Question 1

A nurse tells a patient who is feeling guilty about an infidelity to call the spouse and beg for forgiveness.According to the transactional model of communication,the nurse's response originated from which state?

Accepted Answer

The nurse's statement can be construed as critical.The parent ego state consists of all the nurturing,critical,and prejudicial attitudes,behaviors,and experiences learned from other people,especially from parents and teachers.

Question 2

During the working phase of the relationship,the nurse assesses that the patient may be demonstrating resistance.The most appropriate way to deal with this would be to:

Accepted Answer

The relationship can become stalled if the nurse is not prepared to deal with the impasse.The nurse may use clarification by saying something such as,"I sense that you're struggling with yourself and wanting to explore your relationship with your parents,but that you don't yet want to experience the pain it may bring."

Question 3

Which strategy can the nursing student use to foster authenticity in therapeutic relationships with patients?

Accepted Answer

Nursing students have many new experiences that provide opportunities for self-learning.Nurses should focus on and discuss the feelings related to these experiences.Instructors and peers can help students by facilitating self-awareness during these discussions; self-awareness contributes to authenticity.

Question 4

A nurse's most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to:

Accepted Answer

Self-examination is a task of the preinteraction phase of a relationship.This is especially important if the value systems of the nurse and patient are known to be different.

Question 5

A psychiatric nurse will recognize which action as demonstration of resistance behavior?

Accepted Answer

Resistance is the patient's reluctance or avoidance of verbalizing or experiencing troubling aspects of himself or herself.This is often caused by the patient's unwillingness to change when the need for change is recognized.The remaining options lack the needed reluctance to open communication seen with resistant behaviors.

Question 6

Which task would be most appropriate to focus on during the introductory phase of work with a teenage patient with low self-esteem?

Accepted Answer

The tasks of the introductory phase of the nurse-patient partnership include establishing a climate of trust,understanding,acceptance,and open communication and formulating a contract with the patient.

Question 7

When asked to contrast social superficiality with therapeutic intimacy,an experienced nurse mentor explains to a new nurse that the termination component in therapeutic intimacy is:

Accepted Answer

Conditions for termination are part of the nurse-patient contract negotiated during the introductory/orientation phase of the relationship.In a social relationship,termination is open-ended.

Question 8

A new nurse has the following thoughts: "How will I handle things if my patient walks away from me? How will I react if the patient is sexually provocative? How will I cope with a patient who cries?" These thoughts indicate that the nurse is engaged in:

Accepted Answer

Self-exploration leads to the development of self-awareness,and it is essential that the nurse be self-aware to learn to deal with anxiety,anger,sadness,and joy in helping patients through the health-illness continuum.

Question 9

A person who has always wished to care for "special children" adopts a biracial child and another child who has spina bifida.What is the highest step of the value clarification process that this person has achieved?

Accepted Answer

The highest level of value clarification is acting in a pattern.Adopting two "special children" is affirmation of a pattern.Acting follows choosing and prizing in the sequence of value clarification.

Question 10

A patient reports seeing a "frightening" face on the wall of the dayroom.A nurse attempts to calm her by providing an explanation for the flawed perception of what she saw.The nurse would implement this strategy by stating:

Accepted Answer

Perception is the identification and interpretation of a stimulus based on information received through the senses.In this instance the patient has incorrectly interpreted the shadows as a face on the wall.The remaining options do not relate to a misinterpretation of what the patient actually saw.

Question 11

According to transactional analysis theory,when a patient finally recognizes the importance of being medication-compliant,which type of transaction has occurred?

Accepted Answer

In this interaction the two parties are communicating from adult ego state to adult ego state.Communication flows smoothly between the sender and the receiver.The remaining options do not demonstrate such effective communication.

Question 12

A patient is admitted to the unit and complains of being depressed.The patient says,"I want to feel like my old self again." Which nursing response will be most therapeutic?

Accepted Answer

When a patient initially offers psychiatric symptoms as the reason for admission,the nurse will want to ask for clarification and elaboration to better understand the life experiences of the patient.Understanding fosters empathy,empathic remarks lead the patient to feel understood,and this understanding paves the way for the therapeutic nurse-patient partnership.

Question 13

In the initial sessions a patient frequently asks the nurse for money and expresses doubt about the nurse's ability to help.Which principle provides guidance for the nurse in this situation?

Accepted Answer

Testing behavior serves the purpose of exploring the nurse's consistency and intent.

Question 14

A patient says to a nurse,"My spouse and I get along just fine.We usually agree on everything." The nurse observes nonverbal communication that disagrees with what the patient has verbally communicated.Which of the patient's actions is incongruent with her statement?

Accepted Answer

Incongruent communication occurs when the verbal content and the nonverbal level of communication are not in agreement.Avoiding eye contact during the statement would demonstrate such a disagreement.The remaining options are not in disagreement and so are not incongruent.

Question 15

A nurse makes observations that a depressed patient is more energetic and is smiling much more.Still,the nurse shares with the unit manager that when thinking about the patient a sense of hopelessness surfaces.The nurse manager replies:

Accepted Answer

The feelings that nurses have serve an important purpose.They are valuable clues about the patient's problems,and they are barometers for feedback about the nurses themselves and their relationships with others.

Question 16

A young adult has been receiving treatment for an anxiety disorder.Which statement by the patient confirms that the nurse and patient are most likely entering the terminal phase of the therapeutic relationship?

Accepted Answer

Establishing the reality of separation is difficult for both the nurse and patient.Patients often respond to impending termination with increased anxiety; they may experience negative feelings associated with earlier terminations,and they may regress to previous,less adaptive behaviors in the hope of postponing termination.The expression of the cause of the anxiety is reflective of the working phase while a general statement of the problem is appropriate for the introduction phase.Expressing a need for help is seen in the preinteraction phase.

Question 17

A novice nurse states,"Psychiatric nursing can't be very difficult.After all,I believe in showing care and in mutual exchange with my friends." The experienced nurse's understanding of the difference between a social and a therapeutic relationship is primarily based on the:

Accepted Answer

Quadrant 1 is the open quadrant; it includes the behaviors,feelings,and thoughts known to the individual and others.The smaller an individual's quadrant 1,the poorer the communication of that individual.The goal of increasing self-awareness is to enlarge the area of quadrant 1 and reduce the size of the other three quadrants.

Question 18

A patient admitted with a diagnosis of schizophrenia,paranoid type,coldly tells a nurse during the admission interview,"I am here because my family brought me here and locked me up." The nurse's best response would be:

Accepted Answer

It is appropriate to acknowledge the angry or otherwise negative feelings of a patient who has not voluntarily sought treatment.Feeling understood by the nurse paves the way for a therapeutic relationship.

Question 19

When the nurse suggests the patient communicate to her employer how overwhelmed she is by the workload,the patient responds,"Yes but I'll get fired if I do that." According to transactional analysis theory,this is an example of a(n) _____ transaction.

Accepted Answer

This is an example of the "Why don't you? Yes,but..." game.On the surface the game involves two adults solving problems; in reality,one person is using the child ego state to show what a bad parent the other person is.

Question 20

A nurse engaged in the preinteraction phase of the nurse-patient relationship will:

Accepted Answer

In the preinteraction phase the nurse and the patient have not yet met.The nurse prepares for the initial contact by performing self-assessment,gathering available data about the patient,reviewing the goals of a therapeutic relationship,and considering what he or she has to offer the patient.Contract creation is addressed in the orientation phase while the identification of stress factors occurs in the working phase.

Quiz 2: Therapeutic Nurse-Patient Relationship