On which task should a nurse place priority during the working phase of relationship development?

What occurs during the working phase of the nurse-client relationship?

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During an individual therapy session, a nurse is listening to a client describe her drugaddiction. The client says, “I know I am doing the wrong thing for my kids, but I just can't stopusing drugs.” The nurse maintains eye contact and nods occasionally. The nurse responds bysaying, “You're going through a difficult time.” The nurse's actions and words are an exampleof:

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Which of the following is a nurse's primary tool for treating clients with mental disorders?

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The nurse is caring for a client recently diagnosed with a psychiatric illness. Which key areasshould the nurse focus on while caring for this client? Select all that apply.

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Which of the following would indicate that the nurse–client relationship has passed from theorienting phase to the working phase?

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Which of the following clinical situations provides an example of transference?

2204 Relationship Development

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
A. To clarify personal attitudes, values, and beliefs
B. To obtain thorough assessment data
C. To determine the client's length of stay
D.

ANS: A
The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness.

A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. A nurse streamlines the assessment, verbally assures safety, and provides a warm meal. What is the nurse promoting by these actions?
A. Sympathy
B.

ANS: B
The nurse is promoting trust by streamlining the assessment, assuring safety, and providing a warm meal. Trust implies a feeling of confidence in that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated

Which is the best nursing action when a client demonstrates transference toward a nurse?
A. Promoting safety and immediately terminating the relationship with the client
B. Encouraging the client to ignore these thoughts and feelings
C. Immediately reassi

ANS: D
The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from

What is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
A. Acknowledge the client's actions and generate alternative behaviors
B. Establish rapport and develop treatment goals
C. Attempt to find al

ANS: B
The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance

Which client response should a nurse expect during the working phase of the nurse-client relationship?
A. The client gains insight and incorporates alternative behaviors.
B. The client and nurse establish rapport and mutually develop treatment goals.
C. T

ANS: A
The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem solve, and continually evaluate progress to

What should be the nurse's primary goal during the preinteraction phase of the nurse-client relationship?
A. To evaluate goal attainment and ensure therapeutic closure
B. To establish trust and formulate a contract for intervention
C. To explore self-perc

ANS: C
The nurse's primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase i

Which phase of the nurse-client relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals?
A. Preinteraction
B. Orientation
C. Working
D. Termination

ANS: B
The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, an

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?
A. "I can't bear the thought of leaving here and failing."
B. "I might have a hard time working wi

ANS: C
The nurse should identify that the client statement, "I really don't want to talk any more about my childhood abuse." reflects that the client is in the working phase of the nurse-client relationship. The working phase includes overcoming resistant

A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy?
A. "You are feeling very depressed. I felt the same way when I decided to leave my husband."
B. "I

ANS: A
The nurse's statement, "You are feeling very depressed. I felt the same when I decided to leave my husband," is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal

A mother notified that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy?
A. "This situation is very sad, but time is a great healer."
B. "You are sad, but you must be stron

ANS: D
The nurse's response, "It must be horrible to lose a child; I'll stay with you until your husband arrives." conveys empathy to the client. Empathy is the ability to see the situation from the client's point of view. Empathy is considered to be one

If an individual is "two-faced," which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing?
A. Respect
B. Genuineness
C. Sympathy
D. Rapport

ANS: B
The nurse should identify that genuineness is missing in the relationship. Genuineness refers to the nurse's ability to be open and honest and maintain congruence between what is felt and what is communicated. When a nurse fails to bring genuinenes

On which task should a nurse place priority during the working phase of relationship development?
A. Establishing a contract for intervention
B. Examining feelings about working with a particular client
C. Establishing a plan for continuing aftercare
D. P

ANS: D
The nurse should place priority on promoting the client's insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings abou

A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, "Do you want to be my girlfriend?" Which nursing response is most appropriate?
A. "You are upset now. It would be best if you go to your room u

ANS: B
The nurse should promote the client's insight and perception of reality by confirming appropriate roles in the nurse-client relationship and identifying what is troubling the client in this situation.

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, "You're the only one who can make me well." What does this client response indicate to the nurse?
A. The client is using manipulation to receive sec

ANS: C
Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident.

According to Peplau, which nursing action demonstrates the nurse's role as a resource person?
A. The nurse balances a safe therapeutic environment to increase the client's sense of belonging.
B. The nurse holds a group meeting with the clients on the unit

ANS: D
According to Peplau, a resource person provides specific answers to questions usually formulated with relation to a larger problem.

According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate?
A. The nurse functions as a nurturing parent in order to build a trusting relationship.
B. The nurse plays cards with a small gro

ANS: A
According to Peplau, when a client is acutely ill, he or she may incur the role of infant or child while the nurse is perceived as the mother surrogate.

As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurse's most therapeutic statement?
A. "I want to assure you that I will maintain your confidentiality."
B. "A long-term goal for so

ANS: C
When moving on a continuum from the orientation to working phase of the nurse-client relationship, identified goals are addressed through mutual therapeutic work to promote client behavioral change.

What is the main goal of the working phase of the nurse-client therapeutic relationship?
A. Role modeling to improve interaction with others
B. Resolution of the client's problems
C. Using therapeutic communication to clarify perceptions
D. Helping the cl

ANS: B
The goal of the working phase of the nurse-client therapeutic relationship is to resolve client problems by promoting behavioral change.

Which client statement may indicate a transference reaction?
A. "I need a real nurse. You are young enough to be my daughter and I don't want to tell you about my personal life."
B. "I deserve more that I am getting here. Do you know who I am and what I d

ANS: A
Transference occurs when a client unconscientiously displaces, or "transfers," to the nurse feelings formed toward a person from the past.

Which nursing action demonstrates the role of the teacher in a therapeutic milieu?
A. The nurse implements a self-affirmation exercise during a one-to-one client interaction.
B. The nurse holds a group meeting to present common side effects of psychiatric

ANS: B
The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the client's health.

Which client statement indicates that termination of the therapeutic nurse-client relationship has been handled successfully?
A. "I know I can count on you for continued support."
B. "I am looking forward to discharge, but I am surprised that we will no l

ANS: C
Termination should begin in the orientation phase to minimize feelings of loss when the nurse-client relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals

When is self-disclosure by the nurse appropriate in a therapeutic nurse-client relationship?
A. When it is judged that the information may benefit the nurse and client
B. When the nurse has a duty to warn
C. When the nurse feels emotionally indebted towar

ANS: D
Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurse's needs.

The nurse-client therapeutic relationship includes which of the following characteristics? (Select all that apply.)
A. Meeting the psychological needs of the nurse and the client
B. Ensuring therapeutic termination
C. Promoting client insight into problem

ANS: B, C, D, E
The nurse-client therapeutic relationship should include ensuring therapeutic termination, promoting client insight into problematic behavior, collaboration to set appropriate goals, and meeting the physical and psychological needs of the

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