues, to feel less vulnerable, or to feel more "normal." When used appropriately, self-disclosure benefits the patient. When used inappropriately, it benefits the nurse. In this case, the self-disclosure burdens the patient with the nurse's problems. Empathy focuses on the patient. Countertransference would result in different behaviors. Encouraging expression of negative feelings would be more direct.

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:

Accepted Answer

Healthy closure is facilitated when the patient discusses his or her reactions to termination and the feelings that she or he might be experiencing. The nurse serves as a role model during termination. Providing structure is related more to the orientation and working stages. Informing the patient of progress is paternalistic. The process of termination is facilitated by collaborative work. Describing goals takes place with passage from the orientation to the working stage.

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:

Accepted Answer

The correct comment prevents the nurse from being manipulated by the patient. The nurse should address what happened, along with the expectations. The remaining options do not attempt to address the patient's manipulation of the situation.

Question 4

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

Accepted Answer

This remark uses empathy to acknowledge the patient's feelings and then offers help. Using empathy tells the patient that his or her feelings are understood. Offering help implies hope for a positive resolution. Empathy, rather than sympathy, is a useful tool. Asking what to do for the patient implies helplessness on the part of the nurse. Minimizing the problem is demeaning to the patient.

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.

Accepted Answer

Nurses who engage in therapeutic activities with patients recognize that each encounter with patients is part of an overall therapeutic picture. Patients discuss real problems and solutions and practice skills needed in real-life situations. These encounters offer opportunities for assessment, for patients to process feelings, and for validation and feedback, as well as for tension relief. The correct answer is the most global response. The distracters do not educate the new nurse about the purpose of informal activities.

Question 6

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

Accepted Answer

Consistency and honesty regarding intentions are behaviors that promote patient trust. Enforcing rules is important but not necessarily related to trust building. The other options are nontherapeutic.

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?

Accepted Answer

The nurse learns how well the patient understands the problem by asking for a detailed, in-depth description of situations, thoughts, feelings, and behaviors relevant to the identified problem. This step must be completed before moving through the problem-solving process. The other actions are premature.

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.

Accepted Answer

The patient's remarks call for the nurse to remind the patient of the parameters of their relationship and take the opportunity to discuss the issue of friends. Only this option incorporates both desired elements.

Question 9

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

Accepted Answer

Collaboration takes place when patients recognize problems and the need for assistance. The other responses suggest coercion or simple compliance. They fail to demonstrate the element of self-reflection on the part of the patient.

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?

Accepted Answer

Therapeutic relationships are planned, patient-centered, and goal-directed. This is of particular importance if progress is to be made when the duration of the relationship will be brief. The other options are not the priority. Exploration of patient issues requires trust development before it can proceed.

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?

Accepted Answer

Anger toward the nurse is often displaced anger that has arisen from some situation or significant person in the patient's life. Nurses feel the brunt of the anger because they are "handy" and might be considered by the patient to be a safe object for the displacement. Knowing that the nurse is not the true object of the anger allows the nurse to plan a therapeutic strategy for helping the individual manage the emotion. None of the other options provides an accurate basis for planning intervention.

Question 12

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

Accepted Answer

Problems are defined and priorities for work are set as the nurse and patient collaborate during the orientation stage. This sets the stage for transition into the working stage. Management of emotions can occur during the working stage.

Question 13

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

Accepted Answer

With this remark, the nurse seeks patient collaboration and offers the opportunity to set priorities for the work toward change that will be undertaken. The distracters relate to the orientation stage.

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.

Accepted Answer

This reply explains how many nurses are able to share responsibility and accountability for the care of patients. Good communication enables the nurses to be "on the same page" when it comes to working toward the achievement of patient-centered goals that are appropriate for each stage of the nurse-patient relationship. The other options fail to provide the information the patient needs to understand the current practices.

Question 15

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

Accepted Answer

Patients might be afraid or unable to approach nurses. Nurses must take the initiative to approach the patient, thus acknowledging the patient's worthiness and conveying acceptance. "Why" questions usually elicit rationalization. Leaving the patient alone does not foster trust. Decreasing isolation will not build trust in the nurse.

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:

Accepted Answer

Talking openly about feelings conveys the message that feelings are natural and can be handled. Once feelings can be discussed, the focus can shift to learning to cope more effectively with them. The other options are either avoidant or nontherapeutic.

Question 17

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

Accepted Answer

Suggesting a time-out in the patient's room is often an effective initial strategy, because it permits the patient to go to an area with fewer stimuli. It also removes the patient from other patients who are at risk for injury if the patient's behavior escalates. Restating the rules of the milieu does not help the patient diffuse the anger. Removing other patients is unnecessary unless the patient's behavior escalates.

Question 18

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

Accepted Answer

Early assessment of hallucinations is based on the content of the messages. Content often reveals the dynamics of the patient's symptoms and typically revolves around a theme such as powerlessness, hate, guilt, or loneliness. Ignoring the reference is nontherapeutic and thwarts assessment. Distraction is a possible strategy after the nurse understands the content of the hallucinations. Saying that the voices do not exist negates the patient's experience. Saying you do not hear them is preferable.

Question 19

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

Accepted Answer

Behaviors that require the most immediate limit-setting are verbal and physical aggression, self-destructive behavior, fire setting, alcohol or drug use, manipulation, inappropriate sexual behaviors, and attempts to leave the hospital without consent. In this case the verbal aggression toward the roommate requires immediate intervention to prevent further escalation.

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:

Accepted Answer

Establishing trust is the primary task of the orientation stage of the nurse-patient relationship. The other options are too ambitious for this early stage.

Quiz 9: Working with an Individual Patient