Ch 5: Therapeutic Relationships
During the working phase, a client demonstrates open hostility and reaction to the client last question. Which response should the nurse make to avoid countertransference?
" tell me why you were angry about what I just said"
The most important tool a psychiatric nursing is the
Self
A nurse is assessing an adolescent client who is recently began self mutilating. The nurse asked the client questions to seek to uncover the motivation underline this behavior. The nurses best approach reflects what?
The exploration of behaviors to uncover the clients perspective
Which observation should leave the nurse manager to recognize that counter transference is affecting therapeutic effectiveness in an individual nurse on the unit?
The nurse frequently refers to an elderly, cognitively impaired client as my granny
The nurse learn some new client is a former significant other and the initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?
Asked to be reassigned because of having prior personal relationship with the client
My client states, I can 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 others who care about us is not a sign of weakness
Which are the nurses expectations of a clients responsibility during the orientation phase?
Attendance is expected for each session participation is expected during each session Sharing your feelings and needs are vital to the productivity of the session
Which term is used to describe general feelings or frame of reference around which a person organize his knowledge about the world?
Attitude
A nurse is conducting a six week social skills training program. A young adult with schizophrenia ask the nurse to call the client on the weekends of the client has someone to talk to you who really cares. What action should the nurse take?
Remind the client about the importance of boundaries to keep the therapeutic relationship
A client tells a mental health nurse the client is taking sewing classes to cope with the client sign moving to another state. This use of adaptive coping skills as an example of which aspect of the therapeutic relationship?
Client self exploration
The client expresses worrying about a clients child aggressive behavior. The nurse says you're in a very challenging situation. Your child's aggressive behavior is very stressful for you, is that correct? What does the nurse statement indicate?
The nurse is empathizing with a client
In which phase of the therapeutic relationship does the assessment process begin?
During the initiating or orienting phase
Well providing care to a client with psychosis, the psychiatric nurse uses communication initially for what reason?
Eliciting the clients corporation to the establishment of trust
The 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 carpar's patterns of nursing knowledge, which pattern of knowing is this indicative of?
Empirical knowing (The science of nursing)
A nurse has been working for 15 hours continuously without a break the nurse administrator insist at the nursing home and get some sleep. According to carpers patterns of nursing knowledge, the pattern of knowledge is this indicative of?
Ethical knowing
The nurse prepares to assist a time for the first time. Which option to the nurse take to develop a rapport with the client?
Explain what confidential information will be shared with others establish professional boundaries listen intently to the clients problems and issues
A nursing student is teaching a class on empathy. The instructor determines what the class needs additional education when the client identifies the empathy involves what?
Feeling the same emotions that the client is feeling At the given time
Which nursing intervention demonstrates congruency and a therapeutic nurse client relationship?
Getting an appointment with the client at the previous time agreed-upon
Which is an in accurate statement regarding a pre-conception?
It enables the nurse to get accurate picture of the clients problem
When interacting with a client for the first time, which information would be appropriate for the nurse to disclose?
Name, level of education, and reason for being on the unit
The nurse is reviewing the current history, identifying themes and considers how the nurse can be most therapeutic to a client who has been recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?
Orientation
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 except these gifts because they extend over our discussed boundaries
Which statement is most empathetic response to a clients disclosure that the fathers abandoned the family when the client was a young child?
That must've been a really terribly hurtful experience for you
The client expresses the station and believes the nurse does not want to help him achieve wellness. Which phase of the deteriorating relationship is the client experiencing
Struggling with
Avoiding which outcome is the primary reason for establishing professional boundaries with the clients?
The loss of therapeutic effectiveness
A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?
The client is able to independently express feelings and emotion with the clients friends
Termination takes place during the resolution phase of a nurse client relationship. During the terminate process, a client brings up resolve problems and present him as new issues to work towards. The nurse interprets the client action as indicating what?
The client is attempting to prolong the nurse client relationship
A nurse is meeting a client for the first time. The nurse observes the client smiles appropriately but uses rambling speech when answering the nurses 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 arrive 15 minutes late for their last appointment and did not show up to today's appointment despite confirming the day before. How should the nurse past interpret the clients behavior?
The client is testing the parameters of the relationship
Which problem can arise during the working phase of the nurse client relationship that serves to impair the therapeutic work? Select all that apply
The client struggles with expressing feelings The client demonstrates dependence on the group The nurse demonstrates evidence of counter transference
A nurse is in the orientation phase of a nurse client relationship was with a client diagnosed with a mental disorder. When interviewing the client during the first encounter, which information to the nurse the most important to obtain?
The clients perception of the problem
It is brought to the nurse administrators attention that a nurse has developed an intimate relationship with the client. Which behavior indicates the nurse has engaged in an intimate relationship with a client?
The nurse is having dinner with a client outside of the hospital promise
I understand that giving positive regard to the client how to build trust. Which actions are appropriate when conveying positive regard?
The nurse should address a client by name, the nurse should actively listen to the client, and the nurse should respond openly to the client
What should the nurse avoid when demonstrating genuine interest for a client by making self disclosure?
The nurse should avoid shifting the emphasis to the nurse
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 the situation?
The nurse should notify the primary healthcare provider
Which situation would most likely indicate a violation of professional boundaries?
The nurse strongly defensive clients 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 amount of time with a client on the unit
During the orientation phase of the nurse client relationship, the nurse notes a change the clients behavior. The client has forgotten a scheduled session and then accuses a nurse of breaking confidentiality. The nurse interprets a suggesting what?
The patient is acting out
Which is the nurses primary tool for treating clients with mental disorders?
The therapeutic use of self
A nurse is caring for a client with hematology who has been depressed. The client was a nurse I don't feel like I will ever be independent again. I don't wanna burden everybody in my house. The nurse response 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 the nurse client relationship occurring ?
The working phase
The client tells the nurse, I am just doing my regular sitting breathing exercises. Why do I still feel breathless while walking? The nurse replies, sitting reading exercises alone may not achieve the desired effect. You should also be performing daily deep exercise as well walking. They should help you reduce breathlessness when walking. According to peplau model, the nurse and client are in what phase?
The working phase
Psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?
To provide the client from doing the nurse as a friend rather than a healthcare 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 nurses family or neighbors, because doing so would be a breach of the client confidentiality. Confidentiality is a component of which element of the therapeutic relationship?
Trust
A nursing student is working with a client who has a history of alcohol abuse. Although the nurse has an adverse feeling towards people who abuse alcohol, the nurse feels of the client is worthy of respect and attention regardless of the nurses own personal feelings. Which correctly describes the nurses response to the client?
Unconditional positive regard
Client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective use of therapeutic self?
What types of dresses do you like wearing
The client tells the nurse I had to slap my child, I couldn't help that. Which response by the nurse indicates that the nurse is in the state of unknowing?
What was going on for you when this happened ?
During which phase of the nurse client relationship does the client identify and explore specific problems?
Working phase
A nurse is speaking to a client with a soft smile and iContact. Which statement said by the nurse would indicate a congruent message?
Your hard work and determination has helped you recover
During the termination phase, a client begins to raise old problems that have already been resolved which would be appropriate nursing response? Select all that apply
reassure the client that they already cover these issues review with a client to learn methods to control the problems
