Documentation in a patient's chart shows. "Throughout a 5-minute interaction, patient fidgeted and tapped their left foot, periodically covered their face with their hands, and looked under chair while stating, 1 enjoy spending time with you." Which analysis is most accurate?
The nurse is viewing the patient's behavior through a cultural filter.
The patient is giving positive feedback about the nurse's communication techniques.
The patient is demonstrating psychotic behaviors.
The patient's verbal and nonverbal messages are incongruent.
The Correct Answer is D
A. There is no indication that cultural bias is affecting interpretation; the focus is on the mismatch between verbal and nonverbal cues.
B. While the patient says they enjoy the interaction, their nonverbal behavior (fidgeting, covering face, looking under chair) suggests discomfort or anxiety, not purely positive feedback.
C. The behaviors described (fidgeting, covering face) do not indicate hallucinations or delusions typical of psychosis.
D. The patient verbally states enjoyment, but their body language suggests discomfort, anxiety, or internal conflict, indicating incongruence between words and actions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Culturally influenced responses relate to behaviors shaped by cultural norms, not a temporary feeling of restlessness before a test.
B. Mild anxiety is characterized by increased alertness, restlessness, and improved concentration, which can actually enhance performance on tasks like taking a test.
C. Displacement is a defense mechanism in which emotions are transferred to a less threatening object or person, not simply feeling restless.
D. Trait anxiety refers to a long-term personality characteristic of being generally anxious, not a situational response before an exam.
Correct Answer is C
Explanation
A. Prickly skin sensations may occur with anxiety or substance use, not psychomotor agitation.
B. Slowed verbal responses indicate psychomotor retardation, not agitation.
C. Psychomotor agitation refers to increased, purposeless movement such as pacing, hand-wringing, or fidgeting.
D. Asking to repeat instructions indicates poor concentration, not specifically psychomotor agitation.
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