Chapter 6 Therapeutic Communication

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 providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what?

Presenting the information using language and terms the client will understand

Which zone is an acceptable distance between a speaker and an audience?

Public

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 nurse is asking a client for feedback on the services provided in the hospital. The client responds, "Yeah. It was great." The client spoke in a disgusted and hurried tone and did not make eye contact with the nurse. What is the message conveyed here?

"Don't waste my time asking about your services."

The nurse indicates interest in and acceptance of the client by all of the following except:

sitting behind a desk.

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?

"At what time did you take the last dose of the antianxiety drugs?"

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?"

A client has repeatedly been physically abused by the spouse. The client asks the nurse whether to leave the spouse like the mother has demanded. The nurse responds most therapeutically when answering:

"How would leaving your spouse make you feel?"

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's most therapeutic response?

"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you."

A nurse is assessing an elderly client with a cardiac disorder. Which statement given by the client conveys an abstract message? Choose the best answer.

"I don't really know how it all started. It just happened."

A nurse is engaging in an interpersonal interaction with a young adult client who is admitted to the hospital with suicidal ideation. The client states, "I am really not good at anything." How should the nurse respond to the client's statement?

"I have a really difficult time believing that."

A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response?

"I notice it has been a while since you have had a shower."

The nurse is working in the mental health clinic communicating with a client who is having auditory hallucinations. What should the nurse say to effectively communicate with this client?

"I understand that the voices seem real to you, but I don't hear them."

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?

"I'm concerned that you are not exicited about your mother's visit, We can talk if you want."

The nurse manger is discussing self- awareness during a staff meeting. Which statement(s) by the staff nurse best depicts self-awareness? Select all that apply.

"I'm tired and hungry. I need to take a break and get something to eat." "I asked to be transferred because the nurses on this unit are critical and make me feel inadequate when I work with them."

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?"

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?"

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?

"It sounds like you're feeling unappreciated."

A hospitalized client diagnosed with depression asks a nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection?

"Should you go home for the weekend?"

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?

"Tell me more about that."

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?"

A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response?

"What you are saying and how you say it does not seem to match."

Which statement by the nurse reflects the use of a therapeutic statement?

"You look upset. Would you like to talk about it?"

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?

3 to 6 feet

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication?

3 to 6 feet

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 sad facial expression A fearful tone of voice

"Get the stuff from him" is an example of which type of message?

Abstract

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone?

Beginning at the boundary of the intimate zone and ending at the social zone

Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?"

Broad opening

Which type of cue is being used when the client states, "Nothing can help me"?

Covert

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?

Defending

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?

Emphasis

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening?

General leads

Which zone is a distance that is comfortable between family and friends who are talking?

Personal

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

Presenting reality

Which arrangement is likely to be the least threatening to a psychiatric-mental health client?

Sitting at an angle, 4 to 5 feet apart

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

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?

Social

Which type of touch, according to Knapp, is used in greeting, such as a handshake?

Social-polite

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.

A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation?

The client may be reluctant to dialogue despite the statement to the contrary

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue?

The client may have suicidal ideations.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

The client's room

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 consultation room

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 keenly interested in the client's concerns.

Which is inconsistent with principles of therapeutic communication?

The nurse is the primary focus of the relationship.

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 may lack confidence in therapeutic communication.

A client begins discussing frankly the client's history of sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. The nurse does this for what reason?

To reduce the nurse's own anxiety

When speaking with a client who has a diagnosis of major depression, the nurse has placed a hand lightly on the client's shoulder when responding to one of the client's statements of hopelessness. Which principle should underlie the nurse's use of touch when communicating with clients?

Touch can be a powerful therapeutic tool, but it must be used with caution.

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 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.

advice reassurance disapproval

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.

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication?

emotion underlying the words

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.

The nurse is engaging in assertive communication when which communication approach is used? (Select all that apply.)

expressing feelings attached to the concern using "I" statements using direct language

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited?

impassive

The nurse is assessing a client who is hospitalized for an episode of mania. When the nurse sits down across from the client to begin the interview, the client moves to sit right beside the nurse. The client is positioned in which body space zone of the nurse?

intimate

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

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to:

permit the client to gather the client's thoughts.

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.

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

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

silence

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?

social

A nurse has been in a therapeutic relationship with a client for several weeks. When the client comes in for the weekly appointment, the nurse touches the client's arm when saying hello. The nurse has used which form of touch?

social-polite

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

A nurse is meeting with a client prior to discharge from the hospital. The client tells the nurse he is "really worried about returning home." Which response indicates the nurse is employing therapeutic communication?

"Please share with me what is worrying you right now."

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

"I understand that group can be difficult to attend but coming late is disruptive."

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 client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic?

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks."

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 feedback, sender, receiver, and messages."

The graduate nurse is working in mental health and is learning about the use of touch with clients that have psychiatric disorders. The seasoned mental health care nurse differentiates information about this part of therapeutic communication by stating which information?

"Touch carries different meanings for different individuals.

The nurse therapist calls a client to reschedule their appointment for the following week. When the client arrives at the appointment, the client is uncommunicative and avoids eye contact with the nurse. When asked how things have been going, the client answers, "Fine." How should the nurse confront this behavior?

"You appear to be angry. Perhaps you are angry with me for rescheduling our appointment or something else has happened. Tell me more about what you are feeling."

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?

Abstract

When interviewing a young adult Asian client who immigrated to the United States as a child, the nurse best addresses the impact that culture has on the client's perceptions and beliefs by doing what?

Assessing to what degree the client has embraced the American culture

A psychiatric-mental health nurse is interacting with a client experiencing depression. The nurse is vigilant in observing the nonverbal communication of the client based on the understanding about which aspect associated with clients with mental illness?

Clients have difficulty verbally expressing themselves and interpreting others' emotions

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

During a therapy session, the nurse states, "So you're saying that you've tried many techniques for managing your stress but haven't felt any better?" This is an example of which therapeutic communication technique?

Consensual validation

Which includes the circumstances or parts that clarify the meaning of the content of the message?

Context

Which term is used to refer to signals that encourage effective communication?

Cues

The nurse observes that a client has been pacing in the unit's common area with pursed lips and a furrowed brow for the past 15 minutes. What is the psychiatric-mental health nurse's best action

Engage with the client i to validate why the client is doing this

After reviewing the client's chart, the nurse sets up a time to speak with the client. The client has a history of severe psychological abuse by the client's mother, who has schizophrenia. The nurse plans to ask the client about the abuse and how it has affected the client's sense of self-esteem. This is an example of what kind of intervention?

Excessive probing

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

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

The nursing instructor is teaching about the importance of communication in nursing and relates it to the family. Which statement by a student nurse would indicate that the teaching has not been effective?

Nonverbal communication is not meaningful.

Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason?

Nonverbal communication provides additional client information that is acted out unconsiously

During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which therapeutic communication technique?

Probing

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse

The nurse states,"I feel anxious most of the time." Which defense mechanism(s) are unhealthy ways for the nurse use to decrease anxiety? Select all that apply.

The nurse gets angry with the manager and tries to leave early before the manager comes in for work. After failing to get a promotion to manager, the nurse tells co-workers that manager was not what was wanted all along

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

Which is an inaccurate depiction of concrete messaging?

They require rephrasing of unclear messaging.

High-pitched, rapid delivery of a message often indicates what?

anxiety

A nurse engages in an interpersonal interaction with a client who begins to make confusing statements. In response, the nurse states, "I am not sure I am understanding you correctly, can you explain that to me again?" Which therapeutic communication approach is the nurse employing?

asking for clarification

A nurse is conducting an initial assessment of a client. When the client enters the nurse's office, the client finds the nurse sitting with arms folded across the chest and an emotionless facial expression. The nurse is exhibiting which nonverbal communication technique?

closed body position and impassive face

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse?

public

The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what?

self- disclosure

Which nursing actions if shared with clients, suggest self-disclosure? Select all that apply.

showing family photos attending a weight loss meeting directing to individual Facebook page