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Which issues should a nurse address during the first interview with a patient diagnosed with a psychiatric disorder?
- A. Trust, congruence, attitudes, and boundaries
- B. Goals, resistance, unconscious motivations, and diversion
- C. Relationship parameters, the contract, confidentiality, and termination
- D. Transference, countertransference, intimacy, and developing resources
Correct Answer: C
Rationale: These issues establish the foundation of the therapeutic relationship during the orientation phase.
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As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse's best action?
- A. Accept the card while recognizing the effectiveness of the relationship and the patient's thoughtfulness.
- B. Inform the patient that accepting gifts violates the policies of the facility. Decline the card regretfully.
- C. Acknowledge the patient's transition through the termination phase but decline the card.
- D. Accept the card and invite the patient to return to participate in other arts and crafts groups.
Correct Answer: A
Rationale: Accepting a low-value, meaningful gift like a card acknowledges the patient's gratitude without blurring boundaries.
A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? (Select all that apply.)
- A. Focus dialog with the patient on problems that may occur in the future.
- B. Help the patient express feelings about the relationship with the nurse.
- C. Help the patient prioritize and modify socially unacceptable behaviors.
- D. Reinforce expectations regarding the parameters of the relationship.
- E. Help the patient identify strengths, limitations, and problems.
Correct Answer: A,B
Rationale: Termination involves discussing future challenges and expressing feelings about the relationship to facilitate closure.
A patient says, 'I'm still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?' What is the nurse's best response?
- A. Why are you asking me when you're able to speak for yourself?'
- B. I will be glad to address it when I see your doctor later today.'
- C. That's a good topic for you to take up with your doctor.'
- D. Do you think you can't speak to a doctor?'
Correct Answer: C
Rationale: Encouraging the patient to advocate for themselves promotes independence and optimal functioning.
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.
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.