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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.
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A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks, 'Should I break up with my partner?' Which response by the nurse would be most effective in building rapport between the patient and nurse?
- A. Of course you should; being a lesbian is just not natural.
- B. Yes, I think you should pursue building a relationship with a man.
- C. It sounds like you?re beginning to be uncomfortable in this relationship.
- D. You need to focus on yourself rather than the relationship right now.
Correct Answer: C
Rationale: Building rapport requires a nonjudgmental, empathetic response that acknowledges the patient?s feelings. 'It sounds like you?re beginning to be uncomfortable in this relationship' reflects the patient?s emotions, fostering trust. Options A and B are judgmental and biased, and option D shifts focus prematurely, potentially dismissing the patient?s concerns.
During an interview, a patient tells the nurse that he was recently let go from his job. As the interaction continues, the patient states, 'I was really overqualified for that position anyway. It was definitely below my area of expertise.' The nurse interprets this information as reflecting which of the following?
- A. Denial
- B. Intellectualization
- C. Projection
- D. Passive aggression
Correct Answer: B
Rationale: Intellectualization involves using rational explanations to avoid emotional distress. The patient?s statement minimizes the job loss by focusing on being overqualified, distancing from the emotional impact. Denial avoids the reality, projection attributes feelings to others, and passive aggression expresses hostility indirectly.
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 nurse is engaged in active listening. Which of the following would the nurse use? Select all that apply.
- A. Changing the subject to gather more information
- B. Responding indirectly to statements
- C. Using open-ended statements
- D. Concentrating on what patient says
- E. Allowing the patient to talk as he wishes
Correct Answer: C,D,E
Rationale: Active listening involves concentrating on the patient?s words, using open-ended statements to encourage elaboration, and allowing the patient to express themselves freely. Changing the subject or responding indirectly disrupts the flow and is nontherapeutic.
When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the nurse to keep in mind?
- A. The nurse should self-disclose when indicated.
- B. The patient is the primary focus of the interaction.
- C. The nurse should have an empathetic relationship with the patient.
- D. The patient?s conversations should be recorded.
Correct Answer: B
Rationale: Therapeutic communication prioritizes the patient?s needs and perspective, making the patient the primary focus. Self-disclosure is used cautiously and only when beneficial, empathy is important but secondary to patient focus, and recording conversations is inappropriate without consent and not a primary concern.