Chap 5-Therapeutic Relationships

The nurse is caring for a client with schizophrenia. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone." What is the most appropriate nursing response?

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

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

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

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self?

"What types of dresses do you like wearing?"

A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing?

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

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message?

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

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

-Preventing deterioration of mental status -Promoting mental health -Promoting physical health

A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibilty that the relationship may be moving outside professional boundaries?

-The client brings the nurse a baked item for their lunch. -The nurse is spending more time with the client than the others in the group. -The nurse tells a friend that the nurse is the only one who truly understands this client.

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

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

Which clinical situation provides an example of transference?

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

A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what?

A judgmental attitude

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

Advocate

A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?

Trust

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship?

Client self-exploration

The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?

Countertransference

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

Countertransference

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

During the initiating or orienting phase

A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Empirical knowing

Which is not involved in empathy?

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

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

Hildegard Peplau

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

Lack of self-awareness

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

Lacking genuine interest

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?

Orientation

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

Orientation phase

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

Rambling due to nervousness

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take?

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

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

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

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

The client is nervous and insecure.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase?

The client recognizes feelings of anger and expresses them appropriately.

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

The loss of therapeutic effectiveness

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

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

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

The nurse is empathizing with the client.

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

The therapeutic use of self

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?

The therapist must notify authorities and the potential victim.

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?

To prevent the client from viewing the nurse as a friend rather than health care provider

A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client?

Unconditional positive regard

A psychiatric-mental health nurse is conducting a self-examination of beliefs and values to develop self-awareness. Asking which question would be appropriate for the nurse to determine the fundamental personal attitudes about people of diverse cultures?

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

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

Working

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

Working

During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:

empathy.

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

is attempting to prolong the nurse-client relationship.

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain?

perception of the problem

The most important tool of psychiatric nursing is the:

self.

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

shifting the emphasis to the nurse