Chapter 9 PrepU: The Nurse-Patient Relationship

During which phase of the nurse-client relationship does the client identify and explore specific problems?

Working

During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response? "Any information is only shared with other professionals involved in your care." "Is there some reason why you don't want your family to know your problems?" "I cannot promise that. Your family may ask me questions and I will need to answer truthfully." "It depends upon what they ask me. I might be able to withhold some information, but not all."

"Any information is only shared with other professionals involved in your care."

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."

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."

The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is ...

"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? "I am only doing my job." "I am only trying to help you." "Tell me why you are angry about what I just said." "If you don't want to continue with me, I'll find someone else."

"Tell me why you are angry about what I just said."

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 35-year-old was discharged from care after recovery from depression. The nurse therapist and the client spent many hours working through issues related to the depression. Six months later, the client is admitted again for depression associated with issues similar to those that were previously addressed in the client's therapy. The nurse therapist says to a coworker, "This is unbelievable; we're back at square one again. The client should know better at this point." The nurse's comments reflect what? Countertransference A judgmental attitude Exploitation Poor boundaries

A judgmental attitude.

The nurse and client are entering the orientation phase of a relationship. Which is the goal for the client during this phase? work through problems resolve pressing problems identify potential solutions to issues develop a sense of trust in the nurse

Develop a sense of trust in the nurse.

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? Plan to meet the client since the personal relationship ended. Ask another nurse to attend the meetings to ensure boundaries are not crossed. Ask to be reassigned because of having a prior personal relationship with the client. Meet for the first session but explain that another nurse will be assigned going forward.

Ask to be reassigned because of having a prior personal relationship with the client.

The nurse is concerned that a relationship with a client is not therapeutic. Which behaviors demonstrated by the nurse support this concern? Select all that apply.

Becomes frustrated during the meetings. Remains aloof for several sessions. Discusses topics without consistency. Varies the length of meeting times from session to session.

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. rapport. boundary violation. defense mechanism.

Empathetic linkage.

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: rapport. empathy. self-awareness. projection.

Empathy.

Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship?

Hildegard Peplau

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 nurse interviews a new client in the day room of the psychiatric unit. The nurse is wearing a jacket and a bag and frequently asks the client to repeat the last statement. The nurse's demeanor with the client is reflective of what? Confidentiality Professionalism Lacking genuine interest Unknowing

Lacking genuine interest.

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 Working Termination Resolution

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.

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 Identification phase Exploitation phase Termination phase

Orientation phase.

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.

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.

When engaged in a therapeutic relationship, the nurse's focus is on what?

The client

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.

Avoiding which outcome is the primary reason for establishing professional boundaries with clients?

The loss of therapeutic effectiveness.

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".

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 To prevent disruption of the time that is to be used for therapeutic communication To avoid giving the client the impression that the nurse is not interested in providing effective care To avoid making the client feel that the client's problems are not viewed as being serious

To prevent the client from viewing the nurse as a friend rather than health care provider.

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 ... Confrontation Countertransference Incongruence Transference

Transference Explanation: Transference is the shifting of an emotion from one person to another. 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.

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?

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. 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. 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 phase: although it begins on the first day of the relationship, marks the end of the relationship.

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? Orientation Working Resolution Mutual withdrawal

Working Explanation: The nurse is helping the client to examine the feelings and responses and tries to develop better coping skills and a more positive self-image. The conversation indicates that the client is upset about the client's disability and the nurse is trying to motivate the client. Thus, this conversation is indicative of the working phase. In the orientation phase, the nurse explains the purpose of their meeting and the schedules of the treatment sessions, identifies themes surrounding the client's problems, and clarifies expectations. In the resolution phase, the problems of the client are resolved and the nurse-client relationship comes to an end. Mutual withdrawal is a phase in a nontherapeutic relationship in which the client and nurse give up on each other due to extreme frustration.