4. Spontaneously assisting the client to identify thoughts and feelings

Correct Answer: 4

Rationale 1: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationshipthan a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 2: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationshipthan a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 3: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationshipthan a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Rationale 4: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationshipthan a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 2

Type: MCSA

An experienced nurse is describing the characteristics of a therapeutic one-to-one relationship to a nursing student. Which of the following is the most accurate description?

1. The relationship between the nurse and client is reciprocal.

2. The nursing process is the cornerstone of the relationship.

3. The essential feature of the relationship is a therapeutic alliance.

4. The nurse must meet the clients needs throughout the relationship.

Correct Answer: 3

Rationale 1: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 2: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 3: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Rationale 4: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurseclient relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 3

Type: MCSA

A nursing student asks the nurse educator the differences between social and professional relationships. The nurse educator knows that the defining characteristic of a professional relationship is which of the following?

1. Can be either spontaneous or planned

2. Is the only relationship where roles are defined

3. Requires more planning, consistency, and time

4. Does not address the personal needs of the nurse

Correct Answer: 4

Rationale 1: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 2: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and timethan an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 3: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Rationale 4: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and timethan an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 4

Type: MCMA

The nurse is explaining the nurseclient relationship to a client in their first formal counseling session. Which of the following characteristics should the nurse describe as part of this one-to-one relationship?

Standard Text: Select all that apply.

1. Sympathetic

2. Shared dignity

3. Harmonious

4. Mutually defined

5. Goal directed

Correct Answer: 2,4,5

Rationale 1: Sympathetic. The nurse is expected to be caring and empathetic, but should not let personal feelings interfere with objectivity and the ability to help the client cope effectively.

Rationale 2: Shared dignity. The nurse encourages clients to share freely and openly in an atmosphere of mutual respect and courtesy.

Rationale 3: Harmonious. Nurses and clients may not always be in agreement, particularly if clients do not accept responsibility for their actions. Resistance may be present in one-to-one relationships when clients struggle against change.

Rationale 4: Mutually defined. The terms under which the relationship is to evolve are equally determined by nurse and client and require the commitment of both parties.

Rationale 5: Goal directed. The client is expected to identify and work toward specific objectives within the context of the therapeutic relationship.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Explain the common shared characteristics of one-to-one relationships.

Question 5

Type: MCSA

The nurse is working with the client to identify self-defeating thoughts, feelings, and behaviors. Which behavior by the client does the nurse identify as resistance to the therapeutic process?

1. Changing the subject when asked to explore a specific topic

2. Becoming silent when asked to identify unhealthy behaviors

3. Sharing feelings, fantasies and motives with the nurse

4. Changing behavior outside of the one-to-one therapeutic relationship

Correct Answer: 1

Rationale 1: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 2: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 3: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Rationale 4: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives,or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work.

Global Rationale:

Cognitive Level: Applying

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 6

Type: MCSA

The nurse suspects a client is unwilling to demonstrate self-sufficiency or independence in the therapeutic relationship when the client says, You are the only person I can talk to or trust. Lets go out to dinner tonight so we can spend more time together. Which one of the following nurse responses is most appropriate in this situation?

1. I sense we are beginning to make real progress; I think thats a great idea.

2. Maybe some other time, but right now Im involved in a significant relationship and dont feel right about meeting you for dinner.

3. I sense youve become too dependent on this relationship; lets examine your feelings toward me.

4. Youve become too dependent on me, so I will have to terminate our relationship.

Correct Answer: 3

Rationale 1: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 2: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 3: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate andcould encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Rationale 4: Examining a clients feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate andcould encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous actingout behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the clients mistaken expectation that a relationship might be possible in the future.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 7

Type: MCMA

The nurse is working with a client who has demonstrated an unwillingness to change self-defeating behaviors. The nurse determines that the patient is exhibiting resistance. Which of the following phenomena are forms of client resistance?

Standard Text: Select all that apply.

1. Overdisclosure

2. Negative transference

3. Acting-out

4. Countertransference

5. Positive transference

Correct Answer: 2,3

Rationale 1: Overdisclosure. Overdisclosure refers to an excessive amount of self-disclosure by the nurse that can overwhelm and engulf the client. Overdisclosure can impede therapeutic progress, especially with clients who have poor ego boundaries, but it is not a form of client resistance.

Rationale 2: Negative transference. When a client displays hostility, loathing, bitterness, contempt, and annoyance toward the nurse, the therapeutic process is impeded.

Rationale 3: Acting-out. Displaying inappropriate behavior or acting out a memory that was forgotten or repressed is a particularly destructive form of client resistance.

Rationale 4: Countertransference. Countertransference involves the nurses inappropriate reaction to the client and is not a form of client resistance.

Rationale 5: Positive transference. Positive feelings of the client toward the therapist due, in part, to past relationships with significant others, can help to facilitate therapeutic progress.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 8

Type: MCSA

The nurse is working with a client who appears unwilling to explore a specific topic during the working phase of the therapeutic relationship, by continually changing the subject. Which of the following nursing strategies would be most helpful?

1. Clarify the clients refusal to explore the topic by labeling it as resistance.

2. Accept the clients refusal to talk about the topic by changing the subject.

3. Allow the client to decide the appropriate time to explore the topic.

4. Insist the client discuss the topic by examining the origin of the behavior.

Correct Answer: 1

Rationale 1: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 2: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 3: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Rationale 4: Clarifying the clients refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Encourage the clients systematic use of abilities and behaviors most often associated with growth-producing outcomes.

Question 9

Type: MCSA

During the orientation phase of the nurseclient relationship, the client presents the nurse with a framed picture that was painted during recreational therapy. What is the best response by the nurse?

1. Im sorry but Im not allowed to accept any gifts from clients.

2. How thoughtful; Ill take this home with me so I will be reminded of you every time I see it.

3. Lets examine your motives for trying to bribe me with this picture.

4. Thats a lovely picture; lets put it in the day room for everyone to enjoy.

Correct Answer: 4

Rationale 1: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship. Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 2: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship. Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 3: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship. Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Rationale 4: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the clients self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the clients self-esteem and create an uncomfortable rift in the relationship.

Accusing the client of an ulterior motive by trying to bribe you with the gift may create hostility and distrust.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 10

Type: MCSA

A client who is being discharged offers the nurse a ceramic bowl made during hospitalization as a symbol of the open vessel the client has become for accepting new ideas. What is the best response by the nurse?

1. This is a beautiful gesture, I will place it in the day room for everyone to enjoy.

2. I wish I could accept this, but you know Im not allowed to.

3. Let me pay you for this. I dont feel I should just accept it after all the hard work you put into it.

4. You worked very hard on becoming receptive to new ideas this past month; I would be honored to acceptthis symbol of your progress.

Correct Answer: 4

Rationale 1: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal. Paying the client for any item is discouraged and usually against hospital policy.

Rationale 2: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal. Paying the client for any item is discouraged and usually against hospital policy.

Rationale 3: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal. Paying the client for any item is discouraged and usually against hospital policy.

Rationale 4: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal. Paying the client for any item is discouraged and usually against hospital policy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 11

Type: MCSA

A client is proud of a recent breakthrough in his ability to control his anger when another client had criticized his behavior. The nurse shakes the clients hand and praises him on his accomplishment. How should this nurses behavior be interpreted?

1. This gesture is inappropriate because it could seem condescending to the client.

2. This gesture is appropriately timed and suitable in this situation.

3. The use of touch is inappropriate with any client no matter the reason.

4. The use of touch may be perceived as a sexual overture in this situation.

Correct Answer: 2

Rationale 1: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 2: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 3: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients iftimed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Rationale 4: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 12

Type: MCMA

A client familiar to the nurse is grief-stricken and in tears after learning that his wife has decided to file for divorce and sue for full custody of their children. Which of the following actions by the nurse are appropriate?

Standard Text: Select all that apply.

1. Wiping away the clients tears without permission

2. Asking the client if it is okay to give him a hug

3. Holding the clients hand with his permission

4. Patting the client on the shoulder and offering reassurance

Correct Answer: 2,3

Rationale 1: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 2: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 3: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Rationale 4: Holding the clients hand with his permission is appropriate and can foster a more productive therapeutic relationship.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 13

Type: MCSA

The nurse is working with a client in the dayroom. Which of the following behavioral cues by the nurse may indicate a countertransference reaction?

1. Annoyance and hostility toward a client

2. Ordinary concern for the client

3. Feeling comfortable after meeting with the client

4. Thinking about the interaction after meeting with a client

Correct Answer: 1

Rationale 1: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with theclient are expected behaviors and do not indicate countertransference.

Rationale 2: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with theclient are expected behaviors and do not indicate countertransference.

Rationale 3: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with theclient are expected behaviors and do not indicate countertransference.

Rationale 4: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurseclient relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with theclient are expected behaviors and do not indicate countertransference.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship.

Question 14

Type: MCSA

The nurse is planning care for a new patient admitted to the behavioral health unit. Which of the following activities can the nurse expect to occur in the orientation phase of a therapeutic nurseclient relationship?

1. Explore in-depth how the client relates to others.

2. Emphasize growth and positive aspects of the relationship.

3. Discuss with the client how to work together toward a common goal.

4. Identify dysfunctional client thoughts and emotional patterns.

Correct Answer: 3

Rationale 1: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 2: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 3: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Rationale 4: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the clients expectations and the nurses responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 15

Type: MCSA

The nurse is in the orientation phase of the nurseclient relationship with the client. Which of the following questions would the nurse commonly ask in this phase?

1. Which of your behaviors cause you the most problems in relationships with others?

2. What would you like to accomplish in the time we spend together?

3. What is the most satisfying accomplishment you feel you have made in your relationships with others?

4. How would you describe your relationships with members of your family?

Correct Answer: 2

Rationale 1: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 2: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 3: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Rationale 4: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 16

Type: MCSA

The nurse and client have moved from the orientation phase to the working phase of the nurse-client relationship. Which of the following nursing strategies would assist the client to make constructive changes in a dysfunctional response pattern that is occurring during the early working phase of the nurseclient relationship?

1. Teach the client specific problem-solving strategies.

2. Determine a time and place for working on constructive changes.

3. Remind the client that constructive changes are expected before discharge occurs.

4. Reassure the client that confidentiality will be maintained.

Correct Answer: 1

Rationale 1: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase. Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 2: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase. Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 3: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase. Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Rationale 4: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase. Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 17

Type: MCSA

The nurse educator is teaching a group of students about the phases of the nurseclient relationship. Which of the following objectives does the educator include as indicative of the working phase of the nurseclient relationship?

1. Client accomplishments are honestly evaluated.

2. Plans for follow-up are clearly arranged.

3. Client behaviors and response patterns are openly analyzed.

4. Roles and responsibilities of the client are explicitly defined.

Correct Answer: 3

Rationale 1: Open analysis of client behaviors and response patterns is one of the primary objectives duringthe working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 2: Open analysis of client behaviors and response patterns is one of the primary objectives duringthe working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 3: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Rationale 4: Open analysis of client behaviors and response patterns is one of the primary objectives duringthe working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 18

Type: MCSA

The nurse is assessing a clients current progress in the nurseclient relationship. Which of the following behaviors would indicate to the nurse that the client is beginning the termination phase of the nurseclient relationship?

1. The client verbalizes willingness to change ineffective coping patterns and self-defeating behaviors.

2. The client expresses awareness of potential causes of dysfunctional behavioral patterns.

3. The client uses effective problem-solving strategies on a daily basis.

4. The client requests clarification of the roles and responsibilities in relationship work.

Correct Answer: 3

Rationale 1: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of therelationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Rationale 2: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of therelationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Rationale 3: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase ofthe relationship.

Rationale 4: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 19

Type: MCSA

Which of the following statements by the nurse may prevent successful separation between client and nurse at the end of a therapeutic one-to-one relationship?

1. Im going to miss our sessions together, but I think youre ready to handle difficult situations on your own.

2. I think two or three more sessions are necessary for you to develop more confidence in using this new coping skill effectively.

3. Im skeptical of your ability to assert yourself when new conflicts occur in future relationships, so be careful.

4. I suggest you contact me if you experience any new crisis that you feel unprepared to deal with on your own.

Correct Answer: 3

Rationale 1: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 2: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 3: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Rationale 4: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurseclient relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurseclient relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients.

Question 20

Type: MCSA

During the initial interview with a client, the nurse notices that the client changes the topic when the subject of the clients marital relationship is approached. The nurse is guided by the knowledge of which of the following?

1. Discussion of sensitive issues should only occur in the working phase.

2. Formulation of nursing diagnoses should be avoided until all essential data is obtained.

3. Information that is avoided or omitted is often more crucial than what is shared.

4. Avoidance of a topic is a sign of resistance that will disappear when initial anxiety is decreased.

Correct Answer: 3

Rationale 1: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or centralissues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 2: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 3: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Rationale 4: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurseclient relationship to progress.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 21

Type: MCSA

A client states that she is unhappy and miserable in her marriage and has been for several years. Which of the following responses indicates the nurse is tuning in to the process of the clients interaction rather than thecontent?

1. Do you have any children from this marriage?

2. How long have you been married?

3. It sounds like you have been miserable for quite some time.

4. Has your husband ever cheated on you?

Correct Answer: 3

Rationale 1: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 2: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 3: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possibleinfidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Rationale 4: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client themes. Acknowledging the clients misery is one way to respond to client themes. Asking related questions about the marriage such as duration of the marriage, number of children, or possibleinfidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 22

Type: MCSA

A client states that he is unhappy in his marriage and has felt miserable for several years. Which of the following client responses would indicate that the nurses response to the theme of marital distress was most effective?

1. I guess youre right; I should start thinking about a divorce.

2. I feel so depressed all the time. I dont know what to do or who to turn to.

3. I never thought about her cheating on me before; do you think thats possible?

4. I guess weve stayed together all these years because of the children.

Correct Answer: 2

Rationale 1: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to thetheme of marital distress.

Rationale 2: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Rationale 3: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to thetheme of marital distress.

Rationale 4: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 23

Type: MCSA

The nurse has been working with a depressed client for several months. Which of the following signs would indicate that an ineffective working relationship has evolved between the client and the nurse?

1. The clients sense of relaxation and confidence with the nurse

2. The nurses and clients sense of commitment to addressing the clients problems

3. The nurses sense of the clients severe dysfunction that cannot result in client growth

4. The nurses sense of making contact with the client

Correct Answer: 3

Rationale 1: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 2: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 3: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Rationale 4: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the clients problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurses abilities also indicates an effective working relationship.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 24

Type: MCMA

The nurse is working with a client who started therapy after losing his wife in an automobile accident. Which of the following client behaviors indicates he is ready to terminate the therapeutic nurse-client relationship?

Standard Text: Select all that apply.

1. Initial client treatment goals have been accomplished.

2. Symptoms no longer interfere with the clients comfort.

3. The client refuses to change due to unresolved resistances.

4. Dissatisfaction with interpersonal relationships is expressed.

5. Client well-being and satisfaction is dependent upon the nurse.

Correct Answer: 1,2

Rationale 1: Initial client treatment goals have been accomplished. Planned goals have been achieved.

Rationale 2: Symptoms no longer interfere with the clients comfort. Relief from the presenting problem has occurred.

Rationale 3: The client refuses to change due to unresolved resistances. A disruption in the one-to-one relationship has occurred due to a major impasse.

Rationale 4: Dissatisfaction with interpersonal relationships is expressed. The client has not developed sufficient improvement in social functioning for the relationship to end.

Rationale 5: Client well-being and satisfaction is dependent upon the nurse. The client should experience self-satisfaction and attainment of an independent identity before termination can occur.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 25

Type: MCSA

The nurse notices that a client is unable to control anger when criticized during a group meeting, even though the client had been able to do this effectively for several weeks. Which of the following interventions would be most appropriate in the nurses next one-to-one therapeutic session with the client?

1. Encourage the client to express responses to criticism freely.

2. Insist the client take a time-out until anger is back under control.

3. Offer the client a PRN dose of ziprasidone (Geodon).

4. Encourage a detailed exploration of how the client reacts to criticism.

Correct Answer: 4

Rationale 1: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 2: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offeringthe client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 3: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offeringthe client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Rationale 4: Encouraging an in-depth exploration of the clients feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the clients inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offeringthe client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 26

Type: MCSA

The nurse educator is reviewing a students care plan. Which of the following nursing diagnoses would not be appropriate to include when a patient experiences regressive behavior during the termination phase of the nurseclient relationship?

1. Ineffective Coping

2. Self-care Deficit

3. Powerlessness

4. Knowledge Deficit

Correct Answer: 4

Rationale 1: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert toprevious self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Rationale 2: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping

Rationale 3: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Rationale 4: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Diagnosis

Learning Outcome: Apply the nursing process to the three phases of the nurseclient relationship.

Question 27

Type: MCSA

Establishing and maintaining the therapeutic nurseclient relationship differs according to the clients cultural background. The nurse is guided by knowledge of which of the following?

1. A clients religious beliefs may interfere with constructive change.

2. Alternative values should always be discussed with the client.

3. Clients who believe family problems should not be discussed with strangers should not be coaxed intodoing so.

4. Exploring religious beliefs with the client is not recommended.

Correct Answer: 1

Rationale 1: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action. Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 2: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action. Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 3: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action. Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Rationale 4: A clients religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action. Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Establish and maintain one-to-one relationships within the context of the clients cultural background.

Question 28

Type: MCSA

A client who grew up with alcoholic parents is reluctant to discuss thoughts, feelings, and self-defeating behaviors with the nurse. Which of the following responses by the nurse would be most helpful?

1. We dont have to talk about your feelings if you dont want to. Lets discuss the behaviors you would like to change.

2. Some clients who were raised in alcoholic families are reluctant to discuss their feelings. How has this impacted you?

3. I understand that you are not used to discussing your feelings; however, we cant continue unless you open up to me.

4. I understand that opening up to others is difficult for you, but you need to change your view about discussing family issues with me.

Rationale 1: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 2: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 3: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Rationale 4: Acknowledging the clients reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the clients views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Establish and maintain one-to-one relationships within the context of the clientscultural background.

Question 29

Type: MCSA

Which of the following professionals would be most helpful in providing interdisciplinary supervision regarding specific culture-bound syndromes that interfere with the therapeutic nurseclient relationship?

Correct Answer: 2

Rationale 1: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 2: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 3: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Rationale 4: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise.

Chapter 5. Supportive and Psychodynamic Psychotherapy

Question 1

Type: MCSA

The nurse is documenting observations of client interactions during a group session. The nurse strives to document the behaviors of the client interactions with:

1. Objectivity.

2. Serendipity.

3. Sympathy.

4. Empathy.

Correct Answer: 1

Rationale 1: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective. Serendipity is not used when documenting behaviors of client interaction.

Rationale 2: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective.

Serendipity is not used when documenting behaviors of client interaction.

Rationale 3: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective. Serendipity is not used when documenting behaviors of client interaction.

Rationale 4: The nurse gathers data and objectively documents observations. Empathy is the ability to identify with the situation of another, and is not relative to documenting client behaviors. Sympathy is a feeling that occurs when one feels the experience as another, which can interfere with the ability to remain objective. Serendipity is not used when documenting behaviors of client interaction.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Describe the factors that influence the process of human communication.

Question 2

Type: MCSA

The nurse is validating what was observed before documenting in the progress note. Validation is used as a mechanism to ensure which of the following?

1. The clients affect is appropriate to the situation

2. The clients perception of the response is communicated

3. The clients request is clarified

4. The clients need for further intervention is understood

Correct Answer: 2

Rationale 1: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 2: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 3: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Rationale 4: When evaluating the clients response to an intervention, the nurse validates to ensure the clients perception of the response is communicated. Affect refers to a clients emotional tone, not as a method to validate. The clients need for further intervention will be determined when the response is evaluated, not during validation of the clients response. Clarification is used when a message is not clear.

Global Rationale:

Cognitive Level: Applying

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Describe the factors that influence the process of human communication.

Question 3

Type: MCMA

Which of the following are included when documenting client education?

Standard Text: Select all that apply.

1. The educational content discussed with the client

2. The clients response

3. The purpose for the educational interaction

4. The assessment of the client

5. The nursing diagnosis

Correct Answer: 1,2,3

Rationale 1: The educational content discussed with the client. When documenting client education, the nurse documents the content discussed.

Rationale 2: The clients response. When documenting client education, the nurse documents the clients response.

Rationale 3: The purpose for the educational interaction. When documenting client education, the nurse documents the rationale for the interaction.

Rationale 4: The assessment of the client. The assessment is not part of the client education.

Rationale 5: The nursing diagnosis. The nursing diagnosis and client goal is part of the planning phase, not the intervention phase.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Describe the factors that influence the process of human communication.

Question 4

Type: MCSA

The nurse is developing a plan of care for a client. Which of the following interventions must the nurse be careful to avoid?

1. Discussing expectations with the client

2. Selecting interventions that conflict with the clients value system

3. Identifying the clients perception of the problem

4. Addressing issues related to the clients past experiences

Correct Answer: 2

Rationale 1: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developinga plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 2: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developinga plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 3: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developinga plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Rationale 4: In developing plans of care, the nurse avoids actions that conflict with the clients value system in order to promote communication that fosters the therapeutic relationship. The nurse utilizes information based on the nursing assessment, which includes identifying the clients perception of the problem, when developinga plan of care. The nurse involves the client in the planning process by discussing issues related to the clients experiences and discussing expectations for performance.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Describe the factors that influence the process of human communication.

Question 5

Type: MCSA

The student nurse asks why the nurse is documenting the clients nonverbal responses in addition to verbal responses during the initial assessment. Which of the following statements made by the nurse reflects the rationale for documenting both verbal and nonverbal responses?

1. It is the hospital policy to document both.

2. It is important to be thorough when documenting.

3. Documenting both permits the reader to compare the behaviors for congruence.

4. Charting verbal and nonverbal helps me remain objective.

Correct Answer: 3

Rationale 1: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objectivewhen documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 2: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 3: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Rationale 4: Both verbal and nonverbal behaviors are important to communication. The behaviors are compared to determine if the clients verbal and nonverbal communication are congruent. Nonverbal communication may carry more meaning than verbal communication. It is important to remain objective when documenting; however, the rationale for documenting both is to evaluate congruence. It is important to be thorough when documenting; however, the rationale for documenting verbal and nonverbal responses is to compare for congruence. The rationale for documenting both verbal and nonverbal is to document for congruence, not because it is or is not hospital policy.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub: