Chapter 9: Communication and the Clinical Interview Evolve Questions

Which of the following statements indicate a nontherapeutic communication technique? (select all that apply): A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."

A, C, D, E All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior? A. You have violated Louisa's personal space by physically being too close. B. Louisa has issues with sharing personal information. C. You have not made the patient feel comfortable by explaining the purpose of the admission interview. D. Louisa is responding to the voices in her head telling her to leave.

A. By sitting and leaning in so closely, you have entered into intimate space (0 to 18 inches), rather than social distance and the patient may feel uncomfortable with being so close to someone she does not know. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

Two main principles that can guide the communication process during the nurse-client interview are A. clarity and giving recognition. B. personal and environmental factors. C. passive listening and cultural caution. D. interpreting and speculating on the client's meaning.

A. Clarity refers to mutual understanding of communication, and giving recognition indicates awareness of change and personal efforts. Both are desirable.

What is the focus during clinical supervision? A. The nurse's behavior in the nurse-client relationship B. Analysis of the client's motivation for transferences C. Devising alternative strategies for client growth D. Assisting the client to develop increased independence

A. Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients.

A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is A. African American. B. Hispanic American. C. Asian American. D. British American

B. Highly emotional verbal communication accompanied by dramatic body language when describing emotional problems is a style associated with persons of Hispanic culture. French and Italian Americans also demonstrate animated facial expressions and expressive hand gestures during communication.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Can you tell me what was happening to you that led to your being hospitalized here?" A. Using a minimal encourager B. Using an open-ended question C. Paraphrasing D. Reflecting

B. Open-ended questions require more than one-word answers.

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible? A. William did not love his wife. B. William's response may reflect cultural norms. C. William's response may reflect guilt. D. William may have an antisocial personality, which would explain his lack of feeling.

B. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient did not love his wife, and this would be jumping to conclusions. There is also nothing in the scenario to suggest guilt and there is no evidence in the scenario to suggest antisocial personality disorder.

The content and direction of the clinical interview is determined by the A. nurse. B. client. C. physician. D. health care team.

B. The client always takes the lead and determines the content and direction of the clinical interview, although the nurse may discourage social conversation or intrusive personal questioning.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? A. "Don't let them beat you! Fight back!" B. "School is stressful. What do you find most stressful?" C. "I know just what you are going through. The stress is terrible." D. "You have only two more semesters. You will be glad if you stick it out."

B. This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

The preferred seating arrangement for a nurse-client interview is with A. the nurse behind a desk and the client in a chair in front of the desk. B. the nurse and client sitting at a 90-degree angle to each other. C. the client sitting in a chair and the nurse standing a few feet away. D. the nurse and client sitting facing each other.

B. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A. A recent immigrant from Russia B. A deeply depressed client C. A Chinese American client D. A tearful client reporting pain

C. Chinese Americans may not like to be touched by strangers.

When determining the appropriateness of touching a psychiatric client, the nurse should A. follow his or her instincts concerning touching individual clients. B. touch the elderly but avoid touching the young. C. check the facility's policy on the acceptability of touch. D. perceive touch as a gesture of warmth and friendship that fosters a relationship.

C. Students are urged to check the policy manual of their facilities, because some facilities have a no-touch policy, particularly with adolescents and children who may have experienced inappropriate touch and would not know how to interpret the touch of the health care worker.

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy: Verbal communication relates to content as nonverbal communication relates to A. touch. B. conflict. C. process. D. double messages.

C. The verbal message is sometimes referred to as the content of the message, and the nonverbal behavior is called the process of the message.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

Of the following environments, which would be most conducive to a therapeutic session? A. The nurses' station B. A table in the coffee shop C. A quiet section of the day room D. The utility room

C. Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter.

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a A. safe person to interact with. B. new friend. C. stranger. D. peer.

C. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building.

After a client discusses her relationship with her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" The nurse's purpose is to A. elicit more information. B. encourage evaluation. C. verbalize the implied. D. clarify message.

D. Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions.

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique? A. Korea B. Mexico C. Japan D. Germany

D. Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

Which statement by the nurse reflects the process occurring in the clinical interview? A. "Give me an example of something your wife does that 'drives you nuts.'" B. "What makes you think your doctor will give you a pass?" C. "When is your child custody hearing going to be held?" D. "You are frowning. What are you feeling?"

D. Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of client feelings than what is being verbalized.

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" A. Focusing B. Restating C. Reflection D. Clarification

D. Clarification verifies the nurse's interpretation of the client's message.

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? A. Using emotionally charged words and gestures B. Offering opinions and avoiding periods of silence C. Asking closed-ended questions requiring "yes" or "no" answers D. Asking open-ended questions and seeking clarification

D. Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding.

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? A. Giving information and encouraging evaluation B. Presenting reality and encouraging planning C. Clarifying and suggesting collaboration D. Reflecting and exploring

D. Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should A. quickly break the silence and encourage the client to continue. B. reassure the client that the abuse was not her fault. C. reach out and gently touch the client's arm. D. allow the client to break the silence.

D. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? A. The mental image of a word may not be the same for both nurse and client. B. One statement may simultaneously convey conflicting messages. C. Many of the client's remarks are no more than social phrases. D. Content of messages may be contradicted by process.

D. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message.