Nurse-Client Relationship Phases
A nurse is beginning the pre-interaction phase with a newly admitted client. Which action by the nurse is appropriate?
A. Conduct a nursing assessment
B. Explore their own feelings about working with the client
C. Set mutual goals with the client
D. Encourage the client to discuss feelings
Answer: B
Rationale: The pre-interaction phase focuses on self-reflection by the nurse, not direct client engagement.
Which statement by the nurse reflects the use of therapeutic communication?
A. "Everything will be okay."
B. "Let’s not focus on that right now."
C. "Can you tell me more about what’s troubling you?"
D. "You shouldn’t feel that way."
Answer: C
Rationale: Encouraging elaboration promotes trust and therapeutic dialogue.
A nurse notes a client in a locked psychiatric unit is becoming increasingly agitated and threatening others. What is the priority of nursing action?
A. Call the healthcare provider
B. Attempt to reorient the client
C. Remove other clients from the area
D. Administer PRN medication without consent
Answer: C
Rationale: Safety is the priority; removing others protects them from harm while the client is managed.
A client states, "I don’t know why I feel so angry, I guess I’m just tired." Which defense mechanism is this?
A. Denial
B. Projection
C. Rationalization
D. Displacement
Answer: C
Rationale: Rationalization involves justifying feelings or behaviors with acceptable reasons.
The nurse understands that autonomy is best supported by:
A. Forcing the client to take medications
B. Allowing the client to refuse treatment after being informed
C. Keeping the client isolated for safety
D. Reporting client's private conversations
Answer: B
Rationale: Autonomy includes the right to refuse treatment after informed consent.
A nurse-client relationship is in the working phase. Which is a nurse's appropriate intervention?
A. Introduce self to client
B. Encourage independence and explore coping
C. Review client records
D. Discuss termination
Answer: B
Rationale: The working phase involves implementing care and encouraging behavioral change.
Which of the following best reflects congruence in the therapeutic nurse-client relationship?
A. Saying “I understand” while appearing distracted
B. Focusing on the client's interests only
C. Matching verbal and nonverbal communication
D. Avoiding emotional reactions
Answer: C
Rationale: Congruence involves alignment between the nurse’s words and behaviors, building trust.
A client with schizophrenia says, “The voices told me to hurt the nurse.” What is the nurse’s priority?
A. Distract the client
B. Implement suicide precautions
C. Initiate one-to-one supervision
D. Ignore the voices
Answer: C
Rationale: The client is a danger to others; 1:1 supervision ensures safety.
A client uses displacement as a defense mechanism. Which behavior reflects this?
A. Refusing to accept a terminal diagnosis
B. Yelling at the nurse after an argument with a spouse
C. Forgetting a traumatic event
D. Expressing love through humor
Answer: B
Rationale: Displacement involves transferring emotions to a less threatening target.
What behavior by a nurse indicates boundary violation?
A. Calling the client by their first name
B. Accepting a personal gift from the client
C. Reflecting the client’s emotions
D. Discussing the care plan
Answer: B
Rationale: Accepting personal gifts crosses therapeutic boundaries.
During which phase of the nurse-client relationship is it appropriate to establish the contract for care?
A. Pre-interaction phase
B. Orientation phase
C. Working phase
D. Termination phase
Answer: B
Rationale: The contract, which outlines roles, responsibilities, and goals, is created during the orientation phase.
A client says, “No one cares about me.” Which is the most therapeutic response?
A. “That’s not true.”
B. “Why do you think that?”
C. “Tell me more about how you’re feeling.”
D. “You're just feeling down today.”
Answer: C
Rationale: This response invites further exploration without judgment or minimization.
Which intervention is priority for a client experiencing a panic attack?
A. Teach relaxation techniques
B. Explore underlying triggers
C. Stay with the client and remain calm
D. Administer long-term anxiolytics
Answer: C
Rationale: Immediate support and safety are essential; teaching occurs once the panic resolves.
A nurse recognizes a client’s use of projection when they state:
A. “You’re the one who’s angry, not me.”
B. “I don’t care what happens to me.”
C. “I failed because the teacher hates me.”
D. “It’s all my fault.”
Answer: A
Rationale: Projection involves attributing one’s own feelings to someone else.
Which behavior by a psychiatric nurse demonstrates a violation of professional boundaries?
A. Accepting a small gift
B. Keeping secrets with a client
C. Encouraging autonomy
D. Setting limits on behavior
Answer: B
Rationale: Keeping secrets undermines transparency and violates therapeutic boundaries.
What is the nurse’s priority during the termination phase?
A. Establish a contract
B. Maintain distance
C. Review goals and achievements
D. Begin teaching coping skills
Answer: C
Rationale: Termination includes reflection, closure, and evaluation of the relationship.
A nurse is caring for a client who begins to cry during a session. What is the most therapeutic nursing response?
A. “Let’s talk about something else to distract you.”
B. “Crying isn’t helpful right now.”
C. “It’s okay to cry. What are you feeling right now?”
D. “Don’t worry; everything will be fine.”
Answer: C
Rationale: Acknowledging and validating the client’s emotions fosters therapeutic communication.
A client refuses medication. The nurse restrains the client and administers the injection without a court order. This is a violation of:
A. Veracity
B. Autonomy
C. Confidentiality
D. Justice
Answer: B
Rationale: Forcing treatment without legal authority violates the client’s right to autonomy.
A client exhibiting involuntary reversion to an earlier developmental stage is demonstrating:
A. Rationalization
B. Regression
C. Repression
D. Denial
Answer: B
Rationale: Regression is reverting to childlike behaviors during stress (e.g., bedwetting in an adult).
Which of the following demonstrates justice in nursing ethics?
A. Giving a client medication without consent
B. Providing equal care regardless of ability to pay
C. Maintaining confidentiality
D. Allowing clients to make poor decisions
Answer: B
Rationale: Justice refers to fairness and equality in care and resource distribution.
A client in the termination phase of a therapeutic relationship says, “I’m going to miss you.” What is the best response?
A. "Don’t worry, you’ll meet someone else."
B. "This relationship was only for treatment."
C. "I’ve enjoyed working with you too. Let’s review your progress."
D. "Let’s avoid emotional attachment."
Answer: C
Rationale: Acknowledging feelings and reviewing progress supports healthy closure.
Which therapeutic communication technique helps a client reflect on their own thoughts?
A. Giving advice
B. Interpreting
C. Restating
D. Disagreeing
Answer: C
Rationale: Restating encourages the client to elaborate and examine their own thoughts.
Which nursing action violates a client’s right to informed consent?
A. Explaining risks of treatment
B. Encouraging questions
C. Coercing the client to sign a consent form
D. Providing alternatives to the proposed treatment
Answer: C
Rationale: Informed consent must be given voluntarily, without coercion.
Which of the following best represents altruism as a defense mechanism?
A. A client cleans obsessively to avoid anxiety
B. A nurse volunteers extra shifts to help others after losing a loved one
C. A student blames the teacher for a failed test
D. A man forgets his wife’s birthday after a fight
Answer: B
Rationale: Altruism is managing emotional conflict by helping others, leading to satisfaction.
In a therapeutic relationship, self-disclosure by the nurse should be:
A. Frequent to build trust
B. Avoided at all times
C. Minimal and purposeful
D. Focused on the nurse’s emotions
Answer: C
Rationale: Self-disclosure should be rare and used only when it benefits the client therapeutically.