NURS 3108 - Ch 9 Nurse Patient Relationship EAQs

A client diagnosed with paranoid schizophrenia tells the nurse, "I'm here on a top secret mission for the President. Don't tell anyone I am here." Which response should the nurse provide to address the client's primary concern? "Let's talk about something other than your mission for the President." "Your admission papers do not list you as an employee of the President." "You have lost touch with reality, which is a symptom of your illness." "It sounds like you have some concerns about your privacy. You are safe here."

"It sounds like you have some concerns about your privacy. You are safe here." The correct response focuses on the client's perception and feelings that it is important no one knows where he or she is. Reassuring the client of his or her privacy also offers a safe environment. Changing the subject takes the focus of the interview off the client's feelings and minimizes his or her experiences. It is important not to challenge the client's beliefs by noting the admission papers or saying the client has lost touch with reality, even if the beliefs are unrealistic. Challenging undermines the client's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts that the client's message conveys rather than focusing on the accuracy of the unrealistic statement itself.

A client diagnosed with schizophrenia exhibits paranoid thinking. The client says to the nurse, "The government is trying to find me. They want to get money from me." Which response by the nurse addresses the client's primary concern? "Your money belongs to you. The government cannot take it from you." "Because you are worried about the government, let's talk about something else." "It sounds like you're saying you want information about you to be kept confidential." "Your illness causes you to have these beliefs. The government is not looking for you."

"It sounds like you're saying you want information about you to be kept confidential." The nurse should focus on the feelings associated with the paranoia without engaging in a discussion about the actual content of the client's message. In this instance, the client is worried and fearful. The nurse keeps the focus on the client's feelings by reassuring him or her of the confidentiality of the therapeutic relationship. Telling the client his or her belief is wrong is not helpful for someone who has had a break with reality. Changing the subject will not address the client's fears. Explaining that the client's beliefs are unrealistic is not helpful for a client who has had a break from reality.

A military wife tearfully tells a nurse about her husband's deployment to an active war zone. This client cries daily and says to the nurse, "I am so worried that he will never come home." What response by the nurse addresses the need to identify the client's perception of the problem? "Your husband is safe. You should be proud of him rather than absorbed in worry." "Let's talk about whether crying and the feelings you describe are normal in this situation." "You will eventually get back to normal. Start doing the things that used to be fun for you." "When you find yourself starting to cry or feel sad, distract yourself by getting busy with an activity."

"Let's talk about whether crying and the feelings you describe are normal in this situation." Asking the client to elaborate on her feelings focuses on the client's perception. This aids the client in considering other persons and events from the perspective of the client's own set of values. Telling the client her husband is safe is a false reassurance the nurse cannot know to be true. Telling the client to distract herself does not address her feelings.

A mental health nurse tells a friend, "I have one client who can be difficult. The other nurses are just so hard on her because they don't know her like I do. It can be difficult to always be nice to my clients but I always try. But I know that some of the nurses don't always agree with my nursing style. I guess that the staff just wishes they could be as attuned to their clients as I am to mine. It's a good feeling to know that my clients love me for what I do for them." Which statement by the nurse indicates a possible problem with self-boundaries and countertransference? Select all that apply. "I've never been told that I am an ineffective or uncaring nurse." "It can be difficult to always be nice to my clients but I always try." "The other nurses are just so hard on her because they don't know her like I do." "I guess that the staff just wishes they could be as attuned to their clients as I am to mine." "It's a good feeling to know that my clients really love me for what I do for them."

"The other nurses are just so hard on her because they don't know her like I do." "I guess that the staff just wishes they could be as attuned to their clients as I am to mine." "It's a good feeling to know that my clients really love me for what I do for them." There may be a problem with boundaries or countertransference when the nurse feels that others are too critical of their clients, that he or she is the only one capable of understanding a client, and when he or she feels satisfaction from not only the appreciation but also the love of the client. Stating "I've never been told that I am an ineffective or uncaring nurse" or "It can be difficult to always be nice to my clients but I always try" may identify attempts at deflecting a sense of guilt, but they are not examples of countertransference or inappropriate boundaries.

A nurse is interacting with a child during a home visit. The nurse learns that the child is depressed because of poor grades in school. When the nurse responds, the child says the nurse just doesn't understand. Which nontherapeutic response might the nurse have used to cause this reaction? "Why did you score low in your exams?" "What are you worried about?" "You must be feeling very upset." "What would you like to talk about?"

"Why did you score low in your exams?" The response, "Why did you score low on your exams?" is a nontherapeutic response because the nurse is probing a topic that is sensitive for the child. The nurse should strive to decrease the client's anxiety, and a question like this will likely increase it. The child may then feel that the nurse is unable to understand his or her feelings. The response, "What are you worried about?" is a therapeutic response. The child can then help the nurse understand and acknowledge his or her feelings. The response, "You must be feeling very upset" is a therapeutic response. The nurse has restated the child's feelings to seek clarification. The response, "What would you like to talk about?" is a therapeutic response. It is an example of broad opening in which the nurse encourages the child to share his or her feelings.

Which nursing intervention is effective in building a therapeutic nurse-client relationship? Actively listening as the client expresses his or her thoughts and feelings. Intervening when the client begins to state beliefs related to his or her illness. Evaluating a client's behaviors and interpersonal relationships frequently to identify stressors. Passively allowing the client to control the communication and tone of the discussions.

Actively listening as the client expresses his or her thoughts and feelings.' An effective nurse-client relationship is built upon communication that encourages and respects varying points of view in a nonjudgmental atmosphere. Challenging beliefs and values is not appropriate until the relationship is well established. Evaluating a client's behaviors and interpersonal relationships frequently to identify stressors is not an initial goal when attempts are being made to establish a therapeutic nurse-client relationship. Although the nurse encourages the client to communicate in an honest, unrestricted manner, an entirely passive approach on the nurse's part would not be therapeutic; the nurse must know when to guide the conversation.

A nurse participating in a community health fair interviews an adult who has had no interaction with a health care professional for over 10 years. The client says, "I like to keep to myself. Crowds make me nervous." Which action should the nurse employ? Refer the client for a full health assessment. Explore the client's family and social relationships. Ask the client, "How do you feel about the quality of your life?" Explain to the client, "We can help you feel better about yourself."

Ask the client, "How do you feel about the quality of your life?" Asking the client how he or she feels about the quality of his or her life is an appropriate response because it is open-ended and focuses on the client's ideas and feelings. Referring the client for a full health assessment or exploring his or her family and social relationships may not meet the client's needs, which are unknown, because a nurse-client relationship has not been established. Making a promise about how the client will feel that the nurse does not know can be achieved is not an appropriate response in this interaction.

The nurse is caring for a geriatric client receiving dialysis three times a week. The client frequently discusses family disputes with the nurse and often becomes verbally aggressive. Which countertransference reaction is the nurse most likely to experience toward this client? Rescue Boredom Helplessness Overinvolvement

Boredom Due to the client's behavior, the nurse is at risk to experience a variety of countertransference reactions. If the client gives repeated uninteresting information and uses an offensive style of communication, the nurse may develop boredom and become uninterested in talking to and interacting with the client. The nurse may develop a rescue reaction (a countertransference reaction) when the client shares his or her secrets with the nurse. The nurse may develop feelings of helplessness when the treatment goals are not achieved and if the client does not participate in the treatment effectively. Overinvolvement is experienced by the nurse if the client's behavior reminds him or her of someone who is close to the nurse or of past clients.

The student nurses are arranging seats to conduct clinical interviews with clients who have human immunodeficiency virus (HIV). Which is the most appropriate seating arrangement for the interview? Chairs must be placed at different levels. Chairs must be arranged at 90 to 120 degrees. The client's chair must be placed between the nurse and the doctor. The client's chair must be kept in one corner of the room.

Chairs must be arranged at 90 to 120 degrees. In all clinical interview settings, the seating arrangement is done in such a way that proper eye contact can be maintained and avoided when required. Placing the chairs at 90- to 120-degree angles is less threatening and allows the client and interviewer to look away without discomfort. Chairs should be placed at the same level to avoid a threatening position. If the client is placed between the nurse and the doctor or in the corner of the room, the client may feel trapped.

Who determines the content and direction of the clinical interview? Nurse Client Health care provider Health care team

Client The client should always be able to take the lead and determines the content and direction of the clinical interview, although the nurse may gently guide it by discouraging social conversation or intrusive personal questioning. The therapeutic relationship is consistently focused on the client's problem and needs. The nurse, health care provider, and health care team may take part in assisting the client's progress, but the client ultimately determines the focus of the interview.

Which action by the nurse may acceptable in a social relationship but not in a therapeutic relationship? Giving advice Listening actively Clarifying feelings Giving positive regard

Giving advice Giving and receiving advice is acceptable in a social relationship, but it is not in a therapeutic relationship. In a therapeutic relationship, it is appropriate for the nurse to assist the client in exploring alternative solutions to problems and in making his or her own decisions. Actively listening is imperative for a therapeutic relationship so this is incorrect. Clarifying feelings is appropriate, as is giving positive regard.

Which nonverbal communication techniques will the nurse use for effective nurse-client communication? Select all that apply. Look at the client while he or she speaks. Maintain constant eye contact while speaking to the client. Maintain a distance of 0 to 18 in while communicating with the client. Maintain a high-pitched tone while communicating with the client. Maintain a low-pitched tone while communicating with the client.

Look at the client while he or she speaks. Maintain a low-pitched tone while communicating with the client. It is appropriate to look at the client while the client is speaking. Voice qualities often affect communication and reflect the person's feelings. A nurse should always talk in a low-pitched voice. When the nurse speaks in soft and gentle tones, the client is more likely to feel encouraged to share his or her feelings. Maintaining constant eye contact while speaking to the client may cause discomfort or hinder the communication due to cultural and individual variation; looking at the client is appropriate, but never breaking eye contact can be disconcerting. A distance of 0 to 18 in is usually maintained with people who are close, because this distance often reflects intimacy. High-pitched tones tend to convey anxiety and may make the client uncomfortable.

A client with a leg fracture shares personal feelings about the accident with a nurse and says, "I feel guilty because the accident was my fault. I will be unable to support my family." What is the most therapeutic action by the nurse? Console the client. Describe a similar incident. Give a sedative to relax the client. Sit beside the client and listen attentively.

Sit beside the client and listen attentively. Attending to a client and listening to him or her carefully is a good therapeutic action. It is a way for the client to share his or her feelings. Consoling the client is a sympathetic response though not the most therapeutic. By describing a similar incident, the nurse is taking the focus off the client. Giving a sedative is not necessary in this situation.

A nursing student assisted the staff nurse while caring for a client diagnosed with a chronic lung disorder. The student nurse has had a therapeutic relationship with the client but has to leave due to the completion of the clinical rotation. What is the student nurse's best action before leaving? Go for coffee with the client Explore the problem-causing area Take the telephone number of the client Summarize the goals and objectives achieved

Summarize the goals and objectives achieved Summarizing the goals and objectives achieved is the major task of the termination, because it helps to know the therapeutic benefit received by the client. Going for coffee is unprofessional. Exploring the problem-causing area is a task to be done in the working phase and the next nurse assigned to the client can continue this. Taking the client's phone number implies future interaction, which would be unprofessional.

A client says to the nurse, "I lost custody of my children, and I lost my father at a very young age. I couldn't get proper attention from my mother, which made me feel depressed. I use alcohol and drugs to make me feel happy." The nurse replies, "So alcohol and drugs are part of your life but you are still not happy?" Which therapeutic communication technique did the nurse use? Listening Attending Suspending value judgment Helping client develop resources

Suspending value judgment Suspending value judgment helps the nurse avoid developing strong opinions about the client, and it facilitates further exploration of the client's condition. It also helps the client toward leading a healthy and satisfying life. Listening is a form of attending, not an attitude. Attending is an act of listening that implies being with the client, but this is not an attitude. In helping the client develop resources, the nurse encourages and helps the client understand the resources and makes him or her independent. However, this also does not represent an attitude.

A client readily cooperates with the nurse. The client says, "You remind me of my grandchild." What phenomenon is suggested by the client's comment? The client is experiencing countertransference. The client is experiencing positive transference. The client is experiencing negative transference. The client is experiencing positive countertransference.

The client is experiencing positive transference. Transference is a phenomenon that occurs subconsciously in clients as they associate the nurse with their relatives. When a client effectively interacts and follows the instruction of the nurse due to transference, it is called positive transference. Countertransference is a phenomenon in which the nurse associates the client with previous experience. Countertransference occurs when the nurse displaces the feelings onto the client and identifies with the nurse's past experience. In negative transference, clients avoid interaction with the nurse and get aggressive. This may happen when the clients associate the nurse with a tragic event or person. Countertransference is not categorized as positive or negative.

Of what must the nurse first be aware in order to help a client develop his or her resources? Resistance Countertransference The client's strengths Negative transference

The client's strengths Nurses work to bolster a client's strengths, to identify areas of dysfunction, and to assist in the development of new coping strategies. While being aware of a client's resistance, countertransference, and negative transference is important, the first step is identifying the client's strengths.

A client diagnosed with epilepsy often becomes aggressive and refuses to take prescribed medicines. Which are the nurse's best approaches with this client? Select all that apply. The nurse does not listen or talk to the client. The nurse demonstrates genuineness and concern. The nurse speaks softly in a nonprovocative manner. The nurse turns back with anger and leaves the room. The nurse avoids the client and cares for other clients.

The nurse demonstrates genuineness and concern. The nurse speaks softly in a nonprovocative manner. Good interpersonal contact reduces aggression; therefore, the nurse should demonstrate genuineness and concern. Talking in a calm and low tone of voice reduces anxiety levels and calms down aggressive behavior. The client may get more irritated if he or she is not given proper attention. Turning back with anger or avoiding the client is unprofessional nursing behavior and can cause client withdrawal.

A client has been oppositional, demanding, and resistant to working on goals. A mental health nurse tells the nursing supervisor, "We finally had a serious talk. I let the client know it's time to 'get right' with God and stop this behavior." Recognizing that the nurse's actions were not acceptable, which is the supervisor's most appropriate response? Review the facility policies regarding clients' rights with the nurse. Ask the nurse about documentation related to this client interaction. Schedule the nurse for a staff development activity on cultural sensitivity. Work with the nurse to prepare and analyze a process recording of the interaction.

Work with the nurse to prepare and analyze a process recording of the interaction. Preparing and analyzing a process recording is a helpful way of addressing the nurse's nontherapeutic comments and will help build the nurse's self-awareness regarding reactions to working with this challenging client. Reviewing the policies regarding clients' rights does not address the nurse's need to understand that the nurse's values and beliefs are not necessarily right for everyone else. Asking for documentation will not actively address the nurse's nontherapeutic comments toward the client. After this the supervisor prepares and analyzes a process recording, having the nurse attend a staff development activity on cultural sensitivity may further address the nurse's unacceptable actions and increase the nurse's self-awareness.

A client whose spouse was in the military and died in a helicopter crash six months earlier cries on a daily basis. The client shares, "I think I'm losing it. I'll never be the same." How should the nurse respond when considering functional displays of grief? "You will eventually get back to normal. Just start doing the things that used to be fun for you." "When you find yourself starting to cry or feeling sad, distract yourself by getting busy with an activity." "Your spouse died for our country. You should be proud of your spouse rather than absorbed in grief." "Crying and the feelings you describe are normal after such a loss. It may take a long time to grieve your spouse."

"Crying and the feelings you describe are normal after such a loss. It may take a long time to grieve your spouse." Reassuring the client that his or her feelings are normal and that grief takes time conveys concern and empathy. It also gives information about the grieving process. Telling the client to do what used to be fun, to distract him or herself, or that she should feel pride rather than grief are examples of ineffective responses that hinder communication. These responses minimize the client's feelings and demonstrate inappropriate advice and judgment by the nurse.

A client points to another client and says, "Be careful. That woman is a lesbian." Which is the nurse's most therapeutic response. "That woman is not a lesbian." "Why do you think she is a lesbian?" "How do those assumptions relate to you now?" "Please do not concern yourself with the sexuality of others."

"How do those assumptions relate to you now?" Asking the client how his or her assumptions relate to him or her maintains the focus on the patient rather than another person. Stating that the woman is not a lesbian, asking why the client thinks she is, and telling him or her not to think about it are responses that focus on the other person or exhibit value judgments; these are nontherapeutic techniques.

Which comments by the nurse demonstrate the use of open-ended questions? Select all that apply. "How do you cope with anxiety?" "Do you have any suicidal thoughts?" "How many hours per day do you sleep?" "What time of day do you take your medication?" "What events in your life have been most stressful?"

"How do you cope with anxiety?" "What events in your life have been most stressful?" Open-ended questions encourage clients to share information about experiences, perceptions, or responses to a situation. Because open-ended questions are not intrusive and do not put the client on the defensive, they help the clinician elicit information, especially in the beginning of an interview or when a client is guarded or resistant to answering questions. Examples of these include asking how the client copes with anxiety and what life events have caused his or her stress. Closed-ended questions usually elicit a "yes" or "no" response (such as asking if the client has suicidal thoughts) or focus on facts (such as asking the client about hours of sleep or times of day he or she takes medications).

Which statement made by a mental health nurse demonstrates the need for further education regarding therapeutic communication techniques? "When I use therapeutic silence, I'm giving the client time to think and reflect." "Sharing perceptions doesn't mean I tell the client how my experiences are similar to his or hers." "I generally find it helpful to ask the client why he or she blames others for the mistakes he or she has made." "It's not therapeutic to give the client suggestions as to what he or she needs to do to fix his or her problems."

"I generally find it helpful to ask the client why he or she blames others for the mistakes he or she has made." Asking why the client is behaving in a particular manner often is viewed as judgmental by the client. Presenting such an attitude would be a barrier to communication and thus nontherapeutic. Stating, "When I use therapeutic silence, I'm giving the client time to think and reflect" describes an effective use of silence. Sharing perceptions is used to clarify an understanding of what the client is thinking or feeling. Suggestions are therapeutic only when given as possible alternatives for the client to consider, not when given as advice.

Which statement demonstrates that the nurse understands the guidelines for effectively interviewing a client who is grieving the loss of a spouse? Select all that apply. "I sense you are stressed, and so this interview will be as brief as possible." "It is important that you share with me how losing your spouse has made you feel." "I believe it's important that you talk to your children about what they can do to help you." "Your body posturing makes me think that you are especially anxious about something." "I have worked with many grieving people, and I really think I can help you."

"I sense you are stressed, and so this interview will be as brief as possible." "It is important that you share with me how losing your spouse has made you feel." "Your body posturing makes me think that you are especially anxious about something." Classic guidelines for conducting the initial interview include speaking briefly, saying nothing when you do not know what to say, focusing on feelings, paying attention to nonverbal cues, and keeping the focus on the client. The nurse should avoid giving advice such as telling the client to talk to his or her children. Telling the client about the others with whom the nurse has worked takes the focus off this client and minimizes the client's present experience.

A client in a rehabilitation center says, "I am left alone due to my addiction." What would be the most appropriate response by the nurse? "Why did you get addicted?" "Everything will be all right." "I don't agree with you." "I would like to stay here with you."

"I would like to stay here with you." Saying that the nurse would be with the client indicates that the nurse is available for communicating with the client and cares about his or her loneliness. A client may feel criticized when asked the reason for addiction; this can make the client defensive. The response that everything will be all right gives false hope to the client. The client may feel offended and may stop sharing his or her feelings if the nurse says he or she disagrees with the client's feelings.

A psychiatric nurse works with clients diagnosed with severe and persistent mental illness. While assisting a group of clients in planning a Thanksgiving celebration, a client says, "I don't have anything to be thankful about." Which response should the nurse make to address these stated feelings? "I'd like to hear more about those feelings." "Let's think of some other activities for you on the day of the celebration." "Maybe it would be better for you to stay home on the day of the celebration." "The celebration is part of our programming. You are expected to participate."

"I'd like to hear more about those feelings." Telling the client the nurse would like to hear more about the client's feelings demonstrates exploration of these feelings. This aids the client in examining certain ideas, experiences, or relationships more fully but without probing or prying. Thinking of alternate activities and allowing the client to skip the celebration can result in making the client feel more isolated. Telling the client he or she must participate does not respect the client's individuality, and it does not address the client's feelings.

A client is hospitalized after making a suicide attempt when his or her spouse asks for a divorce. Which comment by the nurse is therapeutic for this client? "Don't you think your life is more valuable than an unhappy marriage?" "You should forget about your marriage and move on with your life." "Let's consider ways other than suicide to cope with your feelings." "I understand your depression. When I got divorced, I was overwhelmed too."

"Let's consider ways other than suicide to cope with your feelings." Considering coping mechanisms other than suicide demonstrates one of the working phase tasks of promoting practice of alternative adaptive behaviors. It also keeps the focus on the client's perception and feelings. Questioning the client's values is nontherapeutic. Telling the client to forget the divorce is unrealistic and minimizes the client's feelings. Bringing up the nurse's own divorce takes the focus off the client.

A group of nurses privately discuss clients under their care. Which nurse's comment indicates the need for clinical supervision regarding countertransference? "My client is always asking my permission to do something, just like a child." "When our unit is understaffed, it seems like we have more incidents of disruptive behavior." "My client tries to tell me what to do all the time. I got a divorce because my ex-spouse used to do that." "Our clients have had so many traumatic life experiences. I find myself feeling sympathetic sometimes."

"My client tries to tell me what to do all the time. I got a divorce because my ex-spouse used to do that." Countertransference refers to a tendency to displace onto the client feelings related to people in the nurse's past, which is evidenced in the nurse's comment about divorcing a spouse. Comparing a client to a child, noting increased incidents of disruptive behavior, and expressing feelings of sympathy are not examples of countertransference.

How should the nurse respond to a client who reports thinking of dropping out of college because it is too stressful? "Don't let them beat you! Fight back!" "School is stressful. What do you find most stressful?" "I know just what you are going through. The stress is terrible." "You have only two more semesters. You will be glad if you stick it out."

"School is stressful. What do you find most stressful?" This response acknowledges the client's perception of school as difficult and asks for further information, keeping the interview focused on the client and his or her feelings. This response suggests the nurse is listening actively and is concerned. The nurse should avoid attacking the target of the client's anxiety. Saying the nurse knows what the client is going through minimizes the client's experience. Saying "the stress is terrible" is an interpretation that should be avoided; this takes the focus off the client's perception. The nurse should also avoid giving advice or false reassurance.

A nurse is interviewing a client who attempted suicide. What question should the nurse ask to initiate the interview? "Are you happy that you survived?" "What made you attempt suicide?" "Did you really want to commit suicide?" "What if you hadn't survived?"

"What made you attempt suicide?" A nurse always starts an interview by asking open-ended questions of the client, for instance, asking about the conditions that led to the client's suicide attempt. This turns the interview over to the client and keeps the focus on his or her perceptions and feelings. Whether the client is happy about his or her survival or whether the client really wanted to attempt suicide are closed-ended questions. These questions limit the conversation and stop the client from sharing information; they also have an implication about how the nurse thinks the client should feel. Asking the client, "What if you hadn't survived?" is not productive and may make the client feel guilty and therefore hinder the conversation.

Which comment by the nurse would be appropriate when beginning a new nurse-client relationship? "Which of your problems is most serious?" "I want you to tell me about your problems." "I'm an experienced nurse. You can trust me." "What would you like to tell me about yourself?"

"What would you like to tell me about yourself?" Asking the client what he or she wants to tell the nurse is an open-ended statement that gives the client control over the interview. It emphasizes the client-centered nature of the nurse-client relationship. The focus is on the client's ideas, experiences, and feelings. Evaluating the client's problems and goals comes later in the working phase of the nurse-client relationship. Bringing up problems right away is not an open-ended approach and can make the client uncomfortable. Bringing up the nurse's experience does not keep the focus on the client.

A nurse is interacting with a client who is diagnosed with human immunodeficiency virus (HIV). The nurse observes that the client appears depressed and avoids interacting whenever possible. What response should the nurse provide to encourage the client to acknowledge his or her feelings? "You look upset about something." "Don't worry about what others would say." "Are you thinking about your illness now?" "I feel you are not willing to interact with me."

"You look upset about something." Observing that the client looks upset invites a response while keeping the focus on the client's feelings. It makes the client feel that the nurse is concerned about him or her and encourages sharing feelings. The nurse should not be judgmental and come to a conclusion that the client is worried about what others would say. The nurse should avoid asking closed-ended questions such as, "Are you thinking about your illness?" It limits the conversation to a "yes" or "no" response and may interfere with further communication. It is unprofessional for the nurse to express his or her own feelings.

Parents of a newborn diagnosed with erythroblastosis fetalis are visibly upset. What nursing response encourages communication by attempting to reflect the parents' feelings? "Things get worse before they get better." "Why didn't you take the Rh immunoglobulins?" "You must be feeling very upset." "Try to get out of the situation as soon as possible."

"You must be feeling very upset." When the nurse says that the parents must be feeling very upset, it reflects the feelings of the clients, which is the most appropriate nursing response. The clients get an impression of being understood, which encourages them to express feelings and ideas. When a nurse responds by saying that things get worse before they get better, it gives an impression to the clients that the nurse is unable to understand the clients' feelings, and the clients may feel degraded. Asking the client the reason for not taking Rh immunoglobulins can make the clients feel guilty. Giving premature advice, such as to get out of the situation as soon as possible, indicates that the nurse is unable to understand the clients' feelings and is giving an opinion.

What should a nurse do to help reduce judgmental thinking and behaviors toward clients with a different value system? Select all that apply. Identify own behaviors or values that are unacceptable. Determine when and how nurse's own responses were learned. Identify ways to ignore behaviors or values that are tolerable. Engage in self-reflection to recognize the presence of such thinking. Focus on identifying the thoughts and experiences that formed this type of thinking.

Identify own behaviors or values that are unacceptable. Engage in self-reflection to recognize the presence of such thinking. Focus on identifying the thoughts and experiences that formed this type of thinking. Although one will always have personal opinions, nurses are more effective when they guard against using their own value systems to judge clients' thoughts, feelings, or behaviors. The nurse should focus on exploring the behavior and work toward identifying the thoughts and feelings that influence this behavior. Judgment on the part of the nurse most likely will interfere with further exploration. The first steps in eliminating judgmental thinking and behaviors are to recognize their presence, identify how or where these responses to the client's behavior were learned, and construct alternative ways to view the client's thinking and behavior. Determining when and how the responses were learned does not necessarily help eliminate them. Denying judgmental thinking will only compound the problem.

During a conversation with a client, which behavior demonstrated by the nurse is a characteristic of effective body language? Select all that apply. Maintaining eye contact with the client to confirm interest in the conversation While maintaining personal space boundaries, leaning in slightly to show attentiveness Using frequent hand gestures to suggest agreement with the client Mimicking the client's facial expressions, especially those of happiness and sadness Sitting with arms crossed to convey a sense of authority

Maintaining eye contact with the client to confirm interest in the conversation While maintaining personal space boundaries, leaning in slightly to show attentiveness Mimicking the client's facial expressions, especially those of happiness and sadness A nurse who leans in slightly toward the speaker while maintaining personal space boundaries, and who matches facial expressions to personal feelings or to the client's feelings can be perceived as open to and respectful of the communication. Making frequent hand gestures may be distracting or otherwise off-putting to the client. A person who slumps in a chair, rolls the eyes, and sits with arms crossed in front of the chest can be perceived as resistant and unreceptive to what another wants to communicate.

When conducting a clinical interview of a client, which techniques should the nurse implement to facilitate effective communication? Select all that apply. Maintaining silence to encourage the client to talk Making nonthreatening observations to initiate conversation Making value judgments about the client's behaviors Reassuring the client that everything will be all right Probing the client for relevant information Asking open-ended questions

Maintaining silence to encourage the client to talk Making nonthreatening observations to initiate conversation Asking open-ended questions Maintaining silence, making observations, and asking open-ended questions are effective therapeutic techniques. Maintaining silence when necessary gives the client time to recollect and think. Making observations and calling attention to the client's behavior helps start a conversation with a withdrawing client. Asking open-ended questions promotes long conversations and encourages the client to respond fully. Making value judgments prevents problem solving, and the client may get angry or dissatisfied. False reassurances will make the client feel unimportant. Probing the client may make him or her withdrawal if the nurse pushes for conversations the client is not ready to have.

A client telephones the nurse at the mental health center daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit-setting strategy should the nurse employ? Suggest the client call other people in the community. Say to the client, "I can talk to you for 15 minutes twice a week." Use the telephone's caller identification to screen calls from the client. Tell the client, "You should discuss these concerns with your personal physician rather than me."

Say to the client, "I can talk to you for 15 minutes twice a week." Telling the client that the nurse can be available for 15 minutes twice a week sets a clear, absolute limit that cannot be misinterpreted. Suggesting the client call other people does not address the nurse's boundaries in the relationship. Using caller identification to avoid the client does not communicate a limit. Unless the client's concerns are out of the nurse's scope, it is unnecessary for the nurse to defer to the physician.

A client reports diarrhea and frequent vomiting. The nurse suspects the client is not paying attention to the advice of the health care provider. Which example of observed body language supports the nurse's suspicion? Select all that apply. The client made hand gestures to the clinician. The client leaned slightly toward the clinician. The client was rolling his or her eyes at the clinician. The client was sitting with arms crossed in front of his or her chest. The client maintained a relaxed and attentive posture.

The client was rolling his or her eyes at the clinician. The client was sitting with arms crossed in front of his or her chest. Body movements and facial expressions reveal a person's feelings. If a client rolls the eyes and sits with arms crossed in front of the chest, it suggests that the client is resistant to receive the information the speaker is communicating. If the client makes hand gestures, leans slightly toward the speaker, and maintains a relaxed and attentive posture, it indicates that the client is open to communication, is able to understand the speaker, and is actively participating in the conversation.

Which seating arrangement appropriately supports communication during a nurse-client interview? The nurse behind a desk and the client in a chair in front of the desk The nurse and client sitting at a 90-degree angle to each other The client sitting in a chair and the nurse standing a few feet away The nurse and client sitting in chairs while facing each other

The nurse and client sitting at a 90-degree angle to each other Sitting at a 90-degree angle to each other is less intense and allows the client and nurse to look away from each other without discomfort. In these positions, the two are at the same height, so neither is in an inferior position. The nurse should avoid placing a barrier like a desk between him- or herself and the client. If the nurse stands while the client sits, this may be threatening to the client. Face-to-face seating is a more confrontational arrangement and therefore can produce anxiety.

Which behavior by the nurse most clearly demonstrates promoting a social relationship instead of a therapeutic nurse-client relationship? The nurse shares stories about his or her children. The nurse talks about favorite television shows with the client. The nurse confides in the client about a frustrating day at work. The nurses talks about a client with another nurse outside the workplace.

The nurse confides in the client about a frustrating day at work. In order to maintain a therapeutic nurse-client relationship, the nurse must remember to focus all interactions on the client and the client's needs. A nurse who talks about a frustrating day at work is focusing on his or her own needs, which imparts a social relationship rather than a therapeutic relationship. A nurse can share a brief story about his or her own personal life, as long as the conversation and interaction remains focused on the client. The nurse can be friendly with the client and talk about favorite television shows while still maintaining a therapeutic relationship. The nurse should not talk about clients outside of the workplace due to privacy issues, but this inappropriate nurse-to-nurse interaction does not necessarily affect the nurse's therapeutic relationship with the client.

A nurse plans to interview a hospitalized client who is lying supine with the head elevated at 45 degrees. Which initial action by the nurse will most enhance the probability of achieving a therapeutic interaction? The nurse should transfer the client to a chair near the door if the client is able to move. The nurse should stand during the interview to establish professional credibility. The nurse should select a chair or stool that positions the nurse at about the same level as the client. The nurse should maintain the room arrangement without alteration to enhance the client's comfort.

The nurse should select a chair or stool that positions the nurse at about the same level as the client. The nurse should arrange the setting to maximize communication. In all settings, chairs should be arranged so that conversation can take place in normal tones of voice and so that eye contact can be comfortably maintained or avoided. Seating should use the same height whenever possible to support the therapeutic relationship. Placing the client near the door may jeopardize the nurse's safe exit if it should become necessary. The nurse should not stand or otherwise be positioned above the client, because this may make the client feel uncomfortable or inferior. The nurse should change the arrangement of the furniture if necessary to maximize the therapeutic value of the visit.

A client diagnosed with major depressive disorder has been socially isolated. The nurse invites the client to a staff luncheon to honor the supervisor. Which analysis best applies to this scenario? The invitation supports development of the client's self-esteem. The nurse's action blurs the boundaries of a therapeutic relationship. The nurse's invitation exposes the client to a therapeutic social activity. The invitation provides an opportunity for the client to practice interactions with others.

The nurse's action blurs the boundaries of a therapeutic relationship. The nurse-client relationship should be conducted within appropriate and clear boundaries. In this scenario, the nurse's invitation blurs those boundaries by adding a social dimension. Supporting the client's self-esteem, exposing the client to a therapeutic social activity, and providing the client an opportunity to interact with others move the relationship toward a social, rather than therapeutic, one.

What is the focus during clinical supervision? The nurse's behavior in the nurse-client relationship Analysis of the client's motivation for transferences Devising alternative strategies for client growth Assisting the client to develop increased independence

The nurse's behavior in the nurse-client relationship Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. This is done to improve the nurse's quality of care; clinical supervision does not address client motivation, growth, or increased independence.