CH8 Therapeutic Relationship

CR1. Which statement made by either the nurse or the patient demonstrates an ineffective patient-nurse relationship? a. "Ive given a lot of thought about what triggers me to be so angry." b. "Why do you think it's acceptable for you to be so disrespectful to staff?" c. "Will your spouse be available to attend tomorrow's family group session?" d. "I wanted you to know that the medication seems to be helping me feel less anxious."

CR1. ANS b

CR10. Emily is a 28-year-old nurse who works on a psychiatric unit. She is assigned to work with Jenna, a 27-year-old who was admitted with major depressive disorder. Emily and Jenna realize that they graduated from the same high school and each has a 2-year-old daughter. Emily and Jenna discuss getting together for a play date with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationship

CR10. ANS c

CR2. The patient expresses sadness at "being all alone with no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship? a. "Loneliness can be a very painful and difficult emotion." b. "Let's talk and see if you and I have any interests in common." с. "I use Facebook to find people who share my love of cooking." d. "Loneliness is managed by getting involved with people."

CR2. ANS a

CR3. Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship? a. Patient will be respectful of other patients on the unit. b. Patient will identify suicidal feelings to staff whenever they occur. c. Patient will engage in at least one social interaction with the unit population daily. d. Patient will consume a daily diet to meet both nutritional and hydration needs.

CR3. ANS b

CR4. What is the greatest trigger for the development of a patient's nurse focused transference? a. The similarity between the nurse and someone the patient already dislikes b. The nature of the patient's diagnosed mental illness c. The history the patient has with their parents d. The degree of authority the nurse has over the patient

CR4. ANS d

CR5. Which patient statement demonstrates a value held regarding children? a. "Nothing is more important to me than the safety of my children." b. "I believe my spouse wants to leave both me and our children." c. "I don't think my child's success depends on going to college." d. "I know my children will help me through my hard times."

CR5. ANS a

CR6. Mary is a 39-year-old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response? a. "I understand you are in a difficult situation." b. "Thinking about being wronged repeatedly does more harm than good." c. "I feel bad about your situation, and I am sorry it is happening to you and your family." d. "It must be so difficult to live with uncaring people."

CR6. ANS a

CR7. A registered nurse is caring for an older male who reports depressive symptoms since his wife of 54 years died suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior? a. Reminding the patient gently that he will "feel better over time" b. Using a soft tone of voice for questioning c. Sitting with the patient and taking cues for when to talk or when to remain silent d. Offering medication and bereavement services

CR7. ANS c

CR8. A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of the conversation. c. The student shares information to make the therapeutic relationship more equal. d. She explains that if he persists in focusing on her, she cannot work with him.

CR8. ANS b

CR9. Morgan is a third-year nursing student in her psychiatric clinical rotation. She is assigned to an 80-year-old widow admitted for major depressive disorder. The patient describes many losses and sadness. Morgan becomes teary and says meaningfully, "I am so sorry for you." Morgan's instructor overhears the conversation and says, "I understand that getting tearful is a human response. Yet, sympathy isn't helpful in this field." The instructor urges Morgan to focus on: a. "Adopting the patient's sorrow as your own." b. "Maintaining pure objectivity." c. "Using empathy to demonstrate respect and validation of the patient's feelings." d. "Using touch to let her know that everything is going to be alright."

CR9. ANS c

PO1. 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

PO1. ANS D Sympathy and the resulting projection of the nurse's feelings limit the client's opportunity to further discuss the problem. The remaining options are positive outcomes.REF: 133

PO2. 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

PO2. ANS D Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.REF: 127-128

PO3. 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

PO3. ANS A Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.REF: 127

PO4. 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

PO4. ANS C In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.REF: 127-128

PO5. 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.

PO5. ANS A Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.REF: 126-127, 133

PR1. During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? A. Preorientation B. Orientation C. Working D. Termination

PR1. ANS B Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship. This function is not associated with any of the other options.REF: 130-131

PR2. The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? Select all that apply. A. Helping patients examine self-defeating behaviors and test alternatives B. Promoting self-care and independence C. Providing the client with opportunities to socialize D. Assisting patients with problem solving to help facilitate activities of daily living E. Facilitating communication of distressing thoughts and feelings

PR2. ANS A, B, D, E Addressing the client's need to socialize is not one of the goals of establishing a therapeutic relationship. The other options are goals addressed in a therapeutic relationship.REF: 125

PR3. What term is a synonym for the characteristic of genuineness? A. Respect B. Empathy C. Authentic D. Positive regard

PR3. ANS C Genuineness refers the nurse's ability to be open, honest, and authentic in interactions with patients. It is the ability to meet others person-to-person without hiding behind roles. While positive characteristics, none of the other options related to genuineness.REF: 133

PR4. Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? A. Preorientation phase B. Orientation phase C. Working phase D. Termination phase

PR4. ANS D Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with the other phases.REF: 132-133

PR5. When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? A. Crisis intervention B. Therapeutic encounter C. Autonomous interaction D. Preorientation phenomenon

PR5. ANS B A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.REF: 126-127

RQ1. 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."

RQ1. ANS C This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient she will get over it does not reflect empathy and is closed-ended.

RQ2. 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."

RQ2. ANS B This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

RQ3. 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."

RQ3. ANS D This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

RQ4. 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.

RQ4. ANS A, C, D The other options describe the opposite meanings of social and therapeutic relationships.

RQ5. 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."

RQ5. ANS D The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.