Relationship Development + Therapeutic Communication

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?

"I really don't want to talk any more about my childhood abuse."

Mrs. S. asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? a. "What do you think would be best for you to do?" b. "Of course you should. Marriage has to be based on truth." c. "Of course not. That would only make things worse." d. "I can't tell you what to do. You have to decide for yourself."

A

Nancy says to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which is an empathetic response by the nurse? a."You are very angry now. This is a normal response to your loss." b."I know what you mean. Men can be very insensitive." c."I understand completely. My husband divorced me, too." d. "You are depressed now, but you will feel better in time."

A

Nancy, a depressed client who has been unkept and untidy for weeks, today comes to group therapy wearing makeup and a clean dress and having washed and combed her hair. Which of the following responses by the nurse is most appropriate? a. "Nancy, I see you have put on a clean dress and combed your hair." b. "Nancy, you look wonderful today!" c. "Nancy, I'm sure everyone will appreciate that you have cleaned up for the group today." d. "Now that you see how important it is, I hope you will do this every day."

A

Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shares the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.

ABC

10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, Im so proud of you for being assertive. You are so good! Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the clients ideas or behaviors are good or bad. This creates a conditional acceptance of the client.

1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A. To clarify personal attitudes, values, and beliefs B. To obtain thorough assessment data C. To determine the clients length of stay D. To establish personal goals for the interaction

ANS: A The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding ones own attitudes, values, and beliefs is called self-awareness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. You appear to be talking to someone I do not see. B. Please describe what you are seeing. C. Why do you continually look in the corner of this room? D. If you hum a tune, the voices may not be so distracting.

ANS: A The nurse is making an observation when stating, You appear to be talking to someone I do not see. Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurses perceptions.

2. Which therapeutic communication technique is being used in this nurseclient interaction? Client: My father spanked me often. Nurse: Your father was a harsh disciplinarian. A. Restatement B. Offering general leads C. Focusing D. Accepting

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the clients statement has been heard and understood.

5. Which client response should a nurse expect during the working phase of the nurseclient relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurseclient relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals.

9. A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. You are feeling very depressed. I felt the same way when I decided to leave my husband. B. I can understand you are feeling depressed. It was a difficult decision. Ill sit with you. C. You seem depressed. It was a difficult decision to make. Would you like to talk about it? D. I know this is a difficult time for you. Would you like a prn medication for anxiety

ANS: A The nurses statement, You are feeling very depressed. I felt the same when I decided to leave my husband, is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal expression alleviates the clients distress.

3. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I am anxious, the only thing that calms me down is alcohol. Nurse: Other than drinking, what alternatives have you explored to decrease anxiety? A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the clients poor coping choice, may serve to prevent anger or anxiety from escalating.

17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. Weve discussed past coping skills. Lets see if these coping skills can be effective now. B. Please tell me in your own words what brought you to the hospital. C. This new approach worked for you. Keep it up. D. I notice that you seem to be responding to voices that I do not hear.

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique the nurse can help the client plan in advance to deal with a stressful situation, which may prevent anger and/or anxiety from escalating to an unmanageable level.

21. A client is trying to explore and solve a problem. Which nursing statement would be an example of verbalizing the implied? A. You seem to be motivated to change your behavior. B. How will these changes affect your family relationships? C. Why dont you make a list of the behaviors you need to change. D. The team recommends that you make only one behavioral change at a time.

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.

27. During a nurseclient interaction, which nursing statement may belittle the clients feelings and concerns? A. Dont worry. Everything will be alright. B. You appear uptight. C. I notice you have bitten your nails to the quick. D. You are jumping to conclusions.

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occurs when the nurse misjudges the degree of the clients discomfort, suggesting a lack of empathy and understanding.

29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. Can you tell me why you said that? B. Keep your chin up. Ill explain the procedure to you. C. There is always an explanation for both good and bad behaviors. D. Are you not understanding the explanation I provided?

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking why a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. Touch carries a different meaning for different individuals. B. Touch is often used when deescalating volatile client situations. C. Touch is used to convey interest and warmth. D. Touch is best combined with empathy when dealing with anxious clients.

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

19. Which client statement may indicate a transference reaction? A. I need a real nurse. You are young enough to be my daughter and I dont want to tell you about my personal life. B. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor. C. I dont seem to be able to relate to people. I would rather stay in my room and be by myself. D. My mother is the source of my problems. She has always told me what to do and what to say.

ANS: A Transference occurs when a client unconsciously displaces or transfers to the nurse feelings formed toward a person from the past.

34. Which of the following individuals are communicating a message? Select all that apply. A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, No one understands me E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

23. A student nurse tells the instructor, Im concerned that when a client asks me for advice I wont have a good solution. Which should be the nursing instructors best response? A. Its scary to feel put on the spot by a client. Nurses dont always have the answer. B. Remember, clients, not nurses, are responsible for their own choices and decisions. C. Just keep the clients best interests in mind and do the best that you can. D. Set a goal to continue to work on this aspect of your practice.

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

15. A mother rescues two of her four children from a house fire. In an emergency department, she cries, I should have gone back in to get them. I should have died, not them. Which of the following responses by the nurse is an example of reflection? A. The smoke was too thick. You couldnt have gone back in. B. Youre feeling guilty because you werent able to save your children. C. Focus on the fact that you could have lost all four of your children. D. Its best if you try not to think about what happened. Try to move on.

ANS: B The best response by the nurse is, Youre experiencing feelings of guilt because you werent able to save your children. This response utilizes the therapeutic communication technique of reflection, which identifies a clients emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

18. What is the main goal of the working phase of the nurseclient therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the clients problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment

ANS: B The goal of the working phase of the nurseclient therapeutic relationship is to resolve client problems by promoting behavioral change. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

2. A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation

ANS: B The nurse is promoting trust by postponing the admission interview, assuring safety, and providing a warm meal. Trust implies a feeling of confidence that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated through nursing interventions that convey a sense of warmth and caring to the client.

11. If an individual is two-faced, which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect B. Genuineness C. Sympathy D. Rapport

ANS: B The nurse should identify that genuineness is missing in the relationship. Genuineness refers to an individuals ability to be open and honest and maintain congruence between what is felt and what is communicated. Genuineness is essential to establishing trust in a relationship.

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

ANS: B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

The nurse patted a client's back while providing care. The client felt offended by the nurse's gesture. Which boundary is in jeopardy in this situation? a. Social boundary b. Material boundary c. Personal boundary d. Professional boundary

c. Personal boundary

13. A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, Do you want to be my girlfriend? Which nursing response is most appropriate? A. You are upset now. It would be best if you go to your room until you feel better. B. Remember, we have a professional relationship. Are you feeling uncomfortable? C. We have discussed this before. I am not allowed to date clients. D. I think you should discuss your fantasies with your therapist.

ANS: B The nurse should promote the clients insight and perception of reality by confirming appropriate roles in the nurseclient relationship and identifying what is troubling the client in this situation.

20. Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the clients health.

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. What occurred prior to the rape, and when did you go to the emergency department? B. What would you like to talk about? C. I notice you seem uncomfortable discussing this. D. How can we help you feel safe during your stay here?

ANS: B The nurses statement, What would you like to talk about? is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the clients role in the interaction.

7. Which phase of the nurseclient relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination

ANS: B The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, and termination.

The nurse is caring for a psychiatric client who has been rejected by his partner. Which nursing intervention will increase feelings of self-worth in the client? a. Expressing empathy towards the client b. Getting acquainted with the client c. Recognizing and respecting the client d. Providing a safe environment to the client

c. Recognizing and respecting the client

4. What is the priority nursing action during the orientation (introductory) phase of the nurseclient relationship? A. Acknowledge the clients actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care.

ANS: B The priority nursing action during the orientation phase of the nurseclient relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurseclient relationship.

26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, You are incompetent! Which is the nurses best response? A. Do you believe that I was the cause of your blood test being canceled? B. I see that you are upset, but I feel uncomfortable when you swear at me. C. Have you ever thought about ways to express anger appropriately? D. Ill give you some space. Let me know if you need anything.

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. I think it would be great if you talked about that problem during our next group session. B. Would you like me to accompany you to your electroconvulsive therapy treatment? C. I notice that you are offering help to other peers in the milieu. D. After discharge, would you like to meet me for lunch to review your outpatient progress?

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing clients feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. My sister has the same diagnosis as you and she also hears voices. B. I understand that the voices seem real to you, but I do not hear any voices. C. Why not turn up the radio so that the voices are muted. D. I wouldnt worry about these voices. The medication will make them disappear.

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

33. A client slammed a door on the unit several times. The nurse responds, You seem angry. The client states, Im not angry. What therapeutic communication technique has the nurse employed, and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.

23. The nurseclient therapeutic relationship includes which of the following characteristics? Select all that apply. A. Meeting the psychological needs of the nurse and the client B. Ensuring therapeutic termination C. Promoting client insight into problematic behavior D. Collaborating to set appropriate goals E. Meeting both the physical and psychological needs of the client

ANS: B, C, D, E The nurseclient therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. The nurses psychological needs should not be addressed within the nurseclient relationship.

21. Which client statement indicates that termination of the therapeutic nurseclient relationship has been handled successfully? A. I know I can count on you for continued support. B. I am looking forward to discharge, but I am surprised that we will no longer work together. C. Reviewing the changes that have happened during our time together has helped me put things in perspective. D. I dont know how comfortable I will feel when talking to someone else.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurseclient relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals.

14. A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, Im not well enough to switch to a different nurse. What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using splitting as a way to remain dependent on the nurse.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurseclient relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident.

9. An instructor is correcting a nursing students clinical worksheet. Which instructor statement is the best example of effective feedback? A. Why did you use the clients name on your clinical worksheet? B. You were very careless to refer to your client by name on your clinical worksheet. C. I noticed that you used the clients name in your written process recording. That is a breach of confidentiality. D. It is disappointing that after being told, youre still using client names on your worksheet.

ANS: C The instructors statement, I noticed that you used the clients name in your written process recording, is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticism.

13. A client diagnosed with dependent personality disorder states, Do you think I should move from my parents house and get a job? Which nursing response is most appropriate? A. It would be best to do that in order to increase independence. B. Why would you want to leave a secure home? C. Lets discuss and explore all of your options. D. Im afraid you would feel very guilty leaving your parents.

ANS: C The most appropriate response by the nurse is, Lets discuss and explore all of your options. In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

8. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurseclient relationship? A. I cant bear the thought of leaving here and failing. B. I might have a hard time working with you. You remind me of my mother. C. I cant tell my husband how I feel; he wouldnt listen anyway. D. Im not sure that I can count on you to protect my confidentiality.

ANS: C The nurse should identify that the client statement I cant tell my husband how I feel; he wouldnt listen anyway reflects resistance to change, which is a common behavior in the working phase of the nurseclient relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

6. What should be the nurses primary goal during the preinteraction phase of the nurseclient relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change

ANS: C The nurses primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase is to obtain available client information.

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? A. Do you know why you are here? B. Are you feeling depressed or anxious? C. Yes, I see. Go on. D. Can you chronologically order the events that led to your admission?

ANS: C The nurses statement, Yes, I see. Go on, is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

19. A clients younger daughter is ignoring curfew. The client states, Im afraid she will get pregnant. The nurse responds, Hang in there. Dont you think she has a lot to learn about life? This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichs and trite expressions are meaningless in a therapeutic nurseclient relationship.

22. The nurse says to a newly admitted client, Tell me more about what led up to your hospitalization. What is the purpose of this therapeutic communication technique? A. To reframe the clients thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. You did not attend group today. Can we talk about that? B. Ill sit with you until it is time for your family session. C. I notice you are wearing a new dress and you have washed your hair. D. Im happy that you are now taking your medications. They will really help.

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client, which reflects the nurses judgment.

28. A client on an inpatient psychiatric unit tells the nurse, I should have died, because I am totally worthless. In order to encourage the client to continue talking about feelings, which should be the nursing initial response? A. How would your family feel if you died? B. You feel worthless now, but that can change with time. C. Youve been feeling sad and alone for some time now? D. It is great that you have come in for help.

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.

14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

17. As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurses most therapeutic statement? A. I want to assure you that I will maintain your confidentiality. B. A long-term goal for someone your age would be to develop better job skills. C. Which identified problems would you like for us to initially address? D. I think first we need to focus on your relationship issues.

ANS: C When moving on a continuum from the orientation to working phase of the nurseclient relationship, the clients identified goals are addressed through mutual therapeutic work to promote client behavioral change.

22. When is self-disclosure by the nurse appropriate in a therapeutic nurseclient relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client

ANS: D Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurses needs.

While caring for a client with persistent depressive disorder, the nurse says, "I can understand what you are feeling now. I too have been in this same situation before." Which feeling of the nurse is indicated by these statements? a. Rapport b. Empathy c. Sympathy d. Genuineness

c. Sympathy ~ Sympathy is the ability to share the feelings of the client. In this case, the nurse is trying to share his or her feelings with the client about a similar situation that was experienced earlier.

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. Everyone diagnosed with OCD needs to control their ritualistic behaviors. B. It is important for you to discontinue these ritualistic behaviors. C. Why are you asking for help if you wont participate in unit therapy? D. Lets figure out a way for you to attend unit activities and still wash your hands.

ANS: D The most appropriate statement by the nurse is, Lets figure out a way for you to attend unit activities and still wash your hands. This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the clients anxiety.

12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. Why do you continue to alienate your peers by your angry outbursts? B. You accomplish nothing when you lose your temper like that. C. Showing your anger in that manner is very childish and insensitive. D. During group, you raised your voice, yelled at a peer, and slammed the door.

ANS: D The nurse is providing appropriate feedback when stating, During group, you raised your voice, yelled at a peer, and slammed the door. Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative or be used to give advice.

1. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I get angry, I get into a fistfight with my wife or I take it out on the kids. Nurse: I notice that you are smiling as you talk about this physical violence. A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

12. On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the clients insight and perception of reality

ANS: D The nurse should place priority on promoting the clients insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase.

3. Which is the best nursing action when a client demonstrates transference toward a nurse? A. Promoting safety and immediately terminating the relationship with the client B. Encouraging the client to ignore these thoughts and feelings C. Immediately reassigning the client to another staff member D. Helping the client to clarify the meaning of the current nurseclient relationship

ANS: D The nurse should respond to a clients transference by clarifying the meaning of the nurseclient relationship, based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present.

10. A mother who has learned that her child was killed in a tragic car accident states, I cant bear to go on with my life. Which nursing statement conveys empathy? A. This situation is very sad, but time is a great healer. B. You are sad, but you must be strong for your other children. C. Once you cry it all out, things will seem so much better. D. It must be horrible to lose a child; Ill stay with you until your husband arrives.

ANS: D The nurses response, It must be horrible to lose a child; Ill stay with you until your husband arrives, conveys empathy to the client. Empathy is the ability to see the situation from the clients point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

5. A nurse states to a client, Things will look better tomorrow after a good nights sleep. This is an example of which communication technique? A. The therapeutic technique of giving advice B. The therapeutic technique of defending C. The nontherapeutic technique of presenting reality D. The nontherapeutic technique of giving false reassurance

ANS: D The nurses statement, Things will look better tomorrow after a good nights sleep, is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the clients feelings.

11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the clients behavior D. To give the client critical information

ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

30. A client states, You wont believe what my husband said to me during visiting hours. He has no right treating me that way. Which nursing response would best assess the situation that occurred? A. Does your husband treat you like this very often? B. What do you think is your role in this relationship? C. Why do you think he behaved like that? D. Describe what happened during your time with your husband.

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. Describe one of the best things that happened to you this week. B. Im having a difficult time understanding what you mean. C. Your counseling session is in 30 minutes. Ill stay with you until then. D. You mentioned your relationship with your father. Lets discuss that further.

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

18. A client tells the nurse, I feel bad because my mother does not want me to return home after I leave the hospital. Which nursing response is therapeutic? A. Its quite common for clients to feel that way after a lengthy hospitalization. B. Why dont you talk to your mother? You may find out she doesnt feel that way. C. Your mother seems like an understanding person. Ill help you approach her. D. You feel that your mother does not want you to come back home?

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

A client states: "I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is the therapeutic response? a. "That's not true." b. "I have a hard time believing that is true." c. "Surely you don't really believe that." d. "I will help you search this room so that you can see there is no camera."

B

Carol, an adolescent, just returned from group therapy and is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? a. "What makes you think you will never have any friends?" b. "You're feeling pretty down on yourself right now." c. "I'm sure they didn't mean to hurt your feelings." d. "Why do you feel this way about yourself?"

B

Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the client's insight and perception of reality. b. Creating an environment for the establishment of trust and rapport. c. Using the problem-solving model toward goal fulfillment. d. Obtaining available information about the client from various sources. e. Formulating nursing diagnoses and setting goals.

B E

Judy has been in the hospital for 3 weeks. She has used Valium "to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse, "I don't know if I will be able to make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which is the most appropriate response by the nurse? a. "Why do you think you have to have drugs to deal with your problems?" b. "Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can." c. "We will just have to think about some things that you can do to decrease your anxiety without resorting to drugs." d. "Just hang in there. I'm sure everything is going to be okay."

C

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?

Clarify personal attitudes, values, and beliefs.

Dorothy was involved in an automobile accident while under the influence of alcohol. She swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? a. "Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again." b. "You know that was a terrible thing you did. That child could have been killed." c. "I'm sure everything is going to be okay now that you understand the possible consequence of such behavior." d. "How are you feeling about what happened?"

D

What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?

Establish rapport and develop treatment goals.

On which task should a nurse place priority during the working phase of relationship development?

Promoting the client's insight and perception of reality

If a client demonstrates transference toward a nurse, how should the nurse respond?

Help the client to clarify the meaning of the relationship, based on the present situation.

Which client action should a nurse expect during the working phase of the nurse-client relationship?

The client gains insight and incorporates alternative behaviors.

Which actions of the nurse convey an attitude of respect towards the client? Select all that apply. a. Being honest while interacting with the client b. Calling the client by name c. Spending time with the client d. Understanding the situation from the client's point of view e. Promoting an atmosphere of privacy during therapeutic interaction

a. Being honest while interacting with the client b. Calling the client by name c. Spending time with the client e. Promoting an atmosphere of privacy during therapeutic interaction

The nurse is in the first phase of relationship development with a client who is an alcoholic. What should be the goal of the nurse during this phase? a. Establishing trust b. Promoting client change c. Exploring self-perceptions d. Ensuring therapeutic closure

c. Exploring self-perceptions

When establishing a therapeutic relationship with a psychiatric client, what is important to remember regarding thought processes? a. Concrete thinking causes client to focus on specifics instead of generalizations b. Abstract thinking allows client to be creative in their contributions to interventions and goals c. Cognition is altered by mental illness' effect on dopamine and serotonin production in the brain. d. Critical thinking skills are underdeveloped due to physiological changes in the brain causing fogginess.

a. Concrete thinking causes client to focus on specifics instead of generalizations ~ Psychiatric clients most often experience concrete thinking which causes them to focus on specifics and the immediacy of things rather than generalizations and eventual outcomes.

A nurse is caring for a client who is very apprehensive and not very forthcoming with information. What interventions will he/she take in order to build a trusting relationship with a client? Select all that apply. a. Keep promises and be honest b. Demonstrate a non-judgmental attitude c. Provide written, structured schedule of activities d. Listen to client preferences, requests, and opinions e. Discuss non-health related topics when client wants

a. Keep promises and be honest b. Demonstrate a non-judgmental attitude c. Provide written, structured schedule of activities d. Listen to client preferences, requests, and opinions

A nurse is communicating with a client who was just admitted for treatment of a substance use disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication? a. Offering advice b. Reflecting c. Listening attentively d. Giving information

a. Offering advice

Which phase of the therapeutic relationship will help the nurse overcome resistance behaviors of the client whose level of anxiety has risen? a. The working phase b. The orientation phase c. The termination phase d. The preinteraction phase

a. The working phase

he client becomes angered when a nurse comes in wearing a hat that reminds the client of the his abusive mother used to wear. Which term describes this emotion? a. Transference b. Countertransference c. Overcoming resistance d. Reality perception

a. Transference

Which statements are true regarding trust and the therapeutic relationship? Select all that apply. a. Trust cannot be presumed b. Trustworthiness is demonstrated through a sense of warmth and caring c. If trust has not been achieved, development of the relationship becomes more difficult d. To demonstrate trust is to believe in the dignity and worth of an individual regardless of his or her behavior e. One must feel confidence in another's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested

a. Trust cannot be presumed b. Trustworthiness is demonstrated through a sense of warmth and caring c. If trust has not been achieved, development of the relationship becomes more difficult e. One must feel confidence in another's presence, reliability, integrity, veracity, and sincere desire to provide assistance when requested

The nurse is caring for a client who is in the isolation room. Which statement made by the nurse indicates that the nurse is trying to increase the client's feeling of self-worth? a. "I see you put away your clothes." b. "I'll sit in here with you for a while." c. "I notice you are pacing a lot." d. "Yes, I understand what you said."

b. "I'll sit in here with you for a while."

The nurse is developing a therapeutic relationship with the client. Which statement made by the nurse indicates an empathetic response? a. "I understand your feelings because I have gone through the same thing." b. "If you felt bad about those harsh comments, it is ok to be sad and cry." c. "I will surely incorporate your ideas and preferences when planning your care." d. "Be assured that whatever we discuss will not leave the boundaries of our health-care team."

b. "If you felt bad about those harsh comments, it is ok to be sad and cry."

client's spouse presents a bouquet of flowers and chocolates to the nurse for taking care of the client. What is the most appropriate response of the nurse? a. "I do not accept gifts." b. "Thank you. I will share your gift with my colleagues." c. "It is against the rules of the hospital to accept gifts." d. "The flowers and chocolates are wonderful. Thank you for them."

b. "Thank you. I will share your gift with my colleagues." ~ accepting small gifts as a token of appreciation from the client may be considered appropriate. If the nurse responds, "Thank you. I will share it with my colleagues," it would be more appropriate because the nurse is acknowledging the effort of other staff members involved in caring for the client.

A client with low self-esteem tells the nurse, "I am of no value to anybody." Which statement by the nurse in response to the client indicates a better example of therapeutic communication? a. "Of course you are something. Everyone is something." b. "You are feeling like nobody cares about you right now." c. "What makes you say this?" d. "You must be feeling very lonely right now."

b. "You are feeling like nobody cares about you right now."

In a therapeutic relationship empathy is extremely important. Which does the nurse know describes empathy? a. Sharing the feelings of another person b. Accurately perceiving and understanding another person's feelings c. Identifying with what another is feeling d. Experiencing a need to alleviate another's distress.

b. Accurately perceiving and understanding another person's feelings

Which action of the nurse indicates the working phase of relationship development with a client? a. Formulating nursing diagnoses b. Examining the client's feelings, fears, and anxieties c. Continuously evaluating the client's progress towards goal attainment d. Developing a plan of action that is realistic for meeting the goals

b. Examining the client's feelings, fears, and anxieties

The nurse is caring for a psychiatric client who is experiencing concrete thinking. Which nursing intervention is most essential to develop a therapeutic relationship with the client? a. Establishing an acquaintance with the client b. Keeping promises made to the client c. Considering the client's ideas when planning care d. Being open and real while interacting with the client

b. Keeping promises made to the client

The nurse is disciplined for having dinner after hours with a client. Which type of boundary was breached? a. Material boundaries b. Professional boundaries c. Personal boundaries d. Social boundaries

b. Professional boundaries ~ Professional boundaries limit and outline expectations for appropriate professional relationships with clients.

The nurse accepts a client unconditionally and regards him or her as a worthy person. Which characteristic is exhibited by the nurse? a. Trust b. Respect c. Empathy d. Genuineness

b. Respect

he client says, "All men are messy and untidy." What type of belief does the client have? a. Faith b. Stereotype c. Rational belief d. Irrational belief

b. Stereotype

What is an example of a negative attitude? a. Having an idea that alcoholism is a disease b. The negative stigma associated with mental illness c. Conveying the truth to all psychotic clients about their medical illness d. Conjecturing that all people with mental illness are dangerous

b. The negative stigma associated with mental illness

Which phase of the nurse-client relationship development deals with creating an environment for the establishment of trust and rapport with the client? a. The working phase b. The orientation phase c. The termination phase d. The preinteraction phase

b. The orientation phase

What are the issues pertaining to general concerns of the professional boundaries of the nurse-client relationship? Select all that apply. a. Trust b. Touch c. Gift-giving d. Genuineness e. Self-disclosure

b. Touch c. Gift-giving e. Self-disclosure

he nurse remains respectful of a client who is engaging in behaviors opposed to the nurse's religious beliefs. Which describes the nurse's response? a. Confidentiality b. Unconditional positive regard c. Genuineness d. Concrete thinking

b. Unconditional positive regard

A client is crying to the nurse because someone made a joke about her being overweight. Which of the nurse's responses is an example of empathy? a. "I can identify with what you are feeling. I am overweight too." b. "I get so angry when people are insensitive like that." c. "You feel angry and embarrassed. It is alright to cry." d. "It's typical of skinny people to be so rude."

c. "You feel angry and embarrassed. It is alright to cry."

A client in group therapy is uncomfortable speaking in front of other members but communicates openly in a one-to-one session with the nurse. Which element is contributing to the client's anxiety? a. Religion b. Values c. Environment d. Culture

c. Environment

The nurse is caring for a client who unconsciously transfers his or her feelings for a person in the client's past towards the nurse because the nurse's appearance reminds the client of that person. Which outcome in the client would indicate the effectiveness of the nursing care? a. The client will formulate a plan with the nurse. b. The client will develop problem-solving skills. c. The client will assume responsibility for his or her own behavior. d. The client will discuss and compare the exhibited behaviors with the nurse.

c. The client will assume responsibility for his or her own behavior.

A nurse is caring for a client with anorexia nervosa. Which of the following examples demonstrates the nurse's use of interpersonal communication? a. The nurse discusses the client's weight loss during a healthcare team meeting b. The nurse examines her own personal feelings about clients who have anorexia nervosa c. The nurse asks the client about her body image perception d. The nurse presents an educational session about anorexia nervosa to a large group of adolescents

c. The nurse asks the client about her body image perception

The nurse is caring for a client during an anger-management program. Which action represents the working phase of therapeutic relationship management? a. The nurse preparing a plan for continuing care. b. The nurse assessing the client's previous medical records. c. The nurse helping the client practice various adaptive procedures to control anger. d. The client and nurse setting goals to develop some adaptive ways to handle anger.

c. The nurse helping the client practice various adaptive procedures to control anger

Which phase of development of the therapeutic relationship involves the evaluation of goals attained by the client after the therapy? a. The working phase b. The orientation phase c. The termination phase d. The preinteraction phase

c. The termination phase

A client mentions to the nurse that his "girlfriend" is coming by to see him and not to tell his wife. The nurse does not condone this type of behavior and is offended. The client and nurse obviously have a difference in what? a. Faith b. Beliefs c. Values d. Attitude

c. Values

A client who lost his or her spouse in an accident tells the nurse, "Leave me alone. I can't talk to you." How should the nurse respond to this client using therapeutic communication techniques? a. "Everything will be fine." b. "Tell me what you are thinking?" c. "I think you should come in here and discuss your feelings." d. "Are you feeling that no one understands your feelings?"

d. "Are you feeling that no one understands your feelings?"

A nurse is caring for the parents of a child who has demonstrated recent changes in behavior and mood. When the mother of the child asks the nurse for reassurance about her son's condition, which of the following responses should the nurse make? a. "I think your son is getting better. What have you noticed?" b. "I'm sure everything will be okay. It just takes time to heal" c. "I'm not sure what's wrong, have you asked the doctor about your concerns?" d. "I understand you're concerned. Let's discuss what concerns you specifically"

d. "I understand you're concerned. Let's discuss what concerns you specifically"

When working with a client who is being treated for depression, the client states, "this rainy weather is really crapping me out." Which is an appropriate example of how the nurse, who suffers from seasonal-affective disorder, can demonstrate genuineness when responding to this client? a. "The sun will be out soon so get up and get your bath, so you will feel better" b. It will soon pass, and the sun will be out again, but for now you need to get up and move around" c. "I get crapped out, too and just want to stay in bed all day, so why don't you just rest a bit longer and you can get up later" d. "Yes, it can be very depressing so why don't we get you up and moving, then we can get your bath which will help you feel better"

d. "Yes, it can be very depressing so why don't we get you up and moving, then we can get your bath which will help you feel better"

The nurse knows which is an important characteristic of the therapeutic relationships? a. Self-directed b. Goal-oriented c. One-sided d. Collaborative

d. Collaborative ~ Ideally, the nurse and client decide together what the goal of the therapeutic relationship will be.

An alcoholic client refuses to attend the alcoholics' support group meetings. The nurse says, "You are so selfish. Don't you have any sense of responsibility for your children?" Which characteristic is indicated in the nurse's response? a. Empathy b. Sympathy c. Transference d. Countertransference

d. Countertransference

Which is a task completed in the preinteraction phase of the client relationship? a. Gathering assessment information to build a strong client database b. Promoting the client's insight and perception of reality c. Using the problem-solving model d. Examining one's own feelings, fears, and anxieties about working with a particular client

d. Examining one's own feelings, fears, and anxieties about working with a particular client ~Gathering assessment information happens in the orientation phase Promoting the client's insight and perception of reality happens in the working phase. Using the problem-solving model happens in the working phase.

The nurse tells the client the truth. What is this characteristic of the nurse called? a. Respect b. Empathy c. Sympathy d. Genuineness

d. Genuineness

A client with a nursing diagnosis of Self-Care Deficit-Bathing/Hygiene and Risk for Infection r/t impaired immune system has not met their designated nursing goals. The nurse re-evaluates and creates new goals for the client and begins to implement them immediately. What has the nurse failed to do in the nurse-client relationship? a. Contact the physician for orders. b. Tell the client they will be changing goals. c. Ask the client's family for permission to make changes. d. Include the client on goal setting and problem-solving.

d. Include the client on goal setting and problem-solving.

A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following aspects of communication should the nurse identify as a verbal component? a. Personal space b. Posture c. Eye Contact d. Intonation

d. Intonation ~ Intonation is the tone of one's voice and can communicate a variety of feelings

The nurse and client have developed a romantic relationship with each other. Which type of boundary is being violated in this situation? a. Social boundary b. Material boundary c. Personal boundary d. Professional boundary

d. Professional boundary

A nurse is in an acute mental health facility is communicating with a client. The client states "I can't sleep, I stay up all night". The nurse responds "You are having a difficult time sleeping?" Which of the therapeutic communication techniques is the nurse demonstrating? a. Offering general leads b. Summarizing c. Focusing d. Restating

d. Restating

Which situation explains the phenomenon of transference? a. The nurse defends the client's rude behavior. b. The nurse encourages the client's dependency. c. The nurse feels worried and tense in the client's presence. d. The client has overwhelming affection for and is excessively dependent on the nurse and becomes agitated when the nurse is not around.

d. The client has overwhelming affection for and is excessively dependent on the nurse and becomes agitated when the nurse is not around

Which best describes therapeutic use of self? a. The nurse and client decide together what the goal of the relationship will be. b. The nurse recognizes and accepts what he or she values and learns to accept the uniqueness of and differences in others. c. Each individual in the interaction perceives the other as a unique human being and capable of adding to the relationship. d. The nurse has the ability to use their personality consciously and in full awareness to establish relatedness and to structure nursing intervention.

d. The nurse has the ability to use their personality consciously and in full awareness to establish relatedness and to structure nursing intervention. ~ Possessing the ability to use personality consciously, in full awareness, is important in establishing a relationship and developing nursing interventions that in the best interest of the client.

Which explains why the client often sees the nurse as a surrogate? a. The nurse provides specific answers to questions usually formulated with relation to a larger problem. b. The nurse uses interpersonal techniques to assist clients in adapting to difficulties or changes in life experiences. c. The nurse understands various medical devices and has the clinical skills necessary to perform interventions that are in the best interest of the client. d. The nurse is perceived as a person who has cared for the client when the client is placed in a situation that generates feelings similar to ones experienced previously.

d. The nurse is perceived as a person who has cared for the client when the client is placed in a situation that generates feelings similar to ones experienced previously.

The nurse is answering a client's query. Which subrole of the nurse does this action indicate? a. The leader b. The stranger c. The surrogate d. The resource person

d. The resource person

While caring for a client with anger, the nurse formulates a plan of action with the client. What would be the rationale behind this nursing intervention? a. To nurture the client in the dependent role b. To find clues to the underlying true feelings of the client c. To encourage a like response from the client d. To prevent anxiety or anger from escalating to an unmanageable level

d. To prevent anxiety or anger from escalating to an unmanageable level