Chapter 6: Therapeutic Communication

Which zone is an acceptable distance between a speaker and an audience? Public Personal Social Intimate

Public

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? "How can you make your anxiety better?" "If you just learn how to breathe, you can manage better." "When did you last take drugs?" "At what time did you take the last dose of the antianxiety drugs?"

"At what time did you take the last dose of the antianxiety drugs?"

The client tells the nurse, "I'm frightened about my surgery tomorrow." What response by the nurse is best? "Hundreds of people have this surgery daily." "Can you tell me what frightens you?" "Didn't the surgeon answer all your questions?" "What's to be frightened about, the OR crew will take care of you."

"Can you tell me what frightens you?"

A client who is hospitalized with depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate? "Another client took that medication, and he really felt better." "I agree with you. I wouldn't want to take this medication either." "Have you ever thought about hurting yourself?" "It's important that you take this medication."

"Have you ever thought about hurting yourself?

A client who is hospitalized with depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate? "It's important that you take this medication." "Have you ever thought about hurting yourself?" "I agree with you. I wouldn't want to take this medication either." "Another client took that medication, and he really felt better."

"Have you ever thought about hurting yourself?"

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." "What you are saying and how you say it does not seem to match." "I am glad to hear that." "A good relationship is a sign of recovery."

"What you are saying and how you say it does not seem to match."

A nurse is speaking to a client with a smiling expression. Which statement by the nurse would promote the most congruent communication? "I know you are in pain. You need to wait until the medication begins to work." "You hard work and determination has really helped you succeed." "Please listen to the instructions carefully before starting the exercises." "Please don't disturb the other clients in the ward."

"You hard work and determination has really helped you succeed."

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

"You look like you are very angry this morning."

A client who has tried several different antidepressant medications tells the nurse that uncomfortable side effects make the client want to stop taking medication altogether. What is the nurse's best response? "If you think that is best for you, I agree." "Antidepressants rarely have side effects." 'Tell me what is it about the medication that is troubling you the most." "All of our clients have some side effects and they manage okay."

'Tell me what is it about the medication that is troubling you the most."

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

3 to 6 feet

Which term is used to refer to signals that encourage effective communication? Metaphor Concrete messages Cue Abstract messages

Cue

A client is speaking to the nurse and expressing dissatisfaction about the care that was provided to the client during a hospital stay. The nurse tells the client, "This is the best hospital in the state. You could not expect better care anywhere else." Which type of communication does this indicate? Agreeing Belittling Defending Challenging

Defending

After spending 15 minutes talking with a client, the client leaves the interaction feeling defensive. This is evidence that the communication can be described as what? In an improper environment Blocked by external noise Therapeutic Nontherapeutic

Nontherapeutic

A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply. Using open-ended statements Changing the subject to gather more information Allowing the client to talk as the client wishes Concentrating fully on what the client says Responding indirectly to statements

Responding indirectly to statements Using open-ended statements Concentrating fully on what the client says

A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship? Communication skills Desire to form friendships Self-awareness Previous social skills

Self-awareness

The nurse is assessing an adolescent with conduct disorder. During the assessment, the nurse notices the client is not making eye contact and is yawning. What may the nurse interpret from this behavior? The adolescent may be sleepy. The adolescent may be listening attentively to the nurse. The adolescent may be trying hard to concentrate. The adolescent may be disinterested in the conversation.

The adolescent may be disinterested in the conversation.

Which behavior of the nurse indicates that the nurse has a therapeutic relationship with the client? The nurse expresses empathy to a client who has recently lost the client's son in an accident. The nurse gives the nurse's phone number and asks the client to give a call whenever needed. The nurse asks the client if the client prefers to have the nurse as a nurse over other staff. The nurse speaks with the client on topics such as fashion and sports.

The nurse expresses empathy to a client who has recently lost the client's son in an accident.

The nurse is speaking with a client. While listening, the nurse faces the client and leans slightly toward the client. How does the client interpret this gesture? The nurse is threatening the client to speak properly. The nurse is keenly interested in the client's concerns. The nurse is unable to hear the client. The nurse is unable to understand what the client is saying.

The nurse is keenly interested in the client's concerns.

Which is inconsistent with principles of therapeutic communication? The nurse must maintain client confidentiality. A professional attitude sets the tone of the therapeutic relationship. The nurse is the primary focus of the relationship. Interventions are implemented from a theoretical base.

The nurse is the primary focus of the relationship.

When speaking with a client who has a diagnosis of major depression, the nurse has placed a hand lightly on the client's shoulder when responding to one of the client's statements of hopelessness. Which principle should underlie the nurse's use of touch when communicating with clients? Touch can be a powerful therapeutic tool, but it must be used with caution. Touching a client is inappropriate and opens the nurse to legal action. Physical touch should be used solely with clients of the same gender as the nurse. The nurse should explicitly ask permission before touching a client in any capacity.

Touch can be a powerful therapeutic tool, but it must be used with caution.

Which question should be avoided because it may be perceived as criticism by the client? What? Where? Why? How?

Why?

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?"

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: excessive probing. gathering assessment data. genuineness and caring. lack of awareness.

excessive probing.

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? body language emotion underlying the words expressions gestures

emotion underlying the words

A nurse is meeting with a client prior to discharge from the hospital. The client tells the nurse he is "really worried about returning home." Which response indicates the nurse is employing therapeutic communication? "Most clients have anxiety before they return home." "Home is a much better place for you." "It is best to complete your recovery surrounded by loved ones." "Please share with me what is worrying you right now."

"Please share with me what is worrying you right now."

A group of nursing students is preparing a presentation about therapeutic communication. As part of the presentation, the group is planning to give examples of maintaining a nonjudgmental attitude. Which would be appropriate to include? "The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself." "I think the client is exaggerating the client's feelings. It's just so that the client can leave work early." "Mental illnesses are, for the most part, an individual perception and could be solved easily if people were forced to continue with their daily activities." "People who are mentally ill chose to live in a way prevents mental wellness."

"The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself."

The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication? "This is overwhelming for you, it is okay to cry." "Your other family members will be willing to help." "A community care nurse will be there to help." "You are worried that your father is dying."

"This is overwhelming for you, it is okay to cry."

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? "Have you ever been sexually abused?" "What specifically makes you uncomfortable?" "It would be great if you could attend an in-service on therapeutic communication." "I can take that client off of your assignment this shift."

"What specifically makes you uncomfortable?"

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

Abstract

High-pitched, rapid delivery of a message often indicates what? Depression Anxiety Reminiscing Confusion

Anxiety

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal 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 Extending outward from the border to the public zone

Beginning at the boundary of the intimate zone and ending at the social zone

The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement? The client feels that the nurse is not doing the job properly. The client feels that the nurse is invading the client's personal zone. The client feels that the nurse is indifferent toward the client. The client is not maintaining boundaries.

The client feels that the nurse is indifferent toward the client.

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

active listening

A nurse engages in an interpersonal interaction with a client who begins to make confusing statements. In response, the nurse states, "I am not sure I am understanding you correctly, can you explain that to me again?" Which therapeutic communication approach is the nurse employing? asking for clarification using a nondirective role using a directive role communicating assertively

asking for clarification

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? rapport empathetic linkages self- disclosure self-awareness

self- disclosure