Question 1

Which actions made by the nurse best exemplify the orientation phase of the nurse-patient therapeutic relationship? Select all that apply.

Accepted Answer

1. Assessing the patient's limitations and educating the patient about the patient's health problem are nursing actions performed in the orientation phase of the nurse-patient therapeutic relationship. Clarifying the patient's expectations for care occurs in the identification phase of the nurse-patient therapeutic relationship. Identifying the resources that will be used in the first interaction and reviewing the patient's history in the patient's medical record are actions that occur in the pre-orientation phase of the nurse-patient therapeutic relationship.
3. Assessing the patient's limitations and educating the patient about the patient's health problem are nursing actions performed in the orientation phase of the nurse-patient therapeutic relationship. Clarifying the patient's expectations for care occurs in the identification phase of the nurse-patient therapeutic relationship. Identifying the resources that will be used in the first interaction and reviewing the patient's history in the patient's medical record are actions that occur in the pre-orientation phase of the nurse-patient therapeutic relationship.

Question 2

The nurse is establishing a therapeutic environment with a newly admitted patient with a severe mental illness. Which statement best demonstrates empathetic communication?

Accepted Answer

2. Empathy is sensing the perceptions or feelings of an individual and one's relationship to the individual's situations and experiences (feeling what the other person is feeling), and communicating and validating or adjusting them based on feedback from that person. Empathy is an important aspect of therapeutic communication. The statement, "You appear upset. Do you want to talk about it?" is the best example of empathetic communication because the nurse is perceiving and validating the patient's feelings. Telling the patient that the nurse feels bad for the patient is expressing sympathy, not empathy. Asking why the patient feels the way that he or she does is not validating the patient's feelings. The nurse should not tell the patient that many people have the same disorder as the patient, as this does not validate the patient's feelings or experience.

Question 3

A novice nurse is learning how to effectively communicate within a therapeutic nurse-patient relationship. What struggle is most harmful when the nurse is new to therapeutic relationships?

Accepted Answer

4. A difficulty that commonly occurs in therapeutic relationships is that newcomers to this type of relationship do not know how to respond, and they often fall back on relationship skills learned in friendships, family relationships, or other personal relationships. This may be most harmful because by relying on these skills, the nurse is not developing the necessary skills for developing the therapeutic relationship. The novice nurse will likely feel uncomfortable and anxious, and fall back on knowledge learned from nursing school; however, these are not most harmful.

Question 4

A novice nurse caring for patients with mental illness wants to use empathy as a therapeutic tool. How is empathy used as a therapeutic tool for nurses?

Accepted Answer

4. Empathy has components of both perception and interaction; it is more than a quality or characteristic, it is also a communication tool that validates the experience of the patient. Empathy does not validate the nurse's expertise or perceptions, nor does it validate the nurse-patient relationship.

Question 5

The nurse understands that health is typically defined as the state of being without illness. What is wrong with this definition?

Accepted Answer

4. How each nurse views the concepts of health and mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Typically, health is defined as the state of being without illness. This definition is problematic in that it suggests that those with a diagnosed illness, such as heart disease or depression, cannot possibly be healthy. In reality, though, many individuals with a variety of illnesses adapt in such a way that they would be considered healthier than some individuals without any illness. This definition does not suggest that being healthy is difficult to achieve or that all without illness are healthy. While the definition may suggest that health and illness correlate with one another, this is not a problem with this definition.

Question 6

The novice nurse is learning about the use of boundaries in the therapeutic nurse-patient relationship. What examples will the nurse recognize as boundary violations? Select all that apply.

Accepted Answer

1. The National Council of State Boards of Nursing defines boundary crossings as decisions to deviate from a boundary for a therapeutic purpose, such as appointment changes, disclosing bits of personal information, or the giving or receiving of small gifts. These are small breaches with a likely return to expected limits of the professional relationship. Boundary violations may include inappropriate self-disclosure and sexual misconduct.
3. The National Council of State Boards of Nursing defines boundary crossings as decisions to deviate from a boundary for a therapeutic purpose, such as appointment changes, disclosing bits of personal information, or the giving or receiving of small gifts. These are small breaches with a likely return to expected limits of the professional relationship. Boundary violations may include inappropriate self-disclosure and sexual misconduct.

Question 7

The nurse is developing a plan of care for a patient. Which intervention must the nurse be careful to avoid?

Accepted Answer

4. When developing a plan of care, the nurse must avoid actions that conflict with the patient's 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 patient's perception of the problem. The nurse involves the patient in the planning process by discussing issues related to the patient's experiences and discussing expectations for performance.

Question 8

The nurse validates the patient's response to an intervention prior to documenting in the progress note. What does validation ensure?

Accepted Answer

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

Question 9

What is the key concept that allows the nurse to maintain professional boundaries when first developing the nurse-patient relationship?

Accepted Answer

1. The key to maintaining boundaries is for the nurse to be intentional in developing the therapeutic relationship with a patient. For example, a nurse meeting a patient for the first time introduces himself or herself as a professional involved in the patient's care, rather than informally telling the patient his or her name and making a comment about the weather, the patient's appearance, or a topic unrelated to patient care. The use of caring, shared goals, and shared knowledge do not aid in the nurse's attempt to maintain professional boundaries within the nurse-patient relationship.

Question 10

The psychiatric-mental health novice nurse asks "What is mental health?" Which qualities will her superior include when describing mental health? Select all that apply.

Accepted Answer

1. How each nurse views the concepts of health and mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health.
2. How each nurse views the concepts of health and mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health.
3. How each nurse views the concepts of health and mental health significantly impacts how he or she understands, relates to the world, and performs his or her role as nurse. Mental health is concept that is often difficult to define. Qualities often mentioned include the ability to give and receive love, having a sense of purpose in life, and the ability to make important decisions in one's own life. Mental health is typically defined as not simply the ability to experience emotions; it is the ability to experience these emotions without distress. While the ability to give and receive criticism is typically considered a healthy personality trait, this characteristic is not typically used when describing mental health.

Question 11

The nurse is caring for a patient who is experiencing dysfunctional grieving following the traumatic death of spouse due to an automobile accident. The nurse also experienced the death of a loved one in the same manner. What statement made by the nurse best exemplifies the nurse using empathy toward the patient?

Accepted Answer

1. One way to prevent misinterpretation of the patient's feelings is for nurses to check his or her perceptions with the patient. The nurse stating, "Many people may feel angry when faced in this situation. How do you feel?" is the best way for the nurse to provide empathetic care while remaining perceptive of his or her own feelings. The nurse should not tell the patient how the nurse felt in the similar situation, because this doing so puts the focus on the nurse rather than the patient. By telling the patient that the nurse is sorry for the patient, the nurse is exhibiting sympathy, not empathy.

Question 12

The nurse manager is meeting with a staff nurse on the inpatient mental health unit for an annual employee review. When discussing the nurse's current concerns, the nurse tells the manager, "I am having trouble sleeping at night thinking about that patient we had who was hospitalized for several weeks. I got so close to that patient and I wonder how she is doing." What is the manager most concerned about regarding the nurse's statement?

Accepted Answer

3. The staff nurse has crossed professional boundaries, perhaps without realizing it, by getting too close to the patient. Setting and maintaining nurse-patient boundaries are essential skills for the psychiatric-mental health nurse. However, these skills are not easy to learn and these boundaries may be crossed at times. There is not enough information to determine if the nurse is experiencing burnout. Although the nurse appears to be experiencing insomnia, this would not cause the manager as much concern as a possible boundary crossing or violation. Though the staff nurse has inadvertently crossed professional nurse-patient boundaries, there is not enough information in the question to determine if the nurse has compromised his or her professional license.

Question 13

A patient experiencing psychosis tells the nurse, "I am in charge. Who are you and why are you here?" What is the most therapeutic response by the nurse?

Accepted Answer

4. Responding with "I am your nurse" is an example of giving information; the nurse responds to the patient's request without getting into a confrontation and conveys respect. Asking if the patient knows who the nurse is or stating that the patient knows the nurse are not therapeutic responses and may be perceived as challenging to the patient. Stating that the patient is not in charge and reminding the patient of his or her inpatient status provide the patient with information and presents reality but do not provide the patient with a response to the question asked.

Question 14

During the first interaction with a client, the nurse makes an introduction and identifies the purpose of the interaction. This serves to accomplish which stage of the nurse-patient relationship?

Accepted Answer

1. The orientation phase of the nurse-patient relationship identifies the purpose of the relationship and its associated structure. Evaluating and implementing are phases of the nursing process, not the nurse-patient relationship. The identification phase of the nurse-patient therapeutic relationship is characterized by interdependence between the nurse and the patient.

Question 15

Which aspect of nonverbal communication conveys the nurse's positive attitude toward the patient? Select all that apply.

Accepted Answer

1. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication.
2. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication.
3. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication.
5. Aspects of nonverbal communication that communicate a positive attitude toward the patient include leaning slightly forward, orienting to face the patient, maintaining physical proximity, and maintaining good eye contact while the patient is speaking. Formulating a reply while the patient is speaking is a barrier to communication and does not communicate a positive attitude. When this occurs, the nurse is analyzing what the patient is saying before the patient's message has been communicated; this may lead to a breakdown in communication.

Question 16

The novice nurse is learning about the various types of relationships and how these affect the role of the nurse when providing care to patients with mental illness. What tool do therapeutic relationships use that is not used in social relationships?

Accepted Answer

4. Therapeutic relationships differ from social relationships; in part, this is because the therapeutic relationship uses the process of interaction as a tool. Communication occurs with all relationships and is not unique to therapeutic ones. Shared power and interest occur in social, not therapeutic, relationships.

Question 17

The psychiatric-mental health nurse is receiving a report on a patient who is being transferred to the hospital from a local emergency department (ED) after expressing suicidal ideations. The ED nurse tells the psychiatric-mental health nurse that the patient is "crazy, just like my aunt!" Which quality that commonly occurs in the pre-interaction stage of the nurse-patient relationship does the ED nurse's statement demonstrate?

Accepted Answer

4. Countertransference occurs when the nurse's previous experiences trigger reactions that have nothing to do with the current patient. In this case, the emergency department nurse labels the patient with depression as "crazy," and identifies the patient with her own family member. Transference is similar to countertransference; however, this occurs in patients, not nurses. Ethnocentrism occurs when an individual judges another individual's values, culture, and beliefs based solely on the judging individual's own culture. Cultural relativism is the concept that beliefs, customs, and ethics of an individual must be considered within that individual's own culture, to evaluate whether the individual deviates from his or her own culture.

Question 18

The nurse is planning care for a newly admitted patient. Which concepts are considered essential in establishing a therapeutic nurse-patient relationship? Select all that apply.

Accepted Answer

1. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship.
2. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship.
4. Essential concepts in establishing a therapeutic nurse-patient relationship include an emphasis on patient care, the nurse's view of health and mental health, and unconditional positive regard for the patient and family. The nurse should empathize, not sympathize with the patient. The nurse should not make judgments regarding the patient's condition, as this will hinder, not establish the therapeutic relationship.

Question 19

What process is used as a tool in developing a therapeutic relationship but is not used in developing a social relationship?

Accepted Answer

1. Therapeutic relationships differ from social relationships; in part, this is because the therapeutic relationship uses the process of interaction as a tool. It is one of the few healthy relationships in which one party helps another or acts in the best interest of another without expectation that the other person will return the action. Equal sharing, mutual knowledge, and intimate disclosures are characteristics of social relationships, not therapeutic relationships.

Question 20

The nurse is caring for a patient with schizophrenia who is admitted to the hospital after being found incoherent and combative at a local grocery store. The patient tells the nurse that he has not taken his medications for over two weeks. The nurse is assessing the patient's needs, symptoms, and strengths. What stage of the nurse-patient relationship is being demonstrated?

Accepted Answer

2. During the orientation phase of the nurse-patient relationship, the nurse assesses needs, symptoms, strengths, and limitations. In the pre-orientation phase, the nurse identifies and collects materials and resources likely to be used at the initial meeting. In the working phase, the "work" of treatment occurs. In the identification phase, the nurse clarifies the patient's expectations for care.

Quiz 8: The Nurse-Patient Relationship and Therapeutic Communication