NR506NP UPDATED SCRIPT 2026
PRACTICE SOLUTIONS GRADED A+
● Therapeutic Alliance. Answer: a feeling that you should create over
the course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be
compromised
• interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
● Creating rapport: tips. Answer: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
● How to approach threatening topics (sensitive/embarrassing material).
Answer: -Normalization
,-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
● Normalization. Answer: Introducing Q with some type of normalizing
statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2. Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or thinking
that strangers are laughing at them. Has that been happening to you?
● Symptom Expectation. Answer: communicate that a behavior is in
some way normal or expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
,-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient may
be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use
symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
● Symptom Exaggeration. Answer: suggesting a frequency of a
problematic behavior that is higher than your expectation, so that the
patient feels that their actual, lower frequency of the behavior will not be
perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
● Reduction of guilt. Answer: seeks to directly reduce a patient's guilt
about a specific behavior in order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial
behavior
Domestic Violence
, -"Have you ever been in situations where fights occurred and you were
affected?"
• If patient answers "yes," you can flesh out whether role was being a
witness, victim, or perpetrator
● According to Peplau's Theory of Interpersonal Relations, establishing
early rapport allows the role of the nurse to evolve from stranger to:.
Answer: resource person, teacher, leader, surrogate, technical expert, and
counselor
● Establishing the Relationship. Answer: -Trust is essential for a
therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is
comfortable
-Ask general questions to arrive at an empathic understanding of how
the client feels
-Listen carefully and communicate an appreciation for the client's
concerns
-Building a trusting relationship based on respect, kindness, and
acceptance will break down barriers and allow for client needs to be the
center of the plan of care
-Being present and openly engaged will enhance the communication
experience
PRACTICE SOLUTIONS GRADED A+
● Therapeutic Alliance. Answer: a feeling that you should create over
the course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be
compromised
• interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
● Creating rapport: tips. Answer: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
● How to approach threatening topics (sensitive/embarrassing material).
Answer: -Normalization
,-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
-Use Familiar Language When Asking about Behaviors
● Normalization. Answer: Introducing Q with some type of normalizing
statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
• ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2. Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
• ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or thinking
that strangers are laughing at them. Has that been happening to you?
● Symptom Expectation. Answer: communicate that a behavior is in
some way normal or expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
,-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient may
be too ashamed to admit it. Rather than gingerly asking "Have you had
any thoughts that you'd be better off dead?" you might decide to use
symptom expectation. "What kinds of ways to hurt yourself have you
thought about?"
*reserve this technique for situations in which it seems appropriate
● Symptom Exaggeration. Answer: suggesting a frequency of a
problematic behavior that is higher than your expectation, so that the
patient feels that their actual, lower frequency of the behavior will not be
perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
● Reduction of guilt. Answer: seeks to directly reduce a patient's guilt
about a specific behavior in order to discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial
behavior
Domestic Violence
, -"Have you ever been in situations where fights occurred and you were
affected?"
• If patient answers "yes," you can flesh out whether role was being a
witness, victim, or perpetrator
● According to Peplau's Theory of Interpersonal Relations, establishing
early rapport allows the role of the nurse to evolve from stranger to:.
Answer: resource person, teacher, leader, surrogate, technical expert, and
counselor
● Establishing the Relationship. Answer: -Trust is essential for a
therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is
comfortable
-Ask general questions to arrive at an empathic understanding of how
the client feels
-Listen carefully and communicate an appreciation for the client's
concerns
-Building a trusting relationship based on respect, kindness, and
acceptance will break down barriers and allow for client needs to be the
center of the plan of care
-Being present and openly engaged will enhance the communication
experience
