Psych Chapter 5

The nurse has been counseling a client with an eating disorder for 1 week. During the morning treatment team meeting, the treatment plan is updated. Which is an appropriate intervention to be included in the nurse-client relationship? Select all that apply. A. Exploring perceptions of reality B. Promoting a positive self-concept C. Explaining the boundaries of the relationship D. Working through resistance E. Addressing testing behaviors

ANS: A. Exploring perceptions of reality B. Promoting a positive self-concept D. Working through resistance

A client being discharged from a substance use disorder treatment program asks the nurse for a date. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. Which technique is the nurse using to manage this situation? A. Defining boundaries B. Defining therapy C. Letting the client down gently D. Reprimanding the client

ANS: A. Defining boundaries

A client being discharged demonstrates anger with the nurse when the nurse attempts to review discharge instructions with the client. The nurse can best assist the client in this stage of the relationship with which response? A. "We have to go over these instructions before you can go. Please try to listen." B. "Would you rather not be discharged today? You should be ready to leave now." C. "I can sense you are angry this morning. Tell me how you feel about being discharged today." D. "You should be able to regulate your feelings better by now. Why are you angry?"

ANS: C. "I can sense you are angry this morning. Tell me how you feel about being discharged today."

A nurse in the behavioral health unit witnessed another nurse violate the boundaries of the professional relationship with a client. When reporting this to the nurse manager, which role is the nurse acting in for the client? A. Teacher B. Parent surrogate C. Advocate D. Care giver

ANS: C. Advocate

The novice nurse is attempting to develop therapeutic nurse-client relationships in the role of a counselor. Which action(s) by the nurse will assist with the development of these relationships to benefit the clients? Select all that apply. A. Obtain feedback from a more experienced nurse. B. Identify areas of weakness and develop a plan for change. C. Ask clients what should be done to improve the relationship. D. Journal the thoughts and feelings that might be present to provide insight. E. Clarify values, attitudes, and belief systems prior to the development of the relationship.

ANS: A. Obtain feedback from a more experienced nurse. B. Identify areas of weakness and develop a plan for change. D. Journal the thoughts and feelings that might be present to provide insight. E. Clarify values, attitudes, and belief systems prior to the development of the relationship.

The nurse manager suspects a nurse of violating the professional boundaries of the nurse-client relationship. Which behaviors identified with the nurse would correlate with the manager's suspicions? Select all that apply. A. The nurse makes exceptions of the rules for the client. B. The nurse is not sharing information about the client with other team members. C. The nurse is talking to team members about the client. D. The nurse is having inappropriate social conversations. E. The nurse brings the client small gifts that other clients are not receiving.

ANS: A. The nurse makes exceptions of the rules for the client. B. The nurse is not sharing information about the client with other team members. D. The nurse is having inappropriate social conversations. E. The nurse brings the client small gifts that other clients are not receiving.

The nurse is caring for a client recently admitted for depression. Which behavior demonstrated by the nurse indicates positive regard? Select all that apply. A. Communicating judgments about the client's behavior B. Calling the client by name C. Spending time with the client D. Responding openly E. Considering the client's ideas and preference when planning care

ANS: B. Calling the client by name C. Spending time with the client D. Responding openly E. Considering the client's ideas and preference when planning care

The nurse maintains a therapeutic relationship with several clients on the behavioral health unit. Which characteristic(s) will be most important for the nurse to foster to maintain these relationships? Select all that apply. A. Offering sound advice to the client B. Establishing boundaries for both the nurse and client C. Maintaining a client focus at all times D. Sharing personal feelings openly with the client E. Avoiding concern with whether the client likes the nurse

ANS: B. Establishing boundaries for both the nurse and client C. Maintaining a client focus at all times E. Avoiding concern with whether the client likes the nurse

The nurse has been working diligently to assist with trauma counseling for clients in the community that was affected by a hurricane that devastated homes and community resources. Which behaviors indicate that the nurse is experiencing compassion fatigue? Select all that apply A. The nurse takes scheduled vacation time to visit family. B. The nurse is visiting the victims of the disaster on off time. C. The nurse is talking about feelings with a trusted co-worker. D. The nurse is worrying about the clients and it is occupying much thought. E. The nurse is staying late each night at work and missing time with family.

ANS: B. The nurse is visiting the victims of the disaster on off time. D. The nurse is worrying about the clients and it is occupying much thought. E. The nurse is staying late each night at work and missing time with family.

The nurse is counseling a client that is being physically abused by a partner. Which outcome may result from the nurse feeling sympathy for the client and situation? Select all that apply. A. The nurse feels sad and be unable to help the client. B. When the nurse feels sympathy, the client may manipulate the nurse's feelings. C. The client is discouraged from exploring their problems, thoughts, and feelings. D. The client is discouraged from growth. E. The client feels dependent on the nurse.

ANS: B. When the nurse feels sympathy, the client may manipulate the nurse's feelings. C. The client is discouraged from exploring their problems, thoughts, and feelings. D. The client is discouraged from growth. E. The client feels dependent on the nurse.

The nurse is counseling a client who has quit several jobs and no longer sends financial support to the client's two children living with their other parent. When discussing family roles with the client, the nurse demonstrates positive regard through which statement? A. "How is not working right now affecting you?" B. "How do you expect your kids to be provided for?" C. "You need to somehow find a way to support your children." D. "Can the children's other parent get by for a while until you get better?"

ANS: A. "How is not working right now affecting you?"

The client is in the termination phase of the nurse-client relationship after successfully meeting the outcomes of counseling. The client states, "Now that this is over and you won't be seeing me professionally, let's go out together." Which is the best response by the nurse? A. "I have enjoyed spending time with you professionally but it would be inappropriate for me to see you socially." B. "I do not make it a habit to see my clients outside of the professional setting so we won't be seeing each other again." C. "You are welcome to stop by and see me at any time in my office. I would be happy to see you again." D. "Now that you are well again, it would be a good idea for you to go out and meet new friends, but I cannot be your friend."

ANS: A. "I have enjoyed spending time with you professionally but it would be inappropriate for me to see you socially."

The client is in the working phase of the nurse-client relationship. Which statement made by the client indicates that the client is successfully working toward completion of the outcomes in this phase? A. "When I become angry and feel as though I could lose control, I walk away and take deep breaths." B. "I appreciate all that you have done to help me in this process and will require no further assistance." C. "I have been able to use so much of what you have taught me in handling my emotions in a productive manner." D. "Can you tell me on which days and times that my appointments will be and how long my therapy is projected to be?"

ANS: A. "When I become angry and feel as though I could lose control, I walk away and take deep breaths."

The nurse is caring for a client when the client begins to revert to child-like behavior. Which action by the nurse can continue to nurture the client while establishing and maintaining appropriate boundaries? A. Retain an easygoing, non-judgmental attitude. B. Employ an authoritative manner to take charge of the situation. C. Allow the client's behavior to continue since it will eventually stop. D. Stop the interaction with the client and leave, returning at a later time.

ANS: A. Retain an easygoing, non-judgmental attitude.

While the nurse and client are interacting during a therapy session, the nurse openly admits to not being able to relate to a client's experience. According to Munhall, this will most likely have which influence on this therapeutic relationship? A. The nurse will avoid imposing any values on the client. B. The client will not trust the nurse's professional abilities. C. The nurse will more likely be manipulated by the client. D. The client will be less likely to self-disclose to the nurse.

ANS: A. The nurse will avoid imposing any values on the client.

During a regular home health visit to an older adult client the client states, "I'm old, and my life has no purpose anymore. But promise me you won't tell anyone." Which is the best response by the nurse? A. "Don't worry, I won't tell anyone else." B. "I'm sorry, but I can't keep that kind of secret." C. "Let's talk about something to cheer you up." D. "What can we do to help you feel better?"

ANS: B. "I'm sorry, but I can't keep that kind of secret."

A client states, "I am just devastated that my marriage is falling apart." Which statement made by the nurse best demonstrates an empathetic response? A. "I feel so bad for what you are going through." B. "You feel like your world is falling apart right now." C. "I have been divorced, too. I know how hard it is." D. "It will get better; let's talk about it."

ANS: B. "You feel like your world is falling apart right now."

The nurse and client are discussing an upcoming sporting event in which they both share an interest. This form of interaction has the potential to pose which threat to the nurse-client relationship? A. Influence whether the client likes the nurse or not. B. Avoid the work needed for the client to reach set goals. C. Let the client know that the nurse is genuine with diverse interests. D. Overstep the ethical boundaries that the nurse should maintain.

ANS: B. Avoid the work needed for the client to reach set goals.

The nurse is caring for adult client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest? A. Teacher B. Caregiver C. Advocate D. Parent surrogate

ANS: B. Caregiver

The nurse is in the process of developing a therapeutic nurse-client relationship with a newly admitted client. Which is the most important behavior the nurse demonstrates to enhance the relationship? A. Confrontation B. Empathy C. Humor D. Reframing

ANS: B. Empathy

The client is in the working phase of the therapeutic nurse-client relationship. Which action by the nurse would best help the client to explore problems? A. Comparing past and present coping strategies B. Encouraging the client to clarify feelings and behavior C. Identifying possible solutions for the client's problems D. Referring the client to a self-help group

ANS: B. Encouraging the client to clarify feelings and behavior

While in the day room of the psychiatric unit, the nurse observes a client sitting quietly alone, eyes downcast, and looking sad. The nurse says to the client, "You look like something is bothering you." Which pattern of knowing did the nurse use to respond to the client? A. Empirical knowing B. Personal knowing C. Ethical knowing D. Aesthetic knowing

ANS: B. Personal knowing

A client states to the nurse, "I am going to kill my cousin. I need you to keep this a secret." Which is the most appropriate action by the nurse? A. Respect the client's privacy and not tell anyone. B. Tell the client that the secret cannot be kept and report to the health care provider. C. Tell the client that the secret will be kept, and then notify the health care provider. D. Tell the client the secret cannot be kept and notify the cousin immediately.

ANS: B. Tell the client that the secret cannot be kept and report to the health care provider.

The nurse has developed a nurse-client relationship with a client that has depression. Which statement made by the nurse indicates that there is a risk for boundary violation? A. "Have you considered sitting down and discussing some of the issues that you are having with your spouse?" B. "I would like for you to talk more about the issues that you are having with your family members." C. "I understand depression. I have been having problems with my spouse cheating and have been so depressed." D. "Be sure to take your medications as prescribed since they make a few weeks to take effect."

ANS: C. "I understand depression. I have been having problems with my spouse cheating and have been so depressed."

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic? A. "I am sure there are other people in your life who are your friends; besides, we just met." B. "It makes me feel good that you trust me so much; it is important for the work we are doing together." C. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." D. "We are definitely not friends. This is strictly professional."

ANS: C. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship."

A client is experiencing a panic attack. The nurse assists the client to redirect thoughts and aid in calming the situation even though it is past the nurse's shift. Which pattern of knowing is the nurse demonstrating by this action? A. Empirical B. Personal C. Ethical D. Aesthetic

ANS: C. Ethical

The client is getting ready to be discharged from the psychiatry unit. The nurse provides education regarding the client's take-home medications. Which role does the nurse exemplify during this intervention? A. Advocate B. Caregiver C. Teacher D. Parent surrogate

ANS: C. Teacher

The nurse is using the Johari window to determine and identify that they are in quadrant 1. Which does this indicate regarding the nurse's ability when communicating with clients? A. The nurse conceals personal information about the nurse. B. The nurse needs to increase insight into the nurse's own characteristics. C. The nurse is open to others. D. The client is sharing more than the nurse in the therapeutic relationship.

ANS: C. The nurse is open to others.

A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this client how to make better choices. The client has been here many times before and goes back home and does the same thing." Which behavior is the nurse demonstrating by verbalizing the statement? A. Value B. Awareness C. Belief D. Attitude

ANS: D. Attitude

The nurse assesses fine hand tremors in a client with a history of heavy alcohol use. If the nurse understands that the tremors are a direct result of alcohol use, the nurse is using which pattern of knowing, according to Carper? A. Aesthetic knowing B. Ethical knowing C. Personal knowing D. Empirical knowing

ANS: D. Empirical knowing

The nurse is initiating a therapeutic relationship with a client. Which information will the nurse include when explaining the purpose of this relationship to the client? A. Alleviating stressors in life B. Allowing the client to know the nurse's feelings C. Establishing a friendship D. Facilitating a positive change

ANS: D. Facilitating a positive change

The nurse has developed a therapeutic relationship with a client in the outpatient behavioral health clinic. Which situation is considered a breach of professional boundaries? A. Client asking a nurse for the nurse's phone number B. The nurse refuses a gift from a client. C. The nurse changes the subject in response to a client's compliment. D. The nurse has a lengthy social conversation with a client on the phone.

ANS: D. The nurse has a lengthy social conversation with a client on the phone.

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." How does the nurse interpret this behavior? A. Confrontation B. Countertransference C. Incongruence D. Transference

ANS: D. Transference