M.H exam 2 Flashcards
A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for clients? a. Perform mental health assessment interviews.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
ANS: B
Prescriptive privileges are granted to master’s-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level performs mental health assessments, establishes relationships, and provides individualized care planning.
A newly admitted client diagnosed with major depressive disorder has gained 20 pounds over a few months and has suicidal ideations. The client has taken antidepressant medication for 1 week without remission of symptoms. What is the priority nursing diagnosis? a. Imbalanced nutrition: more than body requirements
b. Chronic low self-esteem
c. Risk for suicide
d. Hopelessness
ANS: C
Risk for suicide is the priority diagnosis when the client has both suicidal ideation and a plan to carry out the suicidal intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but these problems do not affect client safety as urgently as would a suicide attempt.
A client diagnosed with major depressive disorder has lost 20 pounds in one month, has chronic low self-esteem, and a plan for suicide. The client has taken antidepressant medication for 1 week. Which nursing intervention has the highest priority? a. Implement suicide precautions.
b. Offer high-calorie snacks and fluids frequently.
c. Assist the client to identify three personal strengths.
d. Observe client for therapeutic effects of antidepressant medication.
ANS: A
Implementing suicide precautions is the only option related to client safety. The other options, related to nutrition, self-esteem, and medication therapy, are important but are not priorities.
The desired outcome for a client experiencing insomnia is, “Client will sleep for a minimum of 5 hours nightly within 7 days.” At the end of 7 days, review of sleep data shows the client sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. How should the nurse document the outcome?
a. As consistently demonstrated.
b. As often demonstrated.
c. As sometimes demonstrated.
d. As never demonstrated.
ANS: D
The correct response to this question involves applying the evaluation step of nursing process. Although the client is sleeping 6 hours daily, the total is not one uninterrupted session at night. Therefore, the outcome must be evaluated as never demonstrated.
The desired outcome for a client experiencing insomnia is, “Client will sleep for a minimum of 5 hours nightly within 7 days.” At the end of 7 days, review of sleep data shows the client sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse’s next action? a. Continue the current plan without changes.
b. Remove this nursing diagnosis from the plan of care.
c. Write a new nursing diagnosis that better reflects the problem.
d. Examine interventions for possible revision of the target date.
ANS: D
The correct response to this question involves applying the evaluation step of nursing process. Sleeping a total of 5 hours at night remains a reasonable outcome. Extending the period for attaining the outcome may be appropriate. Examining interventions might result in planning an activity during the afternoon rather than permitting a nap. Continuing the current plan without changes is inappropriate. Removing this nursing diagnosis from the plan of care would be correct when the outcome was met and the problem resolved. Writing a new nursing diagnosis is inappropriate because no other nursing diagnosis relates to the problem.
A client begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, “Encourage client to attend one psychoeducational group daily”?
a. Assessment
b. Analysis
c. Implementation
d. Evaluation
ANS: C
Interventions are the nursing prescriptions to achieve the outcomes. Interventions should be specific.
Before assessing a new client, a nurse is told by another health care worker, “I know that client. No matter how hard we work, there isn’t much improvement by the time of discharge.” What action is the nurse’s responsibility?
a. To document the other worker’s assessment of the client.
b. To assess the client based on data collected from all sources.
c. To validate the worker’s impression by contacting the client’s significant other.
d. To discuss the worker’s impression with the client during the assessment interview.
ANS: B
Assessment should include data obtained from both the primary and reliable secondary sources. The nurse should evaluate biased assessments by others as objectively as possible.
- A client presents to the emergency department (ED) with mixed psychiatric symptoms. The admission nurse suspects the symptoms may be the result of a medical problem. Lab results show elevated BUN (blood urea nitrogen) and creatinine. What is the nurse’s next best action? a. Report the findings to the health care provider.
b. Assess the client for a history of renal problems.
c. Assess the client’s family history for cardiac problems.
d. Arrange for the client’s hospitalization on the psychiatric unit
ANS: B
Elevated BUN and creatinine suggest renal problems. Renal dysfunction can often imitate psychiatric disorders. The nurse should further assess the client’s history for renal problems and then share the findings with the health care provider.
A client states, “I’m not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up.” Which nursing intervention should have the highest priority? a. Self-esteem–building activities
b. Anxiety self-control measures
c. Sleep enhancement activities
d. Suicide precautions
ANS: D
The nurse would place a priority on monitoring and reinforcing suicide self-restraint because it relates directly and immediately to client safety. Client safety is always a priority concern. The nurse should monitor and reinforce all client attempts to control anxiety, improve sleep patterns, and develop self-esteem, while giving priority attention to suicide self-restraint.
Nursing behaviors associated with the implementation phase of nursing process are concerned with what action?
a. Participating in mutual identification of client outcomes.
b. Gathering accurate and sufficient client-centered data.
c. Comparing client responses and expected outcomes.
d. Carrying out interventions and coordinating care.
ANS: D
Nursing behaviors relating to implementation include using available resources, performing interventions, finding alternatives when necessary, and coordinating care with other team members.
Select the best outcome for a client with the nursing diagnosis: Impaired social interaction related to sociocultural dissonance as evidenced by stating, “Although I’d like to, I don’t participate because I don’t speak the language very well.” Client will engage in what action? a. Show improved use of language.
b. Demonstrate improved social skills.
c. Become more independent in decision making.
d. Select and participate in one group activity per day.
ANS: D
The outcome describes social involvement on the part of the client. Neither cooperation nor independence has been an issue. The client has already expressed a desire to interact with others. Outcomes must be measurable. Two of the distracters are not measurable.
Which statement made by a client during an initial assessment interview should serve as the priority focus for the plan of care?
a. “I can always trust my family.”
b. “It seems like I always have bad luck.”
c. “You never know who will turn against you.”
d. “I hear evil voices that tell me to do bad things.”
ANS: D
The statement regarding evil voices tells the nurse that the client is experiencing auditory hallucinations and may create risks for violence. Safety is the nurse’s first concern. The other statements are vague and do not clearly identify the client’s chief symptom.
- Which entry in the medical record best meets the requirement for problem-oriented charting?
a. “A: Pacing and muttering to self. P: Sensory perceptual alteration related to internal auditory stimulation. I: Given fluphenazine HCL 2.5 mg po at 0900 and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV.”
b. “S: States, ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg po. I: Haloperidol 2 mg po given at 0900. E: Returned to lounge at 0930 and quietly watched TV.”
c. “Agitated behavior. D: Client muttering to self as though answering an unseen person. A: Given haloperidol 2 mg po and went to room to lie down. E: Client calmer. Returned to lounge to watch TV.”
d. “Pacing hall and muttering to self as though answering an unseen person.
haloperidol 2 mg po administered at 0900 with calming effect in 30 minutes. Stated, ‘I’m no longer bothered by the voices.’”
ANS: B
Problem-oriented documentation uses the first letter of key words to organize data: S for subjective data, O for objective data, A for assessment, P for plan, I for intervention, and E for evaluation. The distracters offer examples of PIE charting, focus documentation, and narrative documentation.
- A nurse assesses an older adult client brought to the emergency department (ED) by a family member. The client was wandering outside saying, “I can’t find my way home.” The client is confused and unable to answer questions. Select the nurse’s best action.
a. Record the client’s answers to questions on the nursing assessment form.
b. Ask an advanced practice nurse to perform the assessment interview.
c. Call for a mental health advocate to maintain the client’s rights.
d. Obtain important information from the family member.
ANS: D
When the client (primary source) is unable to provide information, secondary sources should be used, in this case, the family member. Later, more data may be obtained from other information sources familiar with the client. An advanced practice nurse is not needed for this assessment; it is within the scope of practice of the staff nurse. Calling a mental health advocate is unnecessary. See relationship to audience response question.
A nurse asks a client, “If you had fever and vomiting for 3 days, what would you do?” Which aspect of the mental status examination is the nurse assessing? a. Behavior
b. Cognition
c. Affect and mood
d. Perceptual disturbances
ANS: B
Assessing cognition involves determining a client’s judgment and decision making. In this case, the nurse would expect a response of “Call my doctor” if the client’s cognition and judgment are intact. If the client responds, “I would stop eating” or “I would just wait and see what happened,” the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.
An adolescent asks a nurse conducting an assessment interview, “Why should I tell you anything? You’ll just tell my parents whatever you find out.” Which response by the nurse is appropriate?
a. “That isn’t true. What you tell us is private and held in strict confidence. Your parents have no right to know.”
b. “Yes, your parents may find out what you say, but it is important that they know about your problems.”
c. “What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team.”
d. “It sounds as though you are not really ready to work on your problems and make changes.”
ANS: C
Adolescents are very concerned with confidentiality. The client has a right to know that most information will be held in confidence, but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse. The incorrect responses are not true, will not inspire the confidence of the client, or are confrontational.
A nurse wants to assess an adult client’s recent memory. Which question would best yield the desired information?
a. “Where did you go to elementary school?”
b. “What did you have for breakfast this morning?”
c. “Can you name the current president of the United States?”
d. “A few minutes ago, I told you my name. Can you remember it?”.
ANS: B
The client’s recall of a meal provides evidence of recent memory. Two incorrect responses are useful to assess immediate and remote memory. The other distracter assesses the client’s fund of knowledge
When a nurse assesses an older adult client, answers seem vague or unrelated to the questions. The client also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be
a. “Are you having difficulty hearing when I speak?”
b. “How can I make this assessment interview easier for you?”
c. “I notice you are frowning. Are you feeling annoyed with me?”
d. “You’re having trouble focusing on what I’m saying. What is distracting you?”
ANS: A
The client’s behaviors may indicate difficulty hearing. Identifying any physical need, the client may have at the onset of the interview and making accommodations are important considerations. By asking if the client is annoyed, the nurse is jumping to conclusions. Asking how to make the interview easier for the client may not elicit a concrete answer. Asking about distractions is a way of asking about auditory hallucinations, which is not appropriate because the nurse has observed that the client seems to be listening intently.
- At what point in an assessment interview would a nurse ask, “How does your faith help you in stressful situations?”
a. childhood growth and development
b. substance use and abuse
c. educational background
d. coping strategies
ANS: D
When discussing coping strategies, the nurse might ask what the client does when upset, what usually relieves stress, and to whom the client goes to talk about problems. The question regarding whether the client’s faith helps deal with stress fits well here. It would be out of place if introduced during exploration of the other topics.
When a new client is hospitalized, a nurse takes the client on a tour, explains rules of the unit, and discusses the daily schedule. The nurse is engaged in what nursing action? a. counseling.
b. health teaching.
c. milieu management.
d. psychobiological intervention.
ANS: C
Milieu management provides a therapeutic environment in which the client can feel comfortable and safe while engaging in activities that meet the client’s physical and mental health needs. Counseling refers to activities designed to promote problem solving and enhanced coping and includes interviewing, crisis intervention, stress management, and conflict resolution. Health teaching involves identifying health education needs and giving information about these needs. Psychobiological interventions involve medication administration and monitoring response to medications.
- After formulating the nursing diagnoses for a new client, what is a nurse’s next action?
a. Designing interventions to include in the plan of care
b. Determining the goals and outcome criteria
c. Implementing the nursing plan of care
d. Completing the spiritual assessment
ANS: B
The third step of the nursing process is planning and outcome identification. Outcomes cannot be determined until the nursing assessment is complete and nursing diagnoses have been formulated.
What is the most appropriate label to complete this nursing diagnosis: related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening.
a. Deficient knowledge
b. Ineffective coping
c. Social isolation
d. Powerlessness
ANS: C
Nursing diagnoses are selected based on the etiological factors and assessment findings, or evidence. In this instance, the evidence shows social isolation that is caused by shyness and poorly developed social skills.
What does “QSEN” refers to?
a. Qualitative Standardized Excellence in Nursing.
b. Quality and Safety Education for Nurses.
c. Quantitative Effectiveness in Nursing.
d. Quick Standards Essential for Nurses.
ANS: B
QSEN represents national initiatives centered on client safety and quality. The primary goal of QSEN is to prepare future nurses with the knowledge, skills, and attitudes to increase the quality, care, and safety in the health care setting in which they work.
A nurse documents: “Client is mute despite repeated efforts to elicit speech. Makes no eye contact. Inattentive to staff. Gazes off to the side or looks upward rather than at speaker.” Which nursing diagnosis should be considered? a. Defensive coping
b. Decisional conflict
c. Risk for other-directed violence
d. Impaired verbal communication
.
ANS: D
The defining characteristics are more related to the nursing diagnosis of impaired verbal communication than to the other nursing diagnoses
A nurse prepares to assess a new client who moved to the United States from Central America 3 years ago. After introductions, what is the nurse’s next comment? a. “How did you get to the United States?”
b. “Would you like for a family member to help you talk with me?”
c. “An interpreter is available. Would you like for me to make a request for these services?”
d. “Are you comfortable conversing in English, or would you prefer to have a
translator present?”
ANS: D
The nurse should determine whether a translator is needed by first assessing the client for language barriers. Accuracy of the assessment depends on the ability to communicate in a language that is familiar to the client. Family members are not always reliable translators. An interpreter may change the client’s responses; a translator is a better resource.
The nurse records this entry in a client’s progress notes:
Client escorted to unit by ER nurse at 2130. Client’s clothing was dirty. In interview room, client sat with hands over face, sobbing softly. Did not acknowledge nurse or reply to questions. After several minutes, abruptly arose, ran to window, and pounded. Shouted repeatedly, “Let me out of here.” Verbal intervention unsuccessful. Order for stat dose 2 mg haloperidol PO obtained; medication administered at 2150. By 2215, client stopped shouting and returned to sit wordlessly in chair. Client placed on one-to-one observation.
How should this documentation be evaluated? a. Uses unapproved abbreviations
b. Contains subjective material
c. Excessively wordy
d. Meets standards
ANS: D
This narrative note describes client appearance, behavior, and conversation. It mentions that less- restrictive measures were attempted before administering medication and documents client response to medication. This note would probably meet standards. A complete nursing assessment would be in order as soon as the client is able to participate. Subjective material is absent from the note. Abbreviations are acceptable.
A nurse assessed a client who reluctantly participated in activities, answered questions with minimal responses, and rarely made eye contact. What information should be included when documenting the assessment? (Select all that apply.) a. The client was uncooperative
b. The client’s subjective responses
c. Only data obtained from the client’s verbal responses
d. A description of the client’s behavior during the interview
e. Analysis of why the client was unresponsive during the interview
ANS: B, D
Both content and process of the interview should be documented. Providing only the client’s verbal responses would create a skewed picture of the client. Writing that the client was uncooperative is subjectively worded. An objective description of client behavior would be preferable. Analysis of the reasons for the client’s behavior would be speculation, which is inappropriate
A nurse performing an assessment interview for a client with a substance use disorder decides to use a standardized rating scale. Which scales are appropriate? (Select all that apply.) a. Addiction Severity Index (ASI)
b. Brief Drug Abuse Screen Test (B-DAST)
c. Abnormal Involuntary Movement Scale (AIMS)
d. Cognitive Capacity Screening Examination (CCSE)
e. Recovery Attitude and Treatment Evaluator (RAATE)
ANS: A, B, E
Standardized scales are useful for obtaining data about substance use disorders. The ASI, B- DAST, and RAATE are scales related to substance abuse. AIMS assesses involuntary movements associated with antipsychotic medications. The CCSE assesses cognitive function.
What information is conveyed by nursing diagnoses? (Select all that apply.)
a. Medical judgments about the disorder
b. Unmet client needs currently present
c. Goals and outcomes for the plan of care
d. Supporting data that validate the diagnoses
e. Probable causes that will be targets for nursing interventions
ANS: B, D, E
Nursing diagnoses focus on phenomena of concern to nurses rather than on medical diagnoses.
A client is very suspicious and states, “The FBI has me under surveillance.” Which strategies should a nurse use when gathering initial assessment data about this client? (Select all that apply.)
a. Tell the client that medication will help this type of thinking.
b. Ask the client, “Tell me about the problem as you see it.”
c. Seek information about when the problem began.
d. Tell the client, “Your ideas are not realistic.”
e. Reassure the client, “You are safe here.”
ANS: B, C, E
During the assessment interview, the nurse should listen attentively and accept the client’s statements in a nonjudgmental way. Because the client is suspicious and fearful, reassuring safety may be helpful, although trust is unlikely so early in the relationship. Saying that medication will help or telling the client that the ideas are not realistic will undermine development of trust between the nurse and client.
A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “This patient is like one of my grandparents … so helpless.” Which response is the nurse demonstrating?
a. Transference
b. Countertransference
c. Catastrophic reaction
d. Defensive coping reaction
ANS: B
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. See relationship to audience response question.
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.
A novice nurse tells a mentor, “I want to convey to my patients that I am interested in them and that I want to listen to what they have to say.” Which behaviors will be helpful in meeting the nurse’s goal? (Select all that apply.)
a. Sitting behind a desk, facing the patient
b. Introducing self to a patient and identifying own role
c. Maintaining control of discussions by asking direct questions
d. Using facial expressions to convey interest and encouragement
e. Assuming an open body posture and sometimes mirror imaging
ANS: B, D, E
Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey interest and encouragement support the nurse’s verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient comfort. A desk would place a physical barrier between the nurse and patient. A face-to-face stance should be avoided when possible and a less intense 90- or 120-degree angle used to permit either party to look away without discomfort.
A novice psychiatric nurse has been assigned a parent diagnosed with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parent’s behavior in the community.
Select the best ways for this nurse to cope with these feelings. (Select all that apply.) a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses.
b. Recognize that these feelings are unhealthy. The nurse should try to suppress them when working with patients.
c. Recognize that psychiatric nursing is not an appropriate career choice. Explore other nursing specialties.
d. The nurse should begin new patient relationships by saying, “My own parent had mental illness, so I accept it without stigma.”
e. Recognize that the feelings may add sensitivity to the nurse’s practice, but supervision is important.
ANS: A, E
The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource that may be helpful. The knowledge and experience gained from the nurse’s relationship with a mentally ill parent may contribute sensitivity to compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories.
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.
nship with the patient is desirable.
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 will 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.
A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, “I really need to talk to you.” What action should nurse take?
a. Invite the interrupting patient to join in the session with the current patient.
b. Tell the interrupting patient, “I am not available to talk with you at the present time.”
c. End the unproductive session with the current patient and spend time with the interrupting patient.
d. Tell the interrupting patient, “This session is 5 more minutes; then I will talk with you.”
ANS: D
When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted, and that the patient and the sessions are important. The incorrect responses preserve the nurse–patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.
Termination of a therapeutic nurse–patient relationship has been successful when the nurse engages in what activity?
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 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 behaviors will the patient demonstrate as desirable outcomes for the orientation stage of a nurse–patient relationship?
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 the patient’s identified 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.
During which phase of the nurse–patient relationship can the nurse anticipate that the patient’s identified 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.
Why does the nurse introduces the matter of a contract during the first session with a new patient?
a. To specify what the nurse will do for the patient.
b. To spell out the participation and responsibilities of each party.
c. To indicate the feeling tone established between the participants.
d. To prevent either party from prematurely ending the relationship.
ANS: B
A contract emphasizes that the nurse works with the patient rather than doing something for the patient. “Working with” is a process that suggests each party is expected to participate and share responsibility for outcomes. Contracts do not, however, stipulate roles or feeling tone, and premature termination is forbidden.
