Ch.9 Pscyh
During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response? A. "Any information is only shared with other professionals involved in your care." B. "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." C> "It depends upon what they ask me. I might be able to withhold some information, but not all." D. "Is there some reason why you don't want your family to know your problems?"
A. "Any information is only shared with other professionals involved in your care."
A client being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the client. The nurse can best assist the client in this stage of the relationship with which response? A. "I can sense you are angry this morning. Tell me how you feel about being discharged today." B. "We have to go over these instructions before you can go. Please try to listen." C. "Would you rather not be discharged today?" D. "You should be able to regulate your feelings better by now. Why are you angry?"
A. "I can sense you are angry this morning. Tell me how you feel about being discharged today."
The nurse is working in the mental health clinic communicating with a client who is having auditory hallucinations. What should the nurse say to effectively communicate with this client? A. "I understand that the voices seem real to you, but I don't hear them." B. "Don't worry about the voices. The medications will make them disappear." C. "Turn the radio up so the voices are muted." D. "My aunt has the same diagnosis as you and also hears voices."
A. "I understand that the voices seem real to you, but I don't hear them."
The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond? A. "Let's talk about infections, and how they heal." B. "Why don't you call a friend in to watch TV with you?" C> "Oh, it is just the infection; in a day or so you'll feel better." D. "Why don't you just rest in bed?"
A. "Let's talk about infections, and how they heal."
During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference? A. "Tell me why you are angry about what I just said." B> "I am only doing my job." C. "I am only trying to help you." D. "If you don't want to continue with me, I'll find someone else."
A. "Tell me why you are angry about what I just said."
During the mental status assessment, the client expresses the belief that the CIA is stalking the client and plans to kidnap the client. Which would be the best response by the nurse? A. "What kinds of things have been happening?" B. "You can tell me about that after I finish asking these questions." C. "That makes no sense at all." D> "Why would the CIA be interested in you?"
A. "What kinds of things have been happening?"
The nurse is caring for a client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest? A. Caregiver B. Advocate C> Teacher D. Parent surrogate
A. Caregiver
A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response? A. It's important to get a break from time to time. How have the last few days been for you? B. I'm really not at liberty to talk about my activities outside of work. I hope you understand. C. I didn't do anything particularly special, but it's always nice to spend time with my family. D. Well, if you had to guess, what do think that I might do in my time outside of work?
A. It's important to get a break from time to time. How have the last few days been for you?
The client is getting ready to be discharged from the psychiatry unit. A nurse and client has just completed reviewing the client's take-home medications. The nurse is exemplifying which role during this intervention? A. Teacher B. Advocate C. Parent surrogate D. Caregiver
A. Teacher
A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase? A. The client is able to independently express feelings and emotions with the client's friends. B. The client explores the emotions and feelings related to the traumatic experience. C. The client becomes more expressive about the client's feelings to the nurse. D. The client tries different coping strategies to deal with stress.
A. The client is able to independently express feelings and emotions with the client's friends.
During a therapeutic communication session, the nurse tells the client of a past experience. Which statement best reflects the nurse's use of self-disclosure? A.Self-disclosure on the nurse's part should benefit the client. B.Self-disclosure should be used with all clients to some degree. C>It forms the solid foundation for effective communication. D>The more the nurse discloses, the more the client will disclose
A.Self-disclosure on the nurse's part should benefit the client.
An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by: A.validating the client's ability to make decisions and effect change. B.reviewing the benefits of the client's treatment to this point. C.teaching the client about the concept of recovery and the likelihood of setbacks. D.emphasizing the importance of adhering to the prescribed drug regimen
A.validating the client's ability to make decisions and effect change.
During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts? A>"Thank you but I will not accept these gifts because they extend over our discussed boundaries." B>"How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" C."They look delicious and I love candy but I'm on a diet and really can't accept them." D>"Thank you so much. I will share them with the other nurses."
A>"Thank you but I will not accept these gifts because they extend over our discussed boundaries."
The nurse educator is teaching the class about communication. Which statement by the student nurse best describes the basic elements of communication? A>"The basic elements of communication include feedback, sender, receiver, and messages." B>"The basic elements of communication include receiver, feedback, flow, and expression." C>"The basic elements of communication include sender, receiver, flow and message." D>"The basic elements of communication include message, sender, feedback, and gesture."
A>"The basic elements of communication include feedback, sender, receiver, and messages."
The nurse understands that empathy is essential to the therapeutic relationship. When a client makes the statement, "I am just devastated that my marriage is falling apart," the nurse can best show empathy through which response? A>"You feel like your world is falling apart right now." B>"It will get better; let's talk about it." C>"I feel so bad for what you are going through." D."I have been divorced, too. I know how hard it is."
A>"You feel like your world is falling apart right now."
The nurse uses a variety of therapeutic communication skills when working with clients. Which is a therapeutic goal that can be accomplished through the use of therapeutic communication skills? A>Assess the client's perception of a problem B>Provide the client with a plan of action C>Inform the client of priority problems D>Assist the client to control emotions
A>Assess the client's perception of a problem
The nurse is caring for a client that is very confused. What intervention should be included with the nurses' non-communication with the client? A>use of gentle touch during activities of daily living B>instructions for feeding the confused client C>speaking louder so the client can hear D>a flat affect so the client will not be misinterpreted
A>use of gentle touch during activities of daily living
The nurse and the client are using therapeutic communication skills. Which statements are true of concrete and abstract messages? Select all that apply.
Abstract messages include figures of speech that are difficult to interpret. Concrete messages are clear, direct, and easy to understand.
The nurse is working with a client who has quit several jobs and no longer sends financial support to the client's two children living with their other parent. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the client, the nurse shows positive regard through which statement? A. "Can the children's other parent get by for a while until you get better?" B. "How is not working right now affecting you?" C> "How do you expect your kids to be provided for?" D. "You need to somehow find a way to support your children." "
B. "How is not working right now affecting you?"
A nurse is caring for a client with depression. The client says that the client cannot stop thinking about the client's dead spouse. Which self-disclosure example given by the nurse is most appropriate? A. "I can understand your situation. Medication could be of great help to relieve your depression." B. "I can understand your situation; my cousin lost a spouse a few months ago." C."I just had a divorce; I can understand how it would feel to be without a partner." D."My father passed away recently. I can understand your problem."
B. "I can understand your situation; my cousin lost a spouse a few months ago."
A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response? A. "Why haven't you taken a shower yet?" B. "I notice it has been a while since you have had a shower." C. "Don't worry, take as long as you need before you get going." D. "I think you need to take a shower."
B. "I notice it has been a while since you have had a shower."
Which statement by the nurse is an example of assertive communication? A. "I'm so happy that you finally decided to join us here in group." B. "I understand that group can be difficult to attend but coming late is disruptive." C. "Oh, you must be really busy to be this late getting to group." D. "You are so rude; I just won't tolerate that in my group."
B. "I understand that group can be difficult to attend but coming late is disruptive."
The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment? A. "Just think of all of the things you can do in the home that you can't do here." B. "It can be scary to leave a place that you trust and feel supported." C. "Don't you think you're ready to be independent?" D> "You are more than ready to get out of here. Have faith in your accomplishments."
B. "It can be scary to leave a place that you trust and feel supported."
The graduate nurse is working in mental health and is learning about the use of touch with clients that have psychiatric disorders. The seasoned mental health care nurse differentiates information about this part of therapeutic communication by stating which information? A. "Touch is best mixed with compassion when dealing with the anxious client." B. "Touch carries different meanings for different individuals." C. "Touch is used to express interest and warmth." D. "Touch is used in situations in which the client is unstable."
B. "Touch carries different meanings for different individuals."
During the admission interview, the nurse asks the client what led to the client's hospitalization. The client responds, "They lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born." What would be the best initial response by the nurse? A. "I just saw your mother. She's fine." B. "You're having very frightening thoughts." C. "If your mother died before you were born, you wouldn't be here." D> "We'll put you in a private room until you're in better control."
B. "You're having very frightening thoughts."
Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? A. Leaning slightly forward to the client B. Sitting behind a desk C. Facing the client at eye level D. Keeping arms and legs uncrossed
B. Sitting behind a desk
The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries? A. Ask another nurse to attend the meetings to ensure boundaries are not crossed. B> Ask to be reassigned because of having a prior personal relationship with the client. C. Plan to meet the client since the personal relationship ended. D. Meet for the first session but explain that another nurse will be assigned going forward.
B> Ask to be reassigned because of having a prior personal relationship with the client.
The nurse is reviewing the client's history, identifies themes, 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? A. Resolution B> Orientation C. Working D. Withholding
B> Orientation
A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic? A>"It makes me feel good that you trust me so much; it is important for the work we are doing together." B>"Since ours is a professional relationship, let's explore other opportunities in your life for friendship." C>"We are definitely not friends. This is strictly professional." D>"I am sure there are other people in your life who are your friends; besides, we just met."
B>"Since ours is a professional relationship, let's explore other opportunities in your life for friendship."
A client states, "Right before I got here I was doing all right. My job was going well, my spouse and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your spouse were happy. Tell me more about that." This is an example of which therapeutic technique? A>General lead B>Exploring C>Restating D>Encouraging comparison
B>Exploring
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? A>Careful listening B>Feeling the same emotions that the client is feeling at a given time C>Being in touch with what the client is saying D>Having insight into the meaning of clients' thoughts, feelings, and behaviors
B>Feeling the same emotions that the client is feeling at a given time
While the nurse and client are in a therapy session, the nurse says to the client, "You become very anxious when we start talking about your drinking." Which technique is the nurse using? A>Verbalizing the implied B>Making an observation C.Translating into feelings D>Confronting behavior
B>Making an observation
A psychiatric-mental health nurse is using the Transitional Relationship Model as a strategy for developing therapeutic relationships. When applying this model, the nurse understands that it is based on the works of which theorist? A>Orem B>Peplau C>Rogers D>Freud
B>Peplau
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? A.The nurse is showing genuine interest in the client. B>The nurse is empathizing with the client. C>The nurse is comforting the client. D>The nurse is sympathizing with the client.
B>The nurse is empathizing with the client.
An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by: A>teaching the client about the concept of recovery and the likelihood of setbacks. B>validating the client's ability to make decisions and effect change. C>reviewing the benefits of the client's treatment to this point. D>emphasizing the importance of adhering to the prescribed drug regimen.
B>validating the client's ability to make decisions and effect change.
When engaged in a therapeutic relationship, the nurse's focus is on what? A. The self B> The family C. The client D. The environment
C. The client
A client experienced physical abuse by his father when he was a child. The client explains some of the intense financial and interpersonal stress that his father was experiencing at the time and describes the relationship between psychosocial stress and abuse. How should the nurse best interpret the client's statement? A. The client is in denial that his father's actions were abusive B. The client has delusions about the circumstances surrounding his abuse C. The client is intellectualizing this traumatic event in order to deal with the emotions involved D. The client has likely processed this trauma successfully as evidenced by his ability to discuss it
C. The client is intellectualizing this traumatic event in order to deal with the emotions involved
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? A. Orientation B. Mutual withdrawal C. Working D. Resolution
C. Working
The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? A. resolve pressing problems B. identify potential solutions to issues C. develop a sense of trust in the nurse D. work through problems
C. develop a sense of trust in the nurse
A client diagnosed with borderline personality disorder is pitting one nurse against the other, calling one a best friend and declaring that the other is horrible. The client is using which defense mechanism? A. sublimation B. suppression C. splitting D. self-observation
C. splitting
The client is getting ready to be discharged from the psychiatry unit. A nurse and client has just completed reviewing the client's take-home medications. The nurse is exemplifying which role during this intervention? A.Caregiver B.Parent surrogate C.Teacher D.Advocate
C.Teacher
A psychiatric-mental health nurse is developing a therapeutic relationship with a client. The nurse demonstrates acceptance by which action? A.The nurse communicates perception of the meanings and feelings of the client. B.The nurse approves of the demonstration of any inappropriate behavior by the client. C.The nurse avoids judgments about the client, no matter what the behavior is. D>The nurse implements actions to punish the client for inappropriate behavior.
C.The nurse avoids judgments about the client, no matter what the behavior is.
Nurses develop empathy with their clients while gathering information about the client. Which of the following hinders the development of empathy? A.focusing on one issue B>asking leading questions C.interjecting personal experiences D.asking the client to restate for clarity
C.interjecting personal experiences
During the working phase of a therapeutic relationship, which action by the nurse would best help the client to explore problems? A. Referring the client to a self-help group B> Comparing past and present coping strategies C> Encouraging the client to clarify feelings and behavior D. Identifying possible solutions for the client's problems
C> Encouraging the client to clarify feelings and behavior
Which would be considered a "usual or expected" response during the first few sessions? A. Bragging about sexual conquests B. Showing up late for the first session C> Rambling due to nervousness D. Being confrontational with nurse and other group members
C> Rambling due to nervousness
The client tells the nurse, "I'm frightened about my surgery tomorrow." What response by the nurse is best? A>"Didn't the surgeon answer all your questions?" B>"What's to be frightened about, the OR crew will take care of you." C>"Can you tell me what frightens you?" D>"Hundreds of people have this surgery daily."
C>"Can you tell me what frightens you?"
A client is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the client to talk? A>"If you are sleepy, would you like me to help you back to your room?" B>"Why are you sitting with your eyes closed?" C>"You look like you are deep in thought." D>"Is something wrong?"
C>"You look like you are deep in thought."
Which communication technique does a nurse use in establishing trust and developing empathy? A>Observation B>Doubt C>Acceptance D>Confrontation
C>Acceptance
A client experienced physical abuse by his father when he was a child. The client explains some of the intense financial and interpersonal stress that his father was experiencing at the time and describes the relationship between psychosocial stress and abuse. How should the nurse best interpret the client's statement? A>The client is in denial that his father's actions were abusive B>The client has likely processed this trauma successfully as evidenced by his ability to discuss it C>The client is intellectualizing this traumatic event in order to deal with the emotions involved D>The client has delusions about the circumstances surrounding his abuse
C>The client is intellectualizing this traumatic event in order to deal with the emotions involved
It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client? A>The nurse examines the genital area of a client diagnosed with a sexually transmitted infection. B>The nurse speaks on topics like sports while performing assessment on the client. C>The nurse is having dinner with a client outside the hospital premises. D>The nurse is talking to the spouse of the client regarding the client's condition.
C>The nurse is having dinner with a client outside the hospital premises.
A nurse is developing a therapeutic relationship with the client. To do this, the nurse must respect the client's religious and spiritual beliefs. Which will occur if the nurse does not show this respect? A.leads to mental health relapse B.longer rehabilitation C>eroding trust D.frustration for the client
C>eroding trust
A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs? A>to discuss it at another time B>to disengage from the interaction C>more time to think D>to avoid the topic
C>more time to think
A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should: A>diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. B>seek out a mentor who has extensive experience in the psychiatric-mental health area. C>reflect critically on the student's own life experiences, perspectives, and characteristics. D>decide what aspects of the student's life and experience the student is willing to disclose to clients.
C>reflect critically on the student's own life experiences, perspectives, and characteristics.
The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to ... A.investigate the source of nonverbal behavior. B.validate the client's feelings. C>validate the meaning of the nonverbal behavior. D>increase the client's awareness of nonverbal behavior.
C>validate the meaning of the nonverbal behavior.
Which statement would be an empathetic response in a client interaction? A. "Why do you think your father chose that time and place to yell at you?" B. "You really should find your own housing and get out of the situation with your father." C. "Well, it sounds like your father has difficulty controlling his temper." D. "You must have been embarrassed when your father yelled at you in the grocery store."
D. "You must have been embarrassed when your father yelled at you in the grocery store."
The nurse asks the client, "What was it like for you when you first knew you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic? A. Apologize for asking such a personal question B. Change the subject to something the patient will discuss C. Encourage the patient to express any unpleasant feelings D. Sit quietly until the patient responds
D. Sit quietly until the patient responds
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? A. The client is experiencing symptoms of a disorder. B> The client is demonstrating a normal reaction. C. The client is attempting to engage in a social relationship. D. The client is nervous and insecure.
D. The client is nervous and insecure.
A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation? A. The client is eager to dialogue with the nurse but is unsure how best to proceed B. The disconnect between the client's verbal and nonverbal messages confirms the presence of mental illness C> The client is glad to talk to the nurse because that is what the client stated D. The client may be reluctant to dialogue despite the statement to the contrary
D. The client may be reluctant to dialogue despite the statement to the contrary
A nurse is communicating with a client who is highly anxious. During the conversation, the nurse notices that the nurse's speech is matching the fast pace of the client's speech, and the nurse's heart rate is increasing. The nurse identifies this as: A. defense mechanism. B. boundary violation. C. rapport. D. empathetic linkage.
D. empathetic linkage.
A client being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the client. The nurse can best assist the client in this stage of the relationship with which response? A>"You should be able to regulate your feelings better by now. Why are you angry?" B>"Would you rather not be discharged today?" C>"We have to go over these instructions before you can go. Please try to listen." D>"I can sense you are angry this morning. Tell me how you feel about being discharged today."
D>"I can sense you are angry this morning. Tell me how you feel about being discharged today."
The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse? A>self disclosure B>empathetic linkages C>self awareness D>active listening
D>active listening
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? A>being too general with the details of the story B.using situations that have occurred on the unit C>providing advice on how to manage a problem D>shifting the emphasis to the nurse
D>shifting the emphasis to the nurse
Which is often considered the most difficult yet most effective communication technique? A>clarifying B.restating C>reflecting D>silence
D>silence
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.