Chapter 5: PrepU
The nurse is meeting with a client experiencing a mood disorder. Which client statement indicates that the nurse-client relationship has been established? "What difference does it make what I say to you?" "I feel worthless and have no real use in life." "I really don't want to talk about that right now." "I know you are busy. I don't have much to say now."
"I feel worthless and have no real use in life." Explanation: People with psychiatric problems often feel alone and isolated. Establishing rapport helps lessen feelings of being alone. When rapport develops, a client feels comfortable with the nurse and finds self-disclosure easier. The nurse also feels comfortable and recognizes that an interpersonal bond or alliance is developing. All of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client relationship. -The other statements indicate that the client is not comfortable with the nurse and does not want to share information or take up much of the nurse's time.
Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment? "Why do you think making that comment is appropriate?" "How would you feel if someone said that to you?" "Our relationship is one of a professional nature." "That type of talk is inappropriate and won't be tolerated."
"Our relationship is one of a professional nature." Explanation: The nurse who does not become upset or responds negatively to a client's outbursts, anger, or acting out conveys acceptance to the client. Avoiding judgments of the person, no matter what the behavior, is acceptance. This does not mean acceptance of inappropriate behavior but acceptance of the person as worthy. When responding to such a situation, the reaction should be respectful and controlled by the nurse.
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." "How did you know that I'm a chocoholic? Will you have a cookie with me while we talk?" "They look delicious and I love candy but I'm on a diet and really can't accept them." "Thank you so much. I will share them with the other nurses."
"Thank you but I will not accept these gifts because they extend over our discussed boundaries." Explanation: During the orientation phase, professional boundaries are set. If the client violates these boundaries, the nurse needs to acknowledge the behavior and reestablish or reinforce the boundaries by not accepting the gifts. Accepting the gifts to share with other nurses or the client violates the professional boundary. Declining the gifts for anything besides the violation of the professional relationship is not honest and may deteriorate the trusting relationship.
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? Respect Self-disclosure Client self-exploration Empathy
Client self-exploration Explanation: When client self-exploration occurs, the nurse encourages the client to learn positive adaptive or coping skills. Self-disclosure refers to the nurse sharing personal information with the client in order to establish trust and improve rapport. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate understanding to the client. Respect is also a condition essential for a therapeutic relationship to occur; however, it is not reflective of the client's adaptive coping.
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? Decompensation Bipolar disorder Compassion fatigue Failure to thrive
Compassion fatigue Explanation: Compassion fatigue, also referred to by many as burnout, may occur when one provides care for others but loses the ability to take care of oneself. According the neurobiological theories of bipolar disorder, the parent would have already been diagnosed with bipolar disorder if this was a possibility. Although poor self-care could result in a failure to thrive for the client's parent, the parent is more likely to experience compassion fatigue, given the client factors presented in this scenario. -Decompensation is a term used to describe worsening symptoms of someone who has maintained recovery of a chronic mental illness. This does not accurately describe the situation for the client's parent.
In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase After the initiating or orienting phase has been completed During the working phase After the working phase has been completed
During the initiating or orienting phase Explanation: 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.
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 Establishing mutual expectations for nursing interventions Facilitating the assessment process and the collection of a database Providing the client contact with a caring professional health care provider
Eliciting the client's cooperation through the establishment of trust Explanation: While providing care to a client with psychosis, the psychiatric nurse uses communication initially for the purpose of eliciting the client's cooperation through the establishment of trust. All the other options are important, but first, the nurse must establish trust with the client.
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? Personal knowing Aesthetic knowing Empirical knowing Ethical knowing
Empirical knowing Explanation: -Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing. Dyspnea and tachycardia are signs related to anxiety attack. -Ethical knowing refers to the moral knowledge of nurse. -Aesthetic knowing refers to the knowledge gained through the art of nursing. -Personal knowing refers to the knowledge gained through experience.
Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Hildegard Peplau Jean Watson Florence Nightingale Clara Barton
Hildegard Peplau Explanation: Peplau's theory is based on the nurse-client relationship as a therapeutic tool.
A nurse who has worked with a client with post-traumatic stress disorder (PTSD) regularly for several months stares blankly at the nurse for a long time. The nurse understands that the client is dissociating. According to the Carper's patterns of nursing knowledge, which pattern of knowing is this indicative of? Empirical knowing Aesthetic knowing Personal knowing Ethical knowing
Personal knowing Explanation: A nurse has good amount of experience working with the client with PTSD. Interpreting the state of the client on the basis of observation reflects that the nurse has gained this knowledge through experience. Ethical knowing refers to the moral knowledge of nurse. Aesthetic knowing refer to the knowledge gained through the art of nursing. Empirical knowing refers to the knowledge that the nurse obtains from the science of nursing.
Which is not a primary behavior of caring, one of the core values of nursing? Setting boundaries within the relationship Meeting the client's needs in a timely manner Providing comfort measures to clients and their families Giving of the self
Setting boundaries within the relationship Explanation: Caring involves giving of oneself for the benefit of the other. Although boundaries are therapeutic, they are not typically seen as an element of caring.
A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase? The client tries different coping strategies to deal with stress. The client is able to independently express feelings and emotions with the client's friends. The client becomes more expressive about the client's feelings to the nurse. The client explores the emotions and feelings related to the traumatic experience.
The client is able to independently express feelings and emotions with the client's friends. Explanation: During the resolution phase, the client connects with community resources, solidifies a newly found understanding, and practices new behaviors. The client also interacts with significant others in new ways. --Trying different coping strategies, exploring emotions and feelings, and increasing ability to express feelings would occur during the working phase.
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. The client is experiencing symptoms of a disorder. The client is demonstrating a normal reaction. The client is attempting to engage in a social relationship.
The client is nervous and insecure. Explanation: In the beginning, clients may deny problems, employ various forms of defense mechanisms, or prevent the nurse from getting to know them. The client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such as rambling. Additional assessment would be needed to determine if the client was exhibiting symptoms of a disorder. The behavior would not be considered normal. If a social relationship was the goal, the client would be engaging the nurse to find out more about the nurse.
Which would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? The client has revitalized the relationship with the client's sister. The nurse has designated a specific time each day to interact with the client. The client expresses a desire to be mothered and pampered. The client recognizes feelings of anger and expresses them appropriately.
The client recognizes feelings of anger and expresses them appropriately. Explanation: When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.
Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The likelihood of a client becoming too dependent on the nurse The possibility of losing control of the milieu The possibility of inappropriate sexual tension developing The loss of therapeutic effectiveness
The loss of therapeutic effectiveness Explanation: The priority reason the psychiatric nurse is careful to maintain professional boundaries with clients is to avoid the loss of therapeutic effectiveness. While the other options can result during the course of a relationship, none of them is the priority reason the psychiatric nurse is careful to maintain professional boundaries with clients.
A client forgets to attend a planned session. Which should the nurse conclude about the client's behavior? Problems are overwhelming. The relationship is being tested. It is time to end the relationship. The client does not like the nurse.
The relationship is being tested. Explanation: During the orientation phase, the client begins to test the relationship to become convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late. Forgetting a session is not an indication that the client's problems are overwhelming, that the relationship should end, or the client does not like the nurse.
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 keep the comment confidential, because the disclosure is protected by therapist-client confidentiality. The therapist must evaluate the threat and notify authorities if it meets credibility criteria. The therapist must meet with an ethics committee to determine the course of action. The therapist must notify authorities and the potential victim.
The therapist must notify authorities and the potential victim. Explanation: As a result of the Tarasoff decision, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.
During which phase of the nurse-client relationship does the client identify and explore specific problems? Working Debriefing Orientation Resolution
Working Explanation: During the working phase, the client uses the relationship to examine specific problems and learn new ways of approaching them. -Debriefing is not a phase of the nurse-client relationship. -During the orientation phase, the nurse and client get to know each other. -The final phase, resolution, is the termination stage of the relationship and lasts from the time the problems are resolved to the close of the relationship.
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? Orientation Working Resolution Termination
Working Explanation: The conversation indicates that the client is trying to understand the problems and trying to solve them by asking for suggestions from the nurse. This behavior is seen in the working phase of the nurse-client relationship. -In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies the client's problems, and clarifies expectations. -In the resolution phase, actual problems are resolved and the relationship terminates. During the resolution phase, the client is redirected toward a life without this specific relationship. The client connects with community resources, solidifies a newfound understanding, and practices new behaviors. -Termination, although it begins on the first day of the relationship, marks the end of the relationship.
Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship? getting an appointment with the client at the time previously agreed upon discussing the client's request for additional privileges with the treatment team sharing examples of stress management techniques implementing restatement as a therapeutic communication method
getting an appointment with the client at the time previously agreed upon Explanation: Congruence occurs when words and actions match. The nurse demonstrates this by fulfilling the promise made to the client. While the remaining options are appropriate behaviors that positively affect the nurse-client relationship, they do not demonstrate congruence.
The most important tool of psychiatric nursing is the: physician. environment. self. nurse.
self. Explanation: 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? providing advice on how to manage a problem being too general with the details of the story shifting the emphasis to the nurse using situations that have occurred on the unit
shifting the emphasis to the nurse Explanation: Self-disclosure examples are most helpful to the client when they represent common day-to-day experiences and do not involve value-laden topics. Self-disclosure can be helpful on occasion, but the nurse must not shift emphasis to his or her own problems rather than to the client's. None of the options are inappropriate.
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? "Your family would want to help if you had a problem." "How do you plan to manage your problems without help?" "Being self-sufficient is a sign of mental health stability." "Asking for help from those who care about us isn't a sign of weakness."
"Asking for help from those who care about us isn't a sign of weakness." Explanation: The correct response by the nurse demonstrates the ability to use the self as a therapeutic tool in order to help the client grow, change, and heal. -Telling the client that being self-sufficient is a sign of mental health stability is an automatic response and would cut off further exploring of the client's perceptions. -Telling the client the family would want to help when there is a problem is making an assumption without first discussing the client's perceptions. -Asking the client how the client plans to manage problems without help communicates sympathy and the need for dependency.
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 client dissatisfaction with care up 10% over the last month staff attendance at educational programs down 9% over the last month number of readmissions down 6% over the last 2 months nurse reassignment increased 8% over the last month
-discharge of clients 5 days earlier than in the past -number of re-admissions down 6% over the last 2 months Explanation: In addition to producing positive therapeutic outcomes, the Transitional Relationship Model also reduces time spent in hospital and re-admissions. Discharging clients earlier and a lower number of re-admissions indicates the model has been successful. Reassigning nurses, client dissatisfaction, and low attendance at educational programs are not indicators to measure the effectiveness of this model.