Nokea
The relationship between a nurse and patient as it relates to status and power is best described by which term?
- A. Symmetric
- B. Complementary
- C. Incongruent
- D. Paralinguistic
Correct Answer: B
Rationale: When a difference in power exists, as between student and teacher or nurse and patient, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.
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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.
Correct Answer: C
Rationale: 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.
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. Patients in a psychiatric setting should not be touched.
Correct Answer: B
Rationale: 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.
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.
Correct Answer: B
Rationale: 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 nontherapeutic. 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.
During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. How should the nurse respond?
- A. You've turned the tables on me.'
- B. Nurses direct the interviews with patients.'
- C. Do not ask questions about my personal life.'
- D. The time we spend together is to discuss your concerns.'
Correct Answer: D
Rationale: When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Saying 'You've turned the tables on me' states the fact but does not refocus the interview.
A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies about giving advice?
- A. It is rarely helpful.
- B. It fosters independence.
- C. It lifts the burden of personal decision making.
- D. It helps the patient develop feelings of personal adequacy.
Correct Answer: A
Rationale: Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.