Lone Star College System, North Harris - PSYC 1301

Chapter 2: Therapeutic Nurse-Patient Relationship Test Bank

MULTIPLE CHOICE

1)A novice nurse states, “Psychiatric nursing can’t be very difficult. After all, I believe in showing care and in mutual exchange with my friends.” The experienced nurse’s understanding of the difference between a social and a therapeutic relationship is primarily based on the:

1. 1. kind of information given.
   2. amount of emotion invested.
   3. degree of satisfaction obtained.
   4. type of responsibility involved.

2.

The diagram above is a Johari window that a nurse thinks is accurately self-representative. If the nurse wishes to be more successful in psychiatric nursing, the nurse should make an initial goal to increase the size of quadrant:

1. 1.
2. 2.
3. 3.
4. 4.

3. Which strategy can the nursing student use to foster authenticity in therapeutic relationships with patients?
   1. Reading and discussing textbook assignments with a study group
   2. Modeling behaviors with patients on the behaviors of a clinically competent staff nurse
   3. Attending patient-centered clinical conferences on the assigned psychiatric inpatient unit
   4. Analyzing feelings associated with psychiatric clinical experience with the help of instructors and peers

4. A person who has always wished to care for “special children” adopts a biracial child and another child who has spina bifida. What is the highest step of the value clarification process that this person has achieved?
   1. Doing something with the choice in a pattern of life
   2. Choosing freely from alternatives
   3. Being happy with the choice
   4. Affirming the choice publicly

5. A nurse makes observations that a depressed patient is more energetic and is smiling much more. Still, the nurse shares with the unit manager that when thinking about the patient a sense of hopelessness surfaces. The nurse manager replies:
   1. “Sometimes it’s best to disregard subjective perceptions like that and focus on the objective signs.”
   2. “Pay attention to your feelings. They can provide valuable clues about the patient’s feelings.”
   3. “You should share your perceptions with the patient and seek an explanation.”
   4. “Confrontation can be a useful tool in situations like this.”

6. A new nurse has the following thoughts: “How will I handle things if my patient walks away from me? How will I react if the patient is sexually provocative? How will I cope with a patient who cries?” These thoughts indicate that the nurse is engaged in:
   1. role modeling.
   2. self-exploration.
   3. altruistic thinking.
   4. value clarification.

7. A nurse’s most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to:
   1. examine personal feelings about homosexuality.
   2. review the literature that pertains to the human sexual response.
   3. attempt to identify the underlying reasons for the patient’s values.
   4. focus on a method to assist the patient with changing personal sexual values.

8. A nurse engaged in the preinteraction phase of the nurse-patient relationship will:
   1. consider what he or she has to offer the patient.
   2. form a workable but detailed contract.
   3. review the general goals of a therapeutic relationship.
   4. plan for the first interaction with the patient.
   5. identify existing stressors affecting the relationship.

9. When asked to contrast social superficiality with therapeutic intimacy, an experienced nurse mentor explains to a new nurse that the termination component in therapeutic intimacy is:
   1. unknown.
   2. open-ended.
   3. specified and agreed to.
   4. closed to negotiation or agreement.

10. Which task would be most appropriate to focus on during the introductory phase of work with a teenage patient with low self-esteem?
    1. Mutual formulation of a contract
    2. Nurse’s self-analysis of strengths
    3. Promotion of patient use of constructive coping mechanisms
    4. Review of progress of therapy and goal attainment with patient

11. A patient admitted with a diagnosis of schizophrenia, paranoid type, coldly tells a nurse during the admission interview, “I am here because my family brought me here and locked me up.” The nurse’s best response would be:
    1. “How has hospitalization affected your life?”
    2. “Do you feel angry or resentful about being hospitalized?”
    3. “I see you are angry about being here. I hope that after we talk you will feel differently.”
    4. “We are here to protect you and see that you do not harm yourself or others in your anger.”

12. A patient is admitted to the unit and complains of being depressed. The patient says, “I want to feel like my old self again.” Which nursing response will be most therapeutic?
    1. “How long have you felt this way?”
    2. “We’re all here to help you get better.”

1. 3. “What do you think the hospital can do for you?”
   4. “Tell me more so that I can better understand.”

13. In the initial sessions a patient frequently asks the nurse for money and expresses doubt about the nurse’s ability to help. Which principle provides guidance for the nurse in this situation?
    1. This behavior is typical of transference reactions.
    2. All patients have feelings of insecurity and low self-esteem.
    3. Manipulative behavior is part of this patient’s psychopathology.
    4. Testing behavior is common during the introductory phase of a relationship.

14. A young adult has been receiving treatment for an anxiety disorder. Which statement by the patient confirms that the nurse and patient are most likely entering the terminal phase of the therapeutic relationship?
    1. “My anxiety seems to be a result of having so much to get done.”
    2. “I don’t know whether I’ll be able to handle things alone.”
    3. “I can’t seem to be able to manage going to school and working.”
    4. “I need to find a way that can help me manage my anxiety.”

15. A psychiatric nurse will recognize which action as demonstration of resistance behavior?
    1. Regularly referring to himself as a “loser”
    2. Becoming tearful during every therapy session about abuse
    3. Asking to postpone a therapy session until after visiting hours
    4. Consistently describing his drug use as starting “a little while ago”

16. During the working phase of the relationship, the nurse assesses that the patient may be demonstrating resistance. The most appropriate way to deal with this would be to:
    1. assist the patient in exploring his or her past for uncovered issues and conflicts.
    2. clarify, share observations, and reflect content and feelings with the patient.
    3. confront the patient with the behavior and state, “You will be expected to work harder.”
    4. avoid mentioning the therapeutic barrier and wait until the patient again indicates readiness.

17. A patient reports seeing a “frightening” face on the wall of the dayroom. A nurse attempts to calm her by providing an explanation for the flawed perception of what she saw. The nurse would implement this strategy by stating:
    1. “Let’s see if anyone else has seen those frightening faces on the walls of the dayroom.”
    2. “The shadows of the tree outside the window make strange shapes on the dayroom walls.”
    3. “Have you ever seen frightening faces like that on the dayroom walls before today?”
    4. “Did someone in the dayroom tell you there were frightening faces on the walls?”

18. A patient says to a nurse, “My spouse and I get along just fine. We usually agree on everything.” The nurse observes nonverbal communication that disagrees with what the patient has verbally communicated. Which of the patient’s actions is incongruent with her statement?
    1. Getting up from her chair while making the statement

1. 2. Walking toward the nurse while talking about her spouse
   3. Staring down at her shoes during the conversation
   4. Smiling while talking with the nurse

19. A nurse tells a patient who is feeling guilty about an infidelity to call the spouse and beg for forgiveness. According to the transactional model of communication, the nurse’s response originated from which state?
    1. Adult
    2. Child
    3. Parent
    4. Complementary

20. According to transactional analysis theory, when a patient finally recognizes the importance of being medication-compliant, which type of transaction has occurred?
    1. Ulterior
    2. Crossed
    3. Incongruent
    4. Complementary

21. When the nurse suggests the patient communicate to her employer how overwhelmed she is by the workload, the patient responds, “Yes but I’ll get fired if I do that.” According to transactional analysis theory, this is an example of a(n)                                  transaction.
    1. ulterior
    2. crossed
    3. congruous
    4. complementary

22. A patient who is currently in an abusive marriage shares, “Some days I think it’s just not worth it. I’d be better off if we separated.” The nurse uses restating as a therapeutic communication technique when responding:
    1. “Are you sure you are ready to be on your own?”
    2. “Can I help you work on a safe, realistic plan to leave?”
    3. “You think you would be better off without your spouse?”
    4. “How much thought have you given to leaving the marriage?”

23. When a patient is late for three consecutive therapy sessions, the nurse implements perception sharing as a communication technique when stating:
    1. “You say how important therapy is to you, but you can’t seem to get here on time.”
    2. “Do you think it’s polite being late for therapy sessions like this?”
    3. “Do you have really good reasons for being late so often?”
    4. “I feel that you aren’t ready to work on your problems.”

24. The therapeutic communication technique of suggesting is appropriate to use when it:
    1. meets the patient’s unmet dependency needs.
    2. shifts responsibility from the patient to the health care professional.
    3. is used during the working stage to present alternative coping strategies.
    4. is used early in the nurse-patient relationship to provide sound, everyday advice.

25. A teenager being treated for oppositional defiance behavior states: “I wish my parents would stop treating me like an irresponsible child.” The nurse implements confrontation as a therapeutic technique when responding:
    1. “How can they treat you like an adult when you are only a teenager?”
    2. “You want to be treated like an adult, but is it adult-like when you skip school?”
    3. “Your parents have a legal responsibility to care for you until you are eighteen.”
    4. “Your parents are worried about giving you more freedom than you can handle.”

26. Which statement is true of planning the timing for the use of confrontation?
    1. Confrontation should never be used during the orientation phase of the relationship.
    2. Confrontation is useful during the working phase to focus on specific patient discrepancies.
    3. Confront patients with their limitations early in the relationship and with their assets later in therapy.
    4. Confront patients when other therapeutic action dimensions have proven ineffective.

27. The nurse suspects that a client has a problem with the action dimension of immediacy when she states, “You can’t tell people very much about yourself; it gives them too much power over you.” The nurse responds:
    1. “It sounds as though people have tried to control you inappropriately in the past.”
    2. “It’s reasonable for you to be suspicious of me until I’ve earned your trust.”
    3. “Allowing yourself to trust people will be a step toward getting well.”
    4. “It appears that you aren’t ready to discuss your problems yet.”