Interpersonal relationships professional communication skills for nurses 7th edition arnold test ban

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Chapter 10: Developing Therapeutic Relationships Arnold: Interpersonal Relationships, 7th Edition MULTIPLE CHOICE 1. Which of the following examples indicates adherence to client confidentiality? a. Talking about the client’s symptoms in front of family members b. Using the client’s name in a social conversation c. Sharing client information with other members of the health care team as needed d. Reading a friend’s chart on another hospital unit ANS: C

The nurse should assure the client that personal information will be treated as confidential and explain that data will be shared with other members of the health care team as needed for making relevant clinical decisions and informing the client about the general composition of the health care team.

DIF: Cognitive Level: Comprehension REF: p. 183 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Management of Care 2. When your are administering medications to a client with human immunodeficiency virus

(HIV), the client states, “I should just stop taking them and get it over with.” A therapeutic response by the nurse would be a. “You have to take these! If you stop you will get very sick.” b. “You’re just feeling depressed right now. You’ll feel better later.” c. “ Tell me more about what you’re feeling.” d. “You have the right to refuse treatment.”

ANS: C

Therapeutic relationships should directly revolve around the client’s needs and each person’s individualized expression of them. Using questions that follow a logical sequence and asking only one question at a time are practices that help clients feel more comfortable and are likely to elicit more complete data. Dealing with the client’s feelings with a statement such as, “Tell me more about…” keeps the conversation flowing. The client has the right to choose a course of action, even when it is at odds with the nurse’s ideas. The nurse stating how the client is feeling is an assumption by the nurse about what the client is feeling. Although the client has the right to refuse treatment, he is not really saying that he will refuse. The nurse needs to obtain more information.

DIF: Cognitive Level: Application REF: p. 190 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 3. A client has been informed by her physician that she requires emergency surgery. The client

tells the nurse, “I will have the surgery after I attend my family vacation.” Which of the following is the most appropriate mutual goal for the client? a. The client will accept the recommended medical regimen. b. The client will alternate activity with rest throughout the day. c. The client will take a leave of absence from her work schedule.

d. The client will check her blood pressure four times a day.

ANS: B

Nurse-client relationships are designed to empower clients and families to assume as much responsibility as possible in self-management of chronic illness. Both nurse and client have responsibilities and work toward agreed-upon goals. Shared knowledge, mutual decision-making power, and respect for the capacities of client to actively contribute to his or her health care to whatever extent is possible are active components. The client always has the right to choose the course of action, even if it does not coincide with medical advice. If the client takes a leave of absence from her work schedule, it is not a mutual goal. Setting the goal of having the client check her blood pressure four times a day does not address the issue from the client perspective.

DIF: Cognitive Level: Application REF: p. 183 TOP: Step of the Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 4. A nurse whose father was an alcoholic is assigned to care for a client who is in alcohol

withdrawal. The nurse’s best therapeutic action would be to a. request another assignment. b. deliver care in short intervals to avoid projecting negativity. c. examine personal vulnerabilities, strengths, and limitations. d. monitor the client’s physical status closely.

ANS: C

Authenticity is a precondition for the therapeutic use of self in the nurse-client relationship.

Authenticity requires recognizing personal vulnerabilities, strengths, and limitations; working within this knowledge in the service of the client; and seeking help when needed to further relationship goals. Self-awareness allows the nurse to fully engage with a client, knowing that parts of the relationship may be painful, distasteful, or uncomfortable. Eventually the nurse will have to deal with the issue. Shortening care time would not be therapeutic. The nurse needs to be emotionally available to the client to be therapeutic.

DIF: Cognitive Level: Application REF: p. 186 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 5. A nurse returns to work to find that a substitute nurse has changed the treatment plan of her

favorite client. In the presence of the client, the nurse becomes angry and critical of the other nurse. This is an example of a. overinvolvement. b. client-centered approach. c. professional focus. d. disengagement.

ANS: A

Boundaries represent a continuum, with issues related to boundaries ranging from a lack of involvement to overinvolvement. The nurse has lost her focus on what is important for the client. The nurse has lost her objectivity. Disengagement is the opposite of overinvolvement.

DIF: Cognitive Level: Application REF: p. 185 TOP: Step of the Nursing Process: All phases

MSC: Client Needs: Psychosocial Integrity 6. The professional relationship goes through a developmental process characterized by

overlapping yet distinct stages, which are a. confidentiality, trust, and empathy. b. listening, hearing, and feeling. c. preinteraction, orientation, working phase, and termination phase. d. getting details, thoughts, and answers.

ANS: C

The professional relationship goes through a developmental process characterized by four overlapping yet distinct stages: (1) preinteraction, (2) orientation, (3) working phase, and (4) termination phase. The preinteraction phase is the only phase of the relationship the client is not part of. During the preinteraction phase, the nurse develops the appropriate physical and interpersonal environment for an optimal relationship, in collaboration with other health professionals and significant others in the client's life. Confidentiality, trust, and empathy are guiding principles, not phases. Listening, hearing, and feeling are communication skills.

Getting details, thoughts, and answers occurs during the orientation phase.

DIF: Cognitive Level: Comprehension REF: p. 181 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 7. Which of the following personality characteristics can affect the nurse’s ability to function in

a therapeutic manner, if disclosed to the client? a. The nurse is shy. b. The nurse becomes angry when criticized. c. The nurse has difficulty handling conflict. d. The nurse struggles with getting up in the morning.

ANS: B

It is up to the nurse, not the client, to resolve interpersonal issues that get in the way of the relationship. Nurses need to acknowledge overinvolvement, avoidance, anger, frustration, or detachment from a client when it occurs. By disclosing that she is shy, the nurse may assist the client to avoid misinterpreting cues. Disclosing that the nurse has difficulty handling conflict may open the way for the client to reveal problems and coping skills. The self-disclosure that the nurse struggles with getting up in the morning demonstrates humanness to the client.

DIF: Cognitive Level: Application REF: p. 186 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 8. In the preinteraction phase of the nurse-client relationship a. professional goals are communicated directly to the client. b. the content of the interaction is vital; the environment has little importance. c. the nurse develops the appropriate physical and interpersonal environment for an

optimal relationship. d. it is the nurse’s knowledge of principles and responsibilities that guarantees a

successful relationship.

ANS: C

The professional relationship goes through a developmental process characterized by four overlapping yet distinct stages: (1) preinteraction, (2) orientation, (3) working phase, and (4) termination phase. The preinteraction phase is the only phase of the relationship the client is not part of. During the preinteraction phase, the nurse develops the appropriate physical and interpersonal environment for an optimal relationship, in collaboration with other health professionals and significant others in the client's life.

DIF: Cognitive Level: Comprehension REF: pp. 187-188 TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 9. Which of the following is a nontherapeutic statement during the orientation phase of a

relationship? a. “I am the nurse who will be caring for you today.” b. “My job is to make you better.” c. “I will be talking with you while I provide care.” d. “You will be receiving care from an assistant and myself.”

ANS: B

The orientation phase ends with a therapeutic contract mutually defined by nurse and client.

The nurse enters the relationship in the “stranger” role and begins the process of developing trust by providing the client with basic information about the nurse (e.g., name and professional status) and essential information about the purpose, nature, and time available for the relationship. It is therapeutic to provide the client with basic and essential information.

Providing information helps develop trust.

DIF: Cognitive Level: Application REF: pp. 188-189 TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 10. The nurse practices “here and now” focus on problem identification, with an emphasis on

quickly understanding the context in which the problem is embedded during which of the following phases of the nurse-client relationship? a. Orientation b. Preinteraction c. Termination d. Working ANS: A

Orientation phase: The therapeutic alliance begins with the same type of introduction and description of purpose identified for long-term relationships with a focus on the nurse and client working as partners to develop a shared understanding of the client's health problems.

Establishing a working alliance where time is an issue requires a “here and now” focus on problem identification, with an emphasis on quickly understanding the context in which the problem is embedded. Meaningful connections occur when nurses initially strive to view each client as a person to be engaged with rather than focusing on what needs to be done.

DIF: Cognitive Level: Knowledge REF: p. 197 TOP: Step of the Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

11. Self-disclosure by the nurse refers to the intentional revealing of personal experiences or

feelings that are similar to or different from those of the client. The purpose of self-disclosure is to a. deepen trust, to be a role model of self-disclosure as a beneficial mode of communicating. b. to find out how the client would like to be. c. to determine how things would be if the problems were solved. d. to work toward resolution of the client’s self-care needs.

ANS: A

Self-disclosure by the nurse refers to the intentional revealing of personal experiences or feelings that are similar to or different from those of the client. The purpose of self-disclosure is to deepen trust and to be a role-model of self-disclosure as a beneficial mode of communicating for people who have trouble disclosing information about themselves.

Appropriate self-disclosure can facilitate the relationship, providing the client with information that is both immediate and personalized.

DIF: Cognitive Level: Application REF: p. 194 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 12. The client becomes more self-directed during which of the following phases of the

nurse-client relationship? a. Orientation b. Preinteraction c. Identification d. Working ANS: D

The working phase focuses on self-direction and self-management to whatever extent is possible in promoting the client’s health and well-being. Orientation is the assessment phase.

The client is not present during the preinteraction phase. Nurses help clients express feelings and clarify ideas and expectations during the identification phase.

DIF: Cognitive Level: Application REF: p. 198 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 13. Which stage of the nursing process corresponds to the exploitation part of the working phase

of the therapeutic relationship? a. Diagnosis b. Assessment c. Implementation d. Planning ANS: C

The exploitation phase corresponds to the implementation phase of the nursing process, where the purpose is to work toward resolution of the client’s self-care needs. Nursing diagnoses are established during the orientation phase. Assessment corresponds to the orientation phase.

Planning corresponds to the working phase.

DIF: Cognitive Level: Comprehension

REF: p. 192

TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 14. When should the nurse first start planning for termination of the nurse-client relationship? a. From the initial encounter b. After goals have been achieved c. When the client requests it d. During the working phase of the relationship ANS: A

It is important to be clear from the beginning about how long a therapeutic relationship will last. During the course of the relationship, termination can be mentioned and clients should be told well in advance of an impending termination date. It is inappropriate to plan for termination after the goals have been achieved, when the client requests termination, or during the working phase of the relationship.

DIF: Cognitive Level: Knowledge REF: p. 195 TOP: Step of the Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 15. A primary difference between a therapeutic helping relationship and a social relationship is a. enjoyment. b. amount of listening. c. worth to participants. d. the focus.

ANS: D

Therapeutic helping relationships have a specific purpose and health-related goal. Enjoyment, amount of listening, and worth to participants can occur in both types of relationships.

DIF: Cognitive Level: Comprehension REF: p. 188 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 16. Which of the following is true about the helping relationship? a. The health care provider takes responsibility for maintaining appropriate

boundaries. b. Both the health care provider and the client have equal responsibility for the relationship. c. Self-disclosure for both the health care provider and the client is expected. d. Understanding does not always have to be put into words.

ANS: A

In a helping relationship, the health care provider takes responsibility for the conduct of the relationship and for maintaining appropriate boundaries.

DIF: Cognitive Level: Knowledge REF: p. 188 TOP: Step of the Nursing Process: All phases MSC: Client Needs: Psychosocial Integrity 17. An appreciative client offers the nurse a box of chocolates. The nurse should a. accept all gifts offered by the client.

b. refuse to accept the chocolates in a gentle, tactful manner. c. accept or refuse based on the uniqueness of the relationship. d. accept the gift but also remind the client of intangible gifts.

ANS: C

In general, nurses should not accept money, or gifts of significant material value. There is no one answer about whether gifts should or should not be exchanged. In fact, if the nurse handled every situation in the same fashion, the nurse would be denying the uniqueness of each nurse-client relationship. Each relationship has its own character and its own strengths and limitations, so what might be appropriate in one situation would be totally inappropriate in another. Token gifts such as chocolates or flowers may be acceptable. In general, nurses should not accept money or gifts of significant material value. Some agencies have policies regarding accepting gifts; others do not. Accept or refuse based on the uniqueness of the situation.

DIF: Cognitive Level: Application REF: p. 196 TOP: Step of the Nursing Process: Evaluation MSC: Client Needs: Management of Care 18. The nurse has been working in a long-term care facility for several years. The nurse has

decided to leave the facility to work elsewhere. When terminating her relationship with clients, the nurse should a. prepare clients for termination. b. inform clients that she will “keep in touch.” c. inform clients that they have benefited from the relationship. d. discuss feelings with clients during the last encounter.

ANS: A

Termination of a meaningful nurse-client relationship in long-term settings should be final. To provide the client with even a hint that the relationship will continue is unfair. It keeps the client emotionally involved in a relationship that no longer has a health-related goal. There needs to be a mutual evaluation of benefits from the relationship. Feelings need to be expressed and discussed well before the last encounter.

DIF: Cognitive Level: Application REF: pp. 198-199 TOP: Step of the Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 19. The student nurse has finished her rotation on the outpatient psychiatric unit. Her client, who

was diagnosed with borderline personality disorder, suddenly displays superficial scratches to both forearms. Which of the following is a nursing diagnosis for the client related to losses and endings in the nurse-client relationship? a. Noncompliance about impending termination of nurse-client relationship b. Knowledge deficit about impending termination of nurse-client relationship c. Self-care deficit related to impending termination of nurse-client relationship d. Anxiety related to impending termination of nurse-client relationship ANS: D

The client’s anxiety has led to the regression in her behavior. Noncompliance, knowledge deficit, and self-care deficit are not diagnoses dealing with losses and endings.

DIF: Cognitive Level: Analysis

REF: p. 195

TOP: Step of the Nursing Process: Diagnosis MSC: Client Needs: Psychosocial Integrity