dentify the choice that best completes the statement or answers the question.
____ 1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
| 1. | Clarify personal attitudes, values, and beliefs. |
| 2. | Obtain thorough assessment data. |
| 3. | Determine the client’s length of stay. |
| 4. | Establish personal goals for the interaction. |
____ 2. If a client demonstrates transference toward a nurse, how should the nurse respond?
| 1. | Promote safety and immediately terminate the relationship with the client. |
| 2. | Encourage the client to ignore these thoughts and feelings. |
| 3. | Immediately reassign the client to another staff member. |
| 4. | Help the client to clarify the meaning of the relationship, based on the present situation. |
____ 3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
| 1. | Acknowledge the client’s actions, and generate alternative behaviors. |
| 2. | Establish rapport and develop treatment goals. |
| 3. | Attempt to find alternative placement. |
| 4. | Explore how thoughts and feelings about this client may adversely impact nursing care. |
____ 4. Which client action should a nurse expect during the working phase of the nurse-client relationship?
| 1. | The client gains insight and incorporates alternative behaviors. |
| 2. | The client establishes rapport with the nurse and mutually develops treatment goals. |
| 3. | The client explores feelings related to reentering the community. |
| 4. | The client explores personal strengths and weaknesses that impact behavioral choices. |
____ 5. 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?
| 1. | “I can’t bear the thought of leaving here and failing.” |
| 2. | “I might have a hard time working with you, because you remind me of my mother.” |
| 3. | “I really don’t want to talk any more about my childhood abuse.” |
| 4. | “I’m not sure that I can count on you to protect my confidentiality.” |
____ 6. A mother who is 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?
| 1. | “This situation is very sad, but time is a great healer.” |
| 2. | “You are sad, but you must be strong for your other children.” |
| 3. | “Once you cry it all out, things will seem so much better.” |
| 4. | “It must be horrible to lose a child, and I’ll stay with you until your husband arrives.” |
____ 7. When an individual is “two-faced,” which characteristic—essential to the development of a therapeutic relationship—should a nurse identify as missing?
| 1. | Respect |
| 2. | Genuineness |
| 3. | Sympathy |
| 4. | Rapport |
____ 8. On which task should a nurse place priority during the working phase of relationship development?
| 1. | Establishing a contract for intervention |
| 2. | Examining feelings about working with a particular client |
| 3. | Establishing a plan for continuing aftercare |
| 4. | Promoting the client’s insight and perception of reality |
____ 9. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
| 1. | Restatement |
| 2. | Offering general leads |
| 3. | Focusing |
| 4. | Accepting |
____ 10. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
| 1. | Reflecting |
| 2. | Making observations |
| 3. | Formulating a plan of action |
| 4. | Giving recognition |
____ 11. The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a “general lead”?
| 1. | “Do you know why you are here?” |
| 2. | “Are you feeling depressed or anxious?” |
| 3. | “Yes, I see. Go on.” |
| 4. | “Can you order the specific events that led to your admission?” |
____ 12. A nurse says to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
| 1. | The therapeutic technique of giving advice |
| 2. | The therapeutic technique of defending |
| 3. | The nontherapeutic technique of presenting reality |
| 4. | The nontherapeutic technique of giving reassurance |
____ 13. A client diagnosed with posttraumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of “broad openings”?
| 1. | “What occurred prior to the rape, and when did you go to the emergency department?” |
| 2. | “What would you like to talk about?” |
| 3. | “I notice you seem uncomfortable discussing this.” |
| 4. | “How can we help you feel safe during your stay here?” |
____ 14. A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening?
____ 15. An instructor is correcting a nursing student’s clinical worksheet. Which instructor statement is the best example of effective feedback?
| 1. | “Why did you use the client’s name on your clinical worksheet?” |
| 2. | “You were very careless to refer to your client by name on your clinical worksheet.” |
| 3. | “Surely you didn’t do this deliberately, but you breeched confidentiality by using names.” |
| 4. | “It is disappointing that after being told you’re still using client names on your worksheet.” |
____ 16. What is a nurse’s purpose for providing appropriate feedback?
| 1. | To give the client good advice |
| 2. | To advise the client on appropriate behaviors |
| 3. | To evaluate the client’s behavior |
| 4. | To give the client critical information |
____ 17. A client exhibiting dependent behaviors says, “Do you think I should move from my parent’s house and get a job?” Which nursing response is most appropriate?
| 1. | “It would be best to do that in order to increase independence.” |
| 2. | “Why would you want to leave a secure home?” |
| 3. | “Let’s discuss and explore all of your options.” |
| 4. | “I’m afraid you would feel very guilty leaving your parents.” |
____ 18. A mother rescues two of her four children from a house fire. In an emergency department, she cries, “I should have gone back in to get them. I should have died, not them.” What is the nurse’s best response?
| 1. | “The smoke was too thick. You couldn’t have gone back in.” |
| 2. | “You’re experiencing feelings of guilt, because you weren’t able to save your children.” |
| 3. | “Focus on the fact that you could have lost all four of your children.” |
| 4. | “It’s best if you try not to think about what happened. Try to move on.” |
____ 19. A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation?
| 1. | “Everyone diagnosed with OCD needs to control their ritualistic behaviors.” |
| 2. | “It is important for you to discontinue these ritualistic behaviors.” |
| 3. | “Why are you asking for help, if you won’t participate in unit therapy?” |
| 4. | “Let’s figure out a way for you to attend unit activities and still wash your hands.” |
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 20. Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.)
| 1. | Meeting the psychological needs of the nurse and the client |
| 2. | Ensuring therapeutic termination |
| 3. | Promoting client insight into problematic behavior |
| 4. | Collaborating to set appropriate goals |
| 5. | Meeting both the physical and psychological needs of the client |
____ 21. Which of the following individuals are communicating a message? (Select all that apply.)
| 1. | A mother spanking her son for playing with matches |
| 2. | A teenage boy isolating himself and playing loud music |
| 3. | A biker sporting an eagle tattoo on his biceps |
| 4. | A teenage girl writing, “No one understands me” |
| 5. | A father checking for new email on a regular basis |
Completion
Complete each statement.
- The term ________________________ implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.
- ___________________ refers to a nurse’s behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurse’s past.
Chapter 6: Relationship Development and Therapeutic Communication
Answer Section
MULTIPLE CHOICE
- ANS: 1
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 126
Heading: The Therapeutic Use of Self > Therapeutic Use of Self
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Easy
| Feedback |
| 1 | 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. |
| 2 | Obtaining thorough assessment data is not the most important task. |
| 3 | Determining the client’s length of stay is not the most important task. |
| 4 | Establishing personal goals for the interaction is not the most important task. |
PTS: 1 CON: Patient-Centered Care
- ANS: 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe the phases of relationship development and the tasks associated with each phase.
Page: 129
Heading: Phases of a Therapeutic Nurse-Client Relationship > Transference and Countertransference
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Easy
| Feedback |
| 1 | This action would not be therapeutic to the client. |
| 2 | The nurse should assist the client in separating the past from the present. |
| 3 | This option would not be therapeutic to the client, who may continue to displace feelings onto others. |
| 4 | The nurse should respond to a client’s transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse. |
PTS: 1 CON: Patient-Centered Care
- ANS: 2
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe the phases of relationship development and the tasks associated with each phase.
Page: 129
Heading: Phases of Therapeutic Nurse-Client Relationship > The Orientation (Introductory) Phase
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Acknowledging the client’s actions and generating alternative behaviors can occur after rapport has been established. |
| 2 | 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, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship. |
| 3 | Attempting to find alternative placement can occur after rapport has been established. |
| 4 | Exploring how thoughts and feelings about this client may adversely impact nursing care can occur after rapport has been established. |
PTS: 1 CON: Communication
- ANS: 1
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe the phases of relationship development and the tasks associated with each phase.
Page: 129
Heading: Phases of Therapeutic Nurse-Client Relationship > The Working Phase
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | The nurse should expect that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. |
| 2 | Establishing rapport with the nurse and mutually developing treatment goals occurs before the working phase. |
| 3 | Exploring feelings related to reentering the community does not occur during the working phase. |
| 4 | Exploring personal strengths and weaknesses that impact behavioral choices does not occur during the working phase. |
PTS: 1 CON: Communication
- ANS: 3
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe the phases of relationship development and the tasks associated with each phase.
Page: 129
Heading: The Working Phase
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Analysis [Analyzing]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Stating, “I can’t bear the thought of leaving here and failing,” does not indicate resistance to the therapeutic relationship between the nurse and client. |
| 2 | Stating, “I might have a hard time working with you, because you remind me of my mother,” does not indicate resistance to the therapeutic relationship between the nurse and client. |
| 3 | 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 resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues. |
| 4 | Stating, “I’m not sure that I can count on you to protect my confidentiality,” does not indicate resistance to the therapeutic relationship between the nurse and client. |
PTS: 1 CON: Communication
- ANS: 4
Chapter: Chapter Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 127–128
Heading: Empathy
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Stating, “This situation is very sad, but time is a great healer,” does not convey empathy and would not be therapeutic to the mother. |
| 2 | Stating, “You are sad, but you must be strong for your other children,” does not convey empathy and would not be therapeutic to the mother. |
| 3 | Stating, “Once you cry it all out, things will seem so much better,” does not convey empathy and would not be therapeutic to the mother. |
| 4 | The nurse’s response, “It must be horrible to lose a child, and 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 of the most important characteristics of the therapeutic relationship. |
PTS: 1 CON: Communication
- ANS: 2
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 127
Heading: Conditions Essential to Development of a Therapeutic Relationship > Genuineness
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Respect is not the characteristic missing when an individual is “two-faced.” |
| 2 | When an individual is “two-faced,” which means double-dealing or deceitful, 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 genuineness to the relationship, trust cannot be established. |
| 3 | Sympathy is not the characteristic missing when an individual is “two-faced.” |
| 4 | Rapport is not the characteristic missing when an individual is “two-faced.” |
PTS: 1 CON: Communication
- ANS: 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 129
Heading: Phases of a Therapeutic Nurse-Client Relationship > The Working Phase
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Establishing a contract for intervention would occur in the orientation phase. |
| 2 | Examining feelings about working with a client should occur in the preinteraction phase. |
| 3 | Establishing a plan for aftercare would occur in the termination phase. |
| 4 | The nurse should place priority on promoting the client’s insight and perception of reality during the working phase of relationship development. |
PTS: 1 CON: Communication
- ANS: 1
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137–138
Heading: Table 6-3 Therapeutic Communication Techniques
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. It allows the client to know whether the statement has been understood and provides an opportunity to continue. |
| 2 | Offering general leads does not involve summarizing the client’s statement. |
| 3 | Offering focusing does not involve summarizing the client’s statement. |
| 4 | Offering accepting does not involve summarizing the client’s statement. |
PTS: 1 CON: Communication
- ANS: 3
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137–138
Heading: Table 6-3 Therapeutic Communication Techniques
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Reflecting does not explore behavior alternatives. |
| 2 | Making observations does not explore behavior alternatives. |
| 3 | The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking. The use of this technique may serve to prevent anger or anxiety from escalating. |
| 4 | Giving recognition does not explore behavior alternatives. |
PTS: 1 CON: Communication
- ANS: 3
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137
Heading: Table 6-3 Therapeutic Communication Techniques; Giving broad openings
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | This is a specific question, not a general lead. |
| 2 | This is a closed ended question; it does not encourage the client to elaborate. |
| 3 | The nurse’s statement, “Yes, I see. Go on,” is an example of a general lead. Offering general leads encourages the client to continue sharing information. |
| 4 | This question does not encourage the client to give more information. |
PTS: 1 CON: Communication
- ANS: 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 139
Heading: Table 6-4 Nontherapeutic Communication Techniques; Giving false reassurance
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | The nurse’s statement does not give advice to the client. |
| 2 | This is not an example of the therapeutic technique of defending. |
| 3 | This statement does not present reality to the client. |
| 4 | The nurse’s statement, “Things will look better tomorrow after a good night’s sleep,” is an example of the nontherapeutic communication technique of giving reassurance. Giving reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client’s feelings. |
PTS: 1 CON: Communication
- ANS: 2
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137
Heading: Table 6-3 Therapeutic Communication Techniques; Giving broad openings
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | This question asks specific information about the rape. |
| 2 | The nurse’s statement, “What would you like to talk about?” is an example of the therapeutic communication technique of a broad opening. Using broad openings allows the client to take the initiative in introducing the topic and emphasizes the importance of the client’s role in the interaction. |
| 3 | This question is not an example of a broad opening. |
| 4 | While this question is important, it is not an example of a broad opening. |
PTS: 1 CON: Communication
- ANS: 2
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe active listening.
Page: 136
Heading: Interpersonal Communication > Active Listening
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | The acronym SOLER includes: sitting squarely facing the client (S). |
| 2 | The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. |
| 3 | The acronym SOLER includes: leaning forward toward the client (L). |
| 4 | The acronym SOLER includes: establishing eye contact (E). |
| 5 | The acronym SOLER includes: relaxing (R). |
PTS: 1 CON: Communication
- ANS: 3
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Discuss therapeutic feedback.
Page: 138
Heading: Interpersonal Communication > Feedback
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Asking questions does not give feedback to the student. |
| 2 | Feedback should impart information to the student. |
| 3 | The instructor’s statement, “Surely you didn’t do this deliberately, but you breeched confidentiality by using names,” is an example of effective feedback. Feedback is method of communication for helping others consider a modification of behavior. |
| 4 | Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice. |
PTS: 1 CON: Communication
- ANS: 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Discuss therapeutic feedback.
Page: 138
Heading: Interpersonal Communication > Feedback
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Feedback should not be used to give advice. |
| 2 | Feedback should not be used to give advice on behaviors. |
| 3 | Feedback should not be used to evaluate behaviors. |
| 4 | The purpose of providing appropriate feedback is to give the client critical information. |
PTS: 1 CON: Communication
- ANS: 3
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 139–140
Heading: Table 6-4 Nontherapeutic Communication Techniques
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Stating, “It would be best to do that in order to increase independence,” does not encourage the client to think independently. |
| 2 | Stating, “Why would you want to leave a secure home?” does not encourage the client to think independently. |
| 3 | The most appropriate response by the nurse is, “Let’s discuss and explore all of your options.” In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. |
| 4 | Stating, “I’m afraid you would feel very guilty leaving your parents,” does not encourage the client to think independently. |
PTS: 1 CON: Communication
- ANS: 2
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137–138
Heading: Table 6-3 Therapeutic Communication Techniques
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Stating, “The smoke was too thick. You couldn’t have gone back in,” is not therapeutic and would not benefit the mother. |
| 2 | The best response by the nurse is, “You’re experiencing feelings of guilt, because you weren’t able to save your children.” This response uses the therapeutic communication technique of restating what the client has said. This lets the client know whether an expressed statement has been understood or if clarification is necessary. |
| 3 | Stating, “Focus on the fact that you could have lost all four of your children,” is not therapeutic and would not benefit the mother. |
| 4 | Stating, “It’s best if you try not to think about what happened. Try to move on,” is not therapeutic and would not benefit the mother. |
PTS: 1 CON: Communication
- ANS: 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Describe therapeutic and nontherapeutic verbal communication techniques.
Page: 137–138
Heading: Table 6-3 Therapeutic Communication Techniques
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1 | Stating, “Everyone diagnosed with OCD needs to control their ritualistic behaviors,” is not therapeutic to the client and may damage rapport. |
| 2 | Stating, “It is important for you to discontinue these ritualistic behaviors,” is not therapeutic to the client and may damage rapport. |
| 3 | Stating, “Why are you asking for help, if you won’t participate in unit therapy?” is not therapeutic to the client and may damage rapport. |
| 4 | The most appropriate statement by the nurse is, “Let’s figure out a way for you to attend unit activities and still wash your hands.” This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship. |
PTS: 1 CON: Communication
MULTIPLE RESPONSE
- ANS: 2, 3, 4, 5
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 125
Heading: The Therapeutic Nurse-Client Relationship
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Moderate
| Feedback |
| 1. | Meeting the nurse’s psychological needs should never be addressed within the nurse-client relationship. |
| 2. | The nurse-client therapeutic relationship should include ensuring therapeutic termination. |
| 3. | The nurse-client therapeutic relationship should include promoting client insight into problematic behavior. |
| 4. | The nurse-client therapeutic relationship should include collaborating to set appropriate goals. |
| 5. | The nurse-client therapeutic relationship should include meeting both the physical and psychological needs of the client. |
PTS: 1 CON: Communication
- ANS: 1, 2, 3, 4
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify components of nonverbal expression.
Page: 134
Heading: Nonverbal Communication
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
| Feedback |
| 1. | The nurse should determine that a mother spanking her son for playing with matches is a way in which people communicate messages to others. |
| 2. | The nurse should determine that a teenage boy isolating himself and playing loud music is a way in which people communicate messages to others. |
| 3. | The nurse should determine that a biker sporting an eagle tattoo on his biceps is a way in which people communicate messages to others. |
| 4. | The nurse should determine that writing is a way in which people communicate messages to others. |
| 5. | Checking for new emails is not an example of communicating a message. |
PTS: 1 CON: Communication
COMPLETION
- ANS:
rapport
Feedback: Rapport implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude. Establishing rapport may be accomplished by discussing non-health-related topics.
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 126
Heading: The Therapeutic Nurse-Client Relationship > Rapport
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
PTS: 1 CON: Communication
- ANS:
Countertransference
Chapter: Chapter 6, Relationship Development and Therapeutic Communication
Objective: Identify and discuss essential conditions for a therapeutic relationship to occur.
Page: 130
Heading: The Therapeutic Nurse-Client Relationship > Countertransference
Integrated Processes: Nursing Process
Client Need: Psychosocial integrity
Cognitive Level: Application [Applying]
Concept: Communication
Difficulty: Easy
Feedback: Countertransference refers to a nurse’s behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurse’s past or they may be generated in response to transference feelings on the part of the client.
PTS: 1 CON: Communication
Chapter 7: The Nursing Process in Psychiatric/Mental Health Nursing
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?
| 1. | Medical history is of little significance and can be eliminated from the nursing assessment. |
| 2. | Assessment provides a holistic view of the client, including biopsychosocial aspects. |
| 3. | Comprehensive assessments can be performed only by advanced practice nurses. |
| 4. | Psychosocial evaluations are gained by subjective reports rather than objective observations. |
____ 2. Which statement regarding nursing interventions should a nurse identify as accurate?
| 1. | Nursing interventions are independent from the treatment team’s goals. |
| 2. | Nursing interventions are solely directed by written physician orders. |
| 3. | Nursing interventions occur independently but in concert with overall treatment team goals. |
| 4. | Nursing interventions are standardized by policies and procedures. |
____ 3. Within the nurse’s scope of practice, which function is exclusive to the advanced practice psychiatric nurse?
| 1. | Teaching about the side effects of neuroleptic medications |
| 2. | Using psychotherapy to improve mental health status |
| 3. | Using milieu therapy to structure a therapeutic environment |
| 4. | Providing case management to coordinate continuity of health services |
____ 4. The nurse should recognize which acronym as representing problem-oriented charting?
| 1. | SOAPIE |
| 2. | APIE |
| 3. | DAR |
| 4. | PQRST |
____ 5. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)?
| 1. | CIWA scale |
| 2. | GGT |
| 3. | MMSE |
| 4. | CAPS scale |
____ 6. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation?
| 1. | Mood |
| 2. | Perception |
| 3. | Orientation |
| 4. | Affect |
____ 7. What is the purpose of a nurse gathering client information?
| 1. | It enables the nurse to modify behaviors related to personality disorders. |
| 2. | It enables the nurse to make sound clinical judgments and plan appropriate care. |
| 3. | It enables the nurse to prescribe the appropriate medications. |
| 4. | It enables the nurse to assign the appropriate Axis I diagnosis. |
____ 8. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse?
| 1. | Health teacher |
| 2. | Case manager |
| 3. | Milieu manager |
| 4. | Psychotherapist |
____ 9. The following outcome was developed for a client: “Client will list five personal strengths by the end of day one.” Which correctly written nursing diagnostic statement most likely generated the development of this outcome?
| 1. | Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements |
| 2. | Self-care deficit R/T altered thought process |
| 3. | Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 |
| 4. | Risk for disturbed self-concept R/T hopelessness AEB suicide attempt |
____ 10. How should a nurse prioritize nursing diagnoses?
| 1. | By the established goal of care |
| 2. | By the life-threatening potential |
| 3. | By the physician’s priority of care |
| 4. | By the client’s preference |
____ 11. A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB MNA, DFA, and daytime napping. Which is a correctly written and appropriate outcome for this client?
| 1. | The client will avoid daytime napping and attend all groups. |
| 2. | The client will exercise, as needed, before bedtime. |
| 3. | The client will sleep seven uninterrupted hours by day four of hospitalization. |
| 4. | The client’s sleep habits will improve during hospitalization. |
____ 12. The following NANDA-I nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement?
| 1. | The client is receiving ECT and is diagnosed with Parkinsonism. |
| 2. | The client has a history of four suicide attempts in adolescence. |
| 3. | The client expresses hopelessness and helplessness and isolates self. |
| 4. | The client has disorganized thought processes and delusional thinking. |
____ 13. A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student’s question?
| 1. | “You can use NIC, a standardized reference for nursing outcomes.” |
| 2. | “Look at your client’s problems and set a realistic, achievable goal.” |
| 3. | “With client collaboration, outcomes should be based on client problems.” |
| 4. | “Copy your standard outcomes from a nursing care plan textbook.” |
____ 14. A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis, which was recently removed from the NANDA-I list, still accurately reflects this client’s problem?
| 1. | Disturbed thought processes |
| 2. | Disturbed sensory perception |
| 3. | Anxiety |
| 4. | Chronic confusion |
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 15. Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.)
| 1. | Client outcomes are specifically formulated by nurses. |
| 2. | Client outcomes are not restricted by time frames. |
| 3. | Client outcomes are specific and measurable. |
| 4. | Client outcomes are realistically based on client capability. |
| 5. | Client outcomes are formally approved by the psychiatrist. |
Other
- Number the following nursing interventions as they would proceed through the steps of the nursing process.
________ Determine if an antianxiety medication is decreasing a client’s stress.
________ Measure a client’s vital signs and review past history.
________ Encourage deep breathing and teach relaxation techniques.
________ Aim, with client collaboration, for a seven-hour night’s sleep.
________ Recognize and document the client’s problem.
Completion
Complete each statement.
- A _________________ __________________ provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.
Chapter 7: The Nursing Process in Psychiatric/Mental Health Nursing
Answer Section
MULTIPLE CHOICE
- ANS: 2
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 148
Heading: The Nursing Process > Assessment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Easy
| Feedback |
| 1 | Medical history is significant and should not be eliminated from the nursing assessment. |
| 2 | The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. |
| 3 | Assessments can be completed by a variety of health-care providers. |
| 4 | The nurse should gather subject and objective information. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 156
Heading: Standards of Practice > Nursing Interventions Classification (NIC)
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client’s care. |
| 2 | Nursing interventions are not solely directed by written physician orders. |
| 3 | The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. |
| 4 | Nursing interventions are created in conjunction with standardized by policies and procedures. |
PTS: 1 CON: Patient-Centered Care
- ANS: 2
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 156
Heading: The Nursing Process > Standard 5D. Prescriptive Authority and Treatment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Teaching about the side effects of neuroleptic medications can be completed by Registered Nurses. |
| 2 | The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. |
| 3 | Using milieu therapy to structure a therapeutic environment can be completed by Registered Nurses. |
| 4 | Providing case management to coordinate continuity of health services can be completed by Registered Nurses. |
PTS: 1 CON: Patient-Centered Care
- ANS: 1
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Document client care that validates use of the nursing process.
Page: 162
Heading: Documentation of the Nursing Process > Problem-oriented Recording
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension (Understanding)
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | The acronym SOAPIE represents problem-oriented charting, which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. |
| 2 | APIE does not represent problem-oriented charting. |
| 3 | DAR does not represent problem-oriented charting. |
| 4 | PQRST does not represent problem-oriented charting. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 147
Heading: The Nursing Process > Assessment
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdrawal from substances such as alcohol. |
| 2 | The GGT test is a blood test used to assess gamma-glutamyl transferase levels, which may be an indication of alcoholism. |
| 3 | The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. |
| 4 | The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Apply the six steps of the nursing process in the care of a client within the psychiatric setting.
Page: 155
Heading: Table 7-1 Brief Mental Status Evaluation
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | These questions do not assess mood. |
| 2 | These questions do not assess perception. |
| 3 | The nurse should ask the client to identify name, date, residential address, and situation to assess the client’s orientation. Assessment of the client’s orientation to reality is part of a mental status evaluation. |
| 4 | These questions do not assess affect. |
PTS: 1 CON: Patient-Centered Care
- ANS: 2
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 156
Heading: The Nursing Process > Planning
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Modifying behaviors can occur after the nurse completes a thorough assessment. |
| 2 | The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers. |
| 3 | After completing a thorough assessment, the nurse can prescribe the appropriate medications. |
| 4 | After completing a thorough assessment, the nurse can assign the appropriate Axis I diagnosis. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7 The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Apply the six steps of the nursing process in the care of a client within the psychiatric setting.
Page: 156
Heading: The Nursing Process > Standard 5F. Milieu Therapy
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Health teaching involves promoting health in a safe environment. |
| 2 | Case management is used to organize client care so that outcomes are achieved. |
| 3 | The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. |
| 4 | Psychotherapy involves conducting individual, couples, group, and family counseling. |
PTS: 1 CON: Patient-Centered Care
- ANS: 1
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Apply the six steps of the nursing process in the care of a client within the psychiatric setting.
Page: 159
Heading: Applying the Nursing Process in the Psychiatric Setting
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day one. |
| 2 | The self-care deficit nursing diagnoses is incorrectly written. |
| 3 | Disturbed body image would generate specific outcomes in accordance with specific needs and goals. |
| 4 | The risk for disturbed self-concept nursing diagnoses is incorrectly written. |
PTS: 1 CON: Patient-Centered Care
- ANS: 2
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Apply the six steps of the nursing process in the care of a client within the psychiatric setting.
Page: 159
Heading: Applying the Nursing Process in the Psychiatric Setting
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis (Analyzing)
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Client care goals can be met after safety has been established. |
| 2 | The nurse should prioritize nursing diagnoses related to their life-threatening potential. Safety is always the nurse’s first priority. |
| 3 | The physician’s priority of care can be met after safety has been established. |
| 4 | The client can choose a goal as a priority after safety has been established. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Apply the six steps of the nursing process in the care of a client within the psychiatric setting.
Page: 159
Heading: Applying the Nursing Process in the Psychiatric Setting
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis (Analyzing)
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Avoiding naps and attending all groups may not be realistic for this client. |
| 2 | Exercising before bedtime will not help the client overcome insomnia. |
| 3 | The outcome “The client will sleep seven uninterrupted hours by day four of hospitalization” is accurately written and an appropriate outcome for a client diagnosed with insomnia. |
| 4 | This diagnosis is not specific towards the client’s needs. |
PTS: 1 CON: Patient-Centered Care
- ANS: 1
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Discuss the list of nursing diagnoses approved by NANDA International for clinical use and testing.
Page: 155
Heading: The Nursing Process > Standard 2. Diagnosis
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury. |
| 2 | History of suicide, hopelessness, and disorganized thoughts would not lead the nurse to formulate a nursing diagnostic stem of risk for injury. |
| 3 | History of hopelessness and helplessness would not lead the nurse to formulate a nursing diagnostic stem of risk for injury. |
| 4 | History of disorganized thoughts and delusional thinking would not lead the nurse to formulate a nursing diagnostic stem of risk for injury. |
PTS: 1 CON: Patient-Centered Care
- ANS: 3
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Discuss the list of nursing diagnoses approved by NANDA International for clinical use and testing.
Page: 155
Heading: The Nursing Process > Standard 2. Diagnosis
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | Using NIC does not help develop outcomes specific for the client. |
| 2 | This option is helpful, but the most attainable goals are set with collaboration. |
| 3 | Client outcomes are most realistic and achievable when there is collaboration among the interdisciplinary team members, the client, and significant others. |
| 4 | Goals should be personalized for each client. |
PTS: 1 CON: Patient-Centered Care
- ANS: 2
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Discuss the list of nursing diagnoses approved by NANDA International for clinical use and testing.
Page: 161
Heading: Applying the Nursing Process in the Psychiatric Setting
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1 | The nursing diagnosis, disturbed thought processes, does not accurately reflect the client’s problem. |
| 2 | The nursing diagnosis disturbed sensory perception accurately reflects the client’s symptoms of hearing things that others do not. The nursing diagnosis describes the client’s condition and facilitates the prescription of interventions. |
| 3 | The nursing diagnosis, anxiety, does not accurately reflect the client’s problem. |
| 4 | The nursing diagnosis, chronic confusion, does not accurately reflect the client’s problem. |
PTS: 1 CON: Patient-Centered Care
MULTIPLE RESPONSE
- ANS: 3, 4
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 155
Heading: Standard 3. Outcomes Identification
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
Difficulty: Moderate
| Feedback |
| 1. | Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, the client, and significant others. |
| 2. | Outcomes should be given a time frame. |
| 3. | The nurse should identify that client outcomes should be specific and measurable. |
| 4. | The nurse should identify that client outcomes should be based on client capability. |
| 4. 5. | Outcomes do not need to be approved by a psychiatrist. |
PTS: 1 CON: Patient-Centered Care
ORDERED RESPONSE
- ANS:
2, 5, 4, 3, 1.
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 147
Heading: The Nursing Process
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback: Measuring a client’s vital signs and reviewing past history is a nursing intervention that occurs in the assessment step of the nursing process. Recognizing and documenting the client’s problem occurs in the nursing diagnosis step. Setting a goal with client collaboration, for a seven-hour night’s sleep occurs in the planning step. Encouraging deep breathing and teaching relaxation techniques occurs in the implementation step. Determining if an antianxiety medication is decreasing a client’s stress occurs in the evaluation step.
PTS: 1 CON: Patient-Centered Care
COMPLETION
- ANS:
nursing diagnosis
Chapter: Chapter 7, The Nursing Process in Psychiatric/Mental Health Nursing
Objective: Identify six steps of the nursing process and describe nursing actions associated with each.
Page: 154
Heading: Core Concept
Integrated Processes: Nursing Process
Cognitive Level: Application [Applying]
Client Need: Psychosocial Integrity
Concept: Patient-Centered Care
Difficulty: Moderate
Feedback: Nursing diagnoses are clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.
