Chapter: Chapter 11: Therapeutic Relationships and Communication
Multiple Choice
1. A nurse learns that a distant family friend has been admitted to the inpatient psychiatric unit where the nurse works. The nurse understands that it is not acceptable to discuss this with family or neighbors, because doing so would breach the client’s confidentiality. Confidentiality is a central component of what element of the therapeutic relationship?
A) Competence
B) Sympathy
C) Trust
D) Autonomy
Ans: C
Chapter: 11
Client Needs: D-1
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 01
Page and Header: 184, Trust
Feedback: An important component of trust is confidentiality. Mental health providers must reassure clients that they will not share the details of clients’ lives outside the professional environment.
2. The nurse provides a new client with information about the antidepressant he has been prescribed and refers him to a community support group. What essential element of a therapeutic relationship is the nurse demonstrating?
A) Empowerment
B) Fidelity
C) Professionalism
D) Recovery
Ans: C
Chapter: 11
Client Needs: D-1
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 01
Page and Header: 184, Professionalism
Feedback: When acting as a professional, the nurse must learn about clients’ conditions, medications, and treatments in order to provide current information and accurate insight. The foci of the nurse–client relationship are problem solving and identifying community resources to fit specific needs.
3. During an assessment interview, a client frequently expresses concern about how her mental health problems will affect her grandmother. The client’s grandmother, mother, and father attend a family session, during which the nurse frequently acknowledges the grandmother. In doing so, the nurse is demonstrating what?
A) Confidentiality
B) Empathy
C) Trust
D) Respect
Ans: D
Chapter: 11
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Caring
Objective: 01
Page and Header: 184, Mutual Respect
Feedback: Nurses must show respect for families who are doing the best they can to help their loved ones while also coping with their own, often challenging circumstances.
4. The parents of a teenage client meet with the nurse for the first family session following the client’s recent suicide attempt. The nurse expresses empathy with the parents about the stress and worry they have felt over the client’s condition. Which of the following reasons most likely explains the nurse’s action?
A) The nurse wishes to show respect for the family.
B) The nurse wants to offset the mother’s protective behaviors.
C) The nurse wants to take the focus off the mother.
D) The nurse is unable to create distance from the family.
Ans: A
Chapter: 11
Client Needs: C
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Caring
Objective: 01
Page and Header: 184, Mutual Respect
Feedback: Nurses must show respect for families who are doing the best they can to help their loved ones while also coping with their own, often stressful circumstances.
5. An adult client has a history of severe psychological abuse by her mother, who has schizophrenia. The nurse plans to ask the client details about each incident of the abuse and how it has affected her sense of self-esteem. This is an example of what kind of intervention?
A) Caring
B) Excessive probing
C) An opportunity to build trust
D) A judgmental attitude
Ans: B
Chapter: 11
Client Needs: C
Cognitive Level: Evaluation
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 02
Page and Header: 189, Excessive Probing
Feedback: Professionals have the right to ask any questions that they deem necessary. They should recognize, however, that the goal is to help clients cope with their current situation. Asking clients to relate painful details of their childhood or to recount the embarrassing circumstances leading to their hospitalization may place an unfair burden on them. Nurses must ask themselves whether their questions are designed to satisfy their own curiosity or to meet the client’s current needs.
6. A male client was discharged from care several months ago after successful treatment for depression. Now, the client is back in the health care facility with severe depression, and all the former issues have returned. The nurse says to a coworker, “This is unbelievable; we’re back at square one again. He should know better at this point.” The nurse’s comments reflect what?
A) Countertransference
B) A judgmental attitude
C) An acceptable level of frustration
D) Her underlying concern for the client
Ans: B
Chapter: 11
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Caring
Objective: 02
Page and Header: 187, Confronting Judgmental Attitudes
Feedback: Judgmental attitudes and preconceptions deter the development of therapeutic relationships. Nurses must examine their own beliefs about mental illness, such as believing that mental illness is as real as any physical illness, suspecting that clients are overdramatizing their symptoms or using them as a crutch to avoid work and social responsibility, viewing mental illness as a sign of a weak character, or asking, “Why doesn’t this person just snap out of it, put his or her problems in perspective, or focus on something else?”
7. A nurse is conducting a life skills program for people who have mental illness. A young adult with schizophrenia asks the nurse to call her on the weekends so she has someone to talk to who really cares about her. Which of the following actions should the nurse take?
A) Tell the client she will call once per week during office hours so that the client can practice phone skills
B) Tell the client firmly that such a request is an inappropriate violation of their professional relationship
C) Temporarily call the client once each weekend to build trust
D) Tell the client to call the office answering service in case of an emergency
Ans: A
Chapter: 11
Client Needs: A-1
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Communication and Documentation
Objective: 02
Page and Header: 188, Enhancing Self-Awareness
Feedback: Nurses need to set limits with clients so that the boundaries of the relationship remain intact. Becoming overly involved with clients in inappropriate ways is evidence of a lack of self-awareness (making extra visits when time does not allow for them or calling clients when off duty).
8. A nurse therapist recently began meeting with a client in an effort to address some of the client’s symptom-management strategies. Which of the following actions by the nurse or client represents the working phase of the therapeutic relationship?
A) Setting goals
B) Communicating interest in the client
C) Identifying past ineffective behaviors
D) Reviewing work that has been done
Ans: C
Chapter: 11
Client Needs: C
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 03
Page and Header: 191, Working (Middle) Phase
Feedback: In the working phase of the relationship, the client is involved actively in achieving goals set during the initial phase. The tasks of the working phase of the therapeutic relationship include identifying past behaviors that have been ineffective for coping with the focal problem; developing a plan of action, practicing implementing it, and evaluating its effectiveness; integrating a new self-concept, worldview, or attitude toward one’s illness as a result of changes in behavior and circumstances; and increasing hopefulness for the future and ability to function independently.
9. During a therapy session, the nurse states, “So you’re saying that you’ve tried many techniques for dealing with your anxiety but haven’t felt any better?” This is an example of which of the following therapeutic communication techniques?
A) Validating
B) Paraphrasing
C) Confirming
D) Offering a broad opening
Ans: B
Chapter: 11
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 06
Page and Header: 194, Table 11.2
Feedback: Paraphrasing involves the nurse restating the client’s message in his or her own words to verify accurate understanding of the client.
10. A client says to the nurse, “Nobody cares about anything I say; even you don’t!” Which of the following responses is most therapeutic?
A) “Why do you say I don’t listen to you?”
B) “It sounds like you’re overreacting somewhat.”
C) “It sounds like you’re feeling ignored.”
D) “I listen to you.”
Ans: C
Chapter: 11
Client Needs: C
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Communication and Documentation
Objective: 06
Page and Header: 194, Table 11.2
Feedback: Reflecting feelings is an effective way to show empathy and facilitate the client’s further disclosure. Avoid “why” questions, which cause defensiveness, avoid belittling the client’s feelings, and do not defend against the client’s belief.
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