Deck 9: Therapeutic Relationships

Question 1

Which action by a nurse shows positive regard?

A) Making rounds according to the daily assignment.
B) Administering daily medication as prescribed.
C) Examining own feelings about a patient.
D) Staying with a patient who is crying.

Answer 1

Staying with a patient who is crying.

Question 2

During which phase of the nurse-patient relationship can a nurse anticipate that patient issues will be explored and resolved?

A) Pre-orientation
B) Orientation
C) Working
D) Termination

Answer 2

Working

Question 3

A nurse explains to the family of a mentally ill patient how the nurse-patient relationship differs from other interpersonal relationships.Which is the best explanation? "The focus:

A) is on the patient.Problems are discussed by the nurse and patient,but solutions are implemented by the patient."
B) shifts from nurse to patient as the relationship develops.Advice is given by both and solutions implemented."
C) is creation of a partnership in which each member is concerned with growth and satisfaction of the other."
D) of the relationship is socialization.Mutual needs are met and feelings are shared openly."

Answer 3

is on the patient.Problems are discussed by the nurse and patient,but solutions are implemented by the patient."

Question 4

Which remark by a patient indicates movement from orientation to the working phase of a nurse-patient relationship?

A) "I don't have any problems."
B) "It is so difficult for me to talk about problems."
C) "I don't know how talking about things twice a week can help."
D) "I want to find ways to deal with my anger without blowing up."

Question 5

A patient frequently asks the nurse for extra snacks,implying more willingness to talk if these items are provided.The nurse should assess this behavior as:

A) typical of transference reactions.
B) indicative of feelings of insecurity.
C) reflecting resistance to involvement.
D) testing the nurse's clinical competence.

Question 6

How should the nurse respond if a patient says,"Please don't share information about me with the other people"?

A) "I cannot tell anyone about you.We can help each other by keeping it between us."
B) "I won't share information with your family or friends without your permission,but I will share information with other staff."
C) "It depends on what you choose to tell me.I will be glad to disclose at the end of each session what I will report to other staff."
D) "Therapeutic relationships are between the nurse and the patient.It's up to you to tell others what you want them to know."

Question 7

Why should a nurse introduce the matter of a contract during the first session with a new patient? Contracts:

A) specify what the nurse will do for the patient.
B) spell out participation and responsibilities of both parties.
C) are indicative of the feeling tone established between the participants.
D) are binding and prevent either party from prematurely ending the relationship.

Question 8

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder?

A) Trust,congruence,attitudes,and boundaries.
B) Goals,resistance,unconscious motivations,and diversion.
C) Relationship parameters,the contract,confidentiality,and termination.
D) Transference,countertransference,intimacy,and developing resources.

Question 9

A nurse is talking with a patient,and 5 minutes remain in the session.This patient has been silent most of the session.Another patient interrupts and says to the nurse,"I really need to talk to you." The nurse should:

A) invite the interrupting patient to join the session with the current patient.
B) tell the interrupting patient,"This session is 5 more minutes,then I will talk with you."
C) say to the interrupting patient,"I am not available to talk with you at the present time."
D) end the unproductive session with the current patient.Spend time with the next patient.

Question 10

Termination of a therapeutic nurse-patient relationship has been successful when the nurse:

A) discusses with the patient changes that happened during the relationship and evaluates outcomes.
B) gives the patient the nurse's cell phone number and permission to call after discharge.
C) avoids upsetting the patient by shifting focus to other patients before the patient's discharge.
D) offers to meet the patient for conversation after discharge.

Question 11

At what point in the nurse-patient relationship should a nurse first address termination?

A) Preorientation phase
B) Orientation phase
C) Working phase
D) Termination phase

Question 12

A nurse caring for a withdrawn,suspicious patient recognizes development of feelings of anger toward the patient.The nurse should:

A) suppress the angry feelings.
B) explore the anger openly and directly with the patient.
C) ask the nurse manager to assign the patient to another nurse.
D) discuss the anger with a clinician during a supervisory session.

Question 13

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia.The nurse should:

A) use extensive self-disclosure in patient interactions.
B) encourage dependence on the nurse for support and reassurance.
C) consistently make interpretive judgments about the patient's behavior.
D) be aware of own feelings and use congruent communication strategies.

Question 14

A nurse assesses an elderly patient who was found wandering and confused.The nurse feels sad and reflects,"She's like my grandmother…so helpless." Which term best applies to the nurse's response?

A) Rapport
B) Transference
C) Countertransference
D) Defensive coping reaction

Question 15

A patient who recently attempted suicide talks with the nurse about wanting to take a walk on hospital grounds.The nurse responds by telling the patient,"I will talk with the psychiatrist on your behalf." Select the accurate analysis of this interaction.

A) The nurse is behaving in an overly helpful way.
B) The nurse is showing positive regard for the patient.
C) The nurse is modeling healthy behaviors for the patient.
D) The patient has manipulated the nurse into taking this action.

Question 16

A psychiatric nurse visits one particular patient before work,seeks out the patient during the shift,and spends a few minutes with the patient after going off duty.Which analysis is accurate? The nurse is:

A) overinvolved.
B) expressing anger.
C) experiencing transference.
D) looking to be rescued.

Question 17

After several therapeutic encounters with a patient who recently attempted suicide,which behavior should cause the nurse to consider the possibility of countertransference?

A) The patient's reactions toward the nurse seem realistic and appropriate.
B) The nurse feels very happy when the patient's mood begins to lift.
C) The patient states,"Talking to you is like talking to my parents."
D) The nurse develops a trusting relationship with the patient.

Question 18

Select the desirable outcome for the initial stage of a nurse-patient relationship.The patient will demonstrate behaviors that indicate:

A) a greater sense of independence.
B) rapport and trust with the nurse.
C) resolved transference.
D) self-responsibility.

Question 19

A patient says,"People should be allowed to commit suicide without interference from others." A nurse replies,"You're wrong.Nothing is bad enough to justify death." What is the best analysis of this interchange?

A) The patient is correct.
B) Neither person is correct.
C) The statements reflect differing values.
D) The nurse has responded therapeutically.

Question 20

Which statement shows a nurse has empathy for a patient who made a suicide attempt?

A) "You must have been very upset to do what you did today."
B) "It makes me sad to see you going through such a difficult experience."
C) "If you tell me what is troubling you,I can help you solve your problems."
D) "Suicide is a drastic solution to a problem that may not be such a serious matter."

Question 21

A nurse provided psychiatric home care services to a patient for 6 months,but now the patient will begin a psychosocial rehabilitation program.On the nurse's final home visit,the patient gives the nurse a gold angel pin and says,"Thank you for being my guardian angel when I needed help." Select the nurse's best response.

A) "I'm happy you have made so much improvement.Thank you for the pin."
B) "Our agency's policies and procedures prohibit me from accepting your gift."
C) "All nurses care.It's rewarding when patients recognize how hard we work."
D) "I'm glad you've made progress and that I helped,but I cannot accept the gift."

Question 22

The nurse tells a peer,"I feel very uncomfortable with a patient and find myself wanting to avoid both informal contacts and scheduled sessions." Without supervision,which outcome is likely?

A) Growing interest and mutuality
B) Mutual withdrawal
C) Positive regard
D) Trust

Question 23

A nurse believes,"I'm the only one who truly understands this patient.Other staff members are too critical." Which situation is evident?

A) Boundary blurring
B) Sexual harassment
C) Positive regard
D) Transference

Question 24

Which behavior shows that a nurse values autonomy? The nurse:

A) sets limits on a patient's romantic overtures toward the nurse.
B) suggests one-on-one supervision for a patient who is suicidal.
C) informs a patient that the spouse will not be in during visiting hours.
D) discusses alternatives and helps the patient weigh the consequences.

Question 25

As a patient with mental illness is discharged from a facility,the nurse invites the patient to the annual staff holiday party.Select the best analysis of this scenario.

A) The invitation facilitates dependency on the nurse.
B) The nurse's action blurs the boundaries of the therapeutic relationship.
C) The invitation is therapeutic for the patient's diversional activity deficit.
D) The nurse's action assists the patient's integration into community living.

Question 26

A psychiatric nurse's parent had bipolar disorder.The nurse angrily recalls childhood memories of embarrassment about the parent's behavior.Select the best coping strategies for this nurse.(Select all that apply. )

A) Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses.
B) Recognize that these feelings are unhealthy.The nurse should repress them when working with patients.
C) Recognize that psychiatric nursing is not an appropriate career choice.Select another area of practice.
D) Begin relationships with new patients by saying,"My parent had mental illness,so I accept it without stigma."
E) Recognize that the feelings may add sensitivity to the nurse's practice,but supervision is important.

Question 27

A nurse ends a relationship with a patient.Which action(s)by the nurse should be included in the termination phase? (Select all that apply. )

A) Establish expectations of how long the relationship will last.
B) Work with the patient to identify strengths,limitations,and problems.
C) Help the patient express feelings about the relationship with the nurse.
D) Help the patient prioritize and modify socially unacceptable behaviors.
E) Focus dialogues with the patient on problems that may develop in the future.

Question 28

As a nurse discharges a patient,the patient gives the nurse a card of appreciation made in an arts and crafts group.Select the nurse's best action.

A) Recognize the patient's thoughtfulness.Express appreciation and accept the card.
B) Inform the patient that accepting gifts violates policies of the facility.Decline the card.
C) Acknowledge the patient's transition through the termination phase,but decline the card.
D) Accept the card.Invite the patient to return to participate in other arts and crafts groups.

Question 29

A community mental health nurse has worked with a patient for 3 years but is moving and must terminate the relationship.When a new nurse begins work with this patient,what is the starting point for the relationship?

A) Begin at the orientation phase
B) Continue the working relationship
C) Start with informal social interactions
D) Return to the emotional catharsis phase

Question 30

Which nursing actions demonstrate consistency and reliability? (Select all that apply. )

A) Providing a schedule of daily activities.
B) Offering solutions to a patient's problems.
C) Having the same nurse care for a patient daily.
D) Setting a time for regular sessions with a patient.
E) Encouraging a patient to share initial impressions of staff.

Question 31

A patient says,"I'm still on restriction,but I want to attend some off-unit activities.Would you ask the doctor to change my privileges?" Select the nurse's best response.

A) "I'll be glad to mention it when I see the doctor today."
B) "That's a good topic for you to take up with your doctor."
C) "Why are you asking me when you're able to speak for yourself?"
D) "I'm glad you feel comfortable asking me to help you with that request."

Question 32

During the first interview,a nurse notices that a patient does not make eye contact.Which analysis is correct?

A) The patient is not truthful and is demonstrating evasive behavior.
B) The patient is shy.The nurse should progress slowly.
C) The patient feels sad and cannot look at the nurse.
D) More information is needed to draw a conclusion.