Exam 1 - Psychiatric Mental Health Nursing with 100- correct answers.

Exam 1 - Psychiatric/Mental Health
Nursing with 100% correct answers




A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained,
f f f f f f f f f f f f f f f f f f f




as though I hadn't rested well." Which response should the nurse use to clarify the patient's
f f f f f f f f f f f f f f f f




comment?
a. "It sounds as though you were uncomfortable with the content of your dream."
f f f f f f f f f f f f f




b. "I understand what you're saying. Bad dreams leave me feeling tired, too."
f f f f f f f f f f f f




c. "So you feel as though you did not get enough quality sleep last night?"
f f f f f f f f f f f f f f




d. "Can you give me an example of what you mean by 'stoned'?" - correct answer ANS: D
f f f f f f f f f f f f f f f f f




The technique of clarification is therapeutic and helps the nurse examine the meaning of the
f f f f f f f f f f f f f f f




patient's statement. Asking for a definition of "stoned" directly asks for clarification. Restating
f f f f f f f f f f f f f




that the patient is uncomfortable with the dream's content is parroting, a non-therapeutic
f f f f f f f f f f f f f




technique. The other responses fail to clarify the meaning of the patient's comment.
f f f f f f f f f f f f




A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us through the
f f f f f f f f f f f f f f f




fluorescent lights in this room. Be careful what you say." Which response by the nurse would be
f f f f f f f f f f f f f f f f




most therapeutic?
f f




a. "Let's talk about something other than the CIA."
f f f f f f f f

,b. "It sounds like you're concerned about your privacy."
f f f f f f f f




c. "The CIA is prohibited from operating in health care facilities."
f f f f f f f f f f




d. "You have lost touch with reality, which is a symptom of your illness." - correct answer ANS: B
f f f f f f f f f f f f f f f f f f




It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging
f f f f f f f f f f f f f f f




undermines the patient's trust in the nurse. The nurse should try to understand the underlying f f f f f f f f f f f f f f f




feelings or thoughts the patient's message conveys. The correct response uses thef f f f f f f f f f f f




therapeutic technique of reflection. The other comments are non-therapeutic. Asking to talk f f f f f f f f f f f f




about something other than the concern at hand is changing the subject. Saying that the CIA is
f f f f f f f f f f f f f f f f f




prohibited from operating in health care facilities gives false reassurance. Stating that the f f f f f f f f f f f f f




patient has lost touch with reality is truthful, but uncompassionate.
f f f f f f f f f




The patient says, "My marriage is just great. My spouse and I always agree." The nurse
f f f f f f f f f f f f f f f f




observes the patient's foot moving continuously as the patient twirls a shirt button. The f f f f f f f f f f f f f f




conclusion the nurse can draw is that the patient's communication is: f f f f f f f f f f




a. clear. f f




b. mixed. f




c. precise.
f




d. inadequate. - correct answer ANS: B
f f f f f f




Mixed messages involve the transmission of conflicting or incongruent messages by the
f f f f f f f f f f f f




speaker. The patient's verbal message that all was well in the relationship was modified by the
f f f f f f f f f f f f f f f f




nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal f f f f f f f f f f f f f f f




message being clear, explicit, or inadequate. f f f f f




A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies
f f f f f f f f f f f f f f




the communication technique of "offering self."
f f f f f




a. "I've also had traumatic life experiences. Maybe it would help if I told you about them."
f f f f f f f f f f f f f f f f




b. "Why do you think you had so much difficulty adjusting to this change in your life?"
f f f f f f f f f f f f f f f f




c. "I hope you will feel better after getting accustomed to how this unit operates."
f f f f f f f f f f f f f f




d. "I'd like to sit with you for a while to help you get comfortable talking to me." - correct answer
f f f f f f f f f f f f f f f f f f f f f




ANS: D f




"Offering self" is a technique that should be used in the orientation phase of the nurse-patient
f f f f f f f f f f f f f f f f




relationship. Sitting with the patient, an example of "offering self," helps to build trust and f f f f f f f f f f f f f f f




convey that the nurse cares about the patient. Two incorrect responses are ineffective and
f f f f f f f f f f f f f f




non-therapeutic. The other incorrect response is therapeutic but is an example of "offering f f f f f f f f f f f f f




hope."

Which technique will best communicate to a patient that the nurse is interested in listening?
f f f f f f f f f f f f f f




a. Restating a feeling or thought the patient has expressed.
f f f f f f f f f




b. Asking a direct question, such as "Did you feel angry?"
f f f f f f f f f f




c. Making a judgment about the patient's problem.
f f f f f f f




d. Saying, "I understand what you're saying." - correct answer ANS: A
f f f f f f f f f f f




Restating allows the patient to validate the nurse's understanding of what has been f f f f f f f f f f f f f




communicated. Restating is an active listening technique. Judgments should be suspended f f f f f f f f f f f




in a nurse-patient relationship. Close-ended questions such as "Did you feel angry?" ask for
f f f f f f f f f f f f f f




specific information rather than showing understanding. When the nurse simply states that he
f f f f f f f f f f f f f

,or she understands the patient's words, the patient has no way of measuring the
f f f f f f f f f f f f f f




understanding.

A patient discloses several concerns and associated feelings. If the nurse wants to seek
f f f f f f f f f f f f f f




clarification, which comment would be appropriate? f f f f f




a. "What are the common elements here?"
f f f f f f




b. "Tell me again about your experiences."
f f f f f f




c. "Am I correct in understanding that . . ."
f f f f f f f f f




d. "Tell me everything from the beginning." - correct answer ANS: C
f f f f f f f f f f f




Asking, "Am I correct in understanding that..." permits clarification to ensure that both the f f f f f f f f f f f f f f




nurse and patient share mutual understanding of the communication. Asking about common
f f f f f f f f f f f f




elements encourages comparison rather than clarification. The remaining responses are f f f f f f f f f f




implied questions that suggest the nurse was not listening. f f f f f f f f




A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most
f f f f f f f f f f f f f f f f f f




therapeutic response. f




a. "Don't talk that way. Of course you will leave here!"
f f f f f f f f f f




b. "Keep up the good work, and you certainly will."
f f f f f f f f f




c. "You don't think you're making progress?"
f f f f f f




d. "Everyone feels that way sometimes." - correct answer ANS: C
f f f f f f f f f f




By asking if the patient does not believe that progress has been made, the nurse is reflecting by
f f f f f f f f f f f f f f f f f f




putting into words what the patient is hinting. By making communication more explicit, issues
f f f f f f f f f f f f f f




are easier to identify and resolve. The remaining options are non-therapeutic techniques.
f f f f f f f f f f f f




Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at
f f f f f f f f f f f f f f f f f




times minimizes feelings. Telling the patient that good work will always result in success is
f f f f f f f f f f f f f f f




falsely reassuring. f




Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient f f f f f f f f f f f




fidgeted and tapped left foot, periodically covered face with hands, and looked under chair f f f f f f f f f f f f f f




while stating, 'I enjoy spending time with you.'" Which analysis is most accurate?
f f f f f f f f f f f f




a. The patient is giving positive feedback about the nurse's communication techniques.
f f f f f f f f f f f




b. The nurse is viewing the patient's behavior through a cultural filter.
f f f f f f f f f f f




c. The patient's verbal and nonverbal messages are incongruent.
f f f f f f f f




d. The patient is demonstrating psychotic behaviors. - correct answer ANS: C
f f f f f f f f f f f




When a verbal message is not reinforced with nonverbal behavior, the message is confusing
f f f f f f f f f f f f f f




and incongruent. Some clinicians call it a "mixed message." It is inaccurate to say that the
f f f f f f f f f f f f f f f f




patient is giving positive feedback about the nurse's communication techniques. The concept
f f f f f f f f f f f f




of a cultural filter is not relevant to the situation because a cultural filter determines what we will
f f f f f f f f f f f f f f f f f f




pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the
f f f f f f f f f f f f f f f f f




patient is demonstrating psychotic behaviors. f f f f




While talking with a patient diagnosed with major depression, a nurse notices the patient is
f f f f f f f f f f f f f f f




unable to maintain eye contact. The patient's chin lowers to the chest, while the patient looks at
f f f f f f f f f f f f f f f f f




the floor. Which aspect of communication has the nurse assessed?
f f f f f f f f f




a. Nonverbal communication
f f f




b. A message filter
f f f

, c. A cultural barrier
f f f




d. Social skills - correct answer ANS: A
f f f f f f f




Eye contact and body movements are considered nonverbal communication. There are
f f f f f f f f f f f




insufficient data to determine the level of the patient's social skills or whether a cultural barrier f f f f f f f f f f f f f f f f




exists.

During the first interview with a parent whose child died in a car accident, the nurse feels
f f f f f f f f f f f f f f f f f




empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's f f f f f f f f f f f f f f f f




behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express
f f f f f f f f f f f f f f f




feelings.
b. The gesture is premature. The patient's cultural and individual interpretation of touch is
f f f f f f f f f f f f f f




unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
f f f f f f f f f f f




d. The action is inappropriate. Psychiatric patients should not be touched. - correct answer
f f f f f f f f f f f f f f




ANS: B f




Touch has various cultural and individual interpretations. Nurses should refrain from using
f f f f f f f f f f f f




touch until an assessment can be made regarding the way in which the patient will perceive
f f f f f f f f f f f f f f f f




touch. The other options present prematurely drawn conclusions. f f f f f f f




During a one-on-one interaction with the nurse, a patient frequently looks nervously at the
f f f f f f f f f f f f f f




door. Select the best comment by the nurse regarding this nonverbal communication.
f f f f f f f f f f f




a. "I notice you keep looking toward the door."
f f f f f f f f




b. "This is our time together. No one is going to interrupt us."
f f f f f f f f f f f f




c. "It looks as if you are eager to end our discussion for today."
f f f f f f f f f f f f f




d. "If you are uncomfortable in this room, we can move someplace else." - correct answer ANS:
f f f f f f f f f f f f f f f f f




A
Making observations and encouraging the patient to describe perceptions are useful f f f f f f f f f f f




therapeutic communication techniques for this situation. The other responses are f f f f f f f f f f




assumptions made by the nurse. f f f f




A black patient says to a white nurse, "There's no sense talking. You wouldn't understand
f f f f f f f f f f f f f f f




because you live in a white world." The nurse's best action would be to: f f f f f f f f f f f f f




a. explain, "Yes, I do understand. Everyone goes through the same experiences."
f f f f f f f f f f f




b. say, "Please give an example of something you think I wouldn't understand."
f f f f f f f f f f f f




c. reassure the patient that nurses interact with people from all cultures.
f f f f f f f f f f f




d. change the subject to one that is less emotionally disturbing. - correct answer ANS: B
f f f f f f f f f f f f f f f




Having the patient speak in specifics rather than globally will help the nurse understand the
f f f f f f f f f f f f f f f




patient's perspective. This approach will help the nurse engage the patient. Reassurance and f f f f f f f f f f f f f




changing the subject are not therapeutic techniques. f f f f f f




A Filipino American patient had a nursing diagnosis of situational low self-esteem related to
f f f f f f f f f f f f f f




poor social skills as evidenced by lack of eye contact. Interventions were used to raise the
f f f f f f f f f f f f f f f f




patient's self-esteem, but after 3 weeks, the patient's eye contact did not improve. What is the f f f f f f f f f f f f f f f f




most accurate analysis of this scenario? f f f f f