Chapter 6

During the mental status assessment, the client expresses the belief that the CIA is stalking him and plans to kidnap him. Which would be the best response by the nurse?

"What kinds of things have been happening?"

The nurse watches the expressions the client is making as group therapy is conducted. Which of the following statements about verbal and nonverbal communication skills is accurate?

Nonverbal communication is as important, if not more than, verbal 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?

broad opening

The nurse using therapeutic communication asks the client what he would like to talk about. This is an example of which of the following?

broad opening

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?"

changing the subject

While the nurse and client are in a therapy session, 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?

making an observation

The nurse asks the client, "What was it like for you when you first knew you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic?

sit quietly until the patient responds

The nurse is sitting down with a client to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the client?

sitting upright facing the client with both feet on the floor

The client says to the nurse, "I wonder what's playing at the movies tonight." The most therapeutic response would be what?

"Are you telling me you would like to go to the movies?"

A nurse is working with a client whose background is very different from hers. A good question to ask herself to assure she can be effective working with this client would be

"What experiences do I have with people with different backgrounds?"

A client remarks, "You know, it's the same thing every time." The nurse should respond by stating,

"I'm not sure what you mean. Please explain."

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

"It would be unusual for anyone to have that kind of power."

The nurse is trying to obtain some information about family relationships from the client. Which of the following statements is best?

"Tell me your feelings about your family situation."

A nurse has been waiting for over an hour for the ancillary department of laboratory to draw blood on a non-critical client with bipolar disorder in the ED. Which response is an example of assertive communication from the nurse to the laboratory personnel?

"When you are late to draw blood the family gets upset, and I don't like having to repeat that you are on your way."

A client is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement is most likely to encourage the client to talk?

"You look like you are deep in thought."

Which of the following statements would be an empathetic response in a client interaction?

"You must have been embarrassed when your father yelled at you in the grocery store."

A client states, "I feel fine. It's a good day." The nurse notes the client looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse?

"You say you feel fine, but you don't really sound fine."

A client says, "Its' been so long since I've been with my family." Which statement by the nurse is an example of restating?

"You say you haven't seen your family in a while."

A client yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be what?

"You seem very irritated."

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." What would be the best initial response by the nurse?

"You're having very frightening thoughts."

A nurse has invited a client to sit down and have a conversation. The client takes the first seat. The nurse pulls up another chair to sit with the client. Approximately how far from the client should the nurse place her chair?

3 to 6 feet

The client frequently attempts to touch the nurse and the nurse has explained the prohibition against this. Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff?

Because some clients with mental illness have difficulty knowing when touch is or is not appropriate

How can a nurse avoid the possibility of finding the client's behavior unacceptable or distasteful?

By being aware of the client's behavior and background before beginning the relationship, and exploring with a colleague the possibility of a conflict.

The nurse and the client are using therapeutic communication skills. Which statements are true of concrete and abstract messages? Select all that apply.

abstract messages include figures of speech that are difficult to interpret concrete message are clear, direct, and easy to understand

The nurse should avoid nontherapeutic techniques. Which of the following are nontherapeutic techniques? Select all that apply.

agreeing, challenging, giving approval

The nurse should use clear, concrete messages when working with clients displaying which of the following conditions? Select all that apply.

anxiety dementia schizophrenia

The nurse uses a variety of therapeutic communication skills when working with clients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication skills?

assess the client's perception of a problem

When preparing for the first clinical experience with clients on a forensic unit at a psychiatric hospital, the nursing instructor discusses students' beliefs and fears surrounding forensic clients. The primary reason for discussing personal beliefs is to...

become aware of possible barriers to developing therapeutic relationships

The client expresses frustration that the doctor does not spend enough time with her 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?

defending

The nurse asks the client to describe the quality of an experience. Which communication skill is the nurse using?

encouraging expression

A nurse is developing a therapeutic relationship with the client. To do this, the nurse must respect the client's religious and spiritual beliefs. Which of the following will occur if the nurse does not show this respect?

eroding trust

Which one of the following goals of therapeutic communication would the nurse strive to attain first?

establish a therapeutic nurse-client relationship

A client states, "Right before I got here I was doing all right. 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?

exploring

During a session with a client, the client 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 nontherapeutic communication technique?

giving advice

The nurse fails to assess personal values surrounding homosexuality before caring for a client who is openly gay. The nurse is most at risk for which of the following when working with this client?

holding a prejudice toward this client

A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the client while respecting the client's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client?

in a quiet corner of the dayroom at least 4 feet away from others

Nurses develop empathy with their clients while gathering information about the client. Which of the following hinders the development of empathy?

interjecting personal experiences

The mother of a small client holds her child close during the initial assessment. Which of the following distance zones is acceptable for people who mutually desire personal contact?

intimate

A student nurse is helping with discussion with a client. Which of these is an explanation why a student nurse does not use active listening?

the student nurse is thinking ahead for answers

The nurse is sitting with a client who is crying. After a few minutes the nurse places one hand on the client's shoulder. Which of the following best describes the purpose of the nurse's touch with this client?

to offer comfort and support for the client

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

validate the meaning of the nonverbal behavior

A nurse has interactions with several clients throughout the day. When would a formal setting for discussion be indicated?

when a client has difficulty maintaining boundaries