PrepU Chapter 5

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

Which would be considered a "usual or expected" response during the first few sessions?

Rambling due to nervousness

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."

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."

A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer.

"It sounds like this is very difficult for you, I can see why it causes you stress."

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."

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."

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."

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 nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply.

A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone

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

Which is not considered a step in the values clarification process?

Assessing

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

Which term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world?

Attitudes

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

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

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.

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

During the initiating or orienting phase

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

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur during this phase? Select all that apply.

Explanation of the purpose of the relationship Discussion of client's expectations Reviewing the client history

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 is an inaccurate statement regarding a preconception?

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

At the end of a 12-hour shift, the nurse overhears that a client that the nurse has cared for before is being readmitted to the mental health facility. The nurse says to the charge nurse, "I better stay around for a couple of hours. I am the only one the client will talk to." This is a warning sign that the nurse is experiencing which obstacle to establishing a therapeutic relationship?

Lack of self-awareness

A nurse interviews a new client in the day room of the psychiatric unit. The nurse is wearing a jacket and a bag and frequently asks the client to repeat the last statement. The nurse's demeanor with the client is reflective of what?

Lacking genuine interest

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

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming?

Parent surrogate

During which phase of the nurse-client relationship may the client express ambivalence about the relationship?

Resolution

During the orientation phase of the nurse-client relationship, the client is involved with what?

Seeking assistance

A nursing instructor is describing the nurse-client relationship to a group of nursing students. Which would the instructor emphasize as crucial for establishing and maintaining the relationship?

Self-awareness

Which is not a primary behavior of caring, one of the core values of nursing?

Setting boundaries within the relationship

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. With which would the client be involved? Select all that apply.

Testing new ways for problem solving Discussing problems related to needs Examining personal issues

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

The client

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.

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.

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

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

The loss of therapeutic effectiveness

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 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

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

Working

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.

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

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

What activity should be included in the first step of self-reflection?

identifying one's own values, attitudes, strengths and weakness

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

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."

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?

Orientation

Which is not a goal of the working phase of the therapeutic relationship?

Reducing the client's anxieties

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."

A female psychiatric client is talking to the nurse about her reasons for being hospitalized. The client begins to discuss her relationship with her female significant other. She is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse?

"It sounds like you're beginning to be uncomfortable in this relationship."

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

Hildegard Peplau

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

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

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

Identifying past ineffective behaviors

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

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

The therapeutic use of self

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."

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."

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 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?"

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?"

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?

Advocate

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

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

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

While interviewing a client, the nurse puts herself into the client's situation and tries to imagine what it would be like and how it would feel. The nurse is demonstrating what?

Empathy

When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what?

Encourage personal goal setting

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

The nurse is reviewing the client's documented history 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

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 would be most important about the client for the nurse to obtain?

Perception of the problem

A nurse who has worked with a client with post-traumatic stress disorder (PTSD) regularly for several months stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Personal knowing

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.

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 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.

Of the following actions, which indicate that the relationship between nurse and client 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 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.

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.

A nurse is caring for a client experiencing delusions. The client tells the nurse "I am sure my brother has plans to kill me. But I am ready; I will be killing him before he tries to reach me." What is the appropriate action of the nurse in this situation?

The nurse should notify to the primary healthcare provider.

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 client is talking to a nurse about the recent death of the client's grandmother. The client is sad, and tears roll down the client's cheeks as the client talks. The nurse remembers how the nurse felt when the nurse's own grandmother died the previous summer. The nurse puts a hand on the client's shoulder and says, "This must be very difficult for you." The nurse is demonstrating empathy based on what?

The nurse's response reflects an attempt to communicate understanding of the client's feelings.

Which is one of the most common reasons clients are often concerned about confidentiality of treatment for mental health problems?

They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness.

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 nurse tells a client that the nurse will come back in 10 minutes to reassess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing?

Trust

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 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 the Peplau model, in which phase of the nurse-client relationship would this conversation occur?

Identification phase

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.

Which self-reflective question is directed towards understanding the fundamental basis of personal attitudes about people of diverse cultures?

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

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase?

Working

A psychiatric nurse tells a client that the nurse will return in 15 minutes to talk with the client. The nurse goes to a meeting that runs overtime and returns in an hour, apologizing for being late. This behavior may have an impact between the nurse and the client in the area of ...

establishing trust in the introductory phase of the relationship.

Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client:

is attempting to prolong the nurse-client relationship.