Mental Health Chapter 9: The Nurse-Patient Relationship

The manager determines that a nurse is using motivational interviewing when talking with a client. Which statment made by the nurse did the manager observe to make this clinical determination?

"How important is it to you to stop drinking?"

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?"

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic?

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

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." -Countertransference is an emotional reaction to the client based upon personal unconscious needs and conflicts.

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."

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?

"There's no need to get rude with me. I'm just trying to do my job and to help you out." - Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

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

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

A care area is having difficulty implementing the transitional care model. Which observation should the nurse manager address to help facilitate this process? Select all that apply.

-nurses feeling overwhelmed - over-reliance on the process - focusing on preexisting conflicts

A client arrives for a scheduled meeting with the nurse. Which statement should the nurse make that indicates the working phase of the relationship?

"Your idea would help prevent this from happening again."

The nurse has been working with a client with an eating disorder for 1 week. During the morning treatment team meeting, the treatment plan is updated. Which would be appropriate interventions at this time in the nurse-client relationship? Select all that apply.

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

Which statement 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.

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.

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

The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply.

- establish professional boundaries - listen intently to the client explain problems and issues - explain what confidential information will be shared with others

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

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

A nurse is assigned to care for a client whose sexual orientation differs from her own. She would need to seek clinical supervision if she attempted to ...

Assist the client to change values

After teaching a class about the phases of the therapeutic relationship, the instructor determines a need for additional education when the class identifies which as a goal of the working phase?

Develop a sense of trust within the relationship.

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 - 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.

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

Encouraging the client to clarify feelings and behavior

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

What occurs during the working phase of the nurse-client relationship?

Evaluation of mutually identified goals

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

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

Which phase of the nurse-client relationship involves establishment of a therapeutic environment by the nurse?

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

Which of the following occurs during problem identification of the working phase?

The client identifies issues or concerns.

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.

A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?

The client is testing the parameters of the relationship. - In the early phases of the nurse-client relationship, lateness and absence often characterize the client's testing of the relationship. This is a well-recognized phenomenon

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.

Which of the following occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others?

Transference

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" - Countertransference occurs when a mental health care professional redirects his or her feelings toward a client or becomes emotionally entangled with a client, as is occurring with the nurse's "granny."

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 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

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 orientation phase is the phase during which the nurse and client get to know each other. During this phase, the client develops a sense of trust in the nurse. In the working phase, the client works through problems and identifies potential solutions to issues. During the termination phase, problems are resolved.

A nurse is communicating with a client who is highly anxious. During the conversation, the nurse notices that the nurse's speech is matching the fast pace of the client's speech, and the nurse's heart rate is increasing. The nurse identifies this as:

empathetic linkage.

The most important tool of psychiatric nursing is the:

self

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. - Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others. Confrontation is a technique used to highlight the incongruence between a person's verbalizations and actual behavior. Countertransference occurs when the therapist displaces onto the client attitudes or feelings from his or her past. Incongruence occurs when the communication content and process disagree.

An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by:

validating the client's ability to make decisions and effect change.