NURSING EXAM
TEST
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
, NURSING EXAM TEST
292 Final Exam Blueprint Week tx with another nurse or therapist in a different setting, or it could be r/t a change in
nurse assignment (vacation or end of a student’s rotation)
1 (Chapter 3)
Nurse-client relationship is the context in which the nursing process occurs and is
the primary means of providing nursing care. Through careful observation and
thoughtfully guided communication, the nurse assists the client to identify needs and
develop new intellectual and interpersonal skills. The vehicle for all nursing actions
is the nurse-client relationship, and it is the basis for a successful and fulfilling
nursing practice as well as for all nursing actions.
Characteristics that define the therapeutic nurse-client relationship:
● To be therapeutic, relationship must be based on mutual respect
● Relationship is client focused and designed to meet client
needs; emotional needs of nurse cannot interfere
● Interactions are goal oriented
● Goals are mutually established by both client and nurse
● Relationship is collaborative
● Client and nurse engage on decision making
● Relationship promotes the client’s independence to the maximum
extent “nurse works with the client not for the client”
● Relationship promotes the expression of the client’s feelings
● Identifying goals and boundaries early in the relationship helps to
define the professional nature of the relationship; different from a
social relationship
Phases of nurse-client relationship: the trust and respect essential to the therapeutic
process develops over time and progresses through stages:
Pre Interaction Phase: begins before nurse and client meet; nurses prepares for
interaction by reviewing available data (can be a medical record, verbal report, or
other source of introductory info) and considers personal feelings/attitudes that may
relate to the client or interfere with providing care
Orientation Phase: getting acquainted, introductory phase; nurse & client have
their initial encounter. Develop trust & establish the nurse as a significant other,
establish a verbal contract or understanding of nature and boundaries of relationship,
collect data as part of completing nursing assessment, formulate nursing diagnosis,
establish mutually acceptable goals & develop a plan of care.
Working Phase: period during which much of the work is done; therapeutic tasks
include acquiring knowledge, implementing problem-solving interventions,
understanding the relationship of feelings to behaviors, & learning new behaviors
and skills.
Termination Phase: ending of nurse-client relationship. Evaluating outcomes,
expressing feelings about ending the relationship, summarizing achievements, and
transitioning to the next level of care, if applicable. Ideally occurs when goals have
been met, but may be r/t discharge from one level of care, with plans for continued
, NURSING EXAM TEST
Conditions Essential to Development of a Therapeutic Relationship: Active Listening: interactive process b/w nurse and client with goal of
understanding and being understood, involving hearing feedback about what was
Respect: unconditional positive regard; ability to accept another’s beliefs even if heard; SOLER: Sit squarely facing the client, Observe an open posture, Lean
they differ from one’s own feelings and beliefs; an accepting and respectful attitude forward the client, Establish eye contact, Relax
is likely to promote client comfort and facilitate the client’s honest expression of
symptoms, beliefs, thoughts, feelings, and concerns.
1.1 NONVERBAL TECHNIQUES:
Trust: basis of therapeutic relationship; client’s ability to trust will be influenced by
how well this developmental task was accomplished during the early interactions.
Genuineness: nurse ability to be oneself, or to be real; helps client to see the shared
humanity b/w client and nurse.
Empathy: ability to put oneself in another’s place and see the world as the
other person does; communicate understanding of client’s thoughts and feelings
Rapport: acceptance, warmth, interest
Transference: client “transfers” feelings and behavioral dispositions formed
towards a person from the past; unconscious feelings, desires, & actions
Countertransference: nurse’s behavioral and emotional response to the client;
positive or negative associations, either case can interfere with therapeutic
relationship
● Signs: inappropriate or exaggerated emotional responses toward the
client, feelings of exhaustion, stereotyped or fixed responses regardless
of what the client is saying, impulses to treat the client in a special way,
and extreme over- or under involvement with the client
● Self Awareness: Recognize emotional & behavioral responses.
Acknowledge these reactions are normal. Examine reasons for reactions
& potential consequences. Discuss with friend, family, or mentor
Conditions that influence the nurse-client relationship:
Client Factors:
● Religion and Culture- styles of communication vary across cultures and
religions; Nurse should clarify person,a preferences w/ each client;
Nurse needs to be sensitive and respectful
● Age/Developmental- communication must be appropriate to client’s
level of comprehension
Nurse Factors:
Boundaries: limits that help establish & maintain nose and client roles in
relationship; understand differences b/w professional and social relationships;
self-disclosures: revealing personal info about oneself; goal of benefiting client and
therapeutic process; should never be used for selfish reasons
Touch: used to convey caring, provide comfort, or other support; essential to inform
clients before touching them for physical care
Communication Techniques:
, NURSING EXAM TEST
● Facial Expression: variety of emotions, tears communication sadness, Projection: Attributing to others an objectionable trait or feeling that really
smile can communicate warmth or happiness emanates from oneself. My husband is cheating on me.
● Eye Contact: varies across cultures
Rationalization: substituting a fictitious, socially acceptable reason for the genuine,
● Posture: standing tall communicates confidence and self esteem, hands
unacceptable reason for one’s wishes or actions. I would have helped you if I could,
on hips or clasped behind the head conveys superiority
but i had to take my dog to the vet.
1.2 VERBAL TECHNIQUES:
● Therapeutic communication: silence, accepting, recognition, offering self,
broad openings, general leads, make observations, description of
perceptions, comparisons, restating, reflecting, focusing, exploring,
clarifying, present reality, voice doubt, state the implied, translate words
into feelings, plan of action
● Nontherapeutic communication: reassurance, rejecting, approving or
disapproving, agree or disagree, giving advice, probing, defending,
request explanation, indicate external source power, minimize feelings,
clichés, denial, interpreting, changing topic
Content of the Message: Verbal communication: vocabulary;
denotative/connotative meaning (shared meaning); Clarity; timing & relevance;
Pacing; Intonation of voice Ego Defense Mechanisms:
Compensation: exaggerating one trait to make up for feelings of inadequacy or
inferiority in another dimension. Physically small man verbally bullies his
employees
Conversion: expressing unconscious emotional conflicts through a physical
symptom w/ demonstrable organic basis. Young women wakes up paralyzed from
the waist down on the morning of her wedding day
Denial: failing to perceive some threatening object or event in the external world.
A woman sets a place for dinner for her husband, who has just been killed
Displacement: attributing feelings to a person or object that are really directed at
another person or object. Woman kicks her cat after a telephone argument w/ boss
Fixation: remaining stuck in a developmental stage. Husband depends totally on his
wife for most of his ADLs
Identification: integrating desired attributes of an admired person to compensate
for perceived inadequacy. Shy adolescent styles her hair the same way of popular
rockstar
Introjection: incorporating another person to avoid the threat posed by the person
or by one’s own urges. Psychotically depressed woman attempts suicide to kill her
mother, whom she states is in her stomach
Isolation: severing the connection b/w thoughts and feelings assoc w/ an event so
the event can conscious w.o undue anxiety.
TEST
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
, NURSING EXAM TEST
292 Final Exam Blueprint Week tx with another nurse or therapist in a different setting, or it could be r/t a change in
nurse assignment (vacation or end of a student’s rotation)
1 (Chapter 3)
Nurse-client relationship is the context in which the nursing process occurs and is
the primary means of providing nursing care. Through careful observation and
thoughtfully guided communication, the nurse assists the client to identify needs and
develop new intellectual and interpersonal skills. The vehicle for all nursing actions
is the nurse-client relationship, and it is the basis for a successful and fulfilling
nursing practice as well as for all nursing actions.
Characteristics that define the therapeutic nurse-client relationship:
● To be therapeutic, relationship must be based on mutual respect
● Relationship is client focused and designed to meet client
needs; emotional needs of nurse cannot interfere
● Interactions are goal oriented
● Goals are mutually established by both client and nurse
● Relationship is collaborative
● Client and nurse engage on decision making
● Relationship promotes the client’s independence to the maximum
extent “nurse works with the client not for the client”
● Relationship promotes the expression of the client’s feelings
● Identifying goals and boundaries early in the relationship helps to
define the professional nature of the relationship; different from a
social relationship
Phases of nurse-client relationship: the trust and respect essential to the therapeutic
process develops over time and progresses through stages:
Pre Interaction Phase: begins before nurse and client meet; nurses prepares for
interaction by reviewing available data (can be a medical record, verbal report, or
other source of introductory info) and considers personal feelings/attitudes that may
relate to the client or interfere with providing care
Orientation Phase: getting acquainted, introductory phase; nurse & client have
their initial encounter. Develop trust & establish the nurse as a significant other,
establish a verbal contract or understanding of nature and boundaries of relationship,
collect data as part of completing nursing assessment, formulate nursing diagnosis,
establish mutually acceptable goals & develop a plan of care.
Working Phase: period during which much of the work is done; therapeutic tasks
include acquiring knowledge, implementing problem-solving interventions,
understanding the relationship of feelings to behaviors, & learning new behaviors
and skills.
Termination Phase: ending of nurse-client relationship. Evaluating outcomes,
expressing feelings about ending the relationship, summarizing achievements, and
transitioning to the next level of care, if applicable. Ideally occurs when goals have
been met, but may be r/t discharge from one level of care, with plans for continued
, NURSING EXAM TEST
Conditions Essential to Development of a Therapeutic Relationship: Active Listening: interactive process b/w nurse and client with goal of
understanding and being understood, involving hearing feedback about what was
Respect: unconditional positive regard; ability to accept another’s beliefs even if heard; SOLER: Sit squarely facing the client, Observe an open posture, Lean
they differ from one’s own feelings and beliefs; an accepting and respectful attitude forward the client, Establish eye contact, Relax
is likely to promote client comfort and facilitate the client’s honest expression of
symptoms, beliefs, thoughts, feelings, and concerns.
1.1 NONVERBAL TECHNIQUES:
Trust: basis of therapeutic relationship; client’s ability to trust will be influenced by
how well this developmental task was accomplished during the early interactions.
Genuineness: nurse ability to be oneself, or to be real; helps client to see the shared
humanity b/w client and nurse.
Empathy: ability to put oneself in another’s place and see the world as the
other person does; communicate understanding of client’s thoughts and feelings
Rapport: acceptance, warmth, interest
Transference: client “transfers” feelings and behavioral dispositions formed
towards a person from the past; unconscious feelings, desires, & actions
Countertransference: nurse’s behavioral and emotional response to the client;
positive or negative associations, either case can interfere with therapeutic
relationship
● Signs: inappropriate or exaggerated emotional responses toward the
client, feelings of exhaustion, stereotyped or fixed responses regardless
of what the client is saying, impulses to treat the client in a special way,
and extreme over- or under involvement with the client
● Self Awareness: Recognize emotional & behavioral responses.
Acknowledge these reactions are normal. Examine reasons for reactions
& potential consequences. Discuss with friend, family, or mentor
Conditions that influence the nurse-client relationship:
Client Factors:
● Religion and Culture- styles of communication vary across cultures and
religions; Nurse should clarify person,a preferences w/ each client;
Nurse needs to be sensitive and respectful
● Age/Developmental- communication must be appropriate to client’s
level of comprehension
Nurse Factors:
Boundaries: limits that help establish & maintain nose and client roles in
relationship; understand differences b/w professional and social relationships;
self-disclosures: revealing personal info about oneself; goal of benefiting client and
therapeutic process; should never be used for selfish reasons
Touch: used to convey caring, provide comfort, or other support; essential to inform
clients before touching them for physical care
Communication Techniques:
, NURSING EXAM TEST
● Facial Expression: variety of emotions, tears communication sadness, Projection: Attributing to others an objectionable trait or feeling that really
smile can communicate warmth or happiness emanates from oneself. My husband is cheating on me.
● Eye Contact: varies across cultures
Rationalization: substituting a fictitious, socially acceptable reason for the genuine,
● Posture: standing tall communicates confidence and self esteem, hands
unacceptable reason for one’s wishes or actions. I would have helped you if I could,
on hips or clasped behind the head conveys superiority
but i had to take my dog to the vet.
1.2 VERBAL TECHNIQUES:
● Therapeutic communication: silence, accepting, recognition, offering self,
broad openings, general leads, make observations, description of
perceptions, comparisons, restating, reflecting, focusing, exploring,
clarifying, present reality, voice doubt, state the implied, translate words
into feelings, plan of action
● Nontherapeutic communication: reassurance, rejecting, approving or
disapproving, agree or disagree, giving advice, probing, defending,
request explanation, indicate external source power, minimize feelings,
clichés, denial, interpreting, changing topic
Content of the Message: Verbal communication: vocabulary;
denotative/connotative meaning (shared meaning); Clarity; timing & relevance;
Pacing; Intonation of voice Ego Defense Mechanisms:
Compensation: exaggerating one trait to make up for feelings of inadequacy or
inferiority in another dimension. Physically small man verbally bullies his
employees
Conversion: expressing unconscious emotional conflicts through a physical
symptom w/ demonstrable organic basis. Young women wakes up paralyzed from
the waist down on the morning of her wedding day
Denial: failing to perceive some threatening object or event in the external world.
A woman sets a place for dinner for her husband, who has just been killed
Displacement: attributing feelings to a person or object that are really directed at
another person or object. Woman kicks her cat after a telephone argument w/ boss
Fixation: remaining stuck in a developmental stage. Husband depends totally on his
wife for most of his ADLs
Identification: integrating desired attributes of an admired person to compensate
for perceived inadequacy. Shy adolescent styles her hair the same way of popular
rockstar
Introjection: incorporating another person to avoid the threat posed by the person
or by one’s own urges. Psychotically depressed woman attempts suicide to kill her
mother, whom she states is in her stomach
Isolation: severing the connection b/w thoughts and feelings assoc w/ an event so
the event can conscious w.o undue anxiety.
