PSYCH – EXAM NCLEX QUESTIONS AND REVISED ANSWERS #19
The nurse is assigned to the care of a patient admitted to the mental health unit. Which
behaviors by the nurse reflect the essential principles of therapeutic relationship? Select
all that apply.
A. Empowering the patient to make decisions regarding care
B. Looking beyond the illness when interacting with the patient
C. Trying to see things from the unique perspective of the patient
D. Sharing personal insights that are relevant to the patient's problems
E. Ensuring that all physical and emotional needs are met by the nurse - correct answer
A, B, C
A. Empowering the patient to make decisions regarding care
B. Looking beyond the illness when interacting with the patient
C. Trying to see things from the unique perspective of the patient
In the context of the therapeutic relationship, nurses strive to empathize with the patient
and fully value the perspective of the patient, whether or not it differs from that of the
nurse. Nurses also view patients holistically, realizing that they are more than just the
sum of the symptoms they present with. Interactions are based on the growth of the
patient and interventions should promote as much autonomy and independence as the
patient is capable of. Sharing personal interests violates the boundaries of the
therapeutic relationship and shifts the focus of the relationship back to the nurse. Acting
to meet every patient need is generally inappropriate; nurses should act to promote
growth and independence by encouraging patients and families to meet their own needs
whenever possible.
The nurse is working with a patient who is struggling to over- come a serious mental
illness. The patient begins crying after learning that her family will no longer be visiting.
Which response by the nurse demonstrates empathy?
A. "I am not sure what I would do if I were in your shoes."
B. "You must be wondering why they are acting this way."
C. "My sense is that this experience has been very painful for you."
D. "I understand because I went through something similar one time." - correct answer
C. "My sense is that this experience has been very painful for you."
Rationale: The nurse using empathy separates the nurse's own feelings, experiences,
and reactions and fully engages with the patient an attempt to get a sense of how the
patient is feeling at that moment in time. In this instance, the nurse must be present to
what the patient is conveying and act to validate the observation of distress, without
conditions or judgment. Options a and d shift focus back to the nurse and fail to
recognize the patient's experience as unique. Option b does not validate the patient's
verbal or nonverbal messages, but instead makes an assumption that is likely to be
based on the own nurse's perspectives.
,The nurse is acting as a preceptor to a recent nurse graduate who wants to obtain a job
on the mental health unit. The new nurse has been struggling to differentiate between
social and therapeutic interactions because so many of the patients are around his own
age. Which evaluation finding indicates that nurse is acting in accordance with
appropriate professional boundaries? Select all that apply.
A. The nurse sets limits on inappropriate behaviors.
B. The nurse uses colloquial language to foster trust.
C. The nurse brings in clothing for a homeless patient.
D. The nurse offers a video collection for a group movie night.
E. The nurse lets a patient know when their time together will end. - correct answer A,
D, E
A. The nurse sets limits on inappropriate behaviors.
D. The nurse offers a video collection for a group movie night.
E. The nurse lets a patient know when their time together will end.
New nurses frequently fall back on relationship skills that have been learned in the
context of families and or friendships. When nurses set limits on behaviors they are
acting in the role of a counselor, educator and caretaker. Nurses act to meet the needs
of all patients, and bringing in movies is an example of sharing a resource that all
patients can use. When the nurse maintains the time frames associated with
professional and not personal relationships the nurse is upholding boundaries
appropriate to nursing role and acting in a manner that is consistent with professional
and ethical standards. The use of colloquial language conveys a sense of familiarity that
is not consistent with a professional relationship. Bringing in clothing for an individual
patient may be construed as "special treatment," and demonstrates an inability to
differentiate between professional and personal relationships.
The nurse is working with a patient who presents in the outpa- tient setting for the
treatment of situational depression. The patient has begun to try out new coping
strategies and has taken advantage of a support group the nurse recommended. The
nurse recognizes that the patient has entered which phase of therapeutic nurse-patient
relationship?
A. Orientation
B. Working
C. Exploitation
D. Resolution - correct answer C. Exploitation
During the exploitation phase, the patient begins to make use of the resources and tools
that have been offered. The orientation phase consists gaining an understanding of the
goals and needs for care. The working phase consists of initial engagement in
treatment. The resolution phase consists of reviewing progress and terminating the
relationship.
, The nurse is working with the patient admitted to the mental health unit. The nurse
learns that the patient has a history of exposure to trauma that that the nurse can relate
to on a per- sonal level. Which rationale best supports nondisclosure on the part of the
nurse?
A. The patient may use the disclosure against the nurse.
B. The nurse may be assuming that the experiences are similar.
C. There is a risk of distortion or shifting of caregiver boundaries.
D. The patient will not have the same resources to cope as the nurse. - correct answer
C. There is a risk of distortion or shifting of caregiver boundaries.
The essential underlying rationale for maintaining professional boundaries is to keep the
focus on meeting patient needs. Disclosure may distort this role as the patient may feel
compelled to support or care for the nurse or question the nurse's ability to remain
focused on the patient's unique needs or experiences. The nurse may have difficulty
retaining a focus on the patient's needs while relating aspects of their own experience.
In some instances patients may use personal information against the nurse, but the
primary reason for non-disclosure relates to the patient's needs, not the nurses. The
nurse may be making assumptions about the patient's needs, but this option fails to
address the outcome of this assumption or the primary threat to the therapeutic
relationship. It may or may not be true that the patient resources differ from that of the
nurse; however, this is not as important as the threat to the overall effectiveness of the
therapeutic relationship.
The nurse is working in an outpatient mental health clinic. The clinic is implementing an
initiative to use telecommunication to deliver care to patients living in remote areas. The
nurse understands that this change will be most likely to affect which aspects of
communication?
A. Nonverbal communication only
B. Nonverbal and meta-communication
C. Verbal and nonverbal communication
D. Meta-, nonverbal, and verbal communication - correct answer B. Nonverbal and
meta-communication
Verbal communication consists of the words used. Nonverbal communication includes
gestures, appearance, tone and volume as well as a variety of other factors. Meta
communication refers to those involved in the interaction, how the message is sent, and
the context of the message. Telecommunication will impact the ability to convey and
receive nonverbal content. Even if visual images are used, the visual field or the quality
of the images may be limited, and other sensory information may not be available.
Because the context and mode of communication will change with telecommunication,
meta-communication will also be impacted. The words or the language used to deliver
care will not necessarily be impacted by the use of telecommunication.
The nurse is assigned to the care of a patient admitted to the mental health unit. Which
behaviors by the nurse reflect the essential principles of therapeutic relationship? Select
all that apply.
A. Empowering the patient to make decisions regarding care
B. Looking beyond the illness when interacting with the patient
C. Trying to see things from the unique perspective of the patient
D. Sharing personal insights that are relevant to the patient's problems
E. Ensuring that all physical and emotional needs are met by the nurse - correct answer
A, B, C
A. Empowering the patient to make decisions regarding care
B. Looking beyond the illness when interacting with the patient
C. Trying to see things from the unique perspective of the patient
In the context of the therapeutic relationship, nurses strive to empathize with the patient
and fully value the perspective of the patient, whether or not it differs from that of the
nurse. Nurses also view patients holistically, realizing that they are more than just the
sum of the symptoms they present with. Interactions are based on the growth of the
patient and interventions should promote as much autonomy and independence as the
patient is capable of. Sharing personal interests violates the boundaries of the
therapeutic relationship and shifts the focus of the relationship back to the nurse. Acting
to meet every patient need is generally inappropriate; nurses should act to promote
growth and independence by encouraging patients and families to meet their own needs
whenever possible.
The nurse is working with a patient who is struggling to over- come a serious mental
illness. The patient begins crying after learning that her family will no longer be visiting.
Which response by the nurse demonstrates empathy?
A. "I am not sure what I would do if I were in your shoes."
B. "You must be wondering why they are acting this way."
C. "My sense is that this experience has been very painful for you."
D. "I understand because I went through something similar one time." - correct answer
C. "My sense is that this experience has been very painful for you."
Rationale: The nurse using empathy separates the nurse's own feelings, experiences,
and reactions and fully engages with the patient an attempt to get a sense of how the
patient is feeling at that moment in time. In this instance, the nurse must be present to
what the patient is conveying and act to validate the observation of distress, without
conditions or judgment. Options a and d shift focus back to the nurse and fail to
recognize the patient's experience as unique. Option b does not validate the patient's
verbal or nonverbal messages, but instead makes an assumption that is likely to be
based on the own nurse's perspectives.
,The nurse is acting as a preceptor to a recent nurse graduate who wants to obtain a job
on the mental health unit. The new nurse has been struggling to differentiate between
social and therapeutic interactions because so many of the patients are around his own
age. Which evaluation finding indicates that nurse is acting in accordance with
appropriate professional boundaries? Select all that apply.
A. The nurse sets limits on inappropriate behaviors.
B. The nurse uses colloquial language to foster trust.
C. The nurse brings in clothing for a homeless patient.
D. The nurse offers a video collection for a group movie night.
E. The nurse lets a patient know when their time together will end. - correct answer A,
D, E
A. The nurse sets limits on inappropriate behaviors.
D. The nurse offers a video collection for a group movie night.
E. The nurse lets a patient know when their time together will end.
New nurses frequently fall back on relationship skills that have been learned in the
context of families and or friendships. When nurses set limits on behaviors they are
acting in the role of a counselor, educator and caretaker. Nurses act to meet the needs
of all patients, and bringing in movies is an example of sharing a resource that all
patients can use. When the nurse maintains the time frames associated with
professional and not personal relationships the nurse is upholding boundaries
appropriate to nursing role and acting in a manner that is consistent with professional
and ethical standards. The use of colloquial language conveys a sense of familiarity that
is not consistent with a professional relationship. Bringing in clothing for an individual
patient may be construed as "special treatment," and demonstrates an inability to
differentiate between professional and personal relationships.
The nurse is working with a patient who presents in the outpa- tient setting for the
treatment of situational depression. The patient has begun to try out new coping
strategies and has taken advantage of a support group the nurse recommended. The
nurse recognizes that the patient has entered which phase of therapeutic nurse-patient
relationship?
A. Orientation
B. Working
C. Exploitation
D. Resolution - correct answer C. Exploitation
During the exploitation phase, the patient begins to make use of the resources and tools
that have been offered. The orientation phase consists gaining an understanding of the
goals and needs for care. The working phase consists of initial engagement in
treatment. The resolution phase consists of reviewing progress and terminating the
relationship.
, The nurse is working with the patient admitted to the mental health unit. The nurse
learns that the patient has a history of exposure to trauma that that the nurse can relate
to on a per- sonal level. Which rationale best supports nondisclosure on the part of the
nurse?
A. The patient may use the disclosure against the nurse.
B. The nurse may be assuming that the experiences are similar.
C. There is a risk of distortion or shifting of caregiver boundaries.
D. The patient will not have the same resources to cope as the nurse. - correct answer
C. There is a risk of distortion or shifting of caregiver boundaries.
The essential underlying rationale for maintaining professional boundaries is to keep the
focus on meeting patient needs. Disclosure may distort this role as the patient may feel
compelled to support or care for the nurse or question the nurse's ability to remain
focused on the patient's unique needs or experiences. The nurse may have difficulty
retaining a focus on the patient's needs while relating aspects of their own experience.
In some instances patients may use personal information against the nurse, but the
primary reason for non-disclosure relates to the patient's needs, not the nurses. The
nurse may be making assumptions about the patient's needs, but this option fails to
address the outcome of this assumption or the primary threat to the therapeutic
relationship. It may or may not be true that the patient resources differ from that of the
nurse; however, this is not as important as the threat to the overall effectiveness of the
therapeutic relationship.
The nurse is working in an outpatient mental health clinic. The clinic is implementing an
initiative to use telecommunication to deliver care to patients living in remote areas. The
nurse understands that this change will be most likely to affect which aspects of
communication?
A. Nonverbal communication only
B. Nonverbal and meta-communication
C. Verbal and nonverbal communication
D. Meta-, nonverbal, and verbal communication - correct answer B. Nonverbal and
meta-communication
Verbal communication consists of the words used. Nonverbal communication includes
gestures, appearance, tone and volume as well as a variety of other factors. Meta
communication refers to those involved in the interaction, how the message is sent, and
the context of the message. Telecommunication will impact the ability to convey and
receive nonverbal content. Even if visual images are used, the visual field or the quality
of the images may be limited, and other sensory information may not be available.
Because the context and mode of communication will change with telecommunication,
meta-communication will also be impacted. The words or the language used to deliver
care will not necessarily be impacted by the use of telecommunication.
