Psych - Unit 1 - Chapter 6: Therapeutic Communication

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 can communicate freely. The client can open up easily. The client may have difficulty maintaining spacial boundaries. The client may be physically expressive.

The client may have difficulty maintaining spacial boundaries. Sitting behind a table while speaking to a client makes the setting formal. This setting would most likely be required when dealing with clients who have difficulty maintaining boundaries. Such a formal setting would make the client more uncomfortable. In such settings, the client may not be able to share feelings freely or to open up easily. It is not appropriate for the nurse to use this kind of setting if the client is willing to express individual feelings.

The nurse is using a directive role when asking a client which question? "Are you thinking about hurting someone else right now?" "Can you tell me more about your relationship with your mother" "How do you feel about being in the hospital?" "How do you feel about being discharged?"

"Are you thinking about hurting someone else right now?" A directive role is used when the nurse needs to ask yes or no questions and uses problem solving to help the client develop new coping mechanisms to deal with here-and-now issues. Often in these cases there can be a risk to safety, calling for a directive approach. The alternative options are all open-ended and the nurse would use these if taking a nondirective role.

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process? "What could you do when you are angry that doesn't involve throwing things?" "Can you explain to me what made you so angry?" "What are you going to do the next time you get angry?" "What do you think is the best thing to do when you are angry?"

"Can you explain to me what made you so angry?" Identifying the problem (trigger for the anger) is the initial step in the problem solving process followed by brainstorming all possible solutions (different ways to manage the anger). Selecting the best alternative, implementing the selected alternation, and then evaluating the situation are the remaining steps in the process.

A psychiatric-mental health nurse has received an in-service education about defense mechanisms. Which statement made by the nurse regarding defense mechanisms would indicate a need for further teaching? "Some defense mechanisms may be either maladaptive or adaptive depending on the context in which they occur." "Defense mechanisms become maladaptive when the use interferes with the client's ability to function." "Defense mechanisms can be conscious or unconscious to the client." "Defense mechanisms indicate that the client is in a problematic mental state."

"Defense mechanisms indicate that the client is in a problematic mental state." Defense mechanisms, also known as coping styles, are psychological mechanisms that help an individual respond to and cope with difficult situations, emotional conflicts, and external stressors. Although defense mechanisms might seem to indicate the existence of problematic mental state, this is not true; therefore, the nurse's statement of "Defense mechanisms indicates that the client is in a problematic mental state" indicates a need for further teaching.. Healthy individuals in many different contexts use defense mechanisms. The use of defense mechanisms may be conscious or unconscious and some defense mechanisms may be either adaptive or maladaptive depending on the context in which they occur. The use of defense mechanisms becomes maladaptive when its persistent use interferes with the person's ability to function and quality of life.

The nurse is caring for a 42-year-old Asian-American client. Which question would assist the nurse in evaluating the client's cultural needs? "Who or what is your greatest source of comfort?" "What do you do when you need to relax?" "What kinds of activities do you do in your spare time?" "How do you typically respond when people touch you?"

"How do you typically respond when people touch you?" Nurses must develop skill in asking questions that define cultural variables with regard to communication, touch, proximity to others, family roles, and social roles. Sample questions include "How do you typically respond when people touch you?"

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." 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.

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." "The chest pain is severe enough to disable me from doing my work." "I suddenly had dull pain around the jaw and neck region." "The sudden onset of my chest pain got my spouse extremely stressed out."

"I don't really know how it all started. It just happened." Abstract messages are those messages that do not convey the meaning of the message clearly. The information given by the client is not explicit and will need to be interpreted. The statement that the client didn't know how it started may not be clearly interpreted for the meaning of "it." The statement that the chest pain was severe enough to disable the client gives a concrete message. The statement that the client suddenly had dull pain around the jaw and neck region conveys a concrete message. The statement that the sudden onset of chest pain got the client's spouse extremely stressed out conveys a concrete message.

Which statement by the nurse is an example of assertive communication? "You are so rude; I just won't tolerate that in my group." "I'm so happy that you finally decided to join us here in group." "Oh, you must be really busy to be this late getting to group." "I understand that group can be difficult to attend but coming late is disruptive."

"I understand that group can be difficult to attend but coming late is disruptive." Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way. It recognizes the rights of both parties. Losing one's temper is an example of aggressive communication. The other options demonstrate passive-aggressive and passive communication.

During a client interview, the client tells the psychiatric-mental health nurse, "If I told you what I did to my son, you'd never want to speak to me again." What is the nurse's most therapeutic response? "I'd very much like to hear about that, and it is okay for you to talk about it with me." "I don't know what you did, but it's likely that it's not nearly as bad as you think it is." "Speaking with you is an important part of my job, and it's helpful for us to know what you did so we can help you." "You don't need to be embarrassed about what you did. This is a safe place to talk."

"I'd very much like to hear about that, and it is okay for you to talk about it with me." Nonjudgmental acceptance should be the nurse's best approach to the client's statement. Saying, "It's my job to speak to you," is not therapeutic. The nurse must avoid false reassurance that the event was likely not that bad. The nurse should avoid presuming that embarrassment is the motivation behind the client's reluctance.

The nurse is attempting to develop a therapeutic nurse-client relationship with a newly admitted client. Which statement or question by the nurse will allow the client to initiate the introduction of the topic? "Is there something you would like to talk about?" "My reason for being here is to talk with you about your feelings." "I notice that you seem to be upset today." "Are you feeling well today?"

"Is there something you would like to talk about?" In order to encourage the client to take the initiative in introducing the topic of conversation, the nurse will use a broad opening question such as, "Is there something you would like to talk about?" Informing a client as to why the interaction is taking place does not allow the client to introduce the topic of conversation or expand on any thoughts or conversation. Asking if the client is feeling well or stating that they seem to be upset does not allow the client to initiate the topic of conversation.

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? "What's wrong with your bed?" "It looks like you're searching for something. Is that right?" "What are you looking for in the bed? There's nothing hidden there." "Are you having any delusions or hallucinations right now?"

"It looks like you're searching for something. Is that right?" When communicating, it is important to make an observation and then seek clarification and encourage the client to explore his or her behavior. This is more conducive to therapeutic communication than making an assumption about a client's actions or motives or explicitly attributing actions to delusions or hallucinations.

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "Why do you say I don't listen to you?" "It sounds like you're overreacting somewhat." "It sounds like you're feeling unappreciated." "I listen to you."

"It sounds like you're feeling unappreciated." Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.

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." "Well, I know you were tired from last night. You can go at 2 p.m." "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." 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 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." "You must feel rejected." "Really?" "I'm sure he loved you, though it sounds like he had trouble expressing it."

"Tell me more about that." Inviting the client to continue to elaborate on the topic by stating "tell me more about that" offers the nurse a brief statement with which exploring can take place.

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." 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? "What specifically makes you uncomfortable?" "I can take that client off of your assignment this shift." "It would be great if you could attend an in-service on therapeutic communication." "Have you ever been sexually abused?"

"What specifically makes you uncomfortable?" It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self-reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.

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 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 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 seem angry. Would you like to talk more about how you're feeling?" "I'm sorry I had to reschedule our appointment. It really couldn't be helped. Is that what's bothering you?"

"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." 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.

The nurse is performing a morning assessment on a client. When asked how they are feeling, the client hesitantly responds in a slow rate of speech "I think I am okay, is that alright?" Which response is appropriate for this speech pattern? "You're speaking slowly today; did you get enough sleep?" "You sound confused. Is that how you are feeling?" "Take a deep breath and try again." "Everything is alright."

"You sound confused. Is that how you are feeling?" Clients' rate and quality of speech are useful assessment data for interpreting client mood, level of orientation, and cognitive processes. This client's slow rate of speech, hesitancy, and indirect answer to the question can indicate that the person is depressed, confused, searching for the correct words, or having difficulty finding the right words to describe an incident. It is important for the nurse to validate these nonverbal indicators rather than to assume that they know what the client is thinking or feeling. Asking the client about sleep does not give the client the opportunity to clarify their thinking. Telling the client to take a deep breath is recommended if the nurse assesses anxiety; this client's slow rate of speech would be incongruent if feeling anxious. Telling the client that everything is alright is nontherapeutic because it falsely reassures the client.

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 0 to 18 inches 18 to 36 inches 3 to 6 feet 12 to 25 feet

3 to 6 feet The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client.

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 cheerful expression A fearful tone of voice A sarcastic tone of voice An erect, confident posture

A sad facial expression A fearful tone of voice A process refers to the nonverbal messages that the speaker uses to give meaning and context to the overall message. The client is diagnosed with cancer and is grieving. Thus, a sad facial expression and a fearful tone of voice are congruent with having been diagnosed with the disease and worrying about the impending health problems. A cheerful expression, a sarcastic tone of voice, and an erect, confident posture are incongruent with the client's statement to the nurse.

"Get the stuff from him" is an example of which type of message? Abstract Concrete Clear Direct

Abstract "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication? Abstract Cliché Proverb Overt cue

Abstract Abstract messages are unclear patterns of words that often contain figures of speech that are difficult to interpret. They require the listener to interpret what the speaker is asking and so can be a barrier to communication. A cliché is an expression that has become trite and generally conveys a stereotype. Proverbs are old accepted sayings with generally accepted meanings. An overt cue is a clear statement of intent.

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 Asking the client to explain what the client thinks is causing the client's panic attacks Researching the physiological and emotional response to anxiety traditionally exhibited by Asians Inquiring how the client feels symptoms should be managed

Assessing to what degree the client has embraced the American culture By assessing the client's degree of cultural assimilation/acculturation, incorrect assumptions regarding the impact of culture on the client's perceptions and beliefs will be minimized. While the other options provided are not inappropriate, none is the best tactic that addresses the impact that culture has on the client's perceptions and beliefs.

A nurse engaged in an interaction with a client recognizes body space zones and works to maintain the client's personal zone. The nurse would interpret this zone as which area ? Beginning at the boundary of the intimate zone and ending at the social zone Extending outward from the border to the public zone Surrounding and protecting an individual from others, especially outsiders The most distant boundary that can be used for recognizing intruders

Beginning at the boundary of the intimate zone and ending at the social zone The four zones are intimate, personal, social, and public. The personal zone begins at the boundary of the intimate zone and ends at the social zone. The intimate zone varies widely in different cultures. The social zone begins at the end of the personal zone and ends at the public zone. The public zone begins at the end of the social zone and extends outward.

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

Broad opening This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.

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? Reflecting feelings Consensual validation Focusing Offering a broad opening

Consensual validation Consensual validation involves the nurse searching for mutual understanding in order for the communication to be meaningful.

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 Broad openings Consensual validation Encouraging comparison

Consensual validation 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? Context Process Congruence Proxemics

Context Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.

Which term is used to refer to signals that encourage effective communication? Abstract messages Concrete messages Cues Metaphors

Cues 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? Agreeing Challenging Defending Belittling

Defending The nurse's statement conveys that the nurse is trying to defend the hospital from the client's criticism. The nurse's statement may not change the client's feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client's discomfort.

The nurse observes that a client has been pacing in the unit's common area in an agitated state for the past 15 minutes. Which is the nurse's priority action? Explore with the client to determine why they are displaying these behaviors. Redirect the client to an activity that will alleviate the client's agitation. Ask the client to sit down and perform deep breathing exercises. Encourage the client to participate in a group activity to provide a therapeutic distraction.

Explore with the client to determine why they are displaying these behaviors. The nurse will attempt to have the client validate their feelings and must precede any interventions such as redirection, relaxation techniques, or group activities. The nurse should avoid presuming that the client's behavior is motivated by anxiety and must validate whether this is the case.

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 Use self-disclosure frequently for empathy Ensure the client's confidentiality Employ theoretically based interventions Give the client advice about what to do

Focus on the client during the interaction Ensure the client's confidentiality Employ theoretically based interventions A nurse engaged in therapeutic communication with a client should follow the principles of therapeutic communication: making the client the primary focus of the interaction; using self-disclosure cautiously and only when it serves a therapeutic purpose; maintaining client confidentiality; implementing interventions from a theoretic base; and avoiding the giving of advice.

A nurse is giving a presentation to colleagues about verbal communication. The audience demonstrates understanding of the information when they identify which component as the first in the process? Formulation of an idea Message encoding Transmission of message Message reception

Formulation of an idea With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.

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

Impassive An impassive face is frozen into an emotionless deadpan expression similar to a mask. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one that is the opposite of what the person wants to convey, or incongruent.

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply. Looking down to the floor Leaning toward the client Mirroring the client's facial expression Maintaining eye contact with the client Sitting with closed arms and crossed legs

Leaning toward the client Maintaining eye contact with the client The nonverbal cues that convey that the nurse is paying attention are leaning toward the client and maintaining eye contact while speaking to the client. If the nurse looks down toward the floor when the client is trying to talk, this indicates that the nurse is disinterested. Having a sad facial expression does not indicate attentiveness. Sitting with closed arms and crossed legs indicates that the nurse is not willing to listen to the client.

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 Psychiatric disorders generally affect a client's ability to communicate verbally Clients are guarded with both verbal and nonverbal communication Psychiatric disorders are more likely to affect thoughts than physical behaviors

Nonverbal communication provides additional client information that is acted out unconsiously Nurses are encouraged to be very observant of a psychiatric client's nonverbal communication behavior, primarily because nonverbal communication can indicate the client's thoughts, feelings, needs, and values when the trust in the relationship has not yet been established. At this point, the client may not be willing to disclose all information that is required for the nurse to be able to engage in the nursing process and offer the self therapeutically. It is not always the case that psychiatric illness affects a clients ability to communicate verbally. Often times when clients are guarded with verbal communication, the nonverbal provides covert cues to meanings for the client. Psychiatric disorders affect both thoughts and physical behaviors.

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 Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Giving the client ample opportunity to ask questions

Presenting the information using language and terms the client will understand 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.

The nurse has been caring for a pediatric client in an inpatient psychiatric unit over the last week. Upon entering the unit for morning assessments, the client greets the nurse and reaches out for a hug. Based on understanding therapeutic principles of touch, which response is appropriate? Greet the client and hug them. Say good morning and offer a fist bump. Step back and tell the client that hugging is against the policy. Turn away from the client and offer a side hug.

Say good morning and offer a fist bump. Functional-professional touch is used in examinations or procedures such as when the nurse touches a client to assess skin turgor or a massage therapist performs a massage. Social-polite touch is used in greetings, such as a handshake or fist bump, and is most appropriate for this situation. The nurse is not the client's friend and a friendship level of touch such as a hug would be inappropriate. Although it is likely unit policy that hugs are not allowed, telling the client this is not allowed while stepping back communicates distrust and may produce hurt feelings in the pediatric client. Turning away is not recommended because the client may react unpredictably when their request for a straightforward hug is not accepted. Side hugs are generally more acceptable in the pediatric inpatient setting but turning away from clients is not.

Which would not be considered a goal of therapeutic communication? Self-exploration of feelings by the nurse Establishing rapport Active listening Guiding the client in problem solving

Self-exploration of feelings by the nurse Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem solving are goals of therapeutic communication.

Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client? Sitting behind a desk Leaning slightly forward toward the client Facing the client at eye level Keeping arms and legs uncrossed

Sitting behind a desk Sitting behind a desk imposes a barrier between the nurse and the client and is therefore the least effective technique listed here. Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward also helps engage the client. Generally, the nurse should not cross the arms or legs during therapeutic communication because such postures erect barriers to interaction; uncrossed arms and legs project openness and a willingness to engage in conversation.

When engaged in therapeutic communication with a client who has a mental disorder, what is the most important for a nurse to keep in mind? The nurse should self-disclose when indicated. The client is the primary focus of the interaction. The nurse should have an empathetic relationship with the client. The client's conversations should be recorded.

The client is the primary focus of the interaction. 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 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 disconnect between the client's verbal and nonverbal messages confirms the presence of mental illness

The client may be reluctant to dialogue despite the statement to the contrary 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 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 want to sleep. The client may be extremely fatigued. The client may have suicidal ideations. The client may need a break to reduce stress.

The client may have suicidal ideations. Covert cues are often vague messages that require interpretation from the nurse or other health care professional. As the client has severe depression, it is possible the client is discussing suicide. The nurse needs to ask a direct yes or no question to determine if this is truly the case. The nurse may be able to surmise that this client is not discussing sleep, fatigue, or needing a break from stress.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries? The client's room An interview room A conference room The end of a hall

The client's room If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

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 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.

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 may lack confidence in therapeutic communication. The nurse can gain information about the client without wasting time.

The nurse may lack confidence in therapeutic communication. 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? They require rephrasing of unclear statements. They elicit more accurate responses. They are easy to understand. There is no need for interpretation.

They require rephrasing of unclear statements. 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 nurse responds to a client's statement with silence to achieve which outcome? To allow the nurse to determine an appropriate response To permit the client to gather their thoughts To encourage self-reflection by the nurse To demonstrate passive listening

To permit the client to gather their thoughts By maintaining silence, the nurse allows the client to gather the client's thoughts and to proceed at the client's own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process.

A nurse is conducting a group session with multiple clients. Which client scenario would the nurse follow-up with the client regarding conflicting verbal and non-verbal messages? a client stating, "I'm feeling sad today" and is crying a client stating, "I want to go home" and appears distracted a client stating, "I am doing great" and is slouched in their seat a client stating, "I want to feel better" and is engaged in the session

a client stating, "I am doing great" and is slouched in their seat Verbal communication, which is primarily achieved by spoken words, includes the underlying emotion, context, and connotation of what is said. Nonverbal communications include gestures, expression, and body language. Verbal and non-verbal language should be congruent, or aligned. If it is conflicting, such as the client who is stating, "I am doing great" and is slouched in their seat, the nurse should follow-up with that client. The client who is stating, "I'm feeling sad today" and is crying, the client who is stating, "I want to go home" and appears distracted, and the client who is stating, "I want to feel better" and is engaged in the session are all congruent with their verbal and non-verbal language, which would not require follow-up from the nurse.

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? empathetic linkages self awareness self disclosure active listening

active listening Active listening is refraining from other internal mental activities and concentrating exclusively on what the client says. Self disclosure, empathetic linkages and self awareness are not communication techniques. Empathetic linkages are the communication of feelings. Self-awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. Self-disclosure is communication by which one person reveals information like thoughts, feelings, aspirations, goals, failures, successes, fears and dreams, as well as one's likes, dislikes and favorites.

A psychiatric-mental health nurse must perform a physical examination on a newly admitted client. What is the nurse's priority action before entering the client's personal space for the examination? asking for the client's permission assessing the client's mental status assessing the client's emotional state asking the client's family for permission

asking for the client's permission Physical boundaries are those established in terms of physical closeness to others, such as who we allow to touch us or how close we want others to stand near us. When boundaries are infringed upon, the client feels threatened and responds to the perceived threat. Before implementing interventions that invade the client's personal space, the nurse must elicit permission from the client. Therefore, the priority intervention by the nurse is to ask for the client's permission before conducting a physical examination on the client. Assessing the client's mental status and emotional state is important to conduct, but the priority action is to ask the client's permission before conducting an examination on the client. Asking the client's family for permission would not be appropriate if the client is able to give permission for themselves.

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 accepting body position and expressive face closed body position and confusing face accepting body position and impassive face

closed body position and impassive face An impassive face is characterized by an emotionless, deadpan expression similar to a mask. The closed body position entails the nurse sitting with arms folded across the chest. Contrarily, an accepting body position would involve the nurse sitting with hands at the side of the body. This open posture demonstrates unconditional positive regard, trust, care and acceptance. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one where the person is verbally expressing one emotion but showing a different one.

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. overt cue. abstract message. concrete message.

covert cue. In this case, the nurse needs to interpret the client's verbal cues for meaning. By making this statement, the client is offering a covert cue about feeling hopeless and possibly considering committing suicide. An overt cue is a clear, direct statement of intent; for example, "I want to die." A concrete message is a verbal communication skill the nurse can use to direct a client when the client's ability to process concepts is low, such as when the client is highly anxious. Abstract messages are unclear patterns of words that can be difficult to interpret and when used by nurses can be misleading or confusing for clients.

A nurse is assessing a client with chronic illness when the client begins to cry. The nurse asks the client, "Is something wrong?" This is indicative of which type of therapeutic communication technique? rationalization focusing encouraging expression encouraging description of perception

encouraging description of perception The client is crying, and the nurse asks the client if anything is wrong. Here the nurse is asking the client to verbalize what the client is perceiving. This is an example of the therapeutic communication technique of encouraging description of perception. Exploring refers to a type of communication through which the nurse delves deeper into the client's concerns. Focusing refers to a type of communication in which the nurse encourages the client to concentrate all energy on a single topic. Encouraging expression refers to the type of communication in which the nurse asks the client to appraise the quality of their experiences. The client is not expressing the ego defense mechanism of rationalization.

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? intimate personal social public

intimate 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 psychiatric-mental health nurse is creating a therapeutic interaction with a client. Which factor(s) is/are included in a therapeutic interaction with a client? Select all that apply. limiting self-disclosure active listening being nice silence giving advice validation

limiting self-disclosure active listening silence validation A therapeutic interaction with a client is different from a social interaction. In a therapeutic interaction, the nurse focuses on the client and client-related issues. Activities should have a definite purpose, and the conversation should focus only on the client. The nurse should not attempt to meet their own social or other needs during the interaction. Limiting self-disclosure, using active listening, selecting appropriate therapeutic techniques, using silence and validation, and using strength-based communication are important factors in a therapeutic interaction. Being nice toward the client is not necessarily therapeutic and is not a factor in a therapeutic interaction. Giving advice to the client is a block to communication and is not a factor in a therapeutic interaction.

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 to avoid the topic to discuss it at another time to disengage from the interaction

more time to think Sometimes silence or long pauses indicate the client is thoughtfully considering the question before responding. In this situation, it would be most therapeutic if the nurse could provide the client more time to think. Talking about the issue another time, avoiding the topic or disengaging from the interaction can only be confirmed if the nurse asks questions. However, it is important to allow the client sufficient time to respond, even if it seems like a long time.

A 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. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. seek out a mentor who has extensive experience in the psychiatric-mental health area. decide what aspects of the student's life and experience the student is willing to disclose to clients.

reflect critically on the student's own life experiences, perspectives, and characteristics. Self-awareness is a critical prerequisite for therapeutic communication and can only be achieved through critical self-reflection. Knowledge of disease processes is important but does not necessarily facilitate therapeutic communication. Self-disclosure is a comparatively minor variable and is provided cautiously on a case-by-case basis. A mentor is also useful but does not replace self-reflection as a precondition for therapeutic communication.

A nurse is caring for a client on the unit who is attempting to manipulate the staff. Which description of the client made by a nurse demonstrates strength-based communication? aggressive resourceful noncompliant argumentative

resourceful Strength-based communication should be supportive, focusing on the client's strengths instead of potential deficits. Language that promotes acceptance and respect should be favored over language that distracts from acceptance of the person. For example, instead of perceiving a client to be "manipulative," an alternative consideration is that the client is "resourceful and trying to get help." Therefore, the client being described as resourceful by the nurse is utilizing strength-based communication. Being described as aggressive, noncompliant, or argumentative is not utilizing strength-based communication.

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-awareness empathetic linkages self- disclosure rapport

self- disclosure Self-disclosure is letting the client know personal information. The conversation should focus on the client, and not the nurse. On revealing personal information the nurse should be purposeful and have identified therapeutic outcomes. Rapport, empathetic linkages, and self-awareness are not included in self-disclosure.

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 self-awareness social zone exploitation

self-disclosure The most important principles of therapeutic communication is to focus the interaction on the patient's concerns. Self-disclosure is telling the client personal information. The nurse can determine how much personal information, if any, to disclose. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes. Self-awareness, social zone and exploitation are not principles of therapeutic communication.

The nurse understands that clients send simultaneous messages, and active listening and observation are used to understand these messages. Which action(s) represents these principles? Select all that apply. sitting facing a client during a conversation using care not to interrupt the client asking the client to explain when unclear noting how the client is sitting and moving process charting this information

sitting facing a client during a conversation using care not to interrupt the client asking the client to explain when unclear noting how the client is sitting and moving To receive the sender's simultaneous messages, the nurse must use active listening and active observation. Active listening means refraining from other internal mental activities and concentrating exclusively on what the client says. Active observation means watching the speaker's nonverbal actions as they communicate. Processing how to chart the information from the conversation does not allow for focusing on the client exclusively.

The nurse asks a client diagnosed with bipolar disorder how they are feeling today. The client replies, "guns and bombs are exploding". Which documentation by the nurse would be appropriate for the client? concrete thinking self-observation symbolism autistic fantasy

symbolism In people with mental illnesses, the use of words to symbolize events, objects, or feelings is often idiosyncratic, and they cannot explain their choices. For example, a person who is feeling scared and anxious may tell the nurse that bombs and guns are exploding. Therefore, the client in the scenario is utilizing symbolism and the nurse would document that observation. Concrete thinking is a type of thinking that the client with a mental illness may have and demonstrates a literal interpretation of the conversation or question. Self-observation is a defense mechanism that occurs when the client notices and expresses their feelings. Autistic fantasy is a defense mechanism that includes excessive daydreaming as a substitute for human relationships, more effective action, or problem solving.

A client begins discussing frankly experiencing sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. Which is the explanation for why the nurse changed the subject? to prevent judging the client's experience to model social skills help the client understand appropriate boundaries to reduce the nurse's own anxiety

to reduce the nurse's own anxiety The nurse has used the nontherapeutic communication technique of 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. People often change the subject in efforts to avoid discussing a topic with which they feel uncomfortable. If the client feels the need to bring up an issue, generally the nurse should resolve personal anxieties and facilitate client exploration. There is no indication that the nurse is attempting to have the client understand boundaries for the nurse-client relationship. Modelling social skills does not correlate with the client scenario related to sexual abuse. The nurse must deliver care in a non-judgmental manner in order to develop a therapeutic nurse-client relationship.

The inpatient psychiatric nurse notes that a client is not interacting with their peers during a leisure group and their affect appears sad. When approached, the client tells the nurse "leave me alone, nothing can help me." Which response is therapeutic? "Are you considering harming yourself?" "You will feel better if you try to spend time with others." "Why do you think that nothing can help you?" "Thank you for letting me know you want some time alone."

"Are you considering harming yourself?" Covert cues are vague or indirect messages that need interpretation and exploration. In addition to the nonverbal affect of appearing sad, clients may covertly cue by indirectly stating that nothing or no one can help them when feeling suicidal. The therapeutic response is the exploration of this covert cue to clarify the client's intent and to protect the client. Telling the client how they will feel is not therapeutic. Clients may not know why they feel a certain way and asking them to explain can feel judgmental. Thanking the client for sharing their feelings is usually helpful but does not address the possibility of the covert cue of self-harm and promote client safety.

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? "If you just learn how to breathe, you can manage better." "When did you last take drugs?" "How can you make your anxiety better?" "At what time did you take the last dose of the antianxiety drugs?"

"At what time did you take the last dose of the antianxiety drugs?" Concrete messages use explicit wording and need no interpretation. Asking the client about the time of the last dose of the antianxiety drugs conveys the most accurate information. Asking the client about when the client stopped taking the drugs fails to specify the type of drug, and using the word "when" will not help the client give the accurate response. Asking the client when the client took them last would confuse the client, as "them" may not be interpreted as drugs.

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? "Your services were not good at all." "Don't waste my time asking about your services." "Your services were wonderful. Keep up the good work." "Your services were good, but you could provide much better service."

"Don't waste my time asking about your services." The client uses a hurried and disgusted tone of voice; moreover, the client makes no eye contact with the nurse. This process is incongruent with the client's statement. The message conveyed is one of unwillingness to answer the questions asked by the nurse. This incongruence suggests that the client was not sincere about the "greatness" of the services provided. The client's statement does not provide sufficient information to determine if the services were not good.

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?" "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." "What do you think your spouse would do if you leave?"

"How would leaving your spouse make you feel?" 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.

The nurse is educating a group of clients about effective anger management with an emphases on the use of assertive sentences while expressing anger. Which sample statement(s) indicate effective teaching on assertive communication? Select all that apply. "You are making me very angry." "Why are you not listening to me?" "I am frustrated with the situation." "How dare you not listen to me?" "I am feeling disrespected by your comments."

"I am frustrated with the situation." "I am feeling disrespected by your comments." Expression of anger using assertive communication refers to the use of statements beginning with 'I' while expressing anger. Statements such as "I am frustrated with this situation" and "I am feeling disrespected by your comments" are examples of assertive communication. Statements or questions such as "You are making me very angry," "How dare you not listen to me?" and "How can you behave like this with me?" are not examples of assertive communication as they communicate accusation, blame, and use "you" rather than "I" in the statement.

A client was admitted to the psychiatric-mental health unit 2 days ago. Upon assessment, the client states, "You locked me up and threw away the key." What is the most therapeutic response made by the nurse to the client? "We don't ever throw away the keys." "I wasn't working when you got admitted." "Are you feeling angry?" "It must be frustrating to feel locked up."

"It must be frustrating to feel locked up." Nurses should not necessarily take verbal messages literally, especially when a client is upset or angry. If the nurse takes the comment literally, the nurse may respond defensively, and communication would likely be blocked. The nurse must identify the desired client outcome by engaging with the client and attempt to interpret the client's feelings. Therefore, the nurse's response of "It must be frustrating to feel locked up" would be most therapeutic in this situation. The nurse's response, "Are you feeling angry?" is a closed-ended question and is not as therapeutic as interpreting their emotions. The nurse's responses of "We don't ever throw away the keys" and "I wasn't working when you got admitted" are defensive comments, which would block communication.

The nurse is talking with a client in the behavioral health unit about what brought them to the unit for admission. Which statement made by the nurse is identified as nontherapeutic and may alter the flow of the conversation and limit information obtained? "I know you are upset right now about being here, but you will find things always look better after a good night's sleep." "So what I hear you telling me is that you feel as though you did not intend to harm yourself when taking the pills." "Can you tell me what you feel about being admitted to the facility and if it will be helpful to you?" "You will have the opportunity to clarify any information that you do not understand about your admission to the facility."

"I know you are upset right now about being here, but you will find things always look better after a good night's sleep." The nurse is giving a cliche' response that has no meaning to the client by telling them they will feel better in the morning. This is a nontherapeutic response that is not helpful to the client and does not elicit any further response. The nurse is closing off further communication with the client with this statement. The nurse is clarifying the information that the client has discussed to be sure the information heard is what the client is stating. Asking the client to state their feelings related to the admission is an opportunity for the client to discuss other issues that they may be processing. The nurse is giving information by letting the client know that all of their concerns and questions will be answered, which is therapeutic.

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? "Why are you sad about your mother's visit?" "I'm concerned that you are not exicited about your mother's visit, We can talk if you want." "I need to know why you are sad." "Is your mother giving you trouble for being here?"

"I'm concerned that you are not exicited about your mother's visit, We can talk if you want." Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client's experience. "Why are you sad about your mother's visit?," "I need to know why you are sad" and "Is your mother giving you trouble for being here?" are not examples of therapeutic communication.

The nurse is discussing self-awareness during a group therapy session with clients on the behavioral health unit. Which statement(s) by the 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." "Yes, I can help with the nurse retention committee, but I don't know when I'll find the time." "I asked to be transferred because the nurses on the unit make me feel inadequate when I work with them." "Yes, I'll work again this evening; I don't need any more than four hours of sleep." "I worry about interrupting the doctor's sleep when I call them at home."

"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 the unit make me feel inadequate when I work with them." Self-awareness is the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations. A well-defined sense of self-awareness can only come after nurses carry out self-examination. Being self-aware is depicted in a statement that the nurse makes by identifying that their needs must be met by taking a break. That the nurse feels inadequate and incompetent and seeks a change in the present job is an indication that the nurse understands that their feeling of self-worth will be further diminished by staying in the same position. Stating, "Yes, I'll work again this evening," "I don't need any more than four hours of sleep," "I worry about interrupting the doctor's sleep when I call them at home" or "Yes, I can help with the nurse retention committee, but I don't know when I'll find the time" are not depicting self-awareness.

The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond? "Oh, it is just the infection; in a day or so you'll feel better." "Let's talk about infections, and how they heal." "Why don't you just rest in bed?" "Why don't you call a friend in to watch TV with you?"

"Let's talk about infections, and how they heal." Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals, such as assessing the client's perception of the problem as it unfolds, teaching the client self-care skills and identifying a plan of action to a satisfying and socially acceptable resolution. "Oh, it is just the infection, in a day or so you'll feel better," "Why don't you just rest in bed?," and "Call a friend in to watch TV," are not examples of therapeutic communication between the nurse and client.

A client diagnosed with a mental illness asks the nurse, "Does mental illness run in your family?". Which response to the client by the nurse would be therapeutic? "Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses." "Actually, my sister is being treated for schizophrenia. It's been hard on our whole family." "I struggle with anxiety and depression at times. I have learned a lot from the group sessions here." "That's not an appropriate question for me. Let's talk about something else."

"Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses." One of the most important principles of therapeutic communication for the nurse to follow is to focus the interaction on the client's concerns. Self-disclosure, telling the client personal information, generally is not a good idea. If the client asks the nurse personal questions, the nurse should elicit the underlying reason for the request. The nurse can then determine how much personal information to disclose, if any. Therefore, the nurse's response of "Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses" would be therapeutic to say to the client. The nurse's responses of "Actually, my sister is being treated for schizophrenia. It's been hard on our whole family" and "I struggle with anxiety and depression at times. I have learned a lot from the group sessions here" are providing too much self-disclosure and are inappropriate in a therapeutic nurse-client relationship. The nurse's response of "That's not an appropriate question for me. Let's talk about something else" is giving disapproval and changing the subject, which are both nontherapeutic techniques for the client.

A psychiatric-mental health nurse has learned about the use of silence with client interactions. Which statement made by the nurse would indicate a need for further teaching? "Silence allows for the client to gather their thoughts during the conversation." "Silence can be interrupted if the client or nurse feels uncomfortable." "The use of silence from the nurse should convey a nonverbal interest in the client." "Silence is one of the most difficult but often the most effective communication techniques."

"Silence can be interrupted if the client or nurse feels uncomfortable." Silence consists of deliberate pauses to encourage the client to reflect and eventually respond. One of the most difficult but often the most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, the nurse allows the client to gather thoughts and to proceed at their own pace. The use of silence includes the nurse remaining quiet but nonverbally expressing interest during an interaction. It is important that the nurse not interrupt silences because of their own anxiety or concern of "not doing anything" if sitting quietly with the client. Therefore, the nurse's response "Silence can be interrupted if the client or nurse feel uncomfortable" indicates a need for further teaching. The other responses indicate the teaching was effective.

A psychiatric-mental health nurse has learned about the importance of self-reflection while caring for clients diagnosed with mental illnesses. Which statement made by the nurse would indicate the need for further teaching? "If I am unaware of my personal feelings, I may unintentionally project my feelings onto my clients." "Developing self-awareness will enhance my objectivity, which fosters a nonjudgmental attitude toward my clients." "Solicitating feedback from my colleagues is not an appropriate way to build self-reflection." "Clinical supervision is an option for building self-reflection and focuses on the growth of the nurse."

"Solicitating feedback from my colleagues is not an appropriate way to build self-reflection." Nurses must understand their own personal feelings and beliefs and try to avoid projecting them onto their clients. The development of self-awareness will enhance the nurse's objectivity and foster a nonjudgmental attitude, which is so important for building and maintaining trust throughout the nurse-client interaction. Soliciting feedback from colleagues and supervisors about how personal beliefs or thoughts are being projected onto others is a useful self-assessment technique. Clinical supervision is another technique that can be used in self-reflection and the focus of clinical supervision in the growth of the nurse. The nurse's statement of "Solicitating feedback from my colleagues is not an appropriate way to build self-reflection" would indicate a need for further teaching. The other statements demonstrating understanding.

A client diagnosed with depression is being counseled by the nurse for cognitive distortions. The client says, "Bad things always happen to me." Which response by the nurse would be therapeutic? "Did you sleep last night?" "Are you feeling more depressed today?" "Tell me about a time when things went your way." "There must have been some good things in your life."

"Tell me about a time when things went your way." Clients diagnosed with depression may use communication styles such as overgeneralizations ("This always happens to me..., everything always turns out for the worse..."). The nurse can assist the client to be more specific, such as asking about a specific time or a specific exception. The client in the scenario is overgeneralizing; therefore, the nurse's response, "Tell me about a time when things went your way" would be therapeutic for the client. The nurse's responses, "Did you sleep last night?", and "Are you feeling more depressed today?" are changing the subject, which is not therapeutic. The nurse's response, "There must have been some good things in your life" is minimizing the client's feelings, which is not therapeutic.

The nurse 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 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 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 seem angry. Would you like to talk more about how you're feeling?" "I'm sorry I had to reschedule our appointment. It really couldn't be helped. Is that what's bothering you?"

"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." 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.

Which statement by the nurse reflects the use of a therapeutic statement? "You look upset. Would you like to talk about it?" "I'd like to know more about your children. Tell me about them." "I understand your husband passed away. I couldn't bear that." "You look very sad. How long have you been this way? Have you been taking care of yourself?"

"You look upset. Would you like to talk about it?" The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.

The nurse observes a group of adolescents in the dayroom during their free time. The group is playing a game of cards and laughing. One client exclaims loudly "if that happened to me, I would just kill myself." Which response by the nurse is appropriate at this time? Continue to observe the group. Stop the game and ask to speak with the client who made the statement in private. Contact the health care provider to report the statement. Interrupt the group and tell them that those statements are not helpful.

Continue to observe the group. Context is the environment in which communication occurs and can include time and the physical, social, emotional, and cultural environments. The context of this situation is a group of adolescents laughing and interacting. The nurse is aware that it is age appropriate to make inflammatory statements such as "if that happened to me, I would just kill myself." Continuing to observe the group allows the nurse to continue to assess the context. Stopping or interrupting the game interferes with the purpose of leisure time. The nurse can ask to speak to the client about the statement in private at a later time.

After spending 15 minutes talking with a client, the client leaves the interaction feeling defensive. This is evidence that the communication can be described as what? In an improper environment Blocked by external noise Therapeutic Nontherapeutic

Nontherapeutic Nontherapeutic communication develops when nurses respond in ways that cause clients to feel defensive, misunderstood, controlled, minimized, alienated, or discouraged from expressing thoughts and feelings.

A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response? It's important to get a break from time to time. How have the last few days been for you? I'm really not at liberty to talk about my activities outside of work. I hope you understand. I didn't do anything particularly special, but it's always nice to spend time with my family. Well, if you had to guess, what do think that I might do in my time outside of work?

It's important to get a break from time to time. How have the last few days been for you? Making a noncommittal and nonspecific statement like "it's important to get a break" and then redirecting the conversation to the patient is the best way to avoid self-disclosure and maintain a therapeutic relationship. Overtly stating that he or she cannot talk about personal matters threatens the rapport between the nurse and patient. The nurse should avoid specifying that he or she spent time with family on days off. Asking the patient to guess about the nurse's activities is of no benefit.

Which zone is a distance that is comfortable between family and friends who are talking? Personal Intimate Social Public

Personal The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.

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 Social Intimate Personal

Public The paranoid client will not be comfortable initially with physical contact and will be very distrustful of the staff; as a result, the public zone will be most comfortable for the client. The social zone allows physical contact, which is likely to make the client very uncomfortable creating a nontherapeutic environment. This intimate zone allows the sort of physical contact not appropriate for a staff-client relationship. This personal zone allows physical contact appropriate for a staff-client relationship but it is likely to be uncomfortable initially for the paranoid client.

Which zone is an acceptable distance between a speaker and an audience? Public Intimate Personal Social

Public The public zone is an acceptable distance between a speaker and an audience. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The personal zone is the distance comfortable between family and friends who are talking. The social zone is the distance acceptable for communication in social, work, and business settings.

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? Public Social Intimate Personal

Social The social zone is appropriate for discussing this type of information as it is not sensitive or private and does require the nurse to be in close proximity of the client to maintain confidentiality. The personal zone refers to an arm's length distance of approximately 1 1/2 to 4 feet. This is the zone in which therapeutic communication occurs. The public zone ranges from 12 to 25 feet. This would be appropriate in this case if the nurse was addressing a whole group of clients. The intimate zone consists of an area in which actions that involve touching another body occur.

A psychiatric-mental health is completing a self-reflection with the goal of "know thyself" in order to care for their clients better. What is a question that the nurse can reflect on that encourages self-reflection? What careers did you do before becoming a nurse? How do you feel about working long shifts? What significant traumatic life events have you experienced? How do you get along with your colleagues?

What significant traumatic life events have you experienced? Knowing thyself as a nurse provides the necessary space to be accepting and respectful of other's choices, beliefs, and practices. Questions for self-reflection include asking what physical problems or illnesses have you experienced; what significant traumatic life events have you experienced; what prejudiced or embarrassing beliefs and attitudes about groups different from yours can you identify from your family, significant others, and yourself; what sociocultural factors in your background could contribute to being rejected by members of other cultures; and how would the above experiences affect your ability to care for clients. Therefore, exploring the question "what significant traumatic life events have you experienced?" would encourage knowing thyself. The questions, "What careers did you do before becoming a nurse?", "How do you feel about working long shifts?", and "How do you get along with your colleagues?" are not questions of self-exploration to know thyself.

A client has learned about defense mechanisms. Which behavior of the client would demonstrate the effective use of sublimination defense mechanism? The client views one friend as being perfect and views another friend as evil. When the client is angry about their boss, they go to a boxing class. The client reaffirms what they want to with social activities. The client notices their feelings and informs their friend of their feelings.

When the client is angry about their boss, they go to a boxing class. Sublimination defense mechanism is channeling potentially maladaptive feelings or impulses into socially acceptable behavior. When the client goes to a boxing class when they are angry about their boss, this demonstrates the sublimination defense mechanism. The example of the client viewing one friend as being perfect and viewing another friend as evil is demonstrating the splitting defense mechanism. The example of the client reaffirming what they want to with social activities is the self-assertion defense mechanism. The example of the client noticing their feelings and informing their friend of their feelings is demonstrating the self-observation defense mechanism.

A client says to the nurse, "I have done something terrible." The nurse replies, "I would like to hear about it. It's okay to discuss it with me." Which therapeutic communication technique is the nurse utilizing? restatement open-ended statements interpretation acceptance

acceptance The therapeutic technique of acceptance involves encouraging and receiving information in a nonjudgmental and interested manner. The statement from the nurse of "I would like to hear about it. It's okay to discuss it with me" demonstrates the use of the acceptance therapeutic communication technique. The technique of interpretation is putting into words what the client is implying or feeling. The open-ended statements technique introduces an idea and lets the client respond. The restatement technique repeats the main idea expressed and lets the client know what was heard. The techniques of restatement, open-ended statements, and interpretation are not utilized with the nurse's statement.

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 silence validation

advice reassurance disapproval Techniques that inhibit communication include advice, reassurance, and disapproval. Therapeutic communication techniques include the use of silence and validation.

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: lack of awareness. genuineness and caring. gathering assessment data. excessive probing.

excessive probing. 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.

A nurse is interviewing a client who is describing difficulties with their family. The client begins crying and says, "I don't want to talk about this anymore." What boundary would the nurse be mindful to avoid crossing with the client? physical social psychological material

psychological Boundaries are the defining limits of individuals, objects, or relationships. Boundaries mark territory, distinguishing what is "mine" from what is "not mine". Humans have many different types of boundaries. Material boundaries, such as fences or property, artificially imposed state lines, and bodies of water, define territory as well as provide security and order. Personal boundaries include physical, psychological, and social dimensions. Physical boundaries are those established in terms of physical closeness to others, such as who we allow to touch us or how close we want others to stand near us. Psychological boundaries are established in terms of emotional distance from others, such as how much of our innermost feelings and thoughts we want to share. Social boundaries, such as norms, customs, and roles, help us establish our closeness and place within the family, culture, and community. Therefore, the client in the scenario is establishing physiological boundaries that the nurse must be careful not to cross. Physical, social, or material boundaries are not at risk being crossed in the scenario.

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. shaking the client's hand when greeting defending the healthcare provider's choice of treatment asking the client to further explain a recurring symptom suggesting the client obtain a second opinion if care is not satisfactory remaining neutral when the client states a lack of faith in medical care

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 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. showing family photos taking the elevator telling the client the nurse attended a weight loss meeting wearing the color blue directing the client to the nurse's Facebook page

showing family photos telling the client the nurse attended a weight loss meeting directing the client to the nurse's Facebook page 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.

Which is often considered the most difficult yet most effective communication technique? silence restating reflecting clarifying

silence Although restating, reflecting, and clarifying are effective therapeutic communication techniques, one of the most difficult but often most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, a nurse allows the client to gather thoughts and to proceed at his or her own pace.