Phil 1 184-212

"I'm glad you were able to tell me how you felt about your loss."

This statement shows use of accepting, a therapeutic technique.

Which statement by a nurse may underrate a patient's feelings and belittle the patient's concerns?

a. "You appear tense." b. "I'm not sure I follow you." c. "Everything will be all right." d. "I notice you are biting your lip." ANS: C "Everything will be all right" offers false reassurance. This is a nontherapeutic technique and suggests a patient's views and feelings are not being taken seriously. The other options use therapeutic techniques.

A depressed patient is unable to maintain eye contact with the nurse. The patient's chin drops, and the patient looks at the floor. Which aspect of communication has the nurse assessed?

a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills ANS: A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine whether a cultural barrier exists or the level of the patient's social skills.

A therapeutic relationship has four phases. Place these phases in proper order.

a. Orientation b. Termination c. Preparation d. Working ANS: C, A, D, B Each of the phases of the therapeutic relationship has identifiable tasks and goals that must be met before advancement to the next phase.

The nurse is collecting the paintings from the clients after the art session is over. A client hands the nurse his paper, which consists of several black scribbles. Which statement reveals nurse understanding of the goals and objectives of art therapy?

1. "(Name), do you want to complete your painting?" 2. "What happened, (Name), don't you like to paint?" 3. "Can you tell me what happened, (Name)?" 4. "Thank you, (Name), I'll put this away for you." ANS: 4 Art therapy is used to help resolve conflicts and promote self-awareness. The nurse should not comment on the quality of the art or the client's talents, but rather treat the project with respect and value. The work is simply each client's self-expression. The other options make judgments about the work.

When a client asks the nurse, "How can jolting me with an electrical shock possibly do me any good?" the answer most reflective of current biologic theory would be:

1. "ECT produces a change in brain chemistry that results in improved mood." 2. "ECT provides you with external punishment so you can stop punishing yourself." 3. "ECT interrupts brain impulses causing hallucinations and delusions." 4. "ECT must sound like a very frightening treatment alternative to you." ANS: 1 Current theory regarding use of ECT is that the electrical stimulus causes electrochemical changes within the brain, resulting in increased availability of neurotransmitters at the synapses and improvement of mood. The other options do not address current biologic theories.

The nurse was reviewing notes she had written following a session with a family who had begun therapy in hopes of becoming a more unified family. Because of their schedules, they were feeling alienated and estranged from each other. Which statement by the 16-year-old son was considered by the therapist as positive evidence of movement toward problem resolution?

1. "I have stopped playing football since practice required me to be away from home so often." 2. "Eating dinner with my parents on Sunday nights has helped us be more aware of each other's needs." 3. "Since my mother quit her job, she is more available to keep the home running smoothly." 4. "My dad has stopped giving me advice on how to live my life." ANS: 2 This statement shows the family has made an effort to improve communication and deal with alienation without any one member bearing complete responsibility. 1. Withdrawing from the team suggests he felt solely responsible for the family problem. 3. Quitting the job suggests the mother saw herself as responsible; however, being home does not guarantee unification. 4. This suggests withdrawal of the father from participation in family matters.

During a nurse-client interaction, the nurse will identify cognitive errors when he or she hears which of these statements? (You may select more than one answer.)

1. "I think I will do well on the next exam, because I have studied." 2. "I failed the last exam; I know I will fail the next one." 3. "Whenever I burn the toast in the morning, I know the whole day will be a mess." 4. "I never do anything right." 5. "My parents had a lot of problems, but I have learned from their mistakes." ANS: 2, 3, 4 Option 1 is a rational thought. Option 2 is the cognitive error of overgeneralization. Option 3 is catastrophizing. Option 4 is overgeneralization. Option 5 is a rational thought.

A nurse on the unit is meeting with her client for the first time. After introducing herself, which of these possible statements best defines the nurse's role as the client's ally and helper?

1. "I will work with your doctor to help you get better." 2. "I'll be working with you to look at problems that are troubling you." 3. "Your medications will help you feel better as soon as they take effect." 4. "You will be expected to attend group activities while you are here." ANS: 2 This statement clearly specifies the nurse's purpose as a helping professional, and establishes the relationship as therapeutic, rather than social. 1. This statement is true but limiting. The nurse has independent functions. 3. This statement overlooks the contributions of staff and the therapeutic milieu. 4. Giving information is appropriate, but this statement does not define the nurse's role as helper and ally.

Which statement by a client who has given informed consent for ECT confirms the client's understanding of the side effects of this treatment?

1. "I won't remember the pain." 2. "It will take several weeks before I feel good again." 3. "Memory loss will be only temporary." 4. "I will be at increased risk for developing epilepsy." ANS: 3 Temporary impairment of recent memory is an expected side effect that occurs to some degree during the course of ECT. The other options suggest the client's understanding of treatment and side effects is flawed.

The nurse and client were interacting during a one-to-one session on the psychiatric unit. In response to the nurse's statement, "Tell me about your family," the client became silent and displayed nonverbally that he was uncomfortable. Which of these statements reflects the nurse's sensitivity to the client?

1. "I'm so sorry. I didn't realize your family was a problem for you." 2. "Learning to express negative feelings will assist you in getting well." 3. "Perhaps you can talk about your feelings to the physician next time you meet." 4. "That seems to be a difficult subject for you. We can discuss it later, if you prefer." ANS: 4 This response acknowledges the situation, is respectful, and refocuses the therapeutic interaction. Option 1 is not sensitively worded. Option 2 offers false reassurance and implies that feelings are negative. Option 3 represents avoidance of dealing with the client's feelings.

A new nurse who will be assessing a client who is receiving ECT asks her mentor, "What sort of memory impairment is present after several ECT treatments?" The best response for the mentor would be:

1. "It's hard to say. Treatment affects everyone differently." 2. "Usually the client has severe difficulty remembering remote events." 3. "Clients have mild difficulty remembering recent events like what was eaten for breakfast." 4. "Both recent and remote memory is affected, producing profound confusional states." ANS: 3 Most clients experience transient recent memory impairment after ECT. The cognitive deficit becomes more pronounced as the number of treatments increases. When the course of treatments is completed, cognitive deficit generally improves to the pretreatment level. The other options are incorrect.

After a nurse who had worked with persistently mentally ill clients transfers to the short-term inpatient unit, he tells his mentor, "I'll never get used to playing cards or other games with clients. It seems like a poor use of scarce nursing time." The best response for the mentor would be:

1. "Perhaps you'll want to rethink your transfer to this unit if you're really uncomfortable." 2. "Your comments make a point about scarce resources. I'll ask the treatment team to review our position on activities." 3. "Activity co-leadership puts us in a position to help clients develop social skills and support them as they take small risks." 4. "Managed care has cost us activities therapists. Activities are necessary to give clients something to do, so we have to fill in." ANS: 3 Nurses who engage in co-leadership of therapeutic activities recognize that each activity contributes to outcome attainment. During activities clients practice skills needed in life situations, process emotions, and give and receive validation and feedback. Option 1 is not supportive of the nurse. Options 2 and 4 do not acknowledge the value of activities therapy.

The family of a teenage boy has been referred by the school to the mental health clinic for family therapy related to the boy's truancy and emotional outbursts. During the first interview the mother asks the nurse, "Why are you bothering to ask the rest of us questions? My son is the one with the problems." The best response for the nurse would be:

1. "We'll get more accurate information if the entire family is involved." 2. "It may seem strange to you, but we'll get better results this way." 3. "When one member is sick, the whole family system is sick." 4. "Every family member's perceptions are important to the total picture." ANS: 4 This response orients the family to the idea that each person's opinion will be valued. Having the family present for assessment prepares them for working together to identify family issues, identify outcomes, and solve problems. Option 1 may or may not be true. Option 2 doesn't convey the real reason. Option 3 is pessimistic and conveys a threatening message.

By day 2 (the end of the orientation phase), which outcome can be identified for a newly admitted client? The client will demonstrate:

1. Ability to problem solve one issue 2. Trust in at least one nurse 3. Positive transference with a staff member 4. Ability to ask for help in meeting needs ANS: 2 Establishing trust in the nurse is a fundamental task of the orientation phase of the relationship; thus it is an appropriate outcome to identify. When trust is present, the client is free to focus on the work and tasks of therapy. 1. This is an outcome appropriate for the working phase. 3. This would not be an identified outcome. 4. This would not be an identified outcome for the orientation phase.

To plan care for a client with a psychiatric disorder, the nurse keeps in mind that the goal of a therapeutic relationship is to:

1. Accomplish tasks in a timely manner 2. Provide a support system for the client 3. Assist the client to become a healthy, responsible individual 4. Carry out relevant and necessary interventions for the client ANS: 3 Assisting the client to become a healthier, more responsible person is the goal of a therapeutic relationship. The other options mention relevant activities, but none can be identified as the goal.

In the ECT treatment preparation period the morning of treatment, the nurse should:

1. Adequately hydrate the client 2. Assess cognitive function 3. Have the client exercise for 10 minutes 4. Ensure that the client does not void ANS: 2 Client assessment is advisable to provide a baseline against which changes resulting from ECT can be measured. While taking vital signs and performing other preparatory tasks, the nurse can assess orientation, immediate memory, thought processes, and attention span. The other options are interventions the nurse should not undertake.

Which intervention will be most valuable for the nurse in developing a therapeutic nurse-client relationship?

1. Administering the prescribed medications accurately 2. Interacting with members of the health care team 3. Being aware of therapeutic modalities 4. Possessing self-awareness and understanding ANS: 4 Self-awareness is fundamental to development of effective use of self in the therapeutic relationship. Without self-awareness, the nurse cannot separate his or her own subjective beliefs from facts. Each of the other options is relevant to providing nursing care but is not basic to development of a relationship.

To effectively plan care for a client, the nurse will understand that activity and adjunct therapies may be more useful in some situations than verbal therapies because adjunct therapies:

1. Allow the client to express feelings on multiple levels at the same time 2. Do not require specific training or expertise to facilitate 3. Provide the client the opportunity to use ego-protective mechanisms 4. Are readily available in the treatment setting ANS: 1 A client is able to express feelings on the emotional, physical, and symbolic level during activity therapy, whereas verbal therapies are limited to one dimension. 2. The primary facilitator of the selected therapy is required to have formal education and supervised experience. 3. Adjunct therapy does not provide this opportunity, which would be considered nontherapeutic. 4. This is not always the case.

A client attending group therapy has improved greatly and is near discharge. The client mentions, "In the beginning, I was so sick that everyone had to help me. For the last few days, it's felt good to be able to give something back to the group." This statement can be assessed as an example of Yalom's factor of:

1. Altruism 2. Harmonizing 3. Cohesiveness 4. Imitative behavior ANS: 1 Altruism refers to the experience of being helpful to others and is clearly what the client is displaying in the scenario. The other factors are not applicable.

A client is scheduled to attend an occupational therapy group to work on the identified goal of "recognizing and using more effective coping techniques." What measure can the nurse use to continue to support the client's attainment of this goal after he returns to the unit?

1. Avoiding setting limits that would increase his anxiety level 2. Praising him for positive behavioral changes 3. Isolating him from more seriously ill clients 4. Permitting him to make mistakes prior to intervening on his behalf ANS: 2 Recognizing and pointing out positive changes provides encouragement to continue pursuing change. Options 1, 3, and 4 would not achieve the nurse's goal.

A client tells the nurse, "I really like you. You're the only true friend I have." The client's remarks call for the nurse to revisit the issue of:

1. Boundaries 2. Trust 3. Safety 4. Countertransference ANS: 1 The client's remarks call for the nurse to remind the client of the parameters of the nurse-client relationship. The remark would also give the nurse the opening to go on to discuss the matter of friends. Options 2, 3, and 4: The client's remarks do not suggest the need to deal with any of these three issues.

Which statement would the nurse use to describe the primary purpose of boundaries?

1. Boundaries define responsibilities and duties to one's self in relation to others. 2. Boundaries determine objectives of the working stage of the relationship. 3. Boundaries differentiate the roles of the nurse and the client. 4. Boundaries prevent the possibility for undesired material to emerge during the interaction. ANS: 1 Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve to define the responsibilities and duties of the nurse in relation to the client. Options 2 and 3: Objectives and role are determined during the orientation stage. Option 4: Emergence of undesired material may be a significant issue for the client.

What milieu factor would need most attention from the nurse who is caring for a client who has received six ECT treatments and has two more scheduled?

1. Boundary maintenance 2. Trust attainment 3. Safety 4. Therapeutic activities ANS: 3 To feel safe, clients need to know what is expected of them in their role as clients. The client receiving ECT often has impaired recent memory and may become confused about the milieu and expectations. The nurse will need to reorient and reteach the client with cognitive deficit. Options 1, 2, and 4 will require attention but not to the same extent as safety.

The nurse knows that a client who is being admitted to the hospital has been approved for only a 4-day stay. This will require the nurse to:

1. Choose a specific theoretical model as the basis for care 2. Establish a relationship that is client-centered and goal-oriented 3. Focus on the milieu and psychopharmacology 4. Promote positive transference in the client ANS: 2 All therapeutic relationships are client-centered and goal-oriented. This becomes critical when the stay is short and the issues of boundaries, safety, and trust must be addressed before beginning work on the identified problem. 1. This is not a requisite. 3. Milieu will be important, but psychopharmacology may not be used. 4. This is not a requirement.

For which client is the nurse most likely to need to schedule a pre-ECT workup and teaching?

1. Client A, who is newly diagnosed with dysthymic disorder 2. Client B, who has melancholic depression that responded well to ECT 2 years ago 3. Client C, who was unresponsive to a 6-week trial of SSRI antidepressant 4. Client D, who has depression associated with diagnosis of inoperable brain tumor ANS: 2 Indications for ECT include clients with major mood disorders, clients who have responded to ECT in the past, clients who are unresponsive to antidepressants or unable to tolerate their side effects and clients who are acutely suicidal or in danger of fluid and electrolyte imbalance related to inability to eat due to depression, severe mania, or severe catatonia. 1. Clients with dysthymia are not candidates for ECT. 3. This client has not run out of medication options. 4. Clients with space-occupying lesions of the brain are not candidates for ECT.

Which client would the group co-leaders determine is demonstrating Yalom's therapeutic factor termed universality?

1. Client A, who states he realizes he is not the only person who has a problem with loneliness 2. Client B, who displays dysfunctional interaction patterns learned in his family of origin 3. Client C, who states he finally feels a strong sense of belonging 4. Client D, who openly expresses his anger about his work ANS: 1 Universality is the factor that refers to understanding that one is not unique, that others share thoughts, reactions, and discomforts like your own. Option 2 refers to corrective recapitulation of the family group. Option 3 provides an example of cohesiveness. Option 4 is an example of catharsis.

A 12-year-old client was referred for art therapy. The nurse and the therapist directing the activity assessed the client's level of functioning as age-appropriate. Which art materials have the potential to promote regression?

1. Colored pens and pencils 2. Magic markers and crayons 3. Large unlined paper 4. Finger paints and Play-doh ANS: 4 Finger paints and Play-doh are useful for preschool children. Options 1 and 2 would be age-appropriate media. Option 3 would promote free expression.

Which nursing intervention will the nurse anticipate taking in the first half hour after the client has received ECT?

1. Continually stimulate client to respond, using physical and verbal means. 2. Continue bagging client to improve respiratory function until client is responsive for 10 minutes. 3. Reorient as necessary to time, place, and person as client level of consciousness improves. 4. Encourage walking and eating breakfast as quickly as possible. ANS: 3 Client memory is likely to be impaired in the immediate post-ECT period. Reorientation will be necessary to help the individual return to a functional state. 1. Continual stimulation is not necessary. 2. This is unnecessary. 4. The client may be allowed to rest and recover at his own pace.

A nurse and client are entering the termination phase in the group experience. An important nursing intervention will be to:

1. Encourage the group to describe goals for change 2. Inquire whether the group needs more time to accomplish goals 3. Assist the group to explore alternative coping strategies for problems 4. Discuss feelings about termination with the group ANS: 4 Healthy termination is facilitated when the group and nurse express reactions to termination. The nurse serves as a role model by being open and genuine as the feelings about the losses incurred with ending are discussed. On a positive note, accomplishments and growth are acknowledged and the transfer of safety and trust to the group members are accomplished. Option 1 is accomplished in the orientation phase. Option 2 is part of the working phase in a relationship that does not have a strict time limit. Option 3 would be part of the working stage.

After attending a group session for 6 weeks, a client was terminating from the group. She believed she had successfully met her established objectives and could manage without the group support. When sharing her feelings about separating, the client stated, "I feel a bit sad and empty that I won't be seeing you folks again." What is the most accurate evaluation of the client's statement?

1. It indicates regression and her lack of readiness to terminate. 2. Unconsciously, she is hoping she will be permitted to continue the group. 3. She is demonstrating normal feelings associated with termination. 4. She needs further evaluation by her therapist to determine readiness to terminate. ANS: 3 The client is expressing feelings of sadness over the loss of the therapeutic group relationships that have been helpful to her. Such feelings are considered normal, just as they are considered normal when the nurse-client relationship terminates. 1. The feelings expressed are normal, not regressive. 2. No hidden meaning is present; the client openly expressed genuine feelings. 4. Further evaluation is not needed. The expression of feelings by the client is considered normal.

About an hour after the client has ECT, he complains of having a headache. The nurse should:

1. Notify the physician stat 2. Administer a prn dose of acetaminophen 3. Take the client through a progressive relaxation sequence 4. Advise going to activities to expend energy and relieve tension ANS: 2 Post-ECT headache is common. Most physicians routinely write a prn order for a headache remedy. Option 1 is unnecessary, since this is an expected side effect. Options 3 and 4 would not be as useful as medication in this instance.

A student asks the nurse, "Why do you go to music therapy every morning at 10?" The nurse explains the nurse's role in music therapy as:

1. Noting client verbal and nonverbal expression of feelings 2. Teaching clients about various styles of music 3. Fostering and encouraging performance talent 4. Selecting and playing numbers that will reduce anxiety and stress ANS: 1 A goal of music therapy is to promote expression and social connection. The nurse should observe and document expression of feelings as they occur. The observations may be used later, as a basis for further consideration by the nurse and client. The other options do not reflect aspects of the nurse's role in music therapy.

The client and the nurse have agreed on problems to be addressed during a short course of outpatient therapy. At the beginning of the appointment, the client states, "I'd like to work on the issue of relationships today." Which assessment can be made?

1. Nurse-client roles have not been clearly delineated. 2. The nurse should suggest several alternative behaviors. 3. The client must be able to manage emotions before continuing. 4. The relationship is moving from orientation to working phase. ANS: 4 Once the client and nurse have collaborated to define and prioritize problems, the relationship moves from orientation to working phase. Options 1, 2, and 3 have no relevance to the scenario.

A 60-year-old client on the psychiatric unit was angry because of a remark another client made to her. The client asked the nurse manager to help resolve the situation. Which action would best support the client's feelings of safety when experimenting with new ways of being?

1. Offer to be present with the client as she discusses her feelings about the incident with the other client. 2. Intervene on the client's behalf and sort out the incident with the other client. 3. Suggest that the client ignore the situation since the other client was probably not aware of her behavior. 4. Encourage the client to report the incident to the other client's physician. ANS: 1 Offering to be with the client affords her a safe nonthreatening opportunity to assume responsibility for meeting her own needs assertively. Option 2 removes the responsibility from the client. Option 3 supports passive behavior. Option 4. There is no need to bring in another person. The client is capable of addressing the problem herself.

A female nurse is assisting the recreational therapist with a dance activity for a mixed adult inpatient group of clients. How can the nurse encourage an extremely shy male client to participate?

1. Offer to dance with the client. 2. Ask the client if this is the first dance he has attended. 3. Sit with the client away from the group. 4. Encourage another client to ask him to dance. ANS: 1 If trust has been established, the client may feel safe enough to dance with the nurse. If trust has not yet been established the client will see the nurse's invitation as demonstrating respect and reaching out to him. Either way, the action will encourage participation. Options 2 and 3 do not encourage participation. 4. The nurse should not make another client responsible for this client's participation.

When an orientee asks why the unit has a multidisciplinary approach to therapeutic activities, the nurse should explain that multidisciplinary collaboration:

1. Produces a higher level of insurance reimbursement 2. Reduces the incidence of aggressive behavior by clients 3. Produces quicker results and earlier discharge to the community 4. Produces better outcomes when client problems are viewed from multiple perspectives ANS: 4 Broader input in problem identification and resolution enhances client outcomes. Options 1, 2, and 3 are either untrue or not relevant.

The physician has ordered atropine 0.5 mg IM for a client to be administered 30 minutes prior to ECT. The rationale for use of this medication is that it reduces secretions and:

1. Protects against vagal bradycardia 2. Prevents incontinence of urine 3. Reduces the need for recovery room staff 4. Improves the scope of convulsive activity ANS: 1 Atropine is used for its ability to prevent vagal bradycardia associated with the electrical stimulus. The other options are either irrelevant or untrue.

The nurse notes that an anxious client sits tensely and moves stiffly. Which of the activity therapies should the nurse recommend to the treatment team to assist the client to relieve tension and achieve increased body awareness?

1. Psychodrama 2. Music therapy 3. Dance therapy 4. Recreation ANS: 3 The large movements involved in dance therapy would enable the client to relieve tension and move with greater body awareness and freedom. The other options will not promote body awareness.

The treatment team was engaged in planning how group therapy could be included as a part of the structured daily activities of the unit. A new team member asked, "Why is it so important to include group therapy for the clients?" The most accurate response would be based on the assumption that:

1. Psychopathology has its source in disordered relationships 2. Some persons do not relate well on an individual basis 3. Hidden agendas frequently surface in group sessions 4. Group therapy is far more cost-effective for the clients ANS: 1 A key assumption of group therapy is that psychopathology has its source in disordered relationships. It follows that individuals will behave in the group as they do in other settings, so group provides an opportunity to help individuals develop more functional relationships. 2. This is not relevant to group work. It is dealt with in one-to-one therapy. 3. This is not a reason to offer group therapy. 4. This is not an assumption about the reason group therapy is effective.

The nurses on the unit were planning care for a group of clients and determining whether they could best meet client needs in a task or a process group. Their decision was based on the understanding that a task group focuses on:

1. Relations among the members 2. Communication styles 3. Content issues 4. The "here and now" ANS: 3 Content-oriented groups focus on goals and tasks of the group. Thus a task-oriented group would focus on content issues. 1. Process groups focus on interpersonal relationships. 2. This is not relevant to describing task-oriented groups. 4. This refers to dealing with issues that are taking place at the present time.

The nurse is concerned that a client will not be able to trust her enough to establish a therapeutic relationship. Which action will best facilitate the development of trust?

1. Responding positively to the client's demands 2. Following through with what was promised 3. Clarifying with the client when in doubt 4. Staying with the client for the entire shift ANS: 2 Being consistent in keeping one's word implies that the nurse is trustworthy and does what is agreed upon. 1. This action is nontherapeutic. Instead, the client will need to learn new techniques for meeting her needs. 3. Clarification is important but is not the best method for promoting trust. 4. Trust is better served by shorter contacts at agreed-upon intervals.

A new client describes having been in an outpatient group in which he reenacted troublesome incidents with his wife. Other clients served as "alter egos." From this description, the nurse can document that the client had been engaged in:

1. Role-playing 2. Psychodrama 3. Cognitive therapy 4. Consensus building ANS: 2 Psychodrama uses spontaneous dramas to act out emotional problems to promote health through development of new perceptions, behaviors, and connections with others. Others in the group take the role of significant others. 1. Role-playing does not use the technique of alter egos. 3. This is not a description of cognitive therapy. 4. Consensus building is not a form of therapy.

A nurse, leading an inpatient group dealing with women's issues, identifies a client who is assuming the role of aggressor. Which behavior characterizes this role?

1. Seeking a position between contending sides 2. Mediating conflicts and disagreements 3. Attempting to manipulate others 4. Criticizing the contributions of others ANS: 4 An aggressor acts in negative ways, displaying hostility, attacking the group, or criticizing the members. Option 1 describes the compromiser. Option 2 describes the harmonizer. Option 3 describes the dominator.

A new nurse asks the mentor, "How can I be sure I'm not developing a social relationship with a client?" The mentor uses as a basis for the response the fact that in a therapeutic relationship:

1. The focus is shared equally between the participants 2. Absence of boundaries is generally accepted 3. Time constraints do not apply 4. A specific client-centered goal is established ANS: 4 In a therapeutic relationship the focus is on the client, boundaries are established early and maintained throughout, definite beginning and ending times are established, and the relationship has a specific client-centered goal.

What is the primary reason for the nurse to have an understanding of the various types of activity and adjunct therapies?

1. The nurse is expected to interpret clients' involvement in the therapies. 2. The nurse needs to be supportive of the treatment team members who direct these therapies. 3. The nurse is responsible for placing the client in the appropriate group. 4. The nurse chooses the most cost-effective therapy group. ANS: 1 The nurse must interpret to clients and others that the purpose of activity therapies is to increase client awareness of feelings and behaviors and to minimize pathology and promote mental health. 2. This is true but not the primary reason. 3. This is the responsibility of the treatment team. 4. This is not the primary reason the nurse needs knowledge of activity therapy.

Immediately after ECT, nursing care of the client is most similar to care of a client:

1. With severe dementia 2. With delirium tremens 3. Recovering from conscious sedation 4. Recovering from general anesthesia ANS: 4 The client who has ECT receives a short-acting IV anesthetic and a skeletal muscle relaxant. Thus care is most similar to the client recovering from general anesthesia. The nurse will assess vital signs, quality of respirations, presence or absence of the gag reflex, level of consciousness, orientation, and motor abilities during the posttreatment period.

Sequence these descriptions of personal space from close to far away.

A. Social distance B. Public distance C. Intimate distance D. Personal distance ANS: 1. C2. D3. A4. B Intimate distance is 0 to 18 inches. Personal distance is 18 to 40 inches. Social distance is 4 to 12 feet. Public distance is 12 feet or more.

Which statement made by a client about a half hour before a scheduled ECT treatment would result in cancellation of the treatment?

ANS: 3 Since the client is to receive general anesthesia and has orders to remain NPO, the nurse should notify the physician immediately. The introduction of food into the stomach could result in aspiration of stomach contents during treatment. The other options offer no contraindication to treatment.

__________ refers to the ability of the nurse to establish a meaningful connection with a client.

ANS: Rapport Rapport is necessary if a therapeutic relationship is to be established with a client. It involves being accepting, caring, and compassionate and showing a genuine interest in the client.

The acronym TEACH represents the components of a therapeutic relationship: __________, __________, __________, __________, and __________.

ANS: Trust, empathy, autonomy, caring, hope These components serve as the framework for the development of a therapeutic relationship between caregiver and client.

"I'd like to hear more about your difficult relationships at work."

This statement shows use of exploring, a therapeutic technique.

"You look very nice today. I'm proud you took more time with your appearance."

This statement shows use of giving approval, a nontherapeutic technique.

"I noticed your hands trembling when you told me about your accident."

This statement shows use of making an observation, a therapeutic technique.

"There are people with problems much worse than yours."

This statement shows use of minimizing feelings, a nontherapeutic technique.

"Why do you think these events have happened to you?"

This statement uses a why question, a nontherapeutic technique.

During an interview, a patient attempts to change the focus from self to the nurse by asking personal questions. Select the nurse's most therapeutic response.

a. "Are you trying to avoid answering these questions?" b. "I am uncomfortable talking to patients about my personal life." c. "I am sure we can solve your problems if you describe them to me." d. "The time we spend together is for you to discuss your problems and concerns." ANS: D When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. In the correct answer, the nurse gives this information. The distracters do not refocus discussion to the patient's needs.

Which remark by the nurse gives a patient verbal tracking feedback?

a. "Describe your relationship with your children." b. "Give me an example of not getting along with your children." c. "Am I correct in stating you are feeling angry with your children?" d. "You're saying you do not have a good relationship with your children?" ANS: D Verbal tracking simply keeps track of what the patient is saying. It is giving neutral feedback in the form of restating or summarizing what the patient has said. The distracters seek validation or explore.

A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response.

a. "Everyone feels that way sometimes." b. "Don't talk that way. Of course you will leave here!" c. "Keep up the good work and you will be discharged." d. "It sounds like you don't feel like you're making progress." ANS: D The nurse reflects by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The distracters are nontherapeutic techniques of disapproving, minimizing feelings, and false reassurance.

A nurse interviews a patient who is having difficulty with self-expression and staying focused. Select the nurse's most helpful comment.

a. "Go on." b. "What would you like to discuss?" c. "Tell me what is happening right now." d. "It seems you are having trouble staying focused." ANS: C This patient needs more direction from the nurse to engage in a meaningful interaction. A general lead, making an observation, or giving a broad opening will not be helpful for this patient.

Which remark by the nurse would be an appropriate way to begin an interview session?

a. "How shall we start today?" b. "Shall we talk about losing your privileges yesterday?" c. "Let's get started discussing your marital relationship." d. "What happened when your family visited yesterday?" ANS: A The interview is patient centered; thus, the patient chooses issues. The nurse assists the patient by using communication skills and actively listening to provide opportunities for the patient to reach goals. In the distracters, the nurse selects the topic.

The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is in the middle of administering medications to all clients on the unit upon the client's arrival to the unit. The client asks the nurse to sit and talk with her for awhile. What is the nurse's best response?

a. "I am busy right now, but I will come back later." b. "Give me just a few more minutes to finish passing medication to the other clients." c. "I will return in 20 minutes so we can talk." d. "I have to finish giving all the clients their medications, but I will then come back so we can talk." ANS: D This is an honest statement that lets the client know exactly what the nurse is doing and helps to build trust in that the nurse is not making up excuses or making false promises. The nurse's statement that she is busy right now would make the client feel unimportant. The nurse would be making false promises if she were to say that she will be back in only a few minutes or even in 20 minutes because most likely, it will take more than this amount of time to finish giving out medications.

Showing empathy toward a client is an effective tool in establishing rapport. Which nurse statement is the best example of an empathetic response?

a. "I am so sorry for your loss." b. "It must be difficult for you going through this loss." c. "I am sure you will feel better soon." d. "Try to look on the bright side." ANS: B Empathy involves trying to understand the emotions another person is experiencing, which is what this statement demonstrates. The nurse's expression of sorrow for the client's loss is an example of a sympathetic response, and the nurse's statement to the client that he or she will feel better soon or to "look on the bright side" disregards the client's feelings.

The characteristic of genuineness helps in establishing a therapeutic relationship with a client. Which nurse response is the best example of a display of genuineness to a client who is going through a difficult divorce?

a. "I know exactly how you feel. My husband and I divorced 2 years ago because of his infidelity." b. "Divorcing my husband was the best thing I ever did." c. "I have friends who have gone through a divorce. It must be difficult for you." d. "I am sorry that you have to go through this difficult time." ANS: C This response shows the client sincerity and honesty, which are components of being genuine. The nurse should not offer too much personal information, such as providing information about her own divorce. When the nurse says that she is sorry that the client is experiencing the difficult time, it is an example of a sympathetic response.

An African American patient says to a white nurse, "You wouldn't understand me because you live in a white world." Select the nurse's best response.

a. "I understand. All people go through the same experiences." b. Reassure the patient that nurses deal with people from all cultures. c. Gently change the subject to one that is less emotionally charged. d. "Please describe an example of something you think I would not understand." ANS: D Having the patient speak in specifics rather than globally will help the nurse understand the patient's perspective. This approach will help the nurse communicate with the patient.

A nurse interacts with a newly hospitalized patient. Select the example of offering self.

a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "I hope you will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me." ANS: D Offering self is a technique that should be used in the orientation phase of the nurse-patient relationship. It helps build trust and convey that the nurse cares about the patient.

A patient says, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which comment would be appropriate if the nurse seeks clarification?

a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So, all in all, you feel as though you had a rather poor night's sleep?" d. "Can you give me an example of what you mean by stoned?" ANS: D The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient's comment.

A patient with paranoid schizophrenia tells the nurse, "The FBI is listening through fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic?

a. "Let's talk about something other than the FBI." b. "It sounds like you're concerned about your privacy." c. "The FBI is prohibited from operating in health care facilities." d. "You have lost touch with reality, which is a symptom of your illness." ANS: B It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. Other distracters use reflection or are nontherapeutic (changing the subject, false reassurance). One distracter presents reality but in an uncompassionate way.

During a therapy session, a patient cries as the nurse explores the relationship of the patient and her now-deceased mother. The patient sobs, "I shouldn't be blubbering like this." A response by the nurse that will hinder communication is:

a. "The relationship with your mother is very painful for you." b. "I can see that you feel sad about this situation." c. "Why do you think you are so upset?" d. "Crying is a way of expressing the hurt you're experiencing." ANS: C "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer; thus they are barriers to communication. The other options are therapeutic in nature.

A patient discloses several concerns and associated feelings. If the nurse wishes to seek clarification, which comment would be appropriate?

a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that..." d. "Tell me everything from the beginning." ANS: C Clarification ensures that both the nurse and patient share mutual understanding of the communication. The distracters encourage comparison rather than clarification and present implied questions that suggest the nurse was not listening.

A patient cries as the nurse explores the patient's relationship with a deceased parent and says, "I shouldn't be crying like this. It happened a long time ago." Which response(s) by the nurse will facilitate communication? (Select all that apply.)

a. "Why do you think you are so upset?" b. "I can see that you feel sad about this situation." c. "The loss of your parent is very painful for you." d. "Crying is a way of expressing the hurt you're experiencing." e. "Let's talk about something else, since this subject is upsetting you." ANS: B, C, D Reflecting and giving information are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope?

a. "You need to take your lithium unless you want to relapse." b. "You are doing so well that there is nothing you can't do if you put your mind to it." c. "You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication." d. "A lot of people are much worse off than you are, so you should be thankful that you are doing as well as you are." ANS: C This option is realistic and provides hope without providing false hope. Stating that the client will relapse if she discontinues medication suggests that the nurse is threatening the client, which provides no hope. Telling the client that "there is nothing that you can't do" may be providing false hope. Reminding the client that others are worse off is disregarding the client's feelings.

A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The client's current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope?

a. Affective b. Contextual c. Temporal d. Affiliative ANS: B Although all the dimensions of hope listed in these options may be difficult for this client, the dimension that is representative of the living and job situation for this client is contextual, because this refers to inadequate physical, financial, and emotional resources.

The nurse who is caring for a client begins to have very protective feelings toward the client that are interfering with the therapeutic relationship between the nurse, the client, and the client's family. This is an example of a problem that is encountered in some therapeutic relationships and is known as:

a. An environmental problem b. Resistance c. Transference d. Countertransference ANS: D Countertransference, the inappropriate emotional response of a caregiver to a client, is occurring in this relationship. Environmental problems refer to items such as privacy and noise levels, resistance is a behavior of the client that demonstrates unwillingness to change or accept the need for change, and transference is the client's inappropriate feelings or behaviors directed toward the caregiver.

The nurse is talking with a newly admitted male client while in the activity room. The client begins to become tearful when talking about his children at home. What is the nurse's best action?

a. Ask the client to talk more about his children b. Take the client into a private area to continue the conversation c. Ask the client why he is crying d. Distract the client by encouraging him to join the group activity ANS: B This action is an example of correcting environmental problems that can occur in a mental health facility. The other options would not encourage the interaction that has been begun between the client and the nurse.

A client response to the termination phase of the therapeutic relationship is withdrawal. This response most often is manifested by client behaviors such as:

a. Bringing up new problems b. Being absent from appointments c. Returning to maladaptive behavior d. Having increased anxiety ANS: B Being absent from appointments is a behavior that is commonly seen when clients are withdrawing from the termination phase of the relationship. It actually is a response that occurs because the client does not want the therapeutic relationship to end. Bringing up new problems refers to the continuation response, and returning to maladaptive behavior and having increased anxiety refer to the regression response.

A male client is being discharged from a mental health facility and is worried about what to tell his friends and co-workers regarding his time away. The nurse helps the client plan what to say to others about his disease. The nurse is functioning in the role of

a. Change agent b. Teacher c. Therapist d. Technician ANS: B This is an example of a teaching opportunity that the nurse is involved in during a therapeutic relationship. Other teaching opportunities include teaching the client how to cope with stressors, early signs of relapse, and effects of medications and providing public education regarding mental illness. The other options do not incorporate the teaching role as a function.

A female client is admitted with suicidal tendencies. The client is placed in suicide precautions for the first 24 hours of her stay. Ensuring client safety is included in the therapeutic role of:

a. Change agent b. Teacher c. Therapist d. Technician ANS: D In addition to ensuring safety, the role of technician includes medication management, management of medical problems in the mental health environment, and management of environmental factors. These responsibilities are not a function of the other roles.

The nurse is preparing an adult male client, who has been successfully treated for a social phobia, for the termination phase of the therapeutic relationship. During their last meeting, the client told the nurse that he noticed he has developed a nervous habit that started a few days ago of checking his door at home several times a day to be sure it is locked. This client is exhibiting the client response to termination known as:

a. Continuation b. Regression c. Withdrawal d. Confabulation ANS: A Continuation sometimes occurs when a client is fearful of ending the therapeutic relationship. This response is characterized by a client's trying to continue the relationship by bringing up new problems or having the caregiver solve his problems. Regression and withdrawal are also client responses to termination, but they do not fit the description in this situation. Confabulation is not a response to termination. It refers to the making up of answers by a client who is experiencing a memory loss.

A nurse documents: "Patient mute despite repeated efforts to elicit speech. No eye contact. Short attention span; less than 1 minute." Which nursing diagnosis should be considered?

a. Defensive coping b. Risk for violence c. Decisional conflict d. Impaired verbal communication ANS: D The defining characteristics are more related to the nursing diagnosis of Impaired verbal communication than to the other nursing diagnoses.

When should the nurse begin preparations for the termination phase of a therapeutic relationship?

a. During the orientation phase b. Prior to the last meeting c. During the last meeting d. After all goals have been met ANS: B Preparing for termination of the relationship should begin prior to the last meeting to allow for review of whether goals have been met and to prepare for client independence. The orientation phase is too early in the relationship to prepare for termination, and the last meeting is too late. Unfortunately, not all goals are always met, so preparing for termination of the relationship after goals have been met may not be a possibility.

Which qualities must be communicated to a client for the establishment of a therapeutic relationship between the nurse and the client? Select all that apply.

a. Genuineness b. Love c. Rapport d. Acceptance e. Enjoyment ANS: A, C, D These qualities foster the development of a therapeutic relationship. Love and enjoyment are seen as qualities of a social relationship.

A nurse working with a depressed patient used humor to lift the patient's spirits. At one point, the patient smiled. Select the best analysis.

a. Humor should be added to interventions in the plan of care. b. The nurse helped the patient. The technique was successful. c. The nurse needs supervision. The communication technique is not appropriate. d. The nurse identified an approach that may prove useful in other, similar situations. ANS: C Clinical supervision will review the nurse's actions and thoughts and help the nurse arrive at a more therapeutic approach. Attempts at cheering up a depressed patient serve only to emphasize the disparity between the patient's mood and that of others. Active listening should be the technique used by the nurse. The distracters suggest the approach is therapeutic when it is not.

A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient setting and is attending group therapy sessions. She is working on controlling the compulsion of touching her head three times every time she talks. To maintain the therapeutic relationship established with the client, by which action can the nurse show acceptance?

a. Ignoring the compulsion during the group therapy session and talking with the client privately about the behavior b. Asking the group to remind the client every time she touches her head to help her consciously stop the compulsion c. Pointing out the compulsion to the group each time the client exhibits the behavior d. Asking the client to stop talking during the group session until she has learned to control her compulsion ANS: A Ignoring the behavior in group therapy shows acceptance of the behavior because the nurse does not embarrass the client in front of the group. Talking with her privately shows compassion for the client. Asking the group to remind the client of the compulsion and pointing out the compulsion to the group would belittle the client. Asking the client to stop talking would defeat the purpose of the support of belonging to a therapeutic group.

The relationship between a nurse and patient as it relates to status and power is best described by which term?

a. Incongruent b. Symmetrical c. Paralinguistic d. Complementary ANS: D When a difference in power exists, as between a student and teacher or nurse and patient, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.

A 16-year-old female client with an eating disorder is an inpatient at a mental health clinic. A mutually agreed upon goal is for her to limit her amount of exercise to 1 hour per day and to consume at least 1000 calories per day for 1 week. This is an example of an interaction that occurs during which phase of the therapeutic relationship?

a. Orientation b. Preparation c. Working d. Termination ANS: C This is an example of a goal that also incorporates limit setting that occurs during the working phase of the relationship. Goal and limit setting do not occur during the other three phases of the relationship.

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

a. Patients withdraw if silences are prolonged. b. The nurse is responsible for breaking silences. c. Silence provides meaningful moments for reflection. d. Silence helps patients know that they are understood. ANS: C Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. Feedback helps patients know they are understood.

Which technique communicates to a patient that a nurse is listening?

a. Saying, "You said you were unsure how to handle your feelings." b. Commenting, "I understand what you're saying." c. Stating, "Your behavior was inappropriate." d. Asking, "Do you feel angry?" ANS: A Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions ask for specific information rather than showing understanding. The patient has no way of knowing whether the nurse understands.

A psychiatric nurse's parent had bipolar disorder. The nurse angrily recalls childhood memories of embarrassment about the parent's behavior. Select the best coping strategies for this nurse. (Select all that apply.)

a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. b. Recognize that these feelings are unhealthy. The nurse should repress them when working with patients. c. Recognize that psychiatric nursing is not an appropriate career choice. Select another area of practice. d. Begin relationships with new patients by saying, "My parent had mental illness, so I accept it without stigma." e. Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important. ANS: A, E The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource who may be helpful. The knowledge and experience gained from the nurse's relationship with a mentally ill parent may contribute sensitivity to compassionate practice. Self-disclosure and suppression are not adaptive coping strategies. The nurse should not give up on this area of practice without first seeking ways to cope with the memories.

When a caregiver becomes a role model for a client during a therapeutic relationship, the caregiver is functioning in the role of a:

a. Teacher b. Therapist c. Technician d. Change agent ANS: D Serving as a role model is one of the many functions of a change agent. The role of a change agent also includes promoting a climate of anticipation of positive change for the client and serving as a socializing agent. The other options are roles of the caregiver, but role model is not included in those roles.

For which roles is the caregiver responsible in a therapeutic relationship? Select all that apply.

a. Teacher b. Therapist c. Technician d. Friend e. Change agent f. Confidante ANS: A, B, C, E These are the typical roles of the caregiver in mental health services. The caregiver should avoid becoming friends with clients because this can cause strain on the professional relationship. The caregiver also should avoid becoming a confidante of the client because this term usually describes someone whom a person trusts with secret or private matters. This is not a role that the caregiver can play, given that caregivers have a responsibility to share with other team members information pertinent to the client's care.

An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by:

a. Telling a client several times a day that he or she cares about him or her b. Asking a client what his or her favorite movie is, then showing that movie during a movie night on the unit c. Giving a client a card that has a sentiment that says the nurse cares about him or her d. Telling a client that he or she is the favorite client ANS: B Showing a favorite movie is a safe way of showing the client that you are aware of him or her as an individual, rather than as just another client. If the nurse only tells the client that she cares about him or her, it does not prove to the client that the nurse cares. Giving a client a card or telling the client that he or she is a favorite is too personal and may mislead the client regarding the development of a social relationship.

A therapeutic relationship differs from other relationships in that the focus of a therapeutic relationship is on:

a. The client b. Establishing a friendship c. The nurse d. The plan of care ANS: A Therapeutic relationships are consciously directed and focus on the client, whereas a social relationship focuses on establishing a friendship. The nurse is never the focus of client care, and the plan of care is developed after the relationship has been established.

A nurse is working with a male client in a mental health outpatient clinic. The client voices a desire to become more autonomous. Which goal will assist the client in becoming more autonomous?

a. The client will check his calendar each night to plan for commitments scheduled on the following day. b. The nurse will remind the client weekly of his appointment at the clinic for the following week. c. The client will ask the nurse to call him to remind him of his appointment. d. The nurse will complete the client's calendar of daily commitments scheduled for the week. ANS: A Autonomy refers to the ability to direct and control one's activities and destiny. Working toward this goal is a simple way to begin to develop control over one's life. Reminding the client and completing the client's calendar are nursing goals rather than client goals. If the client asks the nurse to call him to remind him, no responsibility is placed on the client.

A Puerto Rican American patient uses dramatic body language when describing recent life events. Select the most accurate explanation of the patient's behavior.

a. The nurse has misinterpreted the behavior. b. The patient has a histrionic personality disorder. c. Members of this culture use dramatic body language as the norm. d. The patient believes dramatic body language is sexually appealing. ANS: C Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

During the first interview with a parent whose child died in a car accident, the nurse feels sorry for the patient and reaches out to take the parent's hand. Select the correct analysis of the nurse's behavior.

a. The parent will perceive the gesture as intrusive and overstepping boundaries. b. It shows empathy and compassion. It will encourage the parent to continue to express feelings. c. The action is inappropriate. "No touch" rules are important in all psychiatric interactions. d. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. ANS: D Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.

Documentation in a patient's record shows: During 5-minute interaction, patient fidgeted, tapped foot, periodically covered face with hands, looked under chair. Stated, "I enjoy spending time with you." Which assessment is most accurate?

a. The patient gave positive feedback about the nurse's communication techniques. b. The nurse is viewing the patient's behavior through a cultural filter. c. The patient's verbal and nonverbal messages were incongruent. d. Psychotic thought processes are likely. ANS: C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a "mixed message." Positive feedback is not evident. A cultural filter determines what we will pay attention to and what we will ignore, which is not relevant to the situation presented. Data are insufficient to draw the conclusion that the patient is psychotic.

An Asian American patient rarely showed eye contact. This nursing diagnosis was formulated: Situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions to raise the patient's self-esteem were not successful; the patient's eye contact did not improve. Select the best analysis of this scenario.

a. The patient's poor eye contact is indicative of anger and hostility that have not been addressed. b. The nurse should not have independently assessed, diagnosed, and planned for this patient. c. The patient's eye contact should have been addressed by role-playing to increase comfort. d. The nurse should have assessed the patient's culture before making this diagnosis and plan. ANS: D The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent. In others, eye contact is expected. Asian Americans often prefer not to engage in direct eye contact.

During the preparation phase of a therapeutic relationship with a client, what is the main task to be completed by the nurse?

a. To establish with the client the purpose of the relationship b. To gather and review all possible information regarding the client c. To build trust with the client d. To obtain agreement from the client to work in conjunction with the nurse ANS: B The main task during the preparation phase is to gather and review all possible information regarding the client; this can be accomplished by obtaining data from past and current medical records and from the client's significant others. The other options are tasks that occur during the orientation phase.

A 19-year-old male client is being treated for a drug addiction. He continually voices his dread of being discharged because he knows he will have to live with his parents and follow their rules until he can earn enough money to live on his own. He is showing increasing resistance to treatment measures, such as attending group sessions, but is refusing to acknowledge that he has an addiction or that he needs treatment. Which behavior is the client demonstrating?

a. Transference b. Primary resistance c. Secondary resistance d. Tertiary resistance ANS: C This is an example of secondary resistance in view of the fact that the client is displaying behaviors that will prolong his discharge from the facility, in an attempt to avoid his perception of the unpleasant living situation that awaits him upon discharge. Transference is a client's emotional response, based on earlier relationships, to the care provider. Primary resistance refers to simple avoidance of change or admitting the need for change. Tertiary resistance is not a used term.

*3. A patient says, "My marriage is great. My spouse and I usually agree on everything." The nurse observes the patient's foot moving continuously and fingers twirling a shirt button. What assessment can the nurse make? The patient's communication is:

a. clear. b. mixed. c. explicit. d. inadequate. ANS: B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

A patient is having difficulty making a decision. The nurse is conflicted about whether to provide advice. Which principle usually applies? Giving advice:

a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy. ANS: A Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy.

A nurse can best communicate to a patient an interest in listening by:

a. restating the feeling or thought the patient has expressed. b. asking a direct question, such as "Do you feel guilty?" c. expressing an opinion about the patient's problem. d. saying "I understand what you're saying." ANS: A Restating communicates to the patient that the nurse is listening and allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions ask for specific information rather than showing understanding.