CMN 350 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS RATED A+
✔✔Interactions with patients who have Sexual Innuendos or Inappropriate Touch -
✔✔Some patients may verbalize ___________________________ or try to
___________ the nurse or other patients inappropriately. Patients should be asked to
stop the behavior as a calm request. It may be necessary to communicate to the patient
that the nurse or other patients do not feel safe and become afraid when such
comments or behavior occurs. Patients generally stop inappropriate behaviors when
asked. If the behaviors continue, setting limits will need to be initiated. For example, "I
want to talk to you, but I won't be able to do so if you continue to try to ________- me."
"If you can't stop, I will have to leave and come back later." The nurse is responsible for
maintaining professional boundaries in the relationship, especially when the patient is
having difficulty with his or her own boundaries.
The nurse should refrain from _________ patients who have sexual or boundary issues.
It is a good idea for the nurse to ask a patient if she is okay being touched for routine
vital signs and other medical procedures. Some patients who have experienced sexual
abuse could be triggered when touched. Other patients who are highly sexualized may
misinterpret the nurse's ________ as perhaps erotic.
✔✔Interactions with patients who have Treatment Refusal - ✔✔Entails an explicit
rejection of all or part of a treatment plan by patients. It is important for nurses to realize
that it and nonadherence/noncompliance are not the same. In
nonadherence/noncompliance, the patient agrees to the treatment plan but fails to
consistently carry it out. Those patients who are most prone to refuse treatment typically
have been diagnosed with the following disorders: bipolar disorder, eating disorders,
schizophrenia, substance use disorders, and borderline personality disorder. During
exacerbations, prominent symptoms such as hallucinations, delusions, grandiosity, and
paranoia may interfere with the patient's insight and judgment. Such symptoms can
make it difficult or impossible for patients to know they have a serious problem and are
in need of professional care. Occasionally a patient might admit to the need for help but
disagrees with the type of treatment offered. Listening, clarifying, and verbalizing
thoughts that have been implied are appropriate for identifying the underlying causes of
a lack of cooperation. The causes, fears, and outcomes of patients' behaviors are then
discussed directly: "What are you afraid will happen in the inpatient unit?" The lack of
trust and fear are often issues for these patients; measures to assure the patient that
she is safe and a great deal of patience from the nurse are needed.
✔✔Interactions with patients who have Depressed Affect, Apathy, and Psychomotor
Retardation - ✔✔When patients express sadness, helplessness, hopelessness, lack of
energy, or a negative attitude about everything, the nurse uses patience, frequent
contact, and empathy as effective methods for dealing with these feelings. Even when
patients verbalize their desire for change, they do not always have the energy to make
the adjustment quickly. Improvement in personal hygiene, proper nutrition, and a
, gradual increase in activities are encouraged. Major decisions are postponed until
overwhelming emotions have subsided and thinking is more logical.
✔✔Interactions with patients who have Suspiciousness - ✔✔When patients are
______________, they might be afraid of everyone. The nurse must communicate
clearly, simply, and congruently. Misinterpretations by patients should be clarified, but
arguments over differences in opinion are to be avoided. Simple rationales or
explanations for rules, activities, occurrences, noises, and requests are offered
regularly. The participation of patients in unit activities is encouraged but not forced,
thus avoiding increasing their fears.
✔✔Interactions with patients who have Hyperactivity - ✔✔Excessive physical and
emotional activity of patients is upsetting to other patients, staff, and patients
themselves. Patients might unintentionally harm themselves or others. These patients
should be in a quiet area, with minimal auditory and visual stimulation. The nurse must
remain calm, speak slowly and softly, and respect patients' personal space.
Occasionally, prn medications are required, including one to promote sleep.
✔✔assessing for suicide - ✔✔-previous attempts
-plan
-means (Priority) (get belongings and meds away from them
✔✔how to set up a group - ✔✔Physical arrangements are important considerations in
creating an atmosphere that is conducive to group work. Finding adequate space or a
private room is often difficult but is nevertheless important to ensure privacy and a quiet
atmosphere. Adequate lighting, comfortable temperature, ample seating, and proper
equipment also contribute to successful group functioning. A box of tissues available at
the start can prevent a distracting group scramble looking for tissues when an individual
is sharing painful emotions. Forming a circle of chairs allows patients to see each other
and indicates an expectation that patients will relate to the leader and other group
members. Sitting around a large table is also an option, with the goal being that all
members are "equally at the table." Members sitting on the outside of the circle should
be invited in. Chairs in rows might be appropriate for a didactic session but does not
allow for effective interpersonal communication flow. A blackboard, dry marker board, or
other media such as a DVD player can enhance learning if it is to be an educational
group. Handouts or printed materials might be useful for patients and families to take
home for future reference.
✔✔Rules for groups - ✔✔-usually, only last for 1 hour
-The nurse must be goal-directed and focus on the here and now in each inpatient or
outpatient group session. The leader succinctly states the group's purpose at the
beginning of the session, and most of the session is spent on the work to be
accomplished. The final 5 to 10 minutes are used to summarize and close the session.
The summary should have a positive focus and include information that the patients
have learned or gained from the group. The leader gives positive feedback to the group
regarding progress during the session.
AND SOLUTIONS RATED A+
✔✔Interactions with patients who have Sexual Innuendos or Inappropriate Touch -
✔✔Some patients may verbalize ___________________________ or try to
___________ the nurse or other patients inappropriately. Patients should be asked to
stop the behavior as a calm request. It may be necessary to communicate to the patient
that the nurse or other patients do not feel safe and become afraid when such
comments or behavior occurs. Patients generally stop inappropriate behaviors when
asked. If the behaviors continue, setting limits will need to be initiated. For example, "I
want to talk to you, but I won't be able to do so if you continue to try to ________- me."
"If you can't stop, I will have to leave and come back later." The nurse is responsible for
maintaining professional boundaries in the relationship, especially when the patient is
having difficulty with his or her own boundaries.
The nurse should refrain from _________ patients who have sexual or boundary issues.
It is a good idea for the nurse to ask a patient if she is okay being touched for routine
vital signs and other medical procedures. Some patients who have experienced sexual
abuse could be triggered when touched. Other patients who are highly sexualized may
misinterpret the nurse's ________ as perhaps erotic.
✔✔Interactions with patients who have Treatment Refusal - ✔✔Entails an explicit
rejection of all or part of a treatment plan by patients. It is important for nurses to realize
that it and nonadherence/noncompliance are not the same. In
nonadherence/noncompliance, the patient agrees to the treatment plan but fails to
consistently carry it out. Those patients who are most prone to refuse treatment typically
have been diagnosed with the following disorders: bipolar disorder, eating disorders,
schizophrenia, substance use disorders, and borderline personality disorder. During
exacerbations, prominent symptoms such as hallucinations, delusions, grandiosity, and
paranoia may interfere with the patient's insight and judgment. Such symptoms can
make it difficult or impossible for patients to know they have a serious problem and are
in need of professional care. Occasionally a patient might admit to the need for help but
disagrees with the type of treatment offered. Listening, clarifying, and verbalizing
thoughts that have been implied are appropriate for identifying the underlying causes of
a lack of cooperation. The causes, fears, and outcomes of patients' behaviors are then
discussed directly: "What are you afraid will happen in the inpatient unit?" The lack of
trust and fear are often issues for these patients; measures to assure the patient that
she is safe and a great deal of patience from the nurse are needed.
✔✔Interactions with patients who have Depressed Affect, Apathy, and Psychomotor
Retardation - ✔✔When patients express sadness, helplessness, hopelessness, lack of
energy, or a negative attitude about everything, the nurse uses patience, frequent
contact, and empathy as effective methods for dealing with these feelings. Even when
patients verbalize their desire for change, they do not always have the energy to make
the adjustment quickly. Improvement in personal hygiene, proper nutrition, and a
, gradual increase in activities are encouraged. Major decisions are postponed until
overwhelming emotions have subsided and thinking is more logical.
✔✔Interactions with patients who have Suspiciousness - ✔✔When patients are
______________, they might be afraid of everyone. The nurse must communicate
clearly, simply, and congruently. Misinterpretations by patients should be clarified, but
arguments over differences in opinion are to be avoided. Simple rationales or
explanations for rules, activities, occurrences, noises, and requests are offered
regularly. The participation of patients in unit activities is encouraged but not forced,
thus avoiding increasing their fears.
✔✔Interactions with patients who have Hyperactivity - ✔✔Excessive physical and
emotional activity of patients is upsetting to other patients, staff, and patients
themselves. Patients might unintentionally harm themselves or others. These patients
should be in a quiet area, with minimal auditory and visual stimulation. The nurse must
remain calm, speak slowly and softly, and respect patients' personal space.
Occasionally, prn medications are required, including one to promote sleep.
✔✔assessing for suicide - ✔✔-previous attempts
-plan
-means (Priority) (get belongings and meds away from them
✔✔how to set up a group - ✔✔Physical arrangements are important considerations in
creating an atmosphere that is conducive to group work. Finding adequate space or a
private room is often difficult but is nevertheless important to ensure privacy and a quiet
atmosphere. Adequate lighting, comfortable temperature, ample seating, and proper
equipment also contribute to successful group functioning. A box of tissues available at
the start can prevent a distracting group scramble looking for tissues when an individual
is sharing painful emotions. Forming a circle of chairs allows patients to see each other
and indicates an expectation that patients will relate to the leader and other group
members. Sitting around a large table is also an option, with the goal being that all
members are "equally at the table." Members sitting on the outside of the circle should
be invited in. Chairs in rows might be appropriate for a didactic session but does not
allow for effective interpersonal communication flow. A blackboard, dry marker board, or
other media such as a DVD player can enhance learning if it is to be an educational
group. Handouts or printed materials might be useful for patients and families to take
home for future reference.
✔✔Rules for groups - ✔✔-usually, only last for 1 hour
-The nurse must be goal-directed and focus on the here and now in each inpatient or
outpatient group session. The leader succinctly states the group's purpose at the
beginning of the session, and most of the session is spent on the work to be
accomplished. The final 5 to 10 minutes are used to summarize and close the session.
The summary should have a positive focus and include information that the patients
have learned or gained from the group. The leader gives positive feedback to the group
regarding progress during the session.
