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The Psychiatric Interview 4th Edition Carlat Test Bank
The Psychiatric Interview 4th Edition Carlat Test Bank
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The Psychiatric Interview 4th Edition Carlat Test Bank(Chapter 1-Chapter 3)The Initial Interview: A Preview Chapter 2: Logistic Preparations: What to Do
Before the Interview
Chapter 3: The Therapeutic Alliance: What It Is, Why It's Important, and How to Establish It
MULTIPLE CHOICE
1. Which outcome, focused on recovery, would be expected in the plan of care for a patient
living in the community and diagnosed with serious and persistent mental illness? Within 3
months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
ANS: B
Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role
performance. The goal of recovery is to empower the individual with mental illness to achieve a
sense of meaning and satisfaction in life and to function at the highest possible level of wellness.
The incorrect options focus on the classic medical model rather than recovery.
2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce.
Select the nurses most caring comment.
a. Lets discuss some means of coping other than suicide when you have these feelings.
b. I understand why youre so depressed. When I got divorced, I was devastated too.
c. You should forget about your marriage and move on with your life.
d. How did you get so depressed that hospitalization was necessary?
ANS: A
The nurses communication should evidence caring and a commitment to work with the patient. This
commitment lets the patient know the nurse will help. Probing and advice are not helpful or
therapeutic interventions.
3. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup.
Which comment by the nurse who receives the report best demonstrates advocacy? a.
This is a psychiatric hospital. Craziness is what we are all about.
b. Lets all show acceptance of this patient by wearing lots of makeup too.
,c. Your comments are inconsiderate and inappropriate. Keep the report objective.
d. Our patients need our help to learn behaviors that will help them get along in society.
ANS: D
Accepting patients needs for self-expression and seeking to teach skills that will contribute to their
well-being demonstrate respect and are important parts of advocacy. The on-coming nurse needs
to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate
within the privacy of a shift report but not at the expense of respect for patients. Judging the off-
going nurse in a critical way will create conflict. Nurses must show compassion for each other.
4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which
statement is an example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.
ANS: D
Attending is a technique that demonstrates the nurses commitment to the relationship and
reduces feelings of isolation. This technique shows respect for the patient and demonstrates
caring. Generalizations, probing, and false reassurances are non-therapeutic.
5. A patient shows the nurse an article from the Internet about a health problem. Which
characteristic of the web sites address most alerts the nurse that the site may have biased and
prejudiced information? a. Address ends in .org.
b. Address ends in .com.
c. Address ends in .gov.
d. Address ends in .net.
ANS: B
Financial influences on a site are a clue that the information may be biased. .com at the end of the
address indicates that the site is a commercial one. .gov indicates that the site is maintained by a
government entity. .org indicates that the site is nonproprietary; the site may or may not have
reliable information, but it does not profit from its activities. .net can have multiple meanings.
,6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention;
however, I read a descriptive research study that says that this approach does not work. I plan to stop
calling patients by name. Which statement is the best appraisal of this nurses comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse specialists.
c. New research findings should be incorporated into clinical algorithms before using them in
practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
ANS: A
Descriptive research findings provide evidence for practice but must be viewed in relation to other
studies before practice changes. One study is not enough. Descriptive studies are low on the
hierarchy of evidence. Clinical algorithms use flow charts to manage problems and do not specify
one response to a clinical problem. Classic tenets of practice should change as research findings
provide evidence for change.
7. Two nursing students discuss career plans after graduation. One student wants to enter
psychiatric nursing. The other student asks, Why would you want to be a psychiatric nurse? All
they do is talk. You will lose your skills. Select the best response by the student interested in
psychiatric nursing.
a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient
ratios must be better because of the nature of patients problems.
b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve
multidimensional problems. Im challenged by those situations.
c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I
do not want to continue them after I graduate.
d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical
nurses. That appeals to me.
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical surgical nursing,
although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical
and mental health problems, reflecting the holistic perspective these nurses must have.
Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other
specialties. Psychiatric nursing involves clinical practice, not simply documentation.
Psychosocial pain is real and can cause as much suffering as physical pain.
,8. Which research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
ANS: B
Research findings are graded using a hierarchy of evidence. A systematic review of randomized
controlled trials is Level A and provides the strongest evidence for changing practice. Expert
committee recommendations and descriptive studies lend less powerful and influential evidence. A
critical pathway is not evidence; it incorporates research findings after they have been analyzed.
9. A bill introduced in Congress would reduce funding for the care of people diagnosed with
mental illnesses. A group of nurses write letters to their elected representatives in opposition to
the legislation. Which role have the nurses fulfilled? a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
ANS: A
An advocate defends or asserts anothers cause, particularly when the other person lacks the ability
to do that for himself or herself. Examples of individual advocacy include helping patients
understand their rights or make decisions. On a community scale, advocacy includes political
activity, public speaking, and publication in the interest of improving the individuals with mental
illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to
articulate their own needs.
10. An informal group of patients discuss their perceptions of nursing care. Which comment best
indicates a patients perception that his or her nurse is caring?
a. My nurse always asks me which type of juice I want to help me swallow my medication.
b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better.
c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon.
d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not
alone.
ANS: D
,Caring evidences empathic understanding, as well as competency. It helps change pain and suffering
into a shared experience, creating a human connection that alleviates feelings of isolation. The
incorrect options give examples of statements that demonstrate advocacy or giving advice.
11. A patient who immigrated to the United States from Honduras was diagnosed with
schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no
improvement. Which resource should the treatment team consult for information on more
effective medications for this patient? a. Clinical algorithm
b. Clinical pathway
c. Clinical practice guideline
d. International Statistical Classification of Diseases and Related Health Problems (ICD)
ANS: A
A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn
from large databases of information. These guidelines help the treatment team make decisions
cognizant of an individual patients needs, such as ethnic origin, age, or gender. A clinical pathway
is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines
summarize best practices about specific health problems. The ICD classifies diseases.
12. Which historical nursing leader helped focus practice to recognize the importance of science in
psychiatric nursing? a. Abraham Maslow
b. Hildegard Peplau
c. Kris Martinsen
d. Harriet Bailey
ANS: B
Although all these leaders included science as an important component of practice, Hildegard
Peplau most influenced its development in psychiatric nursing. Maslow was not a nurse, but his
theories influence how nurses prioritize problems and care. Bailey wrote a textbook in the 1930s
on psychiatric nursing interventions. Kris Martinsen emphasized the importance of caring in
nursing practice.
13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients.
,Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a.
distrustful of others.
b. connected with others.
c. uneasy about the future.
d. discouraged with efforts to improve.
ANS: B
A patient is likely to respond to caring with a sense of connectedness with others. The absence of
caring can make patients feel distrustful, disconnected, uneasy, and discouraged.
MULTIPLE RESPONSE
1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you
will instantly know how to take care of psychotic patients. What is the new graduates best
analysis of this comment? Select all that apply.
a. The experienced nurse may have lost sight of patients individuality, which may compromise
the integrity of practice.
b. New research findings must be continually integrated into a nurses practice to provide the
most effective care.
c. Experience provides mental health nurses with the tools and skills needed for effective
professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients
through trial and error.
e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients
needs.
ANS: A, B
Evidence-based practice involves using research findings to provide the most effective nursing
care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The
effective nurse also maintains respect for each patient as an individual. Overgeneralization
compromises that perspective. Intuition and trial and error are unsystematic approaches to care.
2. Which patient statements identify qualities of nursing practice with high therapeutic value? (Select
all that apply.) My nurse:
a. talks in language I can understand.
b. helps me keep track of my medications.
,c. is willing to go to social activities with me.
d. lets me do whatever I choose without interfering.
e. looks at me as a whole person with different needs.
ANS: A, B, E
Each correct answer demonstrates caring is an example of appropriate nursing foci:
communicating at a level understandable to the patient, using holistic principles to guide care,
and providing medication supervision. The incorrect options suggest a laissez-faire attitude on
the part of the nurse, when the nurse should instead provide thoughtful feedback and help patients
test alternative solutions or violate boundaries.
1. An example of an environmental factor that would cause a nurse to modify a planned critical
interaction occurs when the:
a Patient expresses a personal dislike for the nurse
.
b Patient is in total denial about her condition
.
c Nurse lacks the degree of knowledge required for the interaction
.
d Nurse learns that the patients mother has been hospitalized with a stroke
.
ANS: D
Environmental factors include timing. Timing of critical interventions is important. It should occur
when the individual can give full attention to the topic. It would be inappropriate to continue with
the plan in the face of the patients distress related to her mothers illness. The remaining options
reflect other types of factors that influence communication such as attitudes, knowledge, and
relationships.
2. The nurse suspects that the patients communication is being negatively influenced by personal
attitude when he is heard stating:
, a They think Im mentally ill but Im not; I just get a little depressed at times.
.
b I cant concentrate on anything besides getting out of here and back to my kids.
.
c Obviously my therapist cant understand where Im coming from because our lives
. are so different.
d There isnt anyone here in this hospital I can trust enough to talk to about why I
. abuse alcohol and drugs.
ANS: C
Attitude determines how one person responds to another. It includes ones biases, past experiences,
and openness. People of different socioeconomic backgrounds may have difficulty surmounting
this barrier. The remaining options reflect factors that can negatively influence communication but
they are environmental, knowledge, and relationship oriented.
3. The nature of the communication characterized in this exchange between a nurse and a
chronically depressed patient is:
Nurse: Is it true that you enjoy knitting?
Patient: Yes, Ive done it for years and am pretty good at it.
Nurse: Im just a beginner. Do you think you could give me some tips?
Patient: I guess so. What would you like to know?
a Therapeutic
.
b Collegial
.
c Social
.
, d Intrapersonal
.
ANS: C
Although the conversation takes place between the nurse and a patient, it is of a social nature. It is
superficial and benefits both parties mutually by encouraging a relationship based on mutual
interest. No expectation of help exists. Therapeutic communication promotes patient growth and is
patient-focused. Collegial conversation occurs for the purpose of professional collaboration.
Intrapersonal communication takes place within the individual.
4. A patient expresses a sense of genuineness in the nurse providing care when sharing with
family members that:
a I believe the nurse can feel what Im feeling.
.
b I always know what the nurse expects of me; the explanations are always clear.
.
c I can tell the nurse is sincere because the face supports what the mouth is
. saying.
d I may not always like what the nurse has to say but I can always depend on
. what Im told.
ANS: C
Genuineness is demonstrated by congruence between verbal and nonverbal behavior. Empathy is
seeing things from the patients viewpoint. Clearly stating expectations is a characteristic of clarity.
Trustworthiness can be described as dependability.
5. When providing discharge teaching to a patient for whom English is a second language, what
technique will the nurse use to assess the patients understanding of the information being shared
verbally?
a Continuously evaluating the patients nonverbal cues
.
, b Periodically asking the patient if they have any questions
.
c Asking the patient to repeat the information they are given
.
d Providing the information in concise, written form
.
ANS: A
Individuals from different cultures or even different generations often misunderstand and
misinterpret an unfamiliar language. Being aware of and critically examining cues that result from
nonverbal responses is an excellent technique to check their interpretations. Asking if they have
questions is an ineffective technique in light of the language barrier. Repeating the information is
no guarantee that the patient understands the information. Providing the information in written form
reinforces the material but does not ensure understanding especially if the patient has deficiencies
related to reading the language.
6. When communicating with a psychotic, schizophrenic patient, the nurse avoids the use of
slang phrases most importantly because:
a Such phrases have different meanings for different people.
.
b Such phrases will likely trigger anxiety and frustration in the patient.
.
c The use of such phrases is not appropriate when communicating therapeutically
. with a patient.
d This patients altered thought processes will serve to make understanding such
. phrases very unlikely.
ANS: D
Precise verbal communication is important because spoken words often mean different things to
different people. Figures of speech, jokes, clichs, colloquialisms, and other terms or special phrases
carry a variety of meanings especially to individuals with altered thought processes. A person with
schizophrenia interprets concretely and literally whereas psychosis generally brings about loose
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