BH CH 8:

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?

Boundary blurring Rationale: Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.

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?

"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!" Rationale: This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

When a client states "That nurse never seems comfortable being with me." How is the client characterizing the nurse?

As not seeming genuine to the client. Rationale: Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.

A term is a synonym for the characteristic of genuineness?

Authentic Rationale: Genuineness refers the nurse's ability to be open, honest, and authentic in interactions with patients. It is the ability to meet others person-to-person without hiding behind roles. While positive characteristics, none of the other options related to genuineness.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome?

Decreased client communication Rationale: Sympathy and the resulting projection of the nurse's feelings limit the client's opportunity to further discuss the problem. The remaining options are positive outcomes.

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established?

Orientation Rationale: Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship. This function is not associated with any of the other options.

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?

Positive transference Rationale: Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which statement made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed?

"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." Rationale: The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which response by the nurse illustrates empathy?

"That must have been such a hard situation for you to deal with." Rationale: This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient, she will get over it does not reflect empathy and is closed-ended.

Which statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.)

-In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. -Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. -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.

A client has been admitted to an 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 response reflects a helpful trait in a therapeutic relationship?

"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." Rationale: This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.)

-Helping patients examine self-defeating behaviors and test alternatives -Promoting self-care and independence -Assisting patients with problem solving to help facilitate activities of daily living -Facilitating communication of distressing thoughts and feelings

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed?

Termination phase Rationale: Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with the other phases.

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship?

Therapeutic encounter Rationale: A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this form of relationship.

What is the primary difference between a social and a therapeutic relationship?

Type of responsibility involved Rationale: In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.