Ch 5 therapeutic relationships
intimate space
0-18 inches; personal; whispering; this close can cause anxiety or seem threatening
personal space
18-36/40 inches; close conversation with family or friends
Social space
4-12 feet; conversations in social, work or business settings
A
A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques? A) Defining boundaries B) Defining therapy C) Letting the client down gently D) Reprimanding the client
A
A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek clinical supervision? A) When the nurse tries to assist the client to change values B) To discuss the nurse's feelings about the client with a supervisor C) When the nurse begins to empathize with the client D) When the nurse identifies anxieties regarding the client's values and sexuality
C
A nurse is using the Johari window to identify the degree to which he feels comfortable communicating with others. After completing the exercise, the nurse discovers that quadrant 1 has the longest list of qualities. This indicates which of the following about the nurse? A) The nurse conceals personal information about himself. B) The nurse needs to increase insight into his own characteristics. C) The nurse is open to others. D) The patient is sharing more than the nurse in the therapeutic relationship.
C
A nurse is working with a patient whose background is very different from hers. A good question to ask herself to assure she can be effective working with this patient would be, A) ìCan this person understand me?î B) ìDo I understand this patient's expectations of me?î C) ìWhat experiences do I have with people with similar backgrounds?î D) ìIs this person going to be able to relate to me?î
D
A nurse makes the statement in a treatment team meeting, ìIt's not worth it to try to teach this patient how to make better choices. He has been here many times before and goes back home and does the same thing.î The nurse is sharing which of the following? A) Value B) Awareness C) Belief D) Attitude
B
A nurse notices a patient sitting quietly alone, eyes downcast, and looking sad. The nurse says to the patient, ìYou look like something is bothering you.î Which pattern of knowing did the nurse use to respond to the patient? A) Empirical knowing B) Personal knowing C) Ethical knowing D) Aesthetic knowing
C
A patient being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses? A) ìWe have to go over these instructions before you can go. Please try to listen.î B) ìWould you rather not be discharged today?î C) ìI can sense you are angry this morning. Tell me how you feel about being discharged today.î D) ìYou should be able to regulate your feelings better by now. Why are you angry?î
D
The client tells the nurse, ìI don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her.î The nurse should recognize this as A) confrontation. B) countertransference. C) incongruence. D) transference.
C
The client says to the nurse, ìI feel really close to you. You are the only true friend I have.î The most therapeutic response the nurse can make is, A) ìI am sure there are other people in your life who are your friends; besides, we just met.î B) ìIt makes me feel good that you trust me so much; it is important for the work we are doing together.î C) ìSince ours is a professional relationship, let's explore other opportunities in your life for friendship.î D) ìWe are not friends. This is strictly professional.î
B
During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client says, ìI'm old, and my life has no purpose anymore. But promise me you won't tell anyone.î How should the nurse respond? A) ìDon't worry, I won't tell anyone else.î B) ìI'm sorry, but I can't keep that kind of secret.î C) ìLet's talk about something to cheer you up.î D) ìWhat can we do to help you feel better?î
A
During the orientation phase of the nurseñpatient relationship, the nurse directs the patient to do which of the following? A) Identify problems to examine B) Express needs and feelings C) Develop interpersonal skills D) Identify self-care strategies
B
During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems? A) Comparing past and present coping strategies B) Encouraging the client to clarify feelings and behavior C) Identifying possible solutions for the client's problems D) Referring the client to a self-help group
D
One of the primary differences between social and therapeutic relationships is the A) amount of emotion invested. B) degree of satisfaction obtained. C) kind of information given. D) type of responsibility involved.
B
The nurse and patient are visiting about upcoming sporting events of which they both share an interest. This form of interaction has the potential to threaten the nurseñpatient relationship by A) influencing whether the patient likes the nurse or not. B) avoiding serious work that can help the patient change. C) letting the patient know that the nurse is genuine with diverse interests. D) overstepping ethical boundaries that the nurse should maintain.
D
The nurse assesses fine hand tremors in a patient with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper? A) Aesthetic knowing B) Ethical knowing C) Personal knowing D) Empirical knowing
A
The nurse fails to assess personal values surrounding homosexuality before caring for a patient who is openly gay. The nurse is most at risk for which of the following when working with this patient? A) Holding a prejudice toward this patient B) Neglecting to include the patient's desires in the plan of care C) Being manipulated by this patient D) Expressing shock when assessing the patient's history
ABD
The nurse has been working with a patient with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurseñpatient relationship? Select all that apply. A) Exploring perceptions of reality B) Promoting a positive self-concept C) Explaining the boundaries of the relationship D) Working through resistance E) Assisting in identifying problems
D
The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to A) alleviate stressors in life. B) allow the client to know the nurse's feelings. C) establish relationships. D) facilitate a positive change.
BCE
The nurse is mindful of maintaining relationships with patients that are therapeutic. Certain characteristics of the relationships the nurse will foster include: Select all that apply. A) offering sound advice to the patient. B) establishing boundaries for both the nurse and patient. C) maintaining a patient-focus at all times. D) sharing personal feelings openly with the patient. E) avoiding concern with whether the patient likes the nurse.
A
The nurse is working with a patient who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the patient, the nurse shows positive regard through which statement? A) ìHow is not working right now affecting you?î B) ìHow do you expect your kids to be provided for?î C) ìYou need to somehow find a way to support your children.î D) ìCan the children's mother can get by for a while until you get better?î
B
The nurse understands that empathy is essential to the therapeutic relationship. When a patient makes the statement, ìI am just devastated that my marriage is falling apart,î the nurse can best show empathy through which of the following responses? A) ìI feel so bad for what you are going through.î B) ìYou feel like your world is falling apart right now.î C) ìI have been divorced too. I know how hard it is.î D) ìIt will get better; let's talk about it.î
B
What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it secret that the client plans to kill a family member? A) The student nurse must respect the client's privacy and not tell anyone. B) The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. C) The student nurse must tell the client that the student nurse will keep the secret and then tell the instructor and/or staff members. D) The student nurse must tell the instructor and then ask the instructor to keep it secret.
D
When preparing for the first clinical experience with patients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic patients. The primary reason for discussing personal beliefs is to A) practice reflective communication skills in a role-play situation. B) assign the most compatible patients to the students. C) assess the appropriateness of the setting for implementing nursing skills. D) become aware of possible barriers to developing therapeutic relationships.
C
Which is a standard for establishing a code of conduct for living? A) Acceptance B) Empathy C) Values D) Positive regard
BCDE
Which of the following behaviors by the nurse demonstrate positive regard? Select all that apply. A) Communicating judgments about the client's behavior B) Calling the client by name C) Spending time with the client D) Responding openly E) Considering the client's ideas and preference when planning care
B
Which of the following is the most important skill the nurse must bring to the therapeutic nurseñclient relationship? A) Confrontation B) Empathy C) Humor D) Reframing
D
Which of the following occurrences is considered a breach of professional boundaries? A) Patient asking a nurse for her phone number B) Refusing a gift from a patient C) Changing the subject in response to a patient complement D) Having a lengthy social conversation with a patient
BCDE
Which of the following statements correctly depict the problem of feeling sympathy toward the client? Select all that apply. A) This can cause the nurse to feel sad and be unable to help the client. B) When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. C) The client is discouraged from exploring his or her problems, thoughts, and feelings. D) The client is discouraged from growth. E) The client feels dependent on the nurse.
B
Which of the following statements is true of the component of a therapeutic relationshipóìacceptanceî? A) The nurse accepts the behavior of any inappropriate behavior. B) It is avoiding judgments of the person, no matter what the behavior is. C) It involves punishment for inappropriate behavior. D) It is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client.
A
Which one of the following statements about the nurse and ethnocentrism is true? A) Nurses as people may inwardly view their own culture as superior to others. B) Ethnocentrism is a desirable trait in a nurse. C) Nurses must deny their ethnocentrism. D) A nurse must not think of his or her own attitudes and beliefs.
Proxemics
study of personal space
public space
greater than 12 feet; speaker or audience
sympathy
is non therapeutic and non useful to a client
Sit facing open your posture lean forward eye contact and head nodding; smiling when appropriate relax... meaning dont fidget
nonverbal behaviors of active listening include: **think SOLER
empathy
the act of understanding objectively anothers suffering
get permission
touch is appropriate at certain times but always do what first?
