ESSENTIALS OF PSYCHIATRIC NURSING,
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1 — Chapter & Subtopic: Chapter 1 — Foundations of
Psychiatric Nursing: Therapeutic Relationship, Boundaries
Type: Conceptual recall
Stem: A newly assigned nurse notices a client discloses frequent
personal phone conversations and offers gifts. Which nurse
behavior best demonstrates maintaining professional
boundaries in the therapeutic relationship?
Options:
A. Accept gifts and ask about the client's family to build rapport.
B. Politely decline gifts and explain limits of the professional
role.
C. Share similar personal problems to normalize the client's
feelings.
D. Exchange personal phone numbers to continue support after
discharge.
,Correct Answer: B
Rationale — Correct: Politely declining gifts and explaining role
limits preserves professional boundaries and therapeutic trust.
(Maintaining boundaries supports safety and effective care.)
Rationales — Incorrect:
A. Accepting gifts may blur boundaries and could create
obligation or favoritism.
C. Self-disclosure of personal problems risks shifting focus from
client to nurse.
D. Exchanging personal phone numbers violates professional
limits and confidentiality.
NCLEX/HESI applicability: Links to Safe and Effective Care
Environment — Professionalism, therapeutic communication,
and boundary management.
Teaching Point: Clear limits protect clients and the therapeutic
relationship.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Relationship, Professional Boundaries.
2 — Chapter & Subtopic: Chapter 1 — Therapeutic
Communication: Active Listening & Reflection
Type: Application
Stem: A client cries while saying, “I feel worthless and nobody
cares.” Which nurse response best uses therapeutic
communication?
Options:
,A. “Don’t say that — you have a lot going for you.”
B. “I understand; feeling worthless must be painful.”
C. “Maybe if you tried harder people would care.”
D. “You’ll be fine; look on the bright side.”
Correct Answer: B
Rationale — Correct: A reflective, empathic statement validates
feelings and encourages further disclosure—core therapeutic
communication.
Rationales — Incorrect:
A. Minimizes feelings and blocks communication.
C. Blames the client and is nontherapeutic.
D. False reassurance which can invalidate pain and reduce trust.
NCLEX/HESI applicability: Psychosocial Integrity — Therapeutic
communication and therapeutic relationship.
Teaching Point: Reflective empathy fosters safety and
engagement.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Communication.
3 — Chapter & Subtopic: Chapter 2 — Milieu Therapy & Unit
Safety
Type: Clinical scenario
Stem: On an inpatient psychiatric unit after admission, a client
becomes verbally aggressive and bangs a chair. The nurse’s
priority action should be:
Options:
, A. Immediately initiate physical restraint.
B. Remove other clients from immediate area and use verbal
de-escalation.
C. Ignore the behavior to avoid reinforcing attention-seeking.
D. Administer a PRN sedative without attempting de-escalation.
Correct Answer: B
Rationale — Correct: Protecting safety by removing others and
attempting verbal de-escalation follows least restrictive
approaches in milieu management.
Rationales — Incorrect:
A. Restraint is last resort after de-escalation and safety
measures.
C. Ignoring a safety threat risks harm to client and others.
D. Medication without de-escalation and assessment can be
inappropriate and coercive.
NCLEX/HESI applicability: Safety — Safe and effective care
environment; crisis intervention and least-restrictive measures.
Teaching Point: Safety first: de-escalate, protect others, escalate
interventions only as needed.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 2:
Milieu Therapy and Safety.
4 — Chapter & Subtopic: Chapter 3 — Psychiatric Assessment:
Mental Status Exam (MSE)
Type: Conceptual recall
Stem: During the mental status exam, which observation best
3RD EDITION
MARY ANN BOYD; REBECCA LUEBBERT
TEST BANK
1 — Chapter & Subtopic: Chapter 1 — Foundations of
Psychiatric Nursing: Therapeutic Relationship, Boundaries
Type: Conceptual recall
Stem: A newly assigned nurse notices a client discloses frequent
personal phone conversations and offers gifts. Which nurse
behavior best demonstrates maintaining professional
boundaries in the therapeutic relationship?
Options:
A. Accept gifts and ask about the client's family to build rapport.
B. Politely decline gifts and explain limits of the professional
role.
C. Share similar personal problems to normalize the client's
feelings.
D. Exchange personal phone numbers to continue support after
discharge.
,Correct Answer: B
Rationale — Correct: Politely declining gifts and explaining role
limits preserves professional boundaries and therapeutic trust.
(Maintaining boundaries supports safety and effective care.)
Rationales — Incorrect:
A. Accepting gifts may blur boundaries and could create
obligation or favoritism.
C. Self-disclosure of personal problems risks shifting focus from
client to nurse.
D. Exchanging personal phone numbers violates professional
limits and confidentiality.
NCLEX/HESI applicability: Links to Safe and Effective Care
Environment — Professionalism, therapeutic communication,
and boundary management.
Teaching Point: Clear limits protect clients and the therapeutic
relationship.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Relationship, Professional Boundaries.
2 — Chapter & Subtopic: Chapter 1 — Therapeutic
Communication: Active Listening & Reflection
Type: Application
Stem: A client cries while saying, “I feel worthless and nobody
cares.” Which nurse response best uses therapeutic
communication?
Options:
,A. “Don’t say that — you have a lot going for you.”
B. “I understand; feeling worthless must be painful.”
C. “Maybe if you tried harder people would care.”
D. “You’ll be fine; look on the bright side.”
Correct Answer: B
Rationale — Correct: A reflective, empathic statement validates
feelings and encourages further disclosure—core therapeutic
communication.
Rationales — Incorrect:
A. Minimizes feelings and blocks communication.
C. Blames the client and is nontherapeutic.
D. False reassurance which can invalidate pain and reduce trust.
NCLEX/HESI applicability: Psychosocial Integrity — Therapeutic
communication and therapeutic relationship.
Teaching Point: Reflective empathy fosters safety and
engagement.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 1:
Therapeutic Communication.
3 — Chapter & Subtopic: Chapter 2 — Milieu Therapy & Unit
Safety
Type: Clinical scenario
Stem: On an inpatient psychiatric unit after admission, a client
becomes verbally aggressive and bangs a chair. The nurse’s
priority action should be:
Options:
, A. Immediately initiate physical restraint.
B. Remove other clients from immediate area and use verbal
de-escalation.
C. Ignore the behavior to avoid reinforcing attention-seeking.
D. Administer a PRN sedative without attempting de-escalation.
Correct Answer: B
Rationale — Correct: Protecting safety by removing others and
attempting verbal de-escalation follows least restrictive
approaches in milieu management.
Rationales — Incorrect:
A. Restraint is last resort after de-escalation and safety
measures.
C. Ignoring a safety threat risks harm to client and others.
D. Medication without de-escalation and assessment can be
inappropriate and coercive.
NCLEX/HESI applicability: Safety — Safe and effective care
environment; crisis intervention and least-restrictive measures.
Teaching Point: Safety first: de-escalate, protect others, escalate
interventions only as needed.
Cite: Essentials of Psychiatric Nursing, 3rd Ed. — Chapter 2:
Milieu Therapy and Safety.
4 — Chapter & Subtopic: Chapter 3 — Psychiatric Assessment:
Mental Status Exam (MSE)
Type: Conceptual recall
Stem: During the mental status exam, which observation best
