Chapter 5: Therapeutic Relationships

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? "Don't you think you're ready to be independent?" "Just think of all of the things you can do in the home that you can't do here." "It can be scary to leave a place that you trust and feel supported." "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." Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share their feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it. For empathy to develop, there must be a giving of self to the other individual and a reciprocal desire to know each other personally. The process involves the nurse receiving information from the client with open, nonjudgmental acceptance and communicating this understanding of the experience and feelings so the client feels understood. Acknowledging that leaving the hospital can be scary because the client will miss the trust and support provided demonstrates empathy. Questioning about independence, having the client think about things that can be done in the home versus the hospital, and telling the client to have faith in accomplishments do not demonstrate empathy for the client's fear.

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? "What do you think motivated your father to do that." "I too have been disappointed by important people in my life." "You will find that one of the constants in life is that people will often let you down." "That must have been terribly hurtful experience for you."

"That must have been terribly hurtful experience for you." Empathy is important, yet challenging, to communicate. A genuine, open-ended, and nonjudgmental response can often convey empathy to a client. Claiming the same experience, turning the statement into a "lesson," or exploring before acknowledging are communication techniques that can impair communication.

When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response? "Will this conversation involve your desire to harm yourself?" "Don't you trust me to respect your right to confidentiality?" "You know that I can't keep secrets from your health care team." "Without your permission I can't give any information to anyone."

"Will this conversation involve your desire to harm yourself?" Asking whether the conversation will involve the client's desire to hurt the client establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm. The other options are not necessarily true; if the conversation does not affect the client's health or well-being, there is no reason to share the information with anyone. Further, if the conversation affects the client's health or well-being, it will be shared with the client's health care team. The option regarding the client's trust for the nurse is nursing-centered, not client-centered, and does not address the client's question.

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 nurse implements the same interventions with multiple clients despite their personal differences. A client mirrors the nursing student's nervousness and hesitancy during assessment. 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. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life.

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? Poor boundaries A judgmental attitude Exploitation Countertransference

A judgmental attitude Judgmental attitudes and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, "Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?" Countertransference refers to the nurse's response to the client based on personal unconscious needs and conflicts. Exploitation refers to the phase in the therapeutic relationship when the nurse guides the client to examine feelings and responses to develop better coping mechanisms and a more positive self image. Poor boundaries refers to inappropriate levels of personal disclosure to the client or overly social/intimate relationships with the client.

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 another nurse to attend the meetings to ensure boundaries are not crossed. Plan to meet the client since the personal relationship ended. Meet for the first session but explain that another nurse will be assigned going forward. Ask to be reassigned because of having a prior personal relationship with the client.

Ask to be reassigned because of having a prior personal relationship with the client. Since the nurse had a previous personal relationship with the client, the therapeutic boundary is questionable. The best course of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the professional-personal boundary. When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the client immediately.

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason? Establishing mutual expectations for nursing interventions Eliciting the client's cooperation through the establishment of trust Facilitating the assessment process and the collection of a database Providing the client contact with a caring professional health care provider Eliciting kthich

Eliciting the client's cooperation through the establishment of trust While providing care to a client with psychosis, the psychiatric nurse uses communication initially for the purpose of eliciting the client's cooperation through the establishment of trust. All the other options are important, but first, the nurse must establish trust with the client

Which is not involved in empathy? Feeling the same emotions that the client is feeling at a given time Careful listening Being in touch with what clients are saying Having insight into the meaning of clients' thoughts, feelings, and behaviors

Feeling the same emotions that the client is feeling at a given time Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share in those feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it.

Which action by the nurse or client represents the working phase of the therapeutic relationship? Reviewing work that has been done Identifying past ineffective behaviors Communicating interest in the client Testing the relationship

Identifying past ineffective behaviors In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one's illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently. Communicating interest in the client is the role of the nurse, and this takes place in the orientation phase of the relationship. The client tests the relationship during the orientation phase. Reviewing the work that has been done takes place during the resolution phase of the relationship

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? Withholding Resolution Orientation Working

Orientation The orientation phase is the phase during which the nurse and client get to know each other. The nurse reads background materials available on the client and considers his or her personal strengths and limitations in working with this client. The working stages involves problem identifcation and exploitation. Resolution, or the termination phase, begins when problems are resolved and signals the end of the therapeutic relationship. Withholding is a phase in a deteriorating relationship in which the nurse is perceived as withholding nursing support.

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain? Perception of the problem Recent hospitalizations Known allergies Family history

Perception of the problem Although information about allergies, hospitalizations, and family history are important in the orientation phase, it is most important for the nurse to ask a client with a mental disorder about the nature of the problem from the client's perspective. Some clients deny that a problem exists; other clients may have misperceptions about the problem.

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. Reassure the client that they already covered these issues. Get angry at the client and ask the client to leave the session. Do not acknowledge this issue and continue on with the session as planned. Review with the client the learned methods to control the problems. Immediately stop the client and inform the client that the nurse is running the session.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. A typical termination behavior is raising old problems that have already been resolved. The nurse may feel frustrated if clients in the termination phase present resolved problems as if they were new. The clients are attempting to prolong the relationship and avoid its ending. Nurses should avoid addressing these problems. Instead, they should reassure clients that they already covered those issues and learned methods to control them.

When engaged in therapeutic communication with a client who has been diagnosed with a mental disorder, which is the most important principle for a nurse to keep in mind? The nurse should have an empathetic relationship with the client. The client's conversations should be recorded. The client is the primary focus of the interaction. The nurse should self-disclose when indicated.

The client is the primary focus of the interaction. A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what? The therapeutic use of self A demonstration of genuine interest The exploration of behaviors to uncover the client perspective The use of unconditional positive regard self-mutilating: tu cat xen

The exploration of behaviors to uncover the client perspective While all the above principles are followed, the nurse's questioning best reflects the principle that all behavior has meaning and can be understood from the person's perspective. The use of unconditional positive regard is intended to communicate respect to the client. The client becomes aware that he or she is considered a unique worthwhile human being. In this case, the nurse is not using unconditional positive regard in the approach. The demonstration of genuine interest is a means to develop trust in the nurse-client relationship. The nurse may chose to include nonharmful personal disclosure in the effort to establish or continue to build the therapeutic relationship. In this case, the nurse is not using a demonstration of genuine interest. The therapeutic use of self refers to the nurse's conscious awareness of self to promote the client's growth and to avoid limiting the client's choices to those that the nurse values. In this case, the nurse is not engaging in the therapeutic use of self overtly.

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

Working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase, the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

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? Orientation Termination Working Resolution

Working The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies the client's problems, and clarifies expectations. In the resolution phase, actual problems are resolved and the relationship terminates. During the resolution phase, the client is redirected toward a life without this specific relationship. The client connects with community resources, solidifies a newfound understanding, and practices new behaviors. Termination, although it begins on the first day of the relationship, marks the end of the relationship.

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I 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? Mutual withdrawal Working Orientation Resolution

Working The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? getting an appointment with the client at the time previously agreed upon implementing restatement as a therapeutic communication method discussing the client's request for additional privileges with the treatment team sharing examples of stress management techniques

getting an appointment with the client at the time previously agreed upon Congruence occurs when words and actions match. The nurse demonstrates this by fulfilling the promise made to the client. While the remaining options are appropriate behaviors that positively affect the nurse-client relationship, they do not demonstrate congruence.

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 allows the client to see the nurse as a real human being. Self-disclosure can help normalize the client's experience. Self-disclosure can help the client feel like a friend. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued.

self-disclosure can help normalize the client's experience. Nurses may use self-disclosure in the nurse-client relationship to comfort a client who is feeling frustrated and hopeless, enhance trust, decrease role distancing, facilitate the client's self-disclosure, convey support, or normalize the client's experience.

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? being too general with the details of the story shifting the emphasis to the nurse using situations that have occurred on the unit providing advice on how to manage a problem

shifting the emphasis to the nurse Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the option are inappropriate.

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

working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the

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

working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

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." "Is there some reason why you don't want your family to know your problems?" "It depends upon what they ask me. I might be able to withhold some information, but not all."

"Any information is only shared with other professionals involved in your care." The nurse should be clear about any information that is to be shared with anyone else. The nurse shares significant assessment data and client progress with a supervisor, team members, and a physician. Most clients expect the nurse to communicate with other mental health professionals and are comfortable with this arrangement. Restrictions regarding what can be shared and with whom are also covered by state or provincial mental health acts and health information acts. Based upon identified laws, the nurse will unlikely share information with family unless the client provides permission.

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? "Why do you think making that comment is appropriate?" "How would you feel if someone said that to you?" "That type of talk is inappropriate and won't be tolerated." "Our relationship is one of a professional nature."

"Our relationship is one of a professional nature." The nurse who does not become upset or responds negatively to a client's outbursts, anger, or acting out conveys acceptance to the client. Avoiding judgments of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. When responding to such a situation, the reaction should be respectful and controlled by the nurse.

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." "They look delicious and I love candy but I'm on a diet and really can't accept them." "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" "Thank you so much. I will share them with the other nurses."

"Thank you but I will not accept these gifts because they extend over our discussed boundaries." During the orientation phase, professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? "What types of dresses do you like wearing?" "How did the pain start?" "Do you take a vegetarian or nonvegetarian diet?" "Do you want me to inform your spouse about your illness?"

"What types of dresses do you like wearing?" Asking the client about the client's preferences on fashion and dressing indicate that the nurse is trying to build a social relationship with client, not engaging in a therapeutic use of self. This conversation does not influence the client care in any way. Asking the client about pain indicates that the nurse is gathering information about the client's illness. Asking about the client's food preference indicates that the nurse is finding about the nutrition habits of the client. Asking if the client has informed the spouse about the illness indicates that the nurse is allowing the client to take decisions regarding revealing the condition to other people. These questions indicate that the nurse is engaging in therapeutic communication with the client.

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message? "Please listen to the instructions carefully before starting the exercises." "I know you are in pain. Please wait until the medication shows its effect." "Please don't disturb the other clients in the ward." "Your hard work and determination has helped you recover."

"Your hard work and determination has helped you recover." A congruent message is delivered when the actions and the words spoken match. The nurse has a smiling facial expression which indicates that the nurse is happy. The statement that the client's hard work and determination has warded off the disease indicates that the nurse is happy with the outcomes of the client's hard work. A smiling facial expression while saying this statement would deliver a congruent message. The statement that the client should not disturb the other clients in the ward indicates that the nurse is irritated. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should listen to the instructions before starting the exercises indicates a focused approach. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should wait for the medicines to show the therapeutic effect indicates that the nurse has sympathy for the client. A smiling facial expression while saying this statement would not deliver a congruent message.

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? Ability to relate to others Knowledge Values Attitude

Attitude A tone of defeatism or resignation is indicative of an attitude that may inhibit communication and treatment.

Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts? Transference Exploration Countertransference Self-disclosure

Countertransference Countertransference occurs when the nurse responds to the client based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such as biographical data and personal ideas. Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others.

A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Personal knowing Empirical knowing Aesthetic knowing Ethical knowing

Empirical knowing Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing. Dyspnoea and tachycardia are signs related to anxiety attack. Ethical knowing refers to the moral knowledge of nurse. Aesthetic knowing refers to the knowledge gained through the art of nursing. Personal knowing refers to the knowledge gained through experience.

A nurse has been working for 15 hours continuously without a break. The nurse administrator insists that the nurse should go home and sleep. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Empirical knowing Ethical knowing Personal knowing Aesthetic knowing

Ethical knowing Ethical knowledge refers to the knowledge derived from the moral knowledge of the nurse. The nurse administrator understands that the nurse is stressed and requires rest. This indicates moral knowledge. Aesthetic knowing refers to the knowledge gained through the art of nursing. Personal knowing refers to the knowledge gained through experience. Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing.

A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what? Careful listening Having insight into the meaning of clients' thoughts, feelings, and behaviors Being in touch with what the client is saying Feeling the same emotions that the client is feeling at a given time

Feeling the same emotions that the client is feeling at a given time Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share in those feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it.

Which is not involved in empathy? Having insight into the meaning of clients' thoughts, feelings, and behaviors Being in touch with what clients are saying Careful listening Feeling the same emotions that the client is feeling at a given time

Feeling the same emotions that the client is feeling at a given time Empathy is trying to understand the experience of the other person. It is not possible for nurses to feel the actual emotions of the other person.

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Jean Watson Hildegard Peplau Clara Barton Florence Nightingale cornerstone: nền tảng

Hildegard Peplau Peplau's theory is based on the nurse-client relationship as a therapeutic tool.

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply. Reason for being on the unit Home address Family members Name Level of education

Name Level of education Reason for being on the unit On meeting with the client for the first time, the nurse should share appropriate information about the nurse with the client. This information includes the nurse's name, level of education of the nurse, and the reason for being on the unit. Revealing personal information like personal home address and information about the nurse's family to the client is not appropriate in a therapeutic relationship.

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 Identification phase Termination phase Exploitation phase

Orientation phase According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming? Parent surrogate Teacher Advocate Caregiver

Parent surrogate vai tro cha me The nurturing needs of clients who are unable to carry out simple tasks are met by the subrole of the parent surrogate. This not the focus of the other roles.

A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session? Showing up late for the first session Being confrontational with nurse and other group members Bragging about sexual conquests Rambling due to nervousness

Rambling due to nervousness A client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take? Remind the client about the importance of boundaries to keep the relationship therapeutic Tell the client to call the office answering service in case of an emergency Tell the client the nurse will call once per week during office hours so that the client can practice phone skills Call the client once each weekend to build trust

Remind the client about the importance of boundaries to keep the relationship therapeutic Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty).

A client expresses frustration and believes the nurse does not want to help the client achieve wellness. Which phase of the deteriorating relationship is the client describing? Withholding Avoiding Ignoring Struggling with

Struggling with The final phase of the deteriorating relationship is where the client struggles with the relationship and feels frustrated from the lack of support from the nurse. The first phase is withholding where the nurse is perceived as withholding support. The middle phases of this type of relationship are avoiding and ignoring. The client avoids the nurse who is perceived as rude and condescending.

When engaged in a therapeutic relationship, the nurse's focus is on what? The client The self The environment The family

The client in a therapeutic relationship, the nurse focuses on the client and client-related issues even when engaging in social activities with that client. This is essential to the most effective nurse-client relationship, one that is client-centered.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior? The client is in denial about the severity of the illness. The client is testing the parameters of the relationship. The client mistrusts the nurse's ability to promote recovery. The client's illness is being treated by another clinician.

The client is testing the parameters of the relationship. In the early phases of the nurse-client relationship, lateness and absence often characterize the client's testing of the relationship. This is a well-recognized phenomenon and is not normally interpreted as the client being in denial, receiving treatment elsewhere, or mistrusting the nurse's abilities.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? The client recognizes feelings of anger and expresses them appropriately. The client has revitalized the relationship with the client's sister. The client expresses a desire to be mothered and pampered. The nurse has designated a specific time each day to interact with the client.

The client recognizes feelings of anger and expresses them appropriately. When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate? The nurse is empathizing with the client. The nurse is comforting the client. The nurse is sympathizing with the client. The nurse is showing genuine interest in the client.

The nurse is empathizing with the client. Empathizing is the ability of the nurse to perceive the feelings and emotions that the client is trying to communicate. The nurse's statement indicates that the nurse is trying to perceive the problem by relating the problem with the self. This would help the client to feel comfortable and safe while sharing feelings with the nurse. Sympathy is the ability of the nurse to project his or her concern toward the client. The nurse does not perceive the problem of the client. If the nurse is able to empathize with the client then it indicates that the nurse is showing genuine interest and is listening actively to the client.

Which situation would most likely indicate a violation of professional boundaries? Select all that apply. A nurse begins to spend increasing amounts of time with one client on the unit. The nurse strongly defends a client's behavior during a staff meeting. A nurse reports information to the physician after the client asks that it be kept a secret. The nurse refuses a gift from a client and the client's family. A nurse tells other staff that the nurse is the only one who understands the client.

The nurse strongly defends a client's behavior during a staff meeting. A nurse tells other staff that the nurse is the only one who understands the client. A nurse begins to spend increasing amounts of time with one client on the unit. Indicators that the relationship may be moving outside the professional boundaries are gift giving on either party's part, spending more time than usual with a particular client, strenuously defending or explaining the client's behavior in team meetings, the nurse feeling that he or she is the only one who truly understands the client, keeping secrets, or frequently thinking about the client outside of work. Refusing a gift and reporting information to avoid "secrets" would be appropriate professional behavior that does not violate professional boundaries.

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation? The therapist must keep the comment confidential, because the disclosure is protected by therapist-client confidentiality. The therapist must meet with an ethics committee to determine the course of action. The therapist must evaluate the threat and notify authorities if it meets credibility criteria. The therapist must notify authorities and the potential victim.

The therapist must notify authorities and the potential victim. As a result of the Tarasoff decision, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.

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? Caring Positive regard Genuine interest Trust

Trust An important component of trust is confidentiality. Mental health providers must reassure clients that they will not share the details of clients' lives outside the professional environment.

The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply. explain what confidential information will be shared with others listen intently to the client explain problems and issues establish professional boundaries compliment the client regarding clothing selection suggest that another nurse meet with the client because of arriving late

establish professional boundaries listen intently to the client explain problems and issues explain what confidential information will be shared with others When meeting a client for the first time, professional boundaries need to be established in order for the relationship to remain therapeutic. Listening intently demonstrates care and concern. Explaining the need to share information with others helps to establish trust. Reacting to disapproval suggests non-acceptance and will negate efforts to establish rapport. Arriving late is a behavior used to test parameters. The nurse should not react as this behavior works to develop trust.

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 asking the client to clarify a particular issue restating the client's perception of a problem

interrupting the client minimizing the client's concerns arguing with a client over agreed upon plans the success of motivational interviewing depends upon the quality of interaction between the nurse and client. Strong communication is the cornerstone of this technique and unhelpful defense mechanisms such as interrupting, minimizing, and arguing do not support the motivational interviewing process. Asking for clarification and restating a perception support the motivational interviewing process.

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? 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. 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 focus of the therapeutic relationship is the client, not the nurse. The nurse's response is appropriate, because the focus of the therapeutic relationship is the client. The other options do not place the focus of care on the client's needs or reflect a full understanding of the therapeutic relationship.

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? Countertransference Reaction formation Free association Transference

Countertransference Countertransference refers to an instance when the nurse has preconceived attitudes or feelings toward a patient that stem from prior experience. When feelings, either positive or negative, seem extreme or disproportionate to the circumstances, the nurse should consider whether a transferential reaction has occurred.

In what phase of the therapeutic relationship does the assessment process begin? After the working phase has been completed During the working phase During the initiating or orienting phase After the initiating or orienting phase has been completed

During the initiating or orienting phase The first step of the therapeutic relationship is called the initiating or orienting phase. During this phase, the nurse sets the stage for a one-to-one relationship by becoming acquainted with the client. At the same time, the nurse also begins the assessment process.

What occurs during the working phase of the nurse-client relationship? Discussion of expectations of the relationship Evaluation of mutually identified goals Rejection of client needs Discussion regarding termination of the relationship

Evaluation of mutually identified goals Evaluation of mutually identified goals occurs in the working phase of the nurse-client relationship. The nurse discusses expectations during the orientation phase. During the working phase, the nurse assesses client needs. Discussion regarding the termination of the relationship occurs during the orientation phase.

The mental health nurse is responsible for maintaining professional boundaries. Which would be an example of a professional boundary violation? Giving personalized gifts to a client Providing a friendly environment Exhibiting confidentiality Avoiding personal attachment to the client

Giving personalized gifts to a client An example of a professional boundary violation includes giving personal gifts to a client. Providing a friendly environment, exhibiting confidentiality, and avoiding personal attachment to the client are not boundary violations.

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. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship. The client is experiencing symptoms of a disorder.

The client is nervous and insecure. In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.

Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The loss of therapeutic effectiveness The possibility of losing control of the milieu The likelihood of a client becoming too dependent on the nurse The possibility of inappropriate sexual tension developing

The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

A client forgets to attend a planned session. Which should the nurse conclude about the client's behavior? It is time to end the relationship. The relationship is being tested. Problems are overwhelming. The client does not like the nurse.

The relationship is being tested. During the orientation phase, the client begins to test the relationship to become convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late. Forgetting a session is not an indication that the client's problems are overwhelming, that the relationship should end, or the client does not like the nurse.

The nurse-client relationship is classified as which type of relationship? Intimate Social Therapeutic Friendly

Therapeutic The nurse-client relationship is classified as a therapeutic relationship. It is not classified as a social, intimate, or friendly relationship.

The most important tool of psychiatric nursing is the: environment. nurse. physician. self.

self. The most important tool of psychiatric nursing is the self.

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." "We could go to the gym together. Exercise can be very therapeutic for clients with depression." "I often meet people after they are discharged. Sometimes it is difficult to deal with situations after you leave the hospital."

"Before you leave the hospital, I will make sure you have information about the crisis center." The nurse realizes that meeting for coffee would cross the boundaries of the therapeutic relationship and would not be consistent with promoting health and wellness. Providing the number of a crisis center to the client is an example of promoting a healthy strategy that the client can use if symptoms of depression develop again. The other options do not describe actions that would be consistent with the therapeutic nurse-client relationship.

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? "I know you are busy. I don't have much to say now." "I feel worthless and have no real use in life." "I really don't want to talk about that right now." "What difference does it make what I say to you?"

"I feel worthless and have no real use in life." People with psychiatric problems often feel alone and isolated. Establishing rapport helps lessen feelings of being alone. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.

A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy? "I'm sorry for your loss." "It's hard to lose someone you love." "I see this is hard for you. How can I help?" "Maybe it will be better for your friend."

"I see this is hard for you. How can I help?" Empathy is the ability to experience, in the present, a situation as another did. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share their feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it. For empathy to develop, there must be a giving of self to the other individual and a reciprocal desire to know each other personally. The process involves the nurse receiving information from the client with open, nonjudgmental acceptance and communicating this understanding of the experience and feelings so the patient feels understood. Expressing sorrow for a loss and being objective about loss demonstrate sympathy. Saying that it will be getter for the friend is insensitive and nontherapeutic.