CH 9: The Nurse-Patient Relationship

During the first meeting, a client asks, "What information will be shared with others?" Which response would the nurse make?

"Assessment information and your progress is shared."

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established?

"I feel worthless and have no real use in life."

During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response?

"Any information is only shared with other professionals involved in your care."

The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment?

"It can be scary to leave a place that you trust and feel supported."

During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference?

'Tell me why you are angry about what I just said!

During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts?

'Thank you but I will not accept these gifts because they extend over our discussed boundaries."

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child?

'That must have been terribly hurtful experience for you."

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?

Ask to be reassigned because of having a prior personal relationship with the client.

In what phase of the therapeutic relationship does the assessment process begin?

During the initiating or orienting phase

A nurse is communicating with a client who is highly anxious. During the conversation, the notices that the nurse's speech is matching the fast pace of the client's speech, and the nurs heart rate is increasing. The nurse identifies this as:

Empathetic linkage.

While engaged in a conversation during the working phase, the nurse reminds the client that the relationship is going to end once the client's problems have resolved. Which reaction would indicate to the nurse that the client is experiencing stress about terminating the relationship?

Expresses anger toward the nurse.

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship?

Hildegard Peplau (Peptalk Queen)

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

Orientation Phase

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?

Seeking assistance

A client describes panic attacks during which the client rushes to the emergency department with a feeling that death may be imminent. The nurse discloses having had panic attacks during which the nurse also felt very fearful. Which statement about the nurse's self-disclosure is accurate?

Self-disclosure can help normalize the client's experience.

The most important tool of psychiatric nursing is the:

Self.

When engaged in a therapeutic relationship, the nurse's focus is on what?

The client

The nurse has been meeting with a client for several weeks. Which action indicates to the nurse that the relationship is demonstrating signs of being nontherapeutic?

The client and nurse are frustrated with the conversation.

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?

The client is nervous and insecure.

A client with somatic symptom disorder is reporting significant pain in their lower back. When providing care to this client, which would be most important for the nurse to keep in mind?

The client's experience of pain is perceived as real.

Avoiding which outcome is the primary reason for establishing professional boundaries with clients?

The loss of therapeutic effectiveness

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?

The nurse frequently refers to an elderly, cognitively impaired client as "my granny"

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as ...

Transference

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "| don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

Working

During which phase of the nurse-client relationship does the client identify and explore specific problems?

Working

A psychiatric-mental health nurse is caring for a client with a diagnosis of neurocognitive disorder who displays agitation when in the dayroom with other clients. The nurse reviews the client's history and notes their former occupation as a jazz musician. Implementation of playing jazz music in the dayroom successfully reduces client agitation. These actions reflect which of Carper's pattern of knowing?

aesthetic

The graduate nurse asks the nurse preceptor to observe them during a new client admission assessment to the inpatient mental health unit. "Can you help me evaluate whether my verbal and nonverbal behavior is congruent?" Which nursing responsibility does this activity represent?

developing self-awareness

While engaged in a conversation during the working phase, the nurse reminds the client that the relationship is going to end once the client's problems have resolved. Which reaction would indicate to the nurse that the client is experiencing stress about terminating the relationship?

expresses anger toward the nurse

The manager schedules a staff nurse to attend a motivational interviewing training session. Which nurse behavior caused the manager to make this decision? Select all that apply.

interrupting the client minimizing the client's concerns arguing with a client over agreed upon plans

A care area is having difficulty implementing the transitional care model. Which observation should the nurse manager address to help facilitate this process? Select all that apply.

nurses feeling overwhelmed over-reliance on the process focusing on preexisting conflicts