Psych - Videbeck Ch 5

A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what?

The exploration of behaviors to uncover the client perspective

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

develop a sense of trust in the nurse

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

Orientation

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

Rambling due to nervousness

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

The loss of therapeutic effectiveness

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

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

When a client states, "I will solve my own problems without asking my family for help," which response by the nurse demonstrates a therapeutic use of self?

"Asking for help from those who care about us isn't a sign of weakness."

Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts?

Countertransference

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

working

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

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

A nurse is caring for a client with anxiety disorder. The nurse knows that the client will have dyspnea and tachycardia if she has an anxiety attack. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Empirical knowing

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

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

A nurse administrator is observing the behavior of nurses in the hospital. Which behaviors would the nurse administrator consider inappropriate? Select all that apply.

A nurse hugging a client who had come in for an initial visit A nurse speaking to a depressed client in a very strict, disciplinarian tone

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment?

"Our relationship is one of a professional nature."

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child?

"That must have been terribly hurtful experience for you."

Which statement would indicate that the nurse has a non-judgmental attitude?

"The client has struggled with her life circumstance of living with a man who beats her, and she is trying very hard to make the changes necessary to help herself."

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

"What types of dresses do you like wearing?"

A client tells the nurse, "I had to slap my child, I couldn't help that." Which response of the nurse indicates that the nurse is in the state of unknowing?

"What was going on for you when this happened?"

When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response?

"Will this conversation involve your desire to harm yourself?"

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

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

Which clinical situation provides an example of transference?

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

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

Acting out

Which role of the nurse-client relationship is being exhibited when the nurse informs the client and then supports the client in whatever decision the client makes?

Advocate

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?

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

Which term is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world?

Attitudes

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?

Client self-exploration

A 68-year-old parent is the sole care provider for a 39-year-old child who has a diagnosis of bipolar disorder. The 39-year-old has been experiencing worsening of the illness over several years. The nurse should recognize that the parent is at risk for what?

Compassion fatigue

The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?

Countertransference

In what phase of the therapeutic relationship does the assessment process begin?

During the initiating or orienting phase

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

Eliciting the client's cooperation through the establishment of trust

A nurse has been working for 15 hours continuously without a break. The nurse administrator insists that the nurse should go home and sleep. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of?

Ethical knowing

A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what?

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

Which is not involved in empathy?

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

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

Hildegard Peplau

Which is an inaccurate statement regarding a preconception?

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

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply.

Name Reason for being on the unit Level of education

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming?

Parent surrogate

The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areas should the nurse focus on while caring for this client? Select all that apply.

Preventing deterioration of mental status Promoting mental health Promoting physical health

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems.

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call the client on the weekends so the client has someone to talk to who really cares. Which action should the nurse take?

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

A nurse and client are in the orientation phase of the nurse-client relationship. Which behavior would occur during this phase? Select all that apply.

Reviewing the client history Discussion of client's expectations Explanation of the purpose of the relationship

A client relates that the client has panic attacks and, during the attacks, rushes to the emergency department because the client feels like the client is dying. The nurse discloses that the nurse has had panic attacks during which the nurse also felt very fearful. Which statement represents an accurate statement about this self-disclosure?

Self-disclosure can help normalize the client's experience.

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

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

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?

The client is nervous and insecure.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?

The client is testing the parameters of the relationship.

Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase?

The client recognizes feelings of anger and expresses them appropriately.

Which observation should lead the nurse manager to recognize that countertransference is affecting the therapeutic effectiveness of an individual nurse on the unit?

The nurse frequently refers to an elderly, cognitively impaired client as "my granny"

A client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?

The nurse is empathizing with the client.

A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply.

The nurse should address the client by name. The nurse should respond openly to the client. The nurse should actively listen to the client.

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

The therapeutic use of self

A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation?

The therapist must notify authorities and the potential victim.

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

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

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

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

A nurse notices that a neighbor has been admitted to an inpatient psychiatric unit. The nurse understands that the nurse may not discuss this with any of the nurse's family or neighbors, because doing so would breach the client's confidentiality. Confidentiality is a component of which element of the therapeutic relationship?

Trust

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

Working

After meeting with a client experiencing extreme anxiety the nurse notes personal feelings of nervousness. Which action should the nurse take first to address these feelings?

analyze the source of the feelings

During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:

empathy.

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

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

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain?

perception of the problem

The most important tool of psychiatric nursing is the:

self.

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

shifting the emphasis to the nurse

During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts?

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

Which situation would most likely indicate a violation of professional boundaries? Select all that apply.

The nurse strongly defends a client's behavior during a staff meeting. A nurse tells other staff that the nurse is the only one who understands the client. A nurse begins to spend increasing amounts of time with one client on the unit.

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

While interviewing a client, the nurse imagines what it would be like to be in the client's situation and how it would feel. The nurse is demonstrating:

empathy.