chapter 6 therapeutic communication
The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? "When did you last take drugs?" "If you just learn how to breathe, you can manage better." "At what time did you take the last dose of the antianxiety drugs?" "How can you make your anxiety better?"
"At what time did you take the last dose of the antianxiety drugs?" Concrete messages use explicit wording and need no interpretation. Asking the client about the time of the last dose of the antianxiety drugs conveys the most accurate information. Asking the client about when the client stopped taking the drugs fails to specify the type of drug, and using the word "when" will not help the client give the accurate response. Asking the client when the client took them last would confuse the client, as "them" may not be interpreted as drugs.
Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process? "What do you think is the best thing to do when you are angry?" "What are you going to do the next time you get angry?" "Can you explain to me what made you so angry?" "What could you do when you are angry that doesn't involve throwing things?"
"Can you explain to me what made you so angry?" Identifying the problem (trigger for the anger) is the initial step in the problem solving process followed by brainstorming all possible solutions (different ways to manage the anger). Selecting the best alternative, implementing the selected alternation, and then evaluating the situation are the remaining steps in the process.
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? "Some defense mechanisms may be either maladaptive or adaptive depending on the context in which they occur." "Defense mechanisms indicate that the client is in a problematic mental state." "Defense mechanisms can be conscious or unconscious to the client." "Defense mechanisms become maladaptive when the use interferes with the client's ability to function.
"Defense mechanisms indicate that the client is in a problematic mental state." Defense mechanisms, also known as coping styles, are psychological mechanisms that help an individual respond to and cope with difficult situations, emotional conflicts, and external stressors. Although defense mechanisms might seem to indicate the existence of problematic mental state, this is not true; therefore, the nurse's statement of "Defense mechanisms indicates that the client is in a problematic mental state" indicates a need for further teaching.. Healthy individuals in many different contexts use defense mechanisms. The use of defense mechanisms may be conscious or unconscious and some defense mechanisms may be either adaptive or maladaptive depending on the context in which they occur. The use of defense mechanisms becomes maladaptive when its persistent use interferes with the person's ability to function and quality of life.
The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond? "Is your mother giving you trouble for being here?" "I need to know why you are sad." "Why are you sad about your mother's visit?" "I'm concerned that you are not exicited about your mother's visit, We can talk if you want."
"I'm concerned that you are not exicited about your mother's visit, We can talk if you want." Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client's experience. "Why are you sad about your mother's visit?," "I need to know why you are sad" and "Is your mother giving you trouble for being here?" are not examples of therapeutic communication.
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?" "I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" "How do you like to spend your time when you're able to do whatever you like?" "If you had to guess, what do you think I might have done on my days off?"
"I've been off for the past four days. What have you done since I last saw you?" The nurse should avoid self-disclosure. Whenever possible, it is more therapeutic to redirect the conversation rather than setting an explicit boundary. Saying, "How do you like to spend your time when you're able to do whatever you like?" redirects the conversation but is less therapeutic because the nurse has ignored the client's question. Asking the client to speculate serves no therapeutic purpose.
The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior? "It looks like you're searching for something. Is that right?" "Are you having any delusions or hallucinations right now?" "What are you looking for in the bed? There's nothing hidden there." "What's wrong with your bed?"
"It looks like you're searching for something. Is that right?" When communicating, it is important to make an observation and then seek clarification and encourage the client to explore his or her behavior. This is more conducive to therapeutic communication than making an assumption about a client's actions or motives or explicitly attributing actions to delusions or hallucinations.
A client was admitted to the psychiatric-mental health unit 2 days ago. Upon assessment, the client states, "You locked me up and threw away the key." What is the most therapeutic response made by the nurse to the client? "I wasn't working when you got admitted." "We don't ever throw away the keys." "Are you feeling angry?" "It must be frustrating to feel locked up."
"It must be frustrating to feel locked up." Nurses should not necessarily take verbal messages literally, especially when a client is upset or angry. If the nurse takes the comment literally, the nurse may respond defensively, and communication would likely be blocked. The nurse must identify the desired client outcome by engaging with the client and attempt to interpret the client's feelings. Therefore, the nurse's response of "It must be frustrating to feel locked up" would be most therapeutic in this situation. The nurse's response, "Are you feeling angry?" is a closed-ended question and is not as therapeutic as interpreting their emotions. The nurse's responses of "We don't ever throw away the keys" and "I wasn't working when you got admitted" are defensive comments, which would block communication.
A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "It sounds like you're overreacting somewhat." "It sounds like you're feeling unappreciated." "Why do you say I don't listen to you?" "I listen to you."
"It sounds like you're feeling unappreciated." Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.
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? "Oh, it is just the infection; in a day or so you'll feel better." "Why don't you call a friend in to watch TV with you?" "Let's talk about infections, and how they heal." "Why don't you just rest in bed?"
"Let's talk about infections, and how they heal." Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals, such as assessing the client's perception of the problem as it unfolds, teaching the client self-care skills and identifying a plan of action to a satisfying and socially acceptable resolution. "Oh, it is just the infection, in a day or so you'll feel better," "Why don't you just rest in bed?," and "Call a friend in to watch TV," are not examples of therapeutic communication between the nurse and client. Reference:
A client diagnosed with a mental illness asks the nurse, "Does mental illness run in your family?". Which response to the client by the nurse would be therapeutic? "Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses." "Actually, my sister is being treated for schizophrenia. It's been hard on our whole family." "I struggle with anxiety and depression at times. I have learned a lot from the group sessions here." "That's not an appropriate question for me. Let's talk about something else."
"Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses." One of the most important principles of therapeutic communication for the nurse to follow is to focus the interaction on the client's concerns. Self-disclosure, telling the client personal information, generally is not a good idea. If the client asks the nurse personal questions, the nurse should elicit the underlying reason for the request. The nurse can then determine how much personal information to disclose, if any. Therefore, the nurse's response of "Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses" would be therapeutic to say to the client. The nurse's responses of "Actually, my sister is being treated for schizophrenia. It's been hard on our whole family" and "I struggle with anxiety and depression at times. I have learned a lot from the group sessions here" are providing too much self-disclosure and are inappropriate in a therapeutic nurse-client relationship. The nurse's response of "That's not an appropriate question for me. Let's talk about something else" is giving disapproval and changing the subject, which are both nontherapeutic techniques for the client.
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? "Yes, so that you can talk to your family." "Should you go home for the weekend?" "Let me see if I understand." "I don't think you should, you might not be ready."
"Should you go home for the weekend?" Reflection is a therapeutic communication technique used to redirect the idea back to the client for classification of emotional overtones, feelings, and experiences. The nurse's response, "Should you go home for the weekend?" is utilizing the reflection technique. The nurse's statement, "Let me see if I understand" is utilizing the validation technique. The nurse's statements, "Yes, so that you can talk to your family" and "I don't think you should, you might not be ready" is giving advice, which is a block in communication.
A psychiatric-mental health nurse has learned about the importance of self-reflection while caring for clients diagnosed with mental illnesses. Which statement made by the nurse would indicate the need for further teaching? "If I am unaware of my personal feelings, I may unintentionally project my feelings onto my clients." "Clinical supervision is an option for building self-reflection and focuses on the growth of the nurse." "Solicitating feedback from my colleagues is not an appropriate way to build self-reflection." "Developing self-awareness will enhance my objectivity, which fosters a nonjudgmental attitude toward my clients."
"Solicitating feedback from my colleagues is not an appropriate way to build self-reflection." Nurses must understand their own personal feelings and beliefs and try to avoid projecting them onto their clients. The development of self-awareness will enhance the nurse's objectivity and foster a nonjudgmental attitude, which is so important for building and maintaining trust throughout the nurse-client interaction. Soliciting feedback from colleagues and supervisors about how personal beliefs or thoughts are being projected onto others is a useful self-assessment technique. Clinical supervision is another technique that can be used in self-reflection and the focus of clinical supervision in the growth of the nurse. The nurse's statement of "Solicitating feedback from my colleagues is not an appropriate way to build self-reflection" would indicate a need for further teaching. The other statements demonstrating understanding.
A client diagnosed with depression is being counseled by the nurse for cognitive distortions. The client says, "Bad things always happen to me." Which response by the nurse would be therapeutic? "There must have been some good things in your life." "Tell me about a time when things went your way." "Did you sleep last night?" "Are you feeling more depressed today?"
"Tell me about a time when things went your way." Clients diagnosed with depression may use communication styles such as overgeneralizations ("This always happens to me..., everything always turns out for the worse..."). The nurse can assist the client to be more specific, such as asking about a specific time or a specific exception. The client in the scenario is overgeneralizing; therefore, the nurse's response, "Tell me about a time when things went your way" would be therapeutic for the client. The nurse's responses, "Did you sleep last night?", and "Are you feeling more depressed today?" are changing the subject, which is not therapeutic. The nurse's response, "There must have been some good things in your life" is minimizing the client's feelings, which is not therapeutic.
The nurse educator is teaching the class about communication. Which statement by the student nurse best describes the basic elements of communication? "The basic elements of communication include message, sender, feedback, and gesture." "The basic elements of communication include receiver, feedback, flow, and expression." "The basic elements of communication include sender, receiver, flow and message." "The basic elements of communication include feedback, sender, receiver, and messages."
"The basic elements of communication include feedback, sender, receiver, and messages."
A group of nursing students is preparing a presentation about therapeutic communication. As part of the presentation, the group is planning to give examples of maintaining a nonjudgmental attitude. Which would be appropriate to include? "Mental illnesses are, for the most part, an individual perception and could be solved easily if people were forced to continue with their daily activities." "People who are mentally ill chose to live in a way prevents mental wellness." "The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself." "I think the client is exaggerating the client's feelings. It's just so that the client can leave work early."
"The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself." The statement about the client with domestic violence and trying hard to change reflects a nonjudgmental attitude. It is void of personal opinion and value judgments and provides a neutral view. The statements about weak characters, exaggerating feelings (an excuse), and mental illness being all in the head reflect value judgments and opinions.
When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? "What specifically makes you uncomfortable?" "It would be great if you could attend an in-service on therapeutic communication." "I can take that client off of your assignment this shift." "Have you ever been sexually abused?"
"What specifically makes you uncomfortable?" It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self-reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." "Who has made you so upset?" "You look like you are very angry this morning." "I wish you could try to be more positive." "Please calm down; everything is going to be better."
"You look like you are very angry this morning." Replying that the client looks very angry this morning provides reflection of the client's affect (angry) and is making an observation. 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.
Which statement by the nurse reflects the use of a therapeutic statement? "I'd like to know more about your children. Tell me about them." "You look very sad. How long have you been this way? Have you been taking care of yourself?" "I understand your husband passed away. I couldn't bear that." "You look upset. Would you like to talk about it?"
"You look upset. Would you like to talk about it?" The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.
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 cheerful expression An erect, confident posture A sad facial expression A fearful tone of voice A sarcastic tone of voice mỉa mai
A sad facial expression A fearful tone of voice 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 nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of: excessive probing. lack of awareness. gathering assessment data. genuineness and caring.
excessive probing. tham do qua muc Excessive probing is usually nontherapeutic, except in the process of collecting a history. The here and- now is what the client is experiencing and what the nurse can assist the client in changing.
"Get the stuff from him" is an example of which type of message? Direct Clear Concrete Abstract
Abstract "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.
"Get the stuff from him" is an example of which type of message? Direct Abstract Concrete Clear
Abstract "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.
Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" Focusing Broad opening Exploring Accepting
Broad opening This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.
A client expresses to the nurse that the client 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? Consensual validation Broad openings Encouraging comparison Accepting
Consensual validation xac nhan dong thuan 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.
Which includes the circumstances or parts that clarify the meaning of the content of the message? Process Congruence Proxemics Context
Context Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.
A client is speaking to the nurse and expressing dissatisfaction about the care that was provided to the client during a hospital stay. The nurse tells the client, "This is the best hospital in the state. You could not expect better care anywhere else." Which type of communication does this indicate? Belittling Defending Challenging Agreeing
Defending The nurse's statement conveys that the nurse is trying to defend the hospital from the client's criticism. The nurse's statement may not change the client's feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client's discomfort.
When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique? Exploring Accepting Formulating a plan of action Focusing
Exploring Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.
A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? Formulation of an idea Message encoding Message transmission Message reception
Formulation of an idea With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.
A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited? Expressive Incongruent Impassive Confusing schizophrenic /skit sờ phrí ni ờ/ tam than phan liet catatonic tăng lực cơ
Impassive An impassive face is frozen into an emotionless deadpan expression similar to a mask. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one that is the opposite of what the person wants to convey, or incongruent.
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 Sitting with closed arms and crossed legs Looking down to the floor Mirroring the client's facial expression
Leaning toward the client Maintaining eye contact with the client The nonverbal cues that convey that the nurse is paying attention are leaning toward the client and maintaining eye contact while speaking to the client. If the nurse looks down toward the floor when the client is trying to talk, this indicates that the nurse is disinterested. Having a sad facial expression does not indicate attentiveness. Sitting with closed arms and crossed legs indicates that the nurse is not willing to listen to the client.
Which zone is a distance that is comfortable between family and friends who are talking? Social Personal Public Intimate
Personal The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.
A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? Presenting reality Seeking information Making observations Reflecting
Presenting reality All four choices are means of therapeutic communication. In presenting reality, the nurse offers a nonargumentative description of reality for consideration by the client. This can be helpful for the client experiencing hallucinations. Reflecting encourages the client to recognize and accept the client's own actions, thoughts, and feelings; the nurse establishes that the client's point of view has value and the client has a right to think independently. In making observations, the nurse verbalizes what the nurse perceives; this is generally done when the client is unable to verbalize thoughts. The nurse seeks information to gain clarification and help the client articulate thoughts, feelings, and ideas.
When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what? hiểu Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Giving the client ample opportunity to ask questions Presenting the information using language and terms the client will understand
Presenting the information using language and terms the client will understand 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.
During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which nontherapeutic communication technique? Reflecting Clarification Probing Confrontation
Probing An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.
Which zone is an acceptable distance between a speaker and an audience? Social Personal Public Intimate
Public The public zone is an acceptable distance between a speaker and an audience. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The personal zone is the distance comfortable between family and friends who are talking. The social zone is the distance acceptable for communication in social, work, and business settings.
Which would not be considered a goal of therapeutic communication? Active listening Self-exploration of feelings by the nurse Guiding the client in problem solving Establishing rapport
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 form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? Sitting behind a desk Facing the client at eye level Keeping arms and legs uncrossed Leaning slightly forward toward the client
Sitting behind a desk Sitting behind a desk imposes a barrier between the nurse and the client and is therefore the least effective technique listed here. Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward also helps engage the client. Generally, the nurse should not cross the arms or legs during therapeutic communication because such postures erect barriers to interaction; uncrossed arms and legs project openness and a willingness to engage in conversation.
A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness? Intimate Public Social Personal
Social The social zone is appropriate for discussing this type of information as it is not sensitive or private and does require the nurse to be in close proximity of the client to maintain confidentiality. The personal zone refers to an arm's length distance of approximately 1 1/2 to 4 feet. This is the zone in which therapeutic communication occurs. The public zone ranges from 12 to 25 feet. This would be appropriate in this case if the nurse was addressing a whole group of clients. The intimate zone consists of an area in which actions that involve touching another body occur.
Which type of touch, according to Knapp, is used in greeting, such as a handshake? Friendship-warmth Love-intimacy Social-polite Functional-professional
Social-polite Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.
A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment? intimate public social personal
Social-polite Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.
A client is speaking with the nurse about the client's difficult relationship with the client's father. The client states, "He never showed me love or approval unless I was perfect." Which response is most likely to encourage the client to continue elaborating? "I'm sure he loved you, though it sounds like he had trouble expressing it." "You must feel rejected." "Really?" "Tell me more about that."
Tell me more about that." Inviting the client to continue to elaborate on the topic by stating "tell me more about that" offers the nurse a brief statement with which exploring can take place. to elaborate /elébôrate/ marked by complexity, fullness of detail, or ornateness
The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement? The client feels that the nurse is indifferent toward the client. The client is not maintaining boundaries. The client feels that the nurse is not doing the job properly. The client feels that the nurse is invading the client's personal zone.
The client feels that the nurse is indifferent toward the client. Explanation: People from cultures in the Middle East, Asia, and the Mediterranean often are more comfortable with less than 4 to 12 feet of space between them while talking. Thus, it is likely the Middle Eastern client feels that the nurse is behaving indifferently toward the client. If the nurse is aware of behaviors in various cultures, the nurse would interpret it this way. The client not maintaining boundaries is an incorrect interpretation of the client's statement. The client does not convey that the nurse is not doing the job properly. The client does not feel that the nurse is invading the client's personal zone.
The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? The client may have difficulty maintaining spacial boundaries. The client may be physically expressive. The client can communicate freely. The client can open up easily.
The client may have difficulty maintaining spacial boundaries. Sitting behind a table while speaking to a client makes the setting formal. This setting would most likely be required when dealing with clients who have difficulty maintaining boundaries. Such a formal setting would make the client more uncomfortable. In such settings, the client may not be able to share feelings freely or to open up easily. It is not appropriate for the nurse to use this kind of setting if the client is willing to express individual feelings.
A nurse is caring for a client who is experiencing a decline in the client's chronic illness. The nurse feels that the nurse should speak to the client's spouse, who is extremely worried and anxious, and provide the spouse with support. Which setting should the nurse select to speak to the spouse? Choose the best answer. The cafeteria The client's room The consultation room The hallway
The consultation room Explanation: The nurse has to speak to and assess the client's spouse, who is worried and anxious. The nurse should find a secluded place to discuss the spouse's problems. The consultation room would be the best place for the nurse to talk with the client's spouse. The cafeteria is usually crowded and the spouse would not feel comfortable discussing worries there. The client's room is not the appropriate place to speak to the spouse as the spouse may not be willing to discuss fears in front of the client. The hallway is not an appropriate setting, as the spouse may not feel comfortable talking about concerns in the presence of other nurses.
The nurse is speaking with a client. While listening, the nurse faces the client and leans slightly toward the client. How does the client interpret this gesture? The nurse is threatening the client to speak properly. The nurse is keenly interested in the client's concerns. The nurse is unable to hear the client. The nurse is unable to understand what the client is saying.
The nurse is keenly interested in the client's concerns. Facing and leaning slightly toward the client indicates that the nurse is very interested in what the client has to say. Leaning toward the client does not mean that the nurse is unable to hear the client but that the nurse is paying attention to the client. This body language indicates supportive behavior and not that the nurse is trying to threaten the client. This body language does not indicate that the nurse is unable to understand what the client is saying. It indicates that the nurse is listening attentively.
Which is inconsistent with principles of therapeutic communication? Interventions are implemented from a theoretical base. The nurse must maintain client confidentiality. A professional attitude sets the tone of the therapeutic relationship. The nurse is the primary focus of the relationship.
The nurse is the primary focus of the relationship. The client, not the nurse, should be the primary focus of the interaction. The nurse must maintain client confidentiality and use a professional attitude. The interventions are implemented from a theoretical base.
During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way? The nurse has difficulty with conducting an assessment. The nurse can gain information about the client without wasting time. The nurse is accurately observing the client's nonverbal communication. The nurse may lack confidence in therapeutic communication.
The nurse may lack confidence in therapeutic communication.
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 0 to 18 inches 18 to 36 inches 12 to 25 feet 3 to 6 feet
The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings.
Which is an inaccurate depiction of concrete messages? mô tả There is no need for interpretation. They are easy to understand. They require rephrasing of unclear statements. They elicit more accurate responses. gợi ra
They require rephrasing of unclear statements. Explanation: Concrete messages do not require rephrasing of unclear word patterns. Therefore, this is the inaccurate statement that the question asks for. Concrete messages are easy to understand, there is no need for interpretation, and concrete messages elicit more accurate responses than do abstract messages.
A client has learned about defense mechanisms. Which behavior of the client would demonstrate the effective use of sublimination defense mechanism? The client views one friend as being perfect and views another friend as evil. The client reaffirms what they want to with social activities. The client notices their feelings and informs their friend of their feelings. When the client is angry about their boss, they go to a boxing class.
When the client is angry about their boss, they go to a boxing class. Sublimination defense mechanism is channeling potentially maladaptive feelings or impulses into socially acceptable behavior. When the client goes to a boxing class when they are angry about their boss, this demonstrates the sublimination defense mechanism. The example of the client viewing one friend as being perfect and viewing another friend as evil is demonstrating the splitting defense mechanism. The example of the client reaffirming what they want to with social activities is the self-assertion defense mechanism. The example of the client noticing their feelings and informing their friend of their feelings is demonstrating the self-observation defense mechanism.
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? self disclosure empathetic linkages self awareness active listening
active listening Active listening is refraining from other internal mental activities and concentrating exclusively on what the client says. Self disclosure, empathetic linkages and self awareness are not communication techniques. Empathetic linkages are the communication of feelings. Self-awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. Self-disclosure is communication by which one person reveals information like thoughts, feelings, aspirations, goals, failures, successes, fears and dreams, as well as one's likes, dislikes and favorites.
A psychiatric-mental health advanced practice nurse is mentoring a newly hired psychiatric-mental health nurse and role modeling therapeutic communication techniques. The advanced practice nurse observes the new nurse and determines the need for additional role modeling when the new nurse uses which technique? Select all that apply. validation advice disapproval silence reassurance /ri ờ shơ' rờns/ trấn an
advice reassurance disapproval Techniques that inhibit communication include advice, reassurance, and disapproval. Therapeutic communication techniques include the use of silence and validation.
A nurse is caring for a client who is crying and describes an argument that they had with their spouse. The client expressed that after the argument with the partner, the client turned to their friend for emotional support. Which defense mechanism will the nurse document that the client is using? anticipation acting out dissociation affiliation
affiliation liên kết The defense mechanism, affiliation, is turning to others for help or support (sharing problems with others without implying that someone else is responsible for them). The client turning to their friend for emotional support after the argument is demonstrating affiliation. Anticipation is experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic, alternative responses or solutions. Acting out is using actions rather than reflections or feelings during periods of emotional conflict. Dissociation is experiencing a breakdown in the usually integrated functions of self or the environment, or sensory and motor behavior.
A psychiatric-mental health nurse must perform a physical examination on a newly admitted client. What is the nurse's priority action before entering the client's personal space for the examination? asking the client's family for permission asking for the client's permission assessing the client's emotional state assessing the client's mental status
asking for the client's permission Physical boundaries are those established in terms of physical closeness to others, such as who we allow to touch us or how close we want others to stand near us. When boundaries are infringed upon, the client feels threatened and responds to the perceived threat. Before implementing interventions that invade the client's personal space, the nurse must elicit permission from the client. Therefore, the priority intervention by the nurse is to ask for the client's permission before conducting a physical examination on the client. Assessing the client's mental status and emotional state is important to conduct, but the priority action is to ask the client's permission before conducting an examination on the client. Asking the client's family for permission would not be appropriate if the client is able to give permission for themselves.
After discussing feeling guilty about having trouble looking after her children, the client states, "They would be better off if I wasn't around." The client's statement is an example of a(n): covert cue. abstract message. concrete message. overt cue.
covert cue. In this case, the nurse needs to interpret the client's verbal cues for meaning. By making this statement, the client is offering a covert cue about feeling hopeless and possibly considering committing suicide. An overt cue is a clear, direct statement of intent; for example, "I want to die." A concrete message is a verbal communication skill the nurse can use to direct a client when the client's ability to process concepts is low, such as when the client is highly anxious. Abstract messages are unclear patterns of words that can be difficult to interpret and when used by nurses can be misleading or confusing for clients.
Which nursing actions, if shared with clients, suggest self-disclosure? Select all that apply. wearing the color blue taking the elevator directing the client to the nurse's Facebook page telling the client the nurse attended a weight loss meeting showing family photos
directing the client to the nurse's Facebook page telling the client the nurse attended a weight loss meeting showing family photos Self-disclosure is revealing personal information, personal ideas, thoughts and feelings about oneself to clients. Self-disclosure may help the client feel more comfortable and more willing to share thoughts and feelings, or help the client gain insight into his or her situation. Wearing the color blue or taking the elevator are not considered self-disclosure.
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? to avoid the topic to disengage from the interaction more time to think to discuss it at another time
more time to think Sometimes silence or long pauses indicate the client is thoughtfully considering the question before responding. In this situation, it would be most therapeutic if the nurse could provide the client more time to think. Talking about the issue another time, avoiding the topic or disengaging from the interaction can only be confirmed if the nurse asks questions. However, it is important to allow the client sufficient time to respond, even if it seems like a long time.
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? to avoid the topic to discuss it at another time more time to think to disengage from the interaction
more time to think Explanation: Sometimes silence or long pauses indicate the client is thoughtfully considering the question before responding. In this situation, it would be most therapeutic if the nurse could provide the client more time to think. Talking about the issue another time, avoiding the topic or disengaging from the interaction can only be confirmed if the nurse asks questions. However, it is important to allow the client sufficient time to respond, even if it seems like a long time.
A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: permit clients to gather their thoughts. encourage self-reflection by the nurse. demonstrate passive listening. allow the nurse to determine an appropriate response.
permit clients to gather their thoughts. By maintaining silence, the nurse allows the client to gather the client's thoughts and to proceed at the client's own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process.
A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: encourage self-reflection by the nurse. demonstrate passive listening. allow the nurse to determine an appropriate response. permit clients to gather their thoughts.
permit clients to gather their thoughts. Explanation: By maintaining silence, the nurse allows the client to gather the client's thoughts and to proceed at the client's own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process.
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: decide what aspects of the student's life and experience the student is willing to disclose to clients. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. reflect critically on the student's own life experiences, perspectives, and characteristics. seek out a mentor who has extensive experience in the psychiatric-mental health area.
reflect critically on the student's own life experiences, perspectives, and characteristics. Self-awareness is a critical prerequisite for therapeutic communication and can only be achieved through critical self-reflection. Knowledge of disease processes is important but does not necessarily facilitate therapeutic communication. Self-disclosure is a comparatively minor variable and is provided cautiously on a case-by-case basis. A mentor is also useful but does not replace self-reflection as a precondition for therapeutic communication.
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: seek out a mentor who has extensive experience in the psychiatric-mental health area. reflect critically on the student's own life experiences, perspectives, and characteristics. decide what aspects of the student's life and experience the student is willing to disclose to clients. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness.
reflect critically on the student's own life experiences, perspectives, and characteristics. Self-awareness is a critical prerequisite for therapeutic communication and can only be achieved through critical self-reflection. Knowledge of disease processes is important but does not necessarily facilitate therapeutic communication. Self-disclosure is a comparatively minor variable and is provided cautiously on a case-by-case basis. A mentor is also useful but does not replace self-reflection as a precondition for therapeutic communication.
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? social zone self-awareness self-disclosure exploitation
self-disclosure The most important principles of therapeutic communication is to focus the interaction on the patient's concerns. Self-disclosure is telling the client personal information. The nurse can determine how much personal information, if any, to disclose. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes. Self-awareness, social zone and exploitation are not principles of therapeutic communication.
Which is often considered the most difficult yet most effective communication technique? reflecting clarifying restating silence
silence Although restating, reflecting, and clarifying are effective therapeutic communication techniques, one of the most difficult but often most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, a nurse allows the client to gather thoughts and to proceed at his or her own pace.
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? concrete thinking symbolism self-observation autistic fantasy
symbolism In people with mental illnesses, the use of words to symbolize events, objects, or feelings is often idiosyncratic, and they cannot explain their choices. For example, a person who is feeling scared and anxious may tell the nurse that bombs and guns are exploding. Therefore, the client in the scenario is utilizing symbolism and the nurse would document that observation. Concrete thinking is a type of thinking that the client with a mental illness may have and demonstrates a literal interpretation of the conversation or question. Self-observation is a defense mechanism that occurs when the client notices and expresses their feelings. Autistic fantasy is a defense mechanism that includes excessive daydreaming as a substitute for human relationships, more effective action, or problem solving.
The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use? displaying a flat affect so the client will not misinterpret the nurse using gentle touch during activities of daily living providing instructions to the client for feeding oneself speaking louder so the client can hear
using gentle touch during activities of daily living The nurse should supplement verbal communication with therapeutic nonverbal communication, including gentle touch, to reinforce caring feelings for the confused client. Providing instructions for feeding oneself and speaking louder are aspects of verbal communication and, in addition, would not be helpful. Displaying a flat affect is not an aspect of therapeutic nonverbal communication.
