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Test Bank For Primary Care Psychiatry
2nd Edition by Robert McCarron, Glen Xiong
Chapter 1 - 26
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Primary Care Psychiatry 2nd Edition McCarron Xiong Test Bank
Table of Contents:
Chapter 1. The Primary Care Psychiatric Interview
Chapter 2. Primary Care and Psychiatry: An Overview of the Collaborative Care Model
Chapter 3. Preventive Medicine and Behavioral Health
Chapter 4. The Patient and You: Psychological and Cultural Consideration
Chapter 5. Anxiety Disorders
Chapter 6. Obsessive–Compulsive and Related Disorders
Chapter 7. Trauma-Related Disorders
Chapter 8. Mood Disorders—Depression
Chapter 9. Treatment-Resistant Depression
Chapter 10. Psychiatric Disorders: Bipolar and Related Disorders
Chapter 11. Psychotic Disorders
Chapter 12. Neurocognitive Disorders
Chapter 13. Substance Use Disorders—Alcohol
Chapter 14. Substance Use Disorders—Illicit and Prescription Drugs
Chapter 15. Personality Disorders
Chapter 16. Cognitive Behavioral Therapy
Chapter 17. Supportive Psychotherapy in Primary Care
Chapter 18. Motivational Interviewing
Chapter 19. Fundamentals of Psychopharmacology
Chapter 20. Geriatric Behavioral Health
Chapter 21. Child and Adolescent Behavioral Health
Chapter 22. Suicide and Violence Risk Assessment
Chapter 23. Somatic Symptom and Related Disorders
Chapter 24. Insomnia
Chapter 25. Sexual Dysfunction
Chapter 26. Eating Disorders
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Chapter 1: The Primary Care Psychiatric Interview
Primary Care Psychiatry 2nd Edition McCarron Xiong Test Bank
MULTIPLE CHOICE
1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally
drained, as though I hadnt rested well. Which response should the nurse use to clarify the
patients comment?
a. It sounds as though you were uncomfortable with the content of your dream.
b. I understand what youre saying. Bad dreams leave me feeling tired, too.
c. So you feel as though you did not get enough quality sleep last night?
d. Can you give me an example of what you mean by stoned?
ANSWER: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the
patients statement. Asking for a definition of stoned directly asks for clarification. Restating that
the patient is uncomfortable with the dreams content is parroting, a non-therapeutic technique.
The other responses fail to clarify the meaning of the patients comment.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the
fluorescent lights in this room. Be careful what you say. Which response by the nurse would be
most therapeutic?
a. Lets talk about something other than the CIA.
b. It sounds like youre concerned about your privacy.
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c. The CIA is prohibited from operating in health care facilities.
d. You have lost touch with reality, which is a symptom of your illness.
ANSWER: B
It is important not to challenge the patients beliefs, even if they are unrealistic. Challenging
undermines the patients trust in the nurse. The nurse should try to understand the underlying
feelings or thoughts the patients message conveys. The correct response uses the therapeutic
technique of reflection. The other comments are non-therapeutic. Asking to talk about something
other than the concern at hand is changing the subject. Saying that the CIA is prohibited from
operating in health care facilities gives false reassurance. Stating that the patient has lost touch
with reality is truthful, but uncompassionate.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
3. The patient says, My marriage is just great. My spouse and I always agree. The nurse observes
the patients foot moving continuously as the patient twirls a shirt button. The conclusion the
nurse can draw is that the patients communication is:
a. clear. c. precise.
b. mixed. d. inadequate.
ANSWER: B
Mixed messages involve the transmission of conflicting or incongruent messages by the speaker.
The patients verbal message that all was well in the relationship was modified by the nonverbal
behaviors denoting anxiety. Data are not present to support the choice of the verbal message
being clear, explicit, or inadequate.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: mcs 150-151 TOP: Nursing Process: Assessment
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MSC: Client Needs: Psychosocial Integrity
4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the
communication technique of offering self.
a. Ive also had traumatic life experiences. Maybe it would help if I told you about
them.
b. Why do you think you had so much difficulty adjusting to this change in your
life?
c. I hope you will feel better after getting accustomed to how this unit operates.
d. Id like to sit with you for a while to help you get comfortable talking to me.
ANSWER: D
Offering self is a technique that should be used in the orientation phase of the nurse-patient
relationship. Sitting with the patient, an example of offering self, helps to build trust and convey
that the nurse cares about the patient. Two incorrect responses are ineffective and non-
therapeutic. The other incorrect response is therapeutic but is an example of offering hope.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as Did you feel angry?
c. Making a judgment about the patients problem.
d. Saying, I understand what youre saying.
ANSWER: A
Restating allows the patient to validate the nurses understanding of what has been
communicated. Restating is an active listening technique. Judgments should be suspended in a
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nurse-patient relationship. Close-ended questions such as Did you feel angry? ask for specific
information rather than showing understanding. When the nurse simply states that he or she
understands the patients words, the patient has no way of measuring the understanding.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
6. A patient discloses several concerns and associated feelings. If the nurse wants to seek
clarification, which comment would be appropriate?
a. What are the common elements here?
b. Tell me again about your experiences.
c. Am I correct in understanding that . . .
d. Tell me everything from the beginning.
ANSWER: C
Asking, Am I correct in understanding that permits clarification to ensure that both the nurse and
patient share mutual understanding of the communication. Asking about common elements
encourages comparison rather than clarification. The remaining responses are implied questions
that suggest the nurse was not listening.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
7. A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most therapeutic
response.
a. Dont talk that way. Of course you will leave here!
b. Keep up the good work, and you certainly will.
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c. You dont think youre making progress?
d. Everyone feels that way sometimes.
ANSWER: C
By asking if the patient does not believe that progress has been made, the nurse is reflecting by
putting into words what the patient is hinting. By making communication more explicit, issues
are easier to identify and resolve. The remaining options are non-therapeutic techniques. Telling
the patient not to talk that way is disapproving. Saying that everyone feels that way at times
minimizes feelings. Telling the patient that good work will always result in success is falsely
reassuring.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted
and tapped left foot, periodically covered face with hands, and looked under chair while stating, I
enjoy spending time with you. Which analysis is most accurate?
a. The patient is giving positive feedback about the nurses communication
techniques.
b. The nurse is viewing the patients behavior through a cultural filter.
c. The patients verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors.
ANSWER: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and
incongruent. Some clinicians call it a mixed message. It is inaccurate to say that the patient is
giving positive feedback about the nurses communication techniques. The concept of a cultural
filter is not relevant to the situation because a cultural filter determines what we will pay
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attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient
is demonstrating psychotic behaviors.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 150-151 TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
9. While talking with a patient diagnosed with major depression, a nurse notices the patient is
unable to maintain eye contact. The patients chin lowers to the chest, while the patient looks at
the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication c. A cultural barrier
b. A message filter d. Social skills
ANSWER: A
Eye contact and body movements are considered nonverbal communication. There are
insufficient data to determine the level of the patients social skills or whether a cultural barrier
exists.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: mcs 150-152 TOP: Nursing Process: Assessment
MSC: Client Needs: Psychosocial Integrity
10. During the first interview with a parent whose child died in a car accident, the nurse feels
empathic and reaches out to take the patients hand. Select the correct analysis of the nurses
behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to
express feelings.
b. The gesture is premature. The patients cultural and individual interpretation of
touch is unknown.
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c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched.
ANSWER: B
Touch has various cultural and individual interpretations. Nurses should refrain from using touch
until an assessment can be made regarding the way in which the patient will perceive touch. The
other options present prematurely drawn conclusions.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension)
REF: mcs 150 (dm 9-1) | mcs 158-159 TOP: Nursing Process: Evaluation
MSC: Client Needs: Psychosocial Integrity
11. During a one-on-one interaction with the nurse, a patient frequently looks nervously at the
door. Select the best comment by the nurse regarding this nonverbal communication.
a. I notice you keep looking toward the door.
b. This is our time together. No one is going to interrupt us.
c. It looks as if you are eager to end our discussion for today.
d. If you are uncomfortable in this room, we can move someplace else.
ANSWER: A
Making observations and encouraging the patient to describe perceptions are useful therapeutic
communication techniques for this situation. The other responses are assumptions made by the
nurse.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 153-154 (dm 9-2) TOP: Nursing Process: Implementation
MSC: Client Needs: Psychosocial Integrity
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12. A black patient says to a white nurse, Theres no sense talking. You wouldnt understand
because you live in a white world. The nurses best action would be to:
a. explain, Yes, I do understand. Everyone goes through the same experiences.
b. say, Please give an example of something you think I wouldnt understand.
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing.
ANSWER: B
Having the patient speak in specifics rather than globally will help the nurse understand the
patients perspective. This approach will help the nurse engage the patient. Reassurance and
changing the subject are not therapeutic techniques.
PTS: 1 DIF: Cognitive Level: Apply (Application)
REF: mcs 154 (dm 9-2) | mcs 158-159
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
13. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to
poor social skills as evidenced by lack of eye contact. Interventions were used to raise the
patients self-esteem, but after 3 weeks, the patients eye contact did not improve. What is the
most accurate analysis of this scenario?
a. The patients eye contact should have been directly addressed by role-playing to
increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and
planning for this patient.
c. The patients poor eye contact is indicative of anger and hostility that were
unaddressed.
d. The nurse should have assessed the patients culture before making this diagnosis
and plan.
ANSWER: D
