Chapter 6. Relationship Development

Which client statement does the nurse recognize as the client's typical response to stress most often experienced in the working phase of the nurse-client relationship? 1. "I can't bear the thought of leaving here and failing." 2. "You remind me of one of my parents. I might have a hard time working with you." 3. "I can't tell my spouse how I feel; he wouldn't listen anyway." 4. "I'm not sure that I can count on you to protect my confidentiality."

"I can't tell my spouse how I feel; he wouldn't listen anyway."

Which client statement indicates to the nurse that the client may be experiencing a transference reaction? 1. "I need a real nurse. You are young enough to be my daughter, and I don't want to tell you about my personal life." 2. "I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor." 3. "I don't seem to be able to relate to people. I would rather stay in my room and be by myself." 4. "My mother is the source of my problems. She has always told me what to do and what to say."

"I need a real nurse. You are young enough to be my daughter, and I don't want to tell you about my personal life."

A parent who has learned that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? 1. "This situation is very sad, but time is a great healer." 2. "You are sad, but you must be strong for your other children." 3. "Once you cry it all out, things will seem so much better." 4. "It must be horrible to lose a child; I'll stay with you until your spouse arrives."

"It must be horrible to lose a child; I'll stay with you until your spouse arrives."

The psychiatric-mental health nurse is counseling a client whose infant recently died from sudden infant death syndrome. Which nursing response demonstrates empathy? 1. "It must have been frightening when you realized something was wrong." 2. "Tell me how you and your spouse have been doing since the funeral." 3. "Let me help you understand the different stages of the grieving process." 4. "Have you had feelings of hurting yourself or someone else lately?"

"It must have been frightening when you realized something was wrong."

When asked to play a game, a client diagnosed with paranoid schizophrenia becomes agitated. The client states, "Do you want to be my girlfriend?" Which nursing response is best? 1. "You are upset now. It would be best if you go to your room until you feel better." 2. "Remember, we have a professional relationship. Are you feeling uncomfortable?" 3. "We have discussed this before. I am not allowed to date clients." 4. "I think you should discuss your fantasies with your therapist."

"Remember, we have a professional relationship. Are you feeling uncomfortable?"

Which client statement indicates to the nurse that termination of the therapeutic nurse-client relationship has been successful? 1. "I know I can count on you for continued support." 2. "I am looking forward to discharge, but I am surprised that we will no longer work together." 3. "Reviewing the changes that have happened during our time together has helped me put things in perspective." 4. "I don't know how comfortable I will feel when talking to someone else."

"Reviewing the changes that have happened during our time together has helped me put things in perspective."

Which of the following is the nurse's most therapeutic statement when the client and nurse move from the orientation stage to the working stage of the therapeutic relationship? 1. "I want to assure you that I will maintain your confidentiality." 2. "A long-term goal for someone your age would be to develop better job skills." 3. "Which problems that we identified would you like for us to address first?" 4. "I think we need to focus on your relationship issues first."

"Which problems that we identified would you like for us to address first?"

A client has made the decision to leave her alcoholic spouse and reports feeling very depressed. Which of the following statements by the nurse represents sympathy? 1. "You are feeling very depressed. I felt the same way when I decided to leave my spouse." 2. "I can understand you are feeling depressed. It was a difficult decision. I'll sit with you." 3. "You seem depressed. It was a difficult decision to make. Would you like to talk about it?" 4. "I know this is a difficult time for you. Would you like medication for anxiety?"

"You are feeling very depressed. I felt the same way when I decided to leave my spouse."

Which of the following can the psychiatric-mental health nurse utilize to best increase self-awareness? Select all that apply. 1. Values clarification 2. The Johari window 3. Concrete thinking 4. Positive regard 5. Personal boundaries

1, 2

Which of the following indicate that the integrity of the nurse-client relationship may be in jeopardy? Select all that apply. 1. Requesting to be reassigned to a particular client 2. Informing the client that a behavior is unacceptable 3. Touching and hugging the client 4. Expressing sympathy for the client 5. Contacting the client after discharge

1, 5

The nurse-client therapeutic relationship includes which of the following characteristics? Select all that apply. 1. Meeting the psychological needs of the nurse and the client 2. Ensuring therapeutic termination 3. Promoting client insight into problematic behavior 4. Collaborating to set appropriate goals 5. Meeting the holistic needs of the client

2, 3, 4, 5

What is the most essential task for a nurse prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the client's length of stay. 4. Establish personal goals for the interaction.

Clarify personal attitudes, values, and beliefs.

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, "I'm not well enough to switch to a different nurse." Which of the following does the nurse recognize the client is demonstrating? 1. Manipulation to receive secondary gain 2. The defense mechanism of denial 3. Difficulty terminating the relationship 4. Use of "splitting" to remain dependent on the nurse

Difficulty terminating the relationship

Which of the following is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? 1. Acknowledge the client's actions and generate alternative behaviors. 2. Establish rapport and develop mutually agreeable treatment goals. 3. Attempt to find alternative placement for the client. 4. Explore how thoughts and feelings may adversely impact nursing care.

Establish rapport and develop mutually agreeable treatment goals.

Which of the following is the nurse's primary goal during the preinteraction phase of the nurse-client relationship?1. Evaluate goal attainment. 2. Formulate a contract for intervention. 3. Explore self-perceptions. 4. Promote client change.

Explore self-perceptions.

Which nursing intervention described by Peplau demonstrates the nurse's role as a surrogate? 1. Functions as a nurturing parent to build a trusting relationship 2. Plays cards with a small group of clients on the inpatient unit 3. Discusses the client's childhood events that affect personality development 4. Creates a safe social environment within the milieu

Functions as a nurturing parent to build a trusting relationship

Which is the nurse's best action when a client demonstrates transference? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client clarify the meaning of the nurse-client relationship.

Help the client clarify the meaning of the nurse-client relationship.

A nurse discovers that their newly assigned client is their sibling. What would be the most appropriate step in this nurse-client relationship? 1. Notify the charge nurse of the need to withdraw from the care of the client. 2. Notify the other clients in the unit that the nurse and client are related. 3. Notify the client that they do not need to exchange gifts for the holidays this year. 4. Continue with the care and do not acknowledge the relationship.

Notify the charge nurse of the need to withdraw from the care of the client.

Which phase of the nurse-client relationship begins when the nurse and client first meet and is characterized by an agreement to continue meeting and working on setting client-centered goals? 1. Preinteraction 2. Orientation 3. Working 4. Termination

Orientation

The nurse has realized that growing up in an alcoholic family may affect his or her ability to care for an individual client. This task is part of what phase of the therapeutic nurse-client relationship? 1. Preinteraction phase 2. Orientation phase 3. Working phase 4. Termination phase

Preinteraction phase

A client who was discharged 2 weeks ago sends a thank-you card to the psychiatric-mental health nurse and finds season tickets to the city's professional football team. Which of the following must the nurse consider when deciding whether to keep the tickets? 1. Material boundaries 2. Personal boundaries 3. Social boundaries 4. Professional boundaries

Professional boundaries

Which task is the nurse's priority during the working phase of a therapeutic relationship? 1. Establishing a contract for intervention 2. Examining feelings about working with the client 3. Establishing a plan for continuing aftercare 4. Promoting the client's insight and perception of reality

Promoting the client's insight and perception of reality

Which of the nursing actions described by Peplau demonstrates the nurse's role as a resource person? 1. Balances a safe therapeutic environment to increase the client's sense of belonging 2. Conducts a group on the unit to discuss common feelings about mental illness 3. Administers medications and watches for signs of "cheeking" 4. Provides information using language the client can understand

Provides information using language the client can understand

18. Which of the following is the main goal of the working phase of the nurse-client therapeutic relationship? 1. Role-play to improve interaction with others. 2. Resolve the client's problems. 3. Use therapeutic communication to clarify perceptions. 4. Help the client access outpatient treatment.

Resolve the client's problems.

Which outcome does the nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client and nurse establish rapport and mutually develop treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behaviors.

The client gains insight and incorporates alternative behaviors.

Which of the following indicates that the nurse understands self-disclosure is appropriate in a therapeutic nurse-client relationship? 1. The information may benefit the nurse and client. 2. There is a duty to warn. 3. The nurse feels emotionally indebted toward the client. 4. The information may benefit the client.

The information may benefit the client.

A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. The nurse postpones the admission interview, verbally assures safety, and provides the client with a warm meal. Which of the following does the nurse's action demonstrate? 1. Sympathy 2. Trust 3. Veracity 4. Manipulation

Trust

The nurse is providing care to the client during the detoxification process and does so without emotion. The nurse does not recognize the client's perception of the care as cold and judgmental. Which quadrant of the Johari window would this be considered? 1. Open self 2. Unknowing self 3. Private self 4. Unknown self

Unknowing self

Which nursing action demonstrates the role of the teacher in the therapeutic milieu? 1. The nurse implements a self-affirmation exercise during a one-on-one client interaction. 2. The nurse conducts a group meeting to present common side effects of psychiatric medications. 3. The nurse introduces the concept of fair play while playing cards with a group of clients. 4. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

he nurse conducts a group meeting to present common side effects of psychiatric medications.