Therapeutic Communications PrepU

A client being counseled is a survivor of domestic violence. The nurse observes intricate cut marks on the client's arms during the session. Which question should the nurse ask the client?

"How are you coping with your feelings?"

The nurse is talking with the grandparent of an infant born at 32 weeks' gestation to an adolescent mother who states, "I am concerned my grandbaby will have developmental problems." Which response by the nurse is most appropriate?

"The risks of developmental concerns are heightened for your grandchild."

A postoperative vaginal hysterectomy client complains of pain that is more intense than this morning. This factor should be explained to the client as

"Acute pain tends to increase during the day and is called a routine pain response"

A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse?

"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet."

The nurse provides care to a child whose parents recently separated and are planning to divorce. The child's parents ask the nurse how they can help their child deal with the situation. Which response by the nurse is appropriate?

"It is important that you help your child by not speaking negatively about the other."

A client reports an episode of losing control of urination when a bathroom was not close by. The client states, "I am worried this means that I am starting to lose control of my bladder." What is the appropriate nursing response?

"Let's review your medication history and whether you consume bladder irritants."

A client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?

"The paralysis caused by this disease is temporary."

The nurse is talking with a pregnant woman who is a carrier for a genetic disorder. The woman does not have any symptoms of the disorder. The pregnant woman asks the nurse about the risk to her unborn baby. What is the most appropriate response by the nurse?

"We can only assess the potential risk after the baby's father undergoes genetic testing." When an individual is a carrier for a genetic disorder the risk can only be assessed after viewing the genetic profile of the other parent. If the child's father is not a carrier of the gene or have the disorder there is no risk for the child to have the disorder. The child, however, can be a carrier like the mother.

A woman in her 20s has experienced a spontaneous abortion (miscarriage) at 10 weeks' gestation and asks the nurse at the hospital what went wrong. She is concerned that she did something that caused her to lose her baby. The nurse can reassure the woman by explaining that the most common cause of miscarriage in the first trimester is related to which factor?

Chromosomal defects in the fetus

While interviewing a Chinese man about his son's health, the nurse notices that the man keeps his eyes focused on the floor. What is the best action by the nurse?

Continue with the interview.

During an individual therapy session, a nurse is listening to a client describe the client's drug addiction. The client says, "I know I am doing the wrong thing for my kids, but I just can't stop using drugs." The nurse maintains eye contact and nods occasionally. The nurse responds by saying, "You're going through a difficult time." The nurse's actions and words are an example of:

Empathy

A nurse is developing a plan of care for a patient diagnosed with post-traumatic stress disorder (PTSD). Which of the following would be the priority?

Establishing a trusting nurse-patient relationship

When caring for a client who has just been diagnosed with a chronic illness, the nurse understands the importance of promoting health by highlighting which concept?

Focus on what is possible.

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse

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

The clients room

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?

The working phase

At what time is the laboring client encouraged to push?

When the cervix is fully dilated

The nurse is assisting the client who has dementia from the bed to the chair for mealtime. What actions by the nurse would facilitate cooperation from the client? Select all that apply.

calling the client by the preferred name facing the client when speaking providing instructions one at a time being positive in statements when providing instructions

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates an understanding of how to prevent relapse when stating that it will be important to:

continue to take antibiotics for the entire 10 days.

A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:

involve the child's stuffed animal in the educational session.

The nurse is caring for the family of a medically fragile 2-year-old girl. Which activity is most effective in building a therapeutic relationship?

listening to parents' triumphs and failures

Two days ago, a woman gave birth to her third infant; she is now preparing for discharge home. After the birth of her second child, she developed an endometrial infection. Nursing goals for this discharge include all of the following except:

maintaining previous household routines to prevent infection.

During an assessment, a preschool-aged child tells the nurse about having 12 siblings. The nurse is aware that the child has two older brothers. What would be the nurse's best response?

"That is a good pretend answer but tell me the names of the brothers you really have."

The nurse is caring for a client that comes to the clinic after experiencing intimate partner violence and sustaining a fractured arm and jaw. Which statement(s) by the nurse is most therapeutic? Select all that apply.

"I am so sorry that you have been hurt." "You have a right to be safe and respected." "This abuse is not your fault."

A client at 11 weeks' gestation experiences pregnancy loss. The client asks the nurse if the bleeding and cramping that occurred during the miscarriage were caused by working long hours in a stressful environment. What is the most appropriate response from the nurse?

"I can understand your need to find an answer to what caused this. Let's talk about this further."

A client with schizophrenia states, "I hear the voice of King Tut." Which response by the nurse is therapeutic?

"I don't hear the voice, but I know you hear what sounds like a voice."

The nurse is caring for a male toddler with the genetic disorder of muscular dystrophy. The child has had numerous ear infections and is scheduled for pressure-equalizing (PE) tubes surgery. The parents state, "As if our child's muscular dystrophy isn't enough, now he has to endure ear surgery." What is the best response by the nurse?

"I know it is difficult but it's not unusual for children with genetic disorders to have ear structure problems. This will help prevent future ear infections."

An older adult client tells the nurse, "I give myself a mineral oil enema every day." What is the appropriate nursing response?

"Mineral oil enemas can interfere with absorption of fat-soluble vitamins."

The nurse is preparing to perform discharge teaching with a client when the client states, "I am really worried about returning home to the same environment I left." Which response indicates the nurse is employing therapeutic communication?

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

A client continues to complain of pain despite receiving medication. The family states, "In our culture it is acceptable to complain out loud." What would be the best response by the nurse?

"Tell me about your cultural beliefs"

A client who comes to the clinic reporting low-grade afternoon fevers, night sweats, and a productive cough is diagnosed with tuberculosis. Which statement by the nurse would be most appropriate during an initial assessment?

"Tell me how you feel about the diagnosis of tuberculosis."

A competent client requiring long-term mechanical ventilation privately tells a nurse that they want the ventilator withdrawn. Which response by the nurse is best?

"Tell me more about how you are feeling." Asking the client how they are feeling uses an open-ended question that encourages the client to express their feelings. Asking the client to consider their family is judgmental and is an inappropriate statement. Ventilation can be withdrawn according to the client's wishes. The nurse stating, "Now that I'm here" is unprofessional and would be inappropriate. Contacting the healthcare provider would be premature as the nurse needs more information.

The nurse is preparing discharge instructions for a client at 32 weeks' gestation who was admitted for PROM. What is the best response from the nurse when the client asks when she can have intercourse with her husband again?

"That is a question to ask your health care provider; at this point you are on pelvic rest to try and stop any further labor."

Which statement is the most empathic response to a client's disclosure that the client's father abandoned the family when the client was a young child?

"That must have been terribly hurtful experience for you."

A child having tympanostomy tubes placed asks, "How and when will the tubes be removed?" What is the nurse's best response?

"The tubes remain in place for 6 to 12 months until they come out by themselves."

A client with schizophrenia and delusions tells a nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which response by the nurse is appropriate?

"This subject seems to be troubling you. Let's walk to the activity room."

A client tells the nurse "My partner is going to stop drinking, so I know I won't be hit again." What is the nurse's best response?

"Violence is a learned behavior, not caused by alcohol."

The nurse is providing education to the parents of a 2-year-old boy with hydrocephalus who has just had a ventriculoperitoneal shunt placed. Which information is most important for the parents to be taught?

"Watch for changes in his behavior or eating patterns."

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day."

A nurse is interviewing a parent regarding the 2-year-old child's recent illness. The nurse would like the parent to elaborate about any symptoms of the illness noticed. Which would be the most effective question for the nurse to ask the parent in this situation?

"What symptoms has your child exhibited?"

A client tells the nurse that she will be researching an alternative method of treatment for her disease. What is the most appropriate response by the nurse?

"You are within your right to search for other methods of treatment. Just be sure to inform your physician what treatments you are using."

A client states the following to the nurse: "I am a failure, and I wish I had died." Which statement by the nurse demonstrates a therapeutic response?

"You feel like a failure; would you like to talk more about the way you feel?"

A client is admitted to the psychiatric unit and appears agitated. While putting personal items away, the client talks rapidly and folds and unfolds garments several times. The client cannot seem to relax. What statement by the nurse is best?

"You have been folding the same clothing several times. How do you feel right now?"

The parent of a 1-week-old infant is concerned with white scales that have begun to flake off the infant's scalp. The parent asks the nurse what to do to treat this. How should the nurse best respond?

"Your child most likely has cradle cap (seborrhea). You can care for it by cleansing the hair and scalp daily with baby shampoo and applying baby oil."

While undergoing a health history and physical assessment, a patient states, "I'm really afraid this pain in my belly is cancer." Which response by the nurse would be MOST appropriate?

"You seem upset about the pain. Tell me what's happening."

A nurse is preparing a client for chemotherapy to treat colon cancer. The client says, "I don't know about this treatment. After everything is said and done, it may not do a bit of good. This thing may get me anyway." Which response by the nurse is most therapeutic?

"You're wondering whether you've made the right decision about your treatment."

The nurse is working with a parent whose child has just been diagnosed with selective immunoglobulin A deficiency. The parent asks the nurse, "Does this mean that my child is going to die?" How should the nurse respond?

"Your child has a mild genetic immune deficiency caused by a lack of immunoglobulin A, a type of antibody that protects against infections of the lining the mouth and digestive tract."

The nurse reviews the medical record of a woman who has come to the clinic for an evaluation. The client has a history of mitral valve prolapse and is listed as risk class II. During the visit, the woman states, "We want to have a baby, but I know I am at higher risk. But what is my risk, really?" Which response by the nurse would be appropriate?

"Your risk during pregnancy is small, but you should see your cardiologist first before getting pregnant."

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?

3-6 feet

After diagnosing a client with pulmonary tuberculosis, the physician tells family members that they must receive isoniazid (INH) as prophylaxis against tuberculosis. The client's family asks the nurse how long the drug must be taken. What is the usual duration of prophylactic isoniazid therapy?

6-12 months

A client is 33 weeks' pregnant and has had diabetes since age 21. When checking her fasting blood glucose level, which value would indicate the client's disease is controlled?

85 mg/dl

A client with cirrhosis is at risk for developing esophageal varices. Which of the following instructions should a nurse provide the client to minimize such risk?

Abstain from drinking alcohol.

A G4P3 client with a history of controlled asthma is upset her initial prenatal appointment is taking too long, making her late for another appointment. What is the nurse's best response when the client insists she knows how to handle her asthma and needs to leave?

Acknowledge her need to leave but ask her to demonstrate the use of inhaler and peak flow meter before she goes; remind her to take regular medications.

A client has presented to the day surgery unit and will be having a diagnostic procedure that will involve the use of a neuromuscular junction blocker. The client says to the nurse, "Let me get this straight: I won't be able to talk or move my muscles but I'll be awake?" The nurse's response should address the possibility of what nursing diagnosis?

Anxiety related to paralysis

A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of the treatment. The client asks the nurse leading the group if the nurse is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is what?

Appropriate, because the focus of the therapeutic relationship is the client, not the nurse.

The nurse is conducting an interview with a newly admitted client. Which listening behavior should the nurse implement to have a successful interview?

Avoid the impulse to interrupt.

A nurse is providing care to a client who is feeling lonely and isolated. In an effort to develop a trusting nurse-client relationship, the nurse exhibits a caring attitude, ensures the client's privacy, and spends time with the client to promote therapeutic communication. The nurse is meeting which category of client needs?

Loving and belonging

After hospital discharge, the parent of a child newly diagnosed with type 1 diabetes mellitus telephones the nurse because the child is acting confused and very sleepy. Which emergency measure would the nurse suggest the parent carry out before bringing the child to see the health care provider?

Give the child a glass of orange juice.

A nurse practitioner in an emergency room receives a telephone call from a mother whose 4-year-old child has a mosquito stuck in his external ear canal. Which of the following is the best information the nurse could give the mother?

Instill a few drops of warmed mineral oil to cover the insect.

When interacting with parents caring for their newborn in opioid withdrawal, which nursing action is most essential?

Instruct the parents with a nonjudgmental, caring attitude.

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?

It's important to get a break from time to time. How have the last few days been for you?

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action?

Make efforts to demonstrate empathy to the client

A client is considering breast augmentation. Which of the following would the nurse recommend to the client to ensure that there are no malignancies?

Mammogram

The nurse is assessing a pregnant client at 12 weeks' gestation and the client reports some new bumps on the dark part of her nipples. What is the best response from the nurse when questioned by the client as to what they are?

Montgomery glands (Montgomery tubercles); secrete lubricant for the nipples

A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage?

Practicing effleurage on the abdomen

The nurse is preparing to interview a 35-year-old female client diagnosed with depression. Which statements should the nurse use to demonstrate therapeutic communication? Complete the table of therapeutic communication techniques by choosing from the statements that demonstrate the technique.

Reflecting: "You are asking for my opinion." Restating: "You said that you are worried about your family." Validating: "Tell me if I understand that you don't like medication because of how it makes you feel." Exploring: "Explain more about that for me."

The nurse is caring for an older adult client admitted with a terminal illness. The client's chart indicates do not resuscitate (DNR) status. Which communication technique will facilitate a trusting nurse-client relationship?

Speak in a well-modulated voice and listen carefully to what the client says.

The nurse is educating a female patient with a UTI on the pharmacologic regimen for treatment. What is important for the nurse to instruct the patient to do?

Take the antibiotic for 3 days as prescribed.

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. The most appropriate action by the nurse would be to:

Take the child to a private room and interview her regarding her sexual history and partners. Pelvic inflammatory disease can cause sterility in the female primarily by causing scarring in the fallopian tubes that prohibits the passage of the fertilized ovum into the uterus. Adolescents must be made aware of the seriousness of PID, a common result of a chlamydial infection. Be certain to provide the adolescent with a private interview. The adolescent may be extremely reluctant to reveal either social or sexual history especially in the presence of a family member.

A parent asks if her newborn's undescended testicles will need surgery to repair. What is the best response by the nurse?

There is a chance the testicles will descend on their own.

During a class on exercise for clients with diabetes mellitus, a client asks the nurse educator how often to exercise. To meet the goals of planned exercise, the nurse educator should advise the client to exercise:

at least three times per week.

A Malaysian client is admitted to the healthcare facility with reports of cramping pain in the abdomen and loose stools. Where would the nurse be seated when interviewing the client?

at more than one arm's distance