Chapter 08: Therapeutic Relationships |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, ―This patient is like one of my grandparents … so helpless.‖ Which response is the nurse demonstrating? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reaction ANS: B Countertransference is the nurse‘s transference or response to a patient that is based on the nurse‘s unconscious needs, conflicts, problems, or view of the world. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 8-10 to 12, 35 (Table 8-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 2. Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. You must have been very upset when you tried to hurt yourself.‖ b. It makes me sad to see you going through such a difficult experience.‖ c. If you tell me what is troubling you, I can help you solve your problems.‖ d. Suicide is a drastic solution to a problem that may not be such a serious matter.‖ ANS: A Empathy permits the nurse to see an event from the patient‘s perspective, understand the patient‘s feelings, and communicate this to the patient. The incorrect responses are nurse- centered (focusing on the nurse‘s feelings rather than the patient‘s), belittling, and sympathetic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 8-22, 23 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 3. After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? a. The patient‘s reactions toward the nurse seem realistic and appropriate. b. The patient states, ―Talking to you feels like talking to my parents.‖ c. The nurse feels unusually happy when the patient‘s mood begins to lift. d. The nurse develops a trusting relationship with the patient. ANS: C Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable. One incorrect response suggests transference. A trusting relationship with the patient is desirable. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 8-10 to 12, 35 (Table 8-2) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity 4. A patient says, ―Please don‘t share information about me with the other people.‖ How should the nurse respond? a. I will not share information with your family or friends without your permission, but I will share information about you with other staff.‖ b. A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know.‖ c. It 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 others.‖ d. I 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 patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff needs to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse–patient contract is established, and suggest mutual problem solving. The relationship must be patient centered. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 8-18, 19 TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment 5. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, ―I really need to talk to you.‖ The nurse should a. invite the interrupting patient to join in the session with the current patient. b. say to the interrupting patient, ―I am not available to talk with you at the present time.‖ c. end the unproductive session with the current patient and spend time with the interrupting patient. d. tell the interrupting patient, ―This session is 5 more minutes; then I will talk with you.‖