Test Bank Principles and Practices Psychiatric Nursing 9th Stuart

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Test Bank Principles and Practices Psychiatric Nursing 9th Stuart

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Stuart: Principles and Practice of Psychiatric Nursing, 9th Edition

Chapter 02: 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 formulates a reply based on knowledge of the difference between a social and a therapeutic relationship with emphasis on:
1. the kind of information given.
2. the amount of emotion invested.
3. the degree of satisfaction obtained.
4. the type of responsibility involved.

ANS: 4
Social and therapeutic relationships both involve the giving of information, emotional investment, and personal satisfaction. These aspects all have differences, but they are minor in comparison with the difference in responsibility that exists between social and therapeutic relationships. In the therapeutic relationship the nurse has both ethical and legal responsibilities to the patient; these responsibilities do not exist in the social relationship.

DIF: Cognitive Level: Application
REF: Text Page: 13
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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:
1. quadrant 1.
2. quadrant 2.
3. quadrant 3.
4. quadrant 4.

ANS: 1
Quadrant 1 is the open quadrant; it includes the behaviors, feelings, and thoughts known to the individual and others. The smaller an individual’s quadrant 1, the poorer the communication of that individual. The goal of increasing self-awareness is to enlarge the area of quadrant 1 and reduce the size of the other three quadrants.

DIF: Cognitive Level: Application
REF: Text Page: 15
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

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

ANS: 4
Nursing students have many new experiences that provide opportunities for self-learning. Nurses should focus on and discuss the feelings related to these experiences. Instructors and peers can help students by facilitating self-awareness during these discussions; self-awareness contributes to authenticity.

DIF: Cognitive Level: Application
REF: Text Page: 15
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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

ANS: 1
The highest level of value clarification is acting in a pattern. Adopting two “special children” is affirmation of a pattern. Acting follows choosing and prizing in the sequence of value clarification.

DIF: Cognitive Level: Comprehension
REF: Text Page: 16
TOP: Nursing Process: N/A
MSC: NCLEX: Psychosocial Integrity

5. A nurse who is working with a patient diagnosed with major depression remarks, “My patient seems to be affectively brighter and to have more energy, yet I am struck by a sense of hopelessness and despair when I think about the patient.” The best advice to give this nurse would be:
1. “Sometimes it’s best to ignore perceptions like that and focus on the objective signs.”
2. “Pay attention to your feelings. They are a valuable clue about the patient’s feelings.”
3. “You should share your perceptions with the patient and seek an explanation.”
4. “Confrontation is a useful tool in situations like this.”

ANS: 2
The feelings that nurses have serve an important purpose. They are valuable clues about the patient’s problems, and they are barometers for feedback about the nurses themselves and their relationships with others.

DIF: Cognitive Level: Application
REF: Text Page: 17
TOP: Nursing Process: N/A
MSC: NCLEX: Psychosocial Integrity

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.

ANS: 2
Self-exploration leads to the development of self-awareness, and it is essential that the nurse be self-aware to learn to deal with anxiety, anger, sadness, and joy in helping patients through the health-illness continuum.

DIF: Cognitive Level: Application
REF: Text Pages: 17-18
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

7. A nurse’s most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to:
1. examine his or her own 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 his or her sexual values.

ANS: 1
Self-examination is a task of the preinteraction phase of a relationship. This is especially important if the value systems of the nurse and patient are known to be different.

DIF: Cognitive Level: Application
REF: Text Page: 18
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

8. A nurse who has considered what he or she has to offer a patient, reviewed the general goals of a therapeutic relationship, and planned for the first interaction with the patient has engaged in the tasks appropriate to which phase of the nurse-patient relationship?
1. Working phase
2. Orientation phase
3. Termination phase
4. Preinteraction phase

ANS: 4
In the preinteraction phase the nurse and the patient have not yet met. The nurse prepares for the initial contact by performing self-assessment, gathering available data about the patient, reviewing the goals of a therapeutic relationship, and considering what he or she has to offer the patient.

DIF: Cognitive Level: Application
REF: Text Pages: 18-19
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

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 on.
4. closed to negotiation or agreement.

ANS: 3
Conditions for termination are part of the nurse-patient contract negotiated during the introductory/orientation phase of the relationship. In a social relationship, termination is open ended.

DIF: Cognitive Level: Application
REF: Text Pages: 19-20
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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 analysis of his or her own strengths
3. Promotion of patient use of constructive coping mechanisms
4. Review of progress of therapy and goal attainment with patient

ANS: 1
Tasks of the introductory phase of the nurse-patient partnership are to establish a climate of trust, understanding, acceptance, and open communication, and to formulate a contract with the patient.

DIF: Cognitive Level: Application
REF: Text Pages: 19-20
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

11. A patient who is admitted with a diagnosis of schizophrenia, paranoid type, coldly tells a nurse, “I am here because my family brought me here and locked me up.” The best nursing response to use in the introductory session with the patient 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.”

ANS: 3
It is appropriate to acknowledge the angry or otherwise negative feelings of a patient who has not voluntarily sought treatment. Feeling understood by the nurse paves the way for a therapeutic relationship.

DIF: Cognitive Level: Application
REF: Text Page: 21
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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

ANS: 4
When a patient initially offers psychiatric symptoms as the reason for admission, the nurse will want to ask for clarification and elaboration to better understand the life experiences of the patient. Understanding fosters empathy, empathic remarks lead the patient to feel understood, and this understanding paves the way for the therapeutic nurse-patient partnership.

DIF: Cognitive Level: Application
REF: Text Pages: 19-21
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

13. In the initial sessions a patient frequently asks the nurse for cigarettes and 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.

ANS: 4
Testing behavior serves the purpose of exploring the nurse’s consistency and intent.

DIF: Cognitive Level: Application
REF: Text Page: 20
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

14. After eight sessions a patient tells the nurse, “I got to the point where I was feeling pretty good, but now I’m beginning to get anxious again. I don’t know if I’ll be able to handle things on my own. Things feel uncertain, like they did when I left home to go to college.” The nurse and patient most likely are entering which phase of the relationship?
1. Working
2. Termination
3. Introductory
4. Preinteraction

ANS: 2
Establishing the reality of separation is difficult for both the nurse and patient. Patients often respond to impending termination with increased anxiety; they may experience negative feelings associated with earlier terminations, and they may regress to previous, less adaptive behaviors in the hope of postponing termination.

DIF: Cognitive Level: Comprehension
REF: Text Page: 21
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

15. A new nurse is pleased that a patient has been making steady progress during sessions and mentions this to the supervisor. The supervisor smiles and says, “That’s great, but be prepared for resistance.” What resistance behaviors are most easily identified as such by the novice nurse?
1. Self-devaluation
2. Forced flight into health
3. Intensification of psychiatric symptoms
4. Superficial talk and suppression of pertinent information

ANS: 4
Resistance is the patient’s reluctance or avoidance of verbalizing or experiencing troubling aspects of himself or herself. This is often caused by the patient’s unwillingness to change when the need for change is recognized. However, all the behaviors mentioned are possible ways of expressing resistance. Superficial talk and “having nothing to talk about” are behaviors that novice nurses understand as expressing resistance, and the other behaviors listed, although they do occur, are less easily associated with resistance.

DIF: Cognitive Level: Comprehension
REF: Text Page: 39
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

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 that he or she will be expected to work harder.
4. avoid mentioning the therapeutic impasse and wait until the patient again indicates readiness.

ANS: 2
The relationship can become stalled if the nurse is not prepared to deal with the impasse. The nurse may use clarification by saying something such as, “I sense that you’re struggling with yourself and wanting to explore your relationship with your parents, but that you don’t yet want to experience the pain it may bring.”

DIF: Cognitive Level: Application
REF: Text Page: 40
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

17. A patient sees a hideous face on the wall of a room. A nurse attempting to calm the patient says that shadows have been created on the wall by the sun coming through the leaves of a tree near the window. This can be assessed as the patient having made an error in:
1. feedback.
2. perception.
3. experience.
4. transmission.

ANS: 2
Perception is the identification and interpretation of a stimulus based on information received through the senses. In this instance the patient has incorrectly interpreted the shadows as a face on the wall.

DIF: Cognitive Level: Comprehension
REF: Text Page: 26
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

18. A patient says to a nurse, “My spouse and I get along just fine. We usually agree on everything.” While speaking, the patient frowns, continuously moves one foot, and twirls a shirt button. The nurse can assess this communication as:
1. inefficient.
2. inadequate.
3. incongruent.
4. inappropriate.

ANS: 3
Incongruent communication occurs when the verbal content and the nonverbal level of communication are not in agreement.

DIF: Cognitive Level: Comprehension
REF: Text Page: 25
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

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 the:
1. adult ego state.
2. child ego state.
3. parent ego state.
4. complementary transaction state.

ANS: 3
The nurse’s statement can be construed as critical. The parent ego state consists of all the nurturing, critical, and prejudicial attitudes, behaviors, and experiences learned from other people, especially from parents and teachers.

DIF: Cognitive Level: Comprehension
REF: Text Page: 26
TOP: Nursing Process: N/A
MSC: NCLEX: Psychosocial Integrity

20. Nurse: “I understand that you stopped taking your medications after you left the hospital.” Patient: “I didn’t want to rely on medications to solve my problems, but I see now that not taking them only made things worse.” According to transactional analysis theory, the type of transaction recorded above can be assessed as a(n):
1. ulterior transaction.
2. crossed transaction.
3. incongruent transaction.
4. complementary transaction.

ANS: 4
In this interaction the two parties are communicating from adult ego state to adult ego state. Communication flows smoothly between the sender and the receiver.

DIF: Cognitive Level: Comprehension
REF: Text Page: 26
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

21. A patient seeks the nurse’s help with feelings of anxiety that are overwhelming at work. When the nurse suggests the patient try to communicate feelings to a work superior, 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):
1. ulterior transaction.
2. crossed transaction.
3. congruous transaction.
4. complementary transaction.

ANS: 1
This is an example of the “Why don’t you? Yes, but…” game. On the surface the game involves two adults solving problems; in reality, one person is using the child ego state to show what a bad parent the other person is.

DIF: Cognitive Level: Comprehension
REF: Text Page: 27
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

22. Patient: “Some days I think it’s just not worth it. I’d be better off alone. Maybe things would be calmer and simpler if we separated.” Nurse: “Are you saying that things might be better if you left your spouse?” Which therapeutic communication technique is used in this interaction between patient and nurse?
1. Focusing
2. Restating
3. Reflection
4. Clarification

ANS: 4
Clarification involves the nurse attempting to put into words the vague ideas or thoughts that are implicit or explicit in the patient’s conversation.

DIF: Cognitive Level: Comprehension
REF: Text Page: 27 | Text Page: 29 | Text Page: 32
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

23. Patient: “Sorry I’m late. I didn’t realize what time it was.” Nurse: “This is the third time we’ve met, and you’ve been late for each of our sessions. You say how important they are to you, but you can’t seem to get here on time. Could it be that you aren’t ready to work on your problems?” Which therapeutic communication technique is the nurse using?
1. Informing
2. Suggesting
3. Identifying themes
4. Sharing perceptions

ANS: 4
Sharing perceptions involves asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling. The nurse can provide information and then ask for feedback.

DIF: Cognitive Level: Comprehension
REF: Text Page: 29 | Text Page: 32
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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 relationship to provide everyday “common sense” advice.

ANS: 3
Suggesting is the presentation of alternative ideas. It is useful in the working phase of the relationship, when the patient has analyzed the problem and is exploring alternative coping mechanisms. At that time, nurse suggestions will increase the patient’s perceived options.

DIF: Cognitive Level: Application
REF: Text Pages: 30-32
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

25. Patient: “I wish my parents would stop treating me like an irresponsible child.” Nurse: “You say you want your parents to treat you like an adult, but you skip school, stay out after your curfew, and come home stoned. How does that fit?” Which action dimension does the nurse use in this interaction?
1. Immediacy
2. Confrontation
3. Emotional catharsis
4. Nurse self-disclosure

ANS: 2
Confrontation is an expression by the nurse of discrepancies in the patient’s behavior.

DIF: Cognitive Level: Comprehension
REF: Text Page: 38
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

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 proved to be ineffective.

ANS: 2
Confrontation, when posed as an observation of incongruent behavior, can be used infrequently during the orientation phase of the relationship, but it is more useful during the working stage to expand the patient’s awareness and to help him or her move to a higher level of functioning.

DIF: Cognitive Level: Analysis
REF: Text Pages: 35-36
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity

27. Patient: “You can’t tell people very much about yourself; it gives them too much power over you.” Nurse: “I wonder if you’re concerned about talking to me about your problems. I think I may need to earn your trust with a little more time.” This interaction best represents an example of the action dimension called:
1. immediacy.
2. confrontation.
3. emotional catharsis.
4. nurse self-disclosure.

ANS: 1
Immediacy involves focusing on the current interaction of the nurse and the patient in the relationship.

DIF: Cognitive Level: Comprehension
REF: Text Page: 36
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

28. A patient writes to a nurse, “Over the weeks that we’ve been meeting I’ve come to feel as though you are a very special person sent from heaven to guide me out of this darkness of the soul. I know I can count on you to chart my course back to health. I will do whatever you advise and will be forever in your debt.” The nurse can assess this as indicating:
1. a boundary violation.
2. emotional catharsis.
3. positive countertransference.
4. dependent reaction transference.

ANS: 4
Dependent reaction transference is characterized by submissive, ingratiating behavior, regarding the nurse as a godlike figure, and overvaluing the nurse’s characteristics and qualities.

DIF: Cognitive Level: Comprehension
REF: Text Pages: 39-40
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

29. A nurse tells the unit supervisor, “I’m having a difficult time empathizing with my patient. I just can’t understand the patient’s perspective and unwillingness to change. Sometimes I find myself wanting to argue. After sessions I feel both frustrated and kind of depressed.” Self-analysis will probably reveal:
1. countertransference.
2. that the patient is being difficult.
3. a boundary violation by the nurse.
4. poor use of therapeutic communication techniques.

ANS: 1
Countertransference is a therapeutic impasse created by the nurse’s specific emotional response to the qualities of the patient. This response is inappropriate to the content and context of the therapeutic relationship or inappropriate in the degree of intensity of emotion.

DIF: Cognitive Level: Comprehension
REF: Text Pages: 40-41
TOP: Nursing Process: Assessment
MSC: NCLEX: Psychosocial Integrity

 

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