ch6: therapeutic communication

A client has repeatedly been physically abused by the spouse. The client asks the nurse whether to leave the spouse like the mother has demanded. The nurse responds most therapeutically when answering: "What do you think your spouse would do if you leave?" "How would leaving your spouse make you feel?" "Your mother may be right; I'd consider what she is saying." "Your mother doesn't have the right to demand that; it's your decision."

"How would leaving your spouse make you feel?" Exploring the client's thoughts about leaving the situation is the priority for the therapeutic communication to be effective in this case. With this response, the interaction remains client centered and goal directed. Giving advice may facilitate dependency, thus it is important to elicit the client's thoughts on the matter; encouraging problem solving and decision making by the client is more constructive than giving advice.

The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond? "I'm concerned that you are not exicited about your mother's visit, We can talk if you want." "Why are you sad about your mother's visit?" "I need to know why you are sad." "Is your mother giving you trouble for being here?"

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

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

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

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic? "No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." "Why do you think you should be allowed to go for a break?" "Joe, let's review your care plan and discuss whether or not it needs to be revised." "Well, I know you were tired from last night. You can go at 2 p.m."

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security. The nurse describes the client's unacceptable behavior, communicates expected behavior, and offers acceptable alternatives, such as walking with the nurse, talking about feelings and thoughts, or participating in recreational therapy.

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. A fearful tone of voice A sad facial expression A sarcastic tone of voice An erect, confident posture A cheerful expression

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

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

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

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

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

A client expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of? Broad openings Consensual validation Encouraging comparison Accepting

Consensual validation The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.

Which includes the circumstances or parts that clarify the meaning of the content of the message? Proxemics Context Congruence Process

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

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? Expressions Body language Emotion underlying the words Gestures

Emotion underlying the words Verbal communication, which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said. Nonverbal communication includes gestures, expressions, and body language.

A nurse is engaged in a therapeutic relationship with a client. What should the nurse do in order to ensure therapeutic communication takes place? Select all that apply. Ensure the client's confidentiality Employ theoretically based interventions Give the client advice about what to do Focus on the client during the interaction Use self-disclosure frequently for empathy

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

A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? Message reception Formulation of an idea Message encoding Message transmission

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

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse? French Italian Australian Korean

Korean The nurse must understand the differences in how various cultures communicate. It helps to see how a person from another culture acts toward and speaks with others. Australia and many European cultures are individualistic; they value self-reliance and independence and focus on individual goals and achievements and so would be less likely to include others in the discussion. Other cultures, such as Chinese and Korean, are collectivistic, valuing the group and observing obligations that enhance the security of the group.

During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which nontherapeutic communication technique? Probing Reflecting Confrontation Clarification

Probing An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.

Which type of touch, according to Knapp, is used in greeting, such as a handshake? Friendship-warmth Love-intimacy Social-polite Functional-professional

Social-polite Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.

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

The client is the primary focus of the interaction. A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action? The client can communicate freely. The client may be physically expressive. The client may have difficulty maintaining spacial boundaries. The client can open up easily.

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

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue? The client may need a break to reduce stress. The client may want to sleep. The client may be extremely fatigued. The client may have suicidal ideations.

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

The nurse is speaking with a client. The nurse sits with legs crossed and arms folded across the chest while listening to the client. How might the client interpret this posture of the nurse? Choose the best answer. The nurse may be paying close attention to the client. The nurse may be giving utmost importance to the client's concerns. The nurse may be unable to understand what the client is saying. The nurse may be showing nonacceptance toward the client.

The nurse may be showing nonacceptance toward the client. The nurse is exhibiting closed posture. A closed posture indicates indifference and a lack of attentiveness to the client. A closed posture does not indicate that the nurse is unable to understand the client but that the nurse disagrees with what the client is saying. A closed posture indicates complete disregard of the client's concerns, not that the nurse finds them important.

During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way? The nurse may lack confidence in therapeutic communication. The nurse has difficulty with conducting an assessment. The nurse is accurately observing the client's nonverbal communication. The nurse can gain information about the client without wasting time.

The nurse may lack confidence in therapeutic communication. Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. This reflects the nurse's limited confidence in the ability to utilize therapeutic communication skills. The nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen actively and attentively.

Which is an inaccurate depiction of concrete messages? There is no need for interpretation. They require rephrasing of unclear statements. They elicit more accurate responses. They are easy to understand.

They require rephrasing of unclear statements. Concrete messages do not require rephrasing of unclear word patterns. Therefore, this is the inaccurate statement that the question asks for. Concrete messages are easy to understand, there is no need for interpretation, and concrete messages elicit more accurate responses than do abstract messages.

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

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

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

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

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

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

After discussing feeling guilty about having trouble looking after her children, the client states, "They would be better off if I wasn't around." The client's statement is an example of a(n): covert cue. concrete message. overt cue. abstract message.

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

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? Reflecting Presenting reality Making observations Seeking information

Presenting reality All four choices are means of therapeutic communication. In presenting reality, the nurse offers a nonargumentative description of reality for consideration by the client. This can be helpful for the client experiencing hallucinations. Reflecting encourages the client to recognize and accept the client's own actions, thoughts, and feelings; the nurse establishes that the client's point of view has value and the client has a right to think independently. In making observations, the nurse verbalizes what the nurse perceives; this is generally done when the client is unable to verbalize thoughts. The nurse seeks information to gain clarification and help the client articulate thoughts, feelings, and ideas.

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse? Intimate Personal Social Public

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

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

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

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

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

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

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

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to come check on me after dinner yesterday but never came." What is the nurse's most therapeutic response? "I don't know why the doctor didn't check on you yesterday, but I think it's unlikely that the doctor hates you." "Since the doctor didn't come yesterday, would you like me to page her to see you right now?" "I'm sure that the doctor will come and see you as soon as she can." "Unfortunately, the doctor has an extremely busy schedule, and she doesn't always keep promises."

"I don't know why the doctor didn't check on you yesterday, but I think it's unlikely that the doctor hates you." One therapeutic communication technique is to express doubt. This is appropriate when the client expresses a thought that stretches credibility. The nurse does not agree or disagree but does express skepticism, which encourages the client to reconsider. It would be inappropriate for the nurse to characterize the health care provider to the client as someone who "doesn't keep promises." The nurse cannot justifiably reassure the client that the health care provider will come as soon as she is able; the nurse cannot make commitments for the provider. Similarly, it would likely be inappropriate for the nurse to page the health care provider solely in response to the client's statement.

A nurse is assessing an elderly client with a cardiac disorder. Which statement given by the client conveys an abstract message? Choose the best answer. "The chest pain is severe enough to disable me from doing my work." "I don't really know how it all started. It just happened." "I suddenly had dull pain around the jaw and neck region." "The sudden onset of my chest pain got my spouse extremely stressed out."

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

A nurse is engaging in an interpersonal interaction with a young adult client who is admitted to the hospital with suicidal ideation. The client states, "I am really not good at anything." How should the nurse respond to the client's statement? "You just need to keep a positive attitude." "Did you go to relaxation group today?" "I have a really difficult time believing that." "Everyone is good at something."

"I have a really difficult time believing that." Voicing doubt is a therapeutic communication technique the nurse can use to express uncertainty about the reality of the client's perceptions. By saying, "I have a really difficult time believing that..." the nurse can encourage the client to reconsider or reevaluate their point of view. By stating, "Everyone is good at something," the nurse belittles the feelings expressed by the client and misjudges the client's degree of discomfort. By stating, "You just need to keep a positive attitude," the nurse states a meaningless cliche'.

A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response? "Don't worry, take as long as you need before you get going." "I think you need to take a shower." "Why haven't you taken a shower yet?" "I notice it has been a while since you have had a shower."

"I notice it has been a while since you have had a shower." Stating, "I notice it has been a while since you have had a shower," is the correct option. Making an observation helps the nurse verbalize what is perceived. This is therapeutic because sometimes a client may not be able to verbalize or make themselves understood. Stating, "I think you need to take a shower," would be a nontherapeutic statement. This is called advising and entails telling the client what to do, communicating the the nurse knows what is best for the client. Stating, "Don't worry, take as long as you need before you get going," denotes reassuring by the nurse. By saying this, the nurse is communicating that this is not a problem despite the fact that the client is approaching the nurse for support in problem solving. By asking, "Why haven't you taken a shower?" the nurse is requesting an explanation. This is intimidating and the client is likely to become defensive or feel judged and vulnerable.

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

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

A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response? "How do you like to spend your time when you're able to do whatever you like?" "I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" "If you had to guess, what do you think I might have done on my days off?" "I've been off for the past four days. What have you done since I last saw you?"

"I've been off for the past four days. What have you done since I last saw you?" The nurse should avoid self-disclosure. Whenever possible, it is more therapeutic to redirect the conversation rather than setting an explicit boundary. Saying, "How do you like to spend your time when you're able to do whatever you like?" redirects the conversation but is less therapeutic because the nurse has ignored the client's question. Asking the client to speculate serves no therapeutic purpose.

The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior? "It looks like you're searching for something. Is that right?" "What are you looking for in the bed? There's nothing hidden there." "Are you having any delusions or hallucinations right now?" "What's wrong with your bed?"

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

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

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

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

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

A client is crying and shaking when talking about a recent argument they had with a family member. Which response made by the nurse would demonstrate the effective use of validation? "I would like to hear about the situation; it's okay to discuss it with me." "Let me see if I understand." "You should probably tell the family member how you feel." "What does the argument mean to you?"

"Let me see if I understand." The therapeutic communication technique of validation is used to clarify the nurse's understanding of the situation. The response by the nurse, "Let me see if I understand" is using the validation technique. The nurse's response, "I would like to hear about the situation; it's okay to discuss it with me" is utilizing the acceptance technique, not validation. The nurse's response, "What does the argument mean to you?" is demonstrating the technique of open-ended statements, not validation. The nurse's response, "You should probably tell the family member how you feel" is giving advice, which is not therapeutic for the client.

A client is being counseled by the nurse about family conflict. The client asks the nurse, "Should I go home for the weekend?" Which response by the nurse would demonstrate using the reflection communication technique? "Let me see if I understand." "Yes, so that you can talk to your family." "Should you go home for the weekend?" "I don't think you should, you might not be ready."

"Should you go home for the weekend?" Reflection is a therapeutic communication technique used to redirect the idea back to the client for classification of emotional overtones, feelings, and experiences. The nurse's response, "Should you go home for the weekend?" is utilizing the reflection technique. The nurse's statement, "Let me see if I understand" is utilizing the validation technique. The nurse's statements, "Yes, so that you can talk to your family" and "I don't think you should, you might not be ready" is giving advice, which is a block in communication.

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

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

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

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

A client is speaking with the nurse about the client's difficult relationship with the client's father. The client states, "He never showed me love or approval unless I was perfect." Which response is most likely to encourage the client to continue elaborating? "You must feel rejected." "Really?" "I'm sure he loved you, though it sounds like he had trouble expressing it." "Tell me more about that."

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

The nurse educator is teaching the class about communication. Which statement by the student nurse best describes the basic elements of communication? "The basic elements of communication include feedback, sender, receiver, and messages." "The basic elements of communication include message, sender, feedback, and gesture." "The basic elements of communication include sender, receiver, flow and message." "The basic elements of communication include receiver, feedback, flow, and expression."

"The basic elements of communication include feedback, sender, receiver, and messages." Communication includes the elements of sender delivers the message, messages are the content of the communication, receiver receives and decodes the message, and feedback is the message returned by the receiver and indicates whether the sender's message was understood. Flow, expression, and gesture are not included in the basic elements of communication.

When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager? "I can take that client off of your assignment this shift." "It would be great if you could attend an in-service on therapeutic communication." "What specifically makes you uncomfortable?" "Have you ever been sexually abused?"

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

A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? "I don't think you are telling me the truth." "A good relationship is a sign of recovery." "What you are saying and how you say it does not seem to match." "I am glad to hear that."

"What you are saying and how you say it does not seem to match." A congruent message is conveyed when content and process agree. In this case, what the client is saying verbally does not agree with the nonverbal communication. The nurse uses an objective statement of their observation as the first step in the therapeutic interaction. The nurse is effectively engaging in active observation. The nurse's statement, "I am glad glad to hear that" or "A good relationship is a sign of recovery" indicates the nurse has not engaged in active observation of the client's nonverbal communication. Although the nurse's statement, "I don't think you are telling me the truth" addresses the nurse's active observation of the client's nonverbal communication and incongruence of the message, it is not presented in a therapeutic way.

Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." "I wish you could try to be more positive." "You look like you are very angry this morning." "Who has made you so upset?" "Please calm down; everything is going to be better."

"You look like you are very angry this morning." Replying that the client looks very angry this morning provides reflection of the client's affect (angry) and is making an observation. Telling the client to calm down is a platitude, telling the client that there is nothing to be upset about denies the client's feelings, and urging the client to be positive is stated in terms of the nurse's needs and ignores the feelings of the client. Reflection of the client's feelings, mood, and affect is therapeutic in assisting the client to understand himself or herself.

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

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

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication? 15 to 18 feet 3 to 6 feet 15 to 18 inches 10 to 12 inches

3 to 6 feet A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between the client who is Hispanic and the nurse. People from some cultures, including Hispanics, are more comfortable with less than 4 to 12 feet of space between them when talking. A distance of 10 to 12 inches or 15 to 18 inches is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.

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

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

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

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

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

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

Which type of cue is being used when the client states, "Nothing can help me"? Intentional Covert Overt Clear

Covert Cues are considered to be either covert or overt. Covert cues are vague or hidden messages that need interpretation and exploration. Overt cues are clear statements of intent, such as "I want to die."

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

Cues A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? Tone Pitch Emphasis Intensity

Emphasis Emphasis refers to accents on words or phrases that highlight the subject or give insight on the topic. Tone can indicate whether someone is relaxed, agitated, or bored. Pitch carries from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words.

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique? Accepting Exploring Focusing Formulating a plan of action

Exploring Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.

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

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

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

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

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

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

The nursing instructor is teaching about the importance of communication in nursing and relates it to the family. Which statement by a student nurse would indicate that the teaching has not been effective? Nonverbal communication is not meaningful. All communication consists of two levels. Communication theory concerns the sending and receiving of verbal and nonverbal messages. Verbal communication is important.

Nonverbal communication is not meaningful. Communication theory concerns the sending and receiving of both verbal and nonverbal messages. All nonverbal communication is meaningful, and it is just as important as verbal communication. All communication consists of two levels: content (what is said) and relationship (of those interacting).

Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason? Psychiatric disorders are more likely to affect thoughts than physical behaviors Clients are guarded with both verbal and nonverbal communication Psychiatric disorders generally affect a client's ability to communicate verbally Nonverbal communication provides additional client information that is acted out unconsiously

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

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

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

When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what? Giving the client ample opportunity to ask questions Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Presenting the information using language and terms the client will understand

Presenting the information using language and terms the client will understand Being careful not to use technical terms and language that will confuse or intimidate the client will assist the client in grasping and applying the information. While interacting in a nonthreatening, respectful manner is considered expected, it is focused toward establishing a therapeutic relationship and not toward maximizing client learning. Being careful to not overload the client with information is important, but presenting the information in language the client can understand is most important. Giving the client ample opportunity to ask questions is important, too, although the nurse needs to realize that even if given time to ask a question the client may not choose to do so.

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

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

A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness? Public Personal Intimate Social

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

A client with a history of depression has told the nurse that the client is feeling especially "low" this morning. The nurse has responded by stating, "Try thinking about some of the blessings you have in your life." How should the nurse's statement be best interpreted? The nurse made an inappropriate suggestion because it was not preceded by assessment The nurse has inhibited the nurse-client relationship by challenging the client The nurse has inhibited therapeutic communication by giving advice The nurse has violated the ethical principles of beneficence and nonmaleficence

The nurse has inhibited therapeutic communication by giving advice The nurse has blocked communication by giving advice. This action generally inhibits communication, whether or not it is preceded by assessment. This is not an example of challenging. The statement is inappropriate and simplistic but not necessarily a violation of beneficence and nonmaleficence.

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

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

The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse? empathetic linkages self awareness active listening self disclosure

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

The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse? self awareness self disclosure empathetic linkages active listening

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

A nurse is caring for a client who is crying and describes an argument that they had with their spouse. The client expressed that after the argument with the partner, the client turned to their friend for emotional support. Which defense mechanism will the nurse document that the client is using? affiliation anticipation acting out dissociation

affiliation The defense mechanism, affiliation, is turning to others for help or support (sharing problems with others without implying that someone else is responsible for them). The client turning to their friend for emotional support after the argument is demonstrating affiliation. Anticipation is experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic, alternative responses or solutions. Acting out is using actions rather than reflections or feelings during periods of emotional conflict. Dissociation is experiencing a breakdown in the usually integrated functions of self or the environment, or sensory and motor behavior.

A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of: lack of awareness. gathering assessment data. excessive probing. genuineness and caring.

excessive probing. Excessive probing is usually nontherapeutic, except in the process of collecting a history. The here and- now is what the client is experiencing and what the nurse can assist the client in changing.

The nurse is assessing a client who is hospitalized for an episode of mania. When the nurse sits down across from the client to begin the interview, the client moves to sit right less than a foot away from the nurse. The client is positioned in which body space zone of the nurse? personal social public intimate

intimate If the client is sitting next to the nurse, there are only a few inches of space between them. This is the intimate zone and is appropriate for parents with young children, people who mutually desire personal contact, or people whispering. Invasion of this intimate zone by anyone else is threatening and produces anxiety.

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

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

A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs? to discuss it at another time to avoid the topic more time to think to disengage from the interaction

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

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: permit clients to gather their thoughts. demonstrate passive listening. allow the nurse to determine an appropriate response. encourage self-reflection by the nurse.

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

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

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

A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should: seek out a mentor who has extensive experience in the psychiatric-mental health area. decide what aspects of the student's life and experience the student is willing to disclose to clients. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. reflect critically on the student's own life experiences, perspectives, and characteristics.

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

The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what? self- disclosure empathetic linkages self-awareness rapport

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

The nurse wears a cross and has a Facebook page displaying pictures of the family, home and updates on what the nurse is currently doing. These actions are examples of what? social zone self-disclosure exploitation self-awareness

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

The nurse is meeting a client for the first time. Which action should the nurse take to establish a rapport with this client? Select all that apply. shaking the client's hand when greeting defending the healthcare provider's choice of treatment asking the client to further explain a recurring symptom remaining neutral when the client states a lack of faith in medical care suggesting the client obtain a second opinion if care is not satisfactory

shaking the client's hand when greeting asking the client to further explain a recurring symptom remaining neutral when the client states a lack of faith in medical care Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. Shaking the client's hand demonstrates interpersonal warmth. Understanding is demonstrated by asking the client to further explain a recurring symptom. Remaining neutral when the client states a lack of faith in medical care demonstrates a nonjudgmental attitude. Defending the healthcare provider's choice of treatment and suggesting the client obtain a second opinion if care is not satisfactory are behaviors that do not support the establishment of rapport.

Which nursing actions, if shared with clients, suggest self-disclosure? Select all that apply. showing family photos taking the elevator telling the client the nurse attended a weight loss meeting directing the client to the nurse's Facebook page wearing the color blue

showing family photos telling the client the nurse attended a weight loss meeting directing the client to the nurse's Facebook page Self-disclosure is revealing personal information, personal ideas, thoughts and feelings about oneself to clients. Self-disclosure may help the client feel more comfortable and more willing to share thoughts and feelings, or help the client gain insight into his or her situation. Wearing the color blue or taking the elevator are not considered self-disclosure.

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

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

A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment? social personal intimate public

social The client has a known history of sexual abuse. Clients with a history of abuse have had others touch them in harmful, hurtful ways, usually without their consent. This client may be hesitant or even unable to tell the nurse when closeness or touch are uncomfortable. The most appropriate position for the nurse would be to sit in the social zone while conducting the assessment. The nurse would be sitting 4-12 feet away from the client. The intimate zone would only leave 0-18 inches between the client and the nurse. This would not be appropriate, particularly given the client's history of sexual abuse. The personal zone leaves only 18-36 inches between the nurse and client. It would be more appropriately used between two people who know each other well. The public zone leaves 12-25 feet between the nurse and client. This distance is too far to carry out an assessment and may, in fact, compromise confidentiality.

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

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

The nurse is offering an demonstration session on what is done in group. Which client(s) would the nurse determine as conveying a message? Select all that apply. the mother checking her makeup in a mirror a boy displaying a rainbow tattoo on his arm the father slapping his son for picking a wallet from a pocket a girl with headphones playing loud music away from everyone else the teenager who writes "No one loves me" in a journal

the father slapping his son for picking a wallet from a pocket a girl with headphones playing loud music away from everyone else the teenager who writes "No one loves me" in a journal a boy displaying a rainbow tattoo on his arm Non-verbal communication can include gestures, facial expressions, body language, writing, displaying tattoos and slapping another; these are all ways of communicating with others. Checking make-up in a mirror is not a non-verbal communication.

The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use? speaking louder so the client can hear displaying a flat affect so the client will not misinterpret the nurse providing instructions to the client for feeding oneself using gentle touch during activities of daily living

using gentle touch during activities of daily living The nurse should supplement verbal communication with therapeutic nonverbal communication, including gentle touch, to reinforce caring feelings for the confused client. Providing instructions for feeding oneself and speaking louder are aspects of verbal communication and, in addition, would not be helpful. Displaying a flat affect is not an aspect of therapeutic nonverbal communication.

A nurse is caring for a client in a severe anxiety state. What is an important nursing consideration while communicating with the client experiencing anxiety? increasing environmental stimulation for distraction teaching the client coping skills increasing concentration on the task using short and simple statements or questions

using short and simple statements or questions While communicating with clients, it is important for the nurse to consider an individual's mental health challenges when selecting specific communication strategies. For example, clients with increased levels of anxiety may have poor concentration, requiring the nurse to use shorter and simpler statements or questions. Therefore, an important nursing consideration while communicating with the client experiencing anxiety includes using short and simple statements or questions. Teaching the client coping skills is important, but after the client's anxiety level is lower. Increasing concentration on the task would not be appropriate because the client has poor concentration while feeling anxious. Increasing environmental stimulation for distraction would not be appropriate because it would increase the client's anxiety.