Psych Therapeutic Relationships Prep U

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

The client recognizes feelings of anger and expresses them appropriately. When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.

Which situation would most likely indicate a violation of professional boundaries? Select all that apply.

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

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

Acting out The client begins to test the relationship to become convinced that the nurse will really accept the client. Typical acting out includes forgetting a scheduled session, being late, or making an accusation that communicates the client's initial mistrust. In this case, the client also expresses anger at something a nurse says or accuses the nurse of breaking confidentiality. Another common pattern is for the client to first introduce a relatively superficial issue as if it is the major problem. The nurse must recognize that these behaviors are designed to test the relationship and establish its parameters, not to express rejection or dissatisfaction with the nurse. These behaviors also are not an indication of a lack of understanding.

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

Advocate 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.

A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, "What's the use? I don't ever see this changing." The client's statement is suggestive of a potential problem with what factor that influences communication?

Attitude A tone of defeatism or resignation is indicative of an attitude that may inhibit communication and treatment.

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 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.

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

Hildegard Peplau

Which is an inaccurate statement regarding a preconception?

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

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

Lack of self-awareness A warning sign that the nurse is experiencing a lack of self-awareness includes when the nurse believes that he or she is the only person who can help a client, that is, having "rescue fantasies."

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

Lacking genuine interest The nurse's nonverbal behavior conveys that the nurse is disinterested in talking with the client, which communicates a lack of genuine interest. This is a nontherapeutic interaction, because the client will perceive that the nurse is not interested and may also feel uncared about and unimportant.

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship?

Orientation

The nurse is reviewing the client's documented history and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

Orientation

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming?

Parent surrogate The nurturing needs of clients who are unable to carry out simple tasks are met by the subrole of the parent surrogate. This not the focus of the other roles.

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 would be most important about the client for the nurse to obtain?

Perception of the problem

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

Rambling due to nervousness

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

The nurse is empathizing with the client Empathizing is the ability of the nurse to perceive the feelings and emotions that the client is trying to communicate. The nurse's statement indicates that the nurse is trying to perceive the problem by relating the problem with the self. This would help the client to feel comfortable and safe while sharing feelings with the nurse. Sympathy is the ability of the nurse to project his or her concern toward the client. The nurse does not perceive the problem of the client. If the nurse is able to empathize with the client then it indicates that the nurse is showing genuine interest and is listening actively to the client.

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

The therapeutic use of self Through the therapeutic use of self, via therapeutic relationships and communication, nurses help people adapt, change, and grow. Medications and education will influence and enhance growth, but the therapeutic use of self is the nurse's primary tool. Self-help groups do not involve health care professionals

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

shifting the emphasis to the nurse

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?

"Asking for help from those who care about us isn't a sign of weakness." The correct response by the nurse demonstrates the ability to use the self as a therapeutic tool 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 client's perceptions. Telling the client the family would want to help when there is a problem is making an assumption without first discussing the client's perceptions. Asking the client how the client plans to manage problems without help communicates sympathy and the need for dependency.

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 must have been really upset." 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.

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

Countertransference 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?

Countertransference 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.

A nurse has been working for 15 hours continuously without a break. The nurse administrator insists that the nurse should go home and sleep. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Ethical knowing Ethical knowledge refers to the knowledge derived from the moral knowledge of the nurse. The nurse administrator understands that the nurse is stressed and requires rest. This indicates moral knowledge. Aesthetic knowing refers to the knowledge gained through the art of nursing. Personal knowing refers to the knowledge gained through experience. Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing.

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur during this phase? Select all that apply.

Explanation of the purpose of the relationship Discussion of client's expectations Reviewing the client history During the orientation phase, the nurse explains the purpose of the relationship, discusses the client's expectations, and listens to the client's history and perception of the problems. The nurse begins to understand the client and identify themes. Identification of problems occurs during the working phase. Strengthening of relationships occurs during the resolution phase.

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply.

Name Level of education Reason for being on the unit On meeting with the client for the first time, the nurse should share appropriate information about the nurse with the client. This information includes the nurse's name, level of education of the nurse, and the reason for being on the unit. Revealing personal information like personal home address and information about the nurse's family to the client is not appropriate in a therapeutic relationship

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

Orientation phase 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.

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

Preventing deterioration of mental status Promoting mental health Promoting physical health The nurse focuses on working to prevent further mental illness and to promote mental and physical health in the client. Focusing on personal safety communicates an assumption that the client is violent and contributes to upholding stigma. This would not support establishing a therapeutic relationship. Sedation is not an ethically acceptable manner of caring for the psychiatric client.

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. With which would the client be involved? Select all that apply.

Testing new ways for problem solving Discussing problems related to needs Examining personal issues

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

The client is nervous and insecure. In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.

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

The loss of therapeutic effectiveness The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

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

Working

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?

getting an appointment with the client at the time previously agreed upon 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.

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

is attempting to prolong the nurse-client relationship. It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

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

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

A 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

"It sounds like this is very difficult for you, I can see why it causes you stress." 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.

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment?

"Our relationship is one of a professional nature." The nurse who does not become upset or responds negatively to a client's outbursts, anger, or acting out conveys acceptance to the client. Avoiding judgments 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 is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child?

"That must have been terribly hurtful experience for you." Empathy is important, yet challenging, to communicate. A genuine, open-ended, and nonjudgmental response can often convey empathy to a client. Claiming the same experience, turning the statement into a "lesson," or exploring before acknowledging are communication techniques that can impair communication.

A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply.

A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone

A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what?

Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. The nurse's response is appropriate because the focus of the therapeutic relationship is the client. The other options do not place the focus of care on the client's needs or reflect a full understanding of the therapeutic relationship.

Which is not considered a step in the values clarification process?

Assessing 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 term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world?

Attitudes 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.

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

During the initiating or orienting phase The first step of the therapeutic relationship is called the initiating or orienting phase. During this phase, the nurse sets the stage for a one-to-one relationship by becoming acquainted with the client. At the same time, the nurse also begins the assessment process.

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

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

Remind the client about the importance of boundaries to keep the relationship therapeutic Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty).

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?

The client is testing the parameters of the relationship. In the early phases of the nurse-client relationship, lateness and absence often characterize the client's testing of the relationship. This is a well-recognized phenomenon and is not normally interpreted as the client being in denial, receiving treatment elsewhere, or mistrusting the nurse's abilities.

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

The nurse should address the client by name. The nurse should actively listen to the client. The nurse should respond openly to the client. Addressing the client by name, actively listening to the client, and responding openly and honestly to the client conveys positive regard. The nurse cannot practically be present all the time to look after the client. The nurse should try to spend some time with the client. The nurse cannot give the responsibility of planning therapy to the client. The nurse should consider the client's views while planning care. This action would also convey positive regard

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

Unconditional positive regard The nurse needs to treat each person with respect and dignity, regardless of personal value conflicts.

A client treated for depression is ready for discharge from the hospital and tells the nurse, "It would be great if we could meet for coffee should I start feeling low again." Which statement indicates that the nurse understands the boundaries of the therapeutic relationship?

"Before you leave the hospital, I will make sure you have information about the crisis center." The nurse realizes that meeting for coffee would cross the boundaries of the therapeutic relationship and would not be consistent with promoting health and wellness. Providing the number of a crisis center to the client is an example of promoting a healthy strategy that the client can use if symptoms of depression develop again. The other options do not describe actions that would be consistent with the therapeutic nurse-client relationship.

Which statement would indicate that the nurse has a non-judgmental attitude?

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

A nurse has approached a new client on the psychiatric care unit 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 nurse's following responses would constitute countertransference?

"There's no need to get rude with me. I'm just trying to do my job and to help you out." Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

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

"What types of dresses do you like wearing?" Asking the client about the client's preferences on fashion and dressing indicate that the nurse is trying to build a social relationship with client, not engaging in a therapeutic use of self. This conversation does not influence the client care in any way. Asking the client about pain indicates that the nurse is gathering information about the client's illness. Asking about the client's food preference indicates that the nurse is finding about the nutrition habits of the client. Asking if the client has informed the spouse about the illness indicates that the nurse is allowing the client to take decisions regarding revealing the condition to other people. These questions indicate that the nurse is engaging in therapeutic communication with the client.

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

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

A judgmental attitude Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, "Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?" Countertransference refers to the nurse's response to the client based on personal unconscious needs and conflicts. Exploitation refers to the phase in the therapeutic relationship when the nurse guides the client to examine feelings and responses to develop better coping mechanisms and a more positive self image. Poor boundaries refers to inappropriate levels of personal disclosure to the client or overly social/intimate relationships with the client.

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

Client self-exploration When client self-exploration occurs, the nurse encourages the client to learn positive adaptive or coping skills. Self-disclosure refers to the nurse sharing personal information with the client in order to establish trust and improve rapport. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate understanding to the client. Respect is also a condition essential for a therapeutic relationship to occur; however, it is not reflective of the client's adaptive coping.

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?

Compassion fatigue 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.

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason?

Eliciting the client's cooperation through the establishment of trust While providing care to a client with psychosis, the psychiatric nurse uses communication initially for the purpose of eliciting the client's cooperation through the establishment of trust. All the other options are important, but first, the nurse must establish trust with the client.

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

Empirical knowing Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing. Dyspnoea and tachycardia are signs related to anxiety attack. Ethical knowing refers to the moral knowledge of nurse. Aesthetic knowing refers to the knowledge gained through the art of nursing. Personal knowing refers to the knowledge gained through experience

When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what?

Encourage personal goal setting 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.

Which action by the nurse or client represents the working phase of the therapeutic relationship?

Identifying past ineffective behaviors In the working phase of the relationship, the client is involved actively in achieving goals set during the initial 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.

A nurse who has worked with a client with post-traumatic stress disorder (PTSD) regularly for several months stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Personal knowing A nurse has good amount of experience working with the client with PTSD. Interpreting the state of the client on the basis of observation reflects that the nurse has gained this knowledge through experience. Ethical knowing refers to the moral knowledge of nurse. Aesthetic knowing refer to the knowledge gained through the art of nursing. Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing

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.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. 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 nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what?

The exploration of behaviors to uncover the client perspective While all the above principles are followed, the nurse's questioning best reflects the principle that all behavior has meaning and can be understood from the person's perspective. The use of unconditional positive regard is intended to communicate respect to the client. The client becomes aware that he or she is considered a unique worthwhile human being. In this case, the nurse is not using unconditional positive regard in the approach. The demonstration of genuine interest is a means to develop trust in the nurse-client relationship. The nurse may chose to include nonharmful personal disclosure in the effort to establish or continue to build the therapeutic relationship. In this case, the nurse is not using a demonstration of genuine interest. The therapeutic use of self refers to the nurse's conscious awareness of self to promote the client's growth and to avoid limiting the client's choices to those that the nurse values. In this case, the nurse is not engaging in the therapeutic use of self overtly.

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

The nurse frequently refers to an elderly, cognitively impaired client as "my granny" 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 expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

The nurse is empathizing with the client. Empathizing is the ability of the nurse to perceive the feelings and emotions that the client is trying to communicate. The nurse's statement indicates that the nurse is trying to perceive the problem by relating the problem with the self. This would help the client to feel comfortable and safe while sharing feelings with the nurse. Sympathy is the ability of the nurse to project his or her concern toward the client. The nurse does not perceive the problem of the client. If the nurse is able to empathize with the client then it indicates that the nurse is showing genuine interest and is listening actively to the client.

A nurse is caring for a client experiencing delusions. The client tells the nurse "I am sure my brother has plans to kill me. But I am ready; I will be killing him before he tries to reach me." What is the appropriate action of the nurse in this situation?

The nurse should notify to the primary healthcare provider. The client's has made a homicidal threat (expressed wish to kill his brother). According to the law, the nurse is supposed to report the homicidal threat to the nursing superintendent and the attending physician. They would inform about the threat to the police and intended victim. This action is referred to as the duty to warn. Sedating the client would not prevent the client from having homicidal intentions. The client has a psychiatric illness. Advising the client to stop having this thoughts in inappropriate. Threatening the client would only make these feelings much stronger in the client.

A client is talking to a nurse about the recent death of the client's grandmother. The client is sad, and tears roll down the client's cheeks as the client talks. The nurse remembers how the nurse felt when the nurse's own grandmother died the previous summer. The nurse puts a hand on the client's shoulder and says, "This must be very difficult for you." The nurse is demonstrating empathy based on what?

The nurse's response reflects an attempt to communicate understanding of the client's feelings. Empathy involves the nurse receiving information from the client with open, nonjudgmental acceptance. The nurse should communicate this understanding of the experience and feelings so the client feels understood. It is not necessary for the nurse to have had the same experience, but the nurse needs to imagine how having the experience feels to the client. Sympathy is the expression of compassion and kindness.

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

The therapist must notify authorities and the potential victim. 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.

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

To prevent the client from viewing the nurse as a friend rather than health care provider 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 notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?

Trust 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.

When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response?

Will this conversation involve your desire to harm yourself?" Asking whether the conversation will involve the client's desire to hurt the client establishes whether the nurse can keep it confidential. Nurses may find it necessary to reassure a client that confidentiality will be maintained except when the information may be harmful to the client or others and except when the client threatens self-harm. The other options are not necessarily true; if the conversation does not affect the client's health or well-being, there is no reason to share the information with anyone. Further, if the conversation affects the client's health or well-being, it will be shared with the client's health care team. The option regarding the client's trust for the nurse is nursing-centered, not client-centered, and does not address the client's question.

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

Working

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

Working During 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 client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase?

Working The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies the client's problems, and clarifies expectations. In the resolution phase, actual problems are resolved and the relationship terminates. During the resolution phase, the client is redirected toward a life without this specific relationship. The client connects with community resources, solidifies a newfound understanding, and practices new behaviors. Termination, although it begins on the first day of the relationship, marks the end of the relationship.

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

empathy. 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.

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure?

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

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

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