Psychiatric/Mental Health Nursing Practice NCLEX
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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,
the patient's eye contact did not improve. What is the most accurate analysis
of this scenario?
a. The patient's eye contact should have been directly addressed by role-
playing to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment,
diagnosis, and planning for this patient.
c. The patient's poor eye contact is indicative of anger and hostility that were
unaddressed.
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d. The nurse should have assessed the patient's culture before making this
diagnosis and plan.
ANS: D
The amount of eye contact a person engages in is often culturally determined. In
some cultures, eye contact is considered insolent, whereas in others eye contact is
expected. Asian Americans, including persons from the Philippines, often prefer not
to engage in direct eye contact.
When a female Mexican American patient and a female nurse sit together, the
patient often holds the nurse's hand. The patient also links arms with the
nurse when they walk. The nurse is uncomfortable with this behavior. Which
analysis is most accurate?
a. The patient is accustomed to touch during conversation, as are members of
many Hispanic subcultures.
b. The patient understands that touch makes the nurse uncomfortable and
controls the relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient is
reassured and comforted.
d. The patient is trying to manipulate the nurse using nonverbal techniques.
ANS: A
The most likely answer is that the patient's behavior is culturally influenced. Hispanic
women frequently touch women they consider to be their friends. Although the other
options are possible, they are less likely.
A Puerto Rican American patient uses dramatic body language when
describing emotional discomfort. Which analysis most likely explains the
patient's behavior? The patient:
a. has a histrionic personality disorder.
b. believes dramatic body language is sexually appealing.
c. wishes to impress staff with the degree of emotional pain.
d. belongs to a culture in which dramatic body language is the norm.
ANS: D
Members of Hispanic American subcultures tend to use high affect and dramatic
body language as they communicate. The other options are more remote
possibilities.
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During an interview, a patient attempts to shift the focus from self to the nurse
by asking personal questions. The nurse should respond by saying:
a. "Why do you keep asking about me?"
b. "Nurses direct the interviews with patients."
c. "Do not ask questions about my personal life."
d. "The time we spend together is to discuss your concerns."
ANS: D
When a patient tries to focus on the nurse, the nurse should refocus the discussion
back onto the patient. Telling the patient that interview time should be used to
discuss patient concerns refocuses discussion in a neutral way. Telling patients not
to ask about the nurse's personal life shows indignation. Saying that nurses prefer to
direct the interview reflects superiority. "Why" questions are probing and non-
therapeutic.
Which principle should guide the nurse in determining the extent of silence to
use during patient interview sessions?
a. A nurse is responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said was understood.
ANS: C
Silence can be helpful to both participants by giving each an opportunity to
contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse
breaking silences is not a principle related to silences. It is inaccurate to say that
patients withdraw during long silences or that silence helps patients know that they
are understood. Feedback helps patients know they have been understood.
A patient is having difficulty making a decision. The nurse has mixed feelings
about whether to provide advice. Which principle usually applies? Giving
advice:
a. is rarely helpful.
b. fosters independence.
c. lifts the burden of personal decision making.
d. helps the patient develop feelings of personal adequacy.
ANS: A
Giving advice fosters dependence on the nurse and interferes with the patient's right
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to make personal decisions. It robs patients of the opportunity to weigh alternatives
and develop problem-solving skills. Furthermore, it contributes to patient feelings of
personal inadequacy. It also keeps the nurse in control and feeling powerful.
A school age child tells the school nurse, "Other kids call me mean names and
will not sit with me at lunch. Nobody likes me." Select the nurse's most
therapeutic response.
a. "Just ignore them and they will leave you alone."
b. "You should make friends with other children."
c. "Call them names if they do that to you."
d. "Tell me more about how you feel."
ANS: D
The correct response uses exploring, a therapeutic technique. The distracters give
advice, a non-therapeutic technique.
A patient with acute depression states, "God is punishing me for my past
sins." What is the nurse's most therapeutic response?
a. "You sound very upset about this."
b. "God always forgives us for our sins."
c. "Why do you think you are being punished?"
d. "If you feel this way, you should talk to your minister."
ANS: A
The nurse reflects the patient's comment, a therapeutic technique to encourage
sharing for perceptions and feelings. The incorrect responses reflect probing, closed-
ended comments, and giving advice, all of which are non-therapeutic.
Select all that apply.
A patient cries as the nurse explores the patient's feelings about the death of a
close friend. The patient sobs, "I shouldn't be crying like this. It happened a
long time ago." Which responses by the nurse facilitate communication?
a. "Why do you think you are so upset?"
b. "I can see that you feel sad about this situation."
c. "The loss of a close friend is very painful for you."
d. "Crying is a way of expressing the hurt you are experiencing."
e. "Let's talk about something else because this subject is upsetting you."
ANS: B, C, D
Reflecting ("I can see that you feel sad," "This is very painful for you") and giving