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Keltner’s Psychiatric Nursing, 9th Edition Chapter 09 – Working With an Individual Patient
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Keltner’s Psychiatric Nursing, 9th Edition Chapter 09 – Working With an Individual Patient
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Keltner’s Psychiatric Nursing, 9th EditionChapter 09 – Working With an Individual
Patient
A new registered nurse (RN) reports experiencing difficulty knowing how to terminate a
relationship with a patient. What response should the nurse's preceptor make to address the
nurse's concern?
A. "If the relationship has been short, termination may not be necessary."
B. "Just say good-bye and good luck."
C. "Thank the patient for working with you and say how you valued the experience."
D. "Try to move through the termination phase as quickly as possible." - questions and
answers-C
Thanking the patient and acknowledging the value of the experience offers respect and support
to the patient while validating the importance of the relational opportunity for the nurse.
Termination is always appropriate and necessary therapeutically. Wishing the patient "good
luck" is not therapeutic, but instead is casual and informal. Termination should not be rushed,
and—depending upon the length of time in the relationship—planning and discussion of
termination for the patient and nurse are important.
A newly admitted patient is depressed and fears her husband will ask for a divorce and begins
to cry during the initial assessment interview. What nursing strategy should the nurse consider?
A. Postponing the assessment for later
B. Avoid commenting on her tears, and continue the assessment
C. Temporarily stopping the assessment to offer her a tissue
D. Asking her why her husband wants to divorce her - questions and answers-C
Stopping to offer the patient a tissue allows the patient (and the nurse) to pause, think, and
collect herself. Assessment initially may not be postponed; data forms the basis for the plan of
care, and the nurse-patient interaction initiates or establishes the therapeutic relationship.
Making the observation is therapeutic and validates support of the patient. "Why" questions are
considered nontherapeutic and could engender anger and/or defensiveness.
, newly admitted patient continually touches the nursing staff members and makes sexual
innuendoes when interactions are attempted. The initial therapeutic manner of managing such
behavior is demonstrated by what nursing action?
A. Asking to be reassigned to avoid triggering the behavior
B. Demanding firmly that the patient cease all inappropriate touching
C. Asking the patient to explain why the sexual innuendoes occur
D. Explaining that the behavior is inappropriate and must stop - questions and answers-D
Patients generally stop these behaviors when asked and should be reminded that these actions
are inappropriate. The nurse then discusses the underlying need. If the behaviors continue, then
setting limits can be stronger. Avoiding the patient without an explanation is incongruent with
professionalism. Demands are ineffective and disrespectful. While a discussion concerning the
behavior is appropriate, it is not the initial response.
patient experiencing a loss of reality believes in the angry voices in her head. The nurse should
initially respond to a newly admitted patient who is experiencing auditory hallucinations by
making which response?
A. "There are no voices in your head."
B. "Try to ignore them by listening to your favorite music."
C. "While I don't hear voices, I believe that you are."
D. "Just listen to my voice to distract yourself." - questions and answers-C
Initially the nurse acknowledges and respects the patient's experience while presenting reality
and avoiding reinforcement of the hallucinations. Stating that there are no voices discounts and
minimizes the patient's experience. It is nontherapeutic and may be argumentative. More
teaching and support of the patient will be required before distraction can be implemented, and
even then, it may not be possible or realistic for the patient.
The nurse is playing cards with a patient who becomes angry when losing. What statement
suggests that the nurse is using the experience to support learning new coping skills?
A. "I learn something even when I lose."
B. "It's just a game; just let it go."
C. "Let's talk about mistakes you made that resulted in losing."
D. "Let's do something else that doesn't involve winning or losing." - questions and answers-A
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