Which action is the priority when the nurse is establishing a therapeutic environment for a client quizlet?

1. 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 clients length of stay

D. To establish personal goals for the interaction

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 ones own attitudes, values, and beliefs is called self-awareness.

2. A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following?

A. Sympathy

B. Trust

C. Veracity

D. Manipulation

ANS: B

The nurse is promoting trust by postponing the admission interview, assuring safety, and providing a warm meal. Trust implies a feeling of confidence that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated through nursing interventions that convey a sense of warmth and caring to the client.

3. 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 reassigning the client to another staff member

D. Helping the client to clarify the meaning of the current nurseclient relationship

ANS: D

The nurse should respond to a clients transference by clarifying the meaning of the nurseclient relationship, based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present.

4. What is the priority nursing action during the orientation (introductory) phase of the nurseclient relationship?

A. Acknowledge the clients actions and generate alternative behaviors.

B. Establish rapport and develop treatment goals.

C. Attempt to find alternative placement.

D. Explore how thoughts and feelings about this client may adversely impact care.

ANS: B

The priority nursing action during the orientation phase of the nurseclient 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, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurseclient relationship.

5. Which client response should a nurse expect during the working phase of the nurseclient relationship?

A. The client gains insight and incorporates alternative behaviors.

B. The client and nurse establish rapport and mutually develop treatment goals.

C. The client explores feelings related to reentering the community.

D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A

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

6. What should be the nurses primary goal during the preinteraction phase of the nurseclient relationship?

A. To evaluate goal attainment and ensure therapeutic closure

B. To establish trust and formulate a contract for intervention

C. To explore self-perceptions

D. To promote client change

ANS: C

The nurses 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 is to obtain available client information.

7. Which phase of the nurseclient 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, and termination.

8. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurseclient relationship?

A. I cant bear the thought of leaving here and failing.

B. I might have a hard time working with you. You remind me of my mother.

C. I cant tell my husband how I feel; he wouldnt listen anyway.

D. Im not sure that I can count on you to protect my confidentiality.

ANS: C

The nurse should identify that the client statement I cant tell my husband how I feel; he wouldnt listen anyway reflects resistance to change, which is a common behavior in the working phase of the nurseclient relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

9. 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 can understand you are feeling depressed. It was a difficult decision. Ill sit with you.

C. You seem depressed. It was a difficult decision to make. Would you like to talk about it?

D. I know this is a difficult time for you. Would you like a prn medication for anxiety?

ANS: A

The nurses 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 expression alleviates the clients distress.

10. A mother who has learned that her child was killed in a tragic car accident states, I cant 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 strong for your other children.

C. Once you cry it all out, things will seem so much better.

D. It must be horrible to lose a child; Ill stay with you until your husband arrives.

ANS: D

The nurses response, It must be horrible to lose a child; Ill stay with you until your husband arrives, conveys empathy to the client. Empathy is the ability to see the situation from the clients point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

11. 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 an individuals ability to be open and honest and maintain congruence between what is felt and what is communicated. Genuineness is essential to establishing trust in a relationship.

12. 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. Promoting the clients insight and perception of reality

ANS: D

The nurse should place priority on promoting the clients 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 about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase.

13. 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 until you feel better.

B. Remember, we have a professional relationship. Are you feeling uncomfortable?

C. We have discussed this before. I am not allowed to date clients.

D. I think you should discuss your fantasies with your therapist.

ANS: B

The nurse should promote the clients insight and perception of reality by confirming appropriate roles in the nurseclient relationship and identifying what is troubling the client in this situation.

14. A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, Im not well enough to switch to a different nurse. What does this client response indicate to the nurse?

A. The client is using manipulation to receive secondary gain.

B. The client is using the defense mechanism of denial.

C. The client is having trouble terminating the relationship.

D. The client is using splitting as a way to remain dependent on the nurse.

ANS: C

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

15. According to Peplau, which nursing action demonstrates the nurses role as a resource person?

A. The nurse balances a safe therapeutic environment to increase the clients sense of belonging.

B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness.

C. The nurse monitors the administration of medications and watches for signs of cheeking.

D. The nurse explains, in language the client can understand, information related to the clients health care.

ANS: D

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

16. 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 group of clients.

C. The nurse discusses childhood events that may affect personality development.

D. The nurse provides a safe social environment.

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.

17. As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurses most therapeutic statement?

A. I want to assure you that I will maintain your confidentiality.

B. A long-term goal for someone your age would be to develop better job skills.

C. Which identified problems would you like for us to initially address?

D. I think first we need to focus on your relationship issues.

ANS: C

When moving on a continuum from the orientation to working phase of the nurseclient relationship, the clients identified goals are addressed through mutual therapeutic work to promote client behavioral change.

18. What is the main goal of the working phase of the nurseclient therapeutic relationship?

A. Role modeling to improve interaction with others

B. Resolution of the clients problems

C. Using therapeutic communication to clarify perceptions

D. Helping the client access outpatient treatment

ANS: B

The goal of the working phase of the nurseclient therapeutic relationship is to resolve client problems by promoting behavioral change.

19. Which client statement may indicate a transference reaction?

A. I need a real nurse. You are young enough to be my daughter and I dont want to tell you about my personal life.

B. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor.

C. I dont seem to be able to relate to people. I would rather stay in my room and be by myself.

D. My mother is the source of my problems. She has always told me what to do and what to say.

ANS: A

Transference occurs when a client unconsciously displaces or transfers to the nurse feelings formed toward a person from the past.

20. 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 medications.

C. The nurse introduces the concept of fair play while playing cards with a group of clients.

D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B

The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the clients health.

21. Which client statement indicates that termination of the therapeutic nurseclient 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 longer work together.

C. Reviewing the changes that have happened during our time together has helped me put things in perspective.

D. I dont know how comfortable I will feel when talking to someone else.

ANS: C

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

22. When is self-disclosure by the nurse appropriate in a therapeutic nurseclient 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 toward the client

D. When it is judged that the information may benefit the client

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 nurses needs.

23. The nurseclient 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 problematic behavior

D. Collaborating to set appropriate goals

E. Meeting both the physical and psychological needs of the client

ANS: B, C, D, E

The nurseclient therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. The nurses psychological needs should not be addressed within the nurseclient relationship.

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