Mental 5

As a result of the Tarasoff decision

, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.

When client self-exploration occurs

, the nurse encourages the client to learn positive adaptive or coping skills. Self-disclosure refers to the nurse sharing personal information with the client in order to establish trust and improve rapport. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate understanding to the client. Respect is also a condition essential for a therapeutic relationship to occur; however, it is not reflective of the client's adaptive coping.

judgemental attitude

A 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what?

The nurse is empathizing with the client.

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 therapist must notify authorities and the potential victim.

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?

Client self-exploration

A client tells the mental health nurse that the client is taking a sewing class to cope with the client's son's move to another state. The use of this adaptive coping skill is an example of which aspect in the therapeutic relationship?

attitude

A client with a diagnosis of bipolar I disorder has been presented with a coping strategy by the therapist that may help the client manage behavior during manic episodes. The client has responded to the therapist's suggestion by saying, "What's the use? I don't ever see this changing." The client's statement is suggestive of a potential problem with what factor that influences communication?

Which clinical situation provides an example of transference?

A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers. Transference or parataxic distortion occurs when a client exhibits the same attitudes and behaviors with a caregiver as with a significant, seemingly similar person in the client's life.

The nurse should notify to the primary healthcare provider.

A nurse is caring for a client experiencing delusions. The client tells the nurse "I am sure my brother has plans to kill me. But I am ready; I will be killing him before he tries to reach me." What is the appropriate action of the nurse in this situation?

orientation

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?

working phase,

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?

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

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

Remind the client about the importance of boundaries to keep the relationship therapeutic

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?

Rambling due to nervousness

A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session?

The client is nervous and insecure.

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?

"You must have been really upset."

A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse?

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

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?

trust

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?

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

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?

Unconditional positive regard

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?

The client brings the nurse a baked item for their lunch. The nurse is spending more time with the client than the others in the group. The nurse tells a friend that the nurse is the only one who truly understands this client

A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibility that the relationship may be moving outside professional boundaries?

end

According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems, and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an

The client's has made a homicidal threat (expressed wish to kill his brother).

According to the law, the nurse is supposed to report the homicidal threat to the nursing superintendent and the attending physician. They would inform about the threat to the police and intended victim. This action is referred to as the duty to warn. Sedating the client would not prevent the client from having homicidal intentions. The client has a psychiatric illness. Advising the client to stop having this thoughts in inappropriate. Threatening the client would only make these feelings much stronger in the client.

ineffective therapeutic use

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. This conversation does not influence the client care in any way. Asking the client about pain indicates that the nurse is gathering information about the client's illness. Asking about the client's food preference indicates that the nurse is finding about the nutrition habits of the client. Asking if the client has informed the spouse about the illness indicates that the nurse is allowing the client to take decisions regarding revealing the condition to other people. These questions indicate that the nurse is engaging in therapeutic communication with the client.

The loss of therapeutic effectiveness

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

void of genuine interest.

By stating "you must have been really upset," the nurse avoids communicating value judgments about the client's behavior. Indicating that the client attempted to kill oneself for a trivial goal, asking what the client would gain by killing oneself, or telling the client that the behavior was wrong indicate that the nurse is judgmental and

empathy

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:

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

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?

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

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?

working.

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

working..

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

Which is not involved in empathy?

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

Which is an inaccurate statement regarding a preconception?

It enables the nurse to get an accurate picture of the client's problems.

therapeutic relationship

On meeting with the client for the first time, the nurse should share appropriate information about the nurse with the client. This information includes the nurse's name, level of education of the nurse, and the reason for being on the unit. Revealing personal information like personal home address and information about the nurse's family to the client is not appropriate in a .

previous relationship dilemma, what to do?

Since the nurse had a previous personal relationship with the client, the therapeutic boundary is questionable. The best course of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the professional-personal boundary. When concerns arise related to therapeutic boundaries, the nurse must seek clinical supervision or transfer the care of the client immediately.

orientation,

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?

is attempting to prolong the nurse-client relationship.

Termination takes place during the resolution phase of a nurse-client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client:

In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them.

The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.

"What types of dresses do you like wearing?"

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self?

working

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase?

working phase

The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship.

true.

The most important tool of psychiatric nursing is the self

self

The most important tool of psychiatric nursing is the:

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

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?

develop a sense of trust in the nurse

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

Countertransference .

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?

working phase explanation

The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.

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

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?

transitional relationship model

The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating?

true

The nurse needs to treat each person with respect and dignity, regardless of personal value conflicts.

To prevent the client from viewing the nurse as a friend rather than health care provider

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?

shifting the emphasis to the nurse

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

Name Level of education Reason for being on the unit

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose?

the therapeutic use of self

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

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

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

advocate

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?

Hildegard Peplau

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

trust with the client.

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for the purpose of eliciting the client's cooperation through the establishment of trust. All the other options are important, but first, the nurse must establish

Eliciting the client's cooperation through the establishment of trust

While providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason?

In the resolution phase,

actual problems are resolved and the relationship terminates. During the resolution phase, the client is redirected toward a life without this specific relationship. The client connects with community resources, solidifies a newfound understanding, and practices new behaviors.

Termination phase

although it begins on the first day of the relationship, marks the end of the relationship.

Being empathetic is

an active process requiring careful listening and attending to the client. Direct eye contact, a concerned expression, occasional head nods, and a lean forward while listening are nonverbal communication skills that convey empathy. Empathetic responses, such as "You're going through a difficult time," can provide clients with an opportunity to listen to themselves and gain self-awareness.

professional environment.

an important component of trust is confidentiality. Mental health providers must reassure clients that they will not share the details of clients' lives outside the

Judgmental attitudes

and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, "Why doesn't this person just snap out of it, put his or her problems in perspective, or focus on something else?" Countertransference refers to the nurse's response to the client based on personal unconscious needs and conflicts. Exploitation refers to the phase in the therapeutic relationship when the nurse guides the client to examine feelings and responses to develop better coping mechanisms and a more positive self image. Poor boundaries refers to inappropriate levels of personal disclosure to the client or overly social/intimate relationships with the client.

Peplau's theory is

based on the nurse-client relationship as a therapeutic tool.

It is not unusual for clients with mental disorders to

bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

A congruent message is

delivered when the actions and the words spoken match. The nurse has a smiling facial expression which indicates that the nurse is happy. The statement that the client's hard work and determination has warded off the disease indicates that the nurse is happy with the outcomes of the client's hard work. A smiling facial expression while saying this statement would deliver a congruent message. The statement that the client should not disturb the other clients in the ward indicates that the nurse is irritated. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should listen to the instructions before starting the exercises indicates a focused approach. A smiling facial expression while saying this statement would not deliver a congruent message. The statement that the client should wait for the medicines to show the therapeutic effect indicates that the nurse has sympathy for the client. A smiling facial expression while saying this statement would not deliver a congruent message.

One component of the transitional relationship model is

extending the therapeutic relationship until a new relationship with another care provider is established. Avoid and ignore is a phase within a deteriorating relationship where the nurse is perceived as rude and condescending because of ignoring and voiding the client's requests for help. Mutual withdrawal is the final phase of a deteriorating relationship. Motivational interviewing has specific steps that are used to enhance decision-making ability.

Indicators that the relationship may be moving outside professional boundaries are

gift giving on either party's part, spending more time than usual with a particular client, strenuously defending or explaining the client's behavior in team meetings, the nurse feeling that he or she is the only one who truly understands the client, keeping secrets, or frequently thinking about the client outside of the work situation.

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.

Countertransference

is an emotional reaction to the client based upon personal unconscious needs and conflicts. The nurse should recognize that countertransference can occur and prevent it from eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement caused hostility. Defending the statement such as saying, "I am only doing my job," "I am only trying to help you," and "I'll find someone else," demonstrates countertransference.

The priority reason the psychiatric nurse

is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.

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 their feelings. The nurse does not actually have to have had the experience but has to be able to imagine the feelings associated with it. For empathy to develop, there must be a giving of self to the other individual and a reciprocal desire to know each other personally. The process involves the nurse receiving information from the client with open, nonjudgmental acceptance and communicating this understanding of the experience and feelings so the client feels understood. Acknowledging that leaving the hospital can be scary because the client will miss the trust and support provided demonstrates empathy. Questioning about independence, having the client think about things that can be done in the home versus the hospital, and telling the client to have faith in accomplishments do not demonstrate empathy for the client's fear.

the orientation phase

is the phase during which the nurse and client get to know each other. During this phase, the client develops a sense of trust in the nurse. In the working phase, the client works through problems and identifies potential solutions to issues. During the termination phase, problems are resolved.

Self-disclosure examples are

most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the option are inappropriate.

A client is usually

nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Showing up late, being confrontational, and bragging are nontherapeutic ways to not participate in the session.

A tone of defeatism

or resignation is indicative of an attitude that may inhibit communication and treatment.

During the orientation phase,

professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.

the psychiatric nurse recognizes

that excessive social communication with a client is to be avoided primarily because it is likely to encourage the client to view the nurse as a friend rather than health care provider. Boundaries of the nurse-client relationship can only be set effectively if the nurse primarily engages in therapeutic communication with the client as opposed to social communication.

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. This would help the client to feel comfortable and safe while sharing feelings with the nurse. Sympathy is the ability of the nurse to project his or her concern toward the client. The nurse does not perceive the problem of the client. If the nurse is able to empathize with the client then it indicates that the nurse is showing genuine interest and is listening actively to the client.

During the resolution phase,

the client connects with community resources, solidifies a newly found understanding, and practices new behaviors. The client also interacts with significant others in new ways. Trying different coping strategies, exploring emotions and feelings, and increasing ability to express feelings would occur during the working phase.

During the working phase,

the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

During the working phase

the client uses the relationship to examine specific problems and learn new ways of approaching them. Debriefing is not a phase of the nurse-client relationship. During the orientation phase, the nurse and client get to know each other. The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.

he 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. The working stages involves problem identification and exploitation. Resolution, or the termination phase, begins when problems are resolved and signals the end of the therapeutic relationship. Withholding is a phase in a deteriorating relationship in which the nurse is perceived as withholding nursing support.

orientation phase

the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies the client's problems, and clarifies expectations.

In the advocate role,

the nurse informs the client and then supports the client in whatever decision the client makes. The primary caregiving role in mental health settings is the implementation of the therapeutic relationship to build trust and explore feelings. In the teacher role, the nurse instructs the client about the client's medication regimen. In the role of the parent surrogate, the nurse may be tempted to assume a parental role.

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.

Countertransference refers

to an instance when the nurse has preconceived attitudes or feelings toward a patient that stem from prior experience. When feelings, either positive or negative, seem extreme or disproportionate to the circumstances, the nurse should consider whether a transferential reaction has occurred.

Empathy is trying

to understand the experience of the other person. It is not possible for nurses to feel the actual emotions of the other person.

Through the therapeutic use of self,

via therapeutic relationships and communication, nurses help people adapt, change, and grow. Medications and education will influence and enhance growth, but the therapeutic use of self is the nurse's primary tool. Self-help groups do not involve health care professionals.

Congruence occurs

when words and actions match. The nurse demonstrates this by fulfilling the promise made to the client. While the remaining options are appropriate behaviors that positively affect the nurse-client relationship, they do not demonstrate congruence.

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 (making extra visits when time does not allow for them or calling clients when off duty).