Ch 6. Therapeutic Communication

A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction? A) Broad opening B) Focusing C) Giving information D) Silence

Ans: A Feedback: Broad openings allow the client to say as much or little as he or she wants. Focusing (concentrating on a single point) can be intimidating; giving information (making available the facts that the client needs) and silence do not encourage client interaction.

The nurse asks the patient what he would like to talk about. This is an example of A) broad opening. B) encouraging expression. C) focusing. D) offering self.

Ans: A Feedback: Broad openings allow the client to take the initiative in introducing the topic. Encouraging expression involves asking the client to appraise the quality of his or her experiences. The nurse uses focusing when concentrating on a single point. Offering self occurs when making oneself available.

The nurse asks the client what that experience was like. Which communication skill is the nurse using? A) Encouraging expression B) Encouraging description of perceptions C) Exploring D) Requesting an explanation

Ans: A Feedback: Encouraging expression is a therapeutic technique and involves asking the client to appraise the quality of his or her experiences. Encouraging description of perceptions is a therapeutic technique and involves asking the client to verbalize what he or she perceives. Exploring is a therapeutic technique that involves delving further into a subject or an idea. Requesting an explanation is a nontherapeutic verbal communication technique that involves asking the client to provide reasons for thoughts, feelings, behaviors, events.

A patient says, "Its' been so long since I've been with my family." Which statement by the nurse is an example of restating? A) You say you haven't seen your family in a while. B) Tell me when you last saw your family. C) Go on. Tell me more. D) When was the last time you saw your family?

Ans: A Feedback: Restating is repeating the main idea expressed. Restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Focusing or concentrating on a single point encourages the client to concentrate his or her energies on a specific point, which may prevent a multitude of factors or problems from overwhelming the client. General leads give encouragement to continue. They indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Placing events in sequence clarifies the relationship of events in time. This helps both the nurse and the client to see them in perspective.

Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff? A) Because some clients with mental illness have difficulty knowing when touch is or is not appropriate B) Because clients often perceive being touched as a threat and may attempt to protect himself or herself by striking the staff person C) Because it can be threatening to both the client and the nurse D) Because touching always leads to more touching

Ans: A Feedback: Some clients with mental illness have difficulty understanding the concept of personal boundaries or knowing when touch is or is not appropriate. Consequently, most psychiatric inpatient, outpatient, and ambulatory care units have policies against clients touching one another or staff. When a staff member is going to touch a client while performing nursing care, he or she must verbally prepare the client before starting the procedure. A client with paranoia may interpret being touched as a threat and may attempt to protect himself or herself by striking the staff person. Both the client and the nurse can feel threatened if one invades the other's personal or intimate zone, which can result in tension, irritability, fidgeting or even flight. Touching can be comforting and supportive when it is welcome and permitted.

The client stated, "I was so upset about my sister ignoring me when I was talking about being ashamed." Which nontherapeutic communication technique would the nurse be using if the nurse would state, "How are your stress reduction classes going?" A) Changing the subject B) Offering advice C) Challenging D) Disapproving

Ans: A Feedback: The nurse did not respond to the client's statement and instead introduced an unrelated topic. Advising would be telling the client what to do. Challenging would be demanding proof from the client. Disapproving would be denouncing the client's behavior or ideas

Which of the following statements would be an empathetic response in a client interaction? A) You must have been embarrassed when your father yelled at you in the grocery store. B) You really should find your own housing and get out of the situation with your father. C) Well, it sounds like your father has difficulty controlling his temper. D) Why do you think your father chose that time and place to yell at you?

Ans: A Feedback: This statement conveys the nurse's understanding of the client's feelings. Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. The other choices do not convey empathy.

Patient says to the nurse, "I wonder what's playing at the movie tonight." The most therapeutic response would be, A) Are you telling me you would like to go to the movies? B) Why don't you look in the newspaper. C) There's nothing worth watching. D) Do you like to go to the movies?

Ans: A Feedback: Verbalizing the implied/voicing what the client has hinted at or suggested. Putting into words what the client has implied or said indirectly tends to make the discussion less obscure. The nurse should be as direct as possible without being unfeelingly blunt or obtuse. The client may have difficulty communicating directly. 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.

Which of the following statements is true of empathy? Select all that apply. A) It is the ability to place oneself into the experience of another for a moment in time. B) It involves interjecting the nurse's personal experiences and interpretations of the situation. C) It is developed by gathering information from the client. D) It results in negative therapeutic outcomes. E) The client must learn to develop empathy for the nurse.

Ans: A, C Feedback: Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. It does not result in negative therapeutic outcomes. The nurse must develop empathy with the client

The nurse should use clear concrete messages when working with patients displaying which of the following conditions? Select all that apply. A) Anxiety B) Anorexia C) Dementia D) Schizophrenia E) Hypochondriasis

Ans: A, C, D Feedback: Clients who lose cognitive processing, such as those who are anxious, cognitively impaired, or suffering from some mental disorders, often function at a concrete level of comprehension and have difficulty answering abstract questions. The nurse must be sure that statements and questions are clear and concrete.

Which statements are true of concrete and abstract messages? Select all that apply. A) Abstract messages include figures of speech that are difficult to interpret. B) Abstract messages are important for accurate information exchange. C) Concrete messages require the listener to interpret what the speaker says. D) Concrete messages are clear, direct, and easy to understand. E) Abstract messages are best used for persons who are anxious.

Ans: A, D Feedback: Abstract messages include figures of speech that are difficult to interpret. Concrete messages are clear, direct, and easy to understand. Concrete (not abstract) messages are important for accurate information exchange. Abstract (not concrete) messages require the listener to interpret what the speaker says. Concrete (not abstract) messages are best used for persons who are anxious.

The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies, "The doctors are very busy. What can I help you with?" The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic

Ans: B Feedback: Defending attempts to protect someone or something from verbal attack. This implies that the client has no right to express impressions, opinions, or feelings. Belittling is misjudging the degree of the client's discomfort, which implies that the discomfort is temporary, mild, self-limiting, or not very important. Disagreeing is opposing the client's ideas, which may cause the client to feel defensive about his or her point of view or ideas. Introducing an unrelated topic is evidenced when the nurse changes the subject. This takes away the initiative for the client to interact.

Which one of the following goals of therapeutic communication would the nurse strive to attain first? A) Facilitate the client's expression of emotions. B) Establish a therapeutic nurse-client relationship. C) Teach the client and family necessary self-care skills. D) Implement interventions designed to address the client's needs.

Ans: B Feedback: Establishing a therapeutic relationship is one of the most important responsibilities of the nurse when working with clients.

A patient is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the patient to talk? A) If you are sleepy, would you like me to help you back to your room? B) You look like you are deep in thought? C) Is something wrong? D) Why are you sitting with your eyes closed?

Ans: B Feedback: Making observations/verbalizing what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk.

Which of the following statements about verbal and nonverbal communication skills is accurate? A) One third of meaning is transmitted nonverbally and two thirds is communicated verbally. B) Nonverbal communication is as important, if not more than, verbal communication. C) Verbal communication is most important because it is what the patient says. D) Verbal communication involves the unconscious mind.

Ans: B Feedback: Nonverbal communication is as important as, if not more so than, verbal communication. It is estimated that one third of meaning is transmitted by words and two thirds is communicated nonverbally. Verbal communication is often what the patient says but is not the most important. Nonverbal communication involves the unconscious mind acting out emotions related to the verbal content, the situation, the environment, and the relationship between the speaker and the listener.

The nurse is trying to obtain some information about family relationships from the client. Which of the following statements is best? A) Is it upsetting for you to talk about your family? B) Is your family ready for you to come home? C) So, how is your family? D) Tell me your feelings about your family situation.

Ans: D Feedback: This statement asks the client to describe or discuss family; all other statements might get only one-word answers

Which of the following distance zones is acceptable for people who mutually desire personal contact? A) Social B) Intimate C) Personal D) Public

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

The nurse says to the client, "You become very anxious when we start talking about your drinking." Which of the following techniques is the nurse using? A) Confronting behavior B) Making an observation C) Translating into feelings D) Verbalizing the implied

Ans: B Feedback: The nurse is stating what he or she sees; the client can validate it or reject it. The nurse is not confronting the behavior in this situation. The nurse is not translating the message into feelings (seeking to verbalize client's feelings that he or she expresses only indirectly), nor is the nurse verbalizing the implied (voicing what the client has hinted at or suggested).

A nurse has invited a patient to sit down and have a conversation. The patient takes the first seat. The nurse pulls up another chair to sit with the patient. Approximately how far from the patient should the nurse place her chair? A) 1 to 2 feet B) 3 to 4 feet C) 6 to 8 feet D) 8 to 10 feet

Ans: B Feedback: The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings

The nurse uses a variety of therapeutic communication skills when working with patients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication skills? A) Inform the patient of priority problems B) Assess the patient's perception of a problem C) Assist the patient to control emotions D) Provide the patient with a plan of action

Ans: B Feedback: Therapeutic communication can help nurses to accomplish many goals including identifying the most important concern to the client at that moment, assessing the client's perception of the problem, facilitating the client's expression of emotions, and guiding the client toward identifying a plan of action.

The client says to the nurse, "I have special powers because I am the mother of God. I can heal everyone in the hospital." The nurse's best response would be, A) That sounds interesting. What can you do? B) It would be unusual for anyone to have that kind of power. C) You could not heal everyone. No one has that much power. D) Well, you can certainly try.

Ans: B Feedback: When the nurse states, "It would be unusual for anyone to have that kind of power," the nurse is voicing doubt or expressing uncertainty about the reality of the client's perceptions. The other choices have demeaning connotations toward the client and should not be used

During the admission interview, the nurse asks the client what led to his hospitalization. The client responds, "They lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born." The best initial response by the nurse would be, A) I just saw your mother. She's fine. B) You're having very frightening thoughts. C) We'll put you in a private room until you're in better control. D) If your mother died before you were born, you wouldn't be here.

Ans: B Feedback: When the nurse states, "You're having very frightening thoughts," the nurse is verbalizing the implied or voicing what the client has hinted or suggested. The other responses would not be the best initial response in this situation.

A patient remarks, "You know, it's the same thing every time." The nurse should respond by stating, A) I understand. B) I'm sure everyone is doing their best. C) I'm not sure what you mean. Please explain. D) It's the same thing every time?

Ans: C Feedback: Consensual validation-searching for mutual understanding, for accord in the meaning of the words. For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. Sometimes, words, phrases, or slang terms have different meanings and can be easily misunderstood.

A patient asks the nurse what she should do about her "cheating" husband. The nurse replies, "You should divorce him. You deserve better than that." The nurse used which communication technique? A) Giving information B) Verbalizing the implied C) Giving advice D) Agreeing

Ans: C Feedback: The nurse should not give advice, or tell the patient what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the patient needs facts. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the patient has suggested. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the patient is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

The nurse is sitting with a patient who is crying. After a few minutes the nurse places one hand on the patient's shoulder. Which of the following best describes the purpose of the nurse's touch with this patient? A) To express sympathy to the patient B) To assess the patient's skin temperature and circulation status C) To offer comfort and support for the patient D) To extend an offer of friendship to the patient

Ans: C Feedback: Touching a client can be comforting and supportive when it is welcome and permitted. The nurse should not express sympathy to patients, nor should attempt to be "friends" with patients. Physical assessment is not indicated at this time.

During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. The best response by the nurse would be, A) That makes no sense at all. B) You can tell me about that after I finish asking these questions. C) What kinds of things have been happening? D) Why would the CIA be interested in you?

Ans: C Feedback: When the nurse responds, "What kinds of things have been happening?" the nurse is seeking information. "That makes no sense at all," is inappropriate because it may make perfect sense to the client. "You can tell me about that after I finish asking these questions," shows that the nurse is not interested in what the client has to say. "Why would the CIA be interested in you," feeds into the notion that the CIA is stalking the client.

Which of the following are nontherapeutic techniques? Select all that apply. A) Silence B) Voicing doubt C) Agreeing D) Challenging E) Giving approval F) Accepting

Ans: C, D, E Feedback: Silence is a therapeutic technique that involves the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Voicing doubt is a therapeutic technique that involves expressing uncertainty about the reality of the client's perceptions. Agreeing is a nontherapeutic technique that involves indicating accord with the client. Agreeing indicates the client is "right" rather than "wrong", and there is no opportunity for the client to change his or her mind without being "wrong." Challenging is a nonverbal communication technique that involves demanding proof from the client, and this may cause the client to defend delusions or misperceptions more strongly than before. Giving approval is a nontherapeutic communication technique that involves sanctioning the client's behavior or ideas. Accepting is a therapeutic technique that involves indicating reception.

A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the patient while respecting the patient's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client? A) In the patient's room when the patient's roommate is present and 3 feet away B) At the nurse's station when other clients and visitors are less than 4 feet away C) In an interview room in a remote section of the unit with the nurse 1 foot away from the patient D) In a quiet corner of the dayroom at least 4 feet away from others

Ans: D Feedback: A quiet corner of the dayroom at least 4 feet away from others would allow the patient privacy while being to deter any inappropriate activity would be the most appropriate setting. Being in the patient's room when the patient's roommate is present and 3 feet away or at the nurse's station when other patients and visitors are less than 4 feet away would not allow for the patient's privacy. An interview room in a remote section of the unit would not be a good choice as the area is too isolated. Additionally, the nurse should maintain a distance of more than 1.5 feet away from the patient as closer distances are within the intimate zone

The nurse is sitting down with a patient to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the patient? A) Leaning forward with arms on the table sitting directly across for the patient B) Turned slightly to the side of the patients with arms folded across the chest C) Leaning back in the chair next to the patient with legs crossed at the knees D) Sitting upright facing the patient with both feet on the floor

Ans: D Feedback: Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.

A patient states, "Right before I got here I was doing alright. My job was going well, my wife and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your wife were happy. Tell me more about that." This is an example of which therapeutic technique? A) Encouraging comparison B) General lead C) Restating D) Exploring

Ans: D Feedback: Exploring-delving further into a subject or an 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.

The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to A) increase the client's awareness of nonverbal behavior. B) investigate the source of nonverbal behavior. C) validate the client's feelings. D) validate the meaning of the nonverbal behavior.

Ans: D Feedback: It is essential to validate the meaning of nonverbal behavior (rather than assuming what it means) before proceeding with anything else. This item is about the nurse's understanding of nonverbal behavior, not the client's. Before the nurse can investigate the source of nonverbal behavior or validate the client's feelings the nurse must be clear about the meaning of the nonverbal behavior.

A patient yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be, A) "I cannot allow you to yell like that." B) "We care about you." C) "Oh, really?" D) "You seem very irritated."

Ans: D Feedback: Reflecting/directing client actions, thoughts, and feelings back to client. Reflection encourages the client to recognize and accept his or her own feelings. The nurse indicates that the client's point of view has value and that the client has the right to have opinions, make decisions, and think independently.

The nurse asks the patient, "What was it like for you when you first knew you had no place to go?" The patient looks down and pauses for quite some time. Which action by the nurse is most therapeutic? A) Change the subject to something the patient will discuss B) Encourage the patient to express any unpleasant feelings C) Apologize for asking such a personal question D) Sit quietly until the patient responds

Ans: D Feedback: Silence or long pauses in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client is thoughtfully considering the question before responding. At times, the client may seem to be "lost in his or her own thoughts" and not paying attention to the nurse. It is important to allow the client sufficient time to respond, even if it seems like a long time.

A patient states, "I feel fine. It's a good day." The nurse notes the patient looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse? A) I'm glad you are feeling good today. B) I'm not sure I believe you. C) Tell me what is good about today. D) You say you feel fine, but you don't really sound fine.

Ans: D Feedback: This client's verbal and nonverbal communication seems incongruent. To ensure the accuracy of the patient's messages, the nurse identifies the nonverbal communication and checks its congruency with the content. An example is "Mr. Jones, you said everything is fine today, yet you frowned as you spoke. I sense that everything is not really fine" (verbalizing the implied). "I'm glad you are feeling good today," is agreeing or indicating accord with the client. Agreeing leaves no opportunity for the client to change his or her mind without being "wrong." "I'm not sure I believe you" could be interpreted as challenging or demanding proof from the client. Challenging causes the client to defend the misperceptions more strongly than before. "Tell me what is good about today," seems to be asking the client to defend his or her statement.