# A nurse is using motivational interviewing (MI) to help a patient consider changing alcohol use. Which nurse responses align with MI principles? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374931&lang=en  
> language: en  
> subject: Psychosocial Integrity  
> category: PSI

## Question

A nurse is using motivational interviewing (MI) to help a patient consider changing alcohol use. Which nurse responses align with MI principles? Select all that apply.

1

Reflection: "It sounds like part of you is worried about what drinking is doing to your family, and another part really enjoys it as a way to relax."

2

Summary: "So far you have shared concerns about your liver tests, missed work, and arguments with your spouse — and you have also said quitting feels overwhelming. Did I capture that correctly?"

3

Open question: "What concerns do you have about your drinking right now, and what would you like to change if anything?"

4

Affirmation: "It takes real courage to talk openly about this — I appreciate you trusting me with these concerns."

5

If you don't make changes soon, you could face serious liver damage or other health problems. We need to talk about stopping now.

## Explanation

MI uses OARS — Open questions, Affirmations, Reflections, Summaries — to elicit the patient OWN reasons for change (change talk) while honoring ambivalence. Choice 5 (confrontation) violates MI; lecturing increases resistance and backfires. MI spirit is collaborative, evocative, and respects patient autonomy.

## In-depth explanation

MI replaces the older "expert-confront-cure" model. The four MI principles are RULE — Resist the righting reflex, Understand motivation, Listen with empathy, Empower autonomy. Change talk (DARN — Desire, Ability, Reason, Need) signals readiness; sustain talk indicates ambivalence to be reflected, not argued.

## Clinical scenario

Patient with **alcohol use disorder, contemplative stage**. The nurse uses **motivational interviewing (MI)** with OARS skills (Open question, Affirm, Reflect, Summarize) to elicit change talk without arguing for change.

## Key concepts

- **Motivational interviewing (MI)** — Patient-centered counseling style for evoking change by exploring and resolving ambivalence; evidence-based for substance use, chronic disease.
- **OARS** — Open questions, Affirmations, Reflections, Summaries — the four core skills of MI.
- **Stages of Change (Prochaska)** — Precontemplation, contemplation, preparation, action, maintenance, relapse — MI tailored to stage.

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