Ch. 8: Therapeutic Relationships

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? a. congruence b. countertransference c. positive transference d. empathetic feelings

c. positive transference

Core Concepts of patient-centered care

1. dignity and respect 2. information sharing 3. patient and family participation 4. collaboration in policy and program development

Which patient statement demonstrates a value held regarding children? a. "Nothing is more important to me than the safety of my children." b. "I believe my spouse wants to leave both me and our children." c. "I don't think my child's success depends on going to college." d. "I know my children will help me through my hard times."

a. "Nothing is more important to me than the safety of my children."

Pyscotherapy

a formalized approach to talk therapy based on theoretical models

In which circumstance would countertransference be likely to occur? Select all that apply a. When a patient reminds you of someone in your past b. If the patient's transference evokes feelings in the nurse c. In an authority situation d. When it goes unrecognized

a, b, and d

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? select all that apply a. Helping patients examine self-defeating behaviors and test alternatives b. Promoting self-care and independence c. Providing the client with opportunities to socialize d. Assisting patients with problem solving to help facilitate activities of daily living e. Facilitating communication of distressing thoughts and feelings

a, b, d, and e

The patient expresses sadness at being alone with no one to share his life with. Which response by the nurse demonstrates the existence of a therapeutic patient-nurse relationship? a. "Loneliness can be very painful and difficult emotion." b. "Let's talk and see if you and I have anything in common." c. "I use Facebook to find people who share my love of cooking." d. "Loneliness is managed by getting involved with people."

a. "Loneliness can be very painful and difficult emotion."

A nurse seeks to establish a relationship with a patient readmitted to the hospital. The patient has bipolar disorder, depressed type, and was hospitalized the preceding month. Which statement by the nurse would contribute to establishing trust? a. "Weren't you complying with your medication regimen?" b. "It must be discouraging to be readmitted to the hospital so soon." c. "Everyone with bipolar disorder ends up in the hospital occasionally." d. "You must take your drugs as prescribed or you will be rehospitalized."

b. "It must be discouraging to be readmitted to the hospital so soon."

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? a. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." b. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" c. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge." d. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

b. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? a. Preorientation b. Orientation c. Working d. Termination

b. Orientation

What is the primary difference between a social and a therapeutic relationship? a. Type of information exchanged b. Amount of satisfaction felt c. Type of responsibility involved d. Amount of emotion invested

c. Type of responsibility involved

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student? a. The student requests an assignment to a patient of the same gender as the student b. She limits sharing personal information and stresses the patient-centered focus of the conversation c. The student shares information and stressed the patient-centered focus of the conversation d. She explains that if he persists in focusing on her, she cannot work with him

b. She limits sharing personal information and stresses the patient-centered focus of the conversation

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? a. Crisis intervention b. Therapeutic encounter c. Autonomous interaction d. Preorientation phenomenon

b. Therapeutic encounter

A newly admitted client says, "I'm scared to death of this place. It's like being placed in a cage of hungry lions." The best response is? a. "You'll get used to being here in a day or two b. "Take my word for it, this is a good place to be." c. "Being in a strange place can be frightening. The staff will try to help you become more comfortable here. d. "I'll introduce you to some clients who have been here a while and they'll show you around."

c. "Being in a strange place can be frightening. The staff will try to help you become more comfortable here.

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? a. "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." b. "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." c. "Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." d. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

d. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

Which remark is a broad opening? a. "Do you have any health problems?" b. Would you say your in good health?" c. How would you describe your health?" d. "Tell me about your health."

d. "Tell me about your health."

A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? a. "It's good that you feel guilty. That means you still have a chance of being helped." b. "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." c. "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." d. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

d. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? a. Enhanced client coping b. Lessening of client emotional pain c. Increased hope for client improvement d. Decreased client communication

d. Decreased client communication

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? a. Preorientation phase b. Orientation phase c. Working phase d. Termination phase

d. Termination phase

counseling

supportive face to face process that helps individuals problem-solve, resolve conflicts, and feel supported

A client sits wordlessly beside the nurse after exchanging neutral comments about the weather. The client appears to be lost in thought. The nurse should say? a. "It seems as though you'd rather not talk today." b. "Would you rather I went away?" c. "You seem thoughtful just now." d. "Well, what shall we talk about next?"

c. "You seem thoughtful just now."

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? Select all that apply. a. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. b. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. c. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. d. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. e. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

a, c, and d

Mary is a 39-year old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response? a. "I understand you are in a difficult situation." b. "Thinking about being wronged repeatedly does more harm than good." c. "I feel bad about your situation, and I am so sorry it is happening to you and your family." d. "It must be so difficult to live with uncaring people."

a. "I understand you are in a difficult situation."

Client to Nurse: My parents don't understand me. They're nagging at me all the time!" The nurse who decides to use a reflective response would say? a. "You feel your parents don't understand you? b. "Tell me more." c, "Why do you suppose they nag at you? d. "You sound angry with your parents."

a. "You feel your parents don't understand you?

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? a. Boundary blurring b. Value dissonance c. Covert anger d. Empathy

a. Boundary blurring

A client preparing for discharge presents the nurse with a handmade card of appreciation for the care this nurse provided. Should the nurse accept the card? a. Yes b. No c. Not sure

a. Yes

Which statement made by either patient or nurse demonstrates the existence of an ineffective patient-nurse relationship? a. "I've given a lot of thought about what triggers me to be so angry." b. "Why do you think it's acceptable to be so disrespectful to staff?" c. Will your spouse be able to attend tomorrow's meeting?" d. "I wanted you to know that the medication seems to be helping me feel less anxious."

b. "Why do you think it's acceptable to be so disrespectful to staff?"

A client tells the nurse, "I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequence of the nurse's action? a. Healthy feelings of sympathy by the nurse toward the client. b. Blurred boundaries in the nurse-client relationship. c. Improved rapport between the nurse and client. d. Enhanced trust between the nurse and client.

b. Blurred boundaries in the nurse-client relationship

Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship? a. Patient will be respectful of other patients on the unit b. Patient will identify suicidal thoughts to staff whenever they occur c. Patient will engage in at least one social interaction with the unit population daily d. Patient will consume a daily diet to meet both nutritional and hydration needs

b. Patient will identify suicidal thoughts to staff whenever they occur

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? a. I'm so sorry. My father died 2 years ago, so I know how you are feeling." b. "You need to focus on yourself right now. You deserve to take time just for you." c. "That must have been such a hard situation for you to deal with." d. "I know that you will get over this. It just takes time."

c. "That must have been such a hard situation for you to deal with."

Client to nurse: "I feel like a failure every time I come back to the hospital for another stay." The best response is? a. "I suppose with the number of admissions you've had this year, you might feel pretty defeated." b. "We're disappointed, too, when you need to come back." c. Remain silent d. "The hospital really isn't such a bad place to be, is it?"

c. Remain silent

A RN is caring for an older male who reports depressive symptoms since his wife of 54 years dies suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior? a. Reminding the patient gently that he will feel better over time b. Using a soft tone of voice questioning c. Sitting with the patient and taking cues for when to talk or when to remain silent d. Offering medication and bereavement services

c. Sitting with the patient and taking cues for when to talk or when to remain silent

What us the greatest trigger for the development if a patient's nurse focused transference? a. The similarity between the nurse and someone the patient already dislikes b. The nature of the patient's illness c. The history the patient has with their parents d. The degree of authority the nurse has over the patient

d. The degree of authority the nurse has over the patient