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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.
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A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. What is the role of the new nurse who begins working with this patient?
- A. Beginning at the orientation phase
- B. Resuming the working relationship
- C. Entering into a social relationship
- D. Returning to the emotional catharsis phase
Correct Answer: A
Rationale: A new nurse must start at the orientation phase to build trust and establish a new therapeutic relationship.
Termination of a therapeutic nurse-patient relationship with a patient has been successful when nurse engages in what action?
- A. Avoids upsetting the patient by shifting focus to other patients before the discharge.
- B. Gives the patient a personal telephone number and permission to call after discharge.
- C. Discusses with the patient changes that have happened during the relationship and evaluates the outcomes.
- D. Offers to meet the patient for coffee and conversation three times a week after discharge.
Correct Answer: C
Rationale: Summarizing and evaluating progress validates the experience and facilitates closure. Other options promote dependency or avoidance.
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.
A patient says, 'Please don't share information about me with the other people.' How should the nurse respond?
- A. I won't share information with others without your permission, but I will share information about you with other staff members.'
- B. A therapeutic relationship is just between the nurse and the patient. It's up to you to tell others what you want them to know.'
- C. It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others.'
- D. I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.'
Correct Answer: A
Rationale: A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Other staff members need pertinent data, making this response appropriate.
A nurse caring for a withdrawn, suspicious patient recognizes the development of feelings of anger toward the patient. How should the nurse respond?
- A. By suppressing the angry feelings.
- B. By expressing the anger openly and directly with the patient.
- C. By telling the nurse manager to assign the patient to another nurse.
- D. By discussing the anger with a clinician during a supervisory session.
Correct Answer: D
Rationale: Supervision helps address countertransference, maintaining objectivity in the therapeutic relationship.