Chapter 5: Therapeutic Relationships 1. A nurse tells a client that the nurse will come back in 10 minutes to reassess the client’s pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing? Trust pg 76 2. In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase pg 82 3. The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to aclient who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? Orientation pg 83 4. 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. pg 82 5. The nurse has a client who seems like the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term? Countertransference pg 86 6. Avoiding which outcome is the primary reason for establishing professional boundaries with clients? The loss of therapeutic effectiveness pg 87 7. 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 pg 83-84 8. 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.” Pg 77 9. When engaged in a therapeutic relationship, the nurse's focus is on what? The client pg 82 10. The most important tool of psychiatric nursing is the: self. Pg 79 11. The nurse is caring for a client with schizophrenia. The client tells the nurse, “My dead mother is calling me, I will finally be with her tonight. Please do not tell anyone.” What is the most appropriate nursing response? “I cannot keep this a secret. I will ensure that the staff helps keep you safe.” Pg 85 12. 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 pg 82 13. 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? Ask to be reassigned because of having a prior personal relationship with the client. Pg 87 14. Termination takes place during the resolution phase of a nurse–client relationship. During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what? The client: is attempting to prolong the nurse–client relationship. Pg 87 15. What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure? shifting the emphasis to the nurse pg 76 16. The nurse and client are entering the resolution phase of the relationship. Which behaviors indicate that the client does not want the relationship to end? Select all that apply. skips the last session expresses anger towards the nurse and other clients identifies a resolved problem as a new one needing to be addressed pg 87 17. In what phase of the therapeutic relationship does the assessment process begin? During the initiating or orienting phase pg 82 18. 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 pg 82 19. 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 20. 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.” Pg 85 21. A nurse is interviewing a client to obtain a health history. Which would be considered a “usual or expected” response during the first session? Rambling due to nervousness pg 83 22. A client tells the nurse, “I had to slap my child, I couldn’t help that." Which response of the nurse indicates that the nurse is in the state of unknowing? “What was going on for you when this happened?” pg 81 23. When the nurse helps the cognitively impaired client bathe and dress, what role is the nurse assuming? Parent surrogate pg 89 24. During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply. Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems. Pg 87 25. Which is a nurse's primary tool for treating clients with mental disorders? The therapeutic use of self pg 79 26. During which phase of the nurse–client relationship does the client identify and explore specific problems? Working pg 86 27. The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most 28. therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship? Orientation pg 83 29. Which theorist was most widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? Hildegard Peplau pg 81 30. 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.” Pg 87 31. 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 pg 86 32. Which is not considered a step in the values clarification process? Assessing pg 78-79 33. Which is not involved in empathy? Feeling the same emotions that the client is feeling at a given time pg 77 34. A nurse is speaking to a client who attempted suicide. The client says, “It is my dream to become a doctor, and I failed the entrance exam. I am so mad at myself.” Which statement indicates genuine interest by the nurse? “You must have been really upset.” Pg 76 35. The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self? “What types of dresses do you like wearing?” pg 79 36. A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain? Perception of the problem pg 86 37. When a 23-year-old client is admitted to the psychiatric unit after a suicide attempt, the client states the client is willing to speak to the nurse but only if the conversation remains confidential. Which is the nurse's best response? "Will this conversation involve your desire to harm yourself?" pg 85 38. What occurs during the working phase of the nurse-client relationship? Evaluation of mutually identified goals pg 86 39. 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. Pg 86 40. 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. Pg 77 41. A nurse is assessing an adolescent client who has recently been self-mutilating. The nurse asks the client questions that seek to uncover the motivation underlying the behavior. The nurse's approach best reflects what? The exploration of behaviors to uncover the client perspective pg 86 42. Which is an inaccurate statement regarding a preconception? It enables the nurse to get an accurate picture of the client's problems. Pg 81 43. 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. Pg 87 44. 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.” Pg 87 45. 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 pg 46. 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 pg 78