Primary Care Psychiatry 2nd Edition - McCarron & Xiong.
Comprehensive Test Bank: 200 Questions with Answers and
Rationales
ISBN: 978-1-4963-4921-7
CHAPTER 1: THE PRIMARY CARE PSYCHIATRIC INTERVIEW
Questions 1-10
1. A patient tells the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally
drained, as though I hadn't rested well." Which response should the nurse use to clarify the
patient's comment?
A) "It sounds as though you were uncomfortable with the content of your dream."
B) "I understand what you're saying. Bad dreams leave me feeling tired, too."
C) "So you feel as though you did not get enough quality sleep last night?"
D) "Can you give me an example of what you mean by 'stoned'?"
Answer: D
Rationale: The technique of clarification is therapeutic and helps the nurse examine the meaning
of the patient's statement. Asking for a definition of "stoned" directly asks for clarification.
Restating that the patient is uncomfortable with the dream's content is parroting, a non-
therapeutic technique. The other responses fail to clarify the meaning of the patient's comment .
2. A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us
through the fluorescent lights in this room. Be careful what you say." Which response by
the nurse would be most therapeutic?
A) "Let's talk about something other than the CIA."
B) "It sounds like you're concerned about your privacy."
C) "The CIA is prohibited from operating in health care facilities."
D) "You have lost touch with reality, which is a symptom of your illness."
Answer: B
Rationale: It is important not to challenge the patient's beliefs, even if they are unrealistic.
Reflecting the underlying emotion (concern about privacy) validates the patient's feelings
,without endorsing the delusion. Telling the patient not to talk about the CIA is dismissive.
Challenging the delusion directly can damage the therapeutic alliance and increase the patient's
anxiety .
3. Documentation in a patient's chart states: "Throughout a 5-minute interaction, patient
fidgeted and tapped left foot, periodically covered face with hands, and looked under chair
while stating, 'I enjoy spending time with you.'" Which analysis is most accurate?
A) The patient is giving positive feedback about the nurse's communication techniques.
B) The nurse is viewing the patient's behavior through a cultural filter.
C) The patient's verbal and nonverbal messages are incongruent.
D) The patient is demonstrating psychotic behaviors.
Answer: C
Rationale: When a verbal message is not reinforced with nonverbal behavior, the message is
confusing and incongruent. The patient's verbal statement ("I enjoy spending time with you")
contradicts the anxious nonverbal behaviors (fidgeting, covering face, looking under chair). This
mixed message requires clarification .
4. Which statement by the nurse demonstrates the therapeutic communication technique of
"offering self"?
A) "You look upset. Would you like to talk about it?"
B) "I'll stay with you for a while."
C) "I understand how you feel."
D) "Let's focus on what's bothering you."
Answer: B
Rationale: Offering self involves making oneself available to the patient without imposing
expectations. "I'll stay with you for a while" is a direct offer of presence and support. Asking if
the patient wants to talk (A) is more focused on initiating conversation. Understanding how the
patient feels (C) may be presumptuous. Focusing on what's bothering the patient (D) may be
premature .
,5. During an initial interview, a patient avoids eye contact and speaks in a barely audible
whisper. The nurse's best initial response is:
A) "I can't hear you. Please speak up."
B) "It seems like this is difficult for you to discuss."
C) "You need to look at me when you speak."
D) "Would you like to reschedule when you feel more comfortable?"
Answer: B
Rationale: The nurse should observe the patient's behavior and reflect the observation in a non-
judgmental way. "It seems like this is difficult for you to discuss" validates the patient's apparent
discomfort without demanding change. Telling the patient to speak up or make eye contact can
be perceived as demanding. Offering to reschedule may be premature and dismissive .
6. A patient states, "I've been feeling really anxious lately." Which response by the nurse
best facilitates further discussion?
A) "That must be difficult."
B) "Can you tell me more about what that feels like for you?"
C) "Everyone feels anxious sometimes."
D) "What do you think is causing your anxiety?"
Answer: B
Rationale: "Can you tell me more about what that feels like for you?" is an open-ended question
that encourages the patient to elaborate on their experience. This facilitates exploration of the
patient's subjective experience. "That must be difficult" is a supportive statement but does not
encourage elaboration. Minimizing the experience or jumping to causes may not be the most
therapeutic approach .
7. The nurse is interviewing a patient who speaks rapidly, jumps from topic to topic, and
seems unable to focus on any question for more than a few seconds. The nurse should:
A) Ask the patient to slow down and focus on one topic at a time.
B) End the interview and reschedule for another time.
C) Use closed-ended questions to obtain specific information.
D) Allow the patient to continue without interruption, taking notes for later review.
, Answer: C
Rationale: For a patient who has difficulty focusing, closed-ended questions can help obtain
specific information and structure the interaction. Asking the patient to slow down may not be
effective and could increase frustration. Ending the interview may miss an opportunity to gather
important information. Allowing the patient to continue without structure will likely not yield
useful information .
8. A patient with a history of depression tells the nurse, "I'm fine. There's really nothing
wrong." However, the patient is wearing dirty clothing, appears unkempt, and has poor
hygiene. The nurse's best response is:
A) "I'm glad to hear you're doing well."
B) "Your appearance suggests you might not be feeling as well as you say."
C) "I notice you're wearing dirty clothes. Is everything okay?"
D) "You don't look fine to me."
Answer: C
Rationale: The nurse should objectively describe observed behaviors in a non-judgmental
manner. "I notice you're wearing dirty clothes. Is everything okay?" provides concrete
observations and invites the patient to discuss potential concerns. Simply accepting the patient's
statement ignores obvious signs of distress. Making a judgmental statement would be
inappropriate .
9. Which of the following is an example of the therapeutic communication technique of
"restating"?
A) "You seem anxious today."
B) "Let me see if I understand what you're saying..."
C) "You're saying that you feel like giving up?"
D) "I can see this is very difficult for you."
Answer: C
Rationale: Restating involves repeating the patient's own words back to them in a slightly
different form to demonstrate understanding. "You're saying that you feel like giving up?" is a
direct restatement of what the patient may have expressed. "You seem anxious" is an
Comprehensive Test Bank: 200 Questions with Answers and
Rationales
ISBN: 978-1-4963-4921-7
CHAPTER 1: THE PRIMARY CARE PSYCHIATRIC INTERVIEW
Questions 1-10
1. A patient tells the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally
drained, as though I hadn't rested well." Which response should the nurse use to clarify the
patient's comment?
A) "It sounds as though you were uncomfortable with the content of your dream."
B) "I understand what you're saying. Bad dreams leave me feeling tired, too."
C) "So you feel as though you did not get enough quality sleep last night?"
D) "Can you give me an example of what you mean by 'stoned'?"
Answer: D
Rationale: The technique of clarification is therapeutic and helps the nurse examine the meaning
of the patient's statement. Asking for a definition of "stoned" directly asks for clarification.
Restating that the patient is uncomfortable with the dream's content is parroting, a non-
therapeutic technique. The other responses fail to clarify the meaning of the patient's comment .
2. A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us
through the fluorescent lights in this room. Be careful what you say." Which response by
the nurse would be most therapeutic?
A) "Let's talk about something other than the CIA."
B) "It sounds like you're concerned about your privacy."
C) "The CIA is prohibited from operating in health care facilities."
D) "You have lost touch with reality, which is a symptom of your illness."
Answer: B
Rationale: It is important not to challenge the patient's beliefs, even if they are unrealistic.
Reflecting the underlying emotion (concern about privacy) validates the patient's feelings
,without endorsing the delusion. Telling the patient not to talk about the CIA is dismissive.
Challenging the delusion directly can damage the therapeutic alliance and increase the patient's
anxiety .
3. Documentation in a patient's chart states: "Throughout a 5-minute interaction, patient
fidgeted and tapped left foot, periodically covered face with hands, and looked under chair
while stating, 'I enjoy spending time with you.'" Which analysis is most accurate?
A) The patient is giving positive feedback about the nurse's communication techniques.
B) The nurse is viewing the patient's behavior through a cultural filter.
C) The patient's verbal and nonverbal messages are incongruent.
D) The patient is demonstrating psychotic behaviors.
Answer: C
Rationale: When a verbal message is not reinforced with nonverbal behavior, the message is
confusing and incongruent. The patient's verbal statement ("I enjoy spending time with you")
contradicts the anxious nonverbal behaviors (fidgeting, covering face, looking under chair). This
mixed message requires clarification .
4. Which statement by the nurse demonstrates the therapeutic communication technique of
"offering self"?
A) "You look upset. Would you like to talk about it?"
B) "I'll stay with you for a while."
C) "I understand how you feel."
D) "Let's focus on what's bothering you."
Answer: B
Rationale: Offering self involves making oneself available to the patient without imposing
expectations. "I'll stay with you for a while" is a direct offer of presence and support. Asking if
the patient wants to talk (A) is more focused on initiating conversation. Understanding how the
patient feels (C) may be presumptuous. Focusing on what's bothering the patient (D) may be
premature .
,5. During an initial interview, a patient avoids eye contact and speaks in a barely audible
whisper. The nurse's best initial response is:
A) "I can't hear you. Please speak up."
B) "It seems like this is difficult for you to discuss."
C) "You need to look at me when you speak."
D) "Would you like to reschedule when you feel more comfortable?"
Answer: B
Rationale: The nurse should observe the patient's behavior and reflect the observation in a non-
judgmental way. "It seems like this is difficult for you to discuss" validates the patient's apparent
discomfort without demanding change. Telling the patient to speak up or make eye contact can
be perceived as demanding. Offering to reschedule may be premature and dismissive .
6. A patient states, "I've been feeling really anxious lately." Which response by the nurse
best facilitates further discussion?
A) "That must be difficult."
B) "Can you tell me more about what that feels like for you?"
C) "Everyone feels anxious sometimes."
D) "What do you think is causing your anxiety?"
Answer: B
Rationale: "Can you tell me more about what that feels like for you?" is an open-ended question
that encourages the patient to elaborate on their experience. This facilitates exploration of the
patient's subjective experience. "That must be difficult" is a supportive statement but does not
encourage elaboration. Minimizing the experience or jumping to causes may not be the most
therapeutic approach .
7. The nurse is interviewing a patient who speaks rapidly, jumps from topic to topic, and
seems unable to focus on any question for more than a few seconds. The nurse should:
A) Ask the patient to slow down and focus on one topic at a time.
B) End the interview and reschedule for another time.
C) Use closed-ended questions to obtain specific information.
D) Allow the patient to continue without interruption, taking notes for later review.
, Answer: C
Rationale: For a patient who has difficulty focusing, closed-ended questions can help obtain
specific information and structure the interaction. Asking the patient to slow down may not be
effective and could increase frustration. Ending the interview may miss an opportunity to gather
important information. Allowing the patient to continue without structure will likely not yield
useful information .
8. A patient with a history of depression tells the nurse, "I'm fine. There's really nothing
wrong." However, the patient is wearing dirty clothing, appears unkempt, and has poor
hygiene. The nurse's best response is:
A) "I'm glad to hear you're doing well."
B) "Your appearance suggests you might not be feeling as well as you say."
C) "I notice you're wearing dirty clothes. Is everything okay?"
D) "You don't look fine to me."
Answer: C
Rationale: The nurse should objectively describe observed behaviors in a non-judgmental
manner. "I notice you're wearing dirty clothes. Is everything okay?" provides concrete
observations and invites the patient to discuss potential concerns. Simply accepting the patient's
statement ignores obvious signs of distress. Making a judgmental statement would be
inappropriate .
9. Which of the following is an example of the therapeutic communication technique of
"restating"?
A) "You seem anxious today."
B) "Let me see if I understand what you're saying..."
C) "You're saying that you feel like giving up?"
D) "I can see this is very difficult for you."
Answer: C
Rationale: Restating involves repeating the patient's own words back to them in a slightly
different form to demonstrate understanding. "You're saying that you feel like giving up?" is a
direct restatement of what the patient may have expressed. "You seem anxious" is an
