Foundations of Advanced Psychiatric Mental Health Practice (D343)

Correct answer:

C. Leads to community misunderstanding, prejudice, and discrimination

Explanation:

Stigma creates barriers to mental health care by fostering social misconceptions, discrimination, and reluctance to seek treatment. Individuals with mental illness often experience judgment, leading to decreased access to resources, rejection by employers or peers, and internalized shame that prevents them from seeking help. Overcoming stigma is essential to improving mental health outcomes and encouraging open discussions about mental health.

Why other options are wrong:

A. Is an important concept for nurses to teach patients to stop feeling shame

While nurses can help patients cope with stigma, overcoming stigma is not solely about personal responsibility; it requires systemic change and broader public awareness.

B. Not a concern at all

Stigma is a well-documented and significant issue that contributes to mental health disparities, making this option incorrect.

D. Has three types of stigma—public, self, and label avoidance

While this statement is factually correct, it does not fully capture why stigma creates barriers. The best answer focuses on its real-world impact—misunderstanding, prejudice, and discrimination.

Correct Answer:

C. Nurse's role in the nurse-patient relationship

Explanation:

The orientation phase sets the foundation for the therapeutic relationship by clarifying the nurse’s role, responsibilities, and expectations. This phase helps build trust and rapport while ensuring the patient understands the purpose of the interview and the care process. Establishing the nurse’s role creates a safe environment for open communication.

Why other options are wrong:

A. Need for a legally binding contract – While confidentiality and informed consent are discussed, the nurse-patient relationship is not legally binding in the same way a contract is. The focus is on therapeutic engagement, not legal agreements.

B. Achievement of mutually acceptable goals – While goal-setting is essential in the therapeutic process, it typically occurs later in the working phase, after the initial trust-building and assessment.

D. Patient's feelings, beliefs, values, and attitudes – While these factors are assessed during the interview, the primary goal of the orientation phase is to establish the nurse’s role and clarify expectations rather than delve into personal beliefs immediately.

Correct answer:

C. Conducting a Mental Status Examination (MSE) and obtaining the patient’s history

Explanation:

A psychiatric nursing assessment involves a comprehensive evaluation of the patient's mental health, which includes conducting a Mental Status Examination (MSE) and obtaining a detailed patient history. The MSE assesses aspects such as appearance, behavior, thought processes, mood, cognition, and insight. The patient’s history provides context regarding past psychiatric conditions, trauma, substance use, and other factors affecting their mental health.

Why other options are wrong:

A. Gathering the patient's medical history and family background

While medical and family history are important, they alone are not sufficient for a comprehensive psychiatric assessment. Mental health evaluations require more detailed psychological and behavioral assessments, such as an MSE.

B. Performing a physical examination and lab tests

Although physical examinations and lab tests can help rule out medical conditions that might affect mental health (e.g., thyroid disorders), they do not directly assess psychiatric status. They are supplementary rather than primary components of a psychiatric nursing assessment.

D. Reviewing the patient's medication adherence and lifestyle choices

Medication adherence and lifestyle choices are relevant but do not provide a full picture of a patient's mental health status. While these factors contribute to treatment planning, they do not replace the need for an MSE and a thorough psychiatric history

Correct answer:

C. Depression can significantly impact the management of chronic illness

Explanation:

Chronic illnesses often lead to significant lifestyle changes, physical limitations, and emotional distress, all of which can contribute to depression. Depression, in turn, can affect a patient’s motivation, adherence to treatment, and overall quality of life. Assessing for depression in patients with chronic illnesses allows healthcare providers to offer appropriate support and interventions, improving both mental health and physical health outcomes. Early identification and treatment of depression can enhance a patient's ability to cope with their illness and maintain treatment adherence.

Why other options are wrong:

A. Chronic illness does not impact mental health

This statement is incorrect because chronic illnesses can have a profound effect on mental health. Many patients with long-term medical conditions experience emotional distress, anxiety, and depression due to persistent symptoms, lifestyle limitations, and concerns about the future. Ignoring the mental health impact of chronic illness can lead to inadequate care and poorer patient outcomes.

B. Depression is unrelated to chronic illness

Depression is closely linked to chronic illnesses such as diabetes, heart disease, and chronic pain conditions. Studies show that individuals with chronic illnesses are at a higher risk of developing depression, which can negatively affect their physical health, ability to follow medical advice, and overall well-being. Proper assessment ensures that both mental and physical aspects of a patient’s health are managed effectively.

D. Only physical symptoms matter in chronic illness

Mental health is just as important as physical health in managing chronic illnesses. Depression and emotional distress can lead to noncompliance with treatment, increased hospitalization rates, and worse health outcomes. Addressing both the psychological and physical aspects of chronic illness leads to better overall patient care

Correct Answer:

B. Encouraging independence and self-reliance of the client

Explanation:

The termination phase is the final stage of the nurse-client relationship, where the primary goal is to ensure the client can function independently and apply the coping strategies and skills learned during treatment. The nurse should help the client reflect on progress, acknowledge achievements, and encourage confidence in managing future challenges without reliance on the nurse.

Why other options are wrong:

A. To reduce the amount of time spent with the client.

While the termination phase does involve ending the relationship, simply reducing time with the client is not an appropriate approach. Instead, the nurse should focus on a structured conclusion that helps the client transition successfully.

C. Reinforcing continued support following discharge.

While providing resources and follow-up options is important, the primary role of the nurse in termination is to foster the client’s ability to manage independently. Continued support may come from other healthcare professionals or support systems.

D. Discussing possible solutions to the present problem.

Problem-solving typically occurs in the working phase. By the time of termination, the client should have already explored solutions and strategies for dealing with their concerns. The termination phase is focused on reviewing progress and preparing for future independence.

Correct Answer:

B. Active observation

Explanation:

Active observation is a therapeutic communication technique that involves carefully monitoring both verbal and non-verbal cues, such as body language, tone of voice, facial expressions, and gestures. This technique helps nurses identify underlying emotions, inconsistencies between spoken words and body language, and potential distress signals that the patient may not verbally express. By attentively observing, the nurse can respond appropriately, build trust, and provide more effective support.

Why other options are wrong:

A. Empathic listening – This technique focuses on understanding and validating the patient’s emotions through verbal responses, but it does not specifically emphasize watching for non-verbal cues. Active observation includes both verbal and non-verbal monitoring.

C. Reflective responding – Reflective responding involves repeating or paraphrasing what the patient has said to show understanding and encourage further discussion. While it enhances communication, it does not necessarily involve closely monitoring non-verbal behaviors.

D. Clarifying questions – Asking clarifying questions helps ensure that the nurse correctly understands the patient's statements, but it does not primarily focus on non-verbal cues. Active observation, in contrast, emphasizes attentively watching for subtle behavioral indicators.

Correct answer:

B. Keeping a distance of 3-6 ft to ensure comfort

Explanation:

Personal space is an important factor in therapeutic communication. A distance of 3-6 feet is considered appropriate for maintaining a professional yet comfortable interaction. This distance respects the patient's personal boundaries while allowing for effective communication and engagement. It ensures the patient does not feel threatened or overwhelmed while maintaining a connection that facilitates trust.

Why other options are wrong:

A. Maintaining a distance of 1-2 ft to enhance intimacy

This distance is too close for most patients and may cause discomfort or anxiety. In professional settings, such close proximity is generally reserved for specific medical procedures rather than routine communication.

C. Standing 7-10 ft away to avoid invasion of personal space

While this distance prevents personal space invasion, it is too far for effective therapeutic communication. It may create a sense of detachment and make it difficult to establish rapport with the patient.

D. Sitting directly next to the patient to foster closeness

Sitting too close may be perceived as intrusive and may not be appropriate, particularly for patients who are anxious or have personal space concerns. Instead, a balanced distance that allows for both comfort and engagement is preferred.

Correct answer:

B. Providing information

Explanation:

The working phase of the nurse-patient relationship is where active interventions take place, including providing information to support treatment and education. This phase is characterized by problem-solving, therapeutic communication, and helping the patient develop coping strategies. Providing information allows the patient to better understand their condition, treatment options, and ways to manage their mental health effectively.

Why other options are wrong:

A. Establishing rapport

Establishing rapport occurs during the orientation phase of the nurse-patient relationship, where trust is built, and expectations for the relationship are set. The working phase focuses more on addressing the patient's concerns, implementing care plans, and educating the patient, rather than building initial trust.

C. Conducting initial assessments

Initial assessments are part of the orientation phase, where the nurse gathers baseline information about the patient. This data collection is essential for developing a care plan but does not fall under the working phase, which is more focused on intervention and treatment.

D. Planning discharge

Discharge planning is typically a component of the termination phase of the nurse-patient relationship, where the focus shifts to preparing the patient for independence and continued care after hospitalization. While discharge may be discussed throughout the process, the primary work of planning happens as the patient nears the end of their stay.

Correct answer:

C. To gather information about the patient's current mental health status

Explanation:

The main goal of a psychiatric nursing assessment is to collect comprehensive information regarding a patient’s mental health, including symptoms, behaviors, emotional state, and cognitive function. This assessment allows nurses and healthcare providers to determine appropriate interventions and care strategies based on the patient’s immediate needs.

Why other options are wrong:

A. To evaluate the patient's medical history

While reviewing a patient’s medical history is part of the assessment, it is not the primary goal. The main focus is on the patient’s current mental health status, which determines necessary interventions.

B. To identify the patient's strengths and weaknesses

Identifying strengths and weaknesses is important for treatment planning, but it is not the primary objective. The primary goal is to assess the current mental health condition.

D. To establish a treatment plan for the patient

A treatment plan is developed after the psychiatric nursing assessment, but the assessment itself is focused on gathering information rather than setting a treatment plan.