Question 1

During an MSE a patient says, "I am a special messenger sent to provide the world a cure for cancer." The patient's statement indicates the presence of:

Accepted Answer

A)  a phobia. 
B)  a delusion. 
C)  hypervigilance. 
D)  loose associations.

Question 2

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

A)  "We are not friends. Our relationship is a professional one." 
B)  "I feel sure there are other friends in your life. Can you name some?" 
C)  "I am glad you trust me. Trust is important for the work we are doing together." 
D)  "Our relationship is professional, but let's explore ways to strengthen friendships."

Question 3

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

Accepted Answer

A)  Enforcing rules 
B)  Keeping appointments and promises 
C)  Agreeing not to document the patient's disclosures 
D)  Openly challenging unclear statements by the patient

Question 4

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

A)  "Your comments are interesting. With your permission I will share them with the treatment team." 
B)  "We are using a new system because of managed-care requirements. We are hopeful it will be effective." 
C)  "Shift reports, care plans, and progress notes help different nurses work with all patients toward their individual goals." 
D)  "It sounds like you are feeling dissatisfied with your care. After you are discharged, you will receive a form to provide feedback."

Question 5

A patient tells the nurse, "I want to have sex with you." Which nursing responses are appropriate? Select all that apply.

Accepted Answer

A)  "I will forget you said that." 
B)  "Your suggestion frightens me." 
C)  "You must keep your distance." 
D)  "Sex is not part of our relationship." 
E)  "We are here to work on your problems."

Question 6

Select the best outcome for a nurse to include in the care plan for a withdrawn patient who says, "I would like to have more friends." Within 3 days, the patient will:

Accepted Answer

A)  be more outgoing. 
B)  develop greater independence. 
C)  participate in one group activity. 
D)  increase socialization with others.

Question 7

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

A)  The anger was created by a situation or significant person, not the nurse. 
B)  The reaction probably results from transference and countertransference. 
C)  The patient is probably reacting to fear of loss of emotional control. 
D)  The patient has a right to openly express negative feelings.

Question 8

A patient with suicidal ideation is hospitalized. What is the priority intervention?

Accepted Answer

A)  Negotiating a no-harm contract 
B)  Facilitating attendance at groups 
C)  Administering a psychotropic drug 
D)  Determining the precipitating situation

Question 9

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

A)  "Games are part of the therapeutic milieu." 
B)  "Patients need a break from intensive individual therapy." 
C)  "Informal activities help patients develop social skills and take risks." 
D)  "Please review material on the psychotherapeutic management model."

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

A)  Maximize the benefits of milieu management. 
B)  Immediately begin to explore acute patient issues. 
C)  Develop a goal-directed, problem-centered relationship. 
D)  Choose a specific theoretical model as the basis for care.

Question 11

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

Accepted Answer

A)  "I know you are here to help me, and will do whatever you tell me to do." 
B)  "I didn't want to deal with this at first, but I'm glad you made me face it." 
C)  "I realize that I have some issues that I need help resolving." 
D)  "I will do anything to get out of this hospital."

Question 12

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

A)  greater independence." 
B)  increased self-responsibility." 
C)  trust and rapport with two staff members." 
D)  ability to problem-solve one issue."

Question 13

As the nurse plans care for a newly admitted patient, identification of dysfunctional behaviors will provide the focus for:

Accepted Answer

A)  evaluation. 
B)  nursing diagnosis. 
C)  nursing interventions. 
D)  outcome identification.

Question 14

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

Accepted Answer

A)  offer to listen and help. 
B)  directly ask why the patient does not wish to talk. 
C)  involve the patient in a group activity to decrease isolation. 
D)  respect the patient's desire not to talk and leave the patient alone.

Question 15

A nurse considers interventions for a diabetic patient who needs to change eating habits and lose weight. The nurse will base strategies on which principle?

Accepted Answer

A)  The nurse's primary responsibility is to encourage the change. 
B)  Patient-initiated change is more successful than imposed change. 
C)  For successful change, both the benefit and the risk to the patient must be high. 
D)  Patients value advice from nurses because of the trusting dimensions of the relationship.

Question 16

Following the admission interview, a spouse of a patient asks the nurse, "Why did you ask my partner all those questions? Some of them had nothing to do with current problems." The nurse's best response is, "Those questions help us understand:

Accepted Answer

A)  the patient's current status." 
B)  the complete family history." 
C)  the patient's past experiences." 
D)  what the patient's prognosis will be."

Question 17

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

Accepted Answer

A)  "I want to be helpful to you as we explore your problems and the way you express feelings." 
B)  "A good long-term goal for someone your age would be to develop better job-related skills." 
C)  "Of the problems we have discussed so far, which ones would you most like to work on at this time?" 
D)  "When someone gives you a compliment, I notice that you become very quiet and appear uncomfortable."

Question 18

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

A)  provide structure and intensive support. 
B)  inform the patient of the progress made. 
C)  encourage the patient to describe goals for change. 
D)  discuss feelings about termination with the patient.

Question 19

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

A)  self-disclosing inappropriately. 
B)  experiencing countertransference. 
C)  using empathy to establish trust with the patient. 
D)  encouraging the patient to express negative feelings.

Question 20

A psychiatric aide asks, "Can you give me some examples of how we provide structure for patients?" The nurse should offer which suggestions? Select all that apply.

Accepted Answer

A)  Set limits on destructive behavior. 
B)  Direct a patient to go to a quiet place. 
C)  Sit with a withdrawn, isolated patient. 
D)  Distract a patient who is hallucinating. 
E)  Help a patient contemplate needed change.

Exam 9: Working with an Individual Patient