NUR210CH09

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Author:
TomWruble
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199124
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NUR210CH09
Updated:
2013-03-11 11:02:23
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nur210e1 Therapeutic Relationships
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Therapeutic Relationships
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  1. T/F: Therapeutic use of self has been scientifically substantiated as an evidence-based intervention.
    True
  2. T/F: Psychotherapy (talk therapy) actually changes brain chemistry as effectively as medication.
    False, BUT "true" with the phrase: "in much the same way as medication"
  3. Two circumstances where boundaries are blurred.
    • When the relationship slips into a social context
    • When the nurse's needs are met at the expense of the patient's
  4. Blurring of roles often results from unrecognized ...
    • Transference - Pt: "You remind me of my brother."
    • Countertransference - Nurse unconsciously and inappropriately displaces onto the Pt feelings and behaviors related to significant figures in the nurses past.
  5. Signs of countertransference
    • Strong positive reaction or
    • Strong negative reaction
  6. Peplau's phases
    • Preorientation
    • Orientation
    • Working
    • Termination
  7. Items for Orientation Phase
    • Establish rapport
    • Parameters of relationship
    • Formal or informal contract
    • Confidentiality
    • Terms of termination
  8. Tasks of Termination Phase
    • Summarizing the goals and objectives achieved in the relationship
    • Discussing ways for the patient to incorporate into daily life any new coping strategies learned
    • Reviewing situations that occurred during the nurse-patient relationship
    • Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship
  9. Which of the following actions best represents the basis or foundation of all other psychiatric nursing care?

    1. The nurse assesses the patient at regular intervals.
    2. The nurse administers psychotropic medications.
    3. The nurse spends time sitting with a withdrawn patient.
    4. The nurse participates in team meetings with other professionals.
    3. The nurse spends time sitting with a withdrawn patient.

    ANS: 3Rationale: The nurse-patient relationship is the basis for all psychiatric nursing care. Although assessment, administering medications, and participating as a team member all represent roles or activities in mental health nursing, only sitting with a withdrawn patient represents a nursing action that helps build or sustain a therapeutic nurse-patient relationship—the basis for all other nursing care.
  10. A male patient frequently inquires about the female student nurse’s boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior?

    1. The student requests assignment to a patient of the same gender as the student.
    2. She points out to the patient that he is making social inquiries and explores this behavior.
    3. She tells him that she cannot talk about her personal life and refocuses on his issues.
    4. She explains that if he persists in focusing on her she cannot work with him.
    2. She points out to the patient that he is making social inquiries and explores this behavior.

    Others might be appropriate, but not as INITIAL responses.
  11. Mary, a patient in the psychiatric unit, had a very rejecting and abusive father and a difficult childhood, but from age 10 on was raised by a very warm and supportive grandmother who recently passed away. Mary frequently comments on how hard her nurse, Jane, works and on how other staff do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Mary and appreciating her insightfulness, recalling to herself that except for her former head nurse, other staff do not seem to appreciate how hard she works and seem to take her for granted. Jane enjoys the time she spends with Mary and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient?

    1. Mary is experiencing transference; Jane should help Mary to understand that she is emphasizing in Jane those qualities which were missing in her father.
    2. Jane is idealizing Mary, seeing in her strengths and abilities which Mary does not really possess; Jane should temporarily distance herself somewhat from Mary.
    3. Mary is over identifying with Jane, seeing similarities that do not in reality exist; Jane should label and explore this phenomenon in her interactions with Mary.
    4. Jane is experiencing countertransference in response to Mary’s meeting Jane’s needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics.
    4. Jane is experiencing countertransference in response to Mary’s meeting Jane’s needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics.
  12. Which of the following statements would be appropriate during the orientation phase of the nurse-patient relationship? Select all that apply.

    1. “My name is Sarah, and I am a student nurse here to learn about mental health.”
    2. “I will be here each Thursday from 8 am until 12 noon if you would like to talk.”
    3. “Tell me about what you think would best help you to cope with the loss of your wife.”
    4. “Let’s talk today about how our plan for improving your sleep has been working.”
    5. “We will meet weekly for 1 hour, during which we will discuss how to meet your goals.”
    6. “Being home alone while your wife was hospitalized must have been very difficult for you.”
    1, 2, 5 and 6

    3 & 4 are WORKING phase items.
  13. A synonym for genuineness is 

    A. respect.
    B. congruence.
    C. positive regard.
    D. empathy.
    B. congruence.

    Genuineness refers to self-awareness of one's feelings as they arise within the relationship and the ability to communicate them when appropriate. It is the ability to meet others person to person without hiding behind roles. Rogers uses the word congruence to signify genuineness. Text page: 169
    (this multiple choice question has been scrambled)
  14. The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the 

    A. pre-orientation.
    B. orientation.
    C. working.
    D. termination.
    D. termination.

    Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. Text page: 168
    (this multiple choice question has been scrambled)
  15. The pre-orientation phase of the nurse-client relationship in characterized by a focus on: 

    A. incorporating coping skills into client's routine
    B. changing client behavior
    C. The nurse's self-analysis of strengths, limitations, and feelings
    D. clarification of the nurse's role
    C. The nurse's self-analysis of strengths, limitations, and feelings

    During the pre-orientation phase the nurse prepares for a relationship with a client by engaging in self-examination. Text pages: 163, 164
    (this multiple choice question has been scrambled)
  16. The use of empathy and support begins in the stage of the nurse-client relationship termed the 

    A. orientation stage.
    B. working stage.
    C. identification stage.
    D. resolution stage.
    A. orientation stage.

    The use of empathy and support should begin in the orientation stage. These tools are helpful in building trust and furthering the relationship. Text page: 166
    (this multiple choice question has been scrambled)
  17. A client is complaining about her mother-in-law's intrusiveness. The nurse responds "I know how you feel. My mother-in-law is nosy, too." The nurse is most likely 

    A. experiencing countertransference.
    B. using self-disclosure in an appropriate way.
    C. giving the client permission to continue.
    D. using empathy to establish trust.
    A. experiencing countertransference.

    Countertransference refers to the stirring up of feelings in the nurse by the client. Text page: 159
    (this multiple choice question has been scrambled)

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