Chapter 5

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child? a. "That must have been terribly hurtful experience for you." b. "I too have been disappointed by important people in my life." c. "You will find that one of the constants in life is that people will often let you down." d. "What do you think motivated your father to do that."

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

After meeting with a client experiencing extreme anxiety the nurse notes personal feelings of nervousness. Which action should the nurse take first to address these feelings? a. analyze the source of the feelings b. investigate transferring to another care area c. suggest another nurse meet with client going forward d. plan sessions to occur after the client receives medication

a. . analyze the source of the feelings

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. Advocate b. Caregiver c. Teacher d. Parent surrogate

a. Advocate

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship? a. Client self-exploration b. Self-disclosure c. Empathy d. Respect

a. Client self-exploration

Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts? a. Countertransference b. Exploration c. Self-disclosure d. Transference

a. Countertransference

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason? a. Eliciting the client's cooperation through the establishment of trust b. Establishing mutual expectations for nursing interventions c. Facilitating the assessment process and the collection of a database d. Providing the client contact with a caring professional health care provider

a. Eliciting the client's cooperation through the establishment of trust

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? a. Hildegard Peplau b. Jean Watson c. Florence Nightingale d. Clara Barton

a. Hildegard Peplau

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

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

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship? a. Orientation b. Working c. Termination d. Problem identification

a. Orientation

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. Orientation b. Working c. Resolution d. Withholding

a. 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? a. Orientation phase b. Identification phase c. Exploitation phase d. Termination phase

a. Orientation phase

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

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

a. 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? a. The nurse frequently refers to an elderly, cognitively impaired client as "my granny" b. The nurse is referred to as being in a relationship with a client by that client, and the client wants the nurse to accompany the client to the prom c. The nurse begins to experience the symptoms of depression and calls out sick d. The nurse asks to be transferred to another unit to avoid burnout and to work with different disorders

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

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? a. Unconditional positive regard b. Countertransference c. Partnership d. Genuineness

a. Unconditional positive regard

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. "It can be scary to leave a place that you trust and feel supported." c. "Just think of all of the things you can do in the home that you can't do here." d. "You are more than ready to get out of here. Have faith in your accomplishments."

b. "It can be scary to leave a place that you trust and feel supported."

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? a. "How did the pain start?" b. "What types of dresses do you like wearing?" c. "Do you take a vegetarian or nonvegetarian diet?" d. "Do you want me to inform your spouse about your illness?"

b. "What types of dresses do you like wearing?"

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. Compassion fatigue c. Failure to thrive d. Decompensation

b. Compassion fatigue

The mental health nurse is responsible for maintaining professional boundaries. Which would be an example of a professional boundary violation? a. Providing a friendly environment b. Giving personalized gifts to a client c. Exhibiting confidentiality d. Avoiding personal attachment to the client

b. Giving personalized gifts to a client

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. a. Personal safety b. Preventing deterioration of mental status c. Promoting mental health d. Promoting physical health e. Ensuring adequate sedation with medication

b. Preventing deterioration of mental status c. Promoting mental health d. Promoting physical health

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? a. Tell the client the nurse will call once per week during office hours so that the client can practice phone skills b. Remind the client about the importance of boundaries to keep the relationship therapeutic c. Call the client once each weekend to build trust d. Tell the client to call the office answering service in case of an emergency

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

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. The nurse recognizes the client should be involved with which actions? Select all that apply. a. Beginning to identify a need b. Testing new ways for problem solving c. Testing the relationship d. Discussing problems related to needs e. Examining personal issues

b. Testing new ways for problem solving d. Discussing problems related to needs e. Examining personal issues

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? a. The nurse is comforting the client. b. The nurse is empathizing with the client. c. The nurse is sympathizing with the client. d. The nurse is showing genuine interest in the client.

b. The nurse is empathizing with the client.

Which situation would most likely indicate a violation of professional boundaries? Select all that apply. a. The nurse refuses a gift from a client and the client's family. b. The nurse strongly defends a client's behavior during a staff meeting. c. A nurse tells other staff that the nurse is the only one who understands the client. d. A nurse begins to spend increasing amounts of time with one client on the unit. e. A nurse reports information to the physician after the client asks that it be kept a secret.

b. The nurse strongly defends a client's behavior during a staff meeting c. A nurse tells other staff that the nurse is the only one who understands the client. d. A nurse begins to spend increasing amounts of time with one client on the unit.

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

b. The therapeutic use of self

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? a. Did you grow up in a rural or urban community? b. While a child, what attitudes did your family express about other cultures? c. What kinds of experiences have you had with people of other cultures? d. Do you think you hold bias or prejudice attitudes?

b. 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? a. Orientation b. Working c. Resolution d. Mutual withdrawal

b. Working

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

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

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? a. "Of course you should; being a lesbian is just not natural." b. "Yes, I think you should pursue building a relationship with a man." c. "It sounds like you're beginning to be uncomfortable in this relationship." d. "You need to focus on yourself rather than the relationship right now."

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

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. Transference b. Free association c. Countertransference d. Reaction formation

c. Countertransference

During the first meeting with a client, the nurse explains that the relationship is time limited and will end. Which best explains the reason for the nurse's explanation? a. establishing boundaries b. discussing the role of the nurse c. beginning the termination process d. explaining the purpose of the meetings

c. beginning the termination process

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? a. known allergies b. recent hospitalizations c. perception of the problem d. family history

c. perception of the problem

The most important tool of psychiatric nursing is the: a. physician. b. nurse. c. self. d. environment.

c. self

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

c. shifting the emphasis to the nurse

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. Positive regard b. Caring c. Trust d. Genuine interest

c. trust

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. "Who has influenced you with these ideas?" c. "I will speak with the health care provider about the possible use of physical restraints for you tonight." 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."

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? a. The client has revitalized the relationship with the client's sister. b. The nurse has designated a specific time each day to interact with the client. c. The client expresses a desire to be mothered and pampered. d. The client recognizes feelings of anger and expresses them appropriately.

d. The client recognizes feelings of anger and expresses them appropriately.

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

d. develop a sense of trust in the nurse

During which phase of the nurse-client relationship does the client identify and explore specific problems? a. working b. debriefing c. orientation d. resolution

a. working

A care area is having difficulty implementing the transitional care model. Which observation should the nurse manager address to help facilitate this process? Select all that apply. a. nurses feeling overwhelmed b. over-reliance on the process c. recognizing on-site champions d. focusing on preexisting conflicts e. implementing educational modules

a. nurses feeling overwhelmed b. over-reliance on the process d. focusing on preexisting conflicts

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 prevent disruption of the time that is to be used for therapeutic communication c. To avoid giving the client the impression that the nurse is not interested in providing effective care d. To avoid making the client feel that the client's problems are not viewed as being serious

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

During which phase of the nurse-client relationship does the client identify and explore specific problems? a. Working b. Debriefing c. Orientation d. Resolution

a. Working

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self? a. "Asking for help from those who care about us isn't a sign of weakness." b. "Being self-sufficient is a sign of mental health stability." c. "Your family would want to help if you had a problem." d. "How do you plan to manage your problems without help?"

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

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 feel worthless and have no real use in life." b. "I really don't want to talk about that right now." c. "What difference does it make what I say to you?" d. "I know you are busy. I don't have much to say now."

a. "I feel worthless and have no real use in life."

In what phase of the therapeutic relationship does the assessment process begin? a. During the initiating or orienting phase b. After the initiating or orienting phase has been completed c. During the working phase d. After the working phase has been completed

a. During the initiating or orienting phase

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure? a. Self-disclosure can help normalize the client's experience. b. Self-disclosure allows the client to see the nurse as a real human being. c. Self-disclosure can help the client feel like a friend. d. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued.

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

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 nervous and insecure. b. The client is experiencing symptoms of a disorder. c. The client is demonstrating a normal reaction. d. The client is attempting to engage in a social relationship.

a. The client is nervous and insecure.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior? a. The client is testing the parameters of the relationship. b. The client is in denial about the severity of the illness. c. The client mistrusts the nurse's ability to promote recovery. d. The client's illness is being treated by another clinician.

a. The client is testing the parameters of the relationship.

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. a. The nurse should address the client by name. b. The nurse should actively listen to the client. c. The nurse should respond openly to the client. d. The nurse should be available all the time for caring for the client. e. The nurse should give the responsibility of planning therapy to the client.

a. The nurse should address the client by name. b. The nurse should actively listen to the client. c. The nurse should respond openly to the client.

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 lack health care coverage for the treatment. c. They do not understand that most people will not know what a mental health problem is. d. They are concerned about receiving their next paycheck when they return to work.

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.

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. empathy. b. sympathy. c. apathy. d. nontherapeutic communication.

a. empathy.

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

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

Which is not involved in empathy? a. Careful listening b. Being in touch with what clients are saying c. Feeling the same emotions that the client is feeling at a given time d. Having insight into the meaning of clients' thoughts, feelings, and behaviors

b. Being in touch with what clients are saying

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

d. The therapist must notify authorities and the potential victim.

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 angry that the nurse is abandoning the client. b. requires additional therapy. c. is unhappy that the therapy was ineffective. d. is attempting to prolong the nurse-client relationship.

d. is attempting to prolong the nurse-client relationship.

The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating? a. avoid and ignore b. mutual withdrawal c. motivational interviewing d. transitional relationship model

d. transitional relationship model

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 so much. I will share them with the other nurses." 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 but I will not accept these gifts because they extend over our discussed boundaries."

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