PrepU Ch. 11Therapeutic Relationships & Communication

A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? a) Silence b) Broad opening c) Focusing d) Giving information

b) Broad opening Explanation: Broad openings allow the client to say as much or little as he or she wants. Focusing can be intimidating; giving information and silence do not encourage client interaction.

A client who is verbally expressing angry feelings while smiling is exhibiting which type of facial expression? a) Confusing b) Impassive c) Expressive d) Emotionless

a) Confusing Explanation: A confusing facial expression is one that is the opposite of what the person wants to convey. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. An impassive face is frozen into an emotionless deadpan expression similar to a mask. An impassive face is an emotionless face.

The nurse is assessing a client. The client expresses that he has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of? a) Consensual validation b) Encouraging comparison c) Accepting d) Broad openings

a) Consensual validation Explanation: The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.

A nurse is engaged in a therapeutic relationship with a client and is using therapeutic communication. Which of the following would the nurse most likely do? Select all that apply. a) Employ theoretically-based interventions b) Ensure the client's confidentiality c) Use self-disclosure frequently for empathy d) Focus on the client during the interaction e) Give the client advice about what to do

a) Employ theoretically-based interventions b) Ensure the client's confidentiality d) Focus on the client during the interaction Explanation: A nurse engaged in therapeutic communication with a client should follow the principles of therapeutic communication: making the client the primary focus of the interaction; using self-disclosure cautiously and only when it serves a therapeutic purpose; maintaining client confidentiality; implementing interventions from a theoretic base; and avoiding the giving of advice.

Building of the therapeutic relationship begins with the nurse's ... a) Self-awareness b) Desire to form friendships c) Previous social skills d) Communication skills

a) Self-awareness Explanation: Building of the therapeutic relationship begins with the nurse's self-awareness.

Which of the following would indicate that the nurse-client relationship has passed from the orienting phase to the working phase? a) The client recognizes feelings of anger and expresses them appropriately. b) The client expresses a desire to be mothered and pampered. c) The client has revitalized her relationship with her sister. d) The nurse has designated a specific time each day to interact with the client.

a) The client recognizes feelings of anger and expresses them appropriately. Explanation: When the client can begin to recognize feelings and talk about them, the relationship has moved into a working phase.

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. a) An erect, confident posture b) A sad facial expression c) A fearful tone of voice d) A cheerful expression e) A sarcastic tone of voice

b) A sad facial expression c) A fearful tone of voice Explanation: A process refers to the nonverbal messages that the speaker uses to give meaning and context to the overall message. The client is diagnosed with cancer and is grieving. Thus, a sad facial expression and a fearful tone of voice are congruent with having been diagnosed with the disease and worrying about the impending health problems. A cheerful expression, a sarcastic tone of voice, and an erect, confident posture are incongruent with the client's statement to the nurse.

A nurse has approached a new client on the psychiatric care unit in order to establish a therapeutic relationship and conduct a focused assessment. As the nurse approaches the client, the client says, "Oh good. Here comes one more person to tell me that I'm crazy." Which of the nurse's following responses would constitute countertransference? a) "Is that a message you've been hearing a lot over the past couple of days?" b) "There's no need to get rude with me. I'm just trying to do my job and to help you out." c) "It sounds like you're exasperated with the caregivers you've interacted with. Is that fair to say?" d) "Actually, I've not come here to tell you that."

b) "There's no need to get rude with me. I'm just trying to do my job and to help you out." Explanation: Reciprocating a client's hostile or sarcastic tone is an example of countertransference, in which the nurse responds unrealistically to the client's behavior or interaction.

Which of the following statements would be an empathetic response in a client interaction? a) "Well, it sounds like your father has difficulty controlling his temper." b) "You must have been embarrassed when your father yelled at you in the grocery store." c) "You really should find your own housing and get out of the situation with your father." d) "Why do you think your father chose that time and place to yell at you?"

b) "You must have been embarrassed when your father yelled at you in the grocery store." Explanation: This statement conveys the nurse's understanding of the client's feelings. Empathy is the ability to perceive the meanings and feelings of another person and to communicate that understanding to that person. Choices B, C, and D do not convey empathy.

During the admission interview, the nurse asks the client what led to his 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." The best initial response by the nurse would be, a) "I just saw your mother. She's fine." b) "You're having very frightening thoughts." c) "We'll put you in a private room until you're in better control." d) "If your mother died before you were born, you wouldn't be here."

b) "You're having very frightening thoughts." Explanation: The nurse is verbalizing the implied (that the client is frightened). Answers A, C, and D would not be in the initial response in this situation.

The nurse is assessing a client. The client expresses that he has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of? a) Accepting b) Consensual validation c) Broad openings d) Encouraging comparison

b) Consensual validation Explanation: The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.

When is it is appropriate for the nurse to introduce information regarding the termination of the relationship? a) Right before the last meeting b) In the orientation phase c) When goals are being identified d) When the client is emotionally ready

b) In the orientation phase Explanation: Information regarding the termination phase should be introduced during the orientation phase.

The nurse-client relationship is classified as which type of relationship? a) Social b) Therapeutic c) Friendly d) Intimate

b) Therapeutic Explanation: The nurse-client relationship is classified as a therapeutic relationship. It is not classified as a social, intimate, or friendly relationship.

During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. The best response by the nurse would be, a) "That makes no sense at all." b) "You can tell me about that after I finish asking these questions." c) "What kinds of things have been happening?" d) "Why would the CIA be interested in you?"

c) "What kinds of things have been happening?" Explanation: The nurse is using this statement to seek clarification and to understand the client's perception and meaning. Response A is inappropriate because it may make perfect sense to the client. Response B shows that the nurse is not interested in what the client has to say. Response D feeds into the notion that the CIA is stalking the client.

A nurse needs to encourage a Hispanic client who has severe depression to express her feelings. What distance between the nurse and the client may help facilitate therapeutic communication? a) 10 to 12 inches b) 15 to 18 inches c) 3 to 6 feet d) 15 to 18 feet

c) 3 to 6 feet Explanation: A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between a Hispanic client and the nurse. A distance of 10 to 12 inches or 15 to 18 is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.

Which of the following would be a barrier to the nurse-client relationship? a) Acceptance b) Empathy c) Abuse of power d) Trust

c) Abuse of power Explanation: Abuse of power would be a barrier to the nurse-client relationship. Empathy, acceptance, and trust would not be barriers to the nurse-client relationship.

The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily because it is likely to ... a) Make the client feel that his problems are not viewed as being serious b) Give the client the impression that the nurse is not interested in providing effective care c) Encourage the client to view the nurse as a friend rather than health care provider d) Erode into the time that is to be used for therapeutic communication

c) Encourage the client to view the nurse as a friend rather than health care provider Explanation: The psychiatric nurse recognizes that excessive social communication with a client is to be avoided primarily because it is likely to encourage the client to view the nurse as a friend rather than health care provider.

Which of the following would be a factor that enhances the nurse-client relationship? a) Unclear boundaries b) Intimacy c) Genuine interest d) Abuse of power

c) Genuine interest Explanation: Genuine interest would enhance the nurse-client relationship. Intimacy, unclear boundaries, and abuse of power would be barriers to the nurse-client relationship.

A nurse is caring for a client in the health care facility. 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? a) Termination phase b) Exploitation phase c) Orientation phase d) Identification phase

c) Orientation phase Explanation: According to the conversation, the nurse is informing the client about the daily schedule of the therapy. This conversation is indicative of the orientation phase of the nurse-client relationship. During this phase, the nurse explains the schedules of meeting, identifies the client's problems and clarifies the expectations of the client. In the identification phase, the client tries to find the problems that would affect treatment. In the exploitation phase, the client examines the feelings and responses and tries to develop better coping skills and a more positive self-image. The client starts becoming independent in this stage. In the termination phase, the problems of the client are resolved and the nurse-client relationship comes to an end.

Which of the following statements is true about a nurse's self-disclosure? a) The more the nurse discloses, the more the client will disclose. b) Self-disclosure should be used with all clients to some degree. c) Self-disclosure on the nurse's part should benefit the client. d) It is the basis for effective communication.

c) Self-disclosure on the nurse's part should benefit the client. Explanation: The nurse should determine what benefit any given client will gain from nurse self-disclosure; only when that benefit can be clearly identified should self-disclosure be used, and then it should be used judiciously and within the boundaries of the relationship.

During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. What might this indicate to the client? Choose the best answer. a) The nurse may gain information about the client without wasting time. b) The nurse may be able to resolve the client's concerns. c) The nurse may not be able to understand the client's concerns. d) The nurse may be able to complete the assessment in less time.

c) The nurse may not be able to understand the client's concerns. Explanation: Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. Thus, the nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen carefully.

Choose the most therapeutic intervention to the client's statement, "All I feel like doing is screaming as loudly as I can." a) "There is nothing to be so upset about." b) "Please calm down; everything is going to be better." c) "I wish you could try to be more positive." d) "You look like you are very angry this morning."

d) "You look like you are very angry this morning." Explanation: The correct answer provides reflection of the client's affect (angry). Telling the client to calm down is a platitude, telling the client that there is nothing to be upset about denies the client's feelings, and urging the client to be positive is stated in terms of the nurse's needs and ignores the feelings of the client. Reflection of the client's feelings, mood, and affect is therapeutic in assisting the client to understand himself or herself.

When attempting to decide a location for a conversation with a depressed, anxious client, the psychiatric nurse is particularly attentive to the location's a) Temperature b) Lighting c) Nearness to nurse's station d) Amount of activity

d) Amount of activity Explanation: The environmental factor to be given primary consideration is the activity level since the anxious client would likely have difficulty dealing with the noise and confusion. While lighting, temperature, and proximity to the nurse's station may affect communication, they are not as impactful for this client as the amount of activity.

A nurse is assigned to care for a client whose sexual orientation differs from her own. She would need to seek clinical supervision if she attempted to ... a) Identify anxieties regarding the client's values and sexuality b) Discuss her feelings about the client with a supervisor c) Empathize with the client d) Assist the client to change values

d) Assist the client to change values Explanation: It is not the nurse's role to change the values of the client

Which of the following occurs when the nurse responds to the client based on personal unconscious needs and conflicts? a) Exploration b) Transference c) Self-disclosure d) Countertransference

d) Countertransference Explanation: Countertransference occurs when the nurse responds to the client based on personal, unconscious needs and conflicts. During exploration, the client identifies the issues or concerns causing problems. Self-disclosure means revealing personal information, such as biographical data and personal ideas. Transference occurs when the client unconsciously transfers to the nurse feelings he or she has for significant others.

The nurse says to the client, "You become very anxious when we start talking about your drinking." Which of the following techniques is the nurse using? a) Translating into feelings b) Confronting behavior c) Verbalizing the implied d) Making an observation

d) Making an observation Explanation: The nurse is stating what he or she sees; the client can validate it or reject it. The nurse is not confronting the behavior in this situation. The nurse is not translating the message into feelings, nor is he verbalizing the implied.

Calling the client by name and spending time with the client are examples of which of the following? a) Acceptance b) Values c) Empathy d) Positive regard

d) Positive regard Explanation: Positive regard is an unconditional, nonjudgmental attitude. Acceptance occurs when the nurse does not become upset or respond negatively to a client's outbursts, anger, or acting out. Empathy is the ability of the nurse to perceive the meaning and feelings of the client and to communicate that understanding to the client. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living.

When discussing the details of anorexia, the nurse maximizes the client's likelihood of understanding the information by a) Being careful not to overload the client with too much information at one time b) Interacting with the client in a nonthreatening, respectful manner c) Giving the client ample opportunity to ask questions d) Presenting the information using language and terms the client will understand

d) Presenting the information using language and terms the client will understand Explanation: Being careful not to use technical terms and language that will confuse or intimidate the client will assist the client in grasping and applying the information. While interacting in a nonthreatening, respectful manner is considered expected, it is focused toward establishing a therapeutic relationship and not toward maximizing client learning. Being careful to not overload the client with information is important, but presenting the information in language the client can understand is most important. Giving the client ample opportunity to ask questions is important, too, although the nurse needs to realize that even if given time to ask a question the client may not choose to do so

It is important for the mental health nurse to understand the goals of therapeutic communication. Which of the following would not be considered a goal of therapeutic communication? a) Active listening b) Guiding the client in problem-solving c) Establishing rapport d) Self-exploration of feelings by the nurse

d) Self-exploration of feelings by the nurse Explanation: Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem-solving are goals of therapeutic communication.

Which communication technique involves expressing uncertainty about the reality of the client's perception? a) Restating b) Silence c) Reflecting d) Voicing doubt

d) Voicing doubt Explanation: Voicing doubt is expressing uncertainty about the reality of the client's perceptions. Silence is the absence of communication. Restating is repeating the main idea expressed. Reflecting is directing client actions, thoughts, and feelings back to the client.