University of San Francisco - NURS 320

Chapter 09: Working With an Individual Patient Keltner: Psychiatric Nursing, 8th Edition

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?

1. 1. Maximize the benefits of milieu management.
   2. Immediately begin to explore acute patient issues.
   3. Develop a goal-directed, problem-centered relationship.
   4. Choose a specific theoretical model as the basis for care.

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?
   1. Inappropriate self-disclosing
   2. Countertransference

1. 3. Establishment of trust wiNth thRe pIatieGnt

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?
   1. “We are not friends. Our relationship is a professional one.”
   2. “I feel sure there are other friends in your life. Can you name some?”
   3. “I am glad you trust me. Trust is important for the work we are doing together.”
   4. “Our relationship is professional, but let’s explore ways to strengthen personal friendships.”

4. What statement made by a nursing is most helpful when moving into the working stage of a therapeutic relationship with a patient?
   1. “I want to be helpful to you as we explore your problems and the way you express feelings.”
   2. “A good long-term goal for someone your age would be to develop better job-related skills.”
   3. “Of the problems we have discussed so far, which ones would you most like to work on at this time?”
   4. “When someone gives you a compliment, I notice that you become very quiet and appear uncomfortable.”

5. Which goal statement is most appropriate for a newly admitted patient currently in the orientation stage of the nurse-patient relationship?
   1. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate greater independence.
   2. By the end of the orientation    relationship, the patient will

demonstrate increased self-responsibility.

1. 3. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate trust and rapport with two staff members.
   4. By the end of the orientation stage of the therapeutic relationship, the patient will demonstrate ability to problem-solve one issue.

6. A patient is withdrawn and avoids talking to the nurse. The nurse should identify which action is the initial intervention for this patient?
   1. Extend a respectful offer to listen and help.
   2. Directly ask why the patient does not wish to talk.
   3. Involve the patient in a group activity to decrease isolation.
   4. Respect the patient’s desire not to talk by leaving the patient alone.

7. A patient has identified the need for better anger management and tells the nurse, “I’m afraid that someday I might explode.” What is the best strategy for reducing this patient’s fear of losing control?
   1. Talking about these feelings openly and directly
   2. Discussing feelings in general without reference to the patient
   3. Avoiding any discussion concerning feelings until the patient feels comfortable
   4. Reassuring the patient that expressing feelings is the first step to resolving them

8. Which statement is most therapeutic when working with a patient believed to be experiencing emotional pain?
   1. “I hear how painful this is for you. I would like to help you deal with it.”
   2. “I’m so sorry this has Helper do you dont deserve it.”
   3. “What would you like me to do to help you through this pain?”
   4. “I don’t think this is as serious as you believe it is.”

9. A nurse and patient agree on problems to be addressed during a brief hospital stay. Which interpretation of this action is correct?
   1. The relationship is moving into the working stage.
   2. The nurse should reinforce messages about termination.
   3. The nurse needs to direct the patient to begin journaling.
   4. Management of emotions must be ensured before work can continue.

10. A patient with a history of self-mutilation says to the nurse, “I want to stop hurting myself.” What is the initial step of the problem-solving process to be taken toward resolution of a patient’s identified problem?
    1. Deciding on a plan of action
    2. Determining necessary changes
    3. Considering alternative behaviors
    4. Describing the problem or situation

11. A patient says, “I went out drinking only one time last week. At least I’m trying to change.” The nurse responds, “I appreciate your effort, but you agreed to abstain from alcohol completely.” The nurse’s response demonstrates the ability to manage what potential patient centered problem?
    1. Cognitive restructuring
    2. Manipulation

1. 3. Hostility
   4. Denial

12. A nurse and patient who developed a therapeutic relationship enter into the final phase of their relationship as the patient prepares for discharge. What is an important nursing intervention for this stage of the relationship?
    1. Providing structure and intensive support
    2. Informing the patient of the progress made
    3. Encouraging the patient to describe goals for change
    4. Discussing feelings about termination with the patient

13. Which statement by a patient would the nurse interpret as willingness to collaborate in the nurse-patient relationship?
    1. “I know you are here to help me, and will do whatever you tell me to do.”
    2. “I didn’t want to deal with this at first, but I’m glad you made me face it.”
    3. “I realize that I have some issues that I need help resolving.”
    4. “I will do anything to get out of this hospital.”

14. A novice nurse says, “I have more important things to do than play games with patients. These activities are not a worthwhile use of my time.” What is the nurse manager’s most

helpful response?

1. 1. “Games are part of the therapeutic milieu.”
   2. “Patients need a break from intensive individual therapy.”
   3. “Informal activities help patients develop social skills and take risks.”
   4. “Please review material on the psychotherapeutic management model.”

15. An inpatient says, “Last time I was here, a primary nurse talked with me every day. This time, different nurses work with me. How can I make progress?” Which nursing response best addresses the patient’s concern?
    1. “Your comments are interesting. With your permission I will share them with the treatment team.”
    2. “We are using a new system because of managed-care requirements. We are hopeful it will be effective.”

1. 3. “Shift reports, care plans, and progress notes help different nurses work with all patients toward their individual goals.”
   4. “It sounds like you are feeling dissatisfied with your care. After you are discharged, you will receive a form to provide feedback.”

16. Which nursing intervention will initially be most helpful for trust building with a suspicious patient?
    1. Enforcing rules
    2. Keeping appointments and promises
    3. Agreeing not to document the patient’s disclosures
    4. Openly challenging unclear statements by the patient

17. A patient shouts at a nurse who just entered the room, “You’re an incompetent fool. Leave me alone.” The nurse’s response should be based on which rationale?
    1. The anger was created by a situation or significant person, not the nurse.
    2. The reaction probably results from transference and countertransference.
    3. The patient is probably reacting to fear of loss of emotional control.
    4. The patient has a right to openly express negative feelings.

18. Which patient behavior would require the most immediate limit-setting by the nurse?
    1. The patient makes self-deprecating remarks.
    2. At a goal-setting meeting, the patient interrupts others to express delusions.
    3. A patient shouts at a roommate, “You are perverted! You watched me undress.”

1. 4. During dinner, a patient manipulates an older adult patient to obtain a second dessert.

19. A patient playing pool with another patient throws down the pool cue and begins swearing. What action should the nurse implement initially to address this situation?
    1. Asking other patients to leave the room
    2. Calling for assistance to restrain the patient
    3. Suggesting a time-out in the patient’s room
    4. Restating rules of the milieu related to swearing

20. A newly admitted patient tells the nurse, “The voices are bothering me.” What should be the nurse’s initial intervention?
    1. Ignoring the patient’s reference to voices
    2. Distracting the patient from the hallucinations
    3. Telling the patient that the voices do not exist
    4. Seeking a description of the voices to identify themes

21. What fact about a particular patient will have the greatest impact on nurse-patient collaboration?
    1. Involuntary admission
    2. Advance age

1. 3. Hallucinations
   4. Terminal diagnosis

22. A nurse considers interventions for a diabetic patient who needs to change eating habits and lose weight. The nurse will base strategies on which principle?
    1. The nurse’s primary responsibility is to encourage the change.
    2. Patient-initiated change is more successful than imposed change.
    3. For successful change, both the benefit and the risk to the patient must be high.
    4. Patients value advice from nurses because of the trusting dimensions of the relationship.

23. A psychotic patient tells the nurse, “Get away from me or I’ll hit you. You’re sucking the

thoughts out of my head.” To best de-escalate the situation, what intervention should the nurse implement?

1. 1. Directing the patient to a chair
   2. Deny taking the patient’s thoughts
   3. Increasing the distance between nurse and patient
   4. Telling the patient, “You will be restrained if you hit me”

24. The nurse caring for a hyperactive patient should identify what assessment as being the priority?
    1. Physical safety
    2. Emotional trauma
    3. Manipulative behaviors
    4. Feelings about the relationship

25. Assessment findings by the multidisciplinary team after a patient-intake interview are used primarily for what purpose?
    1. Confirm ongoing discharge planning.
    2. Expand and confirm the initial assessment.
    3. Verify the appropriateness of nursing diagnoses.
    4. Analyze the patient’s feelings about hospitalization.

26. Objective data obtained from family in an initial assessment of a patient are of particular value when which situation exists?
    1. The patient is too ill to participate.
    2. The patient’s admission is involuntary.
    3. Family members have admitted the patient
    4. The patient has been transferred from a subacute setting.

27. As the nurse plans care for a newly admitted patient, identification of dysfunctional behaviors will provide the focus for which component of the nursing process?
    1. Evaluation
    2. Nursing diagnosis
    3. Nursing interventions
    4. Outcome identification

28. A patient tells the nurse, “I was raped a month ago. Since then I’ve felt anxious and have been unable to talk normally to my husband. I’ve had frequent thoughts about cutting my wrists.” What is the priority nursing concern regarding this patient?
    1. The risk for self-directed violence
    2. The development of rape traumatic syndrome
    3. The damage that could result in poor self-esteem
    4. The demonstration of signs and symptoms of acute anxiety

29. When the nurse formulates nursing diagnoses, it is necessary to be specific in describing dysfunctional behaviors so as to demonstrate what desired outcome?
    1. The selection of appropriate desirable behaviors
    2. The analysis concerning the patient’s feeling at the time of assessment.
    3. The exploration of the context that precipitated the exacerbation of the illness.
    4. The determination of how the illness relates to the patient’s total life experience.

30. What activity would be involved in achieving an appropriate short-term goal for a patient diagnosed with situational low self-esteem?
    1. Writing a list of strengths, abilities, and talents
    2. Role-playing with others to improve social skills
    3. Replacing a negative self-image with a positive one
    4. Responding with positive self-esteem in all encounters

31. What is a realistic time frame for achievement of short-term goals for a patient who is newly admitted to the hospital?

1. 1. 1 to 2 days.
   2. 4 to 6 days.
   3. 1 to 2 weeks.
   4. 2 to 4 weeks.

32. A patient with suicidal ideation is hospitalized. What is the priority intervention?
    1. Negotiating a no-harm contract
    2. Facilitating attendance at groups
    3. Administering a psychotropic drug
    4. Determining the precipitating situation

33. A patient hospitalized for 6 days has made little progress toward outcomes written at the time of admission. The nurse decides that the lack of progress toward goals indicates a need for

what intervention?

1. 1. A reassessment
   2. Delayed discharge

1. 3. Incorrect nursing diagnoses
   4. Inaccurate nursing interventions

34. The nurse writing a discharge summary for a patient should include achievements as well as what additional information?
    1. Care plan updates
    2. A list of patient strengths
    3. Effective nursing interventions
    4. Outcomes that still need to be addressed

35. A student states, “I do not see the value of process recordings.” The response to this concern should be based on what information related to process recording?
    1. It is a tool for analyzing communication.
    2. It is a verbatim record of a patient interview.
    3. It is a legal document that becomes part of the medical record.
    4. It is a note written at the time of a patient interview to provide information to team members.

36. What is the most effective outcome for a nurse to include in the care plan for a withdrawn patient who says, “I would like to have more friends”? Within 3 days:
    1. the patient will be more outgoing.
    2. the patient will develop grater then
    3. the patient will participate in one group activity.
    4. the patient will increase socialization with others.

37. Following the admission interview, a spouse of a patient asks the nurse, “Why did you ask my partner all those questions? Some of them had nothing to do with the current problems.” The nurse’s best response is based on what assessment focus of the mental status examination (MSE)?
    1. The patient’s current status
    2. The complete family history
    3. The patient’s past experiences
    4. What the patient’s prognosis will be

38. The nurse performing a mental status examination wants to assess for hallucinations. The nurse should ask which question?
    1. “Can you tell me where you are now?”
    2. “Do you hear or see things when others don’t?”
    3. “Do your moods shift more than those of other people?”
    4. “What would you do if you found a stamped, addressed letter on the floor?”

39. During a mental status examination (MSE) a patient says, “I am a special messenger sent to provide the world a cure for cancer.” The patient’s statement indicates the presence of what form of dysfunctional thought content?
    1. Phobia
    2. Delusion
    3. Hypervigilance
    4. Loose associations

MULTIPLE RESPONSE

1. A psychiatric aide asks, “Can you give me some examples of how we provide structure for patients?” The nurse should offer which suggestions? (Select all that apply.)
   1. Set limits on destructive behavior.
   2. Direct a patient to go to a quiet place.
   3. Sit with a withdrawn, isolated patient.
   4. Distract a patient who is hallucinating.
   5. Help a patient contemplate needed change.