CH 8: Therapeutic Communication

A psychiatric-mental health nurse has been off of work for the past 4 days, as per the normal work schedule on the unit. On the nurse's first day back, a longterm client says, "I haven't seen you around here since Thursday. How was your time off?" What is the nurse's most appropriate response?

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

The client says to the nurse, "I wonder what's playing at the movies tonight." Which response by the nurse would be most therapeutic?

"Are you telling me you would like to go to the movies?"

The nurse is assessing a client with a personality disorder. During the interview, the client states, "Sometimes just lose interest in what's going on and just zone out." Which question(s) by the nurse will develop the best therapeutic communication with this client? Select all that apply.

"Can you think of anything that may be triggering this?" "What specifically is happening around you when this occurs?" "Can you describe this dissociative experience?'

The nurse has an admission interview with a client receiving counseling. Which statement reflects the orientation phase of the nurse-client relationship?

"Hello, I am the nurse that will be performing your admission interview today."

The nurse uses a variety of therapeutic communication skills when working with clients. Which is a therapeutic goal that can be accomplished through the use of therapeutic communication skills?

Assess the client's perception of a problem

The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior?

"It looks like you're searching for something. Is that right?"

A client is being counseled by the nurse about family conflict. The client asks the nurse, "Should I go home for the weekend?" Which response by the nurse would demonstrate using the reflection communication technique?

"Should you go home for the weekend?"

A nurse is working with a client whose background is very different from the nurse. Which is a good question to ask to assure the nurse can be effective working with this client?

"What experiences do I have with people with different backgrounds?"

During the mental status assessment, the client whispers, "The CIA is stalking and planning to kidnap me." Which is the best response by the nurse?

"What kinds of things have been happening?"

When a novice psychiatric nurse shares with the nurse manager that talking about sexual abuse with clients is very uncomfortable, which would be the most effective response from the nurse manager?

"What specifically makes you uncomfortable?'

A client states to the nurse, "my parent screamed at me in front of several people in the grocery store when I dropped the eggs." Which statement will be an empathetic response to this client?

"You must have been embarrassed when your parent yelled at you in the grocery store."

A client states, "It's been so long since l've been with my family." Which statement by the nurse demonstrates restating of the client's sentence?

"You say you haven't seen your family in a while."

The nurse is talking with a client that states, "I am so sad today. It is the anniversary of my parent death." Which response by the nurse may impede the communication process between the nurse and client?

"You will feel better tomorrow."

During the admission interview, the nurse asks the client about what led to their hospitalizatio The dient responds, "They lied about me. They said I murdered my mother. You're the killers. Yo allkilled my mother. She died before I was born." Which is the best response by the nurse?

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

A client diagnosed with a mental illness asks the nurse, "Does mental illness run in your fai Which response to the client by the nurse would be therapeutic?

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

A client diagnosed with depression is being counseled by the nurse for cognitive distortions. The client says, "Bad things always happen to me." Which response by the nurse would be therapeutic?

'Tell me about a time when things went your way."

The nurse fails to assess personal values surrounding a client's gender assignment before caring for a client who is transgender. Which issue is the nurse at most at risk for that may hinder development of the nurse-client relationship?

Holding a prejudice toward this client

The nurse is sitting down with a client to begin a conversation. Which position will the nurse take to convey acceptance of the client?

Sitting upright facing the client with both feet on the floor

A psychiatric-mental nurse is preparing to meet a new client. Which principles of therapeutic communication is/are important for the nurse to follow?

Avoid a social relationship Maintain client confidentiality Implement interventions from a theoretical base. Maintain a nonjudgemental attitude

The nurse is talking with the client and demonstrates concern for the way the client is feeling by using verbal affirmations and paraphrasing to show understanding. What communication techniques are being used by the nurse?

Active listening

A nurse has invited a client to sit down and have therapeutic communication. Approximately how far from the client will the nurse place the chair to facilitate this conversation comfortably?

3 to 6 ft

A nurse is conducting a group session with multiple clients. Which client scenario would the nurse follow-up with the client regarding conflicting verbal and non-verbal messages?

A client stating, "I am doing great" and is slouched in their seat

A nursing student has been required to produce a process recording after conducting an admission assessment of a new client. Which of the following would be included in a process recording?

A reflection on the effectiveness of the communication between the student and the client

A psychiatric-mental health nurse must perform a physical examination on a newly admitted client. What is the nurse's priority action before entering the client's personal space for the examination?

Asking for the client's permission

The nurse is performing an admission assessment for a client on the behavioral health unit with depression and anxiety. Which goal of therapeutic communication will the nurse prioritize?

Establish a therapeutic nurse-client relationship.

A client was admitted to the psychiatric unit 2 days ago. Upon assessment, the client states, "You locked me up and threw away the key." What is the most therapeutic response made by the nurse to the client?

It must be frustrating to feel locked up.

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?

While the nurse and client are in a therapy session, the nurse says to the client, "You become very anxious when we start talking about your drinking." Which technique is the nurse using with this statement?

Making an observation

A nurse is interviewing a client who is describing difficulties with their family. The client begins crying and says, "I don't want to talk about this anymore." What boundary would the nurse be mindful to avoid crossing with the client?

Psychological

The nurse is conducting a presentation on the importance of medication compliance to a community group. Which zone is an acceptable distance between a speaker and an audience?

Public

Which zone is an acceptable distance between a speaker and an audience?

Public

A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should:

Reflect critically on the student's own life experiences, perspectives, and characteristics.

The nurse wears a cross and has a Facebook page displaying pictures of the family, home ar updates on what the nurse is currently doing. These actions are examples of what?

Self-disclosure

Which of the following is true about self disclosure?

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

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse

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

Showing family photos. Telling the client the nurse attended a weight loss meeting. Directing the client to the nurse's facebook page.

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

Silence

The nurse asks the client, "What was it like for you when you first realized you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic?

Sit quietly until the client responds.

A client has undergone diagnostic testing to determine whether she has breast cancer. She goes shopping at the mall to stop thinking about the possibility of cancer. She is using which of the following defense mechanisms?

Suppression

The nurse asks a client diagnosed with bipolar disorder how they are feeling today. The client replies, "guns and bombs are exploding". Which documentation by the nurse would be appropriate for the client?

Symbolism

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

The client is intellectualizing this traumatic event in order to deal with the emotions involved

The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior?

The client may be reluctant to dialogue despite the statement to the contrary

The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use?

Using gentle touch during activities of daily living.

Which communication technique involves expressing uncertainty about the reality of the client's perception?

Voicing doubt

A psychiatric-mental health is completing a self-reflection with the goal of "know thyself" in ord to care for their clients better. What is a question that the nurse can reflect on that encourages self-reflection?

What significant traumatic life events have you experienced?

A psychiatric-mental health nurse has noticed a client's use of unconscious defense mechanis Which of the following would be classified as defense mechanisms? Select all that apply.

affiliation denial devaluation idealization

A nurse is caring for a client during a counseling session. Which approach made the nurse is utilizing active listening toward the client?

listening to what the client is saying and interpreting or responding objectively