Arnold: Interpersonal Relationships, 6th Edition

Chapter 01: Theoretical Perspectives and Contemporary Dynamics

Test Bank

MULTIPLE CHOICE

	1.	Which of the following best describes the role of theory in the nurse-client relationship?
a.	Nursing theory provides a common language among nurses.	
b.	Nursing theory is the essence of the nurse-client relationship.	
c.	Nursing theory varies with changes in health care delivery.	
d.	Nursing theory offers a systematic organized way to view and interpret nursing care.	

ANS:	D
Nursing theory informs nursing practice by furnishing a distinct body of nursing knowledge that nurses universally recognize as unique to their discipline, offering a systematic organized way to view and interpret nursing care. Theory does provide a common language for nurses, but this is not the role of theory in the nurse-client relationship. Theory acts as a framework or guide; it is not the essence of the relationship. Theory provides a common framework for describing practice.

DIF:	Cognitive Level: Comprehension	REF:	p. 5	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Safe, Effective Care Environment: Management of Care

	2.	When caring for a client, the nurse demonstrates application of modern nursing theory when:
a.	Administering insulin to a client with diabetes	
b.	Assisting a physician with a pelvic examination	
c.	Teaching a client techniques of breast self-examination	
d.	Making a client’s bed	

ANS:	C
Modern nursing theorists, such as Rosemarie Parse and Betty Newman, incorporate a stronger emphasis on health promotion, client strengths, and preventive nursing strategies to facilitate health and well-being in line with today’s conceptualization of health and well-being. Administering insulin, assisting a physician, and making a client’s bed are all nursing tasks, and modern nursing theory puts less emphasis on tasks and systems.

DIF:	Cognitive Level: Application	REF:	p. 2-3	
TOP:	Step of the Nursing Process: Implementation	
MSC:	Client Needs: Health Promotion and Maintenance

	3.	Nursing theory originated with which of the following nursing leaders?
a.	Virginia Henderson	
b.	Martha Rogers	
c.	Dorothea Orem	
d.	Florence Nightingale	

ANS:	D
The first nursing theorist was Florence Nightingale. She wrote the first published work on nursing theory in which she differentiated the practice of nursing from other disciplines. Virginia Henderson, Martha Rogers, and Dorothea Orem began their theory development after Florence Nightingale.

DIF:	Cognitive Level: Knowledge	REF:	p. 2	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Management of Care		

	4.	Virginia Henderson, Jean Watson, Dorothea Orem, and Rosemary Parse are best known for:
a.	Developing nursing theories	
b.	Linking theory to practice	
c.	Validating existing theory	
d.	Measuring clinical outcomes	

ANS:	A
These are some of the nursing leaders who developed the original theories of nursing. Linking theory to practice, validating existing theory, and measuring clinical outcomes are modern practice-based theories.

DIF:	Cognitive Level: Comprehension	REF:	p. 2-3 | p. 5 | p. 8	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Management of Care		

	5.	Nursing’s metaparadigm, or worldview, distinguishes the nursing profession from other disciplines and emphasizes its unique functional characteristics. The four key concepts that form the foundation for all nursing theories are:
a.	Caring, compassion, health promotion, and education	
b.	Respect, integrity, honesty, and advocacy	
c.	Person, environment, health, and nursing	
d.	Nursing, teaching, caring, and health promotion	

ANS:	C
Nursing’s metaparadigm, or worldview, distinguishes the nursing profession from other disciplines, and emphasizes its unique functional characteristics. Four key concepts–person, environment, health, and nursing–form the foundation for all nursing theories.

DIF:	Cognitive Level: Knowledge	REF:	p. 3	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Management of Care		

	6.	When admitting a client to the medical-surgical unit, the nurse asks the client about cultural issues. The nurse is demonstrating use of the concept of:
a.	Person	
b.	Environment	
c.	Health	
d.	Nursing	

ANS:	B
The concept of environment includes the cultural, developmental, and biopsychosocial conditions that influence a client’s perceptions or behavior. “Person” is the recipient of care; “health” is a dynamic and harmonious equilibrium of all elements and forces making up and surrounding a human being; and “nursing” actions emphasize health and well being.

DIF:	Cognitive Level: Application	REF:	p. 3	
TOP:	Step of the Nursing Process: Assessment		
MSC:	Client Needs: Psychosocial Integrity		

	7.	A young mother tells the nurse, “I’m worried because my son needs a blood transfusion. I don’t know what to do, because blood transfusions cause AIDS.” Which central nursing concept is represented in this situation?
a.	Environment	
b.	Caring	
c.	Health	
d.	Person	

ANS:	D
Person-centered care is mandated as an essential characteristic of contemporary health care. Nursing values important to health care are caring, holism, health promotion, continuity of care, family-based care, and working in partnership with individual and community agendas. The concept of environment includes the cultural, developmental, and biopsychosocial conditions that influence a client’s perceptions or behavior. Caring is recognized as a hallmark of quality nursing practice and an essential concept in effective nurse-client relationships. Health is a dynamic and harmonious equilibrium of all elements and forces making up and surrounding a human being.

DIF:	Cognitive Level: Application	REF:	p. 3 | p. 8 | p. 18	
TOP:	Step of the Nursing Process: Implementation	
MSC:	Client Needs: Psychosocial Integrity		

	8.	The nurse performs a dressing change using sterile technique. This is an example of which pattern of knowledge?
a.	Empirical	
b.	Personal	
c.	Aesthetic	
d.	Ethical	

ANS:	A
Empirical knowledge is the scientific rationale for skilled nursing interventions. Personal ways of knowing allow the nurse to understand and treat each individual as a unique person. Aesthetic ways of knowing allow the nurse to connect in different and more meaningful ways. Ethical ways of knowing refer to the moral aspects of nursing.

DIF:	Cognitive Level: Comprehension	REF:	p. 6	
TOP:	Step of the Nursing Process: Implementation	
MSC:	Client Needs: Management of Care		

	9.	The nurse-client relationship as described by Peplau:
a.	Would not be useful in a short-stay unit	
b.	Allows personal and social growth to occur only for the client	
c.	Facilitates the identification and accomplishment of therapeutic goals	
d.	Focuses on maintaining a personal relationship between the nurse and client	

ANS:	C
Peplau’s model describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being. Despite the brevity of the relationship, Peplau’s basic principles of building rapport, developing a working partnership, and terminating a relationship remain relevant. One of Peplau’s basic principles is terminating the relationship.

DIF:	Cognitive Level: Knowledge	REF:	p. 7	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	10.	Which of the following is the purpose of the nurse-client relationship?
a.	Foster spiritual well-being of the client	
b.	Foster understanding of the client’s health problem	
c.	Foster physical health of the client	
d.	Foster a partnership with the client	

ANS:	D
The purpose of the nurse-client relationship is to have a meaningful shared experience in which personal/social growth occurs for both nurse and client. Spiritual well-being can result from a nurse-client relationship, but that is not the purpose. Understanding of the client’s problem can result from a successful nurse-client relationship, but it also is not the purpose. The nurse-client relationship can foster changes in health status and well-being, but it is not the purpose.

DIF:	Cognitive Level: Knowledge	REF:	p. 12	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	11.	The identification phase of the nurse-client relationship:
a.	Sets the stage for the rest of the relationship	
b.	Correlates with the assessment phase of the nursing process	
c.	Focuses on therapeutic goals to enhance client and family well-being	
d.	Uses community resources to help resolve health care issues	

ANS:	C
Peplau’s mid-range theory of interpersonal relationships describes how the nurse-client relationship can facilitate the identification and accomplishment of therapeutic goals to enhance client and family well-being. The orientation phase sets the stage for the rest of the relationship and correlates with the assessment phase. Using community resources to help resolve health care issues is the termination phase.

DIF:	Cognitive Level: Knowledge	REF:	p. 7	
TOP:	Step of the Nursing Process: Planning		
MSC:	Client Needs: Management of Care		

	12.	Anger directed at the nurse by the family of a client newly diagnosed with cancer can best be understood in the context of:
a.	Harry Stack Sullivan’s model of therapeutic relationship	
b.	Abraham Maslow’s hierarchy of needs	
c.	Carl Jung’s theoretical perspectives	
d.	Sigmund Freud’s ego defense mechanisms	

ANS:	D
Freud believed that people protect themselves against anxiety through the use of unconscious ego defense mechanisms. Defensive behaviors that compromise the development of a therapeutic relationship can reflect a person’s use of ego defense mechanisms. Sullivan introduced the idea of the therapeutic relationship as a human connection that heals. Maslow’s hierarchy of needs theory proposes that people are motivated to meet their needs in an ascending order, beginning with meeting basic survival needs, moving into psychological and social spheres as essential needs are satisfied, and ending with self-actualization. Jung’s theoretical perspectives provide nurses with a basis for examining the complex dimensions of gender roles and our universal heritage as human beings. He referred to a person’s universal heritage as the collective unconscious and suggested that forces from the past continue to influence behaviors in the present.

DIF:	Cognitive Level: Application	REF:	p. 9-11	
TOP:	Step of the Nursing Process: Implementation	
MSC:	Client Needs: Psychosocial Integrity		

	13.	Which of the following theorists viewed the professional’s relationship with the client as a means to help the client grow and change?
a.	Maslow	
b.	Rogers	
c.	Erikson	
d.	Beck	

ANS:	B
According to Carl Rogers, if the professional could provide a certain type of relationship, the client would find the capacity to grow and change. Maslow focused on a hierarchy of needs. Erikson talked about developmental stages. Beck focused on cognitive distortions.

DIF:	Cognitive Level: Knowledge	REF:	p. 12	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	14.	When providing medication education to a group of clients diagnosed with schizophrenia, it would be most helpful for the nurse to keep in mind the concepts of:
a.	Freud’s transference and countertransference	
b.	Rogers’ person-centered model	
c.	Maslow’s self-actualization	
d.	Erikson’s principles of personality development	

ANS:	B
Rogers’ concepts are applicable for nurse-client teaching formats. Transference and counter-transference may occur, but in providing education the most helpful concepts are those of Rogers. Self-actualization is the highest level of need satisfaction; it would not be useful in providing medication education. Erikson describes four stages of the life cycle to help the person develop identity. These would not be useful in providing medication education.

DIF:	Cognitive Level: Analysis	REF:	p. 12	
TOP:	Step of the Nursing Process: Planning		
MSC:	Client Needs: Health Promotion and Maintenance

	15.	Which of the following statements about communication theory is true?
a.	Primates are able to learn new languages to share ideas and feelings.	
b.	Concepts include only verbal communication.	
c.	Perceptions are clarified through feedback.	
d.	Past experience does not influence communication.	

ANS:	C
Feedback is the only way to know that one’s perceptions about meanings are valid. Human communication is unique. Only human beings have large vocabularies and are capable of learning new languages as a means of sharing their ideas and feelings. Communication includes language, gestures, and symbols to convey intended meaning, to exchange ideas and feelings, and to share significant life experience. To encode a message appropriately requires a clear understanding of the receiver’s mental frame of reference (e.g., feelings, personal agendas, past experiences) and knowledge of its purpose or intent.

DIF:	Cognitive Level: Knowledge	REF:	p. 13-14	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	16.	In the circular transactional model of communication:
a.	Systems theory concepts are included	
b.	People take only complementary roles in the communication	
c.	The context of the communication is unimportant	
d.	The purpose of communication is to influence the receiver	

ANS:	A
A circular model is a transactional model that expands linear models to include the context of the communication, feedback loops, and validation. With this model, the sender and receiver construct a mental picture of the other, which influences the message and includes perceptions of the other person’s attitude and potential reaction to the message. In this sense, transactional models reflect system theory with feedback and context added to the linear model. Circular models take into account the role relationships between communicators. People take either symmetrical or complementary roles in communicating. The context is very important. Influencing the receiver is the purpose in the linear model of communication.

DIF:	Cognitive Level: Comprehension	REF:	p. 15	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	17.	The nurse recognizes that feedback:
a.	Does not allow for correction of original information	
b.	Involves only verbal responses	
c.	Does not include validation	
d.	Allows the system to maintain its original information	

ANS:	D
Feedback (from the receiver or the environment) allows the system to correct or maintain its original information. Feedback involves both verbal and nonverbal responses. Feedback is the only way to know that one’s perceptions about meanings are valid.

DIF:	Cognitive Level: Knowledge	REF:	p. 14-15	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Psychosocial Integrity		

	18.	Which of the following statements best represents therapeutic communication when a student discovers a client crying in bed?
a.	“I am the nurse who will be doing your treatments today.”	
b.	“Will you listen to me so I can help you get better?”	
c.	“This is what is going to happen during surgery.”	
d.	“Can we talk about what seems to be bothering you?”	

ANS:	D
Asking about what is bothering the client is goal-directed. Its purpose is to promote client well-being. “I am the nurse who will be doing your treatments today” is a statement of fact and it ignores the client’s emotional needs. “Will you listen to me so I can help you get better?” is not goal-directed and does not involve mutuality. “This is what is going to happen during surgery” is simply one-way. It does not engage the client in a therapeutic manner.

DIF:	Cognitive Level: Application	REF:	p. 15	
TOP:	Step of the Nursing Process: Assessment		
MSC:	Client Needs: Psychosocial Integrity		

	19.	The current focus of the health care delivery system can be best described by:
a.	Telehealth	
b.	The medical model	
c.	Nursing’s metaparadigm	
d.	Capitated health care	

ANS:	C
The current focus of health care delivery is on using a public health framework rather than a traditional model. Nursing’s metaparadigm, with the emphasis on the interrelationship between person, environment, health, and nursing, stresses health promotion and disease prevention. Telehealth is part of the current system, but not the focus. The medical model treatment of disease was a past focus of health care. Capitated health care focuses on resource allocation.

DIF:	Cognitive Level: Comprehension	REF:	p. 3	
TOP:	Step of the Nursing Process: All phases		
MSC:	Client Needs: Health Promotion and Maintenance