329 Chapter 5: Therapeutic Relationships Q's

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? A. "Thank you but I will not accept these gifts because they extend over our discussed boundaries." B. "They look delicious and I love candy but I'm on a diet and really can't accept them." C. "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" D. "Thank you so much. I will share them with the other nurses."

A. "Thank you but I will not accept these gifts because they extend over our discussed boundaries." During the orientation phase, professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.

During which phase of the nurse-client relationship does the client identify and explore specific problems? A. orientation B. working C. resolution D. pre-orientation

B. working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response? A. "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." B. "It depends upon what they ask me. I might be able to withhold some information, but not all." C. "Any information is only shared with other professionals involved in your care." D. "Is there some reason why you don't want your family to know your problems?"

C. "Any information is only shared with other professionals involved in your care." The nurse should be clear about any information that is to be shared with anyone else. The nurse shares significant assessment data and client progress with a supervisor, team members, and a physician. Most clients expect the nurse to communicate with other mental health professionals and are comfortable with this arrangement. Restrictions regarding what can be shared and with whom are also covered by state or provincial mental health acts and health information acts. Based upon identified laws, the nurse will unlikely share information with family unless the client provides permission.

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. A. "Don't worry. Your child will be all right." B. "It sounds like this is very difficult for you, I can see why it causes you stress." C. "I don't know how you've managed to cope, this is awful." D. "That is unbelievable. How could you tolerate this behavior?"

B. "It sounds like this is very difficult for you, I can see why it causes you stress." Empathizing is placing oneself in the experience of another. Developing empathy with the client can lead to better therapeutic communication and better nursing interventions. Telling the client not to worry would indicate that the nurse is trying to be supportive of the client but not empathetic. The nurse telling the client that it must be hard for the client to cope conveys sympathy and feeling sorry for the client. Telling the client that the behavior is unbelievable indicates that the nurse feels shocked at the client's statement.

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? A. Values B. Attitude C. Ability to relate to others D. Knowledge

B. Attitude A tone of defeatism or resignation is indicative of an attitude that may inhibit communication and treatment.

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? A. The therapist must evaluate the threat and notify authorities if it meets credibility criteria. B. The therapist must meet with an ethics committee to determine the course of action. C. The therapist must notify authorities and the potential victim. D. The therapist must keep the comment confidential, because the disclosure is protected by therapist-client confidentiality.

C. The therapist must notify authorities and the potential victim. As a result of the Tarasoff decision, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.

What occurs during the working phase of the nurse-client relationship? A. Discussion regarding termination of the relationship B. Discussion of expectations of the relationship C. Rejection of client needs D. Evaluation of mutually identified goals

D. Evaluation of mutually identified goals Evaluation of mutually identified goals occurs in the working phase of the nurse-client relationship. The nurse discusses expectations during the orientation phase. During the working phase, the nurse assesses client needs. Discussion regarding the termination of the relationship occurs during the orientation phase.

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? A. "There's no need to get rude with me. I'm just trying to do my job and to help you out." B. "Is that a message you've been hearing a lot over the past couple of days?" C. "Actually, I've not come here to tell you that." D. "It sounds like you're exasperated with the caregivers you've interacted with. Is that fair to say?"

A. "There's no need to get rude with me. I'm just trying to do my job and to help you out." Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

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

A. "Your hard work and determination has helped you recover." A congruent message is delivered when the actions and the words spoken match. The nurse has a smiling facial expression which indicates that the nurse is happy. The statement that the client's hard work and determination has warded off the disease indicates that the nurse is happy with the outcomes of the client's hard work. A smiling facial expression while saying this statement would deliver a congruent message. The statement that the client should not disturb the other clients in the ward indicates that the nurse is irritated. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should listen to the instructions before starting the exercises indicates a focused approach. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should wait for the medicines to show the therapeutic effect indicates that the nurse has sympathy for the client. A smiling facial expression while saying this statement would not deliver a congruent message.

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? A. Countertransference B. Reaction formation C. Transference D. Free association

A. Countertransference Countertransference refers to an instance when the nurse has preconceived attitudes or feelings toward a patient that stem from prior experience. When feelings, either positive or negative, seem extreme or disproportionate to the circumstances, the nurse should consider whether a transferential reaction has occurred.

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? A. Orientation phase B. Termination phase C. Exploitation phase D. Identification phase

A. Orientation phase According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

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

A. Rambling due to nervousness A client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

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

A. The client In a therapeutic relationship, the nurse focuses on the client and client-related issues even when engaging in social activities with that client. This is essential to the most effective nurse-client relationship, one that is client-centered.

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

A. The therapeutic use of self Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. Medications and education will influence and enhance growth, but the therapeutic use of self is the nurse's primary tool. Self-help groups do not involve health care professionals.

Which is one of the most common reasons clients are often concerned about confidentiality of treatment for mental health problems? A. They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness. B. They do not understand that most people will not know what a mental health problem is. C. They are concerned about receiving their next paycheck when they return to work. D. They lack health care coverage for the treatment.

A. They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness. Mental health concerns frequently carry social stigmas. Confidentiality protects patient information so that persons not involved with treatment are not privileged to patient information. This prevents further stigmatization.

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? A. To prevent the client from viewing the nurse as a friend rather than health care provider B. To avoid making the client feel that the client's problems are not viewed as being serious C. To avoid giving the client the impression that the nurse is not interested in providing effective care D. To prevent disruption of the time that is to be used for therapeutic communication

A. To prevent the client from viewing the nurse as a friend rather than health care provider The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily because it is likely to encourage the client to view the nurse as a friend rather than health care provider. Boundaries of the nurse-client relationship can only be set effectively if the nurse primarily engages in therapeutic communication with the client as opposed to social communication.

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? A. Trust B. Genuine interest C. Caring D. Positive regard

A. Trust An important component of trust is confidentiality. Mental health providers must reassure clients that they will not share the details of clients' lives outside the professional environment.

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

A. develop a sense of trust in the nurse The orientation phase is the phase during which the nurse and client get to know each other. During this phase, the client develops a sense of trust in the nurse. In the working phase, the client works through problems and identifies potential solutions to issues. During the termination phase, problems are resolved.

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: A. is attempting to prolong the nurse-client relationship. B. is angry that the nurse is abandoning the client. C. requires additional therapy. D. is unhappy that the therapy was ineffective.

A. is attempting to prolong the nurse-client relationship. It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

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

A. shifting the emphasis to the nurse Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the option are inappropriate.

Which clinical situation provides an example of transference? A. A client mirrors the nursing student's nervousness and hesitancy during assessment. B. A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. C. A nurse asks for clarification from a colleague when explaining a coping strategy to a client. D. A nurse implements the same interventions with multiple clients despite their personal differences.

B. A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life.

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. A. Immediately stop the client and inform the client that the nurse is running the session. B. Reassure the client that they already covered these issues. C. Do not acknowledge this issue and continue on with the session as planned. D. Get angry at the client and ask the client to leave the session. E. Review with the client the learned methods to control the problems.

B. Reassure the client that they already covered these issues. E. Review with the client the learned methods to control the problems. A typical termination behavior is raising old problems that have already been resolved. The nurse may feel frustrated if clients in the termination phase present resolved problems as if they were new. The clients are attempting to prolong the relationship and avoid its ending. Nurses should avoid addressing these problems. Instead, they should reassure clients that they already covered those issues and learned methods to control them.

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? A. The client is demonstrating a normal reaction. B. The client is nervous and insecure. C. The client is attempting to engage in a social relationship. D. The client is experiencing symptoms of a disorder.

B. The client is nervous and insecure. In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.

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

B. The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

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? A. Closure B. Trust C. Sympathy D. Empathy

B. Trust When a nurse repeatedly upholds commitments made to a client, it fosters foundational trust within the therapeutic relationship. The other options may be part of the therapeutic relationship, but in this case the nurse's behavior will instill 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? A. Mutual withdrawal B. Working C. Resolution D. Orientation

B. Working The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.

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? A. Parent surrogate B. Teacher C. Advocate D. Caregiver

C. Advocate In the advocate role, the nurse informs the client and then supports the client in whatever decision the client makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the client's medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries? A. Ask another nurse to attend the meetings to ensure boundaries are not crossed. B. Plan to meet the client since the personal relationship ended. C. Ask to be reassigned because of having a prior personal relationship with the client. D. Meet for the first session but explain that another nurse will be assigned going forward.

C. Ask to be reassigned because of having a prior personal relationship with the client. Since the nurse had a previous personal relationship with the client, the therapeutic boundary is questionable. The best course of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the professional-personal boundary. When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the client immediately.

In what phase of the therapeutic relationship does the assessment process begin? A. During the working phase B. After the working phase has been completed C. During the initiating or orienting phase D. After the initiating or orienting phase has been completed

C. During the initiating or orienting phase The first step of the therapeutic relationship is called the initiating or orienting phase. During this phase, the nurse sets the stage for a one-to-one relationship by becoming acquainted with the client. At the same time, the nurse also begins the assessment process.

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

D. "I cannot keep this a secret. I will ensure that the staff helps keep you safe." The nurse is not supposed to keep secrets, especially if the information relates to the client inflicting self-harm. The nurse should inform the client that they will be closely monitored. Asking the client who has influenced the client with these ideas indicates a poor understanding of the nature of the client's illness. For client's with schizophrenia, stimuli are internally generated and can cause emotional dysfunction. The nurse should not exhibit anger, as the nurse is supposed to be accepting of the client in any circumstances. Stating that the client will be restrained may be perceived as threatening.

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? A. "I know you are busy. I don't have much to say now." B. "What difference does it make what I say to you?" C. "I really don't want to talk about that right now." D. "I feel worthless and have no real use in life."

D. "I feel worthless and have no real use in life." People with psychiatric problems often feel alone and isolated. Establishing rapport helps lessen feelings of being alone. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.

The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment? A. "Don't you think you're ready to be independent?" B. "You are more than ready to get out of here. Have faith in your accomplishments." C. "Just think of all of the things you can do in the home that you can't do here." D. "It can be scary to leave a place that you trust and feel supported."

D. "It can be scary to leave a place that you trust and feel supported." Empathy is the ability to experience, in the present, a situation as another did at some time in the past. It is the ability to put oneself in another person's circumstances and to imagine what it would be like to share their feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it. For empathy to develop, there must be a giving of self to the other individual and a reciprocal desire to know each other personally. The process involves the nurse receiving information from the client with open, nonjudgmental acceptance and communicating this understanding of the experience and feelings so the client feels understood. Acknowledging that leaving the hospital can be scary because the client will miss the trust and support provided demonstrates empathy. Questioning about independence, having the client think about things that can be done in the home versus the hospital, and telling the client to have faith in accomplishments do not demonstrate empathy for the client's fear.

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. Countertransference B. Exploitation C. Poor boundaries D. A judgmental attitude

D. A judgmental attitude Judgmental attitudes and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, "Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?" Countertransference refers to the nurse's response to the client based on personal unconscious needs and conflicts. Exploitation refers to the phase in the therapeutic relationship when the nurse guides the client to examine feelings and responses to develop better coping mechanisms and a more positive self image. Poor boundaries refers to inappropriate levels of personal disclosure to the client or overly social/intimate relationships with 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? A. Bipolar disorder B. Failure to thrive C. Decompensation D. Compassion fatigue

D. Compassion fatigue Compassion fatigue, also referred to by many as burnout, may occur when one provides care for others but loses the ability to take care of oneself. According the neurobiological theories of bipolar disorder, the parent would have already been diagnosed with bipolar disorder if this was a possibility. Although poor self-care could result in a failure to thrive for the client's parent, the parent is more likely to experience compassion fatigue, given the client factors presented in this scenario. Decompensation is a term used to describe worsening symptoms of someone who has maintained recovery of a chronic mental illness. This does not accurately describe the situation for the client's parent.

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

D. It enables the nurse to get an accurate picture of the client's problems. A preconception does not enable the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave and can prevent people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? A. Withholding B. Working C. Resolution D. Orientation

D. Orientation The orientation phase is the phase during which the nurse and client get to know each other. The nurse reads background materials available on the client and considers his or her personal strengths and limitations in working with this client. The working stages involves problem identifcation and exploitation. Resolution, or the termination phase, begins when problems are resolved and signals the end of the therapeutic relationship. Withholding is a phase in a deteriorating relationship in which the nurse is perceived as withholding nursing support.

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? A. Self-disclosure can help the client feel like a friend. B. Self-disclosure allows the client to see the nurse as a real human being. C. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued. D. Self-disclosure can help normalize the client's experience.

D. Self-disclosure can help normalize the client's experience. Nurses may use self-disclosure in the nurse-client relationship to comfort a client who is feeling frustrated and hopeless, enhance trust, decrease role distancing, facilitate the client's self-disclosure, convey support, or normalize the client's experience.

A client forgets to attend a planned session. Which should the nurse conclude about the client's behavior? A. It is time to end the relationship. B. Problems are overwhelming. C. The client does not like the nurse. D. The relationship is being tested.

D. The relationship is being tested. During the orientation phase, the client begins to test the relationship to become convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late. Forgetting a session is not an indication that the client's problems are overwhelming, that the relationship should end, or the client does not like the nurse.

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: A. apathy. B. sympathy. C. nontherapeutic communication. D. empathy.

D. empathy. Being empathetic is an active process requiring careful listening and attending to the client. Direct eye contact, a concerned expression, occasional head nods, and a lean forward while listening are nonverbal communication skills that convey empathy. Empathetic responses, such as "You're going through a difficult time," can provide clients with an opportunity to listen to themselves and gain self-awareness.

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

D. working During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.