Chapter 09: Working with an Individual Patient

Chapter 09: Working with an Individual Patient

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A patient is hospitalized for severe depression. Knowing that the patient will be discharged after a short stay, what is the nurse’s first priority?

a.	Maximize the benefits of milieu management.
b.	Immediately begin to explore acute patient issues.
c.	Develop a goal-directed, problem-centered relationship.
d.	Choose a specific theoretical model as the basis for care.

 

 

ANS:  C

Therapeutic relationships are planned, patient-centered, and goal-directed. This is of particular importance if progress is to be made when the duration of the relationship will be brief. The other options are not the priority. Exploration of patient issues requires trust development before it can proceed.

 

DIF:    Cognitive level: Analyzing              REF:   p. 84

TOP:   Nursing process: Implementation     MSC:  NCLEX: Safe, Effective Care Environment

 

2. A nurse tells a patient, “I know how you feel. My spouse can be very insensitive too. I am also considering divorce.” Analysis suggests that the nurse is:

a.	self-disclosing inappropriately.
b.	experiencing countertransference.
c.	using empathy to establish trust with the patient.
d.	encouraging the patient to express negative feelings.

 

 

ANS:  A

Brief self-disclosure is used to help the patient clarify specific issues, to feel less vulnerable, or to feel more “normal.” When used appropriately, self-disclosure benefits the patient. When used inappropriately, it benefits the nurse. In this case, the self-disclosure burdens the patient with the nurse’s problems. Empathy focuses on the patient. Countertransference would result in different behaviors. Encouraging expression of negative feelings would be more direct.

 

DIF:    Cognitive level: Understanding        REF:   p. 85               TOP:   Nursing process: Evaluation

MSC:  NCLEX: Safe, Effective Care Environment

 

3. A patient diagnosed with schizophrenia says to the nurse, “I feel really close to you. You’re the only true friend I have.” Select the nurse’s most therapeutic response.

a.	“We are not friends. Our relationship is a professional one.”
b.	“I feel sure there are other friends in your life. Can you name some?”
c.	“I am glad you trust me. Trust is important for the work we are doing together.”
d.	“Our relationship is professional, but let’s explore ways to strengthen friendships.”

 

 

ANS:  D

The patient’s remarks call for the nurse to remind the patient of the parameters of their relationship and take the opportunity to discuss the issue of friends. Only this option incorporates both desired elements.

 

DIF:    Cognitive level: Applying                REF:   p. 85

TOP:   Nursing process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

4. As a patient and nurse move into the working stage of a therapeutic relationship, the nurse’s most beneficial statement is:

a.	“I want to be helpful to you as we explore your problems and the way you express feelings.”
b.	“A good long-term goal for someone your age would be to develop better job-related skills.”
c.	“Of the problems we have discussed so far, which ones would you most like to work on at this time?”
d.	“When someone gives you a compliment, I notice that you become very quiet and appear uncomfortable.”

 

 

ANS:  C

With this remark, the nurse seeks patient collaboration and offers the opportunity to set priorities for the work toward change that will be undertaken. The distracters relate to the orientation stage.

 

DIF:    Cognitive level: Applying                REF:   pp. 87-88

TOP:   Nursing process: Implementation     MSC:  NCLEX: Psychosocial Integrity