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Exam 1 - Psychiatric/Mental Health Nursing practice questions and answers
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Exam 1 - Psychiatric/Mental HealthNursing practice questions and
answers
A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt
emotionally drained, as though I hadn't rested well." Which response should
the nurse use to clarify the patient's comment?
a. "It sounds as though you were uncomfortable with the content of your
dream."
b. "I understand what you're 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'?" - -ANS: D
The technique of clarification is therapeutic and helps the nurse examine the
meaning of the patient's statement. Asking for a definition of "stoned"
directly asks for clarification. Restating that the patient is uncomfortable with
the dream's content is parroting, a non-therapeutic technique. The other
responses fail to clarify the meaning of the patient's comment.
-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. "Let's talk about something other than the CIA."
b. "It sounds like you're concerned about your privacy."
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." - -
ANS: B
It is important not to challenge the patient's beliefs, even if they are
unrealistic. Challenging undermines the patient's trust in the nurse. The
nurse should try to understand the underlying feelings or thoughts the
patient's 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.
-The patient says, "My marriage is just great. My spouse and I always
agree." The nurse observes the patient's foot moving continuously as the
patient twirls a shirt button. The conclusion the nurse can draw is that the
patient's communication is:
a. clear.
b. mixed.
c. precise.
,d. inadequate. - -ANS: B
Mixed messages involve the transmission of conflicting or incongruent
messages by the speaker. The patient's 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.
-A nurse interacts with a newly hospitalized patient. Select the nurse's
comment that applies the communication technique of "offering self."
a. "I've 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. "I'd like to sit with you for a while to help you get comfortable talking to
me." - -ANS: 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."
-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 patient's problem.
d. Saying, "I understand what you're saying." - -ANS: A
Restating allows the patient to validate the nurse's understanding of what
has been communicated. Restating is an active listening technique.
Judgments should be suspended in a 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 patient's words, the patient has no way of measuring the
understanding.
-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." - -ANS: 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.
-A patient tells the nurse, "I don't think I'll ever get out of here." Select the
nurse's most therapeutic response.
a. "Don't talk that way. Of course you will leave here!"
b. "Keep up the good work, and you certainly will."
c. "You don't think you're making progress?"
d. "Everyone feels that way sometimes." - -ANS: 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.
-Documentation in a patient's 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 nurse's communication
techniques.
b. The nurse is viewing the patient's behavior through a cultural filter.
c. The patient's verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors. - -ANS: 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 nurse's communication techniques. The concept of a cultural filter
is not relevant to the situation because a cultural filter determines what we
will pay attention to and what we will ignore. Data are insufficient to draw
the conclusion that the patient is demonstrating psychotic behaviors.
-While talking with a patient diagnosed with major depression, a nurse
notices the patient is unable to maintain eye contact. The patient's chin
lowers to the chest, while the patient looks at the floor. Which aspect of
communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills - -ANS: A
Eye contact and body movements are considered nonverbal communication.
There are insufficient data to determine the level of the patient's social skills
or whether a cultural barrier exists.
, -During the first interview with a parent whose child died in a car accident,
the nurse feels empathic and reaches out to take the patient's hand. Select
the correct analysis of the nurse's behavior.
a. It shows empathy and compassion. It will encourage the patient to
continue to express feelings.
b. The gesture is premature. The patient's cultural and individual
interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping
boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched. - -
ANS: 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.
-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." - -
ANS: 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.
-A black patient says to a white nurse, "There's no sense talking. You
wouldn't understand because you live in a white world." The nurse's 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 wouldn't
understand."
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing. - -ANS: B
Having the patient speak in specifics rather than globally will help the nurse
understand the patient's perspective. This approach will help the nurse
engage the patient. Reassurance and changing the subject are not
therapeutic techniques.
-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 patient's self-esteem, but after 3 weeks,
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