Psych Videbeck Chapter 6: Therapeutic Communication
A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply.
Leaning toward the client Maintaining eye contact with the client
A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? Seeking information Presenting reality Reflecting Making observations
Presenting reality
When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what? Interacting with the client in a nonthreatening, respectful manner Giving the client ample opportunity to ask questions Being careful not to overload the client with too much information at one time Presenting the information using language and terms the client will understand
Presenting the information using language and terms the client will understand
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.
A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's mosttherapeutic response? -"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you." -"Since the doctor didn't come yesterday, would you like me to page the doctor to come see you right now?" -"Unfortunately, the doctor has an extremely busy schedule and the doctor doesn't always keep up the promises." -"I'm sure that the doctor will come and see you as soon as the doctor is free and able to come see you."
"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you." Because the nurse can be confident that the physician's actions are not motivated by hate, the use of doubt is justified. It would be inappropriate for the nurse to characterize the physician to the client as someone who "doesn't keep promises." The nurse cannot justifiably reassure the client that the physician will come as soon as the doctor is able. Similarly, it would likely be inappropriate for the nurse to page the physician solely in response to the client's statement.
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 0 to 18 inches 3 to 6 feet 12 to 25 feet 18 to 36 inches
3 to 6 feet
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.
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 mosttherapeutically when answering: "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?"
"How would leaving your spouse make you feel?"
A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response? "I notice it has been a while since you have had a shower." "Don't worry, take as long as you need before you get going." "Why haven't you taken a shower yet?" "I think you need to take a shower."
"I notice it has been a while since you have had a shower."
A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response? "I notice it has been a while since you have had a shower." "I think you need to take a shower." "Don't worry, take as long as you need before you get going." "Why haven't you taken a shower yet?"
"I notice it has been a while since you have had a shower." 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? "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'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?"
"I've been off for the past four days. What have you done since I last saw you?"
The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is mostlikely to elicit an explanation of the client's behavior? "What's wrong with your bed?" "What are you looking for in the bed? There's nothing hidden there." "It looks like you're searching for something. Is that right?" "Are you having any delusions or hallucinations right now?"
"It looks like you're searching for something. Is that right?"
A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "It sounds like you're feeling unappreciated." "It sounds like you're overreacting somewhat." "I listen to you." "Why do you say I don't listen to you?"
"It sounds like you're feeling unappreciated."
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.
A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? "I am glad to hear that." "A good relationship is a sign of recovery." "I don't think you are telling me the truth." "What you are saying and how you say it does not seem to match."
"What you are saying and how you say it does not seem to match."
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." "Please calm down; everything is going to be better." "Who has made you so upset?" "I wish you could try to be more positive." "You look like you are very angry this morning."
"You look like you are very angry this morning."
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 non-helpful personal reflection by the nurse. Asking multiple questions may be confusing.
During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which therapeutic communication technique? Reflecting Probing Confrontation Clarification
-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. From the book: "Probing tends to make the client feel used or invaded. Clients have the right not to talk about issues or concerns if they choose. Pushing and probing by the nurse will not encourage the client to talk."
A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication? 3 to 6 feet 10 to 12 inches 15 to 18 inches 15 to 18 feet
3 to 6 feet
"Get the stuff from him" is an example of which type of message?
Abstract
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.
A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? Expressions Body language Emotion underlying the words Gestures
Emotion underlying the words
Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? Emphasis Tone Pitch Intensity
Emphasis -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 group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? Formulation of an idea Message encoding Message transmission Message reception
Formulation of an idea With verbal communication, typically the person 1. formulates an idea 2. encodes a message 3. transmits the message with emotion 4. the message is received 5. message is decoded 6. 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 -Impassive = lack of emotion; 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.
Which zone is a distance that is comfortable between family and friends who are talking? Personal Intimate Social Public
Personal -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 that is comfortable between family and friends who are talking. -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 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.
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? Confrontation Reflecting Clarification Probing
Probing
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 to the client Facing the client at eye level Keeping arms and legs uncrossed
Sitting behind a desk
Which type of touch, according to Knapp, is used in greeting, such as a handshake? Love-intimacy Social-polite Friendship-warmth Functional-professional
Social-polite
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
The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue?
The client may have suicidal ideations.
Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?
The client's room
A nurse is caring for a client who is experiencing a decline in the client's chronic illness. The nurse feels that the nurse should speak to the client's spouse, who is extremely worried and anxious, and provide the spouse with support. Which setting should the nurse select to speak to the spouse? Choose the best answer. The cafeteria The client's room The hallway The consultation room
The consultation room
During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which mostlikely 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.
The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse?
active listening
A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: allow the nurse to determine an appropriate response. permit the client to gather the client's thoughts. encourage self-reflection by the nurse. demonstrate passive listening.
permit the client to gather the client's 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 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.
The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse? active listening empathetic linkages self awareness self disclosure
self disclosure
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? active listening self-awareness empathetic linkages self-disclosure
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 social zone self-awareness exploitation
self-disclosure
The nurse is caring for a client that is very confused. What intervention should be included with the nurses' non-communication with the client? instructions for feeding the confused client speaking louder so the client can hear a flat affect so the client will not be misinterpreted use of gentle touch during activities of daily living
use of gentle touch during activities of daily living
A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse? French Australian Italian Korean
Korean
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."
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. "The sudden onset of my chest pain got my spouse extremely stressed out." "I suddenly had dull pain around the jaw and neck region." "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 don't really know how it all started. It just happened."
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."
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 don't know what you did, but it's likely that it's not nearly as bad as you think it is." "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." "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."
"I'd very much like to hear about that, and it is okay for you to talk about it with me."
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 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 excited 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 excited about your mother's visit, We can talk if you want."
A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response? -"I've been off for the past four days. What have you done since I last saw you?" -"I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" -"How do you like to spend your time when you're able to do whatever you like?" -"If you had to guess, what do you think I might have done on my days off?"
"I've been off for the past four days. What have you done since I last saw you?" 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? "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?"
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."
The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond?
"Let's talk about infections, and how they heal."
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.
The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication? "A community care nurse will be there to help." "You are worried that your father is dying." "Your other family members will be willing to help." "This is overwhelming for you, it is okay to cry."
"This is overwhelming for you, it is okay to cry." In order to promote an effective exchange of information with the client's daughter and ensure therapeutic communication is taking place, the nurse should facilitate the client's daughter's expression of emotion. The statement, "This is overwhelming for you, it is okay to cry" focuses on the client's specific needs and encourages dialogue. The nurse making the statement, "You are worried about your father dying," is nontherapeutic because it introduces an unrelated topic
The graduate nurse is working in mental health and is learning about the use of touch with clients that have psychiatric disorders. The seasoned mental health care nurse differentiates information about this part of therapeutic communication by stating which information? "Touch carries different meanings for different individuals." "Touch is used to express interest and warmth." "Touch is used in situations in which the client is unstable." "Touch is best mixed with compassion when dealing with the anxious client."
"Touch carries different meanings for different individuals." Although the other statements can be true and demonstrate how touch can be used, these statements do not demonstrate how touch is interpreted.
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?"
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." "Have you ever been sexually abused?" "What specifically makes you uncomfortable?" "I can take that client off of your assignment this shift."
"What specifically makes you uncomfortable?"
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 bestresponse? "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. 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.
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?
3 to 6 feet
A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. A sad facial expression A 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. (the client, not the nurse)
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.
x A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone? Beginning at the boundary of the intimate zone and ending at the social zone 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
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? Metaphors Abstract messages Concrete messages Cues
Cues
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
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.
When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique? Exploring Focusing Accepting Formulating a plan of action
Exploring -Exploring is delving further into a subject or area. -Focusing is concentrating on one simple point. -Accepting is indicating reception. -Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.
A 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. Give the client advice about what to do Ensure the client's confidentiality Use self-disclosure frequently for empathy Employ theoretically based interventions Focus on the client during the interaction
Focus on the client during the interaction Ensure the client's confidentiality Employ theoretically based interventions
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
A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?
Presenting reality
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
Which would not be considered a goal of therapeutic communication? Active listening Establishing rapport Self-exploration of feelings by the nurse Guiding the client in problem solving
Self-exploration of feelings by the nurse
A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness? Intimate Social Public Personal
Social
The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement?
The client feels that the nurse is indifferent toward the client. People from cultures in the Middle East, Asia, and the Mediterranean often are more comfortable with less than 4 to 12 feet of space between them while talking. Thus, it is likely the Middle Eastern client feels that the nurse is behaving indifferently toward the client.
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 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.
Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries? A conference room The end of a hall The client's room An interview room
The client's room
Which is inconsistent with principles of therapeutic communication? The nurse is the primary focus of the relationship. The nurse must maintain client confidentiality. 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.
Which is an inaccurate depiction of concrete messaging? They require rephrasing of unclear messaging. They elicit more accurate responses. They are easy to understand. There is no need for interpretation.
They require rephrasing of unclear messaging.
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
Which nursing actions if shared with clients, suggest self-disclosure? Select all that apply. showing family photos taking the elevator attending a weight loss meeting wearing the color blue directing to individual Facebook page
directing to individual Facebook page showing family photos attending a weight loss meeting 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 group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? emotion underlying the words gestures body language expressions
emotion underlying the words
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 Emotional resilience Intolerance of violence Inability to use feeling words
inProxemics Silence Inability to use feeling words 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 (within the self) 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.
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. seek out a mentor who has extensive experience in the psychiatric-mental health area. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. 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.
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.
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 personal social public
social 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 using gentle touch during activities of daily living speaking louder so the client can hear displaying a flat affect so the client will not misinterpret the nurse
using gentle touch during activities of daily living
