Therapeutic  Nurse who appreciates the client as a unique, worthwhile

Chapter 5 – Therapeutic
Relationships human being can respect the client regardless of his or her
Relationship behavior, background, or lifestyle.
- The ability to establish therapeutic relationships with  E.g. calling the client by name, spending time with the
clients is one of the most important skills a nurse can client, and listening and responding openly, considering
develop. the client’s ideas and preferences when planning care.
- Highlight: communicate with patients correctly.  The client may say “I was so mad, I yelled and screamed
- Build trusting relationship at my mother for an hour.”
 Inappropriate: “Well, that didn’t help, did it?” or “I
Components of a Therapeutic Relationship
can’t believe you did that,” the nurse is communicating a
 Balance of power between the therapist and the client. value judgment that the client was “wrong” or “bad.”
A. Trust builds when the client is confident in the nurse  Appropriate: “What happened then?” or “You must have
- Conveys integrity and reliability been really upset.”
- Friendly, caring, interested, understanding, consistent;
Self-Awareness
keeps promises; listens; is honest
- Congruence occurs when words and actions match
 Self-awareness is a process of understanding one’s own
- E.g. the nurse says to the client, “I have to leave now to values, beliefs, thoughts, feelings, attitudes, motivations,
go to a clinical conference, but I will be back at 2 pm”
strengths, and limitations, and how one’s thoughts and
and indeed returns at 2 pm to see the client. behaviors affect others.
- Extra effort for pts with paranoia, low self-esteem,
- Values – abstract standards that give a person a sense of
anxiety. (Mistrust) what is right and wrong and establish a code of conduct
B. Genuine Interest
for living. Values are clarified through choosing, prizing
 When the nurse is comfortable with himself or herself, and acting.
aware or his or her strengths and limitations, and clearly - Case: a clean and orderly student has been assigned to
focused, the client will perceive a genuine person live with another student who leaves clothes and food all
showing genuine interest. over their room.
 Do not show dishonest or artificial behavior such as, - Beliefs – are ideas that one holds to be true.
- Asking a question and then not waiting for the answer, - Attitudes – general feelings or a frame of reference
talking over the client, or assuring the client everything around which a person organizes knowledge about the
will be all right. world. (hopeful, optimistic, pessimistic, positive and
negative)
Empathy (Putting yourself on their shoes)
Therapeutic Use of Self
 Ability of the nurse to perceive the meanings and feelings
of the client and to communicate that understanding to the  Therapeutic use of self is when the nurse uses aspects of
client. his or her personality, experience, values, feelings,
 By listening and sensing the importance of the situation to intelligence, needs, coping skills, and perceptions to
the client, the nurse can imagine the client’s feelings establish relationships with clients that are beneficial to
about the experience. clients.
 Both the client and the nurse give a “gift to self”
 Clients tend to feel better about themselves and more The Johari’s window is a self-awareness tool.
understood when the nurse is empathetic.
 Quadrant 1 (open-public) – qualities one knows about
Sympathy (pity or feeling sorry) oneself and what others also know.
 Quadrant 2 (blind-unaware) – qualities known only to
 Feelings of concern or compassion one shows for another. others.
 In sympathy, you feel sorry.  Quadrant 3 (hidden-private) – qualities known only to
 “I know how confusing sons can be. My son confuses me, oneself.
too, and I know how bad that makes you feel.”  Quadrant 4 (unknown) – an empty quadrant it
 Sympathy often shifts the emphasis to the nurse’s feelings symbolizes qualities yet undiscovered by oneself or
C. Acceptance others.
 Nurse who does not become upset or respond negatively
to a client’s outburst, anger, or acting out conveys Types of Relationship
acceptance to the client.
 Acceptance of the person as worthy.  Social relationships involve friendship, socialization, and
 Clear and firm without anger or judgment. companionship or accomplishment of a task.
 Intimate relationships involve the emotional commitment
Positive Regard of two people to each other, including emotional and/or
sexual intimacy.
 Therapeutic relationships are focused on the needs, 2. The working phase involves problem identification,
experiences, feelings, and ideas of the client, not the where the client identifies issues or concerns causing
nurse. problems, and exploitation, when the nurse guides the
client to examine his or her feelings and responses,
Establishing the Therapeutic Relationship develop better coping skills and a more positive self-
image, change behavior, and develop independence.
Therapeutic relationships are focused on the needs, o Clients may use outrageous stories or acting-out
experiences, feelings, and ideas of the client, not the nurse. behaviors known as testing behaviors to test the nurse’s
dependability, trustworthiness, genuine interest, or
- Focus on the client acceptance.
The therapeutic relationship consists of three phases. Task of the Working Phase
1. In the orientation phase, the nurse and client meet, roles
 Maintaining the relationship
are established, the purposes and parameters of future
 Gathering more data
meetings are discussed, expectations are clarified, and the
client’s problems are identified.  Exploring perceptions of reality
o Before meeting the client, nurse reads background  Developing positive coping mechanisms
materials available on the client, becomes familiar  Promoting a self-concept
with any medications the client is taking, gathers  Encouraging verbalization of feelings
necessary paperwork, and arranges for a quiet,  Facilitating behavior change
private, comfortable setting.  Working through resistance
o A time for self-assessment – nurse should consider  Evaluating progress and redefining goals as appropriate
his or her personal strengths and limitations in  Providing opportunities for the client to practice new
working with this client. behaviors
o Nurse builds trust, may establish a contract, and  Promoting independence
discusses confidentiality and the need to share
information with the treatment team. Mandatory Reporting
o Nurse should share appropriate information about
himself or herself at this time: name, reason for being  Sexual abuse
on the unit, and level of schooling,  Child abuse
o “Hello, James. My name is Miss Ames and I will be  Elder abuse
your nurse for the next 6 Tuesdays. I am a senior  Duty to warn
nursing student at the University of Mississippi.”
In the working phase the nurse must be acutely aware that two
The contract should state: common elements can arise:

 Time, place, and length of sessions  Transference is when clients unconsciously transfer
 When sessions will terminate feelings they have for significant persons in their life onto
 Who will be involved in the treatment plan (family the nurse. (client to nurse)
members, health team members)  Countertransference is when the nurse responds to the
 Client responsibilities (arrive on time, end on time) client based on his or her own unconscious needs and
conflicts. (nurse to client)
 Nurse’s responsibilities (arrive on time, end on time,
3. The termination or resolution phase begins when the
maintain confidentiality at all times, evaluate progress
client’s problems are resolved and ends when the
with client, document sessions)
relationship is ended.
Communication o It is important to deal with feelings of anger or
abandonment that may occur. The client especially may
 Confidentiality feel the termination as an impending loss.
 Self-Disclosure
Behaviors that diminish Therapeutic Relationship
 Sensitivity
 Concluding the relationship  Inappropriate boundaries (relationship becomes social or
intimate)
Nurses should not make promises to keep secrets
 Feelings of sympathy and encouraging client dependency
 Client: “I am going to jump off the 14 th floor of my rather than promoting independence
apartment building tonight, but please don’t tell anyone.”  Non-acceptance of client as a person because of his or her
 Nurse: “I cannot keep such a promise, especially if it behaviors, leading to avoidance of the client
involves your safety. I sense you are feeling frightened.
Therapeutic Roles of the Nurse in a Relationship
The staff and I will help you stay safe.”
 Teacher
 Caregiver
 Advocate
 Parent surrogate

Self-awareness Issues

 Self-awareness on the nurse’s part is crucial to developing

therapeutic relationships.
 Values clarification, journaling, group discussions, and
reading will assist with this process.
 Developing self-awareness is a continual, ongoing
process; the nurse needs to plan for self-growth.
Therapeutic Communication  Love-intimacy touch involves tight hugs and kisses
between lovers or close relative.
 Nurse-Patient Relationship  Sexual-arousal touch is used by lovers.
 Boundaries
 Therapeutic Communication Issues

Therapeutic Relationships o Confidentiality

o Privacy and dignity
o Primary mode of implementing interventions in o Student concerns:
psychiatric nursing - What if no one will talk to me?
o Phases: - What if I say the wrong thing?
- Orientation - What if I can’t think of anything to say?
- Working - How can I ask personal questions without prying?
- Termination
o Students may have a pre-interaction phase Therapeutic Communication

Effective Nurse Behavior o Purpose and Goals:

- Expressing feelings
o Active Listening + Silence – let the patient verbalize! - Clarifying problems
o Focus on Client - Addressing client’s concerns
o Self-Awareness - Resolving problems
o Professional Caring: - Role playing alternatives
- Genuine
- Interest Verbal Skills and Behavior
- Acceptance
o Specific clear messages
Ineffective Nurse Behaviors o Therapeutic communication techniques
o Finding and responding to cues
o Excessive Self-Disclosure o Open ended questions vs. close ended questions
o Anxiety o Directive vs. non-directive interactions
o Distracting non-verbal mannerism of behavior
o Excessive talking Non-Verbal Skills and Behavior
o Asking multiple questions
o Rushing the interaction process – ample time. o Distance (3-4 feet or 18-36 inches)
o Posture (slightly leaning forward)
Boundaries o Eye contact
o Facial expression
o General principles of Boundaries in professional o Tone and volume of voice
relationships o Use of touch
o Special issues in mental health: o Involvement in activity
- Client’s perception of Nurse’s action
- Setting for the interaction Distance Zone
- Use of touch
o Intimate zone (0 to 18 inches between people):
Touch comfortable for parents with young children, people who
mutually desire personal contact, or people whispering.
As intimacy increases, the need for distance decreases. Knapp Invasion of this intimate zone by anyone else is
(1980) identified five types of touch: threatening and produces anxiety.
o Personal zone (18 to 36 inches): comfortable between
 Functional-professional touch is used in examinations or
family and friends who are talking
procedures such as when the nurse touches a client to
o Social zone (4 to 12 feet): acceptable for communication
assess skin turgor or a massage therapist performs a
massage. in social work, and business settings
o Public zone (12 to 25 feet): acceptable distance between
 Social-polite touch is used in greeting, such as a
handshake and the “air kisses” some people use to greet a speaker and an audience, small groups, and other
acquaintances, or when a gentle hand guides someone in informal functions.
the correct direction.
Principles guiding Therapeutic Communication
 Friendship-warmth touch involves a hug in greeting, an
arm thrown around the shoulder of a good friend, or the o Establishing trust
backslapping some people use to greet friends and o Be honest
relatives. o Acceptance of person, not necessarily behavior
o Be empathetic, not sympathetic o Assertive communication techniques allow honest
o Non-judgmental attitude, be matter-of-fact expression of thoughts, feelings and opinions without
o Avoid usual social responses or clichés infringing on the rights of others
o Client usually talks more than nurse o The goal of conflict resolution is a negotiated resolution
in which each party feels they have been heard and gets at
Non-Therapeutic Responses or Questions least some of what they want
o Conflicts may involves clients, staff, or both
o Giving approval/disapproval or advice
o Use of good, bad, right or wrong Example of Assertive Communication
o Asking why questions
o Changing the subject due to nurse’s discomfort o Use of “I” statements
o Stereotyped comments o Avoid use of “you” statements
o Challenging, probing o Be specific, avoid generalization
o Defending belittling client’s feelings o Make clear statements
o Validate other person’s feelings or position
Basic Therapeutic Communication Techniques o Include statement of the problem of conflict
o Include outcome that is desired
o Broad openings, general leads
o Offering self, giving information, placing in time or Therapeutic Communication Techniques
sequence, consensual validation
o Encouraging expression of feelings o Using silence – utilizing absence of verbal
o Exploring, focusing communication
o Reflecting, restating
o Encouraging description of perceptions, making o Accepting – giving indication of reception
comparison, suggesting collaboration o Examples:
o Purposeful use of silence “Yes”
o Summarizing “I follow what you said.”
Nodding
Advanced or Specialized Techniques
o Giving Recognition – acknowledging, indicating
o Verbalizing the implied awareness
o Clients with psychotic symptoms o Examples:
- Presenting reality “Good Morning Mr. S.”
- Voicing doubts “You’ve finished your list of things to do”
- Translating into feelings “I noticed that you’ve combed your hair.”
o Clients with dementia and psychotic symptoms
- Avoid correcting misperceptions if possible o Offering self – making one’s self available
- Going along o Examples:
- Distraction and diversion “I’ll sit with you for a while.”
- Promoting interaction and involvement “I’ll stay here with you.”
“I’m interested in what you’re thinking.”
Responses to Inappropriate Behavior
o Giving Broad Openings – allowing a client to take the
o Giving feedback initiative of introducing the topic
o Limit-setting o Examples:
o Confronting incongruences “Is there something you’d like to talk about?”
o Promoting appropriate behavior “What are you talking about?”
o Offering General Leads – giving encouragement to
Anger and Hostility continue
o Examples:
o Verbal de-escalation techniques
“Go on.”
- Ask what client wants or need “And then?”
- Avoid use of “No” “Tell me about it.”
- Offer alternatives encourage to verbalize feelings
- Offer prn medications if indicated o Placing the Event in time and sequence – clarifying the
- Suggest time out to regain control
relationship of events in time
Conflict o Examples:
“What seemed to lead to…?”
“Was this before or after?”
“When did this happen?”
 “Have I heard you correctly?”
o Making Observations – verbalizing the implied
o Examples: o Presenting reality – offering for consideration that
“You appear tense.” which is real
“Are you comfortable when you…?” o Examples:
“I notice that your biting your lip.” “I see no one else in the room.”
“That sound was a car backfiring.”
o Encouraging description of perception – asking the “Your mother is not here. I’m a Nurse.”
client to verbalize what he or she perceives
o Examples: o Voicing doubt – expressing uncertainty about the reality
“Tell me when you fell anxious.” of the client
“What is happening?” o Examples:
“What does the voice seem to be saying?” “Isn’t that unusual?”
“That’s hard to believe.”
o Encouraging comparison – asking that similarities and
differences noted o Seeking consensual validation – searching for mutual
o Examples: understanding, for accord in the meaning of the words.
“Was this something like…?” o Examples:
“Have you had similar experiences?” “Tell me whether my understanding of it agrees with
yours.”
o Restating – repeating the main idea expressed. “Are you using the word to convey the idea
o Examples: that…?”
Client: “I can’t sleep. I stay awake all night.”
Nurse: “You have difficulty sleeping?” o Verbalizing the implied – voicing what the client has
Client: “I’m really. I’m so upset. hinted at or suggested
Nurse: “You’re really mad and upset.” o Examples:
Client: “I can’t talk to you or anyone. It’s a waste of
o Reflecting – directing questions, feelings, or ideas back to time.”
the client Nurse: “You’re feeling that no one
o Examples: understands?”
Client: “Do you think I should tell the doctor…?” Client: “My wife pushes me around just like my mother
Nurse: “Do you think you should?” and sister did.”
Nurse: “Is it your impression that women
o Focusing – concentrating on a single point are domineering?”
o Examples:
“This point seems worth looking at more closely.” o Encouraging expression – asking the client to appraise
“Of all the concerns you’ve mentioned, which one is most the quality of his or her experiences
troublesome?”
o Example:
o Exploring – delving further into a subject or idea “What are your feelings in regard to…?
o Examples: “Does this contribute to your discomfort?”
“Tell me more about that.”
“Would you like to describe it more fully?” o Attempting to translate into feelings – seeking to
“What kind of work?” verbalize feelings that are only expressed indirectly
o Examples:
o Giving information – making available the facts the Client: “I’m dead.”
client needs Nurse: “Are you suggesting that you feel lifeless? Or is it
o Examples: that like seems to have no meaning?”
“My name is…” Client: “I’m way out in the ocean.”
“Visiting hours are…” Nurse: “You seem to feel lonely or
“My purpose in being here is……..” deserted.”
“I’m taking you to…”
o Suggesting collaboration – offering to share, to strive, to
o Seeking information – seeking to make clear that which work together with the client for his or her benefit.
is not meaningful or that is vague o Examples:
o Examples: “Perhaps you and I can discuss and discover what
“I’m not sure that I follow.” produces your anxiety.”
“What would you say is the main point of what you just “Let’s go to your room, and I’ll help you find
said?” what you’re looking for.”
o Summarizing – organizing and summing up that which o Examples:
has gone before. “Now tell me about…”
o Examples: “Tell me your life history…”
“Have I got this straight?”
“You’ve said that…” o Challenging – demanding proof from the client
“During the past hour you and I have o Examples:
discussed…” “But how can you be President of the United States?”
“If you’re dead, why is your heart beating?”
o Encouraging formulation of a plan of action – asking
the client to consider kinds of behavior likely to be o Testing – appraising the client’s degree of insight.
appropriate in future situations. o Examples:
o Examples: “Do you still have the idea that…”
“What could you do to let your anger out “Do you know what kind of hospital this is?”
harmlessly?”
“Next time it comes up, what might you do o Defending – attempting to protect someone or something
to handle it?” from verbal attack
o Examples:
Non-Therapeutic Responses “This hospital has a fine reputation.”
“No one here would lie to you.”
o Reassuring – indicating that there is no cause for anxiety.
False assurance. o Requesting an explanation – asking the client to provide
o Example:
reasons for thoughts, feelings, behaviors and events.
“I wouldn’t worry about that.” o Examples:
“Everything will be alright.”
“Why do you think that?”
“You’re coming along just fine.”
“Why do you feel this way?”
“Why did you do that?”
o Giving approval – sanctioning the client’s behavior or
ideas o Indicating the existence of an external force –
o Examples:
attributing the source of thoughts, feelings and behaviors
“That’s good.” to others, or to outside influences.
“I’m glad that you…” o Examples:
“What makes you say that?”
o Rejecting – refusing to consider or showing contempt for
“Who told you that you were Jesus?
the client’s ideas or behavior. “What made you do that?”
o Examples:
“Let’s not discuss…” o Belittling feelings expressed – misjudging the degree of
“I don’t want to hear about…..” the client’s discomfort.
o Examples:
o Disapproving - Denouncing the client’s behavior or ideas
Client: “I have nothing to live for. I wish I was dead.”
o Example: Nurse: “Everybody gets down in dumps.” or, “I’ve felt
“That’s bad.” that way sometimes.”
“I’d rather you wouldn’t…”
o Using denial – refusing to admit that a problem exists.
o Agreeing – indicating accord with the client o Examples:
o Examples: Client: “I’m nothing.”
“That’s right” Nurse: “Of course you’re something.
“I agree” Client: “I’m dead.”
Nurse: “Don’t be silly.”
o Disagreeing – opposing the client’s ideas
o Examples: o Interpreting – seeking to make conscious that which is
“That’s wrong.” unconscious, telling the client the meaning of his or her
“I definitely disagree with…” experience
“I don’t believe that.” o Examples:
“What you really mean is…”
o Advising – telling the client what to do “Unconsciously you’re saying…”
o Examples:
“I think you should…” o Introducing an unrelated topic – changing the subject
“Why don’t you…” o Examples:
Client: “I’d like to die.”
o Probing – persistent questioning of the client
 Nurse: “Did you have visitors this weekend?” - Do not give any indication that you believe as the client
does
Behavioral Approaches - Do not touch them without thorough explanation
o Depressed, withdrawn Clients
- Spend time developing rapport o Hypersexual, seductive clients
- Involve periods of silence - Maintain a non-judgmental attitude
- Use of moderate tone of voice - Acknowledge that sexual feelings and needs are important
- Avoid being overly cheerful while setting limits on sexual acting-out or inappropriate
- Observe carefully for any cues or expression of suicidal behavior
ideation or intent - Avoid placing yourself in a potentially compromising
- Be alert to sudden mood swings position
- Any suspicion about suicide should be reported - Confront the client about the inappropriate behavior and
immediately let him or her know the behavior is unacceptable
- Expect slow, gradual improvements
- Do not force clients to progress rapidly o Aggressive, violent clients.
- Avoid isolating yourself or being alone with a client who
o Manic, Hyperactive Clients has a potential for violence
- Maintain calm, low-key matter of fact approach to - If a client become aggressive -Give the client space and
effectively de-escalate manic behavior keep some distance away; DO NOT MOVE AWAY
- Do not encourage the client’s antics CLOSER; DO NOT TURN YOUR BACK on the client;
- Decrease stimulation slowly and deliberately leave the area
- Distract clients to less provocative topic and activities to - Use a calm, quiet tone of voice
help calm manic behavior - Encourage the client to verbalize feelings instead of
acting them out
o Manipulative, demanding behavior - Avoid threatening the client in a judgmental, punitive
- Maintain consistent approach with these clients attitude
- Limits must be stated clearly and reinforces in a non-
punitive manner
- Do not attempt to be liked, popular or the favorites of
these clients Post Test
- Withdraw attention if the client begins saying; “you are
[Link] of the following questions is an example of
the only one I can talk to” or “you are the only one who
understands” a closed-ended question?
- Be kind but firm
- Present the idea that all members of the health care team a) Would you like help?
are involved in his care. b) How can I help you?
c) Which game would you like to play?
o Delusional Clients d) Tell me more about yourself.
- Do not convey the idea that the nurse accepts the
delusions as a reality 2. The client says “I can’t go in that room. It’s
- Do not argue with the client
- Present a factual account of the situation as you see it full of rats.” The best response by the nurse

o Hallucinating Clients is:

- Avoid conveying that the hallucinations are real
- Do not converse with the voices, or reinforce client’s a) “Are you sure there are rats in your room?”
beliefs in the hallucination as reality b) “I don’t see any rats in your room.”
- Focus on the feeling surrounding the hallucination c) “Tell me about rats.”
- Closely observe the client to ensure his safety d) “I’ll see that someone gets rid of them for
you.”
o Paranoid Clients
3. The client says; “I’m so mixed up. I can’t
- Be non-threatening
- Answer the client’s questions with little or no hesitations think straight. What do you think I should
- Do not be secretive with these clients
- Do not whisper in front of a paranoid client do?” The best response by the nurse is:
- Avoid joking
- Avoid discussion of controversial issues a) “I think you’ll have to decide that for
- Do not argue with the client about paranoid delusions but yourself.”
interject reality when appropriate b) “Maybe things will seem better tomorrow.”
 c) “We can talk about that later when you’re not so back in 15 minutes.”
upset.”
d) ” What do you think you should do?” c. “Try not to cry. It will all be over soon.”

d. “It seems you’ve been crying. How are you

feeling?”

4. The client tells the nurse “I’m so upset. My 8. A client with terminal metastatic cancer

parents are getting a divorce and I don’t says to the nurse; “My family makes me so

know what to do.” mad. They keep talking about a cure or a

a. “I know what you mean. That is really bad miracle. I wish they’d stop. I’m the one

news.” who’s dying.” The best response by the

b. “Tell me about it.” nurse is:

c. “Maybe they’ll get back together.” a. “Have you told your family how you’re

d. “There’s probably nothing you can do feeling?”

about it.” b. “Let’s talk about your family and their

5. The nurse who is planning to have therapeutic attitude.”

communication with a client must, as a first c. “Well, your family sounds like they have

priority, do which of the following things that positive attitude.”

serves as the foundation of therapeutic d. “You’re feeling angry that your family

communication? keeps hoping for a cure?”

a. establishes rules c. get eye contact 9.A nurse is engaging in a therapeutic

b. develops rapport d. sit within arm’s length relationship with a client. Which of the

6. When working with a client, you decide you following describe a therapeutic

need to maintain a personal distance from this relationship. Select all that apply.

client. Using the distances identified by Hall, a. Identify and meet the needs of the client

who introduced the concept, you would stand how and nurse.

far from the client? b. Assist the client to explore feelings.

a. 6 to 12 inches c. 4.5 to 5 feet c. Encourage the practice of coping skills.

b. 18 inches to 4 feet d. 5.5 feet d. Give advice if the client requests it.

7. The nurse enters a client’s room on the e. Exchange personal information with the

morning before surgery. The client has client

been crying. The best response by the nurse f. Discuss the client’s issues with family

is: members.

a. “Good morning. Why are you crying?” 10. The following interaction is an example of

b. “I see you need some private time. I’ll be which therapeutic communication
technique? B. "Why don't you talk to your mother? You

Client: “I had an accident?” may find out she doesn't feel that way."

Nurse: “Tell me about your accident.” C. "Your mother seems like an understanding

a) Accepting person. I'll help you approach her."

b) General lead D. "You feel that your mother does not want

c) Making an observation you to come back home?"

d) Offering Self 4. A student nurse tells the instructor, "I'm

1. The nurse is interviewing a newly admitted concerned that when a client asks me for

psychiatric client. Which nursing statement advice I won't have a good solution." Which

is an example of offering a "general lead"? should be the nursing instructor's best

A. "Do you know why you are here?" response?

B. "Are you feeling depressed or anxious?" A. "It's scary to feel put on the spot by a

C. "Yes, I see. Go on." client. Nurses don't always have the answer."

D. "Can you chronologically order the events B. "Remember, clients, not nurses, are

that led to your admission? responsible for their own choices and

2. A nurse is assessing a client diagnosed with decisions."

schizophrenia for the presence of C. "Just keep the client's best interests in

hallucinations. Which therapeutic mind and do the best that you can."

communication technique used by the nurse D. "Set a goal to continue to work on this

is an example of making observations? aspect of your practice."

A. "You appear to be talking to someone I do 5. A client states, "You won't believe what my

not see." husband said to me during visiting hours. He

B. "Please describe what you are seeing." has no right treating me that way." Which

C. "Why do you continually look in the corner nursing response would best assess the

of this room?" situation that occurred?

D. "If you hum a tune, the voices may not be A. "Does your husband treat you like this very

so distracting." often?"

3. A client tells the nurse, "I feel bad because B. "What do you think is your role in this

my mother does not want me to return home relationship?"

after I leave the hospital." Which nursing C. "Why do you think he behaved like that?"

response is therapeutic? D. "Describe what happened during your time

A. "It's quite common for clients to feel that with your husband."

way after a lengthy hospitalization."

6. A client is admitted to the inpatient unit of the client is:

mental health center with a diagnosis of paranoid a. "You shouldn't talk like that. You're not a

schizophrenia. He's shouting that the failure."

government of France is trying to assassinate b. "Once the antidepressants start working you

him. Which of the following responses is most will feel better about yourself."

appropriate? c. "Things could be worse. You should be grateful

A. "I think you're wrong. France is a friendly for what you have."

country and an ally of the United States. Their d. "You've been feeling like a failure your entire

government wouldn't try to kill you." life?"

B. "I find it hard to believe that a foreign 9. The nurse is completing the sexual history

government or anyone else is trying to hurt you. section of the admission assessment. The client

You must feel frightened by this." tells the nurse "I don't want to talk about this.

C. "You're wrong. Nobody is trying to kill you." This is private between my spouse and me."

D. "A foreign government is trying to kill you? Which nurse response reflects empathy?

Please tell me more about it." a. "I am a professional nurse and I know what I

7. Every day for the past 2 weeks, a client with am doing."

schizophrenia stands up during group therapy b. "I understand this is difficult for you to talk

and screams, "Get out of here right now! The about, but I have to complete the admission

elevator bombs are going to explode in 3 assessment."

minutes!" The next time this happens, how c. "Yes, I know just how you feel."

should the nurse respond? d. "I know some of these questions are difficult

A. "Why do you think there is a bomb in the for you."

elevator?" 10. The father of a 16 year old who has

B. "That is the same thing you said in yesterday's just been diagnosed with Hodgkin’s

session." disease tells the nurse he does not want

C. "I know you think there are bombs in the his child to know the diagnosis. The

elevator, but there aren't." nurse’s best response would be?

D. "If you have something to say, you must do it a. “It is best if he knows the diagnosis.”

according to our group rules." b. “The cure rate for Hodgkin’s disease is

8. A client with a history of major depression tells high.”

the nurse "I wish I weren't alive. I have been a c. “Let’s talk about why you don’t want him

failure my entire life and I am totally useless to to know.”

anyone." The most therapeutic response to the d. “Would you like someone with Hodgkin’s
to talk to you?”