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As a nurse escorts a patient being discharged after treatment for major depressive disorder, the patient gives the nurse a gold necklace with a heart pendant and says, 'Thank you for helping mend my broken heart.' Which is the nurse's best response?
- A. Accepting gifts violates the policies and procedures of the facility.'
- B. I'm glad you feel so much better now. Thank you for the beautiful necklace.'
- C. I'm glad I could help you, but I can't accept the gift. My reward is seeing your renewed sense of hope.'
- D. Helping people is what nursing is all about. It's rewarding to me when patients recognize how hard we work.'
Correct Answer: C
Rationale: Accepting gifts blurs therapeutic boundaries. Acknowledging the gesture while declining maintains professionalism.
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Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse-patient relationship?
- A. I don't have any problems.'
- B. It is so difficult for me to talk about my problems.'
- C. I don't know how talking about things twice a week can help.'
- D. I want to find a way to deal with my anger without becoming violent.'
Correct Answer: D
Rationale: Expressing a desire to address specific behaviors indicates readiness for behavioral change, characteristic of the working phase.
As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario?
- A. The invitation facilitates dependency on the nurse.
- B. The nurse's action blurs the boundaries of the therapeutic relationship.
- C. The invitation is therapeutic for the patient's diversional activity deficit.
- D. The nurse's action assists the patient's integration into community living.
Correct Answer: B
Rationale: The invitation creates a social rather than therapeutic relationship, blurring professional boundaries.
A nurse assesses a confused older adult. The nurse experiences sadness and reflects, 'The patient is like one of my grandparents, so helpless.' What feelings does the nurse describe?
- A. Transference
- B. Countertransference
- C. Catastrophic reaction
- D. Defensive coping reaction
Correct Answer: B
Rationale: Countertransference is the nurse's transference or response to a patient that is based on the nurse's unconscious needs, conflicts, problems, or view of the world.
At what point in the nurse-patient relationship should a nurse plan to first address termination?
- A. In the orientation phase
- B. During the working phase
- C. In the termination phase
- D. When the patient initially brings up the topic
Correct Answer: A
Rationale: Informing the patient about the relationship's conditions, including termination, early in the orientation phase ensures clarity and sets expectations.
During the first interview, a nurse notices that the patient does not make eye contact. What can the nurse correctly assume from this behavior?
- A. The patient is not truthful.
- B. The patient is feeling sad.
- C. The patient has a poor self-concept.
- D. The need for more information is required to draw a conclusion.
Correct Answer: D
Rationale: Lack of eye contact alone is insufficient to draw specific conclusions; further assessment is needed.