chap 5 Psyc therapeutic relations
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." -"I cannot promise that. Your family may ask me questions and I will need to answer truthfully." -"It depends upon what they ask me. I might be able to withhold some information, but not all." -"Is there some reason why you don't want your family to know your problems?"
"Any information is only shared with other professionals involved in your care."
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? "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." - "It depends upon what they ask me. I might be able to withhold some information, but not all." -"Is there some reason why you don't want your family to know your problems?" -"Any information is only shared with other professionals involved in your care."
"Any information is only shared with other professionals involved in your care."
A client treated for depression is ready for discharge from the hospital and tells the nurse, "It would be great if we could meet for coffee should I start feeling low again." Which statement indicates that the nurse understands the boundaries of the therapeutic relationship? "That would be fine as long as we go to a public place. Where would you like to meet?" "Before you leave the hospital, I will make sure you have information about the crisis center." "I often meet people after they are discharged. Sometimes it is difficult to deal with situations after you leave the hospital." "We could go to the gym together. Exercise can be very therapeutic for clients with depression."
"Before you leave the hospital, I will make sure you have information about the crisis center."
The nurse is caring for a client with schizophrenia. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone." What is the most appropriate nursing response? "Don't worry; I will keep this secret to myself." -"I cannot keep this a secret. I will ensure that the staff helps keep you safe." -"Who has influenced you with these ideas?" -"I will speak with the health care provider about the possible use of physical restraints for you tonight."
"I cannot keep this a secret. I will ensure that the staff helps keep you safe."
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? "Just think of all of the things you can do in the home that you can't do here." -"You are more than ready to get out of here. Have faith in your accomplishments." -"It can be scary to leave a place that you trust and feel supported." -"Don't you think you're ready to be independent?"
"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? "I am only trying to help you." -"I am only doing my job." -"If you don't want to continue with me, I'll find someone else." -"Tell me why you are angry about what I just said."
"Tell me why you are angry about what I just said."
A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer. "It sounds like this is very difficult for you, I can see why it causes you stress." -"That is unbelievable. How could you tolerate this behavior?" -"Don't worry. Your child will be all right." -"I don't know how you've managed to cope, this is awful."
"It sounds like this is very difficult for you, I can see why it causes you stress."
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? "You will find that one of the constants in life is that people will often let you down." -"I too have been disappointed by important people in my life." -"What do you think motivated your father to do that." -"That must have been terribly hurtful experience for you."
"That must have been terribly hurtful experience for you."
Which statement would indicate that the nurse has a non-judgmental attitude? "I think the client is exaggerating her feelings so she can leave work early." "People who are mentally ill have basically weak characters." "Mental illnesses are, for the most part, all in your head and could be solved more easily if people were forced to continue with their daily activities, instead of listening to their complaints." "The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."
"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."
The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? "How did the pain start?" -"What types of dresses do you like wearing?" -"Do you want me to inform your spouse about your illness?" -"Do you take a vegetarian or nonvegetarian diet?"
"What types of dresses do you like wearing?"
A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing? "I really feel sorry for your child." -"Punishing your child would only make your child worse." -"How could you do this to your child?" -"What was going on for you when this happened?"
"What was going on for you when this happened?"
A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibilty that the relationship may be moving outside professional boundaries? Select all that apply. -The nurse tells a friend that the nurse is the only one who truly understands this client. -The nurse informs the supervisor that the client asked the nurse to "keep a secret from the rest of the staff." --The nurse is spending more time with the client than the others in the group. -The nurse objectively contributes to the team meeting about behaviors the client is displaying. The client brings the nurse a baked item for their lunch.
- The client brings the nurse a baked item for their lunch. -The nurse is spending more time with the client than the others in the group. -The nurse tells a friend that the nurse is the only one who truly understands this client.
During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply. Do not acknowledge this issue and continue on with the session as planned. -Immediately stop the client and inform the client that the nurse is running the session. -Review with the client the learned methods to control the problems. -Reassure the client that they already covered these issues. -Get angry at the client and ask the client to leave the session.
-Reassure the client that they already covered these issues. -Review with the client the learned methods to control the problems.
During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply. Review with the client the learned methods to control the problems. -Get angry at the client and ask the client to leave the session. -immediately stop the client and inform the client that the nurse is running the session. -Reassure the client that they already covered these issues. -Do not acknowledge this issue and continue on with the session as planned.
-Reassure the client that they already covered these issues. -Review with the client the learned methods to control the problems.
Which clinical situation provides an example of transference? -A client mirrors the nursing student's nervousness and hesitancy during assessment. -A nurse asks for clarification from a colleague when explaining a coping strategy to a client. -A nurse implements the same interventions with multiple clients despite their personal differences. -A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
Which clinical situation provides an example of transference? -A nurse asks for clarification from a colleague when explaining a coping strategy to a client. -A client mirrors the nursing student's nervousness and hesitancy during assessment. -A nurse implements the same interventions with multiple clients despite their personal differences. -A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.
A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what? A judgmental attitude Countertransference Exploitation Poor boundaries
A judgmental attitude
A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what? Countertransference Exploitation A judgmental attitude Poor boundaries
A judgmental attitude
Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes? Advocate Teacher Caregiver Parent surrogate
Advocate
A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what? -Inappropriate, because the nurse should have answered to establish a therapeutic relationship. -Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. -Appropriate, because the nurse is not in a relationship or married. -Inappropriate, because the client was just making small talk about the nurse's personal situation to get to know the nurse better.
Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.
A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what? Inappropriate, because the client was just making small talk about the nurse's personal situation to get to know the nurse better. Appropriate, because the nurse is not in a relationship or married. Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. Inappropriate, because the nurse should have answered to establish a therapeutic relationship.
Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.
A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, "What's the use? I don't ever see this changing." The client's statement is suggestive of a potential problem with what factor that influences communication? Attitude Values Ability to relate to others Knowledge
Attitude
A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, "What's the use? I don't ever see this changing." The client's statement is suggestive of a potential problem with what factor that influences communication? Knowledge Ability to relate to others Values Attitude
Attitude
A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? Respect Self-disclosure Client self-exploration Empathy
Client self-exploration
A 68-year-old parent is the sole care provider for a 39-year-old child who has a diagnosis of bipolar disorder. The 39-year-old has been experiencing worsening of the illness over several years. The nurse should recognize that the parent is at risk for what? Failure to thrive -Compassion fatigue -Bipolar disorder -Decompensation
Compassion fatigue
The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? Free association Reaction formation Transference Countertransference
Countertransference
In what phase of the therapeutic relationship does the assessment process begin? During the working phase After the initiating or orienting phase has been completed After the working phase has been completed During the initiating or orienting phase
During the initiating or orienting phase
When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what? Encourage personal goal setting Create constructive dependencies Are personal and intimate Involve doing favors for others
Encourage personal goal setting
When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what? Involve doing favors for others Create constructive dependencies Are personal and intimate Encourage personal goal setting
Encourage personal goal setting
A healthcare organization is increasing the use of telecommunication to reach clients located in remote areas. Which avenue should the nurse question before establishing a therapeutic relationship with a client? videoconferencing software with firewalls telephone calls Facebook
The mental health nurse is responsible for maintaining professional boundaries. Which would be an example of a professional boundary violation? -Exhibiting confidentiality -Avoiding personal attachment to the client -Providing a friendly environment -Giving personalized gifts to a client
Giving personalized gifts to a client
Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Jean Watson Florence Nightingale Clara Barton Hildegard Peplau
Hildegard Peplau
At the end of a 12-hour shift, the nurse overhears that a client that the nurse has cared for before is being readmitted to the mental health facility. The nurse says to the charge nurse, "I better stay around for a couple of hours. I am the only one the client will talk to." This is a warning sign that the nurse is experiencing which obstacle to establishing a therapeutic relationship? Judgmental attitudes -Partnership -Lack of self-awareness -Excessive probing
Lack of self-awareness
A nurse interviews a new client in the day room of the psychiatric unit. The nurse is wearing a jacket and a bag and frequently asks the client to repeat the last statement. The nurse's demeanor with the client is reflective of what? Lacking genuine interest Confidentiality Unknowing Professionalism
Lacking genuine interest
It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship? Working Problem identification Termination Orientation
Orientation
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? Termination phase Exploitation phase Orientation phase Identification phase
Orientation phase
A client is engaged in a nurse-client relationship that is in the orientation phase. With which activity would the client be involved? Establishing boundaries -Seeking assistance -Testing new ways to solve problems -Discussing underlying needs
Seeking assistance
A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. What does this involve? Select all that apply. Testing the relationship Testing new ways for problem solving Discussing problems related to needs Examining personal issues Beginning to identify a need
Testing new ways for problem solving Discussing problems related to needs Examining personal issues
When engaged in a therapeutic relationship, the nurse's focus is on what? The family The environment The client The self
The client
Which statement would indicate that the nurse has a non-judgmental attitude? "The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself." -"I think the client is exaggerating her feelings so she can leave work early." -"Mental illnesses are, for the most part, all in your head and could be solved more easily if people were forced to continue with their daily activities, instead of listening to their complaints." -"People who are mentally ill have basically weak characters."
The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."
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 attempting to engage in a social relationship. -The client is nervous and insecure. -The client is experiencing symptoms of a disorder. -The client is demonstrating a normal reaction.
The client is nervous and insecure.
The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? To avoid making the client feel that the client's problems are not viewed as being serious -To prevent the client from viewing the nurse as a friend rather than health care provider -To avoid giving the client the impression that the nurse is not interested in providing effective care -To prevent disruption of the time that is to be used for therapeutic communication
To prevent the client from viewing the nurse as a friend rather than health care provider
A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship? Trust Caring Genuine interest Positive regard
Trust
A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client? Unconditional positive regard Countertransference Genuineness Partnership
Unconditional positive regard
A psychiatric-mental health nurse is conducting a self-examination of beliefs and values to develop self-awareness. Asking which question would be appropriate for the nurse to determine the fundamental personal attitudes about people of diverse cultures? -What kinds of experiences have you had with people of other cultures? -While a child, what attitudes did your family express about other cultures? -Did you grow up in a rural or urban community? -Do you think you hold bias or prejudice attitudes?
While a child, what attitudes did your family express about other cultures?
The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase? Working -Resolution -Termination -Orientation
Working
After meeting with a client experiencing extreme anxiety the nurse notes personal feelings of nervousness. Which action should the nurse take first to address these feelings? analyze the source of the feelings -suggest another nurse meet with client going forward -investigate transferring to another care area -plan sessions to occur after the client receives medication
analyze the source of the feelings
The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? resolve pressing problems -develop a sense of trust in the nurse -identify potential solutions to issues -work through problems
develop a sense of trust in the nurse
During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of: nontherapeutic communication. sympathy. apathy. empathy.
empathy.
During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of: sympathy. apathy. empathy. nontherapeutic communication.
empathy.
A psychiatric nurse tells a client that the nurse will return in 15 minutes to talk with the client. The nurse goes to a meeting that runs overtime and returns in an hour, apologizing for being late. This behavior may have an impact between the nurse and the client in the area of ... -establishing boundaries on the therapeutic relationship. -getting through the working phase of the relationship. establishing confidentiality. -establishing trust in the introductory phase of the relationship.
establishing trust in the introductory phase of the relationship.
What activity should be included in the first step of self-reflection? determining whether you actually possess qualities that you are unaware of -identifying one's own values, attitudes, strengths and weakness -asking others to share their perceptions of you -categorizing your qualities as being either public or hidden
identifying one's own values, attitudes, strengths and weakness
Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client: is unhappy that the therapy was ineffective. requires additional therapy. is attempting to prolong the nurse-client relationship. is angry that the nurse is abandoning the client.
is attempting to prolong the nurse-client relationship.
The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating? -motivational interviewing -mutual withdrawal -avoid and ignore -transitional relationship model
transitional relationship model