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A patient is a successful insurance salesman; however, because of market changes, his level of sales has dropped. His boss tells him he will consequently be receiving a $2,000 per year cut in his salary. When the patient arrives home from work, the family dog runs to greet him as he always does, barking and jumping up and down and begging for attention. The patient yells at the dog, 'Get away from me; I can?t take your barking right now.' The patient?s response reflects a defense mechanism because it was which of the following?
- A. An intentional behavior performed to let the dog know his behavior was inappropriate
- B. Automatic, protecting the patient from the anxiety related to his upcoming pay cut
- C. Implemented to keep the patient from having to cope with his upcoming pay cut
- D. Implemented so the patient could rationalize his upcoming pay cut
Correct Answer: B
Rationale: The patient?s response reflects displacement, a defense mechanism where emotions (anxiety about the pay cut) are redirected to a less threatening target (the dog). This is automatic and protects the patient from directly confronting anxiety. The response is not intentional training, avoidance of coping, or rationalization.
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A nurse engaged in an interaction with a patient recognizes body space zones. Which of the following would the nurse identify as the individual?s personal zone?
- A. Beginning at the boundary of the intimate zone and ending at the social zone
- B. Extending outward from the border to the public zone
- C. Surrounding and protecting an individual from others, especially outsiders
- D. The most distant boundary that can be used for recognizing intruders
Correct Answer: A
Rationale: The personal zone, per Hall?s proxemics theory, extends from 1.5 to 4 feet, beginning at the boundary of the intimate zone (0?1.5 feet) and ending at the social zone (4?12 feet). It?s used for comfortable interactions. Other options describe the social zone, a general concept, or the public zone, respectively.
A nursing instructor is describing the nurse-patient relationship to a group of nursing students. Which of the following would the instructor emphasize as crucial for establishing and maintaining the relationship?
- A. Rapport
- B. Empathy
- C. Self-awareness
- D. Values
Correct Answer: A
Rationale: Rapport, a trusting and harmonious connection, is crucial for establishing and maintaining the nurse-patient relationship, fostering open communication. Empathy and self-awareness support rapport, but rapport is the foundation. Values guide practice but are less directly tied to the relationship.
A group of nursing students are preparing a class presentation on therapeutic and nontherapeutic techniques of communication. The students demonstrate understanding of the information when they select which techniques to demonstrate as therapeutic? Select all that apply.
- A. Confrontation
- B. Open-ended statements
- C. Reflection
- D. Reassurance
- E. Agreement
- F. Challenges
Correct Answer: B,C
Rationale: Open-ended statements and reflection are therapeutic techniques, encouraging patient exploration and self-expression. Confrontation and challenges can be therapeutic in specific contexts but are often nontherapeutic if poorly timed. Reassurance and agreement risk dismissing patient concerns or aligning too closely, reducing therapeutic value.
A patient who is hospitalized with depression tells the nurse, 'I don?t want to take the medication because I?m afraid I?ll become suicidal.' Which response by the nurse would be most appropriate?
- A. Have you ever thought about hurting yourself?
- B. It?s important that you take this medication.
- C. I agree with you. I wouldn?t want to take this medication either.
- D. Another patient took that medication, and he really felt better.
Correct Answer: A
Rationale: The patient?s fear of becoming suicidal warrants immediate assessment for suicidal ideation. Asking 'Have you ever thought about hurting yourself?' directly addresses this concern and ensures patient safety. Other responses dismiss the fear, agree inappropriately, or provide irrelevant anecdotes, none of which address the patient?s concern effectively.
The nurse is in the orientation phase of the nurse-patient relationship with a patient diagnosed with a mental disorder. When interviewing the patient during this first encounter, which information would be most important for the nurse to obtain about the patient?
- A. Known allergies
- B. Recent hospitalizations
- C. Perception of the problem
- D. Family history
Correct Answer: C
Rationale: In the orientation phase, establishing trust and understanding the patient?s perspective is critical. The patient?s perception of the problem provides insight into their mental health needs and guides the therapeutic relationship. Allergies, hospitalizations, and family history are important but secondary in this initial phase.