PREP U Chapter 6- Mental Health
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?" "How can you make your anxiety better?" "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?" Explanation: 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? "Can you explain to me what made you so angry?" "What are you going to do the next time you get angry?" "What could you do when you are angry that doesn't involve throwing things?" "What do you think is the best thing to do when you are angry?"
"Can you explain to me what made you so angry?" Explanation: 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 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: "What do you think your spouse would do if you leave?" "How would leaving your spouse make you feel?" "Your mother may be right; I'd consider what she is saying." "Your mother doesn't have the right to demand that; it's your decision."
"How would leaving your spouse make you feel?" Explanation: Exploring the client's thoughts about leaving the situation is the priority for the therapeutic communication to be effective in this case. With this response, the interaction remains client centered and goal directed. Giving advice may facilitate dependency, thus it is important to elicit the client's thoughts on the matter; encouraging problem solving and decision making by the client is more constructive than giving advice.
A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to come 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 check on you yesterday, but I think it's unlikely that the doctor hates you." "Since the doctor didn't come yesterday, would you like me to page her to see you right now?" "Unfortunately, the doctor has an extremely busy schedule, and she doesn't always keep promises." "I'm sure that the doctor will come and see you as soon as she can."
"I don't know why the doctor didn't check on you yesterday, but I think it's unlikely that the doctor hates you." Explanation: One therapeutic communication technique is to express doubt. This is appropriate when the client expresses a thought that stretches credibility. The nurse does not agree or disagree but does express skepticism, which encourages the client to reconsider. It would be inappropriate for the nurse to characterize the health care provider to the client as someone who "doesn't keep promises." The nurse cannot justifiably reassure the client that the health care provider will come as soon as she is able; the nurse cannot make commitments for the provider. Similarly, it would likely be inappropriate for the nurse to page the health care provider solely in response to the client's statement.
The nurse is assessing the behavior of a client. The client has a cheerful expression, erect posture, and a confident tone. Which statement made by the client along with these nonverbal cues conveys a congruent message? "Is that so? I never knew that." "I cannot bear the pain, please give me my medication." "I swear to God, I will not make this mistake again." "I feel great and am able to do my exercises properly."
"I feel great and am able to do my exercises properly." Explanation: A cheerful expression, an erect posture, and a confident tone indicate that the client has achieved something and is happy about it. These processes, along with the statement that the client feels good, convey a congruent message. The remaining statements convey incongruent messages as the patient's processes contradict the statement given to the nurse.
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? "Why haven't you taken a shower yet?" "Don't worry, take as long as you need before you get going." "I think you need to take a shower." "I notice it has been a while since you have had a shower."
"I notice it has been a while since you have had a shower." Explanation: Stating, "I notice it has been a while since you have had a shower," is the correct option. Making an observation helps the nurse verbalize what is perceived. This is therapeutic because sometimes a client may not be able to verbalize or make themselves understood. Stating, "I think you need to take a shower," would be a nontherapeutic statement. This is called advising and entails telling the client what to do, communicating the the nurse knows what is best for the client. Stating, "Don't worry, take as long as you need before you get going," denotes reassuring by the nurse. By saying this, the nurse is communicating that this is not a problem despite the fact that the client is approaching the nurse for support in problem solving. By asking, "Why haven't you taken a shower?" the nurse is requesting an explanation. This is intimidating and the client is likely to become defensive or feel judged and vulnerable.
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'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?"
"I've been off for the past four days. What have you done since I last saw you?" Explanation: 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?" "What's wrong with your bed?" "Are you having any delusions or hallucinations right now?" "What are you looking for in the bed? There's nothing hidden there."
"It looks like you're searching for something. Is that right?" Explanation: 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 says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "It sounds like you're overreacting somewhat." "Why do you say I don't listen to you?" "I listen to you." "It sounds like you're feeling unappreciated."
"It sounds like you're feeling unappreciated." Explanation: 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.
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? "Why do you think you should be allowed to go for a break?" "Joe, let's review your care plan and discuss whether or not it needs to be revised." "No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." "Well, I know you were tired from last night. You can go at 2 p.m."
"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." Explanation: Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security. The nurse describes the client's unacceptable behavior, communicates expected behavior, and offers acceptable alternatives, such as walking with the nurse, talking about feelings and thoughts, or participating in recreational therapy.
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? "It is best to complete your recovery surrounded by loved ones." "Most clients have anxiety before they return home." "Please share with me what is worrying you right now." "Home is a much better place for you."
"Please share with me what is worrying you right now." Explanation: Asking the client what worries him the most helps identify the most important client concern at the moment. This helps to set a client-cantered goal. The incorrect responses all reflect non-therapeutic communication given the client's individual situation. Stating, "Home is a much better place for you," communicates reassuring indicating there is no reason for anxiety or other feelings of discomfort. Stating, "It is best to complete your recovery surrounded by loved ones" is advising otherwise telling the client what to do. Stating, "Most clients have anxiety before they return home," belittles the expressed emotions of the client. The nurse misjudging the degree of the clients discomfort.
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." "Tell me more about that." "You must feel rejected." "Really?"
"Tell me more about that." Explanation: 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.
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 sender, receiver, flow and message." "The basic elements of communication include receiver, feedback, flow, and expression." "The basic elements of communication include feedback, sender, receiver, and messages." "The basic elements of communication include message, sender, feedback, and gesture."
"The basic elements of communication include feedback, sender, receiver, and messages." Explanation: Communication includes the elements of sender delivers the message, messages are the content of the communication, receiver receives and decodes the message, and feedback is the message returned by the receiver and indicates whether the sender's message was understood. Flow, expression, and gesture are not included in the basic elements of communication.
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? "It would be great if you could attend an in-service on therapeutic communication." "What specifically makes you uncomfortable?" "I can take that client off of your assignment this shift." "Have you ever been sexually abused?"
"What specifically makes you uncomfortable?" Explanation: 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.
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 3 to 6 feet 0 to 18 inches 12 to 25 feet 18 to 36 inches
3 to 6 feet Explanation: The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client.
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? "I'm sorry I had to reschedule our appointment. It really couldn't be helped. Is that what's bothering you?" "You seem angry, and I understand that you have been depressed, but I feel like you are avoiding speaking to me. Can you explain why you're acting this way?" "You seem angry. Would you like to talk more about how you're feeling?" "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."
"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." Explanation: Confrontation is the skill of pointing out, in a caring way, the discrepancies between what clients say and do. This can be done using a three-step formula called a perception check: describe the inconsistent or confusing behavior, offer at least two possible interpretations of that behavior, and ask for feedback.
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." "I wish you could try to be more positive." "You look like you are very angry this morning." "Please calm down; everything is going to be better." "Who has made you so upset?"
"You look like you are very angry this morning." Explanation: 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? "You look upset. Would you like to talk about it?" "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." "I'd like to know more about your children. Tell me about them."
"You look upset. Would you like to talk about it?" Explanation: 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 who has tried several different antidepressant medications tells the nurse that uncomfortable side effects make the client want to stop taking medication altogether. What is the nurse's best response? "If you think that is best for you, I agree." "Antidepressants rarely have side effects." "All of our clients have some side effects and they manage okay." 'Tell me what is it about the medication that is troubling you the most."
'Tell me what is it about the medication that is troubling you the most." Explanation: Asking the client what is most troubling about the medication allows the client to concentrate on the single most important concern. This can help the nurse identify if the benefits of the medication outweigh the discomfort caused by the side effects. Agreeing with the client communicates approval and indicates the client is "right" without gaining further information to help the client make an informed decision. Using denial minimizes the seriousness of the discomfort caused by the side effects of the medication. Telling the client that all clients have some side effects but manage them belittles the client's expressed concerns. Here the nurse has implied that the discomfort is mild or not significant.
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 sarcastic tone of voice An erect, confident posture A fearful tone of voice A sad facial expression A cheerful expression
-A sad facial expression -A fearful tone of voice Explanation: A process refers to the nonverbal messages that the speaker uses to give meaning and context to the overall message. The client is diagnosed with cancer and is grieving. Thus, a sad facial expression and a fearful tone of voice are congruent with having been diagnosed with the disease and worrying about the impending health problems. A cheerful expression, a sarcastic tone of voice, and an erect, confident posture are incongruent with the client's statement to the nurse.
A 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. Maintaining eye contact with the client Looking down to the floor Mirroring the client's facial expression Sitting with closed arms and crossed legs Leaning toward the client
-Leaning toward the client -Maintaining eye contact with the client Explanation: 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.
A client has been brought to the psychiatric care unit. During the assessment, the nurse observes the client uses ineffective communication skills. Which are interpersonal factors that may influence the client's mental health? Select all that apply. Proxemics Silence Intolerance of violence Inability to use feeling words Emotional resilience
-Proxemics -Silence -Inability to use feeling words Explanation: Understanding the influence of physical space when interacting with another person can influence how others respond to the client. This can have an impact on the client's mental health. If the client uses silence often, interacting with staff and other clients will be ineffective, rendering difficulty in the client's relationships. The client will not be able to benefit from interpersonal and milieu therapies that are offered on the unit. If the client is unable to use feeling words, he or she will not unable to accurately express needs. This can alter treatment and limit the ability of staff to meet the client's needs. Interpersonal factors that may influence mental health are intimacy, a helping nature, and balance of separateness. Emotional resilience is a personal factor influencing mental health. Emotional resilience is a personal factor. Intolerance of violence is a social factor influencing mental health.
The nurse is meeting a client for the first time. Which action should the nurse take to establish a rapport with this client? Select all that apply. asking the client to further explain a recurring symptom remaining neutral when the client states a lack of faith in medical care defending the healthcare provider's choice of treatment suggesting the client obtain a second opinion if care is not satisfactory shaking the client's hand when greeting
-shaking the client's hand when greeting -asking the client to further explain a recurring symptom -remaining neutral when the client states a lack of faith in medical care Explanation: Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. Shaking the client's hand demonstrates interpersonal warmth. Understanding is demonstrated by asking the client to further explain a recurring symptom. Remaining neutral when the client states a lack of faith in medical care demonstrates a nonjudgmental attitude. Defending the healthcare provider's choice of treatment and suggesting the client obtain a second opinion if care is not satisfactory are behaviors that do not support the establishment of rapport.
Which nursing actions, if shared with clients, suggest self-disclosure? Select all that apply. taking the elevator directing the client to the nurse's Facebook page telling the client the nurse attended a weight loss meeting wearing the color blue showing family photos
-showing family photos -showing family photos -directing the client to the nurse's Facebook page Explanation: 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 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? 15 to 18 inches 15 to 18 feet 10 to 12 inches 3 to 6 feet
3 to 6 feet Explanation: A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between the client who is Hispanic and the nurse. People from some cultures, including Hispanics, are more comfortable with less than 4 to 12 feet of space between them when talking. A distance of 10 to 12 inches or 15 to 18 inches is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.
Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" Exploring Broad opening Focusing Accepting
Broad opening Explanation: 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. Reference:
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? Accepting Consensual validation Encouraging comparison Broad openings
Consensual validation Explanation: The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.
Which includes the circumstances or parts that clarify the meaning of the content of the message? Congruence Context Proxemics Process
Context Explanation: 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.
Which term is used to refer to signals that encourage effective communication? Abstract messages Concrete messages Cues Metaphors
Cues Explanation: A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.
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? Challenging Defending Belittling Agreeing
Defending Explanation: 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.
A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? Gestures Expressions Emotion underlying the words Body language
Emotion underlying the words Explanation: Verbal communication, which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said. Nonverbal communication includes gestures, expressions, and body language.
Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? Pitch Emphasis Intensity Tone
Emphasis Explanation: Emphasis refers to accents on words or phrases that highlight the subject or give insight on the topic. Tone can indicate whether someone is relaxed, agitated, or bored. Pitch carries from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words
A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited? Expressive Impassive Confusing Incongruent
Impassive Explanation: 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 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? Message reception Formulation of an idea Message encoding Message transmission
Formulation of an idea Explanation: 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 from which cultural background would most likely have an older family member present when discussing health issues with the nurse? Korean Italian Australian French
Korean Explanation: The nurse must understand the differences in how various cultures communicate. It helps to see how a person from another culture acts toward and speaks with others. Australia and many European cultures are individualistic; they value self-reliance and independence and focus on individual goals and achievements and so would be less likely to include others in the discussion. Other cultures, such as Chinese and Korean, are collectivistic, valuing the group and observing obligations that enhance the security of the group.
A client is exhibiting anxiety after being told that the client's spouse has sustained a heart attack. The nurse's response to the client is "everything will be okay." Which type of nontherapeutic communication technique is being exhibited by the nurse? Judgmental attitude Failure to listen Giving advice Reassurance
Reassurance Explanation: Clichés such as "everything will be okay" or "don't worry, the doctor will make you well" are examples of false reassurance. No one can predict or guarantee the outcome of a situation. Failure to listen, giving advice, and having a judgmental attitude are all ineffective communication techniques.
Which zone is a distance that is comfortable between family and friends who are talking? Personal Social Public Intimate
Personal Explanation: 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 Reflecting Making observations Seeking information
Presenting reality Explanation: 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? Giving the client ample opportunity to ask questions Being careful not to overload the client with too much information at one time Interacting with the client in a nonthreatening, respectful manner Presenting the information using language and terms the client will understand
Presenting the information using language and terms the client will understand Explanation: Being careful not to use technical terms and language that will confuse or intimidate the client will assist the client in grasping and applying the information. While interacting in a nonthreatening, respectful manner is considered expected, it is focused toward establishing a therapeutic relationship and not toward maximizing client learning. Being careful to not overload the client with information is important, but presenting the information in language the client can understand is most important. Giving the client ample opportunity to ask questions is important, too, although the nurse needs to realize that even if given time to ask a question the client may not choose to do so.
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 Confrontation Probing Clarification
Probing Explanation: 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 would not be considered a goal of therapeutic communication? Establishing rapport Active listening Self-exploration of feelings by the nurse Guiding the client in problem solving
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.
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 Public Personal Intimate
Social Explanation: 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 Functional-professional Social-polite
Social-polite Explanation: 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.
The nurse is assessing an adolescent with conduct disorder. During the assessment, the nurse notices the client is not making eye contact and is yawning. What may the nurse interpret from this behavior? The adolescent may be disinterested in the conversation. The adolescent may be sleepy. The adolescent may be trying hard to concentrate. The adolescent may be listening attentively to the nurse.
The adolescent may be disinterested in the conversation. Explanation: Expressions such as not making eye contact and yawning may indicate disinterest, lying, or boredom. In this context, yawning is unlikely to indicate that the client is sleepy. Turning the eyes away is likely a sign that the client is not willing to concentrate rather than trying hard to concentrate. Not making eye contact with the nurse and yawning do not indicate the client is listening attentively.
When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind? The client is the primary focus of the interaction. The nurse should have an empathetic relationship with the client. The nurse should self-disclose when indicated. The client's conversations should be recorded.
The client is the primary focus of the interaction. Explanation: A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.
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 disconnect between the client's verbal and nonverbal messages confirms the presence of mental illness The client is eager to dialogue with the nurse but is unsure how best to proceed The client is glad to talk to the nurse because that is what the client stated
The client may be reluctant to dialogue despite the statement to the contrary Explanation: In general, nonverbal messages supersede verbal messages. This disconnect between the two types of communication, however, are not limited to persons with mental illness.
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 can communicate freely. The client can open up easily. The client may be physically expressive.
The client may have difficulty maintaining spacial boundaries. Explanation: 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 hallway The consultation room The client's room
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.
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 The nurse made an inappropriate suggestion because it was not preceded by assessment The nurse has inhibited the nurse-client relationship by challenging the client The nurse has violated the ethical principles of beneficence and nonmaleficence
The nurse has inhibited therapeutic communication by giving advice Explanation: The nurse has blocked communication by giving advice. This action generally inhibits communication, whether or not it is preceded by assessment. This is not an example of challenging. The statement is inappropriate and simplistic but not necessarily a violation of beneficence and nonmaleficence.
Which is inconsistent with principles of therapeutic communication? The nurse must maintain client confidentiality. The nurse is the primary focus of the relationship. Interventions are implemented from a theoretical base. A professional attitude sets the tone of the therapeutic relationship.
The nurse is the primary focus of the relationship. Explanation: 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 is accurately observing the client's nonverbal communication. The nurse can gain information about the client without wasting time. The nurse may lack confidence in therapeutic communication.
The nurse may lack confidence in therapeutic communication. Explanation: Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. This reflects the nurse's limited confidence in the ability to utilize therapeutic communication skills. The nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen actively and attentively.
Which is an inaccurate depiction of concrete messages? There is no need for interpretation. They elicit more accurate responses. They require rephrasing of unclear statements. They are easy to understand.
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 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 make sure the nurse understands other problem areas in the client's life To help the client understand appropriate boundaries To model social skills To reduce the nurse's own anxiety
To reduce the nurse's own anxiety Explanation: The nurse has used the nontherapeutic communication technique called introducing an unrelated topic to reduce the nurse's anxiety. The nurse has effectively taken the initiative away from the client because the nurse is uncomfortable and does not know how to respond. The nurse often changes the subject in efforts to avoid discussing a topic with which he or she feels uncomfortable. If the client feels the need to bring up an issue, generally the nurse should resolve personal anxieties and facilitate client exploration.
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? Touching a client is inappropriate and opens the nurse to legal action. The nurse should explicitly ask permission before touching a client in any capacity. Touch can be a powerful therapeutic tool, but it must be used with caution. Physical touch should be used solely with clients of the same gender as the nurse.
Touch can be a powerful therapeutic tool, but it must be used with caution. Explanation: The nurse should always exercise caution when touching people. Touch can be a powerful component of communication and is appropriate in clinical settings, but it must be used judiciously to avoid negative consequences or impairing therapeutic relationships and communication.
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 awareness self disclosure empathetic linkages active listening
active listening Explanation: 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 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. gathering assessment data. lack of awareness. genuineness and caring.
excessive probing. Explanation: 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.
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 less than a foot away from the nurse. The client is positioned in which body space zone of the nurse? personal public intimate social
intimate Explanation: If the client is sitting next to the nurse, there are only a few inches of space between them. This is the intimate zone and is appropriate for parents with young children, people who mutually desire personal contact, or people whispering. Invasion of this intimate zone by anyone else is threatening and produces anxiety.
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 more time to think to disengage from the interaction to discuss it at another time
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: encourage self-reflection by the nurse. allow the nurse to determine an appropriate response. demonstrate passive listening. 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. 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. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness.
reflect critically on the student's own life experiences, perspectives, and characteristics. Explanation: 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? self-disclosure social zone self-awareness exploitation
self-disclosure Explanation: 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.
The nurse is talking with the client about lowering cholesterol and raising high density lipoproteins (HDLs). The nurse states, "Niacin with applesauce helps to prevent the flushing sensation that often accompanies taking this drug." What is the nurse providing with this statement? empathetic linkages self-disclosure self-awareness active listening
self-disclosure Explanation: Self-disclosure is revealing personal information (biographical information, personal ideas, thoughts and feelings) about oneself to clients. Purposeful, well-planned disclosure, can improve rapport between the nurse and client. The nurse can use self-disclosure to convey support, educate clients and demonstrate that a client's anxiety is normal and that many people deal with stress and problems in their lives. The nurse is not providing empathetic linkages, active listening or self-awareness in this statement.
Which is often considered the most difficult yet most effective communication technique? silence reflecting restating clarifying
silence Explanation: 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.
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 social personal public
social Explanation: The client has a known history of sexual abuse. Clients with a history of abuse have had others touch them in harmful, hurtful ways, usually without their consent. This client may be hesitant or even unable to tell the nurse when closeness or touch are uncomfortable. The most appropriate position for the nurse would be to sit in the social zone while conducting the assessment. The nurse would be sitting 4-12 feet away from the client. The intimate zone would only leave 0-18 inches between the client and the nurse. This would not be appropriate, particularly given the client's history of sexual abuse. The personal zone leaves only 18-36 inches between the nurse and client. It would be more appropriately used between two people who know each other well. The public zone leaves 12-25 feet between the nurse and client. This distance is too far to carry out an assessment and may, in fact, compromise confidentiality.
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? providing instructions to the client for feeding oneself speaking louder so the client can hear using gentle touch during activities of daily living displaying a flat affect so the client will not misinterpret the nurse
using gentle touch during activities of daily living Explanation: 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
