THERAPEUTIC COMMUNICATION

Eliminate answer choices in which the nurse is telling the patient what to do without regard to the patient’s desires or feelings. Example:

• insisting that the patient follow unit rules
• insisting that the patient do what you command, immediately

Eliminate close-ended questions that can be answered with the words YES, NO or other monosyllabic answers. Close-ended questions discourage the patient from sharing thoughts and feelings. Example:

• "Are you feeling guilty about what happened?"
• "How many children do you have?"

Eliminate responses that are "why" questions: ones that seek reasons or justification. "Why" questions imply disapproval of the patient who may become defensive. Any response that puts the patient on the defensive is nontherapeutic and therefore incorrect. Example:

• "What makes you think that?"
• "Why do you feel this way?"

Avoid being a junior psychiatrist. Eliminate responses that include the word "explore". It is not the nurse’s role to delve into reasons why the patient is feeling a particular way. The patient must be allowed to verbalize the fact that he or she is sad, angry, fearful or overwhelmed. Example of "let’s explore" responses:

• "let’s talk about why you didn’t take your medication."
• "tell my why you really injured yourself."

Eliminate choices that offer false reassurance. These responses would discourage communication between the nurse and the patient by not allowing the patient to explore his or her own ideas and feelings. False reassurance discounts that what the patient is feeling.

Example:

• "It’s going to be OK."
• "Don’t worry. Your doctors will do everything necessary for your care."

Eliminate choices if the focus of the comment is on the nurse. Be careful, because these answers may sound very empathetic. The focus of your communication should always be on the patient. Example:

• "That happened to me once."
• "I know from experience this is hard for you."

More often than not, the answer choice that states "call the physician, or refer to somebody" is the WRONG answer. Usually there is something you need to do before you make the call. In a given situation, the test wants to know what a registered professional nurse will do….not what the physician is going to do.

Example:

A 53 year old man is receiving PRBC. Several minutes after the infusion is started, he complains for itching and develops hives on his chest and abdomen. Which of the following actions should the nurse take first?

A. slow down the rate of the transfusion
B. call the physician for an order of antihistamine
C. mix IV fluid with the blood to dilute it
D. stop the transfusion

It sounds like the patient is having an allergic reaction tot he transfusion. What should you do first for this patient?

A. slowing down the rate of transfusion is not the right action
B. antihistamines are given for allergic reactions. This answer is a possibility but there is something you should do first!
C. This does not have anything to do with an allergic transfusion reaction.
D. This is the best action to take first before calling the physician.  (Answer)

THE RULES OF MANAGEMENT

DO THE FOLLOWING ON THE EXAM DAY

KEEP MOVING FORWARD. By the test day, do enough preparation so that it becomes an instinct to keep moving forward instead of getting bogged down in a difficult question. The best test takers don’t get bothered by difficult questions because they accept that everyone encounters them on the exam.

DON’T LISTEN TO NEGATIVE WORDS OR BEHAVIOR. Don’t be distracted by the ignorant babble or the behavior of other, less prepared, less skilled examinees around you. Negative thoughts lead to negative feelings and may interfere with you performing your best on the test day.

DON’T BE ANXIOUS IF OTHER TEST TAKERS SEEM TO BE WORKING HARDER OR ANSWERING QUESTIONS MORE QUICKLY. Continue to spend your time patiently but doggedly thinking through your answers. Set your own pace and stick to it.

KEEP BREATHING!!! Some test takers start holding their breath without realizing it. This can hurt confidence and accuracy. Do what you can to instill awareness or proper breathing before and during each study or testing session.

DO SOME QUICK ISOMETRICS DURING THE TEST. This is helpful especially if your concentration is wandering or energy is waning. For example, put your palms together and press intensely for a few seconds.

Try saying this to yourself everyday: