Chapter 5 Therapeutic Relationship
The nurse is caring for a client with schizophrenia. The client tells the nurse, "My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone." What is the most appropriate nursing response?
"I cannot keep this a secret. I will ensure that the staff helps keep you safe."
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."
A client treated for depression is ready for discharge from the hospital and tells the nurse, "It would be great if we could meet for coffee should I start feeling low again." Which statement indicates that the nurse understands the boundaries of the therapeutic relationship?
"Before you leave the hospital, I will make sure you have information about the crisis center."
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."
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." p 78
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?"
During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference?
"Tell me why you are angry about what I just said."
The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment?
"It can be scary to leave a place that you trust and feel supported."
A female psychiatric client is talking to the nurse about her reasons for being hospitalized. The client begins to discuss her relationship with her female significant other. She is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse?
"It sounds like you're beginning to be uncomfortable in this relationship.
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."
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?" (p 81)
A nurse is speaking to a client who attempted suicide. The client says, "It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself." Which statement indicates genuine interest by the nurse?
"You must have been really upset."
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. p 86
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
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 are the nurse's expectations of the client's responsibilities during the orientation phase of the nurse-client relationship? Select all that apply.
Attendance is expected for each session. Participation is expected during each session. Sharing of feelings and needs are vital to the productivity of the session
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 ( p 86)
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
Which occurs when the nurse responds to the client based on personal unconscious needs and conflicts?
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 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
When comparing social interactions with therapeutic interactions, the nurse understands that therapeutic interactions do what?
Encourage personal goal setting
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 action by the nurse or client represents the working phase of the therapeutic relationship?
Identifying past ineffective behaviors
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 Level of education Reason for being on the unit
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
A nurse is caring for a client on an inpatient mental health unit of a hospital. 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?
Orientation phase
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
A nurse is interviewing a client to obtain a health history. Which would be considered a "usual or expected" response during the first session?
Rambling due to nervousness
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 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.
When engaged in a therapeutic relationship, the nurse's focus is on what?
The client
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.
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
Avoiding which outcome is the primary reason for establishing professional boundaries with clients?
The loss of therapeutic effectiveness
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 actively listen to the client. The nurse should respond openly to the client.
A nurse is caring for a client experiencing delusions. The client tells the nurse "I am sure my brother has plans to kill me. But I am ready; I will be killing him before he tries to reach me." What is the appropriate action of the nurse in this situation?
The nurse should notify to the primary healthcare provider.
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.
A client forgets to attend a planned session. Which should the nurse conclude about the client's behavior?
The relationship is being tested. (p 86)
Which is a nurse's primary tool for treating clients with mental disorders?
The therapeutic use of self
The nurse is caring for a forensic client scheduled for discharge. Which mental health principle is most influential in recovery after discharge?
To prevent the client from viewing the nurse as a friend rather than health care provider
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
During which phase of the nurse-client relationship does the client identify and explore specific problems?
Working
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
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.
During the first meeting with a client, the nurse explains that the relationship is time limited and will end. Which best explains the reason for the nurse's explanation?
begininin the termination
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 manager is reviewing the implementation of the Transitional Relationship Model (TRM) on a care area. Which data should the manager identify that supports the successful implementation of this model? Select all that apply.
discharge of clients 5 days earlier than in the past number of readmissions down 6% over the last 2 months
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
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.
Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?
getting an appointment with the client at the time previously agreed upon
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 minimizing the client's concerns arguing with a client over agreed upon plans
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
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
The nurse maintains a therapeutic relationship until the client is successfully transferred to another facility. What is the nurse demonstrating?
transitional relationship model
A nurse tells a client that the nurse will come back in 10 minutes to reassess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing?
trust
During which phase of the nurse-client relationship does the client identify and explore specific problems?
working
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.
A nursing student is working with a client who has a history of abusing alcohol. Although the nurse has an aversive feeling toward people who abuse alcohol, the nurse feels that the client is worthy of respect and attention regardless of the nurse's own personal feelings. Which correctly describes the nurse's response to the client?
Unconditional positive regardWhile providing care to a client with psychosis, the psychiatric nurse uses communication initially for which reason?
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"
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 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."
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 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.
The most important tool of psychiatric nursing is the:
self (p 79)
The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply.
skips the last session expresses anger towards the nurse and other clients identifies a resolved problem as a new one needing to be addressed