Chapter 10: Communication and the Therapeutic Relationship
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."
A psychiatric-mental health nurse has received an in-service education about defense mechanisms. Which statement made by the nurse regarding defense mechanisms would indicate a need for further teaching?
"Defense mechanisms indicate that the client is in a problematic mental state."
A nurse is caring for a client with depression. The client says that the client cannot stop thinking about the client's dead spouse. Which self-disclosure example given by the nurse is most appropriate?
"I can understand your situation; my cousin lost a spouse a few months ago."
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."
A client remarks, "You know, it's the same thing every time." Which is the most therapeutic response by the nurse?
"I'm not sure what you mean. Please explain."
A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?
"I've been off for the past four days. What have you done since I last saw you?"
Which nursing response would likely inhibit communication and be nontherapeutic in helping the client achieve treatment goals related to improving poor self-esteem?
"If you are serious about getting better you need to get a job and support yourself."
A client is being counseled by the nurse about family conflict. The client asks the nurse, "Should I go home for the weekend?" Which response by the nurse would demonstrate using the reflection communication technique?
"Should you go home for the weekend?"
During the mental status assessment, the client whispers, "The CIA is stalking and planning to kidnap me." Which is 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?"
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 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." How does the nurse interpret this behavior?
Transference
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
The nurse is preparing to interview a newly admitted client. Which action will the nurse make a priority during the first interaction with this client?
Establish rapport.
A nursing instructor is teaching a class on empathy. The instructor determines that the class needs additional education when the students identify that empathy involves what?
Feeling the same emotions that the client is feeling at a given time
The nurse fails to assess personal values surrounding a client's gender assignment before caring for a client who is transgender. Which issue is the nurse at most at risk for that may hinder development of the nurse-client relationship?
Holding a prejudice toward this client
The nurse observes the parent of a child client holding the child close on the lap during the initial assessment. Which distance zone is the parent exhibiting for people who mutually desire personal contact?
Intimate
A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response?
It's important to get a break from time to time. How have the last few days been for you?
A nurse recently began working with a client in the community. The client arrived 15 minutes late for the last appointment and did not show up for today's scheduled appointment, despite confirming the day before. How should the nurse best interpret this client's behavior?
The client is testing the parameters of the relationship.
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 client expresses worry about the client's child's aggressive behavior. The nurse says "You are in a very challenging situation. Your child's aggressive behavior is very stressful for you, is this correct?" What does this nurse's statement indicate?
The nurse is empathizing with the client.
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?
A psychiatric-mental health is completing a self-reflection with the goal of "know thyself" in order to care for their clients better. What is a question that the nurse can reflect on that encourages self-reflection?
What significant traumatic life events have you experienced?
A psychiatric-mental health nurse is conducting a self-examination of beliefs and values to develop self-awareness. Asking which question would be appropriate for the nurse to determine the fundamental personal attitudes about people of diverse cultures?
While a child, what attitudes did your family express about other cultures?
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
Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?
abstract
A client says to the nurse, "I have done something terrible." The nurse replies, "I would like to hear about it. It's okay to discuss it with me." Which therapeutic communication technique is the nurse utilizing?
acceptance
A teenager is mad at the teenager's parents about not being able to drive the father's car. The teenager begins to stay out late with friends after curfew. What defense mechanism is the teenager using?
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
A nurse is communicating with a client who is highly anxious. During the conversation, the nurse notices that the nurse's speech is matching the fast pace of the client's speech, and the nurse's heart rate is increasing. The nurse identifies this as:
empathetic linkage.
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." Which therapeutic communication is the nurse using with the client?
exploring
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, and arguing with a client over agreed upon plans
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 clientminimizing the client's concernsarguing with a client over agreed upon plans
What should the nurse avoid when demonstrating genuine interest for a client by making a self-disclosure?
shifting the emphasis to the nurse
The nurse asks a client diagnosed with bipolar disorder how they are feeling today. The client replies, "guns and bombs are exploding". Which documentation by the nurse would be appropriate for the client?
symbolism
