ESSENTIALS OF PSYCHIATRIC NURSING,
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1. Question 1 — Chapter 1: Foundations of Psychiatric
Nursing, Therapeutic Relationship
Type: Conceptual recall
Stem: A nurse is establishing rapport with a newly
admitted client with major depressive disorder who is
withdrawn and answers questions with single words.
Which initial nursing approach best promotes
development of a therapeutic relationship?
Options:
A. Encourage the client to socialize with other patients
immediately.
B. Sit quietly and allow the client to set the pace of
interaction.
C. Provide direct advice about positive thinking techniques.
D. Ask multiple closed questions to speed the assessment.
, Correct Answer: B
Rationale — Correct: Sitting quietly and allowing the client
to set the pace shows respect, supports trust-building, and
reduces pressure—core early therapeutic relationship
techniques. (Essentials of Psychiatric Nursing, 3rd Ed. —
Chapter 1: Foundations — Therapeutic Relationship).
Guideline: Consistent with trauma-informed and person-
centered engagement principles (SAMHSA).
Rationales — Incorrect:
A. Immediate socialization may overwhelm a withdrawn
client and impede rapport.
C. Giving advice prematurely can be nontherapeutic and
reduce client autonomy.
D. Multiple closed questions can feel interrogative and
hinder rapport.
NCLEX/HESI applicability: Tests therapeutic
communication and establishment of nurse–client
relationship—Psychosocial Integrity.
Teaching Point: Let the client set the interaction pace to
build trust.
Mapping: Chapter 1 — Foundations — Therapeutic
relationship & rapport.
2. Question 2 — Chapter 1: Foundations, Therapeutic
Communication
Type: Application
,Stem: During a milieu therapy group, a client becomes
tearful while discussing loss. Which nurse response
demonstrates therapeutic communication?
Options:
A. "You should try to stop crying; it makes others
uncomfortable."
B. "Tell me more about what you're feeling right now."
C. "I'm surprised you're still upset — it’s been months."
D. "Let's change the subject to something more positive."
Correct Answer: B
Rationale — Correct: Open invitation encourages
expression and exploration of emotion, a core therapeutic
communication skill. (Essentials — Chapter 1: Therapeutic
Communication).
Guideline: Encouraging emotional expression aligns with
recovery-oriented, person-centered care (WHO/SAMHSA).
Rationales — Incorrect:
A. Promotes stigma and is nontherapeutic.
C. Minimizes and judges the client's feelings.
D. Avoids processing important emotion and undermines
therapeutic goals.
NCLEX/HESI applicability: Assesses therapeutic
communication and psychosocial support—Psychosocial
Integrity.
Teaching Point: Use open invitations to facilitate emotional
processing.
, Mapping: Chapter 1 — Therapeutic Communication —
Encouraging expression.
3. Question 3 — Chapter 2: Psychiatric Assessment &
Diagnostic Reasoning, Mental Status Exam
Type: Clinical scenario
Stem: A 28-year-old client presents with disorganized
speech, auditory hallucinations, and flat affect for 6 weeks.
On MSE, thought blocking and poverty of content are
noted. Which diagnostic consideration is most
appropriate?
Options:
A. Major depressive disorder with psychotic features.
B. Brief psychotic disorder.
C. Schizophrenia spectrum disorder—schizophreniform vs.
schizophrenia.
D. Bipolar II disorder.
Correct Answer: C
Rationale — Correct: Psychotic symptoms lasting several
weeks with negative symptoms require consideration of
schizophrenia spectrum disorders (schizophreniform if <6
months, schizophrenia if ≥6 months). (Essentials —
Chapter 2: Mental Status Exam & Diagnostic Reasoning).
Guideline: DSM-5-TR diagnostic timeframes guide this
differential (DSM-5-TR, 2022).
Rationales — Incorrect:
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1. Question 1 — Chapter 1: Foundations of Psychiatric
Nursing, Therapeutic Relationship
Type: Conceptual recall
Stem: A nurse is establishing rapport with a newly
admitted client with major depressive disorder who is
withdrawn and answers questions with single words.
Which initial nursing approach best promotes
development of a therapeutic relationship?
Options:
A. Encourage the client to socialize with other patients
immediately.
B. Sit quietly and allow the client to set the pace of
interaction.
C. Provide direct advice about positive thinking techniques.
D. Ask multiple closed questions to speed the assessment.
, Correct Answer: B
Rationale — Correct: Sitting quietly and allowing the client
to set the pace shows respect, supports trust-building, and
reduces pressure—core early therapeutic relationship
techniques. (Essentials of Psychiatric Nursing, 3rd Ed. —
Chapter 1: Foundations — Therapeutic Relationship).
Guideline: Consistent with trauma-informed and person-
centered engagement principles (SAMHSA).
Rationales — Incorrect:
A. Immediate socialization may overwhelm a withdrawn
client and impede rapport.
C. Giving advice prematurely can be nontherapeutic and
reduce client autonomy.
D. Multiple closed questions can feel interrogative and
hinder rapport.
NCLEX/HESI applicability: Tests therapeutic
communication and establishment of nurse–client
relationship—Psychosocial Integrity.
Teaching Point: Let the client set the interaction pace to
build trust.
Mapping: Chapter 1 — Foundations — Therapeutic
relationship & rapport.
2. Question 2 — Chapter 1: Foundations, Therapeutic
Communication
Type: Application
,Stem: During a milieu therapy group, a client becomes
tearful while discussing loss. Which nurse response
demonstrates therapeutic communication?
Options:
A. "You should try to stop crying; it makes others
uncomfortable."
B. "Tell me more about what you're feeling right now."
C. "I'm surprised you're still upset — it’s been months."
D. "Let's change the subject to something more positive."
Correct Answer: B
Rationale — Correct: Open invitation encourages
expression and exploration of emotion, a core therapeutic
communication skill. (Essentials — Chapter 1: Therapeutic
Communication).
Guideline: Encouraging emotional expression aligns with
recovery-oriented, person-centered care (WHO/SAMHSA).
Rationales — Incorrect:
A. Promotes stigma and is nontherapeutic.
C. Minimizes and judges the client's feelings.
D. Avoids processing important emotion and undermines
therapeutic goals.
NCLEX/HESI applicability: Assesses therapeutic
communication and psychosocial support—Psychosocial
Integrity.
Teaching Point: Use open invitations to facilitate emotional
processing.
, Mapping: Chapter 1 — Therapeutic Communication —
Encouraging expression.
3. Question 3 — Chapter 2: Psychiatric Assessment &
Diagnostic Reasoning, Mental Status Exam
Type: Clinical scenario
Stem: A 28-year-old client presents with disorganized
speech, auditory hallucinations, and flat affect for 6 weeks.
On MSE, thought blocking and poverty of content are
noted. Which diagnostic consideration is most
appropriate?
Options:
A. Major depressive disorder with psychotic features.
B. Brief psychotic disorder.
C. Schizophrenia spectrum disorder—schizophreniform vs.
schizophrenia.
D. Bipolar II disorder.
Correct Answer: C
Rationale — Correct: Psychotic symptoms lasting several
weeks with negative symptoms require consideration of
schizophrenia spectrum disorders (schizophreniform if <6
months, schizophrenia if ≥6 months). (Essentials —
Chapter 2: Mental Status Exam & Diagnostic Reasoning).
Guideline: DSM-5-TR diagnostic timeframes guide this
differential (DSM-5-TR, 2022).
Rationales — Incorrect:
