Therapeutic Relationships

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." "I really don't want to talk about that right now." "What difference does it make what I say to you?" "I know you are busy. I don't have much to say now."

"I feel worthless and have no real use in life." The other options do not provide a sense of sharing

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? "How did the pain start?" "What types of dresses do you like wearing?" "Do you take a vegetarian or nonvegetarian diet?" "Do you want me to inform your spouse about your illness?"

"What types of dresses do you like wearing?" Asking the client about the client's preferences on fashion and dressing indicate that the nurse is trying to build a social relationship with client, not engaging in a therapeutic use of self. This conversation does not influence the client care in any way. Asking the client about pain indicates that the nurse is gathering information about the client's illness. Asking about the client's food preference indicates that the nurse is finding about the nutrition habits of the client. Asking if the client has informed the spouse about the illness indicates that the nurse is allowing the client to take decisions regarding revealing the condition to other people. These questions indicate that the nurse is engaging in therapeutic communication with the client.

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?" "You know that I can't keep secrets from your health care team." "Without your permission I can't give any information to anyone." "Don't you trust me to respect your right to confidentiality?"

"Will this conversation involve your desire to harm yourself?" Confidentiality is not to be maintained if involving self-harm. Furthermore, it's okay to ask non-open-ended questions if involving self-harm.

Which clinical situation provides an example of transference? A nurse implements the same interventions with multiple clients despite their personal differences. A nurse asks for clarification from a colleague when explaining a coping strategy to a client. A client mirrors the nursing student's nervousness and hesitancy during assessment. A female client with a history of sexual abuse exhibits a profound mistrust of male caregivers.

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

A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what? Inappropriate, because the client was just making small talk about the nurse's personal situation to get to know the nurse better. Inappropriate, because the nurse should have answered to establish a therapeutic relationship. Appropriate, because the nurse is not in a relationship or married. Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.

Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.

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? Transference Free association Countertransference Reaction formation

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

In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase After the initiating or orienting phase has been completed During the working phase After the working phase has been completed

During the initiating or orienting phase The first step of the therapeutic relationship is called the initiating or orienting phase. During this phase, the nurse sets the stage for a one-to-one relationship by becoming acquainted with the client. At the same time, the nurse also begins the assessment process.

What occurs during the working phase of the nurse-client relationship? Evaluation of mutually identified goals Discussion of expectations of the relationship Rejection of client needs Discussion regarding termination of the relationship

Evaluation of mutually identified goals Evaluation of mutually identified goals occurs in the working phase of the nurse-client relationship. The nurse discusses expectations during the orientation phase. During the working phase, the nurse assesses client needs. Discussion regarding the termination of the relationship occurs during the orientation phase.

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 Working Resolution Withholding

Orientation

When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming? Parent surrogate Advocate Caregiver Teacher

Parent surrogate The nurturing needs of clients who are unable to carry out SIMPLE tasks are parent surrogate.

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? Tell the client the nurse will call once per week during office hours so that the client can practice phone skills Remind the client about the importance of boundaries to keep the relationship therapeutic Call the client once each weekend to build trust Tell the client to call the office answering service in case of an emergency

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

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. The client is experiencing symptoms of a disorder. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship.

The client is nervous and insecure. In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling.

Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The loss of therapeutic effectiveness The possibility of losing control of the milieu The likelihood of a client becoming too dependent on the nurse The possibility of inappropriate sexual tension developing

The loss of therapeutic effectiveness

Which is a nurse's primary tool for treating clients with mental disorders? Psychotropic medications The therapeutic use of self Self-help groups Family education and therapy

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

The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid ... a) The loss of therapeutic effectiveness b) The possibility of losing control of the milieu c) Likelihood of a client becoming too dependent on the nurse d) The possibility of inappropriate sexual tension developing

a) The loss of therapeutic effectiveness

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

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

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? Orientation Working Resolution Mutual withdrawal

Working The nurse is helping the client to EXAMINE the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client

While working with an older male client, the nurse begins to think that the client reminds her of her grandfather, and responds as if she was the granddaughter. The nurse is developing which of the following? a) Empathy b) Modeling c) Transference d) Countertransference

d) Countertransference

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? a) "What provoked you to take this action?" b) "I really feel sorry for your child." c) "How could you do this to your child?" d) "Punishing your child would only make him or her worse."

a) "What provoked you to take this action?"

The nurse manager recognizes that countertransference is affecting the therapeutic effectiveness of the nurse when he ... a) Consistently refers to an elderly, cognitively impaired client as "my granny" and takes responsibility for all her care b) Begins to experience the symptoms of depression and calls out sick c) Asks to be transferred to another unit to avoid burnout and to work with different disorders d) Is asked by a teenaged client be her "boyfriend" and to consider taking her to her prom when she's discharged

a) Consistently refers to an elderly, cognitively impaired client as "my granny" and takes responsibility for all her care

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? a) Empirical knowing b) Ethical knowing c) Personal knowing d) Aesthetic knowing

a) Empirical knowing

Empathy involves all but which of the following? a) Feeling the same emotions that the client is feeling at a given time b) Being in touch with what clients are saying c) Having insight into the meaning of clients' thoughts, feelings, and behaviors d) Careful listening

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

Which of the following would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? a) The client recognizes feelings of anger and expresses them appropriately. b) The client has revitalized her relationship with her sister. c) The nurse has designated a specific time each day to interact with the client. d) The client expresses a desire to be mothered and pampered.

a) The client recognizes feelings of anger and expresses them appropriately.

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. a) The nurse should actively listen to the client. b) The nurse should respond openly to the client. c) The nurse should be available all the time for caring for the client. d) The nurse should address the client by name. e) The nurse should give the responsibility of planning therapy to the client.

a) The nurse should actively listen to the client. b) The nurse should respond openly to the client. d) The nurse should address the client by name.

A client is undergoing individual psychotherapy. He is yelling at the therapist because of a fight with his wife about their children several years ago. In this instance, the client is exhibiting which response? a) Transference b) Parataxis c) Resistance d) Countertransference

a) Transference

When a therapist is interviewing a client diagnosed with depression, the client's feelings toward her parents as a child are being directed at the therapist. This is an example of which of the following? a) Transference b) Psychoanalysis c) Countertransference d) Object relations

a) Transference

The nurse is caring for a client with depression who states he cannot stop thinking about his dead wife. Which is the best example of self-disclosure the nurse may provide to the client? a) "I can understand your situation. Medication could be of great help to relieve your depression." b) "I can understand your situation; my brother too lost his wife two months back." c) "My father passed away recently. I can understand your problem." d) "I just had a divorce; I can understand how it would feel to be without a partner."

b) "I can understand your situation; my brother too lost his wife two months back." The client is depressed because of a spouse's death. The nurse should provide empathy using self-disclosure examples. The self-disclosure examples should not be related to nurse's concerns or painful experiences of the nurse. Stating that the nurse's father passed away recently could be extremely painful for the nurse. Stating that the nurse recently got divorced would also be painful.

A nurse is speaking to a client with a smiling expression. Which statement said by the nurse would indicate a congruent message? a) "Please don't disturb the other clients in the ward." b) "You hard work and determination has warded off your disease." c) "I know you are in pain. Please wait until the medication shows its effect." d) "Please listen to the instructions carefully before starting the exercises."

b) "You hard work and determination has warded off your disease."

A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if he is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is which of the following? a) Inappropriate, because the client was just making small talk about the nurse's personal situation to get to know the nurse better. b) Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. c) Appropriate, because the nurse is neither married nor has a girlfriend. d) Inappropriate, because the nurse should have answered to establish a therapeutic relationship.

b) Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.

What occurs during the working phase of the nurse-client relationship? a) Discussion regarding termination of the relationship b) Evaluation of mutually identified goals c) Discussion of expectations of the relationship d) Assessment of client needs

b) Evaluation of mutually identified goals

The mental health nurse is responsible for maintaining professional boundaries. Which of the following would be an example of a professional boundary violation? a) Providing a friendly environment b) Giving personalized gifts to a client c) Avoiding personal attachment to the client d) Exhibiting confidentiality

b) Giving personalized gifts to a client

A nurse is caring for a client in the health care facility. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse client relationship does this communication indicate, according to the Peplau's model? a) Exploitation phase b) Orientation phase c) Termination phase d) Identification phase

b) Orientation phase

When the medical health nurse helps the cognitively impaired client bathe and dress herself, the role being assumed is a) Nurse-teacher b) Parent surrogate c) Nurse-therapist d) Technical nurse

b) Parent surrogate

In what phase of the therapeutic relationship does the assessment process begin? a) During the working phase b) After the working phase has been completed c) After the initiating or orienting phase has been completed d) During the initiating or orienting phase

d) During the initiating or orienting phase

A client relates that she has panic attacks and, during the attacks, rushes to the emergency department because she feels like she is dying. The nurse discloses that she has had panic attacks during which she also felt very fearful. Which of the following statements represents an accurate statement about this self-disclosure? a) Self-disclosure allows the client to see the nurse as a real human being. b) Self-disclosure can help normalize the client's experience. c) Self-disclosure should be detailed so the client doesn't feel unimportant or devalued. d) Self-disclosure can help the client feel like a friend.

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

A nurse is conducting a 6-week social skills training program. A young adult with schizophrenia asks the nurse to call her on the weekends so she has someone to talk to who really cares about her. Which of the following actions should the nurse take? a) Tell the client she will call once per week during office hours so that the client can practice phone skills b) Tell the client firmly that such a request is an inappropriate violation of their professional relationship c) Tell the client to call the office answering service in case of an emergency d) Call the client once each weekend to build trust

b) Tell the client firmly that such a request is an inappropriate violation of their professional relationship

While assessing the behavior of the nurses, the nurse administrator finds that a nurse has an intimate relationship with a client. Which behavior of the nurse indicates that the nurse has an intimate relationship? a) The nurse speaks on topics like sports while performing assessment on the client. b) The nurse is having dinner with a client outside the hospital premises. c) The nurse is talking to the spouse of the client regarding the client's condition. d) The nurse examines the genital area of a client diagnosed with a venereal disease.

b) The nurse is having dinner with a client outside the hospital premises.

A psychiatric nurse tells her client that she will return in 15 minutes to talk with him. She goes to a meeting that runs overtime and returns in an hour, apologizing for being late. This behavior may have an impact between the nurse and her client in the area of a) getting through the working phase of the relationship. b) establishing trust in the introductory phase of the relationship. c) establishing confidentiality. d) establishing boundaries on the therapeutic relationship.

b) establishing trust in the introductory phase of the relationship.

The nurse is caring for a schizophrenic client. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Today is my last day on this planet. Please do not tell anyone." What is the most appropriate nursing response? a) "I will speak with the health-care provider about the possible use of physical restraints for you tonight." b) "Are you out of your mind? Why are you having these ideas?" c) "I cannot keep this a secret. I will ensure that the staff helps keep you safe." d) "Don't worry; I will keep this secret to myself."

c) "I cannot keep this a secret. I will ensure that the staff helps keep you safe."

Which of the following terms is used to describe general feelings or a frame of reference around which a person organizes knowledge about the world? a) Self-awareness b) Values c) Attitudes d) Beliefs

c) Attitudes

Which of the following occurs when the nurse responds to the client based on personal unconscious needs and conflicts? a) Transference b) Exploration c) Countertransference d) Self-disclosure

c) Countertransference

Which of the following is an inaccurate statement regarding a preconception? a) It prevents people from getting to know one another. b) It is a way that a person expects another to behave. c) It enables the nurse to get an accurate picture of the client's problems. d) It may prevent the nurse from developing a therapeutic relationship with the client.

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

The nurse uses self-disclosure to ... a) Shift the focus from the client to the nurse b) Initiate conversations c) Meet therapeutic goals d) Meet personal goals

c) Meet therapeutic goals

It is the nurse's responsibility to define the boundaries of the relationship during which phase of the nurse-client relationship? a) Working b) Termination c) Orientation d) Problem identification

c) Orientation

A client with post traumatic stress disorder (PTSD) stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? a) Empirical knowing b) Ethical knowing c) Personal knowing d) Aesthetic knowing

c) Personal knowing

A client expresses worry about her child's aggressive behavior. The nurse says "If I would have been in your situation, I too would worry about my child." What does this nurse's statement indicate? a) The nurse is showing genuine interest in the client. b) The nurse is comforting the client. c) The nurse is empathizing with the client. d) The nurse is sympathizing with the client.

c) The nurse is empathizing with the client.

The nurse-client relationship is classified as which type of relationship? a) Social b) Intimate c) Therapeutic d) Friendly

c) Therapeutic

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference? a) "It sounds like you're exasperated with the caregivers you've interacted with. Is that fair to say?" b) "Actually, I've not come here to tell you that." c) "Is that a message you've been hearing a lot over the past couple of days?" d) "There's no need to get rude with me. I'm just trying to do my job and to help you out."

d) "There's no need to get rude with me. I'm just trying to do my job and to help you out."

Which of the following is not considered a step in the values clarification process? a) Choosing b) Acting c) Prizing d) Assessing

d) Assessing

All except which of the following are goals of the working phase of the therapeutic relationship? a) Develop a plan of action, practice it, and evaluate its effectiveness b) Identify past behaviors that have been ineffective for coping with the focal problem c) Increase hopefulness for the future d) Reduce the client's anxieties

d) Reduce the client's anxieties

Building of the therapeutic relationship begins with the nurse's ... a) Previous social skills b) Desire to form friendships c) Communication skills d) Self-awareness

d) Self-awareness

A nurse tells a client that she will come back in 10 minutes to re-assess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing? a) Closure b) Empathy c) Sympathy d) Trust

d) Trust

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. sympathy. apathy. nontherapeutic communication.

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

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? providing advice on how to manage a problem being too general with the details of the story shifting the emphasis to the nurse using situations that have occurred on the unit

shifting the emphasis to the nurse