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A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A "You have everything to live for." B "Why do you see yourself as a failure?" C "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"
D Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings. In addition, use of the word "why" is nontherapeutic.
When the community health nurse visits a patient at home, the patient states, "I haven't slept the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient. A "I see." B "Really?" C. "You're having difficulty sleeping?" D "Sometimes, I have trouble sleeping too."
C. "You're having difficulty sleeping?" The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.
A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat? A Using open-ended questions and silence B Sharing personal preference regarding food choices C Documenting reasons why the patient does not want to eat D Offering opinions about the necessity of adequate nutrition
A
A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing? A Denial B Projection C Regression D Rationalization
A Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.
A patient diagnosed with terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A "Have you shared your feelings with your family?" B "I think we should talk more about your anger with your family." C "You're feeling angry that your family continues to hope for you to be cured?" D "You are probably very depressed, which is understandable with such a diagnosis."
C Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feeling, this is non-therapeutic in the one-to-one relationship.
On review of the patient's record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior? A Fearfulness regarding treatment measures. B Anger and aggressiveness directed toward others. C An understanding of the pathology and symptoms of the diagnosis. D A willingness to participate in the planning of the care and treatment plan.
D In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient's understanding of their illness, only of their desire for help.
A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY? A Contact the patient's health care provider (HCP). B Call the patient's family to arrange for transportations. C Attempt to persuade the patient to stay for only a few more days. D Tell the patient that leaving would likely result in an involuntary commitment.
A In general, patients seek, voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient's' permission. While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to staying "a few more days" has little value and will not likely be successful. Many states require that the patient submit a written release notice to the facility staff members, who reevaluate the patient's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.
When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? A Monitor closely for harm to self or others. B Assist in completing an application for admission. C Supply the patient with written information about their mental illness. D Provide an opportunity for the family to discuss why they felt the admission was needed.
A Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patient's' admission.
The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is MOST APPROPRIATE for this phase? A Planning short-term goals B Making appropriate referrals C Developing realistic solutions D Identifying expected outcomes
B Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals and dealing with the common behaviors associated with termination. The remaining options identify tasks appropriate for the working phase of the relationship.
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to the nurse, "How is Mary doing? She is my best friend and is seen at your clinic every week." Which is the MOST APPROPRIATE nursing response? A "I can not discuss any patient situation with you." B "If you want to know about Mary, you need t ask her yourself." C "Only because you're worried about a friend, I'll tell you that she is improving." D "Being her friend, you know she is having a difficult time and deserves her privacy."
A The nurse is required to maintain confidentiality regarding the patient and the patient's care. Confidentiality is basic to the therapeutic relationship and is a patient's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain patient confidentiality.
The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. A Libel B Battery C Assault D Slander E False Imprisonment
BCE False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient. Assault and battery are related to the act of restraining the patient in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the patient
Libel
A written defamation of a person's character, reputation, business, or property rights.
Slander
Spoken defamation
battery
Illegal touching of another person
assault
A threatened or attempted physical attack by someone who appears to be able to cause bodily harm if not stopped
The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply. A Restating B Listening C Asking the patient "Why?" D Maintaining neutral responses E Providing acknowledgment and feedback F Giving advice and approval or disapproval
ABDE Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.
A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism? A Denial B Projection C Rationalization D Intellectualization
A Denial is refusal to admit to a painful reality and may be a response by a victim of sexual abuse. In this case the patient is not acknowledging the trauma of the assault either verbally or nonverbally. Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else. Rationalization is justifying the unacceptable attributes about oneself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.
A patient's unresolved feelings related to loss would be MOST LIKELY observed during which phase of the therapeutic nurse-patient relationship? A Trusting B Working C Orientation D Termination
In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. The remaining options are not specifically associated with this issue of unresolved feelings.
Which statement demonstrates the BEST understanding of the nurse's role regarding ensuring that each client's rights are respected? A "Autonomy is the fundamental right of each and every client." B "A patient's rights are guaranteed by both state and federal laws." C "Being respectful and concerned will ensure that I'm attentive to my patient's rights." D "Regardless of the patient's conditions, all nurses have the duty to respect patient rights."
C The nurse needs to respect and have concern for the patient; this is vital to protecting the patient's rights. While it is true the autonomy is a basic client right, there are other rights that must also be both respected and facilitated. State and federal laws do protect a patient's rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. It is a fact that safeguarding a patient's rights are a nursing responsibility, but stating that fact does not show understanding or respect for the concept.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A Encouraging comparison B Exploring C Formulating a plan of action D Making observations
D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A Restatement B Offering general leads C Focusing D Accepting
A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A Reflecting B Making observations C Formulating a plan of action D Giving recognition
C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.
Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A "Do you know why you are here?" B "Are you feeling depressed or anxious?" C "Yes, I see. Go on." D "Can you chronologically order the events that led to your admission?"
C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.
A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A The therapeutic technique of "giving advice" B The therapeutic technique of "defending" C The nontherapeutic technique of "presenting reality" D The nontherapeutic technique of "giving false reassurance"
D The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.
A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A "What occurred prior to the rape, and when did you go to the emergency department?" B "What would you like to talk about?" C "I notice you seem uncomfortable discussing this." D "How can we help you feel safe during your stay here?"
B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.
A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A "You appear to be talking to someone I do not see." B "Please describe what you are seeing." C "Why do you continually look in the corner of this room?" D "If you hum a tune, the voices may not be so distracting."
A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.
A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A S B O C L D E E R
B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
S
sitting squarely facing the client (S)
O
open posture when interacting with the client (O)
L
leaning forward toward the client (L)
E
establishing eye contact (E)
R
relaxing (R)
An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A "Why did you use the client's name on your clinical worksheet?" B "You were very careless to refer to your client by name on your clinical worksheet." C "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." D "It is disappointing that after being told, you're still using client names on your worksheet."
The instructor's statement, "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.
After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A The nontherapeutic technique of giving approval B The nontherapeutic technique of interpreting C The therapeutic technique of presenting reality D The therapeutic technique of making observations
A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.
What is the purpose of a nurse providing appropriate feedback? A To give the client good advice B To advise the client on appropriate behaviors C To evaluate the client's behavior D To give the client critical information
D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.
A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A "Why do you continue to alienate your peers by your angry outbursts?" B "You accomplish nothing when you lose your temper like that." C "Showing your anger in that manner is very childish and insensitive." D "During group, you raised your voice, yelled at a peer, left, and slammed the door."
D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.
A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A "It would be best to do that in order to increase independence." B "Why would you want to leave a secure home?" C "Let's discuss and explore all of your options." D "I'm afraid you would feel very guilty leaving your parents."
C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.
When interviewing a client, which nonverbal behavior should a nurse employ? A Maintaining indirect eye contact with the client B Providing space by leaning back away from the client C Sitting squarely, facing the client D Maintaining open posture with arms and legs crossed
C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A "The smoke was too thick. You couldn't have gone back in." B "You're feeling guilty because you weren't able to save your children." C "Focus on the fact that you could have lost all four of your children." D "It's best if you try not to think about what happened. Try to move on."
B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B "It is important for you to discontinue these ritualistic behaviors." C "Why are you asking for help if you won't participate in unit therapy?" D "Let's figure out a way for you to attend unit activities and still wash your hands."
D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.
Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A "We've discussed past coping skills. Let's see if these coping skills can be effective now." B "Please tell me in your own words what brought you to the hospital." C "This new approach worked for you. Keep it up." D "I notice that you seem to be responding to voices that I do not hear."
A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.
A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A "It's quite common for clients to feel that way after a lengthy hospitalization." B "Why don't you talk to your mother? You may find out she doesn't feel that way." C "Your mother seems like an understanding person. I'll help you approach her." D "You feel that your mother does not want you to come back home?"
D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.
A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A Requesting an explanation B Belittling the client C Making stereotyped comments D Probing
C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.
Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A "You did not attend group today. Can we talk about that?" B "I'll sit with you until it is time for your family session." C "I notice you are wearing a new dress and you have washed your hair." D "I'm happy that you are now taking your medications. They will really help."
C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.
A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A "You seem to be motivated to change your behavior." B "How will these changes affect your family relationships?" C "Why don't you make a list of the behaviors you need to change." D "The team recommends that you make only one behavioral change at a time."
A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.
The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A To reframe the client's thoughts about mental health treatment B To put the client at ease C To explore a subject, idea, experience, or relationship D To communicate that the nurse is listening to the conversation
C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B "Remember, clients, not nurses, are responsible for their own choices and decisions." C "Just keep the client's best interests in mind and do the best that you can." D "Set a goal to continue to work on this aspect of your practice."
B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.
A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A "Touch carries a different meaning for different individuals." B "Touch is often used when deescalating volatile client situations." C "Touch is used to convey interest and warmth." D "Touch is best combined with empathy when dealing with anxious clients."
A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.
Which nursing statement is a good example of the therapeutic communication technique of focusing? A "Describe one of the best things that happened to you this week." B "I'm having a difficult time understanding what you mean." C "Your counseling session is in 30 minutes. I'll stay with you until then." D "You mentioned your relationship with your father. Let's discuss that further."
D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.
After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A "Do you believe that I was the cause of your blood test being canceled?" B "I see that you are upset, but I feel uncomfortable when you swear at me." C "Have you ever thought about ways to express anger appropriately?" D "I'll give you some space. Let me know if you need anything."
B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.
During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A "Don't worry. Everything will be alright." B "You appear uptight." C "I notice you have bitten your nails to the quick." D "You are jumping to conclusions."
A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.
A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A "How would your family feel if you died?" B "You feel worthless now, but that can change with time." C "You've been feeling sad and alone for some time now?" D "It is great that you have come in for help."
C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A "Can you tell me why you said that?" B "Keep your chin up. I'll explain the procedure to you." C "There is always an explanation for both good and bad behaviors." D "Are you not understanding the explanation I provided?"
A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.
A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A "Does your husband treat you like this very often?" B "What do you think is your role in this relationship?" C "Why do you think he behaved like that?" D "Describe what happened during your time with your husband."
D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A "My sister has the same diagnosis as you and she also hears voices." B "I understand that the voices seem real to you, but I do not hear any voices." C "Why not turn up the radio so that the voices are muted." D "I wouldn't worry about these voices. The medication will make them disappear."
B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.
Which nursing statement is a good example of the therapeutic communication technique of offering self? A "I think it would be great if you talked about that problem during our next group session." B "Would you like me to accompany you to your electroconvulsive therapy treatment?" C "I notice that you are offering help to other peers in the milieu." D "After discharge, would you like to meet me for lunch to review your outpatient progress?"
B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.
A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A Making observations and the defense mechanism of suppression B Verbalizing the implied and the defense mechanism of denial C Reflection and the defense mechanism of projection D Encouraging descriptions of perceptions and the defense mechanism of displacement
B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.
Which of the following individuals are communicating a message? (Select all that apply.) A A mother spanking her son for playing with matches B A teenage boy isolating himself and playing loud music C A biker sporting an eagle tattoo on his biceps D A teenage girl writing, "No one understands me" E A father checking for new e-mail on a regular basis
ABCDE The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.
A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A "The smoke was too thick. You couldn't have gone back in." B "You're feeling guilty because you weren't able to save your children." C "Focus on the fact that you could have lost all four of your children." D "It's best if you try not to think about what happened. Try to move on."
B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
According to the therapeutic communication theory, what criteria must be met for successful communication? A Nonverbal communication is consistent with verbal communication. B The communication needs to be efficient, appropriate, flexible, and include feedback. C The individuals communicating with each other must share a similar perception of the conversation. D The communication must be intrapersonal, interpersonal, group, or societal in nature.
B Rationale:
The communication must be intrapersonal, interpersonal, group, or societal in nature. Therapeutic communication theory believes communication occurs in four different settings: intrapersonal, interpersonal, group, and societal.
The communication needs to be efficient, appropriate, flexible, and include feedback. The formal criteria for successful communication are efficiency, appropriateness, flexibility, and feedback.
Nonverbal communication is consistent with verbal communication. Nonverbal communication can contradict the verbal message.
The individuals communicating with each other must share a similar perception of the conversation. Perception is highly personal and internal.
The nonverbal communication that expresses emotion is: A Body positioning. B Eye contact. C Facial expressions. D Cultural artifacts.
C Rationale:
Body positioning. Body position is an indication of how open one person is to another person or how interested or attractive one person is to another.
Cultural artifacts. Cultural artifacts are items in contact with interacting people that may function as nonverbal stimuli, e.g., nose or eyebrow piercing.
Facial expressions. Facial expressions communicate emotions and are the single most important source of nonverbal communication.
Eye contact. Eye contact projects an interest in communicating with a person; averting eye contact implies rejection.
In the symbolic interactionist view of communication, how is the meaning of the message determined? A It is predetermined by the person initiating the interaction. B It is mutually negotiated between the individuals involved in the interaction. C It is based on the recipient's perception and interpretation. D It is transferred from the sender to the receiver.
B
It is predetermined by the person initiating the interaction. The symbolic interactionist views communication as a simultaneous process that is influenced by both individuals.
It is based on the recipient's perception and interpretation. An individual's perception does influence communication, but is not the basis of the interactionist view of communication.
It is transferred from the sender to the receiver. Communication is not transferred between people; the meaning of the message is negotiated between the individuals involved in the communication.
It is mutually negotiated between the individuals involved in the interaction. The meaning of the message is mutually agreed upon between the individuals involved in the process.
The nurse is discussing problem-solving strategies with a client who recently experienced the death of a family member and the loss of a full-time job. The client says to the nurse, "I hear what you're saying to me, but it just isn't making any sense to me. I can't think straight now." The client is expressing feelings of: A Hostility. B Overload. C Disqualification. D Rejection.
B Rationale:
Rejection. Rejection conveys the message "you're wrong."
Overload. Overload results from sensory input exceeding the tolerance level of the receiver.
Disqualification. When a person communicates in such a way as to invalidate messages sent or received from another person, this is known as disqualification.
Hostility. The client is expressing a sense of feeling overwhelmed and is not communicating hostile feelings.
The nurse is interacting with a client and observes the client's eyes moving from side to side prior to answering a question. The nurse interprets this behavior as:
A The client responding to auditory hallucinations. B The client processing auditory information. C The client engaging in intrapersonal communication. D The client being bored with the interaction.
B
The client responding to auditory hallucinations. Eye movement side to side is an example of eyes accessing cues to an individual's thinking process and is not necessarily indicative of auditory hallucination.
The client processing auditory information. An individual processing auditory information usually moves the eyes from side to side.
The client being bored with the interaction. Rolling of the eyes is typically observed in an individual who is bored with a situation.
The client engaging in intrapersonal communication. A person engaging in intrapersonal communication usually focuses the eyes down in the direction of the nondominant hand.
The nurse is caring for a client who is hard of hearing. To facilitate communication with the client, the nurse will: A Make sure the client can see her lips move when she is speaking. B Ask closed-ended questions. C Stand 5 to 8 feet from the client when speaking. D Speak slowly, using monosyllabic words whenever possible.
A
Stand 5 to 8 feet from the client when speaking. The ideal distance to stand when speaking to a client who is hard of hearing is 3 to 6 feet.
Speak slowly, using monosyllabic words whenever possible. It is important to speak at a natural rate. People comprehend faster than they speak. Using monosyllabic words may be insulting to the client.
Ask closed-ended questions. Asking closed ended questions will impede communication.
Make sure the client can see her lips move when she is speaking. Clients who are hard of hearing may need to see the other person's lips moving to know they are speaking. They may also read lips in an attempt to understand what is being said.
A client with a history of major depression tells the nurse "I wish I weren't alive. I have been a failure my entire life and I am totally useless to anyone." The most therapeutic response to the client is: A "You've been feeling like a failure your entire life?" B "You shouldn't talk like that. You're not a failure." C "Once the antidepressants start working you will feel better about yourself." D "Things could be worse. You should be grateful for what you have."
A Rationale:
"You shouldn't talk like that. You're not a failure." Telling clients how they should or should not feel invalidates their feelings and is nontherapeutic.
"Once the antidepressants start working you will feel better about yourself." The client's depressive symptomatology should improve with antidepressants. However, this response is not the most therapeutic at this time.
"Things could be worse. You should be grateful for what you have." This response minimizes the client's feelings and can be perceived as punitive.
"You've been feeling like a failure your entire life?" This response restates what the client said and in doing so encourages the client to continue talking.
The nurse is completing the sexual history section of the admission assessment. The client tells the nurse "I don't want to talk about this. This is private between my spouse and me." Which nurse response reflects empathy? A "Yes, I know just how you feel." B "I know some of these questions are difficult for you." C "I am a professional nurse and I know what I am doing." D "I understand this is difficult for you to talk about, but I have to complete the admission assessment."
B
"Yes, I know just how you feel." This response shifts the focus from the client to the nurse, which is nontherapeutic.
"I understand this is difficult for you to talk about, but I have to complete the admission assessment." The nurse's need to complete the admission assessment does not take precedence over the client's feelings.
"I know some of these questions are difficult for you." This statement is empathic and acknowledges the client's feelings.
"I am a professional nurse and I know what I am doing." This statement negates the client's feelings and is nontherapeutic.
To provide effective feedback to a client, the nurse will focus on: A The client. B Making inferences of the behaviors observed. C Providing solutions to the client. D The present and not the past.
D
The client. To provide nonthreatening feedback, the focus should be on the behavior and not the client.
The present and not the past. Focusing on the here and now makes the feedback more meaningful. Feedback should be given as soon as it is appropriate to do so.
Providing solutions to the client. Assisting the client with identifying possible alternatives or goals for a problem is more effective than giving the client the answers. Providing solutions to the client gives the message that the client is not capable of doing so.
Making inferences of the behaviors observed. Inferences imply conclusions and assumptions and don't give the client an opportunity to explain a situation.
The use of facial expressions and gestures communicates: A Personality traits. B Interest in, and attraction to, another person. C Rejection. D Emotions.
D
Personality traits. Voice quality and tone reflect an individual's personality. People who vary their tone and increase their rate of speech are viewed as active and dynamic.
Interest in, and attraction to, another person. Body position reveals an individual's interest in or attraction to another person. The person who sits or stands far away from another person attempts interpersonal distance. Sitting in close proximity to another person usually indicates attraction.
Emotions. Facial expressions are the most important nonverbal communication and convey emotions.
Rejection. Averting eye contact with another individual conveys the message of rejection of the other person's request.
Which approach reflects an obstacle to effective nurse-patient communication?
1 Discussing fears about a patient with members of the health care team 2 Obtaining information about a critically ill patient from his or her family 3 Admitting a mistake to a patient's family 4 Avoiding issues that are uncomfortable for a patient
4 Rationale: A therapeutic nurse-patient relationship is goal directed. It can also include the need to help a patient discuss any pertinent topics, whether comfortable or uncomfortable.
The nurse is caring for a postoperative patient who is still having pain despite analgesia administration. Which statement by the nurse best reflects therapeutic communication?
1 "I think your doctor needs to know that you're still in pain." 2 "What do you want me to do about your pain problem?" 3 "When it comes to pain, your doctor tends to undermedicate his patients." 4 "Your pain will be a lot better in the morning."
1 Rationale: Therapeutic communication is goal directed, which in this situation is better pain management for the patient.
A patient recovering from a bilateral mastectomy for breast cancer tearfully tells the nurse that she is feeling depressed and worthless as a woman. Which communication phrase is not effective?
1 "Many women have body image concerns after undergoing this surgery."
2 "Tell me more about how you feel."
3 "Why do you feel depressed and worthless?"
4 "How long have you been feeling this way?"
3 Rationale: The use of "why" questions may cause defensiveness in the patient and hinder communication. The other options promote communication by encouraging the patient to communicate.
Which initial approach would be best when working with an anxious patient?
1 Tell the patient that everything he or she says will be kept private.
2 Ask the patient what he or she believes is causing his or her anxiety.
3 Watch the patient's behavior for the amount of anxiety being exhibited.
4 Explain what the patient can expect in terms that he or she can understand.
3 Rationale: The nurse needs to first assess the level of anxiety so appropriate communication techniques and strategies can be used. The patient may not have the insight to understand what is currently causing his or her behavior.
A nurse is working with a potentially threatening patient. Which nursing intervention is most appropriate?
1 Speaking clearly and slightly louder so the patient does not need the nurse to repeat what was said.
2 Positioning himself or herself near the exit of the room to prevent being blocked by the patient.
3 Bringing in other team members so the patient knows there are others to help him or her gain control.
4 Asking the patient which comfort measures he or she uses when he or she becomes out of control.
2 Rationale: Speaking louder and bringing in other team members may be perceived as threatening and may cause the patient's behavior to become out of control faster. The patient may not be aware of his or her behavior; therefore asking about comfort measures to relieve the threatening behavior may also cause him or her to escalate. The nurse may need to leave the room quickly. By positioning himself or herself near the door, he or she should not be trapped by the patient.
A visitor from another country became ill and required hospitalization. He is having difficulty getting the staff to understand his needs. Which approach by the nurse demonstrates the most cultural sensitivity?
1 Asking one of the patient's family members to help with the communication process
2 Using good eye contact while speaking clearly with easily understood words
3 Obtaining a medical interpreter to facilitate the communication process
4 Touching the patient more often while assessing him to make him feel that the nurse cares about him
3 Rationale: Direct eye contact and excessive touch can be offensive to persons from certain cultures. The patient's right to privacy must be guarded; therefore the use of a medical interpreter provides for correct, confidential communication.
A patient is exhibiting signs and symptoms of anxiety. What should be the first step in establishing communication with him or her?
1 Providing good personal hygiene
2 Letting the patient make as many choices as possible
3 Being nonjudgmental and accepting of feelings
4 Exhibiting appropriate nonverbal behaviors and active listening skills
4 Rationale: Patients with anxiety need assistance in clarifying factors that cause the anxiety and coping more effectively. Active listening helps to identify the source of the anxiety. Meeting basic needs and being nonjudgmental and accepting of feelings is important but not your first step. Ultimately once a cause for anxiety is known, you can help the patient by letting him or her make as many choices about care as possible
A nurse is working with an older adult with a cognitive impairment who is having a tantrum and acting hostile toward other patients in the dayroom. Which approach by the nurse is most appropriate to handle this situation?
1 Asking three other staff members to help put the patient back to bed
2 Using the patient's favorite crackers to distract him from the other patients
3 Explaining to the patient how he will benefit by behaving better
4 Asking the family how they managed the tantrums while the patient was still living at home
2 Rationale: Distraction is often effective for this type of patient. Strategies that may have worked before may not be as effective now. There is no time to call the family when the patient is already hostile. A show of force could make the patient agitated.
A patient recovering from a recent amputation of his foot because of diabetes has been very withdrawn and not sleeping or eating well. Which initial nursing intervention would be most effective to help him with his depression?
1 Suggesting the use of antidepressant medication to his health care provider
2 Spending time with the patient and telling him how lucky he is that he was able to keep most of his leg
3 Talking with physical therapy about how soon he can be fitted for a prosthesis
4 Encouraging the patient to talk about his feelings while allowing angry outbursts
4 Rationale: Even though being positive about the situation is a strategy, this patient is grieving for the loss of his extremity and is depressed. Antidepressant medications are not given initially. The patient needs the opportunity to express feelings, especially anger, which is normal behavior. The health care provider, not the physical therapist, would be consulted about when he would be evaluated for a prosthesis.
The nurse is preparing to provide patient education. Which question is most appropriate for the nurse to ask?
1 Are you ready to learn now?
2 Can you use a computer?
3 Is your family here to learn also?
4 How do you best learn?
4 Rationale: The method of instruction should be based on the patient's preferred method of learning. It can incorporate a variety of methods that would be appropriate for the information being conveyed and how the patient learns best. The other options are either demeaning (option 1), too narrow in scope and closed ended (option 2) or family-centered instead of patient-centered (option 3).
Which of the following is an example of a therapeutic communication technique? Choose all that apply. A. Listening B. Restating C. Giving advice D. Reflecting E. Clarifying
abde
Giving advice is nontherapeutic and can serve as a barrier to communicating with patients. The other listed techniques are considered to be therapeutic.
Which of the following is an example of a nontherapeutic communication technique? Choose all that apply. A. Challenging B. Defending C. Focusing D. Paraphrasing E. Disapproving
abe Focusing and paraphrasing are therapeutic communication techniques. The other techniques are considered to be nontherapeutic.
Which statement demonstrates the most effective strategy for providing teaching to a depressed patient?
A. Information is given to the patient in small amounts. B. Information is given to the patient in written form. C. Patients who are depressed do not benefit from health teaching. D. Patients who are depressed respond better to the NAP for health teaching.
A
When providing health teaching to a depressed patient, it is important to provide the information in small amounts, as patients with depression tend to have poor concentration and limited memory as symptoms of their condition. Consequently, giving too much information at a time may prove to be an ineffective strategy.
You are the nurse assigned to care for a 4-year-old child who was involved in an automobile accident. She is withdrawn and is not communicating readily with the staff. What strategy can you use to interact with her?
A. Ask her open-ended questions. B. Give her paper and crayons. C. Ask her family for help. D. Consult the staff psychologist.
B When interacting with children, it is important to understand the child's developmental level and to select the most age-appropriate communication techniques. Drawing is an appropriate pre-reading communication technique for a 4-year-old child.
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