MH - Chapter 5

b

The emotional frame of reference by which one sees the world is created by a values b. attitudes c. beliefs d. personal philosphy

duty to warn

The exception to the clients right to confidentiality; when health care providers are legally obligated to warn another person wo his the target of the threats or plan by the client, even if the threats were discussed during therapy sessions otherwise protected by confidentiality

c

ideas that one holds as true are a. values b. attitudes c. beliefs d. personal philosophy

beliefs

ideas that one holds to be true

therapeutic relationship

(See therapeutic nurse-client relationship) professional, planned relationship between the client and the nurse that focuses on client needs, feelings, problems, and ideas; interaction designed to promote client growth, discuss issues, and resolve problems; includes the three phases of orientation; working (identification and exploitation) and termination (resolution): also called therapeutic nurse-patient relationship

d (during the orientation phase, the client seeks assistance, identifies needs, and commits to a therapeutic relationship; the client beings to test the relationship later in this phase. The client discusses underlying needs and tests new ways to solve problems in the working phase. The nurse is responsible for establishing boundaries during the orientation phase.)

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity? a. seeking assistance b. testing new ways to solve problems c. establishing boundaries d. discussing underlying needs

b, c, d (During the orientation phase, the nurse explains the purpose of the relationship, discusses the clients expectations, and listens to the clients history and perception for the problems. The nurse begins to understand the client and identify themes. Exploration of the the problems occurs during the working phase. Strengthening of relationships occurs during the resolution phase.)

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur ding this phase? Select all that apply a. strengthening of relationships b. discussion of clients expectation c. explanation of the purpose of the relationship d. reviewing client history d. exploration of problems

intimate relationship

A relationship involving two people who are emotionally committed to each other; both parties are concerned about having their individual needs met an helping each other to need needs as well; the relationship may include sexual or emotional intimacy as well as sharing of mutual goals.

values

Abstract standards that give a person a sense of right and wrong and establish a cod of conduct for living

acceptance

Avoiding judgements of the person, no matter what the behavior =

a, c, d

Confidentiality means respecting the clients right to keep his or her information private. When can the nurse share information about the client? (SELECT ALL THAT APPLY) a. The client threatens to harm a family member b. sharing the information is in the clients best interest c. the client gives written permission d. the clients legal guardian asks for information e. the client is discharged to the patients care f. the client admits to domestic abuse

attitudes

General feelings or a frame of reference around which a person organizes knowledge about the world

working phase

In the therapeutic relationship, the phase where issues are addressed, problems identified, and solutions explored; both nurse and client work to accomplish goals; contains Peplau's phases of problems identification and exploitation.

a (during the orientation phase, the nurses responsibility is to define the boundaries of the relationship. The orientation phase of the nurse-client relationship involves the establishment of a therapeutic environment by the nurse. The working phase of the nurse-client relationship includes exploration of feelings and participation in identifying problems. The termination phase is the final stage in the nurse-client relationship. Problem identification occurs in the working phase.)

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship? a. orientation b. termination c. problem identification d. working

therapeutic use of self

Nurses use themselves as a therapeutic tool to establish the therapeutic relationship with clients and to help clients grow, change and heal

congruence

Occurs when words and actions match

problem identification

Part of the working phase of the nurse-client situation, when the client identifies the issue of concerns causing problems

exploitation

Phase of nurse-client relationship, identified by Peplau, when the nurse guides the client to examine feelings and responses and to develop better coping skills and more positive self image; this encourages behavior change and develops independence; part of the working phase

social relationship

Primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task

confidentiality

Respecting the clients right to keep private any information about his or her mental and physical health and related care.

self-discolosure

Revealing personal information such as biographical information and person experiences, ideas, thoughts, and feelings about oneself.

empathy

The ability to perceive the meanings and feelings of another person and to communicate that understanding to that person

oreientation phase

The beginning of the nurse-client relationship; begins when the nurse and client meet and ends when the client begins to identify problems to examine

termination or resolution phase

The final stage in the nurse/client relationship; it begins when the clients problems are resolved and concludes when the relationship ends.

patterns of knowing

The four patterns of knowing in nursing are empirical knowing (Derived from the science of nursing), personal knowing (derived from life experiences), ethical knowing (derived from moral knowledge of nursing), and aesthetic knowing (derived from the art of nursing); these patterns provide the nurse with a clear method of observing and understanding every client interaction

d (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

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. using situations that have occurred on the unit c. being too general with the details of the story d. shifting emphasis to the nurse

c (a nurse-client relationship is classified as a therapeutic relationship. It is not classified as a social, intimate, or friendly relationship.)

The nurse-client relationship is classified as which type of relationship? a. intimate b. social c. therapeutic d. friendly

advocacy

The process of acting on the clients behalf when he or she cannot do so

preconceptions

The way one person expects another to behave or speak; often a roadblock to the formation of an authentic relationship

genuine interest

Truly paying attention to the client, caring about what he or she is saying; only possible when the nurse is comfortable with himself or herself and ware of his or her strengths and limitations.

a (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 relating 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 stope is to compare lists and assign qualities to the appropriate quadrant.)

What activity should be included in the first step of self-awareness? a. identifying one's own values, attitudes, strengths and weakness b. asking others to share their perceptions of you c. determining whether you actually possess qualities that you are unaware of d. categorizing your qualities as being either public or hidden

b (attitudes are feelings or a frame of reference around which a person organizes knowledge about the world. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living. Beliefs are ideas that one holds to be true. Self-awareness is the process of developing an understanding of one's own values, beliefs, thoughts, feelings, attitudes, motivations, etc.)

Which term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world? a. self awareness b. attitudes c. beliefs d. values

positive regard

unconditional, nonjudgmental attitude that implies respect for the person.

unknowing

when the nurse admits she does not know the client or the clients subjective world; this opens the way for a truly authentic encounter; the nurse in a state of unknowing is open to seeing and hearing the clients views without imposing any of his or her values or viewpoints

compassion fatigue

A type of secondary trauma or stress resulting from helping others work through traumatic stress; experienced by those in the helping professions

b (self awareness is curucial in a nurse-client relationship. Without it, nurses will find it impossible to establish and maintain therapeutic relationships with a clients. Although rapport and empathy are important considerations for a nurse-client relationship, self-awareness is key. Values are inherent in nurses, and a nurse must be self-aware of his or her own values.)

A nursing instructor is describing the nurse-client relationship to a group of nursing students. Which would the instructor emphasize as most important to establishing and maintaining the relationship? a. values b. self awareness c. rapport d. empathy

b (reciprocating a clients hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the clients behavior or interaction.)

A nurse has approached a new client on the psychiatric care unti 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 nurses following responses would constitute countertransference? a. It sounds like you're exasperated with the caregivers youve interacted with. Is that fair to say? b. Theres no need to get rude with me. Im just trying to do my job and to help you out. c. actually, Ive not come here to tell you that d. Is that a message you've been hearing a lot over the past couple of days?

b, c, d (During the working phase, the client discusses problems underlying the needs, uses the emotional safety of the relationship to examine personal issues, and tests new ways of solving problems. Identifying a need and testing the relationship typically occur during the orientation phase of the relationship.)

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 in which actions? Select all that apply a. beginning to identify a need b. examining personal issues c. testing new ways for problem solving d. discussing problems related to needs e. testing the relationship

d (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? a. showing up late for the first session b. being confrontational with the nurse and other group members c. bragging about sexual conquests d. rambling due to nervousness

a

Abstract standards that provide a person with his or her code of conduct are a. values b. attitudes c. beliefs d. personal philosophy

a

Building trust is important in a. the orientation phase of the relationship b. the problem identification subphase of the relationship c. all phases of the relationship d. the exploitation subphase of the relationship

c

The client tells the nurse, "My biggest problem right now is trying to deal with a divorce. I didn't want a divorce and I still don't. But it is happening anyway." Which of the following responses by the nurse will convey empathy? a. Can you tell me about it? b. Im so sorry. No wonder you're upset c. Sounds like it has been a difficult time d. You must be devastated

c (the correct response by the nurse demonstrates the ability to use the self as a therapeutic too in order to help the client grow, change, and heal. Telling the client that being self sufficient is a sign of mental health stability is an automatic response and would cut off further exploring of the clients perceptions. Telling the client the family would want to help when there is a problem is making an assumption without first discussing the clients perceptions. Asking the client how the client plans to manage problems without help communicates sympathy and the need for dependency.)

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. being self sufficient is a sign of mental health stability b. how do you plan to manage your problems without health c. asking for help from those who care about us isnt a sign of weakness d. your family would want to help if you had a problem

d (in the working phase of the relationship, the client is involved actively in acheiving goals set during the intial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one's illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently. Communicating interest in the client is the role of the nurse, and this takes place in the orientation phase of the relationship. The client tests the relationship during the orientation phase. Reviewing the work that has been done takes place during the resolution phase of the relationship.)

Which action by the nurse or client represents the working phase of the therapeutic relationship? a. communicating interest in the client b. testing the relationship c. reviewing work that has been done d. identifying past ineffective behaviors

c, e, f

Which are specific tasks of the working phase of a therapeutic relationship? (SELECT ALL THAT APPLY) a. begin planning for termination b. build trust c. encourage expression of feelings d. Establish a nurse-client contract e. Facilitate behavior change f. Promote self-esteem

c (a preconception does not enable the nurse to get an accurate picture of the clients problems. It is a way that 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.)

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 enables the nurse to get an accurate picture of the clients problems d. it prevents people from getting to know one another.

d (a reduction in anxiety must be achieved by the client, not by the nurse, and indicates a positive outcome of the termination stage.)

Which is not a gal of the working phase of the therapeutic relationship? a. Developing a plan of action, practicing it, and evaluating its effectiveness b. increasing hopefulness for the future c. identifying past behaviors that have ben ineffective for coping with the focal problem d. reducing the clients anxieties

c (Assessing is not a step in the values clarification process. Choosing is when the person considers a range of possibilities and freely chooses the values that feel right. Prizing is when the person considered the value, cherishes it, and publicly attaches it to himself or herself. Acting is when the person puts the values into action)

Which is not considered a step in the values clarification process? a. choosing b. acting c. assessing d. prizing

a (congruence occurs when words and actions match. The nurse demonstrates this by fulfilling the promise made to the client. While the remaining options are appropriate behaviors that positively affect the nurse-client relationship, they do not demonstrate congruence.)

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? a. getting an appointment with the client at the time they previously agreed upon b. sharing examples of stress management techniques c. discussing the clients request for additional privileges with the treatment team d. implementing restatement as a therapeutic communication method.

d (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.)

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. teacher b. caregiver c. parent surrogate d. advocate

c (the nurse who does not become upset or responds negatively to a clients outburst, anger, or acting out conveys acceptance to the client. Avoiding judgements of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. When responding to such a situation, the reaction should be respectful and controlled by the nurse)

Which statement by the nurse demonstrates acceptance to a client who has made a sexually inappropriate comment? a. how would you feel if someone said that to you b. that type of talk is inappropriate and wont be tolerated c. our relationship is one of a professional nature d. why do you think making that comment is appropriate

d (The statement about the client who is trying to make the individual changes necessary is void of personal opinion and value judgements. It is a neutral statement of client data.)

Which statement would indicate that the nurse has a non-judgmental attitude? a. people who are mentally ill have basically weak characters b. mental illnesses are for the most part all in your head and could be solved more easily if people were forced to continue with their daily activities, instead of listening to their complaints c. i think the client is exaggerating her feelings so she can leave work early d. the client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself.