RPNCE - Registered Psychiatric Nurse of Canada Examination Therapeutic Relationships and Communication Questions and Answers — Questions and Answers
Question 1: A client admitted for anxiety states, 'I'm so worried about this new medication. What if I have a terrible reaction?' Which of the following responses by the Registered Psychiatric Nurse (RPN) best demonstrates the therapeutic communication technique of exploring?
- "Don't worry, adverse reactions are very rare with this medication."
- "Tell me more about what specifically concerns you about having a reaction." (Correct answer)
- "Why would you think you'd have a terrible reaction?"
- "I can see you're anxious, but the doctor has prescribed what's best for you."
Correct answer: "Tell me more about what specifically concerns you about having a reaction."
The correct answer, 'Tell me more about what specifically concerns you about having a reaction,' is an example of exploring. This technique encourages the client to delve deeper into their feelings and concerns, which is essential for a therapeutic relationship. The other options are non-therapeutic: giving false reassurance, asking 'why' which can be perceived as accusatory, and dismissing the client's feelings.
Question 2: During the termination phase of the therapeutic relationship, a client becomes visibly upset and says, 'I feel like I'm losing my only support system.' What is the RPN's most appropriate action?
- Immediately extend the therapeutic relationship for a few more weeks.
- Acknowledge the client's feelings and review the progress made during therapy. (Correct answer)
- Suggest that the client is becoming overly dependent and needs to be more self-reliant.
- Provide personal contact information to stay in touch after termination.
Correct answer: Acknowledge the client's feelings and review the progress made during therapy.
The termination phase can be challenging for clients. The most therapeutic approach is to validate their feelings, reinforce their accomplishments, and discuss future coping strategies. Extending the relationship, suggesting dependency, or blurring boundaries by offering personal contact information are all non-therapeutic and unprofessional actions.
Question 3: Which of the following is a core component of establishing a therapeutic relationship, as outlined in the RPNCE competencies?
- Offering personal advice based on the nurse's own life experiences.
- Maintaining a strictly formal and distant demeanor to ensure professionalism.
- Developing rapport and promoting trust through genuineness and empathy. (Correct answer)
- Focusing the conversation primarily on the nurse's assessment of the client's problems.
Correct answer: Developing rapport and promoting trust through genuineness and empathy.
According to the RPNCE entry-level competencies, developing rapport and promoting trust through mutual respect, genuineness, empathy, acceptance, and collaboration are fundamental to establishing a therapeutic relationship. Offering personal advice, being overly distant, or dominating the conversation are contrary to a client-centered approach.
Question 4: A client tells the RPN, 'I didn't take my morning medication because I'm feeling fine today.' The RPN responds, 'So, you felt well this morning and decided not to take your medication.' This response is an example of which therapeutic technique?
- Confrontation
- Giving recognition
- Reflecting
- Restating (Correct answer)
Correct answer: Restating
Restating involves repeating the main idea of what the client has said. This lets the client know they are being heard and understood. Reflecting would direct the focus back to the client's feelings (e.g., 'You seem confident in your decision'). Confrontation would challenge the client's statement, and giving recognition would involve praise.
Question 5: An RPN is working with a client who has a history of trauma. The nurse makes a conscious effort to be aware of their own personal beliefs and emotional responses during interactions to prevent them from affecting client care. This practice is best described as:
- Countertransference
- Therapeutic use of self (Correct answer)
- Consensual validation
- Boundary violation
Correct answer: Therapeutic use of self
Therapeutic use of self is the deliberate and conscious process of using one's own personality, insights, and judgments as part of the therapeutic process. It involves a high degree of self-awareness to ensure the relationship remains professional, client-centered, and therapeutic. Countertransference is the nurse's emotional reaction to the client, which this practice aims to manage.
Question 6: A client in a group therapy session remains silent and avoids eye contact. Which action by the RPN is most therapeutic?
- Insist that the client speaks to the group to overcome their shyness.
- Make an observation, such as, 'I notice you've been quiet today. Is there anything you'd like to share?' (Correct answer)
- Allow the silence to continue indefinitely without intervention.
- Ask other group members why they think the client is not participating.
Correct answer: Make an observation, such as, 'I notice you've been quiet today. Is there anything you'd like to share?'
Making an observation is a therapeutic technique that states what the nurse perceives without being judgmental or demanding. It acknowledges the client's behavior and provides a gentle, open-ended invitation to participate without pressure. Forcing the client to speak or putting them on the spot is counterproductive. While silence can be therapeutic, prolonged silence in this context may indicate unaddressed issues.
RPNCE - Registered Psychiatric Nurse of Canada Examination Therapeutic Relationships and Communication Questions and Answers
A client admitted for anxiety states, 'I'm so worried about this new medication.
What if I have a terrible reaction?' Which of the following responses by the Registered Psychiatric Nurse (RPN) best demonstrates the therapeutic communication technique of exploring?