PSYCH - PREP U - CHAPTER 6 - LEGAL AND ETHICAL BASIS FOR PRACTICE

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?

"Tell me more about that." Explanation: 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. p. 94

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?

"Tell me about a time when things went your way." Explanation: 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 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?

"What you are saying and how you say it does not seem to match. Explanation: 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. p. 94

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?

A. Abstract Explanation: 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. p. 96

The nurse is using a directive role when asking a client which question?

A. "Are you thinking about hurting someone else right now?" Explanation: 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. p. 108

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?

A. "At what time did you take the last dose of the antianxiety drugs?" Explanation: Concrete messages use explicit wording and need no interpretation. Asking the client about the time of the last dose of the antianxiety drugs conveys the most accurate information. Asking the client about when the client stopped taking the drugs fails to specify the type of drug, and using the word "when" will not help the client give the accurate response. Asking the client when the client took them last would confuse the client, as "them" may not be interpreted as drugs. p. 100

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:

A. "How would leaving your spouse make you feel?" Explanation: 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. p. 109

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?

A. "I don't know why the doctor didn't check on you yesterday, but I think it's unlikely that the doctor hates you". Explanation: 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. p. 96

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.

A. "I don't really know how it all started. It just happened." Explanation: 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. p. 96

The nurse is assessing the behavior of a client. The client has a cheerful expression, erect posture, and a confident tone. Which statement made by the client along with these nonverbal cues conveys a congruent message?

A. "I feel great and am able to do my exercises properly" Explanation: A cheerful expression, an erect posture, and a confident tone indicate that the client has achieved something and is happy about it. These processes, along with the statement that the client feels good, convey a congruent message. The remaining statements convey incongruent messages as the patient's processes contradict the statement given to the nurse. p. 106

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?

A. "I'm concerned that you are not exicited about your mother's visit, We can talk if you want." Explanation: 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. p. 94

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?

A. "I've been off for the past four days. What have you done since I last saw you?" Explanation: 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. p. 96-100

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?

A. "It looks like you're searching for something. Is that right?" Explanation: 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. p. 106

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?

A. "It must be frustrating to feel locked up." Explanation: 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.

The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond?

A. "Let's talk about infections, and how they heal." Explanation: Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals, such as assessing the client's perception of the problem as it unfolds, teaching the client self-care skills and identifying a plan of action to a satisfying and socially acceptable resolution. "Oh, it is just the infection, in a day or so you'll feel better," "Why don't you just rest in bed?," and "Call a friend in to watch TV," are not examples of therapeutic communication between the nurse and client. p. 96

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?

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

A. "Should you go home for the weekend?" Explanation: 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 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?

A. "The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself." Explanation: The statement about the client with domestic violence and trying hard to change reflects a nonjudgmental attitude. It is void of personal opinion and value judgments and provides a neutral view. The statements about weak characters, exaggerating feelings (an excuse), and mental illness being all in the head reflect value judgments and opinions. p. 107

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?

A. "What specifically makes you uncomfortable?" Explanation: 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. p. 95

Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can."

A. "You look like you are very angry this morning." Explanation: 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. p. 93-94

Which statement by the nurse reflects the use of a therapeutic statement?

A. "You look upset. Would you like to talk about it?" Explanation: 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. p. 99

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?

A. 3 to 6 feet Explanation: 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. p, 94

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?

A. Affiliation Explanation: 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.

Which includes the circumstances or parts that clarify the meaning of the content of the message?

A. Context Explanation: 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. p. 106

Which term is used to refer to signals that encourage effective communication?

A. Cues Explanation: 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. p. 100

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?

A. Defending Explanation: The nurse's statement conveys that the nurse is trying to defend the hospital from the client's criticism. The nurse's statement may not change the client's feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client's discomfort. p 101

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?

A. Defending Explanation: The nurse's statement conveys that the nurse is trying to defend the hospital from the client's criticism. The nurse's statement may not change the client's feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client's discomfort. p. 101

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?

A. Exploring Explanation: 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. p. 96

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?

A. It's important to get a break from time to time. How have the last few days been for you? Explanation: 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. p. 107-108

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

A. Presenting reality Explanation: 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. p. 98

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?

A. Presenting reality Explanation: 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. p. 98

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?

A. Probing Explanation: 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. p. 102

Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client?

A. Sitting behind a desk. Explanation: 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. p. 104

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?

A. The adolescent may be disinterested in the conversation. Explanation: Expressions such as not making eye contact and yawning may indicate disinterest, lying, or boredom. In this context, yawning is unlikely to indicate that the client is sleepy. Turning the eyes away is likely a sign that the client is not willing to concentrate rather than trying hard to concentrate. Not making eye contact with the nurse and yawning do not indicate the client is listening attentively. p. 107

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?

A. The client is the primary focus of the interaction Explanation: 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. p. 94

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?

A. The client's room Explanation: If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication. p. 94

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?

A. The nurse is keenly interested in the client's concerns. Explanation: Facing and leaning slightly toward the client indicates that the nurse is very interested in what the client has to say. Leaning toward the client does not mean that the nurse is unable to hear the client but that the nurse is paying attention to the client. This body language indicates supportive behavior and not that the nurse is trying to threaten the client. This body language does not indicate that the nurse is unable to understand what the client is saying. It indicates that the nurse is listening attentively. p. 104

Which is inconsistent with principles of therapeutic communication?

A. The nurse is the primary focus of the relationship. Explanation: The client, not the nurse, should be the primary focus of the interaction. The nurse must maintain client confidentiality and use a professional attitude. The interventions are implemented from a theoretical base. p. 94

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.

A. The nurse may be showing nonacceptance toward the client. Explanation: 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. p. 104

If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

A. The nurse may lack confidence in therapeutic communication. Explanation: 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. p. 94

Which is an inaccurate depiction of concrete messages?

A. They require repharsing of unclear statements. Explanation: 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. p. 96

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?

A. What significant traumatic life events have you experienced? Explanation: 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 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?

A. affiliation Explanation: 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 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?

A. affiliation Explanation: 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 nurse is conducting an initial assessment of a client. When the client enters the nurse's office, the client finds the nurse sitting with arms folded across the chest and an emotionless facial expression. The nurse is exhibiting which nonverbal communication technique?

A. closed body position and impassive face Explanation: An impassive face is characterized by an emotionless, deadpan expression similar to a mask. The closed body position entails the nurse sitting with arms folded across the chest. Contrarily, an accepting body position would involve the nurse sitting with hands at the side of the body. This open posture demonstrates unconditional positive regard, trust, care and acceptance. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one where the person is verbally expressing one emotion but showing a different one. p. 105

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening?

A. general leads Explanation: General leads give encouragement to continue. Focusing is concentrating on a single point. Accepting is indicating reception. Exploring is delving further into a subject or idea. pg 98

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?

Consensual validation Explanation: 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. p. 97

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. Explanation: 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). p. 93-94

Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason?

Nonverbal communication provides additional client information that is acted out unconsiously Explanation: 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. p. 95

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?

using gentle touch during activities of daily living Explanation: 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. p. 95