Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
Foundations of Psychiatric Mental Health Nursing A Clinical Approach, 5th Edition by Elizabeth M. Varcarolis
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Chapter 10: Developing Therapeutic Relationships
Complete Chapter Questions With Answers
Sample Questions Are Posted Below
MULTIPLE CHOICE
1) A client, brought to the emergency department after attempting suicide by taking an overdose of acetaminophen (Tylenol), has been lavaged. She appears tense, withdrawn, and frightened. The nurse tells her “I am Mr. G, a unit nurse. You seem to be tense and I’m wondering if you are feeling frightened. I’d like to sit here with you for a while.” The behavior indicating that the nurse has entered into a therapeutic rather than social encounter with the client is:
| A. | The statement of “I’d like to sit here with you . . .” is offering friendship. |
| B. | The statement of “I’d like to sit here with you . . .” is meeting the need for a time of quiet reflection. |
| C. | The statement of “You seem tense and I’m wondering if you are feeling frightened” seeks to identify emotional needs. |
| D. | The statement of “You seem tense and I’m wondering if you are feeling frightened” is interpreting her behavior. |
ANS: C
Through the use of empathy the nurse is fostering trust and communication. Options A and B: He is offering positive regard rather than friendship or a time for reflection. Option D: His remarks are not interpretations.
DIF: Cognitive Level: Application REF: Text Page: 156
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
2) The statement showing that the nurse has empathy for a client who has recently made a suicide attempt is
| A. | “It makes me sad to see you going through such anguish.” |
| B. | “If you tell me what is troubling you, I will be glad to speak to the doctor for you.” |
| C. | “You must have been very upset to do what you did today.” |
| D. | “Suicide is a drastic solution to a problem that may not be a matter of life or death at all.” |
ANS: C
Empathy permits the nurse to see an event from the client’s perspective, understand the client’s feelings, and communicate this to the client. Option A is nurse centered, focusing on the nurse’s feelings rather than the client’s. Option B is not empathetic but is a nontherapeutic action that promotes client dependence. Option D is a belittling statement.
DIF: Cognitive Level: Application REF: Text Page: 157
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
3) After several therapeutic encounters with a client who recently attempted suicide, the behavior that would cause the nurse to consider the possibility of countertransference is that
| A. | the client’s reactions toward the nurse seem realistic and appropriate. |
| B. | the client states the nurse is concerned about her, just like her father. |
| C. | the nurse develops a trusting relationship with the client. |
| D. | the nurse feels exceptionally happy when the client’s mood begins to lift. |
ANS: D
Strong positive or negative reactions to a client or overidentification with the client signals possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference, then seek supervision. Option A describes a desirable outcome. Option B suggests transference. Option C describes a desirable outcome.
DIF: Cognitive Level: Application
REF: Text Page: 159, Text Page: 160, Text Page: 161
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity
4) How should the nurse respond if a client asks him not to share information with others?
| A. | “I will not share information with your family or friends without your permission. I will, however, need to share information that relates to your reason for being here with other staff who work with you.” |
| B. | “The nice thing about a therapeutic relationship is that it is just between the nurse and the client. You will have to tell others whatever you want them to know about you and the problems that led to your hospitalization.” |
| C. | “It really 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. | “I really cannot tell anyone about you. It will be as though I am talking about my own problems and we can help each other by keeping it between us.” |
ANS: A
A client has the right to know with whom the nurse will share information and that confidentiality will be protected. Option B is untrue. Although the relationship is primarily between the nurse and client, other staff need to know pertinent data. Option C is inappropriate, promotes incomplete disclosure on the part of the client, and requires daily renegotiation of an issue that should be resolved as the nurse-client contract is established. Option D presents an inappropriate picture of the nurse-client relationship, suggesting it is used for mutual problem solving. The relationship must be client centered.
DIF: Cognitive Level: Application REF: Text Page: 165
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
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