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NUR 190 Psychiatric Mental Health Nursing
Final Exam 2025/2026 2 0 0 Questions And
Answers Graded A+
The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is: a. clear. b. mixed. c. precise. d. inadequate. ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.
A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "I hope you will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me." ANS: D "Offering self" is a technique that should be used in the orientation phase of the
nurse-patient relationship. Sitting with the patient, an example of "offering self," helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and non-therapeutic. The other incorrect response is therapeutic but is an example of "offering hope."
Which technique will best communicate to a patient that the nurse is interested in listening? a. Restating a feeling or thought the patient has expressed. b. Asking a direct question, such as "Did you feel angry?" c. Making a judgment about the patient's problem. d. Saying, "I understand what you're saying." ANS: A
Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as "Did you feel angry?" ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.
During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication. a. "I notice you keep looking toward the door." b. "This is our time together. No one is going to interrupt us." c. "It looks as if you are eager to end our discussion for today." d. "If you are uncomfortable in this room, we can move someplace else." ANS: A Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.
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." ANS: C 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.
A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. a. "Don't talk that way. Of course you will leave here!"
b. "Keep up the good work, and you certainly will." c. "You don't think you're making progress?" d. "Everyone feels that way sometimes." ANS: C By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are non-therapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
Documentation in a patient's chart shows, "Throughout a 5-minute interaction,
patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate? a. The patient is giving positive feedback about the nurse's communication techniques. b. The nurse is viewing the patient's behavior through a cultural filter. c. The patient's verbal and nonverbal messages are incongruent. d. The patient is demonstrating psychotic behaviors. ANS: C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a "mixed message." It is inaccurate to say that the patient is giving positive feedback about the nurse's communication techniques. The concept of a cultural filter is not relevant to the situation because a cultural filter determines what we will pay attention to and
what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.
While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills ANS: A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or whether a cultural barrier exists.
During the first interview with a parent whose child died in a car accident, the
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."
ANS: B
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 non-therapeutic. 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.
ANS: D
Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.
During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:
a. "Why do you keep asking about 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."
ANS: D
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. "Why" questions are probing and non- therapeutic.
Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?
a. A nurse is responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said was understood.
ANS: C
Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.
A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice:
a. is rarely helpful.
b. fosters independence.
c. lifts the burden of personal decision making.
d. helps the patient develop feelings of personal adequacy.
ANS: A
Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.
Select all that apply.
A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication?
a. "Why do you think you are so upset?"
b. "I can see that you feel sad about this situation."
c. "The loss of a close friend is very painful for you."
d. "Crying is a way of expressing the hurt you are experiencing."
e. "Let's talk about something else because this subject is upsetting you."
ANS: B, C, D
Reflecting ("I can see that you feel sad," "This is very painful for you") and giving information ("Crying is a way of expressing hurt") are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.
Select all that apply.
Which benefits are most associated with use of telehealth technologies?
a. Cost savings for patients
b. Maximize care management
c. Access to services for patients in rural areas
d. Prompt reimbursement by third party payers
e. Rapid development of trusting relationships with patients
ANS: A, B, C
Telehealth has shown it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems. Although telehealth's improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third party payers. Telehealth technologies have not shown rapid development of trusting relationships.
Select all that apply.
Which comments by a nurse demonstrate use of therapeutic communication techniques?
a. "Why do you think these events have happened to you?"
b. "There are people with problems much worse than yours."
c. "I'm glad you were able to tell me how you felt about your loss."
d. "I noticed your hands trembling when you told me about your accident."
e. "You look very nice today. I'm proud you took more time with your appearance."
ANS: C, D
The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are non-therapeutic techniques.
Which statement shows a nurse has empathy for a patient who made a suicide attempt?
a. "You must have been very upset when you tried to hurt yourself."
b. "It makes me sad to see you going through such a difficult experience."
c. "If you tell me what is troubling you, I can help you solve your problems."
d. "Suicide is a drastic solution to a problem that may not be such a serious matter."
ANS: A
Empathy permits the nurse to see an event from the patient's perspective, understand the patient's feelings, and communicate this to the patient. The incorrect responses are nurse- centered (focusing on the nurse's feelings rather than the patient's), belittling, and sympathetic.
After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?
a. The patient's reactions toward the nurse seem realistic and appropriate.
b. The patient states, "Talking to you feels like talking to my parents."
c. The nurse feels unusually happy when the patient's mood begins to lift.
d. The nurse develops a trusting relationship with the patient.
ANS: C
Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable. See relationship to audience response question.
A patient says, "Please don't share information about me with the other people." How should the nurse respond?
a. "I will not share information with your family or friends without your permission, but I share information about you with other staff."
b. "A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know."
c. "It 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."
ANS: A
A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff needs to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse-patient contract is established, and suggest mutual problem solving. The relationship must be patient centered. See relationship to audience response question.
c. discusses with the patient changes that happened during the relationship and evaluates outcomes.
d. offers to meet the patient for coffee and conversation three times a week after discharge.
ANS: C
Summarizing and evaluating progress help validate the experience for the patient and the nurse and facilitate closure. Termination must be discussed; avoiding discussion by spending little time with the patient promotes feelings of abandonment. Successful termination requires that the relationship be brought to closure without the possibility of dependency-producing ongoing contact.
What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:
a. self-responsibility and autonomy.
b. a greater sense of independence.
c. rapport and trust with the nurse.
d. resolved transference.
ANS: C
Development of rapport and trust is necessary before the relationship can progress to the working phase. Behaviors indicating a greater sense of independence, self- responsibility, and resolved transference occur in the working phase.
During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?
a. Preorientation
b. Orientation
c. Working
d. Termination
ANS: C
During the working phase, the nurse strives to assist the patient in making connections among dysfunctional behaviors, thinking, and emotions and offers support while alternative coping behaviors are tried.
At what point in the nurse-patient relationship should a nurse plan to first address termination?
a. During the orientation phase
b. At the end of the working phase
c. Near the beginning of the termination phase
d. When the patient initially brings up the topic
ANS: A
The patient has a right to know the conditions of the nurse-patient relationship. If the relationship is to be time-limited, the patient should be informed of the number of sessions. If it is open-ended, the termination date will not be known at the outset, and the patient should know that the issue will be negotiated at a later date. The nurse is responsible for bringing up the topic of termination early in the relationship, usually during the orientation phase.
