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Therapeutic Relationship
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mental health testu3
| Question | Answer |
|---|---|
| Social relationship | two way energy exchange, based on the sharing of personal opinions, attitudes & taste |
| Therapeutic Relationship | focus of energy is primarily on client/patient and the relationship is consciously directed |
| Trust | the assured belief that another individual is capable of assisting |
| Empathy | enables nurse to enter into the life of another person, to share their emotions, meanings & attitudes |
| Autonomy | relates to ability to direct & control one’s own activities & destiny |
| caring | – energy that allows nurses to unconditionally accept each person, even when they are most unlovable |
| hope | dynamic life force characterized by confident yet uncertain expectation of future good |
| preparation | data collection, learning as much as possible before meeting |
| orientation | become acquainted, agree to work together, est purpose for relationship. |
| working | actually working on the relationship, working phase, in therapy, etc, working through issues |
| termination phase | review steps taken toward meeting the therapeutic goal. |
| boundaries | Serve to separate and define entities at the point of interaction Definition and separation of self from others Often patients have an unclear sense of self, responsibilities of self, others Safety – patient must feel confidentiality will be maintai |
| Therapeutic Use of Self | The use of oneself in such a way that one becomes an effective tool in the assessment, intervention and evaluation process Planned interaction Rapport Interplay between nurse and patient |
| The self | Others see and we do not Social self Private self Invisible aspects Professional self |
| Personal Characteristics promoting therapeutic use of self | Insight Energy Empathy Patience Honesty Humor Valuing the individual Caring |
| Health care professionals – often serve as therapeutic instruments | each interaction with patients is designed to move patients towards the goals of care |
| Role models | physical health mental health |
| To practice effectively | our approach to patient’s must be constantly monitored, evaluated and adjusted |
| Self-awareness | consciousness of one’s personality Therapeutic use of self |
| Requires | insight, caring, acceptance, consideration of values, positive outlook, self-nurturance |
| Identify negative or unresolved issues | Issues that need to be changed, id the unresolved issues from the past |
| life-long process | continue to work through them |
| Characteristics/Attitudes to develop for effective use of self | Genuineness Authenticity Transparence Positive regard Empathy Trustworthiness Clarity Responsibility Assertiveness |
| Caring | universal need for love and belonging Caring is the “energy” on which the health care professions are built Concern for the well-being of another person Accepting, comforting, honesty, attentive listening, sensitivity |
| Nursing as a “Caring Science” Jean Watson – theory of human caring Carative Factors | Formation of humanistic-altruistic system of values Instillation of faith-hope Cultivation of sensitivity to one’s self and to others Development of helping-trusting, authentic caring relationship Promotion and acceptance of the expression of positive |
| Caring Science | Promotion and acceptance of the expression of positive and negative feelings Systematic use of creative problem-solving caring process, engage in artistry of caring-healing practices |
| The client says to the nurse, “I have special powers because I am the mother of God. I can heal everyone in the hospital.” The nurse's best response would be, | It would be unusual for anyone to have that kind of power.” |
| The nurse understands that empathy is essential to the therapeutic relationship. When a patient makes the statement, “I am just devastated that my marriage is falling apart” the nurse can best show empathy through which of the following responses? | It will get better, let’s talk about it.” |
| Which of the following is the essential component the nurse must bring to the therapeutic nurse–client relationship? | Empathy |
| The nurse is sitting down with a patient to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the patient? | Sitting upright facing the patient with both feet on the floor |
| A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? | Broad opening |
| A patient states, “I feel fine. It’s a good day.” The nurse notes the patient looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse? | You say you feel fine, but you don’t really sound fine.” |
| A patient has just been told she has cervical cancer. When asked about how this is impacting her she states, “It’s just an infection, it will clear up.” The statement indicates that this patient: | is using denial to protect herself from an emotionally painful thought |
| The nurse is talking to a client who is having difficulty following the rules of the inpatient unit. A patient says, “Its’ been so long since I’ve been with my family.” Which statement by the nurse is an example of restating? | You say you haven’t seen your family in a while.” |
| A college student decides to go to a party the night before a major exam instead of studying. After receiving a low score on the exam, the student tells a fellow student, “I have to work too much and don't have time to study. It wouldn't matter anyway bec | Rationalization and projection |
| Client: “I was so upset about my sister ignoring me when I was talking about being ashamed.”Nurse: “How are your stress reduction classes going?”This is a nontherapeutic response because the nurse has | Changed the topic |
| A patient reports a pattern of being suspicious and mistrusting of others, causing difficulty in sustaining lasting relationships. Which stage according to Erikson’s psychosocial development was not successfully completed? | Trust |
| The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies, “The doctors are very busy. What can I help you with?” The nurse incorporated which nontherapeutic technique in this respo | Defending |
| A patient asks the nurse what she should do about her “cheating” husband. The nurse replies, “You should divorce him. You deserve better than that.” The nurse used which communication technique? | Giving advice |
| The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to | Validate the meaning of the nonverbals |
| Which of the following statements is true about a nurse's self-disclosure? | Self-disclosure on the nurse's part should benefit the client. |
| The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, “I saw you sitting alone and thought I might keep you company.” The client turns away from the nurse. Which of the following is the most thera | Move to a chair a little further away and say, “We can just sit together quietly.” |
| Which of the following occurrences is considered a breach of professional boundaries? | Having a lengthy social conversation with a patient |
| The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms? | Intellectualization |
| A patient asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. The best explanation by the nurse would be which of the followi | Medications help your brain function better, but the therapy helps you achieve lasting behavior change.” |
| A patient shows no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the patient’s affect? | Flat affect |
| The nurse initiating a therapeutic relationship with a client should explain the purpose, which is to | Facilitate a positive change |
| A client who had been in a substance abuse treatment program asks the nurse for a date after the client is discharged. The nurse talks to the client about the importance of a therapeutic relationship and its, characteristics. The nurse is using which of t | Defining boundaries |
| When preparing for the first clinical experience with patients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students’ beliefs and fears surrounding forensic patients. The primary reason for discussing personal beliefs is | become aware of possible barriers to developing therapeutic relationships. |
| During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems? | Encouraging the client to clarify feelings and behavior |
| The nurse fails to assess personal values surrounding homosexuality before caring for a patient that is openly gay. The nurse is most at risk for which of the following when working with this patient? | Holding a prejudice toward this patient. |
| A patient being discharged appears angry with the nurse when she attempts to review discharge instructions with the patient. The nurse can best assist the patient in this stage of the relationship with which of the following responses? | I can sense you are angry this morning. Tell me how you feel about being discharged today.” |
| Which of the following individual is at highest for committing suicide? | 71 year old male, alcohol user, independent-minded |
| A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which of the following nursing diagnoses has the highest priority? | Risk for suicide related to highly lethal plan |
| A client with depression appears lethargic and apathetic but agrees to participate in a leisure activity group. Which of the following actions by the nurse is most likely to help the client be successful in this group? | ) Structuring the activity to facilitate completion of one specific task |
| A patient is admitted for major depression. The nurse should expect to find which of the following in the assessment? | Anhedonia, feelings of worthlessness, and difficulty focusing |
| The nurse is teaching a 70-year-old man about his depression. Which of the following statements by the client would indicate that teaching has been effective? | “I never knew depression could just happen for no specific reason.” |
| A patient has a history of suicidal ideation. The nurse understands that the patient is at highest risk for self-harm at which of the following times? | Approximately 2 weeks after starting antidepressant medication |
| A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asks for a bed bath, and makes many demands of the nurses. He also yells that they are lazy and incompetent. The client's behavior is an example of | Projection |
| During a regular home health visit the nurse observes that the client has feelings of hopelessness and despair. The client says, “I'm old, and my life has no purpose anymore. But promise me you won't tell anyone.” How should the nurse respond? | I'm sorry, but I can't keep that kind of secret.” |
| A patient with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The patient has a history of moderate but steady alcohol use over the past 45 years. Which of the following medications is least suitable for this patient? | ) Tacrine (Cognex) because it elevates liver enzymes in 50% of patients |
| The nurse can distinguish delirium from dementia by knowing which of the following? | Dementia has a gradual onset and is progressive in course. |
| A client has been admitted to the inpatient unit after using inhalants recently. Which of the following is an antidote to treat inhalant toxicity? | There is no antidote |
| Which of the following terms is used to describe deterioration in language function? | Aphasia |
| A patient with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the patient’s side for 5-10 minutes and then returns. Which of the following best explains the nurses’ behavior? | The nurse gave the patient a chance to calm down before resuming the meal |
| The nurse encourages the patient with dementia to meet nutritional needs. Which of the following is the best approach to assist in meeting adequate dietary intake? | ) Serve meals in small, bite-size pieces |
| A client will be taking disulfiram (Antabuse) after discharge from an alcohol treatment program. Which of the following statements would indicate that teaching has been effective? | Drinking alcohol while taking Antabuse can cause dangerous symptoms.” |
| The caregiver of a dementia patient reports to the nurse that often the patient will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. which one is best? | Let’s look at what is on television.” |
| The adult son of a patient with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. The best guidance the nurse can give is which of the following? | Go along with her thought of it having been a busy day, but do not refer to her work |
| The nurse is encouraging a group of patients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? | Demonstrate the exercises while patients simultaneously perform them |
| Which of the following is believed to be a risk factor specific to the development of delirium? | Co-occurring general medical condition |
| The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. | Call the manager and report the observations. |
| The nurse caring for an elderly woman with dementia has asked the woman’s children to bring old photo albums when they visit. Which of the following best describes the usefulness of viewing photos when caring for the dementia patient? | ) Viewing photos will help stimulate remote memory |
| At the change of shift report the nurse learns that a patient in the intensive care unit has developed signs of delirium over the past 8 hours. Which of the following behaviors documented in the nursing notes is the most probable indication of delirium? | Disoriented to person |
| The nurse is assessing a patient’s risk factors for developing a substance abuse disorder. Which of the following family characteristics would the nurse identify as a significant risk factor | One parent that is an alcoholic |
| The nursing supervisor in an extended care facility is managing the environment to best help the patients with dementia. Which of the following should the nurse include in planning the living environment? A) Assign peer-led exercise activates on a dail | Plan for the same caregivers to provide care to individuals as much as possible |
| dementia patients for almost 6 months. During a staff meeting the nurse expresses frustration because the same instructions have to be giving to patients on a daily basis. The nurse states, “I feel like all my work doesn’t do them any good.” which one? | Try to stay supportive and meet the patients’ needs at the current moment |
| Neurochemical influences on substance abuse patterns point to which of the following explanations as the probable cause of substance abuse? | Stimulation of dopamine pathways in the brain |
| When interviewing the family members of a client being treated for substance abuse problems, which of the following behaviors would alert the nurse to the possibility of codependency? | Blaming themselves for the family's problems |
| The nurse is assessing the drinking history of a patient being admitted for alcohol abuse. Which of the following statements reflects the most probable patient statement at this time? | I don’t really have a problem with alcohol. I’ve just been having a streak of bad luck lately.” |
| Which of the following communication techniques is most effective to use with anxious clients? | Stand or sit in the center of the client's visual field to facilitate attention. |
| The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid? | Explaining the consequences the client will face if control is lost |
| A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints. The nurse will explain the reason for restraints to the client by saying, | This is a means of keeping you and others safe.” |
| When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following? | Caffeine |
| When a client is experiencing severe anxiety, which of the following is the priority intervention? | Move the client to a quiet environment |
| The client identifies anger management as a problem. What is the next step in planning therapeutic interactions? | Give the client permission to be angry. |
| A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. The best approach by the nurse would be to | Use brief statements and questions to obtain information |
| he client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate that client education about this medication has been effective? | This medication will relax me so I can focus on problem solving.” |
| A patient is observed pacing the hall with clenched fists, and swearing at others. The nurse intervenes immediately to prevent the patient from escalating to which phase of the aggressing cycle? | Crisis |
| A patient states, “I will just die if I don’t get this job.” The nurse then asks the patient, “What will be the worst that will happen if you don’t get the job?” The nurse is using this response to: | appraise his situation more realistically. |
| Which of the following statements would be an empathetic response in a client interaction? | You must have been embarrassed when your father yelled at you in the grocery store.” |
| After an angry outburst, the patient is tearful and remorseful. The nurse can be most supportive to the patient through which of the following responses? | What could you have done when you first started to feel angry?” |
| A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? | Broad opening |
| The nurse is teaching a patient with an anxiety disorder ways to manage anxiety. The nurse suggests the following schedule for practicing stress management techniques: | Practice the techniques when relatively calm |
| Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective? | Anxiety is learned in childhood through interactions with caregivers |
| After an angry outburst, a patient quickly appears more calm and rational. The nurse approaches the client. Which of the following is the most helpful response to the patient at this time? | “What happened that got you so upset?” |
| married man expresses to the nurse that his wife’s frequent nagging angers him. The nurse role plays assertive communication techniques with husband. Which of the following indicates the husband understands how to use assertive techniques effectively? | “I feel unappreciated when you criticize me.” |
| A patient experiences panic attacks when confronted with riding in elevators. The therapist is teaching the patient ways to relax while incrementally exposing the patient to getting on an elevator. This technique is called | Systematic desensitization |
| A client suddenly jumps up from the chair and begins yelling and cursing at the nurse. The best response by the nurse would be, | You seem angry. Tell me more about how you're feeling.” |
| A nurse is working with a patient that has frequent angry outbursts. Which of the following statements is most helpful when working with this patient? | Anger is a normal feeling and you can use it to solve problems.” |
| Congruence refers to the difference between an individual’s verbal and nonverbal communication. | False |
| Positive regard is the unconditional, nonjudgmental attitude demonstrated by the nurse to the client. | True |
| Therapeutic relationships are similar to social relationships in that they are primarily initiated for companionship or accomplishment of a task. | false |
| The nurse may act as a parent surrogate within the therapeutic relationship. | True |
| Self-disclosure is appropriate in all nurse-client interactions | False |
| _______________ is the ability of a nurse to perceive the meaning and feelings of a client and to convey this to him or her. | Empathy |
| _______________ is the ability to develop an understanding of one’s own beliefs, values, strengths, and limitations. | self-awareness |
| ______________ are ideas that an individual may have regarding how another person may speak and behave. | preconception |
| During the ____________ identification phase in the therapeutic relationship, the client identifies issues and concerns. | Problem |
| The nurse engages in ______________ when he or she acts on the client’s behalf when the client is unable to do so. | Advocacy |
| Context is the environment in which communication occurs. | True |
| Covert cues are clear statements of intent. | False |
| When the nurse uses broad, open-ended statements in a therapeutic interaction, he or she is said to be assuming a nondirective role. | True |
| Spirituality is conceptualized the same as religion | False |
| Active observation involves refraining from other internal mental activities and concentrating solely on what the client says. | False |
| __________ is the study of distance zones between people during communication. | Proxemics |
| Sitting defensively with legs or arms crossed is an example of a ___________ body position. | closed |
| The ________________ zone (18 to 36 inches) is the distance that is comfortable between family and friends who are talking. | personal |
| ___________________ is the use of extraneous words with long tedious descriptions. | circumstantiality |
| _____________ communication is the behavior that a person exhibits while delivering a verbal message. | Nonverbal |
| Mild anxiety can be productive and does not require direct intervention. | True |
| An individual experiencing panic attacks can also experience depersonalization, which is the sense that things are not real. | false |
| Obsessions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. | false |
| Anxiety and fear both refer to the same feeling of being afraid or threatened by an external stimulus. | false |
| Positive reframing involves turning negative messages into positive messages. | true |
| In the ______________ phase of Seyle’s General Adaptation Syndrome, the body has responded negatively to anxiety and stress and is depleted physically and emotionally. | exhaustion |
| _____________ mechanisms are cognitive distortions that a person uses unconsciously to maintain a sense of control of a situation, and to deal with the stress. | defense |
| A(n) ____________ is an illogical intense persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. | phobia |
| _________________ is a treatment used for obsessive compulsive disorder in which the client is assisted in deliberately confronting the situation and stimuli that the individual usually avoids. | exposure |
| _________________ are automatic, unconscious mannerisms that a person with panic disorder may exhibit. | automatisms |
| Depressed individuals who are newly taking antidepressant medication are at an increased risk for suicide. | true |
| Antidepressant medications can be discontinued quickly by the client. | false |
| Electroconvulsive therapy can be safely administered to pregnant women. | true |
| Depressed individuals can experience a lack of energy known as anhedonia. | false |
| A lithium level of 1.6 mEq/L is within therapeutic range. | false |
| ________________ is a process by which seizure activity in the brain is initially stimulated by the cumulative effects of stress, low amounts of electric impulses, or chemicals that sensitize the neuronal pathways. | kindling |
| Clients taking MAOIs and who eat foods containing tyramine risk experiencing a(n) _______________ crisis, which is a potentially fatal reaction. | hypertensive |
| An individual experiencing mania can exhibit rapidly changing emotions, also known as ______________ emotions. | labile |
| Suicidal ___________________ refers to having thoughts of killing oneself. | ideation |
| In the _________________ approach to mood disorders, there is a belief that anger turned inward toward oneself can lead to depression. | psychoanalytic |
Created by:
hajet