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An advanced practice nurse is conducting an in-service education program for a group of new nurses at the mental health clinic. After describing the nurse–client relationship, the advanced practice nurse determines that the program was successful when the group identifies which characteristic as critical to the nurse–client relationship?
A. Confidence
B. Trust
C. Sympathy
D. Adaptation
Answer: B
Rationale: Trust is vital in the nurse–client relationship related to the vulnerable position in which the client is placed. To become sympathetic and meld into the client's problem is nontherapeutic. Confidence and adaptation are important but not vital to the nurse–client relationship.
While talking with the nurse manager of the mental health unit, which statement made by a staff mental health nurse demonstrates a need for additional education about the importance of maintaining professional boundaries?
A. “The best part of this job is knowing that the clients really need me.”
B. “Clients like mine can be very vulnerable and often overly dependent.”
C. “I always wait for my discharged clients to speak first when I see them in the community.”
D. “I'm available to talk with you whenever I'm here on the unit.”
Answer: A
Rationale: When nurses allow a strong sense of commitment and need to help overshadow a focus on the client's needs, professional boundaries have been crossed. The nurse cannot let the relationship fulfill a personal desire, such as being needed, and remain objective about the client's needs at the same time. The remaining options demonstrate the appropriate boundaries required of a professional relationship.
A client's anger begins to become hostile. Which action should the nurse take to de-escalate the situation?
A. Use touch to convey a caring demeanor to the client
B. Warn the client what action will be taken if the behavior doesn't stop
C. Enter the client's personal space to demonstrate caring
D. Offer the client suggestions concerning how to regain control
nswer: D
Rationale: The client should be offered time to regain control and stop the hostile behavior. The nurse should not attempt to touch the client without their approval. The client should not be provoked or threatened with action. The nurse should not enter the client's personal space when the client is out of control.
The nurse implements limit setting for a client who is manipulative. Which intervention would be most appropriate to use initially?
A. Focusing on the feelings the client is currently feeling
B. Explaining the expected outcome of the boundary setting
C. Recognizing what the client is attempting to do as being controlling
D. Applying firm but fair boundaries
Answer: C
Rationale: The nursing approach begins with recognizing what the client is attempting to do. This is followed by focusing on the client's feelings, explaining the expected outcomes, and then applying firm but fair boundaries.
A nurse is teaching a client diagnosed with an anxiety disorder about ways to appropriately cope. The nurse and client are in which stage of the nurse–client relationship?
A. Preinteraction
B. Orientation
C. Working
D. Termination
Answer: C
Rationale: The working stage involves work by both the nurse and the client to develop an awareness of the problem and possible solutions to it. During this stage, the nurse becomes a role model and teaches appropriate coping skills. The other stages are not focused on outcomes and interventions.
A nurse and client are in the termination phase of the nurse–client relationship. Which activity would be the most likely focus during this phase?
A. Encouraging independence
B. Planning of outcomes and goals
C. Evaluating the effectiveness of changes
D. Building trust and establishing roles
Answer: A
Rationale: During the termination phase, the client is encouraged to be independent in getting along with others in preparation for discharge. Planning of outcomes and goals and evaluating the effectiveness of changes occur in the working stage. Building trust and establishing roles occur in the orientation phase.
The nurse is working with a client who has made a sexually inappropriate remark. Which intervention would the nurse initially implement to maintain appropriate professional boundaries while continuing to preserve a therapeutic nurse–client relationship?
A. Explore with the client what the underlying issue is that allowed the statement to be made.
B. Explain immediately and directly why the remark was unacceptable and disturbing.
C. Explain that other staff members will assume the responsibility of interacting with the client.
D. Respond to the statement by immediately terminating the conversation with the client.
Answer: B
Rationale: Most clients will refrain from making suggestive or sexually oriented comments or advances once they are asked to do so. The nurse should be direct in letting the client know that the actions are disturbing and unacceptable. Once the limits have been established, the client has a choice to use self-control. The nurse can then proceed to discuss the underlying issue with the client. If the behavior continues, the nurse can terminate the session, citing the behavior as the reason. This will allow the client time to reflect on the actions and leave open the option of discussing the behavior at a later point. The nurse should consult with a supervisor or colleague for a change of assignment only if the situation becomes unmanageable.
The nurse is developing a therapeutic relationship with a newly admitted client. Which component is essential for both the nurse and the client in a therapeutic relationship?
A. Family support
B. Intelligence
C. Acceptance
D. Dependency needs
Answer: C
Rationale: Acceptance demonstrated by both the nurse and the client is an essential characteristic for a therapeutic relationship. Family support, intelligence, and dependency needs are not necessary for a therapeutic nurse–client relationship.
A nurse is working with a client diagnosed with anger management issues. Which statement made by the nurse best demonstrates empathy and objectivity?
A. “I care that you are so hurt and angry; what can I do to help?”
B. “I can see why you are so angry but throwing the chair is not an acceptable way to handle that anger.”
C. “Let us discuss how anger and violence are not allowing you to be happy and emotionally healthy.”
D. “Can you and I talk about the things that trigger your anger?”
Answer: B
Rationale: Empathy is vital to the establishment of trust. At the same time, it is important for the nurse to maintain enough distance from the situation to be objective and remain in touch with their own feelings. Acknowledging the client's feelings while identifying inappropriate behavior is an example of empathy and objectivity. Offering to help is an example of caring. Sharing information about how anger affects a person is an example of explanations, while discussing triggers is associated with self-awareness.
A client repeatedly fails to abide by the unit's rules. Which intervention would be most appropriate for the nurse to do to foster the therapeutic relationship?
A. Informing the client they will have only one more chance before losing television privileges for the infraction
B. Asking the client to discuss why following the rules is so difficult to do
C. Reminding the client that they have lost television privileges as the consequence for failing to follow the rules
D. Reminding the client of the unit rules each morning before breakfast
Answer: C
Rationale: The foundation of the relationship is based on dependable interactions that demonstrate honesty, integrity, and consistency. Involved in this honesty is the establishment of boundaries and limit setting with predetermined consequences. This assists the client in self-control and management of behavior. To provide additional chances undermines both an honest approach and consistency. While discussing why compliance is so difficult and providing reminders of the rules are both appropriate, they do not demonstrate honesty and consistency as does enforcing consequences.
A client has a history of verbally abusing the client's children. Which question would the nurse most likely use to best determine the client's sense of self-awareness regarding therapy for this problem?
A. “Is your relationship with your children important enough for you to change how you interact with them?”
B. “Can you tell me if anyone ever verbally abused you as a child?”
C. “Do you have any idea how you make your children feel when you use words to hurt them so badly?”
D. “How long have you been verbally abusing your children?”
Answer: A
Rationale: The awareness of oneself as a whole person comes with an attitude of openness and wanting to come to an honest evaluation of behavior with a desire to make changes. By being open to change so that the parent–child relationship improves best demonstrates self-awareness. Understanding the effects of verbal abuse is awareness of the behavior but not necessarily indicative of self-awareness. The other options are details associated with the behavior but do not demonstrate any understanding or self-reflection.
An advanced practice nurse is working with a staff nurse on establishing professional boundaries. The advanced practice nurse identifies the need for additional discussion based on which statement?
A. “I promised to call the client's mother and tell her the client is sorry for hurting her.”
B. “I told the client that I'd let the case manager know the client has financial concerns.”
C. “The client and I are going to identify ways to improve the client's social skills.”
D. “I'm going to spend time with the client discussing the importance of friendships.”
Answer: A
Rationale: Situations such as involvement in personal relationships of the client, financial affairs unrelated to the treatment process, or a third-party liaison that is not treatment related are issues that must be clearly understood. Calling the client's parent for the purpose of apologizing is a breach of professional boundaries since that is the client's responsibility. Referring financial concerns as well as discussing the importance of social skills and interpersonal relations is therapeutic and not social in nature.
The nurse is reinforcing rules and boundaries to a newly admitted client. The nurse is involved with which phase of the therapeutic relationship?
A. Preinteraction
B. Orientation
C. Working
D. Termination
Answer: B
Rationale: Rules and boundaries are explained to provide structure with guidelines for behavior during the orientation phase of the therapeutic relationship. There is no preinteraction phase of the therapeutic relationship. During the working phase, outcomes and interventions toward behavior change are planned and goals are developed to improve the client's well-being. The client is allowed to depend on their own strengths while developing improved adaptive skills during the termination phase.
The nurse is assisting the client to overcome the fear of public places. The nurse and the client are in which phase of the therapeutic relationship?
A. Preinteraction
B. Orientation
C. Working
D. Termination
Answer: C
Rationale: During the working phase, outcomes and interventions toward behavior change are planned and goals are developed to improve the client's well-being. This involves work by both the nurse and the client to develop an awareness of the problem and possible solutions to it. Rules and boundaries are explained to provide structure with guidelines for behavior during the orientation phase of the therapeutic relationship. There is no preinteraction phase of the therapeutic relationship. The client is allowed to depend on their own strengths while developing improved adaptive skills during the termination phase.
The nurse determines that a client is attempting to manipulate staff into allowing unauthorized use of the telephone. How should the nurse respond initially?
A. Reintroduce the rules regarding telephone use with both the client and the staff
B. Engage the client in a conversation about the negative aspects of using manipulation
C. Ask the client to describe the feelings the client is currently experiencing
D. Assure the client they can use the telephone in accordance with the established rules
Answer: C
Rationale: In response to manipulation, nurses should avoid reinforcing the negative behavior and focus on the feelings the client is experiencing at the present time. Further interaction can then be aimed toward the client's thoughts and response. Discussion of the rules and the expected outcomes associated with manipulative behavior is appropriate; however, this discussion does not address the underlying cause of the behavior.
A nurse shows concern for a client's well-being. The nurse is demonstrating which characteristic of the nurse–client relationship?
A. Self-awareness
B. Empathy
C. Acceptance
D. Genuineness
Answer: D
Rationale: Genuineness or realness is an attribute of concern that fosters an honest and caring foundation for the trust that is forming. Self-awareness is a consciousness of one's own individuality and personality, or looking at oneself in the mirror. Empathy is the ability to hear what another person is saying, to have temporary access to that person's feelings, and to perceive the situation from that person's perspective. Acceptance is the ability of the nurse to understand that the client has worth and dignity who is not judged or labeled by the nurse's standards.
A psychiatric clinical nurse specialist is working with a nurse on ways to manage a client’s manipulative behavior. The clinical nurse specialist asks the nurse how they would respond to a client’s manipulation. Which response by the nurse would the clinical nurse specialist identify as appropriate?
A. “Why do you need to manipulate the discussions we have in group sessions?”
B. “You seem to need to control all discussions we have. Let's talk about what makes you feel that need.”
C. “How long have you used manipulation as a way to get what you want?”
D. “It's apparent you like being in control. Do you realize that most people will not tolerate that behavior in public?”
Answer: B
Rationale: In response to manipulation, nurses should avoid reinforcing the negative behavior and focus on the feelings the client is experiencing at the present time. The other options focus on the negative behavior and would be viewed by the client as barriers to future discussions.
A nurse manager is conducting a review session for a group of staff nurses at the mental health center about the nurse–client relationship. The nurse manager would determine that the teaching review session was successful when the group states which characteristic(s) as being critical to include? Select all that apply.
A. Empathy
B. Genuineness
C. Individuality
D. Acceptance
E. Consistency
Answer: A, B, D, E
Rationale: The establishment of a therapeutic nurse–client relationship is dependent on certain consistent characteristics including, empathy, genuineness, acceptance, and consistency. Individuality is not an essential element of a nurse–client relationship.
A nurse is working to develop a nurse–client relationship with a client. Throughout the relationship, the nurse would focus attention on which aspect(s) about the client? Select all that apply.
A. Attitude concerning the problem
B. Personality traits and temperament
C. Ability to engage in the process
D. Degree of social support from family and friends
E. Identification of client needs
Answer: C, E
Rationale: The phases of the nurse–client relationship must center on the client's ability to function in the process. The relationship is one that focuses on identifying the client's problems, developing goals for improvement, and promoting a return to independent living within societal norms. The relationship may vary in intensity, length, and focus depending on the particular client's needs. The client's attitude, personality, and social support are important to the relationship but are not at the center.
A nurse is evaluating the relationship between themself and a client. The nurse determines that the relationship was therapeutic based on which finding(s)? Select all that apply.
A. It was dependent on the situation and needs of the client.
B. The relationship focused on identified client problems.
C. It included interactions that were special and social in nature.
D. The client returned to independent living within societal norms
E. Goals for improvement of existing problems were developed.
Answer: A, B, D, E
Rationale: The therapeutic relationship is not a social interaction but one that focuses on identifying the client's problems, developing goals for improvement, and promoting a return to independent living within societal norms. It is dependent on the situation and needs of the individual client.