Chapter 09: Working With an Individual Patient
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. A patient is hospitalized for severe depression. Knowing that the patient will be discharged after
a short stay, what is the nurse‘s first priority?
a. Maximize the benefits of milieu management.
b. Immediately begin to explore acute patient issues.
c. Develop a goal-directed, problem-centered relationship.
d. Choose a specific theoretical model as the basis for care.
ANS: C
Therapeutic relationships are planned, patient-centered, and goal-directed. This is of particular
importance if progress is to be made when the duration of the relationship will be brief. The
other options are not the priority. Exploration of patient issues requires trust development before
it can proceed.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
2. A nurse tells a patient, ―I know how you feel. My spouse can be very insensitive too. I am
also considering divorce.‖ What behavior is the nurse demonstrating?
a. Inappropriate self-disclosing
b. Countertransference
c. Establishment of trust with the patient
d. Encouraging the patient to express negative feelings
ANS: A
, Brief self-disclosure is used to help the patient clarify specific issues, to feel less vulnerable, or
to feel more ―normal.‖ When used appropriately, self-disclosure benefits the patient. When used
inappropriately, it benefits the nurse. In this case, the self-disclosure burdens the patient with the
nurse‘s problems. Empathy focuses on the patient. Countertransference would result in different
behaviors. Encouraging expression of negative feelings would be more direct.
DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
3. A patient diagnosed with schizophrenia says to the nurse, ―I feel really close to you. You‘re
the only true friend I have.‖ What is the nurse‘s most therapeutic response?
a. ―We are not friends. Our relationship is a professional one.‖
b. ―I feel sure there are other friends in your life. Can you name some?‖
c. ―I am glad you trust me. Trust is important for the work we are doing together.‖
d. ―Our relationship is professional, but let‘s explore ways to strengthen personal friendships.‖
ANS: D
The patient‘s remarks call for the nurse to remind the patient of the parameters of their
relationship and take the opportunity to discuss the issue of friends. Only this option incorporates
both desired elements.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
4. What statement made by a nursing is most helpful when moving into the working stage of a
therapeutic relationship with a patient?
a. ―I want to be helpful to you as we explore your problems and the way you express
feelings.‖
b. ―A good long-term goal for someone your age would be to develop better job-related skills.‖
c. ―Of the problems we have discussed so far, which ones would you most like to
work on at this time?‖
d. ―When someone gives you a compliment, I notice that you become very quiet and
, appear uncomfortable.‖
ANS: C
With this remark, the nurse seeks patient collaboration and offers the opportunity to set priorities
for the work toward change that will be undertaken. The distracters relate to the orientation stage.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. Which goal statement is most appropriate for a newly admitted patient currently in the orientation
stage of the nurse-patient relationship?
a. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate
greater independence.
b. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate
increased self-responsibility.
c. By the end of the orientation stage of the therapeutic relationship, the patient will
Steele: Keltner’s Psychiatric Nursing,
MULTIPLE CHOICE
1. A patient is hospitalized for severe depression. Knowing that the patient will be discharged after
a short stay, what is the nurse‘s first priority?
a. Maximize the benefits of milieu management.
b. Immediately begin to explore acute patient issues.
c. Develop a goal-directed, problem-centered relationship.
d. Choose a specific theoretical model as the basis for care.
ANS: C
Therapeutic relationships are planned, patient-centered, and goal-directed. This is of particular
importance if progress is to be made when the duration of the relationship will be brief. The
other options are not the priority. Exploration of patient issues requires trust development before
it can proceed.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation
MSC: Client Needs: Safe, Effective Care Environment
2. A nurse tells a patient, ―I know how you feel. My spouse can be very insensitive too. I am
also considering divorce.‖ What behavior is the nurse demonstrating?
a. Inappropriate self-disclosing
b. Countertransference
c. Establishment of trust with the patient
d. Encouraging the patient to express negative feelings
ANS: A
, Brief self-disclosure is used to help the patient clarify specific issues, to feel less vulnerable, or
to feel more ―normal.‖ When used appropriately, self-disclosure benefits the patient. When used
inappropriately, it benefits the nurse. In this case, the self-disclosure burdens the patient with the
nurse‘s problems. Empathy focuses on the patient. Countertransference would result in different
behaviors. Encouraging expression of negative feelings would be more direct.
DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation
MSC: Client Needs: Safe, Effective Care Environment
3. A patient diagnosed with schizophrenia says to the nurse, ―I feel really close to you. You‘re
the only true friend I have.‖ What is the nurse‘s most therapeutic response?
a. ―We are not friends. Our relationship is a professional one.‖
b. ―I feel sure there are other friends in your life. Can you name some?‖
c. ―I am glad you trust me. Trust is important for the work we are doing together.‖
d. ―Our relationship is professional, but let‘s explore ways to strengthen personal friendships.‖
ANS: D
The patient‘s remarks call for the nurse to remind the patient of the parameters of their
relationship and take the opportunity to discuss the issue of friends. Only this option incorporates
both desired elements.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
4. What statement made by a nursing is most helpful when moving into the working stage of a
therapeutic relationship with a patient?
a. ―I want to be helpful to you as we explore your problems and the way you express
feelings.‖
b. ―A good long-term goal for someone your age would be to develop better job-related skills.‖
c. ―Of the problems we have discussed so far, which ones would you most like to
work on at this time?‖
d. ―When someone gives you a compliment, I notice that you become very quiet and
, appear uncomfortable.‖
ANS: C
With this remark, the nurse seeks patient collaboration and offers the opportunity to set priorities
for the work toward change that will be undertaken. The distracters relate to the orientation stage.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
5. Which goal statement is most appropriate for a newly admitted patient currently in the orientation
stage of the nurse-patient relationship?
a. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate
greater independence.
b. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate
increased self-responsibility.
c. By the end of the orientation stage of the therapeutic relationship, the patient will
