NR548 COMPREHENSIVE CERTIFICATION
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● Therapeutic Alliance
Answer: a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be
compromised
• interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
●● Creating rapport: tips
Answer: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
,●● How to approach threatening topics (sensitive/embarrassing
material)
Answer: -Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
●● Normalization
Answer: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2. Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or thinking
that strangers are laughing at them. Has that been happening to you?
●● Symptom Expectation
,Answer: communicate that a behavior is in some way normal or
expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient may
be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use
symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
●● Symptom Exaggeration
Answer: suggesting a frequency of a problematic behavior that is higher
than your expectation, so that the patient feels that their actual, lower
frequency of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
●● Reduction of guilt
, Answer: seeks to directly reduce a patient's guilt about a specific
behavior in order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial
behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were
affected?"
• If patient answers "yes," you can flesh out whether role was being a
witness, victim, or perpetrator
●● According to Peplau's Theory of Interpersonal Relations, establishing
early rapport allows the role of the nurse to evolve from stranger to:
Answer: resource person, teacher, leader, surrogate, technical expert, and
counselor
●● Establishing the Relationship
Answer: -Trust is essential for a therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is
comfortable
-Ask general questions to arrive at an empathic understanding of how
the client feels
EVALUATION VERIFIED QUESTIONS AND
FULL SOLUTIONS
●● Therapeutic Alliance
Answer: a feeling that you should create over the course of the
diagnostic interview, a sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be
compromised
• interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
●● Creating rapport: tips
Answer: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
,●● How to approach threatening topics (sensitive/embarrassing
material)
Answer: -Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
●● Normalization
Answer: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2. Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or thinking
that strangers are laughing at them. Has that been happening to you?
●● Symptom Expectation
,Answer: communicate that a behavior is in some way normal or
expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient may
be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use
symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
●● Symptom Exaggeration
Answer: suggesting a frequency of a problematic behavior that is higher
than your expectation, so that the patient feels that their actual, lower
frequency of the behavior will not be perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
●● Reduction of guilt
, Answer: seeks to directly reduce a patient's guilt about a specific
behavior in order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial
behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were
affected?"
• If patient answers "yes," you can flesh out whether role was being a
witness, victim, or perpetrator
●● According to Peplau's Theory of Interpersonal Relations, establishing
early rapport allows the role of the nurse to evolve from stranger to:
Answer: resource person, teacher, leader, surrogate, technical expert, and
counselor
●● Establishing the Relationship
Answer: -Trust is essential for a therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is
comfortable
-Ask general questions to arrive at an empathic understanding of how
the client feels
