Mental Health: CHAPTER 5-Therapeutic Relationships
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? "Is there some reason why you don't want your family to know your problems?" "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." "Any information is only shared with other professionals involved in your care." "It depends upon what they ask me. I might be able to withhold some information, but not all."
"Any information is only shared with other professionals involved in your care." Explanation: 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.
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." "I will speak with the health care provider about the possible use of physical restraints for you tonight." "Who has influenced you with these ideas?" "Don't worry; I will keep this secret to myself."
"I cannot keep this a secret. I will ensure that the staff helps keep you safe." Explanation: 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? "I know you are busy. I don't have much to say now." "What difference does it make what I say to you?" "I really don't want to talk about that right now." "I feel worthless and have no real use in life."
"I feel worthless and have no real use in life." Explanation: 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? "Don't you think you're ready to be independent?" "It can be scary to leave a place that you trust and feel supported." "Just think of all of the things you can do in the home that you can't do here." "You are more than ready to get out of here. Have faith in your accomplishments."
"It can be scary to leave a place that you trust and feel supported." Explanation: 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 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. "Don't worry. Your child will be all right." "I don't know how you've managed to cope, this is awful." "That is unbelievable. How could you tolerate this behavior?" "It sounds like this is very difficult for you, I can see why it causes you stress."
"It sounds like this is very difficult for you, I can see why it causes you stress." Explanation: 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
During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference? "I am only doing my job." "I am only trying to help you." "Tell me why you are angry about what I just said." "If you don't want to continue with me, I'll find someone else."
"Tell me why you are angry about what I just said." Explanation: Countertransference is an emotional reaction to the client based upon personal unconscious needs and conflicts. The nurse should recognize that countertransference can occur and prevent it from eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement caused hostility. Defending the statement such as saying, "I am only doing my job," "I am only trying to help you," and "I'll find someone else," demonstrates countertransference
During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference? "I am only trying to help you." "Tell me why you are angry about what I just said." "I am only doing my job." "If you don't want to continue with me, I'll find someone else."
"Tell me why you are angry about what I just said." Explanation: Countertransference is an emotional reaction to the client based upon personal unconscious needs and conflicts. The nurse should recognize that countertransference can occur and prevent it from eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement caused hostility. Defending the statement such as saying, "I am only doing my job," "I am only trying to help you," and "I'll find someone else," demonstrates countertransference.
A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse? "You were killing yourself for this?" "It is wrong to commit suicide." "You must have been really upset." "What would you gain by killing yourself?"
"You must have been really upset." Explanation: By stating "you must have been really upset," the nurse avoids communicating value judgments about the client's behavior. Indicating that the client attempted to kill oneself for a trivial goal, asking what the client would gain by killing oneself, or telling the client that the behavior was wrong indicate that the nurse is judgmental and void of genuine interest.
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? Ask another nurse to attend the meetings to ensure boundaries are not crossed. Plan to meet the client since the personal relationship ended. Meet for the first session but explain that another nurse will be assigned going forward. Ask to be reassigned because of having a prior personal relationship with the client.
Ask to be reassigned because of having a prior personal relationship with the client. Explanation: 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.
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? Decompensation Bipolar disorder Compassion fatigue Failure to thrive
Compassion fatigue Explanation: 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.
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? Decompensation Failure to thrive Compassion fatigue Bipolar disorder
Compassion fatigue Explanation: 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 occurs when the nurse responds to the client based on personal unconscious needs and conflicts? Self-disclosure Exploration Countertransference Transference
Countertransference Explanation: Countertransference occurs when the nurse responds to the client based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such as biographical data and personal ideas. Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others.
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? Transference Reaction formation Countertransference Free association
Countertransference Explanation: 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.
When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what? Are personal and intimate Create constructive dependencies Encourage personal goal setting Involve doing favors for others
Encourage personal goal setting Explanation: Therapeutic interactions are designed specifically to encourage the client to engage in personal goal setting. Personal and intimate activities, favors for others, and constructive dependencies are all inappropriate activities for the nurse-client relationship.
A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what? Feeling the same emotions that the client is feeling at a given time Careful listening Being in touch with what the client is saying Having insight into the meaning of clients' thoughts, feelings, and behaviors
Feeling the same emotions that the client is feeling at a given time Explanation: 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 in those feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it.
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? Resolution Orientation Withholding Working
Orientation Explanation: 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 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? Exploitation phase Orientation phase Termination phase Identification phase
Orientation phase Explanation: 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? Bragging about sexual conquests Being confrontational with nurse and other group members Showing up late for the first session Rambling due to nervousness
Rambling due to nervousness Explanation: 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.
A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session? Rambling due to nervousness Being confrontational with nurse and other group members Bragging about sexual conquests Showing up late for the first session
Rambling due to nervousness Explanation: 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.
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 asks to be transferred to another unit to avoid burnout and to work with different disorders The nurse frequently refers to an elderly, cognitively impaired client as "my granny" 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 The nurse begins to experience the symptoms of depression and calls out sick
The nurse frequently refers to an elderly, cognitively impaired client as "my granny" Explanation: Countertransference occurs when a mental health care professional redirects his or her feelings toward a client or becomes emotionally entangled with a client, as is occurring with the nurse's "granny." Being asked to the prom by a client is not an example of countertransference but rather reflects a client's misdirected emotion, referred to as transference. Countertransference does not involve the development of a mental illness or the resulting absenteeism. And countertransference does not involve burnout or the desire to expand one's professional expertise.
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 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 The nurse begins to experience the symptoms of depression and calls out sick The nurse asks to be transferred to another unit to avoid burnout and to work with different disorders The nurse frequently refers to an elderly, cognitively impaired client as "my granny"
The nurse frequently refers to an elderly, cognitively impaired client as "my granny" Explanation: Countertransference occurs when a mental health care professional redirects his or her feelings toward a client or becomes emotionally entangled with a client, as is occurring with the nurse's "granny." Being asked to the prom by a client is not an example of countertransference but rather reflects a client's misdirected emotion, referred to as transference. Countertransference does not involve the development of a mental illness or the resulting absenteeism. And countertransference does not involve burnout or the desire to expand one's professional expertise.
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 keep the comment confidential, because the disclosure is protected by therapist-client confidentiality. The therapist must notify authorities and the potential victim. The therapist must meet with an ethics committee to determine the course of action. The therapist must evaluate the threat and notify authorities if it meets credibility criteria.
The therapist must notify authorities and the potential victim. Explanation: 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.
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? Caring Trust Positive regard Genuine interest
Trust Explanation: 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.
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? Countertransference Genuineness Partnership Unconditional positive regard
Unconditional positive regard Explanation: The nurse needs to treat each person with respect and dignity, regardless of personal value conflicts.
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? Orientation Working Mutual withdrawal Resolution
Working Explanation: 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.
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? Resolution Mutual withdrawal Working Orientation
Working Explanation: 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.
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: apathy. sympathy. nontherapeutic communication. empathy.
empathy. Explanation: 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.
The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply. explain what confidential information will be shared with others listen intently to the client explain problems and issues compliment the client regarding clothing selection establish professional boundaries suggest that another nurse meet with the client because of arriving late
establish professional boundaries listen intently to the client explain problems and issues explain what confidential information will be shared with others Explanation: When meeting a client for the first time, professional boundaries need to be established in order for the relationship to remain therapeutic. Listening intently demonstrates care and concern. Explaining the need to share information with others helps to establish trust. Reacting to disapproval suggests non-acceptance and will negate efforts to establish rapport. Arriving late is a behavior used to test parameters. The nurse should not react as this behavior works to develop trust.
What activity should be included in the first step of self-awareness? determining whether you actually possess qualities that you are unaware of categorizing your qualities as being either public or hidden identifying one's own values, attitudes, strengths and weakness asking others to share their perceptions of you
identifying one's own values, attitudes, strengths and weakness Explanation: One tool that is useful in learning more about oneself is the Johari window. In creating a Johari window, the first step is for the nurse to appraise his or her own qualities by creating a list of them: values, attitudes, feelings, strengths, behaviors, accomplishments, needs, desires, and thoughts. The second step is to find out others' perceptions by interviewing them and asking them to identify qualities, both positive and negative, they see in the nurse. To learn from this exercise, the opinions given must be honest; there must be no sanctions taken against those who list negative qualities. The third step is to compare lists and assign qualities to the appropriate quadrant.
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? recent hospitalizations family history perception of the problem known allergies
perception of the problem Explanation: Although information about allergies, hospitalizations, and family history are important in the orientation phase, it is most important for the nurse to ask a client with a mental disorder about the nature of the problem from the client's perspective. Some clients deny that a problem exists; other clients may have misperceptions about the problem.
A care area is implementing motivational interviewing. What skills will be implemented by the nurse for this technique to be successful? Select all that apply. self-awareness use of a variety of defense mechanisms active listening empathetic linkages strong communication
self-awareness active listening empathetic linkages strong communication Explanation: Because the success of motivational interviewing is dependent on contingent factors, nurses will need frequent instruction and feedback on its use. Strong communication, self-awareness, empathetic linkages, and active listening are all essential skills for motivational interviewing. Unhelpful defense mechanisms should be avoided
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? being too general with the details of the story providing advice on how to manage a problem using situations that have occurred on the unit shifting the emphasis to the nurse
shifting the emphasis to the nurse Explanation: 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.
The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply. expresses anger towards the nurse and other clients identifies a resolved problem as a new one needing to be addressed asks to keep in touch with the nurse after the relationship ends skips the last session lists actions to move forward at the conclusion of the meeting
skips the last session expresses anger towards the nurse and other clients identifies a resolved problem as a new one needing to be addressed Explanation: Ending the therapeutic relationship can produce anxiety in the client. The client may skip the last session to avoid ending the relationship. Expressing anger towards the nurse and other clients indicates that the client does not want the relationship to end. Identifying a resolved problem as a new problem is an action to keep the relationship going. Listing actions to move forward is a desired outcome at the conclusion of a therapeutic relationship. Asking to keep in touch with the nurse after the relationship ends is testing the boundaries but does not necessarily indicate that the client does not want the relationship to end.
During which phase of the nurse-client relationship does the client identify and explore specific problems? orientation resolution working debriefing
working Explanation: 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.
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? "Don't you think you're ready to be independent?" "It can be scary to leave a place that you trust and feel supported." "You are more than ready to get out of here. Have faith in your accomplishments." "Just think of all of the things you can do in the home that you can't do here."
"It can be scary to leave a place that you trust and feel supported." Explanation: 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.
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? "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" "They look delicious and I love candy but I'm on a diet and really can't accept them." "Thank you but I will not accept these gifts because they extend over our discussed boundaries." "Thank you so much. I will share them with the other nurses.
"Thank you but I will not accept these gifts because they extend over our discussed boundaries." Explanation: 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.
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? "I really feel sorry for your child." "What was going on for you when this happened?" "Punishing your child would only make your child worse." "How could you do this to your child?"
"What was going on for you when this happened?" Explanation: The state of unknowing is referred to as the nurse's behavior where the nurse is open to seeing and listening to the client's views without imposing any of the nurse's values or viewpoints. Asking the client about what was happening for the client at the time the action took place indicates that the nurse is trying to know more about the client's behavior without making any judgment. The statement about feeling sorry for the child or asking how the client could slap the child indicates that the nurse has a notion that the client has taken a wrong action. In addition, the statement that punishing the child would make it worse indicates that the nurse has a notion that the client has taken a wrong action. Thus, these responses do not indicate that the nurse is in the state of unknowing.
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? "I know you are in pain. Please wait until the medication shows its effect." "Your hard work and determination has helped you recover." "Please listen to the instructions carefully before starting the exercises." "Please don't disturb the other clients in the ward."
"Your hard work and determination has helped you recover." Explanation: 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.
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? "Please don't disturb the other clients in the ward." "Please listen to the instructions carefully before starting the exercises." "I know you are in pain. Please wait until the medication shows its effect." "Your hard work and determination has helped you recover."
"Your hard work and determination has helped you recover." Explanation: 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.
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. Review with the client the learned methods to control the problems. Get angry at the client and ask the client to leave the session. Immediately stop the client and inform the client that the nurse is running the session. Reassure the client that they already covered these issues. Do not acknowledge this issue and continue on with the session as planned.
Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. Explanation: 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 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? Self-disclosure can help the client feel like a friend. Self-disclosure can help normalize the client's experience. Self-disclosure should be detailed so the client doesn't feel unimportant or devalued. Self-disclosure allows the client to see the nurse as a real human being.
Self-disclosure can help normalize the client's experience. Explanation: 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.
The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason? To avoid making the client feel that the client's problems are not viewed as being serious To prevent disruption of the time that is to be used for therapeutic communication To prevent the client from viewing the nurse as a friend rather than health care provider To avoid giving the client the impression that the nurse is not interested in providing effective care
To prevent the client from viewing the nurse as a friend rather than health care provider Explanation: 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 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? Resolution Orientation Mutual withdrawal Working SUBMIT ANSWER
Working Explanation: 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.
