therapeutic communication/relationship

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? A. Boundary blurring B. Value dissonance C. Covert anger D. Empathy

A. Boundary blurring

At what point in the nurse-patient relationship should a nurse plan to first address termination? A. During the orientation phase B. At the end of the working phase C. Near the beginning of the termination phase D. When the patient initially brings up the topic

A. During the orientation phase

Termination of a therapeutic nurse-patient relationship has been successful when the nurse A. avoids upsetting the patient by shifting focus to other patients before the discharge. B. gives the patient a personal telephone number and permission to call after discharge. C. discusses with the patient changes that happened during the relationship and evaluates outcomes. D. offers to meet the patient for coffee and conversation three times a week after discharge.

C. discusses with the patient changes that happened during the relationship and evaluates outcomes.

Which behavior shows that a nurse values autonomy? The nurse A. suggests one-on-one supervision for a patient who has suicidal thoughts. B. informs a patient that the spouse will not be in during visiting hours. C. discusses options and helps the patient weigh the consequences. D. sets limits on a patient's romantic overtures toward the nurse.

C. discusses options and helps the patient weigh the consequences.

What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate A. self-responsibility and autonomy. B. a greater sense of independence. C. rapport and trust with the nurse. D. resolved transference.

C. rapport and trust with the nurse.

A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should A. suppress the angry feelings. B. express the anger openly and directly with the patient. C. tell the nurse manager to assign the patient to another nurse. D. discuss the anger with a clinician during a supervisory session.

D. discuss the anger with a clinician during a supervisory session.

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should A. restate what the patient says. B. use congruent communication strategies. C. use self-revelation in patient interactions. D. consistently interpret the patient's behaviors.

B. use congruent communication strategies.

During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved? A. Preorientation B. Orientation C. Working D. Termination

C. Working

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."

A, C, D, E

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.) A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

A,B,D

A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a nonjudgmental response by the nurse. A. "How do you feel about that?" B. "I am glad that you realize this." C. "That's not a good way to behave." D. "Have you outgrown that type of behavior?"

A. "How do you feel about that?"

A patient says, "Please don't share information about me with the other people." How should the nurse respond? A. "I will not share information with your family or friends without your permission, but I will share information about you with other staff." B. "A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know." C. "It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others." D. "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us."

A. "I will not share information with your family or friends without your permission, but I will share information about you with other staff."

A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from social relationships. Which is the best explanation? A. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." B. "The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented." C. "The focus of the relationship is socialization. Mutual needs are met, and feelings are shared openly." D. "The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other."

A. "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient."

Which statement shows a nurse has empathy for a patient who made a suicide attempt? A. "You must have been very upset when you tried to hurt yourself." B. "It makes me sad to see you going through such a difficult experience." C. "If you tell me what is troubling you, I can help you solve your problems." D. "Suicide is a drastic solution to a problem that may not be such a serious matter."

A. "You must have been very upset when you tried to hurt yourself."

A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship? A. Begin at the orientation phase. B. Resume the working relationship. C. Initially establish a social relationship. D. Return to the emotional catharsis phase.

A. Begin at the orientation phase.

A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? (Select all that apply.) A. Focus dialogues with the patient on problems that may occur in the future. B. Help the patient express feelings about the relationship with the nurse. C. Help the patient prioritize and modify socially unacceptable behaviors. D. Reinforce expectations regarding the parameters of the relationship. E. Help the patient to identify strengths, limitations, and problems.

A. Focus dialogues with the patient on problems that may occur in the future. B. Help the patient express feelings about the relationship with the nurse.

As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurse's best action? A. Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card. B. Inform the patient that accepting gifts violates policies of the facility. Decline the card. C. Acknowledge the patient's transition through the termination phase but decline the card. D. Accept the card and invite the patient to return to participate in other arts and crafts groups.

A. Recognize the effectiveness of the relationship and patient's thoughtfulness. Accept the card.

A novice psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parent's behavior in the community. Select the best ways for this nurse to cope with these feelings. (Select all that apply.) A. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. B. Recognize that these feelings are unhealthy. The nurse should try to suppress them when working with patients. C. Recognize that psychiatric nursing is not an appropriate career choice. Explore other nursing specialties. D. The nurse should begin new patient relationships by saying, "My own parent had mental illness, so I accept it without stigma."A. E.Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important.

A. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. E.Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A. The nurse violated the client's personal space by physically being too close. B. The client has issues with sharing personal information. C. The nurse failed to explain the purpose of the admission interview. D. The client is responding to the voices by ending the conversation.

A. The nurse violated the client's personal space by physically being too close.

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

A. The nurse's behavior in the nurse-client relationship

A nurse says, "I am the only one who truly understands this patient. Other staff members are too critical." The nurse's statement indicates A. boundary blurring. B. sexual harassment. C. positive regard. D. advocacy.

A. boundary blurring.

A client states "That nurse never seems comfortable being with me." The nurse can be described as A. not seeming genuine to the client. B. transmitting fear of clients. C. unfriendly and aloof. D. controlling.

A. not seeming genuine to the client.

An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion? A. "This patient continues to deny problems resulting from drinking." B. "My parents were alcoholics and often neglected our family." C. "The patient cannot identify any goals for improvement." D. "The patient said I have many traits like her mother."

B. "My parents were alcoholics and often neglected our family."

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"

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

B. "School is stressful. What do you find most stressful?"

A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "This patient is like one of my grandparents ... so helpless." Which response is the nurse demonstrating? A. Transference B. Countertransference C. Catastrophic reaction D. Defensive coping reaction

B. Countertransference

A novice nurse tells a mentor, "I want to convey to my patients that I am interested in them and that I want to listen to what they have to say." Which behaviors will be helpful in meeting the nurse's goal? (Select all that apply.) A. Sitting behind a desk, facing the patient B. Introducing self to a patient and identifying own role C. Maintaining control of discussions by asking direct questions D. Using facial expressions to convey interest and encouragement E. Assuming an open body posture and sometimes mirror imaging

B. Introducing self to a patient and identifying own role D. Using facial expressions to convey interest and encouragement E. Assuming an open body posture and sometimes mirror imaging

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? A. The nurse behind a desk and the client in a chair in front of the desk. B. The nurse and client sitting at a 90-degree angle to each other. C. The client sitting in a chair and the nurse standing a few feet away. D. The nurse and client sitting facing each other.

B. The nurse and client sitting at a 90-degree angle to each other

As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? A. The invitation facilitates dependency on the nurse. B. The nurse's action blurs the boundaries of the therapeutic relationship. C. The invitation is therapeutic for the patient's diversional activity deficit. D. The nurse's action assists the patient's integration into community living.

B. The nurse's action blurs the boundaries of the therapeutic relationship.

A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A. The patient in denial. B. The response may reflect cultural norms. C. The response may reflect personal guilt. D. The patient may have an antisocial personality.

B. The response may reflect cultural norms.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Please tell me what was happening that led to your hospitalization here?" A. Using a minimal encourager B. Using an open-ended question C. Paraphrasing D. Reflecting

B. Using an open-ended question

A nurse introduces the matter of a contract during the first session with a new patient because contracts A. specify what the nurse will do for the patient. B. spell out the participation and responsibilities of each party. C. indicate the feeling tone established between the participants. D. are binding and prevent either party from prematurely ending the relationship.

B. spell out the participation and responsibilities of each party.

A nurse wants to enhance growth of a patient by showing positive regard. The nurse's action most likely to achieve this goal is A. making rounds daily. B. staying with a tearful patient. C. administering medication as prescribed. D. examining personal feelings about a patient.

B. staying with a tearful patient.

As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, "Thank you for helping mend my broken heart." Which is the nurse's best response? A. "Accepting gifts violates the policies and procedures of the facility." B. "I'm glad you feel so much better now. Thank you for the beautiful necklace." C. "I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope." D. "Helping people is what nursing is all about. It's rewarding to me when patients recognize how hard we work."

C. "I'm glad I could help you, but I can't accept the gift. My reward is seeing you with a renewed sense of hope."

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? A. "I'm so sorry. My father died 2 years ago, so I know how you are feeling." B. "You need to focus on yourself right now. You deserve to take time just for you." C. "That must have been such a hard situation for you to deal with." D. "I know that you will get over this. It just takes time."

C. "That must have been such a hard situation for you to deal with."

A patient says, "I'm still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?" What is the nurse's best response? A. "Why are you asking me when you're able to speak for yourself?" B. "I will be glad to address it when I see your doctor later today." C. "That's a good topic for you to discuss with your doctor." D. "Do you think you can't speak to a doctor?"

C. "That's a good topic for you to discuss with your doctor."

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A. A recent immigrant from Russia B. A deeply depressed client C. A Chinese American client D. A tearful client reporting pain

C. A Chinese American client

Of the following environments, which would be most conducive to a therapeutic session? A. The nurses' station B. A table in the coffee shop C. A quiet section of the day room D. The utility room

C. A quiet section of the day room

A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? A.Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder? A. Trust, congruence, attitudes, and boundaries B. Goals, resistance, unconscious motivations, and diversion C. Relationship parameters, the contract, confidentiality, and termination D. Transference, countertransference, intimacy, and developing resources

C. Relationship parameters, the contract, confidentiality, and termination

After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? A. The patient's reactions toward the nurse seem realistic and appropriate. B. The patient states, "Talking to you feels like talking to my parents." C. The nurse feels unusually happy when the patient's mood begins to lift. D. The nurse develops a trusting relationship with the patient.

C. The nurse feels unusually happy when the patient's mood begins to lift.

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? A. The nurse is a safe person to interact with. B. The nurse is a new friend. C. They view the nurse as a stranger. D. They view the nurse as a peer.

C. They view the nurse as a stranger.

7.What is the primary difference between a social and a therapeutic relationship? A. Type of information exchanged B. Amount of satisfaction felt C. Type of responsibility involved D. Amount of emotion invested

C. Type of responsibility involved

Which comment best indicates that a patient perceived the nurse was caring? "My nurse A. always asks me which type of juice I want to help me swallow my medication." B. explained my treatment plan to me and asked for my ideas about how to make it better." C. spends time listening to me talk about my problems. That helps me feel like I am not alone." D. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner."

C. spends time listening to me talk about my problems. That helps me feel like I am not alone."

Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship? A. "I don't have any problems." B. "It is so difficult for me to talk about problems." C. "I don't know how it will help to talk to you about my problems." D. "I want to find a way to deal with my anger without becoming violent."

D. "I want to find a way to deal with my anger without becoming violent."

A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? A. "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

D. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." C. "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? A. Quickly break the silence and encourage the client to continue. B. Reassure the client that the abuse was not her fault. C. Reach out and gently touch the client's arm. D. Allow the client to break the silence.

D. Allow the client to break the silence.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A. Using emotionally charged words and gestures B. Offering opinions and avoiding periods of silence C. Asking closed-ended questions requiring "yes" or "no" answers D. Asking open-ended questions and seeking clarification

D. Asking open-ended questions and seeking clarification

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" A. Focusing B. Restating C. Reflection D. Clarification

D. Clarification

After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? A. Eliciting more information B. Encouraging evaluation C. Verbalizing the implied D. Clarifying the message

D. Clarifying the message

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A. The mental image of a word may not be the same for both nurse and client. B. One statement may simultaneously convey conflicting messages. C. Many of the client's remarks are no more than social phrases. D. Content of messages may be contradicted by process.

D. Content of messages may be contradicted by process.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? A. Enhanced client coping B. Lessening of client emotional pain C. Increased hope for client improvement D. Decreased client communication

D. Decreased client communication

A patient says, "People should be allowed to commit suicide without interference from others." A nurse replies, "You're wrong. Nothing is bad enough to justify death." What is the best analysis of this interchange? A. The patient is correct. B. The nurse is correct. C. Neither person is correct. D. Differing values are reflected in the two statements.

D. Differing values are reflected in the two statements.

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? A. Congruence B. Empathetic feelings C. Countertransference D. Positive transference

D. Positive transference

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A. Giving information and encouraging evaluation B. Presenting reality and encouraging planning C. Clarifying and suggesting collaboration D. Reflecting and exploring

D. Reflecting and exploring

A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, "I really need to talk to you." The nurse should A. invite the interrupting patient to join in the session with the current patient. B. say to the interrupting patient, "I am not available to talk with you at the present time." C. end the unproductive session with the current patient and spend time with the interrupting patient. D. tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."

D. tell the interrupting patient, "This session is 5 more minutes; then I will talk with you."