Therapeutic Communication Final

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting

Answer: A. Restatement The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

Your 17-year-old patient Mary just came back from the OR the day before from having facial surgery following a motor vehicle accident (MVA). She has many sutured lacerations and contusions and a fractured nose from the event. When changing her bandages, she asks you how her face looks because she is afraid to look in the mirror. What is your best response to Mary? a. "I don't think it looks so bad; I don't think you'll be horrified." b. "Mary, I think you will see it is different from how you looked prior to the accident. Do you want me to sit with you while you take a peek?" c. "Don't be a baby, it could be far worse! At least you are alive!" d. "Mary, maybe you ought to wait for the swelling to go down before you look."

ANS: B "Mary, I think you will see it is different from how you looked prior to the accident. Do you want me to sit with you while you take a peek?"

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

Answer: C. Formulating a plan of action The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. A. Libel B. Battery C. Assault D. Slander E. False Imprisonment

Answers: B, C and E. False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient. Assault and battery are related to the act of restraining the patient in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the patient.

You are a new graduate on a 24-bed surgical unit in a community hospital. You have worked all summer without any break, covering for other employees taking vacation time, when the manager asks if you wouldn't mind coming in on Saturday as she is short staffed. You had been looking forward to your first weekend off and had made plans to go away with your family. Question: What is the best response to enable you to preserve your well-deserved plans? a. "There is no possible way I will do Saturday night." b. "I am sorry I had made plans already and this weekend is very important to me." c. "No, I have been doing all this time for everyone else, and finally it's my turn!" d. "Well, I really don't want to do it but let me see if I can rearrange my plans."

ANS: B "I am sorry I had made plans already and this weekend is very important to me."

Mr. Bigs is a 67-year-old patient who has had a persistent wound infection for the past 8 weeks. He has been treated with numerous antibiotics and has even had some toes amputated for poor blood supply and necrosis. Mr. Bigs requires a lengthy dressing change as well as multiple IV meds. When you walk in to his room, there is an offensive odor coming from his wound. You have been floated from another unit for the evening, and upon walking in to Mr. Bigs's room he says to you, "So they sent me a brand new one tonight, honey. I need someone who is older and knows the ropes. Now move along and get someone in here who knows what she's doing." Question: What might be an appropriate response to Mr. Bigs? a. Mr. Bigs, I am certainly more than able to care for you! I have been out of school for 1 year now! b. "Mr. Bigs, you've hurt my feelings." c. "Mr. Bigs, why is it you think I don't know what I am doing?" d. "Mr. Bigs, is there someone you are more accustomed to who does your dressings?"

ANS: D "Mr. Bigs, is there someone you are more accustomed to who does your dressings?"

Your patient Marie is dying and is asking you not to "leave her alone." You have 2 hours left to your shift and are quite behind on your procedures and patient charting. You very much want to be there for Marie, but the clock is ticking and there is not enough time to get your work finished.What would be the best response to Marie? a. "Marie, I can't possibly sit with you right now. I am sorry." b. Marie, I am needing to finish up care on my other patients and then I will make some time for you; is there anyone I can call or something I can get for you until then?" c. "Marie, I will call your husband to come and sit with you." d. "Marie, I have called the clergy who has more time to spend with you. He will be here within the hour."

ANS:B Marie, I am needing to finish up care on my other patients and then I will make some time for you; is there anyone I can call or something I can get for you until then?"

Showing respect involves more than doing the least required. The following are actions that accomplish the task at hand but do not necessarily promote a strong relationship of warmth and respect. Look at the term in the left column, and in the right column define and expand on the behavior to promote in the recipient a feeling of being cared for and respected.

- Introducing oneself - Greeting someone/shaking hands - Giving direct eye contact - Getting patient comfortable in the situation - Sitting across table to interview patient

Which of the following groups of patients would you need to evaluate carefully prior to using humor in the clinical area? a. The pediatric ICU b. The psychiatric unit c. The emergency room d. The neuropsych unit e. All of the above

ANS: E All of the above

You are a new student in the sophomore nursing class, and lately your grades have been low in your med-surg course. You are concerned that your falling grades may affect your ability to move on. You find yourself progressively more anxious when going into an exam to the extent that you have nausea, stomachache, diarrhea, and vomiting. You are not sure what to do. You contemplate your options. What might be a suitable option? a. Make an appointment at the academic success/counseling center to explore options. b. Join a study group. c. Let the instructor know that the questions on the exam are unreasonable and argue for points. d. See your PCP about getting an antianxiety medication.

ANS: A Make an appointment at the academic success/counseling center to explore options.

You have been teaching Mrs. Brown, a 55-year-old woman, about administering her own insulin. You feel that she is attentive but only retains a portion of what you tell her. You end your current session and agree to meet tomorrow to review. Which response given at the end of the session might be helpful in teaching Mrs. Brown? a. "Mrs. Brown, what other questions should I be asking? What else might you want to know?" b. "Mrs. Brown, is something wrong with the way I am giving you this information?" c. "Mrs. Brown, I am worried you are not getting the bulk of what I am telling you." d. "Is there something on your mind other than our lesson, Mrs. Brown?"

ANS: A Mrs. Brown, what other questions should I be asking? What else might you want to know?"

You are beginning your nursing career on a pediatric unit. The mentor who has been assigned to you is 62-year-old Barbara who is the oldest nurse on the unit. You have serious doubts about what the two of you may have in common and how you will get along. You consider speaking to your manager, but you do not want to give her trouble this soon. You decide to try it out and be mentored by Barbara.Realizing what you do about multigenerational nurses and the relationships they have you know that: a. Barbara is ready to retire, and you couldn't possibly have anything in common with her. b. Barbara can give you the benefit of mentoring and share her expertise, and you can share new technological advances with her c. You will have the opportunity to update her and show her the new ways of doing things. d. Her skills are probably outdated, and you will be hard pressed to learn something new from her.

ANS: B Barbara can give you the benefit of mentoring and share her expertise, and you can share new technological advances with her

You are a new grad just out of orientation and taking care of Mr. T, an 84-year-old male post MI on the cardiac unit. Since you have come on duty, Mr. T does not look well. He has become tachycardic and is diaphoretic and clammy. You question the patient and he says he "feels fine." You are inclined to call Mr. T's PCP, but you have heard he "yells and screams" if you bother him for nothing. Knowing what you know about working with male physicians, you decide to be proactive and assertive.Which would be the best action to take in this situation? a. Have the charge nurse call the PCP instead. b. Apologize to the physician for calling, and then tell him you fear the patient is not doing well. c. Organize your clinical data and give the physician a succinct report of the patient's symptoms and your concerns. d. Since the patient "feels fine," you decide to wait to see if anything develops. You will call the PCP if the situation worsens.

ANS: C Organize your clinical data and give the physician a succinct report of the patient's symptoms and your concerns.

A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

Answer: B. "What would you like to talk about?" The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

You and your friend Lily were part of a community service project sponsored by your local college. You ran two separate booths at Special Olympics for the younger kids. After the event, there was a postmortem meeting to talk about how the event went. When it came to Lily's booth, the organizers felt that the children had fun but there was no close supervision and injuries could have easily occurred. They asked next year that Lily walk the children through a certain point in the game to avoid injuries. After the meeting, you were surprised to find Lily upset. She said, "They can have their event. Obviously I didn't do a very good job." Question: What is your best response to Lily? a. "Lily, I don't think that's what they said at all, you're way too sensitive." b. "Lily, I believe that the organizer pointed out the good in the job you did as well. Why not look at all that was said and not just focus on the bad?" c. "Lily, you should have known better than to have the kids jump over that pile all alone." d. "I am glad we had a chance to hear both the good and the bad about the event. It's a great way to make the event even better next year."

ANS: B "Lily, I believe that the organizer pointed out the good in the job you did as well. Why not look at all that was said and not just focus on the bad?"

You are 1 hour away from the end of your shift, and you find out you have an admission. With eight patients already, you know you were running very behind on your charting and procedures. With reluctance you go to the ER to get your patient, Mr. K, and bring him to his room. The patient is upset over his care while in the ER. While you are trying to interview him and do his assessment, he begins to complain to you that they did not feed him and when they did 2 hours later the food was cold. Mr. K tells you that his care was less than perfect and describes to you all the wrongdoings he was subjected to. You are getting more and more stressed as you are not able to progress through this interview because the patient is complaining so much.What is your best response at this time? a. "Mr. K, I only have another half hour to do this interview. Can we please stick to the task at hand?" b. "Mr. K, it seems as though you have a lot of feelings about your care while in the ER. Would it be okay to have the patient advocate speak to you so we can better improve our care? Then we can finish admitting you to get you settled and comfortable." c. "Mr. K, truly I have had a bad day and must hurry if I am to leave on time from my shift. Can we keep to the task at hand?" d. "Mr. K, it sounds like you have reason to be upset but right now I need to finish these admission forms."

ANS: B "Mr. K, it seems as though you have a lot of feelings about your care while in the ER. Would it be okay to have the patient advocate speak to you so we can better improve our care? Then we can finish admitting you to get you settled and comfortable."

Ms. Nguyen is a 28-year-old Vietnamese patient who has just delivered a 6-pound baby boy after a 24-hour labor. Her IV was accidentally pulled out while moving her from the stretcher to the bed coming from labor and delivery. You assess her and find she has a temperature of 100.8 °F and seems flushed with dry mucous membranes. You tell Ms. Nguyen it is important to drink fluids and leave her with a diet Coke and a glass of ice water. You come back to the room an hour later and she has not touched either. What is your best response? a. "Ms. Nguyen, you really need to drink in order to keep the IV out; otherwise I will need to reinsert it." b. "Ms. Nguyen, drinking is really important to get you feeling better. Is there something you'd prefer instead of the Coke and ice water?" c. "Ms. Nguyen, your body will not produce milk if you insist on not drinking." d. "Ms. Nguyen, I have brought you a yummy strawberry milkshake to drink."

ANS: B "Ms. Nguyen, drinking is really important to get you feeling better. Is there something you'd prefer instead of the Coke and ice water?"

You are caring for a 65-year-old patient, Mrs. Lewis, who is postoperative knee replacement. She has an order for compression stockings, which need to be removed and reapplied each shift. The doctor comes up when the stockings are off and demands Mrs. Lewis tell him the name of the nurse caring for her that shift. She tells him your name ,and he comes to the nurses' station screaming "Where's Nancy?" He later goes on to tell you how he is sick of his orders not being followed and demands nursing "tighten up their s—t!" Discuss what you as the nurse would do next. a. Exclaim to the doctor, "I don't have to put up with this abuse!" b. Ask the doctor to step out of the nurses' station to a nonpatient care area and let him know his order was in fact followed and the patient was just in the "remove" stage. If he continues to be unreasonable, have another nurse present while you assertively state your defense. c. Realize everyone has bad days, and quietly tell the doctor you are sorry because he came when she was ready to get stockings reapplied. Let it go. d. Report to the chief of medicine that this doctor has humiliated you and that this can't be tolerated.

ANS: B Ask the doctor to step out of the nurses' station to a nonpatient care area and let him know his order was in fact followed and the patient was just in the "remove" stage. If he continues to be unreasonable, have another nurse present while you assertively state your defense.

You begin your new full-time position at the university hospital 1 month after graduation. You are so enthusiastic at the beginning, but as the weeks go on, you get less excited as the stress and job reality kick in. You are unsure of many things, especially of the "politics" of the unit, and are trying to figure this out along with everything else you must learn. You have days when you contemplate whether this is the right profession for you. Which of the following actions might be helpful to you as you transition into your new role? a. Ask for a leave of absence to get your head together. b. Begin the process of looking for a mentor, realizing that this may be an added support for you. c. Request to change to a different unit. d. Ask to start orientation all over again.

ANS: B Begin the process of looking for a mentor, realizing that this may be an added support for you.

You are employed as a new grad in a small community hospital of 150 beds in a rural part of the state. In response to the abuse of some of the staff using cell phones for personal business, the hospital has "banned" cell phone use during working hours. A new policy came out saying "all cell phones/Smartphones need to be kept off patient units and can be stored in your locker or purse in the staff lounge." The policy also suggested leaving phones in the car. As much as you can see their point, you use your Smartphone for clinical use. You have downloaded several programs like "e-MAR BMV" that check to ensure that meds are compatible.What should you do? Please pick the best initial response. a. Use your phone despite the new rule as it has clinical use for you. b. Talk to your nurse manager about the applications you use and share with her how helpful they are. c. Consider changing jobs to go to an institution more "technology-friendly." d. Try to find a book that has the same information.

ANS: B Talk to your nurse manager about the applications you use and share with her how helpful they are.

You are a new graduate on the surgical unit at your community hospital. It has been a tough transition for you over the past few weeks, and many days you leave work feeling overwhelmed. You recognize the need for support if you are going to survive in this position long term. You approach a co-worker, Jillian, who has reached out to you in the past.Which statement below would be appropriate to enlist Jillian's expertise? a. "I am looking for a mentor. Would you please do it for me?" b. "I've noticed how professional you are in dealing with the everyday stresses of this unit and was wondering if you would be available to mentor me over the next few months?" c. "If this keeps up, Jillian, I don't think I will be able to stay here; it's way too stressful." d. "Does anyone around here care how I am doing? Everyone's just so interested in themselves and their own problems!"

ANS: B "I've noticed how professional you are in dealing with the everyday stresses of this unit and was wondering if you would be available to mentor me over the next few months?"

Your clinical group is working on an Alzheimer's unit for the next 4 weeks. You find it sad and disheartening to see some of the patients and how poorly they are doing. Nurse Susan has been employed on this unit for the past 20 years, and it is quite noticeable just how fulfilling her job is to her by how happy she is and how much she enjoys the patients and students. You wonder how she does it and find yourself wanting to be much like her. You share your observations with your classmates and instructor, and they suggest you speak to her about her experiences and philosophies.How would you approach her? a. "Susan, can I have a word with you when you're not busy?" b. "Susan, you seem to really enjoy your job working here. Can you share some of your thoughts with me on your happiness and enthusiasm after working here for 20 years?" c. "Susan, why is it that you are not burned out like the rest of this staff?" d. "Susan, you seem too good to be true! How can you put up with such a depressing place like this?"

ANS: B "Susan, you seem to really enjoy your job working here. Can you share some of your thoughts with me on your happiness and enthusiasm after working here for 20 years?"

The instructor asks students to sign up to let her know the topic they want to talk about in post conference. You sign up to do "alcoholism" because the subject interests you a great deal. When the instructor goes over the list, you see another student's name under that topic instead of your own. Your name has been crossed out, and instead "Brenda" is listed. You are quite angry and upset. What should you do? a. Say nothing. The last thing you need right now is conflict. b. Ask around and see who might have erased your name. c. Confront Brenda and ask her why she scratched out your name; you were there first. d. Approach the instructor to see if she had changed it, state your case, and then approach Brenda, letting her know you were first to sign and that the topic was important to you if the instructor did not do it.

ANS: D Approach the instructor to see if she had changed it, state your case, and then approach Brenda, letting her know you were first to sign and that the topic was important to you if the instructor did not do it.

The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply. A. Restating B. Listening C. Asking the patient "Why?" D. Maintaining neutral responses E. Providing acknowledgment and feedback F. Giving advice and approval or disapproval

Answer: A, B, D, and E. Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

Answer: A. "Don't worry. Everything will be alright." This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.

The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to the nurse, "How is Mary doing? She is my best friend and is seen at your clinic every week." Which is the MOST APPROPRIATE nursing response? A. "I can not discuss any patient situation with you." B. "If you want to know about Mary, you need to ask her yourself." C. "Only because you're worried about a friend, I'll tell you that she is improving." D. "Being her friend, you know she is having a difficult time and deserves her privacy."

Answer: A. "I cannot discuss any patient situation with you." The nurse is required to maintain confidentiality regarding the patient and the patient's care. Confidentiality is basic to the therapeutic relationship and is a patient's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain patient confidentiality.

A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

Answer: A. "Touch carries a different meaning for different individuals." Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

Answer: A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY? A. Contact the patient's health care provider (HCP). B. Call the patient's family to arrange for transportations. C. Attempt to persuade the patient to stay for only a few more days. D. Tell the patient that leaving would likely result in an involuntary commitment.

Answer: A. Contact the patient's health care provider (HCP). In general, patients seek, voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient's' permission. While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to staying "a few more days" has little value and will not likely be successful. Many states require that the patient submit a written release notice to the facility staff members, who reevaluate the patient's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.

A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism? A. Denial B. Projection C. Rationalization D. Intellectualization

Answer: A. Denial Denial is refusal to admit to a painful reality and may be a response by a victim of sexual abuse. In this case the patient is not acknowledging the trauma of the assault either verbally or nonverbally. Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else. Rationalization is justifying the unacceptable attributes about oneself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.

A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing? A. Denial B. Projection C. Regression D. Rationalization

Answer: A. Denial. Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.

When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? A. Monitor closely for harm to self or others. B. Assist in completing an application for admission. C. Supply the patient with written information about their mental illness. D. Provide an opportunity for the family to discuss why they felt the admission was needed.

Answer: A. Monitor closely for harm to self or others. Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patient's' admission.

A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat? A. Using open-ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the patient does not want to eat D. Offering opinions about the necessity of adequate nutrition

Answer: A. Using open-ended questions and silence Open-ended questions and silence are strategies use to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention. The remaining options are not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

Answer: B. "I understand that the voices seem real to you, but I do not hear any voices." This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

Answer: B. "Remember, clients, not nurses, are responsible for their own choices and decisions." Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

Answer: C. "You've been feeling sad and alone for some time now?" This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

Answer: D. "Describe what happened during your time with your husband." This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

Answer: D. "During group, you raised your voice, yelled at a peer, left, and slammed the door." The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

Answer: D. "Let's figure out a way for you to attend unit activities and still wash your hands." The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.

You are working in the ER one evening when there is a motor vehicle accident (MVA) with many casualties. Three teens were killed in the accident, and their parents, who are on their way to the hospital, do not yet know. You dread what will take place over the next few hours. What type of actions could you take as the nurse to anticipate the needs of what is about to take place? a. Clear out a private area in which to receive and speak to the families. b. Mobilize additional support staff to be involved, including nutritional services, social work, and pastoral care. c. Reassign current staff to better meet the needs of unit. d. Utilize all of the above options.

ANS: D Utilize all of the above options.

A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

Answer: A. "You seem to be motivated to change your behavior." This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.

The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is MOST APPROPRIATE for this phase? A. Planning short-term goals B. Making appropriate referrals C. Developing realistic solutions D. Identifying expected outcomes

Answer: B. Making appropriate referrals. Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals and dealing with the common behaviors associated with termination. The remaining options identify tasks appropriate for the working phase of the relationship.

A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

Answer: C. Making stereotyped comments This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

Answer: A. The nontherapeutic technique of giving approval. The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

Which statement demonstrates the BEST understanding of the nurse's role regarding ensuring that each client's rights are respected? A. "Autonomy is the fundamental right of each and every client." B. "A patient's rights are guaranteed by both state and federal laws." C. "Being respectful and concerned will ensure that I'm attentive to my patient's rights." D. "Regardless of the patient's conditions, all nurses have the duty to respect patient rights."

Answer: C. "Being respectful and concerned will ensure that I'm attentive to my patients' rights." The nurse needs to respect and have concern for the patient; this is vital to protecting the patient's rights. While it is true the autonomy is a basic client right, there are other rights that must also be both respected and facilitated. State and federal laws do protect a patient's rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. It is a fact that safeguarding a patient's rights are a nursing responsibility, but stating that fact does not show understanding or respect for the concept.

A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A. "You have everything to live for." B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"

Answer: D. "You've been feeling like a failure for a while?" Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings. In addition, use of the word "why" is nontherapeutic.

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

Answer: D. Making observations The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

Your nursing lab partner, Jenny, has been practicing with you for days for your upcoming lab assessment exam. You will need to do a history and interview on her. One of the things you find really annoying is that when you ask her direct questions she goes in circles and gets off track so you lose your place and don't know how to respond to some of her way-out responses. This makes you look bad and unprepared to deal with the data she is giving you. You decide to be assertive and confront her. You begin by saying, "Jenny, I am concerned about the lab exam next week and would like to talk to you about it."Which response below is the best to begin this dialogue? a. "I am worried about how to respond to some of the comments you make when I am interviewing you. I am unclear as to why you are answering me with vague unrelated comments." b. "I do not think we are compatible in our interviewing skills. Maybe we should find other lab partners." c. "When I interview you, I get confused." d. "When answering the questions I ask you, just answer "yes" or "no."

ANS: A "I am worried about how to respond to some of the comments you make when I am interviewing you. I am unclear as to why you are answering me with vague unrelated comments."

You are a hospice nurse who is working with a 55-year-old woman, Mrs. Jones, who is dying from liver cancer. The woman's daughter, Mary, has been with her mother supporting her and helping her along the way despite the fact she has three children all younger than 5 years old. Mrs. Jones's condition is worsening, and Mary is becoming quiet and introspective. You encourage her to verbalize her feelings, and she cries that she needs her mother and cannot let her go. She wonders how she will manage without all the support she has given her through the years. You have been there before, having lost your mother in much the same way. What would be the best response to Mary at this time? a. "I lost my mom to cancer about your age as well. It helped me to talk about it. I am glad you feel free to talk about your feelings and I am willing to listen." b. "Mary, perhaps you need a quiet place to cry." c. "It must be horrible going through this with all the small children needing you as well." d. "I am feeling you are decompensating. Would you like me to make a psych consult for you?"

ANS: A "I lost my mom to cancer about your age as well. It helped me to talk about it. I am glad you feel free to talk about your feelings and I am willing to listen."

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

Answer: B. "I see that you are upset, but I feel uncomfortable when you swear at me." This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

Answer: B. "You're feeling guilty because you weren't able to save your children." The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

Answer: B. O. The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."

Answer: C. "Let's discuss and explore all of your options." The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

5. A patient diagnosed with terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A. "Have you shared your feelings with your family?" B. "I think we should talk more about your anger with your family." C. "You're feeling angry that your family continues to hope for you to be cured?" D. "You are probably very depressed, which is understandable with such a diagnosis."

Answer: C. "You're feeling angry that your family continues to hope for you to be cured?" Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feeling, this is non-therapeutic in the one-to-one relationship.

Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

Answer: D. "You mentioned your relationship with your father. Let's discuss that further." This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

A patient's unresolved feelings related to loss would be MOST LIKELY observed during which phase of the therapeutic nurse-patient relationship? A. Trusting B. Working C. Orientation D. Termination

Answer: D. Termination In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. The remaining options are not specifically associated with this issue of unresolved feelings.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

Answer: D. The nontherapeutic technique of "giving false reassurance" The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

Jim goes on to run the marathon and on this very hot day of 80 °F collapses on the eighth mile and is brought to the local ER for evaluation. The ER asks you to see him and suggest a plan. You walk into his room and find him staring out the window. What is your best response? a. "Jim, are you okay? That heat with all your running could have killed you, you are lucky to be alive!" b. "Jim, how are you doing? Tell me what happened." c. "Jim, I think we should have held your insulin this a.m. despite the carb load you had the night before. I think we made a mistake." d. "Jim, didn't you follow the recommendations I gave you on Friday?"

ANS: B "Jim, how are you doing? Tell me what happened."

You are involved in teaching your new diabetic 15-year-old about his diet. He seems to understand his dietary restrictions, but an hour later you see him in the coffee shop with two of his friends enjoying an ice cream soda and a large bag of M & Ms. What is your best response at this time? a. Confront him! Go up to him while in the coffee shop and ask him what he is doing after all your hard work and teaching. b. Choose to do nothing at this time, but plan on confronting him when alone and back in his room. c. Realize he is a teenager and he will do what he wants. d. Call his doctor and let her know immediately of the situation, letting her handle it.

ANS: B Choose to do nothing at this time, but plan on confronting him when alone and back in his room.

You are upset by a recent decision made by your state senator on a local health issue. You decide you must do something proactive to express your opinion and offer alternatives. Each of the following would be a healthy action for you to take except one.Which would not be helpful? a. Call together all the students to sign a petition stating your opposition. b. Call together all the students to explore alternative ideas and compose an editorial. c. Realize that the problem is too big and it is unlikely you can make a difference. d. Participate in an interview on local radio highlighting the issue at hand.

ANS: C Realize that the problem is too big and it is unlikely you can make a difference.

You have an upcoming test in med-surg that covers an enormous amount of material, and you are overwhelmed. You decide to gear yourself up by using some positive self-talk as you learned in communication class.What is the most important part of successful self-talk? a. Being confident and believing that you will be successful. b. Getting no less than 1 hour of uninterrupted time to practice. c. Writing down an entire script of how you think this will go and what you will tell yourself. d. Getting help from your friends to help the process along.

ANS: A Being confident and believing that you will be successful

A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

Answer: D. "You feel that your mother does not want you to come back home?" This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

On review of the patients record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior? A. Fearfulness regarding treatment measures. B. Anger and aggressiveness directed toward others. C. An understanding of the pathology and symptoms of the diagnosis. D. A willingness to participate in the planning of the care and treatment plan.

Answer: D. A willingness to participate in the planning of the care and treatment plan. In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient's understanding of their illness, only of their desire for help.

What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information

Answer: D. To give the client critical information The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."

Answer:A. "You appear to be talking to someone I do not see." The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

You have learned about visualization in your communication class and would like to try it out. All of the following are crucial to successful visualization. Please number the following steps in the proper order to achieve the process of visualization. ____Focus on becoming clear what you want to create. ____Find a quiet space without possibility of interruption. ____Evaluate if the session was successful. ____Achieve a sense of relaxation to rid your mind of other details. ____Have complete faith your goal will be met and create exact images.

1. Find a quiet space without possibility of interruption. 2/3. Achieve a sense of relaxation to rid your mind of other details. 2/3. Focus on becoming clear what you want to create. 4. Have complete faith your goal will be met and create exact images. 5. Evaluate if the session was successful.

Maria is a 42-year-old woman who is dying from cancer. You are assigned to Maria. Her transition to hospice care has not been going well. Her chemo is no longer working, and she has been in increasingly more pain. Maria has three children ages 3, 5, and 8, and she tells you she cannot fathom what their lives will be like without their mother. Maria feels there are so many lessons that they have yet to learn. You find Maria frequently crying, and she tells you her children need her and she is not ready to go. Maria asks if you would help her to hire a videographer and get her all the materials she needs so she can "make a movie" for the kids. This idea is new to you. What is your best response to Maria? a. "That is such a special idea. How would it feel for you to make this type of movie? Let's talk about what you would require to get started." b. "A movie? Aren't they a little young to watch it?" c. "Maria, as your nurse I don't think at this time you have the strength to take on a project like this. Do you have any other ideas?" d. "I'm not clear, Maria, how this would help you. Can you tell me how it would make you feel better to do all of this?"

ANS: A "That is such a special idea. How would it feel for you to make this type of movie? Let's talk about what you would require to get started."

Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

Answer: A. "Can you tell me why you said that?" This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

You are working with Jim, a 17-year-old male, who has just been diagnosed with diabetes. He has been coming to the ambulatory clinic where you work for the past week while trying to regulate his blood sugar and receiving training for self-management of his disease. The patient enjoys exercising, and you have been working with him diligently to get his blood sugar under control while doing this. During his Friday appointment, the patient announces to you that he is running the 26-mile Boston Marathon on Monday and needs your help to make sure he "makes it to the finish line." You are concerned that his health is not yet stable enough to participate in this taxing activity. What is your best response? a. "Jim, I am concerned that this may not be the time to do this. Why not wait until next year's marathon when you'll be in much better control?" b. "Jim, this is the craziest idea I have ever heard. Why not just do a local marathon of 3 miles?" c. "Jim, this certainly seems important to you. Can you share with me what experiences you've had with running in the past and we can explore ways that we might do this safely." d. "Jim, you are just so unstable right now; this is a bad idea."

ANS: C "Jim, this certainly seems important to you. Can you share with me what experiences you've had with running in the past and we can explore ways that we might do this safely."

The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

Answer: C. To explore a subject, idea, experience, or relationship This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to deliver further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

Your roommate Donna returns back to the dorm at 1 a.m. to tell you that she is done with her boyfriend. She says he dumped her for another girl she had been friends with. She is highly upset about losing her boyfriend, not to mention having a friend go out with him. She says she can't take it anymore and can't focus on studying for tomorrow morning's test. You find yourself getting progressively upset as she reveals her story.What might be the best action to take at this time? a. "Donna, I want to hear your story, but it is late and I must go to bed soon." b. "Donna, I can see you are visibly upset. Is there someone with whom you can talk about this in the morning?" c. "Donna, you have a test that is important in the morning. What can you do now to make sure you are ready to take it? Can we talk about this situation once the test is over?" d. "Donna, I am so sorry for your situation. I want to talk with you but only for another few minutes as we both need to get some sleep."

ANS: All responses could be used under the right situation. Discuss why one would be picked over another.

Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis

Answer: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

Answer: C. Sitting squarely, facing the client When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

Answer: C. "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." The instructor's statement, "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.

Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"

Answer: C. "Yes, I see. Go on." The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.

Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."

Answer: C. "I notice you are wearing a new dress and you have washed your hair." This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.

Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

Answer: B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

Answer: B. Verbalizing the implied and the defense mechanism of denial This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.

Your clinical group just began its rotation in psych, and your group was assigned to an alcohol addiction unit. After attending the meeting, a patient, "Greg," comes up to you and asks if you are also an alcoholic. Before answering, Greg informs you that the only staff that are "any good" around here are those who have struggled with alcohol themselves.What response would be best in addressing Greg? a. "Greg, I don't think that is any of your business." b. "Greg, right now we need to focus on helping you. I am glad to hear there are members of the staff whom you can identify with to get the help you need." c. "Greg, if someone on the staff shared that he is a drinker, can you give me his name? I need to report him to the manager of the unit." d. "Greg, all staff have something to offer you, whether they were drinkers or not."

ANS: B "Greg, right now we need to focus on helping you. I am glad to hear there are members of the staff whom you can identify with to get the help you need."

When the community health nurse visits a patient at home, the patient states, "I haven't slept the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient. A. "I see." B. "Really?" C. "You're having difficulty sleeping?" D. "Sometimes, I have trouble sleeping too."

Answer: C. "You're having difficulty sleeping?" The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

Many of your senior classmates belong to a student nurse listserv. When in OB, you were able to be present for a delivery that resulted in a severe birth defect—the baby delivered had anencephaly. Given the rarity of this condition, you take a picture of the baby's head when no one is in the room to share with fellow student nurses on the listserv. While loading the picture onto the website, your roommate comes home and tells you she doesn't think that's a good idea.What should you do? a. Read about posting on the website and try to make the face not fully visible. b. Decide that posting the photo to the website is a violation of HIPAA and dispose of it. c. Print the photo and keep it for yourself and your friends to share. d. Give the photo to your school secretary to make copies for the class.

ANS: B Decide that posting the photo to the website is a violation of HIPAA and dispose of it.

You are in clinical and are taking care of Mr. Dean who is in end-stage liver disease. Mr. Dean has been a heavy drinker for over 40 years. At post conference, your instructor told you that you had to present Mr. Dean's case study to the other students in the group. During the day, you were quite busy and never had time to look up your pathophysiology on liver disease, and you fear your instructor will be upset. Other students said they would prompt you if needed, but you are a nervous wreck.What would be the best action to take at this time? a. Tell your instructor you are sick and ask to go home. b. Find a quiet spot for a few minutes and write down the steps of what you'll talk about in conference. When done, do some "on-the-spot" relaxation exercises before going in. c. Realize you will never adequately be able to know and look up this information so tell your instructor to give you an "F" as you just can't pull it off. d. Go out to your car, deep breathe, and listen to soothing music.

ANS: B Find a quiet spot for a few minutes and write down the steps of what you'll talk about in conference. When done, do some "on-the-spot" relaxation exercises before going in.