EXAM 2 NR548 PSYCHIATRIC ASSESSMENT
PAPER 2026 QUESTIONS AND ANSWERS
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
PAPER 2026 QUESTIONS AND ANSWERS
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
