mental health prep u chapter 5

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self?

"Asking for help from those who care about us isn't a sign of weakness."

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

working

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

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?"

Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts?

Countertransference

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

Acting out

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

After teaching a class about the phases of the therapeutic relationship, the instructor determines a need for additional education when the class identifies which as a goal of the working phase?

Develop a sense of trust within the relationship.

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?

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

Which is not involved in empathy?

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

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."

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.

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?

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

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

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

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

The loss of therapeutic effectiveness

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

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?"

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?

Your idea would help prevent this from happening again."

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."

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?"

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

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

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

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

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference?

"There's no need to get rude with me. I'm just trying to do my job and to help you out."

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."

The nurse is concerned that a relationship with a client is not therapeutic. Which behaviors demonstrated by the nurse support this concern? Select all that apply.

- Becomes frustrated during the meetings - Remains aloof for several sessions - Discusses topics without consistency - Varies the length of meeting times from session to session

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.

- Establish professional boundaries - Listen intently to the client explain problems and issues - Explain what confidential information will be shared with others

Which situation would most likely indicate a violation of professional boundaries? Select all that apply.

- 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.

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 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.

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

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

the client

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

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason?

Eliciting the client's cooperation through the establishment of trust

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

What occurs during the working phase of the nurse-client relationship?

Evaluation of mutually identified goals

Which action by the nurse or client represents the working phase of the therapeutic relationship?

Identifying past ineffective behaviors

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

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply.

Name Level of education Reason for being on the unit

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.

Promoting physical health Preventing deterioration of mental status Promoting mental health

A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session?

Rambling due to nervousness

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?

Struggling with

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?

The client is able to independently express feelings and emotions with the client's friends.

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

The client is nervous and insecure.

A 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 testing the parameters of the relationship.

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

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 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

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.

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

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

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?

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

The most important tool of psychiatric nursing is the:

self

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

shifting the emphasis to the nurse