Question 1

A nurse tells the unit supervisor,"I'm having a difficult time empathizing with my patient especially since he is so unwilling to change.Talking with him makes me feel both frustrated and depressed." The supervisor may suspect that the cause of the barrier in this nurse-client relation is the:

Accepted Answer

A)   existence of countertransference on the part of the nurse.
B)   patient's demonstration of resistance to the prescribed plan of care.
C)   violation of a therapeutic boundary by either the nurse or the patient.
D)   nurse's ineffective use of therapeutic verbal communication techniques. A

Question 2

Which statement is true of planning the timing for the use of confrontation?

Accepted Answer

A)   Confrontation should never be used during the orientation phase of the relationship.
B)   Confrontation is useful during the working phase to focus on specific patient discrepancies.
C)   Confront patients with their limitations early in the relationship and with their assets later in therapy.
D)   Confront patients when other therapeutic action dimensions have proven ineffective. B

Question 3

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

A)   This behavior is typical of transference reactions.
B)   All patients have feelings of insecurity and low self-esteem.
C)   Manipulative behavior is part of this patient's psychopathology.
D)   Testing behavior is common during the introductory phase of a relationship. D

Question 4

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

A)   "Sometimes it's best to disregard subjective perceptions like that and focus on the objective signs."
B)   "Pay attention to your feelings. They can provide valuable clues about the patient's feelings."
C)   "You should share your perceptions with the patient and seek an explanation."
D)   "Confrontation can be a useful tool in situations like this."

Question 5

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

A)   unknown.
B)   open-ended.
C)   specified and agreed to.
D)   closed to negotiation or agreement.

Question 6

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

A)   role modeling.
B)   self-exploration.
C)   altruistic thinking.
D)   value clarification.

Question 7

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

Accepted Answer

A)   consider what he or she has to offer the patient.
B)   form a workable but detailed contract.
C)   review the general goals of a therapeutic relationship.
D)   plan for the first interaction with the patient.
E)   identify existing stressors affecting the relationship.

Question 8

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

A)   Mutual formulation of a contract
B)   Nurse's self-analysis of strengths
C)   Promotion of patient use of constructive coping mechanisms
D)   Review of progress of therapy and goal attainment with patient

Question 9

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

A)   "How long have you felt this way?"
B)   "We're all here to help you get better."
C)   "What do you think the hospital can do for you?"
D)   "Tell me more so that I can better understand."

Question 10

A teenager being treated for oppositional defiance behavior states: "I wish my parents would stop treating me like an irresponsible child." The nurse implements confrontation as a therapeutic technique when responding:

Accepted Answer

A)   "How can they treat you like an adult when you are only a teenager?"
B)   "You want to be treated like an adult, but is it adult-like when you skip school?"
C)   "Your parents have a legal responsibility to care for you until you are eighteen."
D)   "Your parents are worried about giving you more freedom than you can handle."

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

A)   Ulterior
B)   Crossed
C)   Incongruent
D)   Complementary

Question 12

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

A)   "My anxiety seems to be a result of having so much to get done."
B)   "I don't know whether I'll be able to handle things alone."
C)   "I can't seem to be able to manage going to school and working."
D)   "I need to find a way that can help me manage my anxiety."

Question 13

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

A)   "How has hospitalization affected your life?"
B)   "Do you feel angry or resentful about being hospitalized?"
C)   "I see you are angry about being here. I hope that after we talk you will feel differently."
D)   "We are here to protect you and see that you do not harm yourself or others in your anger."

Question 14

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

A)   kind of information given.
B)   amount of emotion invested.
C)   degree of satisfaction obtained.
D)   type of responsibility involved.

Question 15

A chronically depressed patient has been diagnosed with having a dependent personality.The nurse suspects that the situation has resulted in dependence transference when the patient shares that:

Accepted Answer

A)   "Leaving the hospital and helpful, caring people like you will be really hard."
B)   "Over the weeks we've been meeting I've come to feel as though you are a very special person."
C)   "I think of you as being sent from heaven to guide me out of this darkness of the soul."
D)   "I know I can count on you to chart my course back to health. I will do whatever you say."

Question 16

When a patient is late for three consecutive therapy sessions,the nurse implements perception sharing as a communication technique when stating:

Accepted Answer

A)   "You say how important therapy is to you, but you can't seem to get here on time."
B)   "Do you think it's polite being late for therapy sessions like this?"
C)   "Do you have really good reasons for being late so often?"
D)   "I feel that you aren't ready to work on your problems."

Question 17

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

A)   Adult
B)   Child
C)   Parent
D)   Complementary

Question 18

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

A)   Doing something with the choice in a pattern of life
B)   Choosing freely from alternatives
C)   Being happy with the choice
D)   Affirming the choice publicly

Question 19

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

A)   Getting up from her chair while making the statement
B)   Walking toward the nurse while talking about her spouse
C)   Staring down at her shoes during the conversation
D)   Smiling while talking with the nurse

Question 20

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

Accepted Answer

A)   Regularly referring to himself as a "loser"
B)   Becoming tearful during every therapy session about abuse
C)   Asking to postpone a therapy session until after visiting hours
D)   Consistently describing his drug use as starting "a little while ago"

Exam 2: Therapeutic Nurse-Patient Relationship