Capstone Therapeutic Communication

Which of the following individuals are communicating a message? Select all that apply. A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me." E. A father checking for new e-mail on a regular basis

A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal. It is the act of conveying meanings from one body or group to another through the use of mutually understood signs, symbols, and semiotic rules. Option A: Nonverbal communication involves the transmission of messages without the use of words. It involves facial expression, posture, touch, gestures, physical appearance, eye contact, and other body movements. These are considered more accurate expressions of true feelings. Gestures impart meanings that are more powerful than words. Option B: Listening is the ability to accurately receive and interpret messages in the communication process. (e.g., radio, audio conferencing). Various modes or mediums to transmit and receive the information are referred to as "communication channels." Option C: Sight is the process, power, or function of seeing (e.g.., the sights of the newly-built hospital). Physical appearance or artifacts involves items in the client's environment such as grooming or the use of clothing and jewelry. They may convey nonverbal messages that might enhance or hinder the real message of the spoken words. Option D: Reading refers to the complex cognitive process of decoding symbols involving word recognition, comprehension, fluency, and motivation (e.g., written letters, memos, chats, and messaging). Option E: Communication is the process of sharing information or the process of generating and transmitting meanings. The father checking for new emails on a regular basis lacks some of the elements of communication, such as the stimulus, receiver, and channel.

Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

A. "Can you tell me why you said that?" This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings. Option B: Stereotyped comments refer to offering meaningless cliches or trite comments. Social conversations contain many cliches and much meaningless chit-chat. Such comments are of no value in the nurse-client relationship. Any automatic responses will lack the nurse's consideration or thoughtfulness. Option C: Attempts to dispel the client's anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings. Vague reassurances without accompanying facts are meaningless to the client. Option D: Interpreting refers to making conscious that which is unconscious to the client. The client's thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelings.

A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

A. "Touch carries a different meaning for different individuals." Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. The Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England (Skills for Care and Skills for Health, 2013) Section 1.6 states that you must maintain and establish appropriate and clear professional boundaries with your patients. This includes knowing when it is not appropriate to use touch or when that touch could be misunderstood by the patient. Option B: As Quiddington (2009:65) states "touching a person is a boundary issue, so do not assume that every individual finds being touched acceptable or desirable." Just as it may not be appropriate for a support worker to provide personal intimate care to a patient of the opposite sex then so too expressive touch may not be appropriate. Option C: Expressive touch can be an important means of communication. Chamley and James (2013:584) identify that it is "a two-way process involving feelings and sensation, and indicates a caring or loving relationship." Skills for Care (2016) states that touch can also be used in a more practical way to communicate with people who are deaf and visually impaired by signing information directly onto the person's hand. Option D: There is also a fourth type of touch known as therapeutic touch. Within the nursing literature, this is often wrongly confused with expressive touch. However, therapeutic touch is a complementary therapy whereby the trained support worker uses their hands to facilitate relaxation and healing. The goal is to smooth out or relieve energy congestion over the patient's body and is believed to be helpful in reducing pain and anxiety (Coakley and Barron, 2012) and enhances the healing process of patients who are injured or ill (Kozier et al, 2012).

A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing? A. Denial B. Projection C. Regression D. Rationalization

A. Denial. Denial is a refusal to admit to a painful reality, which was treated as if it does not exist. It involves blocking external events from awareness. If some situation is just too much to handle, the person refuses to experience it. This is a primitive and dangerous defense - no one disregards reality and gets away with it for long! It can operate by itself or, more commonly, in combination with other, more subtle mechanisms that support it. Option B: In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Projection is a psychological defense mechanism proposed by Anna Freud in which an individual attributes unwanted thoughts, feelings, and motives onto another person. Option C: Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. This is a movement back in psychological time when one is faced with stress. Regression functions as a form of retreat, enabling a person to psychologically go back in time to a period when the person felt safer. Option D: Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener. Rationalization is a defense mechanism proposed by Anna Freud involving a cognitive distortion of "the facts" to make an event or an impulse less threatening.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The non-therapeutic technique of giving approval B. The non-therapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

A. The non-therapeutic technique of giving approval. The group leader has employed the non-therapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client. Option B: Interpreting is making conscious that which is unconscious to the client; telling the client the meaning of his or her experience. The client's thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning. Option C: Presenting reality refers to offering for consideration that which is real. When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing the nurse's perceptions or the facts not by way of arguing with the client or belittling his experience. Option D: Making observations refers to verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

A patient whose history includes physically abusing his spouse and children has been admitted to the unit for alcohol and drug dependency. Which nurse will likely experience difficulty establishing a therapeutic relationship with this patient? A. The nurse who has experienced physical abuse B. The novice nurse who has never cared for an abuser C. The experienced nurse who has 'seen too many abusers' D. The nurse who has been in treatment for abusing a spouse

A. The nurse who has experienced physical abuse The therapeutic use of the self begins with knowing yourself. Knowing yourself is a complex and lifelong learning process. At the core of self-knowledge is the nurse's ability to correctly identify his or her own negative or unresolved issues including family backgrounds, dynamic cultural and social issues, values, biases, and prejudices. Having been a victim of physical abuse places this nurse in a situation that can be very harmful to the development of an affective nurse-patient relationship. The novice nurse may lack some of the knowledge and experience necessary to be effective but is not a likely to have intruding biases and prejudices. The experienced nurse is more likely to have worked on the ability to provide effective care in spite of such experience with this type of diagnosis whereas, the nurse having been treated for the diagnosis is most likely to show empathy and caring.

The nurse is working on the inclusion of therapeutic humor in interactions with a chronically ill schizophrenic patient who was hospitalized after an attempted suicide. Which outcomes are realistic expectations for this patient? Select all that apply. A. Improved cognition B. Decreased interest in self-harm C. Increased ability to experience pleasure D. Decrease in the expression of fear and anxiety E. Appropriate expression of emotions through affect

B, C, D, E In two studies, researchers found that humor-based group activities provided to patients with chronic schizophrenia showed that they had a significant reduction in negative symptoms, self-injury, self-reported anger, anxiety, and depression. Although the results may be preliminary, they suggest that humor-based interventions may be beneficial for patients with chronic mental illness. There is no supporting evidence that cognitive abilities improve with the introduction of therapeutic humor.

The nurse calls security and has physical restraints applied when a client who is admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. A. Libel B. Battery C. Assault D. Slander E. False Imprisonment

B, C, and E Voluntary admission to an acute inpatient psychiatric hospital occurs when a person goes for psychiatric evaluation and the evaluating mental health provider and patient agree that the patient would benefit from hospitalization and meets the criteria for hospitalization. Option A: Libel is the publication of writing, pictures, cartoons, or any other medium that exposes a person to public hatred, shame, disgrace, or ridicule, or induce an ill opinion of a person, and are not true. Option B: Battery is the intentional act of causing physical harm to someone. Unlike assault, one doesn't have to warn the victim or make him fearful before hurting them for it to count as a battery. Option C: Assault and battery are related to the act of restraining the patient in a situation that did not meet the criteria for such an intervention. If the mental health professional evaluates the patient and feels that he/she is at risk of harm to self/others or unable to care for self, the mental health professional can convert the admission to involuntary admission. Option D: Slander is not applicable here since the nurse did not verbally make untrue statements about the patient. If the patient later requests discharge, the hospital can hold the patient on the unit for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe for discharge. Option E: A false imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient.

The nurse has developed a plan in which nursing interventions are used to reinforce the patient's healthy behaviors. Which statement by the nurse will positively reinforce the patient's efforts regarding the plan? A. "How can a stress reduction plan help you at home?" B. "It sounds like you have the incentive to make healthy choices." C. "When you tried to follow the plan, how well did it work for you?" D. "It sounds as though making healthy choices is very important to you."

B. "It sounds like you have the incentive to make healthy choices." This answer offers a positive response to a patient who is trying out new behaviors. This nursing response will serve to encourage the patient's efforts. The remaining options do not provide positive reinforcement but rather are attempts to gather more information or clarify the patient's motivation to change.

A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

B. "You're feeling guilty because you weren't able to save your children." The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted. Option A: Denouncing the client's ideas or behaviors is nontherapeutic. Disapproval implies that the nurse has a right to pass judgement on the client's actions. It further implies that the client is expected to please the nurse. Option C: Attempts to dispel the client's anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings. Vague reassurances without accompanying facts are meaningless to the client. Option D: Advising is non-therapeutic for the client. The nurse should not tell the client what to do; giving an opinion or making decisions for the client is inappropriate. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client.

A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

B. Verbalizing the implied and the defense mechanism of denial This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. Option A: Making observations refers to verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood, or the client may not be ready to talk. Forcing the unwanted information out of the awareness is known as suppression. In most cases, however, this removal of anxiety-provoking memories from our awareness is believed to occur unconsciously. Option C: Reflection is directing client actions, thoughts, and feelings back to the client; may use the same words. This encourages the client to recognize and accept his feelings. Projection is a defense mechanism that involves taking our own unacceptable qualities or feelings and ascribing them to other people. Option D: Encouraging descriptions of perceptions refers to asking the client to verbalize what he or she perceives. To understand the client, the nurse must see things from the client's perspective. Displacement involves taking out our frustrations, feelings, and impulses on people or objects that are less threatening.

A patient diagnosed with terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A. "Have you shared your feelings with your family?" B. "I think we should talk more about your anger with your family." C. "You're feeling angry that your family continues to hope for you to be cured?" D. "You are probably very depressed, which is understandable with such a diagnosis."

C. "You're feeling angry that your family continues to hope for you to be cured?" Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. Restating is done to clarify the client's message by repeating the same statement back to the client. Option A: Judgements place a positive or negative value on the client and their messages. The therapeutic nurse-client relationship must be, at all times, nonjudgmental, open, and honest. Option B: While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. Option D: The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feelings; this is non-therapeutic in the one-to-one relationship.

When the community health nurse visits a patient at home, the patient states, "I haven't slept the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient? A. "I see." B. "Really?" C. "You're having difficulty sleeping?" D. "Sometimes, I have trouble sleeping too."

C. "You're having difficulty sleeping?" The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patient's major theme, which assists the nurse in obtaining a more specific perception of the problem from the patient. Option A: An essential factor to build a therapeutic nurse-client relationship is showing genuine interest to the client. For the nurse to do this, he or she should be open, honest, and display congruent behavior. Congruence only occurs when the nurse's words match with her actions. Option B: Stay away from nontherapeutic habits such as asking irrelevant personal questions, stating personal opinions, or showing disapproval. Ask open-ended questions, such as, "Tell me about your difficulties," to encourage the patient to take the lead in the discussion, and prompt him by suggesting he tell you more. Option D: This option is not a therapeutic response since it does not encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

The nurse has been working for several weeks with a single mom who has been both verbally and physically abused by her childrens father. Which nursing actions are appropriate for this stage of treatment?Select all that apply. A. Asking, "How does it make you feel when he hits you?" B. Providing information regarding women's shelters in the local area C. Assuring the patient that her children can visit when she wants to see them D. Sharing that, "I know leaving him is difficult but you need a plan if he abuses you again." E. Responding, "You've certainly become more assertive; don't be afraid to stand up for yourself."

A, B, D The working phase of the nurse-patient relationship involves evaluating the affects of the abuse, providing information that will help formulate a plan to end or manage the effects of the abuse, and encouraging the patient to confront the problem even when it is stressful. Assuring the patient that her children may visit is something that would happen in the orientation phase of the relationship when making the patient comfortable and responsive to treatment occurs. Positively reinforcing behaviors occurs in the termination phase as preparations are being made for discharge.

The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply. A. Restating B. Listening C. Asking the patient "Why?" D. Maintaining neutral responses E. Providing acknowledgment and feedback F. Giving advice and approval or disapproval

A, B, D, and E Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Option A: Restating is done to clarify the client's message by repeating the same statement back to the client. For example, when a client says, "I am ready to do some walking" and the nurse says, "Did I hear you say that you are now ready to do some walking?" Option B: Active listening involves showing interest in what patients have to say, acknowledging that you're listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as "What happened next?" to guide the conversation or propel it forward. Option C: Asking why is often interpreted as being accusatory by the patient and should also be avoided. Challenging, simply defined in this context, is forcing the client to defend and justify their opinions, beliefs, and feelings. Challenging shows a lack of respect for the client and a lack of acceptance of the client as a unique being who has and is entitled to, their own beliefs and opinions. The client has valid feelings that should never be challenged by the nurse. Option D: Focusing on the subject at hand decreases the risk of having these kinds of distractions impair the therapeutic communication process. For example, the nurse may say, "Mr. Burke, your family is very interesting and successful. Thank you for sharing this information with me. Now, let's discuss your diabetes and the insulin that you will be taking after you leave the hospital". Option E: Recognition, acknowledgment, and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts. Option F: Providing advice or giving approval or disapproval are barriers to communication. Telling the client what to do, giving opinions, or making decisions for the client, implies the client cannot handle his or her own life decisions and that the nurse is accepting responsibility.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting

A. Restatement The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood. Option B: Providing a lead to the client enables the client to continue discussing things with the nurse and it also facilitates the client's beginning a new discussion that is focused on a particular thing. For example, the nurse may say, "Tell me about your concerns relating to your new medications". Hopefully, the client will take this lead and begin a discussion about their new medications and their concerns relating to them with the nurse. Option C: Focusing with the client is a therapeutic communication technique used by nurses, and other members of the health care team, that facilitates the client's abilities to focus on and pay attention to the matters at hand, which should reflect the client's priorities. At times, some clients may use the nurse's presence to talk about things not even related to their health care and their health care problems. Option D: Recognition, acknowledgment, and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts It also allows the client to recognize that the nurse is open, honest and without any bias or judgments.

A patient experiencing disturbed thought processes believes that his food is has been poisoned. Which communication technique should the nurse use to encourage the patient to eat? A. Using open-ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the patient does not want to eat D. Offering opinions about the necessity of adequate nutrition

A. Using open-ended questions and silence. Open-ended questions and silence are strategies used to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention. One of the most important skills of a nurse is developing the ability to establish a therapeutic relationship with clients. For interventions to be successful with clients in a psychiatric facility and in all nursing specialties it is crucial to build a therapeutic relationship. Option B: Focusing on one's self is a non-therapeutic communication technique. This refers to responding in a way that focuses attention on the nurse instead of the client. An essential factor to build a therapeutic nurse-client relationship is showing genuine interest to the client. For the nurse to do this, he or she should be open, honest, and display congruent behavior. Congruence only occurs when the nurse's words match with her actions. Option C: Focusing on the negative should be done less than giving options for the patient. Encourage the patient to consider the pros and cons of possible options. In dealing with clients their interest should be the nurse's greatest concern. Thus, empathizing with them is the best technique as it acknowledges the feelings of the client and at the same time, it allows a client to talk and express his or her emotions. Option D: The remaining option is not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

A nurse has for the past 4 weeks been working with a psychotic patient who has been mute and very withdrawn. The patient suddenly encroaches on the nurse's personal space by touching inappropriately. What is the most therapeutic response by the nurse to address this behavior? A. Ignore it this time because the patient is, at last, responding. B. Firmly communicate acceptable boundaries to the patient. C. Gently touch the patient's head and then observe the reaction. D. Smile while telling the patient that people don't like being touched like that.

B. Firmly communicate acceptable boundaries to the patient. The therapeutic response is to clearly communicate appropriate boundaries. There are times when patients misinterpret the nurse's nurturing as an invitation to an intimate relationship. In these instances, boundaries must be firmly, but neutrally, explained. The behavior should not be ignored since doing so may well result in the patient repeating the behavior with others, perhaps with disastrous results. Touch is often misinterpreted by psychotic patients and in this case has no therapeutic value. Nonverbal communication should always be congruent so as to avoid confusing the patient.

Which statement demonstrates the best understanding of the nurse's role regarding ensuring that each client's rights are respected? A. "Autonomy is the fundamental right of each and every client." B. "A patient's rights are guaranteed by both state and federal laws." C. "Being respectful and concerned will ensure that I'm attentive to my patient's rights." D. "Regardless of the patient's conditions, all nurses have the duty to respect patient rights."

C. "Being respectful and concerned will ensure that I'm attentive to my patients' rights." The nurse needs to respect and have concern for the patient; this is vital to protecting the patient's rights. Patient rights are a subset of human rights. Whereas the concept of human rights refers to minimum standards for the ways persons can expect to be treated by others, the concept of ethics refers to customary standards for the ways persons should treat others. Option A: While it is true that autonomy is a basic client right, there are other rights that must also be both respected and facilitated. Commonly established rights tend to derive from a core set of ethical principles, including autonomy of the patient, beneficence, nonmaleficence, (distributive) justice, patient-provider fiduciary (trusting) relationship, and inviolability of human life. Option B: State and federal laws do protect a patient's rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. As such, rights and ethics are usually flip sides of the same coin, and behind every 'patient right' is one or more ethical principles from which that right is derived. Option D: It is a fact that safeguarding a patient's rights is a nursing responsibility, but stating that fact does not show understanding or respect for the concept. Establishing clearly defined patient rights helps standardize care across healthcare fields and enables patients to have uniform expectations during their treatment.

The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

C. To explore a subject, idea, experience, or relationship This is an example of the therapeutic communication technique of exploring. The purpose of exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. Option A: The statement is not used to reframe the client's thoughts. A helpful therapeutic technique can be theme identification. It allows the nurse to best promote the client's exploration and understanding of important problems. Option B: This statement will not put the client at ease. When clients deal with topics superficially, exploring can help them examine the issue more fully. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his wishes. Option D: Providing general leads indicates that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he is hesitant or uncomfortable about the topic.

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

D. "Describe what happened during your time with your husband." This is an example of the therapeutic communication technique of exploring. The purpose of exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. Option A: Testing is appraising the client's degree of insight. These types of questions force the client to try to recognize his problems. The client's acknowledgment that he doesn't know these things may meet the nurse's needs but is not helpful for the client. Option B: Indicating the existence of an external source refers to attributing the source of thoughts, feelings, and behavior to others or to outside influences. To question this implies that the client was made or compelled to think in a certain way. Usually, the nurse does not intend to suggest that the source is external but that is often what the client thinks. Option C: Usually a "why" question is intimidating. In addition, the client is unlikely to know why and may become defensive trying to explain himself. Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife, or I take it out of the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

D. Making observations The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse. Option A: Often, patients can draw upon experience to deal with current problems. By encouraging them to make comparisons, nurses can help patients discover solutions to their problems. Option B: Exploring, in contrast to invasive and non-therapeutic probing, is using techniques that encourage the client to provide more details and information about a particular topic or health care problem. Option C: Formulating a plan of action refers to asking the client to consider the kinds of behavior likely to be appropriate in future situations. For example, the nurse asks the client, "What could you do to let your anger out harmlessly?"

During the termination phase of the nurse-patient relationship with a dependent patient, the nurse evaluates the effectiveness of coping techniques learned by: A. Asking, "When you used assertiveness to deal with your father during his visit, how did it work?" B. Role playing with the patient in order to practice being assertive C. Asking the patient to define the difference between being assertive and being aggressive. D. Discussing how her father effectively used both assertiveness and aggressiveness to control her

A. Asking, "When you used assertiveness to deal with your father during his visit, how did it work?" Evaluation is a task of the termination phase. Asking such a question encourages patients to evaluate actions and look at the outcomes of behaviors. Role playing to practice the technique, defining the relevant terms, and discussing the effects of the father's behavior would occur during the working phase of the relationship and does not encourage evaluation of the newly learned skills.

During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

A. "Don't worry. Everything will be alright." This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort. Thus a lack of empathy and understanding may be conveyed. Option B: Making observations refers to verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk. Option C: Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that might pose a problem for them. Observing that they look tired may prompt patients to explain why they haven't been getting much sleep lately; making an observation that they haven't been eating much may lead to the discovery of a new symptom. Option D: The nurse denies the client's feelings or the seriousness of the situation by dismissing his comments without attempting to discover the feeling or meaning behind them

A nurse is considering the therapeutic value of touch when planning care for an anxious patient. What is the initial question the nurse should answer before initiating this technique? A. "How comfortable am I with touching this patient?" B. "Will the patient find therapeutic touch supportive?" C. "Does research support the use of therapeutic touch?" D. "Has therapeutic touch proven to be therapeutic with anxious patients?"

A. "How comfortable am I with touching this patient?" Touch will only communicate warmth and thus be therapeutic if the nurse is comfortable with it. Although the other options are all appropriate, they do not have priority in this situation.

The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors ask the nurse, "How is Mary doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response? A. "I can not discuss any patient situation with you." B. "If you want to know about Mary, you need to ask her yourself." C. "Only because you're worried about a friend, I'll tell you that she is improving." D. "Being her friend, you know she is having a difficult time and deserves her privacy."

A. "I cannot discuss any patient situation with you." The nurse is required to maintain confidentiality regarding the patient and the patient's care. Confidentiality is basic to the therapeutic relationship and is a patient's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. Option B: Some people working in mental health, such as phone crisis counselors or life coaches, are not licensed by their state. These people may not be legally required to protect client confidentiality. Yet most agree not to reveal identifying information about their clients anyway. Option C: Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. For example, it is common that therapists will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality. Option D: The remaining options identify statements that do not maintain patient confidentiality. Therapists who break confidentiality can get in trouble with state licensing boards. They can also be sued by their clients in some cases.

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level. Option B: Asking this question should be done at the assessment phase of the nursing process. Encouraging the description of perceptions is a therapeutic technique that allows the nurse to see things from the client's perspective. Encouraging the client to describe fully may relieve the tension the client is feeling. Option C: Acknowledging that the approach is working occurs in the evaluation phase of the nursing process. Noting the efforts that the client has made shows that the nurse recognizes the client as an individual. Such recognition does not carry the notion of value, that is, of being "good" or "bad". Option D: Making observations or verbalizing what the nurse perceives may occur in the assessment phase. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."

A. "You appear to be talking to someone I do not see." The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions. Option B: Encouraging description of perceptions is asking the client to verbalize what he or she perceives. To understand the client, the nurse must see things from the client's perspective. Encouraging the client to describe fully may relieve the tension the client is feeling, and he might be less likely to take action on ideas that are harmful or frightening. Option C: Requesting an explanation is asking the client to provide reasons for thoughts, feelings, behaviors, and events. There is a difference between asking the client to describe what is occurring and or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option D: Telling the client what to do and giving an opinion or making decisions for the client is nontherapeutic. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client.

A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

A. "You seem to be motivated to change your behavior." This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly. The nurse should take care to express only what is fairly obvious; otherwise, the nurse may be jumping to conclusions or interpreting the client's communication. Option B: This statement can be referred to as formulating a plan of action, wherein the nurse is asking the client to consider the kinds of behavior likely to be appropriate in future situations. It may be helpful for the client to plan in advance what he or she might do in future similar situations. Option C: Usually a "why" question is intimidating. In addition, the client is unlikely to know why and may become defensive trying to explain himself. Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. Option D: Advising refers to telling the client what to do; giving an opinion or making decisions for the client is inappropriate. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client.

A patient admitted voluntarily for the treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially? A. Contact the patient's health care provider (HCP). B. Call the patient's family to arrange for transportations. C. Attempt to persuade the patient to stay for only a few more days. D. Tell the patient that leaving would likely result in an involuntary commitment.

A. Contact the patient's health care provider (HCP). In general, patients seek voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. Option B: While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient's permission. If the patient later requests discharge, the hospital can hold the patient on the unit for up to 72 hours until a mental health professional can evaluate the patient for safety concerns. The patient will be discharged if the evaluating mental health professional determines that the patient is safe for discharge. Option C: While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to stay "a few more days" has little value and will not likely be successful. Option D: Many states require that the patient submits a written release notice to the facility staff members, who reevaluate the patient's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.

A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism? A. Denial B. Projection C. Rationalization D. Intellectualization

A. Denial Denial is the refusal to admit to a painful reality and maybe a response by a victim of sexual abuse. In this case, the patient is not acknowledging the trauma of the assault either verbally or nonverbally. If a situation is just too much to handle, the person may respond by refusing to perceive it or by denying that it exists. Option B: Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else. Projection is a psychological defense mechanism proposed by Anna Freud in which an individual attributes unwanted thoughts, feelings, and motives onto another person. Option C: Rationalization is justifying the unacceptable attributes of oneself. Rationalization is a defense mechanism proposed by Anna Freud involving a cognitive distortion of "the facts" to make an event or an impulse less threatening. Option D: Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking. In psychology, this behavior pattern is referred to as intellectualization, a defense mechanism, which according to Freud involves engrossing oneself so deeply in the reasoning aspect of a situation that you completely disregard the emotional aspect that is involved.

When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? A. Monitor closely for harm to self or others. B. Assist in completing an application for admission C. Supply the patient with written information about their mental illness. D. Provide an opportunity for the family to discuss why they felt the admission was needed.

A. Monitor closely for harm to self or others. Involuntary admission is necessary when a person is a danger to himself or others or is in need of psychiatric treatment regardless of the patient's willingness to consent to the hospitalization. The person must pose a "clear and present danger" to self or others based upon statements and behavior that occurred in the past 30 days. Option B: A written request is a component of voluntary admission. Involuntary admission to an acute inpatient psychiatric hospital occurs when the patient does not agree to hospitalization on a locked inpatient psychiatric unit, but a mental health professional evaluates the patient and believes that, as a result of mental illness, the patient is at risk of harming self or others, or is unable to care for self. Option C: Providing written information regarding the illness is likely premature initially. The decision to discharge the patient or request a longer commitment is made by the treatment team based on concerns for the safety of the patient or others. Option D: The family may have had no role to play in the patient's admission. However, any person (including police and doctors) can petition or request an involuntary psychiatric evaluation for another person. The person requesting the evaluation is known as the "petitioner." A request for an evaluation can be made by going to any CRC or by calling a mobile crisis team to come to the petitioner's home.

A nurse is discussing unit expectations with a newly admitted patient diagnosed with poor impulse control. The nurse shows an understanding of the use of body language to convey feelings when documenting that the patient is angry and resistant to authority based on which of the following? Select all that apply. A. Patients reluctance to make eye contact B. Crossed-arm posture the patient assumes C. Quizzical expression on the patients face D. Sharp rapping of the patients fingers against the table E. Patients tendency to lean forward when seated in the chair

B, D Body language includes facial expressions, reflexes, body posture, hand gestures, eye movement, mannerisms, touch, and other body motions. Body posture and facial expressions, including eye movements, are two of the most important cues to determine how a person is responding to the message. This patients crossed-arm posture and sharp finger rapping are indicators of anger. Poor eye contract is recognized as poor self-esteem or guilt cues, whereas a quizzical expression is likely an indication of confusion. Leaning forward in the chair is generally viewed as a positive sign of interest and/or cooperation

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

B. "I see that you are upset, but I feel uncomfortable when you swear at me." This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify. The nurse should seek to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships. Option A: These types of questions force the client to try to recognize his problems. The client's acknowledgment that he doesn't know these things may meet the nurse's needs but is not helpful for the client. Option C: Interpreting refers to making conscious that which is unconscious to the client. The client's thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelings. Option D: Sanctioning the client's behavior is nontherapeutic. This gives the client the impression that he is "right" because of agreement with the nurse. Opinions and conclusions should be exclusively to the clients.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hear voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

B. "I understand that the voices seem real to you, but I do not hear any voices." This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client. Option A: It is nontherapeutic when the nurse agrees with the client. Approval indicates that the client is "right" rather than "wrong". This gives the client the impression that he is "right" because of agreement with the nurse. Opinions and conclusions should be exclusive to the clients. Option C: Advising refers to telling the client what to do; giving an opinion or making decisions for the client is inappropriate. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client. Option D: False reassurance refers to indicating there is no reason for anxiety or other feelings of discomfort. Attempts to dispel the client's anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings. Vague reassurances without accompanying facts are meaningless to the client.

A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

B. "Remember, clients, not nurses, are responsible for their own choices and decisions." Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client. Option A: Ignoring the client or refusing to consider the client's idea is nontherapeutic. When the nurse rejects any topic, he closes it off from exploration. In turn, the client may feel personally rejected along with his ideas. Option C: Keeping the client's best interests may not always be the best for clients. The nurse may not approve or disapprove of the client's behaviors, or he may not agree or disagree with the client's ideas. The nurse may allow the client to lead the interaction and help the client formulate a plan of action to increase the likelihood of the client effectively coping in certain situations. Option D: The nurse must include the client in their plan of action and setting of goals. Offering to share, to strive, to work with the client for his benefit suggests collaboration. The nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally, and improve the ability to form satisfactory relationships.

A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

B. "What would you like to talk about?" The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction. Option A: Placing events in time or sequences refers to clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences. Option C: Making observations refers to verbalizing what the nurse perceives. For example, the nurse says, "You appear tense." or "I notice you are biting your lip." Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk. Option D: Theme identification allows the nurse to identify underlying issues and problems experienced by the client that emerge repeatedly during a nurse-client relationship. It allows the nurse to best promote the client's exploration and understanding of important problems.

Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" This is an example of the therapeutic communication technique of offering self. Offering self-makes the nurse available on an unconditional basis, increasing the client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self. Option A: Exploring refers to delving further into a subject or idea. When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. Option C: Giving recognition or acknowledging the efforts the client has made can be therapeutic. It shows that the nurse recognizes the client as an individual. Such recognition does not carry the notion of value, that is, of being "good" or "bad". Option D: It would be inappropriate for the nurse to let herself become available to a client who has been discharged from care. The nurse and the client must recognize that loss may accompany the ending of a relationship.

The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is most appropriate for this phase? A. Planning short-term goals B. Making appropriate referrals C. Developing realistic solutions D. Identifying expected outcomes

B. Making appropriate referrals. Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals, and dealing with the common behaviors associated with termination. After the client's problems or issues are addressed, the relationship needs to be completed before it can be terminated. Option A: The working or middle phase of the relationship is where nursing interventions frequently take place. Problems and issues are identified and plans to address these are put into action. Positive changes may alternate with resistance and/or lack of change. Option C: Develop realistic solutions belong to the working phase. New problems and needs may emerge as the nurse-client relationship develops and as earlier identified issues are addressed. The nurse advocates for the client to ensure that the client's perspectives and priorities are reflected in the plan of care. Option D: The remaining options identify tasks appropriate for the working phase of the relationship. The nurse assists the client to explore thoughts (e.g. views of self, others, environment, and problem-solving), feelings (e.g. grief, anger, mistrust, sadness), and behaviors (e.g. promiscuity, aggression, withdrawal, hyperactivity).

A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

B. O. The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. Open posture when interacting with the client (O). Crossing the arms would make the nurse anxious or defensive. The acronym SOLER includes: Option A: Sitting squarely facing the client (S). Sit and face the client. The nurse should sit attentively at an angle to the client so that she can look at them directly and show them that she is listening to them and paying attention. Option C: Leaning forward toward the client (L). The nurse should lean forward to show that she is interested in what the client is talking about. It also means that the client can lower their voice if they wish to if they are talking about personal issues, for example. Option D: Establishing eye contact (E). Maintaining eye contact shows that the nurse is interested and listening to what the client has to say. It does not mean that the nurse has to stare at the client because this can make them feel uncomfortable, but maintain good, positive eye contact. Option E: Relaxing (R). R stands for relaxed body language. This shows the client that the nurse is not in a rush to get away, but is letting them talk at their own pace.

Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."

C. "I notice you are wearing a new dress and you have washed your hair." This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment. It shows that the nurse recognizes the client as an individual. Such recognition does not carry the notion of value, that is, of being "good" or "bad". Option A: Theme identification refers to underlying issues or problems experienced by the client that emerge repeatedly during a nurse-client relationship. It allows the nurse to best promote the client's exploration and understanding of important problems. Option B: Offering self refers to making oneself available. The nurse can offer his presence, interest, and desire to understand. It is important that this offer is unconditional, that is, the client does not have to respond verbally to get the nurse's attention. Option D: Giving approval or sanctioning the client's behavior or ideas can be nontherapeutic. Saying what the client thinks or feels is "good" implies that the opposite is "bad". Approval, then, tends to limit the client's freedom to think, speak, or act in a certain way.

A client diagnosed with dependent personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."

C. "Let's discuss and explore all of your options." The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. Any problem or concern can be better understood if explored in depth. Option A: Advising refers to telling the client what to do; giving an opinion or making decisions for the client is inappropriate. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client. Option B: Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option D: Interpreting or making conscious what is unconscious to the client is nontherapeutic. The client's thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelings.

Which nursing response would indicate an empathetic approach to a patient who is depressed over recent losses in her life? A. "Losing a job isn't always a bad thing." B. "I lost my parents last year and still feel sad." C. "Please tell me more about what you are feeling." D. "Let's not focus on what's sad but rather what is good about life."

C. "Please tell me more about what you are feeling." Empathy or empathic understanding is the nurse's ability to see things from the patient's viewpoint and to communicate this understanding to the patient. This response focuses on the patient's feelings and encourages further discussion. Minimizing the loss or suggesting a change in focus sounds judgmental or patronizing and will likely cut off communication. Although self-disclosure can be therapeutic, this focuses on the nurse's feelings.

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

C. "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." The instructor's statement, "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual. Option A: Some students need to be nudged to achieve at a higher level and others need to be handled very gently so as not to discourage learning and damage self-esteem. A balance between not wanting to hurt a student's feelings and providing proper encouragement is essential. Option B: When feedback is predominantly negative, studies have shown that it can discourage student effort and achievement (Hattie & Timperley, 2007, Dinham). A teacher has the distinct responsibility to nurture a student's learning and to provide feedback in such a manner that the student does not leave feeling defeated. Option D: Providing feedback means giving students an explanation of what they are doing correctly and incorrectly. However, the focus of the feedback should be based essentially on what the students are doing right. It is most productive to a student's learning when they are provided with an explanation and example as to what is accurate and inaccurate about their work.

Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"

C. "Yes, I see. Go on." The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Option A: Asking the client why he is here is a type of exploring. Exploring refers to delving further into a subject or idea. When clients deal with topics superficially, exploring can help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. Option B: Asking the client if he is depressed or anxious may be inappropriate because it may put words into the client's mouth. It would be best to let the client speak out by offering him leads or encouraging him to voice out his feelings through exploring. Option D: Placing events in time or sequences refer to clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences.

A client on an in-patient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

C. "You've been feeling sad and alone for some time now?" This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. Option A: Testing is appraising the client's degree of insight. These types of questions force the client to try to recognize his problems. The client's acknowledgment that he doesn't know these things may meet the nurse's needs but it is not helpful for the client. Option B: False reassurance refers to indicating there is no reason for anxiety or other feelings of discomfort. Attempts to dispel the client's anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings. Vague reassurances without accompanying facts are meaningless to the client. Option D: Saying what the client thinks or feels is "good" implies that the opposite is "bad". Approval, then, tends to limit the client's freedom to think, speak, or act in a certain way. This can lead to the client's acting in a particular way just to please the nurse.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

C. Formulating a plan of action The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating. Option A: This therapeutic communication technique reflects and mirrors what the nurse believes the client's feelings to be underneath the words. It mirrors, or reflects, the patient's feelings, not words, back to the client so that the client's feelings can be further explored and expressed by the patient. Option B: Making observations refers to verbalizing what the nurse perceives. For example, the nurse says, "You appear tense." or "I notice you are biting your lip." Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk. Option D: Recognition, acknowledgment, and acceptance of the client and their thoughts which are conveyed during communication are therapeutic communication techniques and strategies that give the nurse the opportunity to let the client know that you are interested in them and respectful of them and their thoughts It also allows the client to recognize that the nurse is open, honest and without any bias or judgements.

A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

C. Making stereotyped comments This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship. Such comments are of no value in the nurse-client relationship. Any automatic responses will lack the nurse's consideration or thoughtfulness. Option A: Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option B: Belittling the client refers to misjudging the degree of the client's discomfort. When the nurse tries to equate the intense and overwhelming feelings the client has expressed to "everybody" or to the nurse's own feelings, the nurse implies that the discomfort is temporary, mild, self-limiting, or not very important. The client is focused on his or her own worries and feelings' hearing the problems or feelings of others is not helpful. Option D: Probing is the persistent questioning of the client. 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 patient indicates that he is about to share information about his illness that is shocking and embarrassing. Which nursing intervention has priority in this situation in facilitating the communication process? A. Reassuring the patient that talking will be therapeutic B. Assuring the patient the information will be kept confidential C. Responding to the patient's information in an accepting manner D. Providing the patient with a private place for the discussion to occur

C. Responding to the patient's information in an accepting manner Responding to the patient's information in a nonjudgmental, accepting manner will encourage continued therapeutic communication. The remaining options, although appropriate, will not have the same generalized affect on the communication process as the correct option.

When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

C. Sitting squarely, facing the client. When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). Option A: Maintaining eye contact shows that the nurse is interested and listening to what the client has to say. It does not mean that the nurse has to stare at the client because this can make them feel uncomfortable, but maintain good, positive eye contact. Option B: The nurse should lean forward to show that she is interested in what the client is talking about. It also means that the client can lower their voice if they wish to if they are talking about personal issues, for example. Option D: Open posture when interacting with the client (O). Crossing the arms would make the nurse anxious or defensive. The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER.

A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

D. "During the group, you raised your voice, yelled at a peer, left, and slammed the door." The nurse is providing appropriate feedback when stating, "During the group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice. Option A: Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option B: Telling the client what to do or giving an opinion or making decisions for the client is inappropriate and nontherapeutic. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client. Option C: Disapproving or denouncing the client's behavior is nontherapeutic. Disapproval implies that the nurse has a right to pass judgement on the client's actions. It further implies that the client is expected to please the nurse.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

D. "Let's figure out a way for you to attend unit activities and still wash your hands." The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety. Option A: Disapproving or denouncing the client's behavior is nontherapeutic. Disapproval implies that the nurse has a right to pass judgement on the client's actions. It further implies that the client is expected to please the nurse. Option B: Advising refers to telling the client what to do; giving an opinion or making decisions for the client is inappropriate. It implies that the client cannot handle life decisions and only the nurse knows what is best for the client. Option C: Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating.

The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Can you chronologically order the events that led to your admission?" D. "Yes, I see. Go on."

D. "Yes, I see. Go on." The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. It indicates that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Option A: There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option B: Interpreting refers to making conscious that which is unconscious to the client. The client's thoughts and feelings are his own, not to be interpreted by the nurse or for hidden meaning. Only the client can identify or confirm the presence of feelings. Option C: Placing events in time or sequences refers to clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause-and-effect behavior and consequences, or the client may be able to see that perhaps some things are not related.

A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

D. "You feel that your mother does not want you to come back home?" This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue or clarify if necessary. Option A: When the nurse tries to equate the intense and overwhelming feelings the client has expressed to "everybody" or to the nurse's own feelings, the nurse implies that the discomfort is temporary, mild, self-limiting, or not very important. The client is focused on his or her own worries and feelings' hearing the problems or feelings of others is not helpful. Option B: Requesting an explanation or asking the client to provide reasons for thoughts, feelings, behaviors or events is nontherapeutic. There is a difference between asking the client to describe what is occurring or has taken place and asking him to explain why. Usually, a "why" question is intimidating. Option C: Attempts to dispel the client's anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings. Vague reassurances without accompanying facts are meaningless to the client.

Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

D. "You mentioned your relationship with your father. Let's discuss that further." This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another. The nurse encourages the client to concentrate his energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. Option A: Theme identification refers to underlying issues or problems experienced by the client that emerge repeatedly during nurse-client relationship. It allows the nurse to best promote the client's exploration and understanding of important problems. Option B: Seeking information refers to seeking to make clear that which is not meaningful or that which is vague. The nurse should seek clarification throughout interactions with clients. Doing so can help the nurse to avoid making assumptions that understanding has occurred when it has not. Option C: The nurse can offer his presence, interest, and desire to understand. It is important that this offer is unconditional, that is, the client does not have to respond verbally to get the nurse's attention.

A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A. "You have everything to live for." B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"

D. "You've been feeling like a failure for a while?" Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. It's frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with a phrase like "Does that sound correct?" gives patients explicit permission to make corrections if they're necessary. Option A: Some people confuse empathizing with sympathizing. To establish a good nurse-patient relationship, the nurse should use empathy, not sympathy. Sympathy is defined as the feelings of concern or compassion one shows for another. By sympathizing, the nurse projects his or her own concerns to the client, thus, inhibiting the client's expression of feelings. Option B: This option blocks communication because it minimizes the patient's experience and does not facilitate exploration of the patient's expressed feelings. In addition, the use of the word "why" is nontherapeutic. Option C: Internal validation is a non-therapeutic communication technique. This refers to making an assumption about the meaning of someone else's behavior that is not validated by the other person (jumping into conclusion).

On review of the patient's record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient's behavior? A. Fearfulness regarding treatment measures. B. Anger and aggressiveness directed toward others. C. An understanding of the pathology and symptoms of the diagnosis. D. A willingness to participate in the planning of the care and treatment plan.

D. A willingness to participate in the planning of the care and treatment plan. In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectation is the patient will participate in the treatment program since they are actively seeking help. Voluntary admission to an acute inpatient psychiatric hospital occurs when a person goes for psychiatric evaluation and the evaluating mental health provider and patient agree that the patient would benefit from hospitalization and meets criteria for hospitalization. Option A: Fearfulness is characteristic of involuntary admission. Involuntary admission to an acute inpatient psychiatric hospital occurs when the patient does not agree to hospitalization on a locked inpatient psychiatric unit, but a mental health professional evaluates the patient and believes that, as a result of mental illness, the patient is at risk of harming self or others, or is unable to care for self. Option B: The remaining option is not characteristic of this type of admission. Anger and aggressiveness are more characteristic of involuntary admission. Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients' autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed. Option C: Voluntary admission does not guarantee a patient's understanding of their illness, only of their desire for help. A mental health professional will evaluate an individual who goes to one of the above facilities and will determine whether the patient is appropriate for an inpatient psychiatric unit.

The nurse is considering the need for both effective means of communication and safety when caring for a patient with impulse control issues and poor social skills. Which nursing intervention is most appropriate to address these needs? A. Reminding the patient with each interaction what space boundaries are considered safe and desired B. Asking the patient to describe and set space boundaries that feel safe and facilitate effective communication C. Clearly setting space boundaries for the patient so both patient and staff feel safe and can communicate more effectively D. Discussing the need for space boundaries and how they help both the patient and the staff feel safe and aide in communicating effectively

D. Discussing the need for space boundaries and how they help both the patient and the staff feel safe and aide in communicating effectively Space as a concept of boundaries and safety is important to understand because the nurse and the patient need to respect the distance that each needs. For successful communication to occur, both parties need to feel safe. Some patients have problems with their boundaries and invade other patients' own safe zones; patients who perceive this as threatening react aggressively to such boundary violations. The nurse may need to help the patient understand the need for appropriate distances in order for everyone to feel safe and to communicate effectively. Reminding the patient of what the boundaries are without first discussing the importance of space boundaries is not an effective technique. Having the patient set the boundaries does not take into consideration the needs of others, whereas staff setting the boundaries without patient involvement ignores the needs of the patient and prevents the patient from understanding of the situation.

A patient's unresolved feelings related to loss would be most likely observed during which phase of the therapeutic nurse-patient relationship? A. Trusting B. Working C. Orientation D. Termination

D. Termination In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. Option A: Sometimes during the working phase of the relationship, the nurse may choose to self-disclose information about themselves to relate to the client. Limited self-disclosure may be beneficial when it helps the client express their feelings as they relate their experience to what the nurse has disclosed. Sharing personal information with a client can deepen trust. Option B: Within this phase, relevant treatment goals are established to guide nursing interventions and client actions, and the conversation in the working phase turns to active problem solving related to assessed needs. Clients can more deeply disclose concerns/issues that they are having. Option C: The nurse begins to build a sense of trust by providing the client with basic information (name, professional status, and essential information about the purpose and nature of the relationship). Introductions are important even when the client is confused, aphasic, unresponsive, or unable to respond. Nonverbal supportive communication such as a handshake, eye contact, a smile, and appropriate body language reinforce spoken words.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

D. The non-therapeutic technique of "giving false reassurance." The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings. Option A: Telling the client what to do, giving opinions, or making decisions for the client, implies the client cannot handle his or her own life decisions and that the nurse is accepting responsibility. Option B: Defensiveness occurs when the nurse feels the need to defend themselves, their actions, their employers, or others for their failures and shortcomings. Again, this technique fulfills the needs of the nurse rather than the client and, as such, it is not therapeutic. Option C: Presenting reality is offering for consideration that which is real. When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real. The nurse does this by calmly and quietly expressing the nurse's perceptions or the facts not by way of arguing with the client to consider, not to "convince" the client that he is wrong.

When communicating with a psychotic, schizophrenic patient, the nurse avoids the use of slang phrases most importantly because: A. Such phrases have different meanings for different people. B. Such phrases will likely trigger anxiety and frustration in the patient. C. The use of such phrases is not appropriate when communicating therapeutically with a patient. D. This patient's altered thought processes will serve to make understanding such phrases very unlikely.

D. This patient's altered thought processes will serve to make understanding such phrases very unlikely. Precise verbal communication is important because spoken words often mean different things to different people. Figures of speech, jokes, clichés, colloquialisms, and other terms or special phrases carry a variety of meanings especially to individuals with altered thought processes. A person with schizophrenia interprets concretely and literally whereas psychosis generally brings about loose associations. Although all the options are reasons to avoid the use of slang phrases, the primary reason in this case in to avoid confusing the patient.