Chapter 5: Therapeutic Relationships PrepU

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?

Orientation

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? Reaction formation Transference Free association Countertransference

Countertransference

A nurse is caring for a client with depression. The client says that the client cannot stop thinking about the client's dead spouse. Which self-disclosure example given by the nurse is most appropriate? "I can understand your situation; my cousin lost a spouse a few months ago." "I just had a divorce; I can understand how it would feel to be without a partner." "My father passed away recently. I can understand your problem." "I can understand your situation. Medication could be of great help to relieve your depression."

"I can understand your situation; my cousin lost a spouse a few months ago."

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? "I will speak with the health care provider about the possible use of physical restraints for you tonight." "Don't worry; I will keep this secret to myself." "Who has influenced you with these ideas?" "I cannot keep this a secret. I will ensure that the staff helps keep you safe."

"I cannot keep this a secret. I will ensure that the staff helps keep you safe."

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." "I really don't want to talk about that right now." "What difference does it make what I say to you?" "I know you are busy. I don't have much to say now."

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

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? "Our relationship is one of a professional nature." "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."

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." "Tell me why you are angry about what I just said." "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."

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

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

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

"What types of dresses do you like wearing?"

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? "I know you are in pain. Please wait until the medication shows its effect." "Please listen to the instructions carefully before starting the exercises." "Your hard work and determination has helped you recover." "Please don't disturb the other clients in the ward."

"Your hard work and determination has helped you recover."

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship? "You have learned how to handle that problem already." "Your idea would help prevent this from happening again." "I do not give out my cell phone number to clients." "Thank you for arriving on time."

"Your idea would help prevent this from happening again."

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 female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. A nurse implements the same interventions with multiple clients despite their personal differences. 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 female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

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

When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what? Create constructive dependencies Involve doing favors for others Encourage personal goal setting Are personal and intimate

Encourage personal goal setting

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 Feeling the same emotions that the client is feeling at a given time Being in touch with what the client is 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

Which is an inaccurate statement regarding a preconception? It prevents people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client. It enables the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave.

It enables the nurse to get an accurate picture of the client's problems.

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? Orientation Resolution Withholding Working

Orientation

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? Resolution Orientation Withholding Working

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? Exploitation phase Orientation phase Identification phase Termination phase

Orientation phase

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? Known allergies Family history Perception of the problem Recent hospitalizations

Perception of the problem

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

Rambling due to nervousness

A 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? 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 Tell the client to call the office answering service in case of an emergency

Remind the client about the importance of boundaries to keep the relationship therapeutic

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

The client

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.

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 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.

The client is testing the parameters of the relationship.

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 client is the primary focus of the interaction. The nurse should have an empathetic relationship with the client. The nurse should self-disclose when indicated. The client's conversations should be recorded.

The client is the primary focus of the interaction.

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 nurse has designated a specific time each day to interact with the client. The client expresses a desire to be mothered and pampered. The client has revitalized the relationship with the client's sister.

The client recognizes feelings of anger and expresses them appropriately.

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 exploration of behaviors to uncover the client perspective The therapeutic use of self The use of unconditional positive regard A demonstration of genuine interest

The exploration of behaviors to uncover the client perspective

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

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 nurse begins to experience the symptoms of depression and calls out sick The nurse is referred to as being in a relationship with a client by that client, and the client wants the nurse to accompany the client to the prom The nurse asks to be transferred to another unit to avoid burnout and to work with different disorders

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

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 comforting the client. The nurse is empathizing with the client. The nurse is showing genuine interest in the client. The nurse is sympathizing with the client.

The nurse is empathizing with the client.

It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client? The nurse is having dinner with a client outside the hospital premises. The nurse examines the genital area of a client diagnosed with a sexually transmitted infection. The nurse speaks on topics like sports while performing assessment on the client. The nurse is talking to the spouse of the client regarding the client's condition.

The nurse is having dinner with a client outside the hospital premises.

Which is a nurse's primary tool for treating clients with mental disorders? Self-help groups Psychotropic medications The therapeutic use of self Family education and therapy

The therapeutic use of self

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 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 To avoid giving the client the impression that the nurse is not interested in providing effective care

To prevent the client from viewing the nurse as a friend rather than health care provider

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? Countertransference Partnership Unconditional positive regard Genuineness

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? 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? What kinds of experiences have you had with people of other cultures?

While a child, what attitudes did your family express about other cultures?

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 Resolution Orientation

Working

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 Working Resolution Termination

Working

The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? develop a sense of trust in the nurse work through problems identify potential solutions to issues resolve pressing problems

develop a sense of trust in the nurse

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

getting an appointment with the client at the time previously agreed upon

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: requires additional therapy. is unhappy that the therapy was ineffective. 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.

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

orientation

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

shifting the emphasis to the nurse

A care area is implementing motivational interviewing. What skills will be implemented by the nurse for this technique to be successful? Select all that apply. strong communication self-awareness active listening use of a variety of defense mechanisms empathetic linkages

strong communication self-awareness active listening empathetic linkages

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

Countertransference

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 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. A nurse reports information to the physician after the client asks that it be kept a secret. The nurse strongly defends a client's behavior during a staff meeting.

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.

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? To prevent the client from viewing the nurse as a friend rather than health care provider To avoid making the client feel that the client's problems are not viewed as being serious 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 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 evaluate the threat and notify authorities if it meets credibility criteria. The therapist must meet with an ethics committee to determine the course of action. The therapist must notify authorities and the potential victim.

The therapist must notify authorities and the potential victim.