Ch. 5 Therapeutic Relationships

The nurse is working with a patient who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the patient, the nurse shows positive regard through which statement?

"How is not working right now affecting you?"

A patient being discharged appears angry with the nurse when the nurse attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses?

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

During a regular home health visit to an elderly client, the nurse observes that the client has feelings of hopelessness and despair. The client says, "I'm old, and my life has no purpose anymore. But promise me you won't tell anyone." How should the nurse respond?

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

The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is,

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

A nurse is working with a patient whose background is very different from hers. A good question to ask herself to assure she can be effective working with this patient would be,

"What experiences do I have with people with similar backgrounds?"

The nurse understands that empathy is essential to the therapeutic relationship. When a patient makes the statement, "I am just devastated that my marriage is falling apart," the nurse can best show empathy through which of the following responses?

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

Which of the following behaviors by the nurse demonstrate positive regard? ~select all that apply~

- Calling the client by name - Spending time with the client - Responding openly - Considering the client's ideas and preference when planning care

Which of the following are specific tasks of the working phase of a therapeutic relationship? ~select all that apply~

- Encourage expression of feelings - Facilitate behavior change - Promote self-esteem

The nurse has been working with a patient with an eating disorder for one week. During the morning treatment team meeting, the treatment plan is updated. Which of the following would be appropriate interventions at this time in the nurse-patient relationship? ~select all that apply~

- Exploring perceptions of reality - Promoting a positive self-concept - Working through resistance

Confidentiality means respecting the client's right to keep his/her information private. When can the nurse share information about the client? ~select all that apply~

- The client threatens to harm a family member - The client gives written permission - The client's legal guardian asks for information

Which of the following statements correctly depict the problem of feeling sympathy toward the client? ~select all that apply~

- When the nurse's behavior is rooted in sympathy, the client finds it easier to manipulate the nurse's feelings. - The client is discouraged from exploring his or her problems, thoughts, and feelings. - The client is discouraged from growth. - The client feels dependent on the nurse.

The nurse is mindful of maintaining relationships with patients that are therapeutic. Certain characteristics of the relationships the nurse will foster include: ~select all that apply~

- establishing boundaries for both the nurse and patient. - maintaining a patient-focus at all times. - avoiding concern with whether the patient likes the nurse.

Which of the following statements is true of empathy? Select all that apply.

-It is the ability to place oneself into the experience of another for a moment in time. -It is developed by gathering information from the client.

What are possible warnings or signals of abuse of the nurse-client relationship? Select all that apply.

-nurse making exceptions to client -keeping secrets -inappropriate conversations in the nurse-client relationship

A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this patient how to make better choices. He has been here many times before and goes back home and does the same thing." The nurse is sharing which of the following?

Attitude

The emotional frame of reference by which one sees the world is created by

Attitudes

Ideas that one holds as true are

Beliefs

How can a nurse avoid the possibility of finding the client's behavior unacceptable or distasteful?

By being aware of the client's behavior and background before beginning the relationship; and exploring the possibility of a conflict of a colleague.

The nurse is caring for her 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?

Caregiver

A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its characteristics. The nurse is using which of the following techniques?

Defining boundaries

Which of the following is the most important skill the nurse must bring to the therapeutic nurse-client relationship

Empathy

The nurse assesses fine hand tremors in a patient 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?

Empirical knowing

During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems?

Encouraging the client to clarify feelings and behavior

The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to...

Facilitate a positive change

Nurses must be aware of the importance of boundaries, not only for the client but also for the nurse. Which of the following occurrences is considered a breach of professional boundaries?

Having a lengthy social conversation with a patient

The nurse fails to assess personal values surrounding homosexuality before caring for a patient who is openly gay. The nurse is most at risk for which of the following when working with this patient?

Holding a prejudice toward this patient

The nurse is meeting with her client for the first time. During the orientation phase of the nurse-patient relationship, the nurse directs the patient to do which of the following?

Identify problems to examine

Which of the following statements is true of the component of a therapeutic relationship "acceptance"?

It is avoiding judgments of the person, no matter what the behavior is.

A tool the nurse uses to learn more about his or her qualities and communication with others is called?

Johari Window

Which one of the following statements about the nurse and ethnocentrism is true?

Nurses have a tendency to inwardly view their own culture as superior to others.

An adolescent patient has just been found to have broken one of the unit rules. The nurse imposes the consequence of losing phone privileges. In this instance, the nurse is acting as

Parent surrogate

A nurse notices a patient sitting quietly alone, eyes downcast, and looking sad. The nurse says to the patient, "You look like something is bothering you." Which pattern of knowing did the nurse use to respond to the patient?

Personal knowing

While in the day room of the psych unit the nurse notices 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?

Personal knowing

During a therapeutic communication session, the nurse tells the client of a past experience. Which of the following statements is true about a nurse's self-disclosure?

Self-disclosure on the nurse's part should benefit the client.

The client tells the nurse "My biggest problem right now is trying to deal with a divorce. I didn't want a divorce and I still don't. But it's happening anyway!" Which of the following responses by the nurse will convey empathy?

Sounds like it has been a difficult time

The client is getting ready to be discharged from the psych unit. A nurse and client has just completed reviewing the client's take-home medications. The nurse is exemplifying which role during this intervention?

Teacher

What is the primary differences between social and therapeutic relationships?

The focus of the relationship

A nurse is using the Johari window to identify the degree to which he feels comfortable communicating with others. After completing the exercise, the nurse discovers that quadrant 1 has the longest list of qualities. This indicates which of the following about the nurse?

The nurse is open to others

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 what influence on the therapeutic relationship?

The nurse will avoid imposing any values on the client.

Building trust is important in

The orientation phase of the relationship

What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it secret that the client plans to kill a family member?

The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members.

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." The nurse should recognize this as

Transference

Abstract standards that provide a person with his/her code of conduct are

Values

The nurse must be able to make decisions that are based on the principles of right and wrong. What is the standard for establishing such a code of conduct for living?

Values

A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek clinical supervision?

When the nurse desires to assist the client to change values

A nurse in the geri-psych unit witnesses another nurse violate the boundaries of the professional relationship with the client. What role is the nurse taking as he or she speaks to the supervisor about this situation and then the offending nurse?

advocate

The nurse and patient are visiting about upcoming sporting events of which they both share an interest. This form of interaction has the potential to threaten the nurse-patient relationship by

avoiding serious work that can help the patient change.

When preparing for the first clinical experience with patients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic patients. The primary reason for discussing personal beliefs is to

become aware of possible barriers to developing therapeutic relationships.

A client recently experienced a panic attack. A nurse has worked with the client to redirect the client's thoughts and to aid in calming the situation even though it is past the nurse's shift. This is an example of which pattern of knowing?

ethical

An experienced nurse takes pride in the therapeutic use of self. Nurse-client relationships are meaningful to both the nurse and the client. Nurses that have use of self skills help clients do which of the following?

grow, challenge, and heal