Foundations of Advanced Psychiatric Mental Health Practice (D343)

Correct Answer:

B. The patient’s needs

Explanation:

Therapeutic communication is centered on the patient’s needs, ensuring that interactions promote healing, understanding, and emotional well-being. The goal is to establish trust, encourage self-expression, and support the patient in addressing their concerns. Nurses use therapeutic communication to assess and respond to patients effectively while maintaining professional boundaries.

Why other options are wrong:

A. The family's wishes – While family input can be important, the primary focus of therapeutic communication should be on the patient. The patient’s perspective, emotions, and experiences should take precedence in therapeutic conversations.

C. The health care provider’s goals for the patient – While providers set goals for treatment, therapeutic communication is meant to help the patient express feelings and concerns. The process is patient-centered, not dictated solely by the provider’s objectives.

D. The intimate relationship between the nurse and patient – A therapeutic relationship is professional, not intimate. Boundaries must be maintained to ensure ethical and effective care. The focus should always be on the patient’s well-being rather than personal attachment.

Correct answer:

A. Facilitating the patient's understanding of their treatment plan.

Explanation:

Therapeutic communication in mental health nursing aims to help patients understand their condition, treatment options, and coping strategies. Nurses use therapeutic techniques such as active listening, clarification, and reflection to ensure patients comprehend their care plans and feel empowered to participate in decision-making.

Why other options are wrong:

B. Encouraging family involvement in the patient's care.

While family involvement is important, therapeutic communication focuses primarily on the nurse-patient interaction and the patient's own understanding.

C. Providing emotional support without addressing practical needs.

Effective therapeutic communication includes both emotional support and practical guidance to help patients navigate their treatment and recovery.

D. Minimizing patient participation in decision-making.

A core principle of therapeutic communication is to empower patients and encourage active participation in their care rather than minimizing their involvement

Correct answer:

B. Psychosocial, spiritual, cultural, and religious assessments

Explanation:

A comprehensive psychiatric nursing evaluation involves assessing multiple dimensions of a patient's well-being beyond just physical or cognitive health. Psychosocial, spiritual, cultural, and religious assessments provide insight into the patient’s support systems, personal values, coping mechanisms, and potential barriers to treatment. These assessments help nurses develop holistic care plans that address the patient’s mental health needs while considering their unique background and belief systems.

Why other options are wrong:

A. Physical, emotional, and cognitive assessments

While these are important components of a psychiatric evaluation, they do not encompass the full scope of a comprehensive assessment. A psychiatric nurse must also evaluate social, cultural, and spiritual factors, which play significant roles in mental health and treatment outcomes.

C. Behavioral, environmental, and nutritional assessments

These assessments contribute to understanding a patient's well-being but are not the primary focus of a comprehensive psychiatric nursing evaluation. Psychiatric assessments prioritize social, cultural, and spiritual influences alongside psychological and emotional factors.

D. Neurological, genetic, and pharmacological assessments

While relevant in some cases, these assessments are typically more specialized and fall under medical or psychiatric evaluations rather than comprehensive nursing assessments. A psychiatric nurse focuses more on psychosocial, cultural, and emotional aspects of care.

Correct answer:

C. Seeking an additional analgesic medication order for a patient who is experiencing severe pain

Explanation:

Patient advocacy involves acting in the best interest of the patient by addressing their needs, ensuring their rights are upheld, and communicating on their behalf when necessary. Seeking an additional analgesic for a patient in severe pain demonstrates advocacy because the nurse is recognizing and addressing the patient's discomfort, ensuring proper pain management, and advocating for an adjustment in treatment when necessary.

Why other options are wrong:

A. Collecting blood samples according to the physician's order each morning

While following physician orders is important, this task is a standard procedure rather than an act of advocacy. Advocacy involves going beyond routine duties to ensure patient well-being.

B. Assessing the vital signs of a patient who is receiving a blood transfusion

Monitoring vital signs during a transfusion is an essential nursing responsibility, but it does not specifically involve advocacy. Advocacy requires taking action to protect or improve patient care beyond routine assessment.

D. Accompanying an ambulating patient who is walking for the first time after undergoing surgery

Assisting a patient with ambulation is an important nursing role, but it does not qualify as advocacy. Advocacy focuses on speaking up for patient needs, ensuring they receive appropriate interventions, and making changes when necessary.

Correct answer:

D. discharge many chronic patients into hostile communities without adequate care.

Explanation:

Shortening psychiatric hospitalization has often led to the premature discharge of patients with severe mental illnesses into communities that lack the necessary support systems. Without adequate follow-up care, housing, and mental health services, these individuals may struggle to manage their condition, leading to increased homelessness, incarceration, or repeated hospitalizations.

Why other options are wrong:

A. allow the less severe patients better access to mental health care.

While shorter hospital stays may open up beds for other patients, they do not necessarily improve access to care for those with milder conditions. Instead, they often result in inadequate treatment for those with severe psychiatric disorders.

B. move patients into situations involving treatment by paraprofessionals.

Although community-based care may involve paraprofessionals, this is not the primary negative consequence of shortened hospitalizations. The main issue is the lack of adequate resources for patients after discharge.

C. cost states large amounts of money for added care in half-way houses.

While states do spend money on community mental health programs, many areas lack sufficient funding for halfway houses or transitional care. The real issue is that many patients are released into environments without proper support

Correct answer:

 D.Reflecting

Explanation:

Reflecting is a therapeutic communication technique that helps patients recognize their own thoughts and emotions by directing their statements back to them. It validates their experiences, fosters self-awareness, and encourages personal growth. By using reflection, the nurse empowers the patient to explore their own ideas, reinforcing their autonomy and decision-making abilities.

Why other options are wrong:

A. Summarizing.

Summarizing involves reviewing key points of a conversation to ensure understanding but does not directly encourage the patient to explore their feelings or develop self-awareness.

B. Restating.

Restating involves repeating what the patient has said using slightly different words to clarify meaning. However, it does not direct the conversation back to the patient in a way that encourages self-reflection and personal decision-making.

C. Exploring.

Exploring is used to encourage patients to discuss a topic in more depth, but it does not necessarily validate their emotions or reinforce their sense of self-capability in the same way that reflecting does

Correct answer:

D. Encouraging expression

Explanation:

Encouraging expression is a therapeutic communication technique that allows patients to openly discuss their thoughts, feelings, and concerns. This fosters trust, helps nurses understand the patient's emotional state, and supports the development of effective coping strategies. Encouraging expression helps patients process their emotions and feel validated in their experiences, making it an essential part of therapeutic communication.

Why other options are wrong:

A. Approval

Giving approval, such as saying, “That’s a good decision,” can be non-therapeutic because it implies judgment. It may make the patient feel like they need to seek approval for their thoughts or actions rather than making their own informed choices. Instead, nurses should focus on neutral and supportive responses that empower the patient.

B. Agreeing

Agreeing with a patient’s statements, such as saying, “You’re absolutely right,” can shut down further discussion and discourage the patient from exploring their thoughts more deeply. Therapeutic communication focuses on open-ended dialogue and exploration rather than simply affirming the patient’s viewpoint.

C. Reassurance

Offering false reassurance, such as saying, “Everything will be fine,” can minimize the patient’s concerns and make them feel unheard. Instead, therapeutic communication involves acknowledging the patient’s emotions and providing realistic support, such as saying, “I understand that this is a difficult time for you. Let’s talk about what we can do to support you.”

Correct Answer:

C. Orientation phase

Explanation:

The orientation phase is the initial stage of the nurse-patient relationship, during which trust begins to form. The nurse establishes rapport by demonstrating empathy, active listening, and nonjudgmental support. This phase also involves explaining roles, setting expectations, and outlining goals. The success of later phases relies on the foundation of trust established during this stage.

Why other options are wrong:

A. Termination phase.

The termination phase marks the end of the nurse-patient relationship, where progress is evaluated, and future care plans are discussed. Trust is already established by this point, and the focus is on closure rather than initiation.

B. Working phase.

The working phase is when therapeutic work occurs, but trust must already be established by this point for the patient to feel comfortable opening up. This phase builds on the foundation laid in the orientation phase.

D. Assessment phase.

Although assessment is important, it is a component of the orientation phase rather than a distinct phase of the nurse-patient relationship. Trust is built through the overall orientation process, not just the assessment alone

Correct answer:

A. Effective communication

Explanation:

Effective communication is a crucial interpersonal factor that fosters trust, understanding, and emotional support in relationships. It allows individuals to express their feelings, resolve conflicts, and develop deeper connections with others. Strong communication skills contribute to mental well-being by reducing misunderstandings, promoting emotional validation, and encouraging healthy interactions. In therapeutic settings, effective communication helps nurses establish rapport, provide education, and support patients in their mental health journey.

Why other options are wrong:

B. Social isolation

Social isolation negatively impacts mental well-being by reducing opportunities for emotional support and connection. It is linked to increased stress, depression, and anxiety, as individuals lack meaningful interactions that can provide reassurance and a sense of belonging. Isolation can also exacerbate existing mental health conditions by reinforcing feelings of loneliness and helplessness.

C. Emotional detachment

Emotional detachment can hinder strong relationships by creating barriers to genuine connection and empathy. When individuals suppress their emotions or avoid expressing them, they may struggle to build meaningful relationships and seek support when needed. Emotional detachment can contribute to difficulties in communication and may lead to increased stress, loneliness, and dissatisfaction in personal and professional relationships.

D. Conflict avoidance

While avoiding conflict may seem like a way to maintain harmony, it can lead to unresolved issues and resentment in relationships. Healthy conflict resolution is an essential aspect of effective communication, allowing individuals to express concerns, set boundaries, and strengthen trust. Avoiding conflict altogether can prevent meaningful discussions and hinder personal growth and emotional well-being.