NURS417 Ch10: Therapeutic Communication and Relationships

A psychiatric-mental health nurse is engaged in communication with a client. Which nonverbal behavior by the nurse would convey a positive message? Select all that apply.

Nurse sits at the same eye level as the client. Nurse leans slightly forward in the chair.

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 speaks

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."

Which statement by the nurse is an example of assertive communication?

"I understand that group can be difficult to attend but coming late is disruptive."

A nurse has been providing care to a client diagnosed with an anxiety-related disorder for the past 2 weeks. Which statement made by the nurse suggests a possible professional boundary issue?

"I'm going to rearrange my schedule today so we can spend more time talking." Maintaining professional boundaries may be more difficult in an ongoing therapeutic relationship. Indicators that the relationship may be moving outside of professional boundaries are gift giving on either party's part, providing the client with a personal phone number, or spending more time than usual with a particular client. None of the other options present with behaviors or attitudes that breach the criteria for professional boundaries.

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. Could you please explain?"

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 long-term client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?

"I've been off for the past four days. What have you done since I last saw you?"

A client is attending anger management class and wants to know how the class will help. What is the nurse's best response?

"It will help you to learn how to control the arousal of anger."

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?

"Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses."

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic?

"Since ours is a professional relationship, let's explore other opportunities in your life for friendship."

During the working phase, a client demonstrates open hostility in reaction to the nurse's last question. Which response should the nurse make to avoid countertransference?

"Tell me why you are angry about what I just said."

During the admission interview, the nurse asks the client about what led to their 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." Which is the best response by the nurse?

"You're having very frightening thoughts. Let's talk about them."

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 messages are clear, direct, and easy to understand.

The nurse is meeting with the client for the first time. During the orientation phase of the nurse-client relationship, the nurse assists the client with which activity?

Identifying needs

The nurse is caring for adult client that has a history of being neglected. Which role of the nurse is most likely to create difficulty for the nurse-client relationship if the client confuses physical care with intimacy and sexual interest?

Caregiver

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following?

Client's safety

A nurse who works with potentially aggressive clients should do so with respect and concern. What are goals of de-escalation? Select all that apply.

Empathize with the client's perspective. Work with clients to find solutions. Avoid a power struggle. Approach clients calmly. NOT Sympathize with the client's perspective.

The client is in the working phase of the therapeutic nurse-client relationship. Which action by the nurse would best help the client to explore problems?

Encouraging the client to clarify feelings and behavior

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by possession of which attribute?

Low self-esteem

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 technique is the nurse using with this statement?

Making an observation

A nurse and client are engaged in a therapeutic relationship. The nurse explains the boundaries of the relationship and clarifies expectations. The nurse and client are in which phase of the nurse-client relationship?

Orientation

The nurse is reviewing the client's history, identifies themes, and considers how the nurse can be most therapeutic to a client who was recently admitted to a psychiatric unit. The nurse is functioning in which phase of the therapeutic relationship?

Orientation

A nurse is caring for a client on an inpatient mental health unit of a hospital. The nurse tells the client, "You are scheduled to attend therapy sessions every morning at 9:00 a.m. Please make sure that you complete your morning routine, such as using the restroom, bathing, and eating breakfast, before you come for the sessions." Which phase of the nurse-client relationship does this communication indicate, according to the Peplau's model?

Orientation phase

The client was brought to the emergency department by family members after hearing voices and exhibiting erratic behavior. The family seems truly concerned as this is new for this family member. What should the nurse teach the family about psychosis? Select all that apply.

Psychosis is not an illness. Psychosis is based on symptoms. There may be an underlying cause. Psychosis refers to a set of symptoms that includes perceptual disturbances, disorganized thinking, and behavior alterations. Psychosis is not an illness. These symptoms demonstrate the disorganization that is present in the individual's mental processes and reflect the behavior, emotional response, and thought processes of the individual who has lost contact with reality. Psychosis may be seen in some medical conditions such as delirium, medication toxicity, dementia, mood disorders, and other delusional disorders. The nurse should not tell the family this may be a one-time event; this may be true but further investigation is needed for causation. Some individuals may experience this as a single psychotic event; this could occur after an extremely stressful event, trauma, or illegal substance ingestion. The nurse should not tell them the symptoms will progress as further investigation is needed for underlying causation. The episode may last a few days and usually resolves within several weeks. In other situations, such as with schizophrenia, symptoms are gradual in the beginning—sometimes even unnoticed—and recur for the rest of the individual's life.

During the termination phase, a client begins to raise old problems that have already been resolved. Which would be appropriate nursing responses? Select all that apply.

Reassure the client that they already covered these issues. Review with the client the learned methods to control the problems.

The nurse is caring for a client when the client begins to revert to child-like behavior. Which action by the nurse can continue to nurture the client while establishing and maintaining appropriate boundaries?

Retain an easygoing, non-judgmental attitude. By retaining an open, easygoing, nonjudgmental attitude, the nurse can continue to nurture the client while establishing boundaries. Employing an authoritative attitude may encourage the client to continue the behaviors and become more resistant to the change. The limits for behavior should be set and not encouraged to continue and reset the limits if needed. The nurse should not leave the client and return later since that will not be effective in maintaining trust in the nurse-client relationship.

During a therapeutic communication session, the nurse tells the client of a past experience. Which statement best reflects the nurse's use of self-disclosure?

Self-disclosure on the nurse's part should benefit the client.

The nurse has been meeting with a client for several weeks. Which action indicates to the nurse that the relationship is demonstrating signs of being nontherapeutic?

The client and nurse are frustrated with the conversation.

A client experienced physical abuse by his father when he was a child. The client explains some of the intense financial and interpersonal stress that his father was experiencing at the time and describes the relationship between psychosocial stress and abuse. How should the nurse best interpret the client's statement?

The client is intellectualizing this traumatic event in order to deal with the emotions involved Detached rationalization and discussion of a trauma suggests the client is using the defense mechanism of intellectualization. This is not synonymous with delusion thinking, however, and the client is not necessarily in denial that the experience was wrong and painful. Intellectualization does not indicate successful processing of a trauma.

A client with somatic symptom disorder is reporting significant pain in their lower back. When providing care to this client, which would be most important for the nurse to keep in mind?

The client's experience of pain is perceived as real.

A nurse is reading a journal article about the therapeutic relationship. The nurse demonstrates understanding of the information when the nurse identifies which aspect as the primary difference between social and therapeutic relationships?

The focus of the relationship.

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 has inhibited therapeutic communication by giving advice

A psychiatric-mental health nurse is developing a therapeutic relationship with a client. The nurse demonstrates acceptance by which action?

The nurse avoids judgments about the client, no matter what the behavior is.

A nurse and a client being prepared for surgery are engaged in an interaction. Which statement best reflects decoding and validation of the message?

The nurse responds to the client, "While you say everything is alright, you seem anxious." The client formulates an idea, encodes that message (puts ideas into words), and then transmits the message with emotion. The client's words and their underlying emotional tone and connotation communicate the individual's needs and emotional problems. The nurse receives the message, decodes it (interprets the message, including its feelings, connotation, and context), and then responds to the client. Validation is essential to ensure that the nurse has received the information accurately. While offering or declining services involves addressing needs neither option demonstrates validation as effectively as further exploring the verbal and nonverbal responses of the client. The client's response to the nurse's inquiry regarding anxiety does not demonstrate validation effectively, because the client minimizes the anxiety.

A client forgets to attend a planned session. Which should the nurse conclude about the client's behavior?

The relationship is being tested. During the orientation phase, the client begins to test the relationship to become convinced that the nurse will really accept him or her. Typical "testing behaviors" include forgetting a scheduled session or being late. Forgetting a session is not an indication that the client's problems are overwhelming, that the relationship should end, or the client does not like the nurse.

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 significant traumatic life events have you experienced

During which phase of the nurse-client relationship does the client identify and explore specific problems?

Working

The client tells the nurse, "I am regularly doing my sitting breathing exercises. Why do I still feel breathless while walking?" The nurse replies, "Sitting breathing exercises alone may not achieve the desired effects. You also should perform daily deep breathing exercises while walking. This should help you to reduce breathlessness while walking." According to Peplau's model, the nurse and client are in which phase?

Working

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?

acceptance

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

The nurse is caring for a 30-year-old female client with a diagnosis of traumatic brain injury. Client does not talk, receives total care, and receives medication and nutrition via a permanent gastrostomy tube. The nurse walks past an open door to the client's room and observes the medication technician administering medications via the gastrostomy tube with the client's chest exposed. The nurse enters the room and covers the client's chest and explains to the technician that unnecessarily exposing the chest is a violation of the client's right to privacy. This action reflects which role of the nurse?

advocate

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

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?

asking for the client's permission

The nurse and the client develop a treatment plan strategy to allow the client the opportunity to practice cognitive reframing techniques. The nurse describes the treatment plan and asks the client "Tell me whether my understanding of the plan agrees with yours." This activity represents which therapeutic communication technique?

consensual validation Consensual validation is the search for mutual understanding between the nurse and the client. Asking the client to describe their perspective on the treatment plan in comparison to the nurse's understanding allows for discovering where the nurse or client may not agree. The technique of encouraging comparisons asks the client to reflect on similarities or differences in experiences to recall past coping strategies that were effective or remember that they have survived a similar situation. Seeking information is seen when the nurse asks the client to explain what is or is not important about a situation or point out a vague statement that may need explanation. The nurse and the client have already discussed the treatment plan and formed a plan of action.

A male client comes to the emergency department and appears to be intoxicated. He fell and hit his head at home and has a minor laceration. The nurse asks when his last drink was. The client states that he didn't have a drink and "never touches the stuff." The client is exhibiting which defense mechanism?

denial

A mental health facility is planning to implement the transitional relationship model. Which intention will the organization emphasize when communicating this strategy with the nursing staff?

eases the transition from hospital to community

What is a characteristic of unit culture that predicts client violence?

rigid unit rules

Which nursing actions, if shared with clients, suggest self-disclosure? Select all that apply.

showing family photos telling the client the nurse attended a weight loss meeting directing the client to the nurse's Facebook page

Which is often considered the most difficult yet most effective communication technique?

silence

A client diagnosed with borderline personality disorder is pitting one nurse against the other, calling one a best friend and declaring that the other is horrible. The client is using which defense mechanism?

splitting

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?

symbolism

When engaged in a therapeutic relationship, the nurse's focus is on what?

the client

An advanced practice nurse has chosen to apply motivational interviewing (MI) in the care of a client who will transition back to the community from inpatient treatment. The nurse should begin to apply this method by:

validating the client's ability to make decisions and effect change.

A nurse is caring for a client with hemiplegia who has been depressed. The client tells the nurse, "I don't feel I would ever be independent again. I would be a burden to everybody in my house." The nurse responds by stating, "Your family misses you a lot and wants you home as soon as possible. The rehab team is very confident about your progress." Which phase of nurse-client relationship is occurring?

working

During which phase of the nurse-client relationship does the client identify and explore specific problems?

working