Communication Prep U

While interviewing a client, the nurse imagines what it would be like to be in the client's situation and how it would feel. The nurse is demonstrating:

empathy

A psychiatric-mental health nurse is developing a therapeutic relationship with a client. The nurse demonstrates acceptance by which action?

the nurse avoids judgments about the client, no matter what the behavior is

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic?

"Since ours is a professional relationship, let's explore other opportunities in your life for friendship."

The nurse is concerned that a relationship with a client is not therapeutic. Which behaviors demonstrated by the nurse support this concern? Select all that apply.

- Becomes frustrated during the meetings - Remains aloof for several sessions - Discusses topics without consistency - Varies the length of meeting times from session to session

Which behavior by the nurse demonstrates positive regard? Select all that apply.

- Calling the client by name - Spending time with the client - Responding openly - Considering the client's ideas and preferences when planning care

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply.

- Client who is experiencing depression - Client who is lost in own thoughts - Client who is constructing a response - Client who is pondering the question

A nurse knows rapport has been established when the client:

- Develops a sense of sharing - Displays decreased anxiety and feels comfortable in the presence of the nurse

Which statement is true of empathy? Select all that apply.

- It is the ability to place oneself into the experience of another for a moment in time - It is developed by gathering information from the client

Which statement by the nurse is an example of assertive communication?

I understand that groups can be difficult to attend but coming late is disruptive

A client remarks, "You know, it's the same thing every time." The nurse should respond by stating:

I'm not sure what you mean. Please explain

Which communication technique does a nurse use in establishing trust and developing empathy?

acceptance

During the orientation phase of a nurse-client relationship, the nurse notes a change in the client's behavior. The client has forgotten a scheduled session and then accuses the nurse of breaking confidentiality. The nurse interprets this as suggesting what?

acting out

The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse?

active listening

During a first meeting a client asks that information shared will not be relayed to immediate family members. Which should the nurse say in response?

any information is only shared with other professionals involved in your care

The client says to the nurse, "I wonder what's playing at the movies tonight." Which response by the nurse would be most therapeutic?

are you telling me you would like to go to the movies?

The nurse is using a directive role when asking a client which question?

are you thinking about hurting someone else right now?

The nurse learns that a new client is a former significant other and an initial session is scheduled for early in the afternoon. Which action should the nurse take to maintain professional boundaries?

ask to be reassigned because of having a prior personal relationship with the client

The nurse uses a variety of therapeutic communication skills when working with clients. Which is a therapeutic goal that can be accomplished through the use of therapeutic communication skills?

assess the client's perception of a problem

A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this client how to make better choices. The client has been here many times before and goes back home and does the same thing." As the supervisor addresses the nurse and the nurse's statement, the supervisor understands the nurse is sharing what?

attitude

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process?

can you explain to me what made you so angry?

Despite best efforts, a nurse and client are engaged in a nontherapeutic relationship. Which client response would most likely occur?

client leaves the unit, not being available for a scheduled meeting

After reviewing information about defense mechanisms, a group of students demonstrates the need for additional review when they identify which defense mechanism as almost always maladaptive?

denial

A client states, "Right before I got here I was doing all right. My job was going well, my spouse and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your spouse were happy. Tell me more about that." This is an example of which therapeutic technique?

exploring

Which behavior would a psychiatric-mental health nurse identify as a testing behavior on the part of the client that usually happens during the "honeymoon phase" of the nurse-client relationship?

expressing anger and accusing the nurse of breaking confidentiality

The nurse initiating a therapeutic relationship with a client. Which information would the nurse most likely include when explaining the purpose of this relationship?

facilitating a positive change

Which nursing intervention demonstrates congruence in a therapeutic nurse-client relationship?

getting an appointment with the client at the time previously agreed upon

The nurse fails to assess personal values surrounding homosexuality before caring for a client who is openly gay. The nurse is most at risk for what when working with this client?

holding a prejudice towards this client

The nurse is working with a client who has quit several jobs and no longer sends financial support to the client's two children living with their other parent. This behavior is in conflict with the nurse's values concerning responsible parenting. When discussing family roles with the client, the nurse shows positive regard through which statement?

how is not working right now affecting you?

The nurse is meeting with the client for the first time. During the orientation phase of the nurse-client relationship, the nurse assists the client with which activity?

identifying needs

The parent of a child client holds the child close during the initial assessment. Which distance zone is acceptable for people who mutually desire personal contact?

intimate

The nurse and client are discussing discharge plans. Which statement should the nurse make that demonstrates empathy for the client's fear of returning to a group home environment?

it can be scary to leave a place that you trust and feel supported

The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond?

let's talk about infections, and how they heal

A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs?

more time to think

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

orientation

Which statement by the nurse demonstrates acceptance to the client who has made a sexually inappropriate comment?

our relationship is one of a professional nature

A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should:

reflect critically on the student's own life experiences, perspectives, and characteristics

A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship?

self-awareness

The nurse wears a cross and has a Facebook page displaying pictures of the family, home and updates on what the nurse is currently doing. These actions are examples of what?

self-disclosure

During a therapeutic communication session, the nurse tells the client of a past experience. Which statement best reflects the nurse's use of self-disclosure?

self-disclosure on the nurse's part should benefit the client

What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?

shifting the emphasis to the nurse

Which is often considered the most difficult yet most effective communication technique?

silence

The nurse asks the client, "What was it like for you when you first knew you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic?

sit quietly until the patient responds

A nurse is meeting a client for the first time. The nurse observes that the client smiles appropriately but is using rambling speech while answering the nurse's questions. Which would most likely be the reason for this behavior?

the client is nervous and insecure

A client diagnosed with borderline personality disorder is pitting one nurse against the other, calling one a best friend and declaring that the other is horrible. The client is using which defense mechanism?

splitting

A client expresses frustration and believes the nurse does not want to help the client achieve wellness. Which phase of the deteriorating relationship is the client describing?

struggling with

During the next meeting during the working phase of the relationship the client brings the nurse homemade chocolate chip cookies and a box of chocolates. Which response should the nurse make to the client about these gifts?

thank you but i will not accept these gifts because they extend over our discussed boundaries

A nurse is caring for a client with posttraumatic stress disorder. Which behavior of the client indicates the resolution phase?

the client is able to independently express feelings and emotions with the client's friends

A client experienced physical abuse by his father when he was a child. The client explains some of the intense financial and interpersonal stress that his father was experiencing at the time and describes the relationship between psychosocial stress and abuse. How should the nurse best interpret the client's statement?

the client is intellectualizing this traumatic event in order to deal with the emotions involved

A client with a history of depression has told the nurse that the client is feeling especially "low" this morning. The nurse has responded by stating, "Try thinking about some of the blessings you have in your life." How should the nurse's statement be best interpreted?

the nurse has inhibited therapeutic communication by giving advice

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as:

transference

The nurse is caring for a client that is very confused. What intervention should be included with the nurses' non-communication with the client?

use of gentle touch during activities of daily living

The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to ...

validate the meaning of the nonverbal behavior

An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by:

validating the client's ability to make decisions and effect change

During the mental status assessment, the client expresses the belief that the CIA is stalking the client and plans to kidnap the client. Which would be the best response by the nurse?

what kinds of things have been happening?

The client presents with signs and symptoms of anxiety. What conversation initiated by the nurse demonstrates an ineffective therapeutic use of self?

what types of dresses do you like wearing?

A nurse has interactions with several clients throughout the day. When would a formal setting for discussion be indicated?

when a client has a difficulty maintaining boundaries

In a nontherapeutic relationship, the nurse and client both feel very frustrated and keep varying their approach with each other in an attempt to establish a meaningful relationship. A deteriorating relationship starts with which phase?

withholding

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

working

During the admission interview, the nurse asks the client what led to the client's hospitalization. The client responds, "They lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born." What would be the best initial response by the nurse?

you are having very frightening thoughts

A client is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the client to talk?

you look like you are deep in thought

The nurse prepares to assess a client for the first time. Which action should the nurse take to develop a rapport with this client? Select all that apply.

- Establish professional boundaries - Listen intently to the client explain problems and issues - Explain what confidential information will be shared with others

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply.

- Focus on the client during the interaction - Ensure the client's confidentiality - Employ theoretically based interventions

The manager schedules a staff nurse to attend a motivational interviewing training session. Which nurse behavior caused the manager to make this decision? Select all that apply.

- Interrupting the client - Minimizing the client's concerns - Arguing with a client over agreed upon plans

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply.

- Leaning toward the client - Maintaining eye contact with the client

When interacting with a client for the first time, which information would be appropriate for the nurse to disclose? Select all that apply.

- Name - Level of education - Reason for being on the unit

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.

- Reassure the client that they already covered these issues - Review with the client the learned methods to control the problems

The nurse is meeting a client for the first time. Which action should the nurse take to establish a rapport with this client? Select all that apply.

- Shaking the client's hand when greeting - Asking the client to further explain a recurring symptom - Remaining neutral when the client states a lack of faith in medicine

A nurse understands that giving positive regard to the client helps in building trust for the nurse. Which actions are appropriate while conveying positive regard? Select all that apply.

- The nurse should address the client by name - The nurse should actively listen to the client - The nurse should respond openly to the client

Which situation would most likely indicate a violation of professional boundaries? Select all that apply.

- The nurse strongly defends a client's behavior during a staff meeting - A nurse tells other staff that the nurse is the only one who understands the client - A nurse begins to spend increasing amounts of time with one client on the unit

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

orientation phase

The nurse demonstrates understanding of the information when the nurse identifies which aspect as the primary difference between social and therapeutic relationships?

the focus of the relationship

The nurse understands that empathy is essential to the therapeutic relationship. When a client makes the statement, "I am just devastated that my marriage is falling apart," the nurse can best show empathy through which response?

you feel like your world is falling apart right now

A client yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be what?

you seem very irritated