3710 checkpoint 1

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following describes the role of the nurse in the resolution of ethical dilemmas? 1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations 2 To await new clinical orders from the physician 3 To limit discussions about ethical principals 4 To allow the patient and the physician to resolve the dilemma without regard to personally held values or opinions regarding the ethical issues

1 To articulate his or her unique point of view, including knowledge based on clinical and psychosocial observations

A precise definition for the word quality is difficult to articulate when it comes to quality of life. Why? (Select all that apply.) 1 Quality of life is measured by potential income, and average income varies in different regions of the country. 2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

2 Community values are subject to change, and communities influence definitions of "quality." 3 Individual experiences influence perceptions of quality in potentially different ways, making consensus difficult. 4 Placing measurable value on elusive elements such as cognitive skills, ability to perform meaningful work, and relationship to family is challenging.

When an ethical dilemma occurs on your unit, can you resolve the dilemma by taking a vote? 1 Yes because ethics is essentially a democratic process, with all participants sharing an equal voice 2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do 3 Yes because ethical dilemmas otherwise take up time and energy that is better spent at the bedside performing direct patient care 4 No because most ethical dilemmas are resolved by deferring to the medical director of the ethics department

2 No because an ethical dilemma involves the resolution of conflicting values and principals rather than simply the identification of what people want to do

A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) 1 Information provided by the head nurse 2 Policies and procedures of the employing hospital 3 State Nurse Practice Act 4 Regulations identified in The Joint Commission's manual 5 The American Nurses Association standards of nursing practice

2 Policies and procedures of the employing hospital 3 State Nurse Practice Act 4 Regulations identified in The Joint Commission's manual 5 The American Nurses Association standards of nursing practice Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.

Which of the following explain how health care reform is an ethical issue? (Select all that apply.) 1 Access to care is an issue of beneficence, a fundamental principal in health care ethics. 2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

2 Reforms promote the principle of beneficence, a hallmark of health care ethics. 3 Purchasing health care insurance may become an obligation rather than a choice, a potential conflict between autonomy and beneficence. 4 Lack of access to affordable health care causes harm, and nonmaleficence is a basic principal of health care ethics.

Which is the best method of negotiating or processing difficult ethical situations? 1 Ethical issues arise between dissenting providers and can be best resolved by deference to an independent arbitrator such a chaplain. 2 Since ethical issues usually affect policy and procedure, a legal expert is the best consultant to help resolve disputes. 3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus. 4 Medical experts are best able to resolve conflicts about outcome predictions.

3 Institutional ethics committees help to ensure that all participants involved in the ethical dilemma get a fair hearing and an opportunity to express values, feelings, and opinions as a way to find consensus.

The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principal, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you deleted all patient identifiers? 1 Yes because patient privacy would not be violated as long as the patient identifiers were removed 2 Yes because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work 4 No because the principal of justice requires you to allocate resources fairly

3 No because, even though patient identifiers are removed, someone could identify the patient based on other comments that you make online about his or her condition and your place of work

When a nurse assesses a patient for pain & offers a plan to manage the pain, which principle is used to encourage the nurse to monitor the patients response to the pain? A - Fidelity B - Beneficence C - Nonmaleficence D - Respect for autonomy

A - Fidelity

Successful ethical discussion depends on people who have a clear since of personal values. When a group of people share many of the same values, it may be possible to refer for guidance to philosophical principles of utilitarianism. This philosophy proposes which of the following? A - the value of something is determined by its usefulness to society B - people's values are determined by religious leaders C - the decision to perform a liver transplant depends on a measure of the moral life that the patient has lead so far D - the best way to determine the solution to an ethical dilemma is to refer the case to the attending physician or health care provider

A - the value of something is determined by its usefulness to society

A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.) A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." C. "I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing." D. "Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses."

A. "I am thinking about joining the health committee at my church." B. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health."

Which of the following statements indicate a nontherapeutic communication technique? (Select all that apply.) A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."

A. "Why didn't you attend group this morning?" C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today."

You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first? A. Call the nursing supervisor to discuss the situation B. Discuss the problem with a colleague C. Leave the nursing unit and go home D. Say nothing and begin your work

A. Call the nursing supervisor to discuss the situation

The patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) A. Failure to document a change in assessment data B. Failure to provide discharge instructions C. Failure to follow the six rights of medication administration D. Failure to use proper medical equipment ordered for patient monitoring E. Failure to notify a health care provider about a change in the patient's condition

A. Failure to document a change in assessment data E. Failure to notify a health care provider about a change in the patient's condition

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.) A. In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship communication remains on a more superficial level, allowing patients to feel comfortable.

A. In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient.

Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) A. Taking or selling controlled substances B. Refusing to provide health care information to a patient's child C. Reporting suspected abuse and neglect of children D. Applying physical restraints without a written physician's order

A. Taking or selling controlled substances D. Applying physical restraints without a written physician's order

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior? A. You have violated Louisa's personal space by physically being too close. B. Louisa has issues with sharing personal information. C. You have not made the patient feel comfortable by explaining the purpose of the admission interview. D. Louisa is responding to the voices in her head telling her to leave.

A. You have violated Louisa's personal space by physically being too close.

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual & society, outweigh the temporary discomforts. Which principle is involved in this situation? A - Fidelity B - Beneficence C - Nonmaleficence D - Respect for autonomy

B - Beneficence

Ethical dilemmas often arise over a conflict of opinion. What is the critical first step in negotiating the difference of opinion? A - consult a professional ethicist to ensure that the steps of the process occur in full B - gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma C - ensure that the attending physician or ECP has written an order for an ethics consultation to support the ethics process D - list the ethical principles that inform the dilemma so negotiations agree on the language of the discussion

B - gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma

The philosophy sometimes called the ethics of care suggests that ethical dilemmas can best be solved by attention to which of the following? A - patients B - relationships C - ethical principles D - code of ethics for nurses

B - relationships

Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference? A. "My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge." D. "My patient, Gayle, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. "My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"

The nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline the nurse will follow? A. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. C. The patient cannot make changes in the advance directive once admitted to the hospital. D. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? A. Family member B. Surgeon C. Nurse D. Nurse Manager

B. Surgeon

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible? A. William did not love his wife. B. William's response may reflect cultural norms. C. William's response may reflect guilt. D. William may have an antisocial personality, which would explain his lack of feeling.

B. William's response may reflect cultural norms.

The point of the ethical principal to "do no harm" is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agree to do this in the least painful & harmful way possible. Which principle describes this agreement? A - Beneficence B - Accountability C - Nonmaleficence 4 - Respect for autonomy

C - Nonmaleficence

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurses point of view valuable? A - nurses understand the principle of autonomy to guide respect for patients self-worth B - nurses have a scope of practice that encourages the presence during ethical discussions C - nurses develop a relationship to the patient that is unique among all health care providers D - the nurses code of ethics recommends that a nurse be present at any ethical discussion about patient care

C - nurses develop a relationship to the patient that is unique among all health care providers

Your patient, Emma, is crying in your one-to-one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy? A. "Emma, I'm so sorry. My father died two years ago, so I know how you are feeling." B. "Emma, you need to focus on yourself right now. You deserve to take time just for you." C. "Emma, that must have been such a hard situation to deal with." D. "Emma, I know that you will get over this. It just takes time."

C. "Emma, that must have been such a hard situation to deal with."

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? A. Document her findings and treat the patient B. Instruct the mother on safe handling of a 2-year-old child C. Contact a child abuse hotline D. Discuss this story with a colleague

C. Contact a child abuse hotline

You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the first nursing action to take? A. Give the family the record B. Give the patient the record C. Discuss the issues that concern the family with them D. Call the nursing supervisor

C. Discuss the issues that concern the family with them Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how to best address their concerns.

A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nursing manager because this action is a violation of which act? A. Mental Health Parity Act B. Patient Self-Determination Act (PSDA) C. Health Insurance Portability and Accountability Act (HIPAA) D. Emergency Medical Treatment and Active Labor Act

C. Health Insurance Portability and Accountability Act (HIPAA)

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.

The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? A. Discussing patient conditions in the nursing report room at the change of shift B. Allowing nursing students to review patient charts before caring for patients to whom they are assigned C. Posting medical information about the patient on a message board in the patient's room D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

C. Posting medical information about the patient on a message board in the patient's room

A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? A. The nurse's automobile insurance B. The nurse's homeowner's insurance C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence D. The Patient Care Partnership, which may grant immunity from suit if the injured party consents

C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence

A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) A. The nurse represents the plaintiff. B. The defendant must prove injury, damage, or loss. C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury.

C. The person filing the lawsuit has the burden of proof. D. The plaintiff must prove that a breach in the prevailing standard of care caused an injury. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.

What is the best example of the nurse practicing patient advocacy? A - seek out the nursing supervisor in conflicting procedural situations B - Document all clinical changes in the medical record in a timely manner C - Work to understand the law as it applies to an error in following standards of care D - Assess the patient's point of view and prepare to articulate it

D - Assess the patient's point of view and prepare to articulate it

The patient for whom you are caring needs a liver transplant to survive. The patient has been in & out of work for several months & doesn't seem to have health insurance or enough cash. What principles would be a priority in a discussion about ethics? A - accountability B - Respect C - Ethics of care D - Justice

D - Justice because the first & greatest question in this situation is how to determine the just distribution of resources

You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed? A. "Allison, you are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. (to fellow nurse): "I haven't met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Allison, now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

D. "Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even be out of prison." C. "The biggest question is, will you do it again? You will end up right back in prison, and have even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility? A. Obtain a court order to give the blood B. Coerce the husband into giving the blood C. Call security and have the husband removed from the hospital D. Abide by the husband's wishes and inform the health care provider

D. Abide by the husband's wishes and inform the health care provider

A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? A. Health Insurance Portability and Accountability Act (HIPAA) B. Americans with Disabilities Act (ADA) C. Patient Self-Determination Act (PSDA) D. Emergency Medical Treatment and Active Labor Act (EMTALA)

D. Emergency Medical Treatment and Active Labor Act (EMTALA)

Amanda was raised by a rejecting and abusive father and had a difficult childhood. As an inpatient, she frequently comments on how hard her nurse, Jane, works and on how other staff members do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Amanda. Jane appreciates her insightfulness, and realizes that the other staff members do not appreciate how hard she works and take her for granted. Jane enjoys the time she spends with Amanda and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient? a. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father. b. Jane is idealizing Amanda, seeing in her strengths and abilities that Amanda does not possess; Jane should temporarily distance herself somewhat from Amanda. c. Amanda is overidentifying with Jane, seeing similarities that do not in reality exist; Jane should label and explore this phenomenon in her interactions with Amanda. d. Jane is experiencing countertransference in response to Amanda's meeting Jane's needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics.

a. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father.

A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship? a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. b. Offering the patient advice on how he could cope more effectively with stress. c. Controlling the pace of the relationship by selecting topics for each interaction. d. Limiting the discussion of termination issues so as not to sadden the patient unduly.

a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak.

Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? a. The nurse assesses the patient at regular intervals. b. The nurse administers psychotropic medications. c. The nurse spends time sitting with a withdrawn patient. d. The nurse participates in team meetings with other professionals.

a. The nurse assesses the patient at regular intervals.

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just now; don't you feel well?" d. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"

b. "You say you look forward to the meeting, but you appear anxious or unhappy."

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of the conversation. c. She tells him that she will not talk about her personal life. d. She explains that if he persists in focusing on her, she cannot work with him.

b. She limits sharing personal information and stresses the patient-centered focus of the conversation.

Which student behavior is consistent with therapeutic communication? a. Offering your opinion when asked in order to convey support. b. Summarizing the essence of the patient's comments in your own words. c. Interrupting periods of silence before they become awkward for the patient. d. Telling the patient he did well when you approve of his statements or actions.

b. Summarizing the essence of the patient's comments in your own words.

James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons; what you saw were hallucinations." b. "It is not possible for anyone to enter your room at night; you are safe here." c. "You seem very upset; please tell me more about what you experienced last night." d. "That must have been very frightening, but we'll check on you at night and you'll be safe."

c. "You seem very upset; please tell me more about what you experienced last night."

Emily is a 28-year-old nurse on the psychiatric unit. She has been working with Jenna, a 27-year-old who was admitted with depression. Emily and Jenna find they have much in common, including each having a 2-year-old daughter and each having graduated from the same high school. Emily and Jenna discuss getting together for lunch with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationship

c. Boundary blurring

Which statement about nonverbal behavior is accurate? a. A calm expression means that the patient is experiencing low levels of anxiety. b. Patients respond more consistently to therapeutic touch than to verbal interventions. c. The meaning of nonverbal behaviors varies with cultural and individual differences. d. Eye contact is a reliable measure of the patient's degree of attentiveness and engagement.

c. The meaning of nonverbal behaviors varies with cultural and individual differences.

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction? Select all that apply. a. Apologize for the differential in height and proceed while standing to avoid delay. b. If permitted, raise the head of the bed and, with the patient's permission, sit on the bed. c. If permitted, raise the head of the bed to approximate the nurse's height while standing. d. Sit in whatever chair is available in the room to convey informality and increase comfort. e. Locate a chair or stool that would place the nurse at approximately the level of the patient. f. Remain standing and proceed so as not to create distraction by altering the arrangements.

e. Locate a chair or stool that would place the nurse at approximately the level of the patient.