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NURS 3645 PSYCHIATRIC mental health nursing practicum exam questions with verifies solutions
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NURS 3645 PSYCHIATRIC/MENTALHEALTH NURSING PRACTICE
QUESTION (100% SOLVED)
A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally
drained, as though I hadn't rested well." Which response should the nurse use to clarify
the patient's comment?
a. "It sounds as though you were uncomfortable with the content of your dream."
b. "I understand what you're saying. Bad dreams leave me feeling tired, too."
c. "So you feel as though you did not get enough quality sleep last night?"
d. "Can you give me an example of what you mean by 'stoned'?" - ANS: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of
the patient's statement. Asking for a definition of "stoned" directly asks for clarification.
Restating that the patient is uncomfortable with the dream's content is parroting, a non-
therapeutic technique. The other responses fail to clarify the meaning of the patient's
comment.
A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us
through the fluorescent lights in this room. Be careful what you say." Which response by
the nurse would be most therapeutic?
a. "Let's talk about something other than the CIA."
b. "It sounds like you're concerned about your privacy."
c. "The CIA is prohibited from operating in health care facilities."
d. "You have lost touch with reality, which is a symptom of your illness." - ANS: B
It is important not to challenge the patient's beliefs, even if they are unrealistic.
Challenging undermines the patient's trust in the nurse. The nurse should try to
understand the underlying feelings or thoughts the patient's message conveys. The
correct response uses the therapeutic technique of reflection. The other comments are
non-therapeutic. Asking to talk about something other than the concern at hand is
changing the subject. Saying that the CIA is prohibited from operating in health care
facilities gives false reassurance. Stating that the patient has lost touch with reality is
truthful, but uncompassionate.
The patient says, "My marriage is just great. My spouse and I always agree." The nurse
observes the patient's foot moving continuously as the patient twirls a shirt button. The
conclusion the nurse can draw is that the patient's communication is:
a. clear.
b. mixed.
,c. precise.
d. inadequate. - ANS: B
Mixed messages involve the transmission of conflicting or incongruent messages by the
speaker. The patient's verbal message that all was well in the relationship was modified
by the nonverbal behaviors denoting anxiety. Data are not present to support the choice
of the verbal message being clear, explicit, or inadequate.
A nurse interacts with a newly hospitalized patient. Select the nurse's comment that
applies the communication technique of "offering self."
a. "I've also had traumatic life experiences. Maybe it would help if I told you about
them."
b. "Why do you think you had so much difficulty adjusting to this change in your life?"
c. "I hope you will feel better after getting accustomed to how this unit operates."
d. "I'd like to sit with you for a while to help you get comfortable talking to me." - ANS: D
"Offering self" is a technique that should be used in the orientation phase of the nurse-
patient relationship. Sitting with the patient, an example of "offering self," helps to build
trust and convey that the nurse cares about the patient. Two incorrect responses are
ineffective and non-therapeutic. The other incorrect response is therapeutic but is an
example of "offering hope."
Which technique will best communicate to a patient that the nurse is interested in
listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as "Did you feel angry?"
c. Making a judgment about the patient's problem.
d. Saying, "I understand what you're saying." - ANS: A
Restating allows the patient to validate the nurse's understanding of what has been
communicated. Restating is an active listening technique. Judgments should be
suspended in a nurse-patient relationship. Close-ended questions such as "Did you feel
angry?" ask for specific information rather than showing understanding. When the nurse
simply states that he or she understands the patient's words, the patient has no way of
measuring the understanding.
A patient discloses several concerns and associated feelings. If the nurse wants to seek
clarification, which comment would be appropriate?
a. "What are the common elements here?"
b. "Tell me again about your experiences."
c. "Am I correct in understanding that . . ."
d. "Tell me everything from the beginning." - ANS: C
Asking, "Am I correct in understanding that..." permits clarification to ensure that both
the nurse and patient share mutual understanding of the communication. Asking about
common elements encourages comparison rather than clarification. The remaining
responses are implied questions that suggest the nurse was not listening.
A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most
therapeutic response.
,a. "Don't talk that way. Of course you will leave here!"
b. "Keep up the good work, and you certainly will."
c. "You don't think you're making progress?"
d. "Everyone feels that way sometimes." - ANS: C
By asking if the patient does not believe that progress has been made, the nurse is
reflecting by putting into words what the patient is hinting. By making communication
more explicit, issues are easier to identify and resolve. The remaining options are non-
therapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying
that everyone feels that way at times minimizes feelings. Telling the patient that good
work will always result in success is falsely reassuring.
Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient
fidgeted and tapped left foot, periodically covered face with hands, and looked under
chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate?
a. The patient is giving positive feedback about the nurse's communication techniques.
b. The nurse is viewing the patient's behavior through a cultural filter.
c. The patient's verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors. - ANS: C
When a verbal message is not reinforced with nonverbal behavior, the message is
confusing and incongruent. Some clinicians call it a "mixed message." It is inaccurate to
say that the patient is giving positive feedback about the nurse's communication
techniques. The concept of a cultural filter is not relevant to the situation because a
cultural filter determines what we will pay attention to and what we will ignore. Data are
insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.
While talking with a patient diagnosed with major depression, a nurse notices the
patient is unable to maintain eye contact. The patient's chin lowers to the chest, while
the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills - ANS: A
Eye contact and body movements are considered nonverbal communication. There are
insufficient data to determine the level of the patient's social skills or whether a cultural
barrier exists.
During the first interview with a parent whose child died in a car accident, the nurse
feels empathic and reaches out to take the patient's hand. Select the correct analysis of
the nurse's behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to
express feelings.
b. The gesture is premature. The patient's cultural and individual interpretation of touch
is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched. - ANS: B
, Touch has various cultural and individual interpretations. Nurses should refrain from
using touch until an assessment can be made regarding the way in which the patient
will perceive touch. The other options present prematurely drawn conclusions.
During a one-on-one interaction with the nurse, a patient frequently looks nervously at
the door. Select the best comment by the nurse regarding this nonverbal
communication.
a. "I notice you keep looking toward the door."
b. "This is our time together. No one is going to interrupt us."
c. "It looks as if you are eager to end our discussion for today."
d. "If you are uncomfortable in this room, we can move someplace else." - ANS: A
Making observations and encouraging the patient to describe perceptions are useful
therapeutic communication techniques for this situation. The other responses are
assumptions made by the nurse.
A black patient says to a white nurse, "There's no sense talking. You wouldn't
understand because you live in a white world." The nurse's best action would be to:
a. explain, "Yes, I do understand. Everyone goes through the same experiences."
b. say, "Please give an example of something you think I wouldn't understand."
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing. - ANS: B
Having the patient speak in specifics rather than globally will help the nurse understand
the patient's perspective. This approach will help the nurse engage the patient.
Reassurance and changing the subject are not therapeutic techniques.
A Filipino American patient had a nursing diagnosis of situational low self-esteem
related to poor social skills as evidenced by lack of eye contact. Interventions were used
to raise the patient's self-esteem, but after 3 weeks, the patient's eye contact did not
improve. What is the most accurate analysis of this scenario?
a. The patient's eye contact should have been directly addressed by role-playing to
increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and
planning for this patient.
c. The patient's poor eye contact is indicative of anger and hostility that were
unaddressed.
d. The nurse should have assessed the patient's culture before making this diagnosis
and plan. - ANS: D
The amount of eye contact a person engages in is often culturally determined. In some
cultures, eye contact is considered insolent, whereas in others eye contact is expected.
Asian Americans, including persons from the Philippines, often prefer not to engage in
direct eye contact.
When a female Mexican American patient and a female nurse sit together, the patient
often holds the nurse's hand. The patient also links arms with the nurse when they walk.
The nurse is uncomfortable with this behavior. Which analysis is most accurate?
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