Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily due to which reason?
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
Explanation:
The psychiatric nurse recognizes that excessive social commuTo prevent disruption of the time that is to be used for therapeutic
nication with a client is to be avoided primarily because it is
communication
likely to encourage the client to view the nurse as a friend rather
than health care provider. Boundaries of the nurse-client relationTo prevent the client from viewing the nurse as a friend rather than
ship can only be set effectively if the nurse primarily engages in
health care provider
therapeutic communication with the client as opposed to social
communication.
To avoid giving the client the impression that the nurse is not
interested in providing effective care
Which observation should lead the nurse manager to recognize
that countertransference is affecting the therapeutic effectiveness
The nurse frequently refers to an elderly, cognitively impaired
of an individual nurse on the unit?
client as "my granny"
Explanation:
The nurse is referred to as being in a relationship with a client by
that client, and the client wants the nurse to accompany the client
Countertransference occurs when a mental health care profesto the prom
sional redirects his or her feelings toward a client or becomes
emotionally entangled with a client, as is occurring with the nurse's
The nurse begins to experience the symptoms of depression and
"granny." Being asked to the prom by a client is not an example
calls out sick
of countertransference but rather reflects a client's misdirected
emotion, referred to as transference. Countertransference does
The nurse asks to be transferred to another unit to avoid burnout
not involve the development of a mental illness or the resulting
and to work with different disorders
absenteeism. And countertransference does not involve burnout
or the desire to expand one's professional expertise.
The nurse frequently refers to an elderly, cognitively impaired
client as "my granny"
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 nurse's family or neighbors, because Trust
doing so would breach the client's confidentiality. Confidentiality is Explanation:
a component of which element of the therapeutic relationship?
An important component of trust is confidentiality. Mental health
Caring
providers must reassure clients that they will not share the details
Trust
of clients' lives outside the professional environment.
Positive regard
Genuine interest
When comparing social interactions with therapeutic interactions, Encourage personal goal setting
the nurse understands that therapeutic interactions do what?
Explanation:
Are personal and intimate
Create constructive dependencies
Encourage personal goal setting
Involve doing favors for others
Which occurs when the nurse responds to the client based on
personal unconscious needs and conflicts?
Self-disclosure
Exploration
Countertransference
Transference
Therapeutic interactions are designed specifically to encourage
the client to engage in personal goal setting. Personal and intimate
activities, favors for others, and constructive dependencies are all
inappropriate activities for the nurse-client relationship.
Countertransference
Explanation:
Countertransference occurs when the nurse responds to the client
based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such
as biographical data and personal ideas. Transference occurs
when the client unconsciously transfers to the nurse feelings he
or she has for significant others.
A nurse is interacting with a client who is expressing feelings about "It sounds like this is very difficult for you, I can see why it causes
the client's child's insensitive behavior. Which statement made by you stress."
the nurse indicates the nurse is empathizing with the client?
Explanation:
Choose the best answer.
1 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
Empathizing is placing oneself in the experience of another. Developing empathy with the client can lead to better therapeutic
communication and better nursing interventions. Telling the client
"I don't know how you've managed to cope, this is awful."
not to worry would indicate that the nurse is trying to be supportive
of the client but not empathetic. The nurse telling the client that
"That is unbelievable. How could you tolerate this behavior?"
it must be hard for the client to cope conveys sympathy and
feeling sorry for the client. Telling the client that the behavior is
"It sounds like this is very difficult for you, I can see why it causes unbelievable indicates that the nurse feels shocked at the client's
you stress."
statement
"Don't worry. Your child will be all right."
"What was going on for you when this happened?"
Explanation:
A client tells the nurse, "I had to slap my child, I couldn't help that."
The state of unknowing is referred to as the nurse's behavior
Which response of the nurse indicates that the nurse is in the state
where the nurse is open to seeing and listening to the client's
of unknowing?
views without imposing any of the nurse's values or viewpoints.
Asking the client about what was happening for the client at the
"I really feel sorry for your child."
time the action took place indicates that the nurse is trying to know
more about the client's behavior without making any judgment.
"What was going on for you when this happened?"
The statement about feeling sorry for the child or asking how the
client could slap the child indicates that the nurse has a notion
"Punishing your child would only make your child worse."
that the client has taken a wrong action. In addition, the statement
that punishing the child would make it worse indicates that the
"How could you do this to your child?"
nurse has a notion that the client has taken a wrong action. Thus,
these responses do not indicate that the nurse is in the state of
unknowing.
The nurse is caring for a client with schizophrenia. The client tells "I cannot keep this a secret. I will ensure that the staff helps keep
the nurse, "My dead mother is calling me, I will finally be with her you safe."
tonight. Please do not tell anyone." What is the most appropriate Explanation:
nursing response?
The nurse is not supposed to keep secrets, especially if the infor"I cannot keep this a secret. I will ensure that the staff helps keep mation relates to the client inflicting self-harm. The nurse should
you safe."
inform the client that they will be closely monitored. Asking the
client who has influenced the client with these ideas indicates
"I will speak with the health care provider about the possible use a poor understanding of the nature of the client's illness. For
of physical restraints for you tonight."
client's with schizophrenia, stimuli are internally generated and
can cause emotional dysfunction. The nurse should not exhibit
"Who has influenced you with these ideas?"
anger, as the nurse is supposed to be accepting of the client in
any circumstances. Stating that the client will be restrained may
"Don't worry; I will keep this secret to myself."
be perceived as threatening.
Working
Explanation:
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
Mutual withdrawal
Resolution
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.
During a first meeting a client asks that information shared will not "Any information is only shared with other professionals involved
be relayed to immediate family members. Which should the nurse in your care."
say in response?
Explanation:
"Is there some reason why you don't want your family to know your The nurse should be clear about any information that is to be
problems?"
shared with anyone else. The nurse shares significant assessment
2 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
data and client progress with a supervisor, team members, and
"I cannot promise that. Your family may ask me questions and I will
a physician. Most clients expect the nurse to communicate with
need to answer truthfully."
other mental health professionals and are comfortable with this
arrangement. Restrictions regarding what can be shared and with
"Any information is only shared with other professionals involved
whom are also covered by state or provincial mental health acts
in your care."
and health information acts. Based upon identified laws, the nurse
will unlikely share information with family unless the client provides
"It depends upon what they ask me. I might be able to withhold
permission.
some information, but not all."
"Your hard work and determination has helped you recover."
Explanation:
A congruent message is delivered when the actions and the words
A nurse is speaking to a client with a soft smile and eye contact.
spoken match. The nurse has a smiling facial expression which
Which statement said by the nurse would indicate a congruent
indicates that the nurse is happy. The statement that the client's
message?
hard work and determination has warded off the disease indicates
that the nurse is happy with the outcomes of the client's hard
"I know you are in pain. Please wait until the medication shows its
work. A smiling facial expression while saying this statement would
effect."
deliver a congruent message. The statement that the client should
not disturb the other clients in the ward indicates that the nurse is
"Your hard work and determination has helped you recover."
irritated. A smiling facial expression while saying this statement
would not deliver a congruent message. The statement that the
"Please listen to the instructions carefully before starting the exclient should listen to the instructions before starting the exercises
ercises."
indicates a focused approach. A smiling facial expression while
saying this statement would not deliver a congruent message. The
"Please don't disturb the other clients in the ward."
statement that the client should wait for the medicines to show
the therapeutic effect indicates that the nurse has sympathy for
the client. A smiling facial expression while saying this statement
would not deliver a congruent message.
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
"You must have been really upset."
exam. I am so mad at myself." Which statement indicates genuine
Explanation:
interest by the nurse?
"You were killing yourself for this?"
"It is wrong to commit suicide."
"You must have been really upset."
By stating "you must have been really upset," the nurse avoids
communicating value judgments about the client's behavior. Indicating that the client attempted to kill oneself for a trivial goal,
asking what the client would gain by killing oneself, or telling
the client that the behavior was wrong indicate that the nurse is
judgmental and void of genuine interest.
"What would you gain by killing yourself?"
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
Explanation:
Rambling due to nervousness
A client is usually nervous and insecure during the first few sesBeing confrontational with nurse and other group members
sions and may exhibit behavior reflective of these emotions, such
as rambling. Showing up late, being confrontational, and bragging
Bragging about sexual conquests
are nontherapeutic ways to not participate in the session.
Showing up late for the first session
During the termination phase, a client begins to raise old problems
Reassure the client that they already covered these issues.
that have already been resolved. Which would be appropriate
nursing responses? Select all that apply.
Review with the client the learned methods to control the problems.
Review with the client the learned methods to control the probExplanation:
lems.
Get angry at the client and ask the client to leave the session.
A typical termination behavior is raising old problems that have
already been resolved. The nurse may feel frustrated if clients in
3 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
Immediately stop the client and inform the client that the nurse is
running the session.
the termination phase present resolved problems as if they were
new. The clients are attempting to prolong the relationship and
Reassure the client that they already covered these issues.
avoid its ending. Nurses should avoid addressing these problems.
Instead, they should reassure clients that they already covered
Do not acknowledge this issue and continue on with the session those issues and learned methods to control them
as planned.
During the working phase, a client demonstrates open hostility in "Tell me why you are angry about what I just said."
reaction to the nurse's last question. Which response should the Explanation:
nurse make to avoid countertransference?
Countertransference is an emotional reaction to the client based
"I am only doing my job."
upon personal unconscious needs and conflicts. The nurse should
recognize that countertransference can occur and prevent it from
"I am only trying to help you."
eroding the professional boundaries. One way to prevent countertransference is to ask the client to explain why the statement
"Tell me why you are angry about what I just said."
caused hostility. Defending the statement such as saying, "I am
only doing my job," "I am only trying to help you," and "I'll find
"If you don't want to continue with me, I'll find someone else."
someone else," demonstrates countertransference
skips the last session
The nurse and client are entering the resolution phase of the
expresses anger towards the nurse and other clients
relationship. Which behaviors indicate that the client does not want
the relationship to end? Select all that apply.
identifies a resolved problem as a new one needing to be addressed
expresses anger towards the nurse and other clients
Explanation:
identifies a resolved problem as a new one needing to be addressed
asks to keep in touch with the nurse after the relationship ends
skips the last session
lists actions to move forward at the conclusion of the meeting
Ending the therapeutic relationship can produce anxiety in the
client. The client may skip the last session to avoid ending the
relationship. Expressing anger towards the nurse and other clients
indicates that the client does not want the relationship to end.
Identifying a resolved problem as a new problem is an action to
keep the relationship going. Listing actions to move forward is a
desired outcome at the conclusion of a therapeutic relationship.
Asking to keep in touch with the nurse after the relationship ends
is testing the boundaries but does not necessarily indicate that the
client does not want the relationship to end.
"I feel worthless and have no real use in life."
Explanation:
The nurse is meeting with a client experiencing a mood disorder.
Which client statement indicates that the nurse-client relationship People with psychiatric problems often feel alone and isolated.
has been established?
Establishing rapport helps lessen feelings of being alone. When
rapport develops, a client feels comfortable with the nurse and
"I know you are busy. I don't have much to say now."
finds self-disclosure easier. The nurse also feels comfortable and
recognizes that an interpersonal bond or alliance is developing. All
"What difference does it make what I say to you?"
of these factors—comfort, sense of sharing, and decreased anxiety—are important in establishing and building the nurse-client
"I really don't want to talk about that right now."
relationship. The client stating feelings of worthlessness and having no real use in life demonstrates comfort with the nurse-client
"I feel worthless and have no real use in life."
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.
"It can be scary to leave a place that you trust and feel supported."
Explanation:
The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the
Empathy is the ability to experience, in the present, a situation as
client's fear of returning to a group home environment?
another did at some time in the past. It is the ability to put oneself
in another person's circumstances and to imagine what it would
"Don't you think you're ready to be independent?"
be like to share their feelings. The nurse does not actually have
to have had the experience but has to be able to imagine the
"It can be scary to leave a place that you trust and feel supported."
feelings associated with it. For empathy to develop, there must be a
giving of self to the other individual and a reciprocal desire to know
4 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
each other personally. The process involves the nurse receiving
information from the client with open, nonjudgmental acceptance
and communicating this understanding of the experience and
"You are more than ready to get out of here. Have faith in your
feelings so the client feels understood. Acknowledging that leaving
accomplishments."
the hospital can be scary because the client will miss the trust
and support provided demonstrates empathy. Questioning about
"Just think of all of the things you can do in the home that you can't independence, having the client think about things that can be
do here."
done in the home versus the hospital, and telling the client to
have faith in accomplishments do not demonstrate empathy for
the client's fear.
The nurse learns that a new client is a former significant other and
an initial session is scheduled for early in the afternoon. Which
Ask to be reassigned because of having a prior personal relationaction should the nurse take to maintain professional boundaries?
ship with the client.
Explanation:
Ask another nurse to attend the meetings to ensure boundaries
are not crossed.
Since the nurse had a previous personal relationship with the
client, the therapeutic boundary is questionable. The best course
Plan to meet the client since the personal relationship ended.
of action would be for the nurse to ask to be reassigned. Meeting the client or asking another nurse to attend could blur the
Meet for the first session but explain that another nurse will be
professional-personal boundary. When concerns arise related to
assigned going forward.
therapeutic boundaries, the nurse must seek clinical supervision
or transfer the care of the client immediately.
Ask to be reassigned because of having a prior personal relationship with the client.
A client describes panic attacks during which the client rushes
to the emergency department with a feeling that death may be
imminent. The nurse discloses having had panic attacks during
which the nurse also felt very fearful. Which statement about the
nurse's self-disclosure is accurate?
Self-disclosure can help normalize the client's experience.
Explanation:
Self-disclosure can help the client feel like a friend.
Nurses may use self-disclosure in the nurse-client relationship to
Self-disclosure can help normalize the client's experience.
comfort a client who is feeling frustrated and hopeless, enhance
trust, decrease role distancing, facilitate the client's self-discloSelf-disclosure should be detailed so the client doesn't feel unim- sure, convey support, or normalize the client's experience.
portant or devalued.
Self-disclosure allows the client to see the nurse as a real human
being.
The nurse has a client who seems like the nurse's sister, with
Countertransference
whom the nurse has a close and positive relationship. This phe- Explanation:
nomenon is best characterized by which term?
Countertransference refers to an instance when the nurse has
Transference
preconceived attitudes or feelings toward a patient that stem
Reaction formation
from prior experience. When feelings, either positive or negative,
Countertransference
seem extreme or disproportionate to the circumstances, the nurse
Free association
should consider whether a transferential reaction has occurred.
During an individual therapy session, a nurse is listening to a client
describe the client's drug addiction. The client says, "I know I am
doing the wrong thing for my kids, but I just can't stop using drugs."
The nurse maintains eye contact and nods occasionally. The nurse
responds by saying, "You're going through a difficult time." The
nurse's actions and words are an example of:
apathy.
sympathy.
nontherapeutic communication.
empathy.
empathy.
Explanation:
Being empathetic is an active process requiring careful listening
and attending to the client. Direct eye contact, a concerned expression, occasional head nods, and a lean forward while listening
are nonverbal communication skills that convey empathy. Empathetic responses, such as "You're going through a difficult time,"
can provide clients with an opportunity to listen to themselves and
gain self-awareness.
Compassion fatigue
Explanation:
5 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
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
During which phase of the nurse-client relationship does the client
identify and explore specific problems?
orientation
resolution
working
debriefing
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?
Exploitation phase
Orientation phase
Termination phase
Identification phase
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?
Resolution
Orientation
Mutual withdrawal
Working
SUBMIT ANSWER
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.
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.
Orientation phase
Explanation:
According to the conversation, the nurse is informing the client
about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship.
During this phase, the nurse explains the schedules of meeting,
identifies the client's problems, and clarifies the expectations of
the client. In the identification phase, the client tries to find the
problems that would affect treatment. In the exploitation phase, the
client examines the feelings and responses and tries to develop
better coping skills and a more positive self-image. The client
starts becoming independent in this stage. In the termination
phase, the problems of the client are resolved and the nurse-client
relationship comes to an end.
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.
A nurse is interviewing a client to obtain a health history. Which
Rambling due to nervousness
would be considered a "usual or expected" response during the
Explanation:
first session?
Bragging about sexual conquests
Being confrontational with nurse and other group members
Showing up late for the first session
Rambling due to nervousness
A client is usually nervous and insecure during the first few sessions and may exhibit behavior reflective of these emotions, such
as rambling. Showing up late, being confrontational, and bragging
are nontherapeutic ways to not participate in the session.
6 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
"Tell me why you are angry about what I just said."
Explanation:
During the working phase, a client demonstrates open hostility in
reaction to the nurse's last question. Which response should the
Countertransference is an emotional reaction to the client based
nurse make to avoid countertransference?
upon personal unconscious needs and conflicts. The nurse should
recognize that countertransference can occur and prevent it from
"I am only trying to help you."
eroding the professional boundaries. One way to prevent coun"Tell me why you are angry about what I just said."
tertransference is to ask the client to explain why the statement
"I am only doing my job."
caused hostility. Defending the statement such as saying, "I am
"If you don't want to continue with me, I'll find someone else."
only doing my job," "I am only trying to help you," and "I'll find
someone else," demonstrates countertransference.
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 "Thank you but I will not accept these gifts because they extend
to the client about these gifts?
over our discussed boundaries."
Explanation:
"How did you know that I'm a chocoholic? Will you have a cookie
with me while we talk?"
During the orientation phase, professional boundaries are set. If
the client violates these boundaries, the nurse needs to acknowl"They look delicious and I love candy but I'm on a diet and really edge the behavior and reestablish or reinforce the boundaries by
can't accept them."
not accepting the gifts. Accepting the gifts to share with other
nurses or the client violates the professional boundary. Declining
"Thank you but I will not accept these gifts because they extend the gifts for anything besides the violation of the professional relaover our discussed boundaries."
tionship is not honest and may deteriorate the trusting relationship.
"Thank you so much. I will share them with the other nurses.
"It can be scary to leave a place that you trust and feel supported."
Explanation:
Empathy is the ability to experience, in the present, a situation as
The nurse and client are discussing discharge plans. Which stateanother did at some time in the past. It is the ability to put oneself
ment should the nurse make that demonstrates empathy for the
in another person's circumstances and to imagine what it would
client's fear of returning to a group home environment?
be like to share their feelings. The nurse does not actually have
to have had the experience but has to be able to imagine the
"Don't you think you're ready to be independent?"
feelings associated with it. For empathy to develop, there must be a
giving of self to the other individual and a reciprocal desire to know
"It can be scary to leave a place that you trust and feel supported."
each other personally. The process involves the nurse receiving
information from the client with open, nonjudgmental acceptance
"Just think of all of the things you can do in the home that you can't
and communicating this understanding of the experience and
do here."
feelings so the client feels understood. Acknowledging that leaving
the hospital can be scary because the client will miss the trust
"You are more than ready to get out of here. Have faith in your
and support provided demonstrates empathy. Questioning about
accomplishments."
independence, having the client think about things that can be
done in the home versus the hospital, and telling the client to
have faith in accomplishments do not demonstrate empathy for
the client's fear.
A nursing student is working with a client who has a history
of abusing alcohol. Although the nurse has an aversive feeling
toward people who abuse alcohol, the nurse feels that the client
is worthy of respect and attention regardless of the nurse's own Unconditional positive regard
personal feelings. Which correctly describes the nurse's response Explanation:
to the client?
The nurse needs to treat each person with respect and dignity,
Countertransference
regardless of personal value conflicts.
Genuineness
Partnership
Unconditional positive regard
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"
Explanation:
7 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
The nurse asks to be transferred to another unit to avoid burnout
and to work with different disorders
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." Being asked to the prom by a client is not an example
The nurse is referred to as being in a relationship with a client by of countertransference but rather reflects a client's misdirected
that client, and the client wants the nurse to accompany the client emotion, referred to as transference. Countertransference does
to the prom
not involve the development of a mental illness or the resulting
absenteeism. And countertransference does not involve burnout
The nurse begins to experience the symptoms of depression and or the desire to expand one's professional expertise.
calls out sick
The nurse frequently refers to an elderly, cognitively impaired
client as "my granny"
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 notify authorities and the potential victim.
The therapist must meet with an ethics committee to determine
the course of action.
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.
The therapist must evaluate the threat and notify authorities if it
meets credibility criteria.
Compassion fatigue
Explanation:
A 68-year-old parent is the sole care provider for a 39-year-old
Compassion fatigue, also referred to by many as burnout, may
child who has a diagnosis of bipolar disorder. The 39-year-old has
occur when one provides care for others but loses the ability
been experiencing worsening of the illness over several years. The
to take care of oneself. According the neurobiological theories
nurse should recognize that the parent is at risk for what?
of bipolar disorder, the parent would have already been diagnosed with bipolar disorder if this was a possibility. Although poor
Decompensation
self-care could result in a failure to thrive for the client's parent,
Failure to thrive
the parent is more likely to experience compassion fatigue, given
Compassion fatigue
the client factors presented in this scenario. Decompensation is
Bipolar disorder
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.
"Your hard work and determination has helped you recover."
Explanation:
A congruent message is delivered when the actions and the words
spoken match. The nurse has a smiling facial expression which
A nurse is speaking to a client with a soft smile and eye contact. indicates that the nurse is happy. The statement that the client's
Which statement said by the nurse would indicate a congruent
hard work and determination has warded off the disease indicates
message?
that the nurse is happy with the outcomes of the client's hard
work. A smiling facial expression while saying this statement would
"Please don't disturb the other clients in the ward."
deliver a congruent message. The statement that the client should
"Please listen to the instructions carefully before starting the ex- not disturb the other clients in the ward indicates that the nurse is
ercises."
irritated. A smiling facial expression while saying this statement
"I know you are in pain. Please wait until the medication shows its would not deliver a congruent message. The statement that the
effect."
client should listen to the instructions before starting the exercises
"Your hard work and determination has helped you recover."
indicates a focused approach. A smiling facial expression while
saying this statement would not deliver a congruent message. The
statement that the client should wait for the medicines to show
the therapeutic effect indicates that the nurse has sympathy for
the client. A smiling facial expression while saying this statement
would not deliver a congruent message.
8 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
Orientation
Explanation:
The nurse is reviewing the client's history, identifies themes, and
considers how the nurse can be most therapeutic to a client
The orientation phase is the phase during which the nurse and
who was recently admitted to a psychiatric unit. The nurse is
client get to know each other. The nurse reads background mafunctioning in which phase of the therapeutic relationship?
terials available on the client and considers his or her personal
strengths and limitations in working with this client. The working
Resolution
stages involves problem identifcation and exploitation. Resolution,
Orientation
or the termination phase, begins when problems are resolved
Withholding
and signals the end of the therapeutic relationship. Withholding
Working
is a phase in a deteriorating relationship in which the nurse is
perceived as withholding nursing support.
What activity should be included in the first step of self-awareness?
identifying one's own values, attitudes, strengths and weakness
Explanation:
One tool that is useful in learning more about oneself is the
Johari window. In creating a Johari window, the first step is for
determining whether you actually possess qualities that you are
the nurse to appraise his or her own qualities by creating a list
unaware of
of them: values, attitudes, feelings, strengths, behaviors, accomplishments, needs, desires, and thoughts. The second step is to
categorizing your qualities as being either public or hidden
find out others' perceptions by interviewing them and asking them
to identify qualities, both positive and negative, they see in the
identifying one's own values, attitudes, strengths and weakness
nurse. To learn from this exercise, the opinions given must be
honest; there must be no sanctions taken against those who list
asking others to share their perceptions of you
negative qualities. The third step is to compare lists and assign
qualities to the appropriate quadrant.
The nurse prepares to assess a client for the first time. Which
establish professional boundaries
action should the nurse take to develop a rapport with this client?
listen intently to the client explain problems and issues
Select all that apply.
explain what confidential information will be shared with others
Explanation:
explain what confidential information will be shared with others
When meeting a client for the first time, professional boundaries
need to be established in order for the relationship to remain
therapeutic. Listening intently demonstrates care and concern.
compliment the client regarding clothing selection
Explaining the need to share information with others helps to
establish trust. Reacting to disapproval suggests non-acceptance
establish professional boundaries
and will negate efforts to establish rapport. Arriving late is a
behavior used to test parameters. The nurse should not react as
suggest that another nurse meet with the client because of arriving
this behavior works to develop trust.
late
listen intently to the client explain problems and issues
A nurse is in the orientation phase of the nurse-client relationship perception of the problem
with a client diagnosed with a mental disorder. When interviewing Explanation:
the client during this first encounter, which information about the
client would be most important for the nurse to obtain?
Although information about allergies, hospitalizations, and family
history are important in the orientation phase, it is most important
recent hospitalizations
for the nurse to ask a client with a mental disorder about the nature
family history
of the problem from the client's perspective. Some clients deny that
perception of the problem
a problem exists; other clients may have misperceptions about the
known allergies
problem.
A nursing instructor is teaching a class on empathy. The instructor Feeling the same emotions that the client is feeling at a given time
determines that the class needs additional education when the Explanation:
students identify that empathy involves what?
Empathy is the ability to experience, in the present, a situation as
Feeling the same emotions that the client is feeling at a given time another did at some time in the past. It is the ability to put oneself in
Careful listening
another person's circumstances and to imagine what it would be
Being in touch with what the client is saying
like to share in those feelings. The nurse does not actually have to
Having insight into the meaning of clients' thoughts, feelings, and have had the experience but has to be able to imagine the feelings
behaviors
associated with it.
Working
Explanation:
9 / 10
Mental Health: CHAPTER 5-Therapeutic Relationships
Study online at https://quizlet.com/_9n1iom
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?
Resolution
Mutual withdrawal
Working
Orientation
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.
What should the nurse avoid when demonstrating genuine interest
for a client by making a self-disclosure?
shifting the emphasis to the nurse
Explanation:
being too general with the details of the story
Self-disclosure examples are most helpful to the client when they
providing advice on how to manage a problem
represent common day-to-day experiences and do not involve
value-laden topics. Self-disclosure can be helpful on occasion, but
using situations that have occurred on the unit
the nurse must not shift emphasis to his or her own problems
rather than to the client's. None of the option are inappropriate.
shifting the emphasis to the nurse
self-awareness
active listening
A care area is implementing motivational interviewing. What skills
empathetic linkages
will be implemented by the nurse for this technique to be successstrong communication
ful? Select all that apply.
Explanation:
self-awareness
use of a variety of defense mechanisms
active listening
empathetic linkages
strong communication
Because the success of motivational interviewing is dependent
on contingent factors, nurses will need frequent instruction and
feedback on its use. Strong communication, self-awareness, empathetic linkages, and active listening are all essential skills for
motivational interviewing. Unhelpful defense mechanisms should
be avoided
10 / 10