Mental Health Ch 5

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

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

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

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

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

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

During 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."

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?

"What was going on for you when this happened?"

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?

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

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 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

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?

Client self-exploration

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

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

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

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?

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?

Countertransference

The manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply.

Discharge of clients 5 days earlier than in the past Number of readmissions down 6% over the last 2 months

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

During the initiating or orienting phase

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?

Empirical knowing

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?

Ethical knowing

Which is not involved in empathy?

Feeling the same emotions that the client is feeling at a given time

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

Hildegard Peplau

A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy?

I see this is hard for you. How can I help?"

Which is an inaccurate statement regarding a preconception?

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

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

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

The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areas should the nurse focus on while caring for this client? Select all that apply.

Preventing deterioration of mental status Promoting mental health Promoting physical health

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. Review with the client the learned methods to control the problems.

The most important tool of psychiatric nursing is the:

Self

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure?

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

Which is a nurse's primary tool for treating clients with mental disorders?

The therapeutic use of self

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

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."

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.

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

The loss of therapeutic effectiveness

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

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

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.

A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply.

The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client.

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 notify authorities and the potential victim

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

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

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

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?

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?

Working

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

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?

Working

A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse?

You must have been really upset

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

During the first meeting with a client, the nurse explains that the relationship is time limited and will end. Which best explains the reason for the nurse's explanation?

beginning the termination process

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 Correct response:

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:

empathy

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

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

A care area is implementing motivational interviewing. What skills will be implemented by the nurse for this technique to be successful? Select all that apply.

self-awareness active listening empathetic linkages strong communication

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

shifting the emphasis to the nurse

The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating?

transitional relationship model