Chapter 5 PREPU

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

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

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 is most important for the nurse to obtain about the client?

perception of the problem

The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase?

develop a sense of trust in the nurse

The graduate nurse asks the nurse preceptor to observe them during a new client admission assessment to the inpatient mental health unit. "Can you help me evaluate whether my verbal and nonverbal behavior is congruent?" Which nursing responsibility does this activity represent?

developing self-awareness

A client expresses frustration and believes the nurse does not want to help the client achieve wellness. Which phase of the deteriorating relationship is the client describing?

Struggling with The final phase of the deteriorating relationship is where the client struggles with the relationship and feels frustrated from the lack of support from the nurse. The first phase is withholding where the nurse is perceived as withholding support. The middle phases of this type of relationship are avoiding and ignoring. The client avoids the nurse who is perceived as rude and condescending.

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.

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

The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established?

"I feel worthless and have no real use in life."

The nurse is caring for a client diagnosed with chronic alcohol use disorder. The client tells the nurse that their drinking does not impact their children. The nurse notices feeling unexpectedly angry and recognizes that what may be occurring?

countertransference When the nurse responds to the client based on personal unconscious needs and conflicts; this is called countertransference. When the client responds to the nurse based on personal unconscious needs and conflicts, it is called transference.

Empathy vs. Sympathy

In empathy, we understand the feelings of others. In sympathy, we feel the feelings of others.

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.

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

working

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

The loss of therapeutic effectiveness

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

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

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

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?

"Any information is only shared with other professionals involved in your care."

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."

What occurs during the working phase of the nurse-client relationship?

evaluation of mutually identified goals

The most important tool of psychiatric nursing is the

self

When engaged in a therapeutic relationship, the nurse's focus is on what?

the client

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."

Which is not involved in empathy?

Feeling the same emotions that the client is feeling at a given time

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

rambling due to nervousness

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

the therapeutic use of self

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 mostappropriate nursing response?

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

A psychiatric-mental health nurse is sitting in the day room with a client. The client tells the nurse, "No one cares about me here." The nurse sits with an open, relaxed posture. Which action by the nurse demonstrates congruence?

"I care about you and want to sit with you to show that I care" in a calm, soft voice

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."

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

rapport

A positive relationship

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?

Ask to be reassigned because of having a prior personal relationship with the client.

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.

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.

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?

Orientation The orientation phase is the phase during which the nurse and client get to know each other. The nurse reads background materials available on the client and considers his or her personal strengths and limitations in working with this client.

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

Peplau

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. The nurse recognizes the client should be involved with which actions? Select all that apply.

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

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 the nurse's questioning best reflects the principle that all behavior has meaning and can be understood from the person's perspective.

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"

The nurse-client relationship is classified as which type of relationship?

Therapeutic

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

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

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

The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client?

establish professional boundaries listen intently to the client explain problems and issues explain what confidential information will be shared with others

The most important tool of psychiatric nursing is the:

self

During an early meeting in the orientation phase, a client arrives late and then accuses the nurse of sharing confidential information. In which way would the nurse interpret the client's behavior?

testing the relationship

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

Assessing 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.

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?

The client is able to independently express feelings and emotions with the client's friends.

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.

The nurse is preparing to interview a newly admitted client. Which action will the nurse make a priority during the first interaction with this client?

establish rapport

A client explains feelings of sadness and loss after the death of a close friend. Which nursing statement best demonstrates empathy?

"I see this is hard for you. How can I help?"

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?

"It can be scary to leave a place that you trust and feel supported."

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?

"Tell me why you are angry about what I just said."

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?

"Thank you but I will not accept these gifts because they extend over our discussed boundaries."

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.

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?"

A nurse is speaking to a client with a soft smile and eye contact. Which statement said by the nurse would indicate a congruent message?

"Your hard work and determination has helped you recover."

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?

"Your idea would help prevent this from happening again." In the working phase of the nurse-client relationship, the nurse encourages client to prepare for the future.

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 have already covered these issues -review with the client the learned methods to control the problems

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 that understands the client -the nurse begins to spend increasing amounts of time with one client on the unit

A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? A nurse speaking to a client at a distance of 4 feet A nurse hugging a client who had come in for an initial visit A nurse palpating the neck of a client during the assessment A nurse speaking to a depressed client in a very strict, disciplinarian tone A nurse holding the hand of a client who is depressed because of the client's child's chronic illness.

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 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. 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.

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 Reviewing the client history Discussion of client's expectations Strengthening of relationships Exploration of problems

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. Exploration of problems occurs during the working phase. Strengthening of relationships occurs during the resolution phase.

Which is an inaccurate statement regarding a preconception?

It enables the nurse to get an accurate picture of the client's problems. A preconception does not enable the nurse to get an accurate picture of the client's problems. It is a way that a person expects another to behave and can prevent people from getting to know one another. It may prevent the nurse from developing a therapeutic relationship with the client.

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 Home address Family members Reason for being on the unit

Name Level of education Reason for being on the unit

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 is most important for the nurse to obtain about the client?

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 the client with a mental disorder about the nature of the problem from the client's perspective.

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.

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. Personal safety Preventing deterioration of mental status Promoting mental health Promoting physical health Ensuring adequate sedation with medication

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.

A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?

Seeking assistance During the orientation phase, the client seeks assistance, identifies needs, and commits to a therapeutic relationship; the client begins to test the relationship later in this phase. The client discusses underlying needs and tests new ways to solve problems in the working phase. The nurse is responsible for establishing boundaries during the orientation phase.

A client describes panic attacks during which the client rushes to the emergency department with a feeling that death may be imminent. The nurse discloses having had panic attacks during which the nurse also felt very fearful. Which statement about the nurse's self-disclosure is accurate?

Self-disclosure can help normalize the client's experience. Nurses may use self-disclosure in the nurse-client relationship to comfort a client who is feeling frustrated and hopeless, enhance trust, decrease role distancing, facilitate the client's self-disclosure, convey support, or normalize the client's experience.

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.

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 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

A new nurse is conducting an admission interview and the client repeatedly uses the phrase "dirty whor*" when talking about their spouse and children. Which action(s) by the nurse, if observed by the nurse manager, will require the nurse manager to intervene? Select all that apply.

asking another nurse to complete the interview communicating distaste in the comment nonverbally telling the client using the phrase may result in loss of privileges

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 expectations, reviewing the client history

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

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.Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others.

The graduate nurse asks the nurse preceptor to observe them during a new client admission assessment to the inpatient mental health unit. "Can you help me evaluate whether my verbal and nonverbal behavior is congruent?" Which nursing responsibility does this activity represent?

developing self-awareness Seeking feedback from colleagues and others is an essential component of developing self-awareness.

While engaged in a conversation during the working phase, the nurse reminds the client that the relationship is going to end once the client's problems have resolved. Which reaction would indicate to the nurse that the client is experiencing stress about terminating the relationship?

expresses anger towards the nurse

The nurse and client have been meeting weekly. Which action indicates to the nurse that the relationship has moved into the working phase?

identifies problems to work on

What activity should be included in the first step of self-awareness?

identifying one's own values, attitudes, strengths and weakness

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

identifying past ineffective behaviors

The manager schedules a staff nurse to attend a motivational interviewing training session. Which nurse behavior caused the manager to make this decision? Select all that apply.

interrupting the client, minimizing the client's concerns, arguing with a client over agreed plans

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

shifting the emphasis to the nurse

The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply.

skips the last session, expresses anger towards the nurse and other clients, identifies a resolved problem as a new one needing to be addressed

The nurse has been meeting with a client for several weeks. Which action indicates to the nurse that the relationship is demonstrating signs of being nontherapeutic?

the client and nurse are frustrated with the conversation

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

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

When engaged in therapeutic communication with a client who has been diagnosed with a mental disorder, which is the most important principle for a nurse to keep in mind?

the client is the primary focus of the interaction

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 is preparing to implement motivational interviewing with a client. Which action(s) will the nurse take when implementing this technique? Select all that apply.

use empathy, roll with resistance, negotiate plans to change, strengthen the client's talk about change