CHAPTER 3 COMMUNICATION

38. Which nurse-client communication-centered skill implies "correctness"? 1. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification. 2. The nurse communicates an understanding of the client's world from the client's internal frame of reference, with sensitivity to the client's current feelings, and the ability to communicate this understanding in a language attuned to the client. 3. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent. 4. The nurse communicates specific terminology rather than abstractions in the discussion of the client's feelings, experiences, and behaviors.

1."Respect," not correctness, is the responsive dimension that is characterized in this example. 2. "Empathetic understanding," not correctness, is the responsive dimension that is character- ized in this example. 3. "Genuineness," not correctness, is the responsive dimension that is characterized in this example. ✅4. "Correctness" is the responsive dimension that is characterized in this example TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review responsive dimensions of the client-nurse relationship.

52. Collards, cornbread, and okra are to the diet of the African American client as tortillas, black beans, and enchiladas are to the diet of the: 1. Native American client. 2. Mormon (the Church of Jesus Christ of Latter Day Saints) client. 3. Asian/Pacific Island client. 4. Latino American client.

The African American diet differs little from that of the mainstream culture. Some African Americans follow their heritage and enjoy what has come to be known as "soul" food. Included are poke salad, collard greens, okra, beans, corn, black-eyed peas, grits, cornbread, and fried chicken. These foods also are enjoyed by most of the population of the southern United States. 1. Meat and corn products have been identified as preferred foods of Native Americans. Fruits and vegetables are often scarce in their defined Indian geographical regions. Because fiber intake is low, and saturated fat intake is increasing, nutritional deficiencies are com- mon among tribal Native Americans. 2. Alcohol is considered taboo for members of the Mormon religion, as are coffee and tea, which contain caffeine. For some Mormons, this taboo extends to cola and other caffeinat- ed beverages, but usually not to chocolate. 3. Although rice, vegetables, and fish are the main staple foods in the diet of Asian Americans, with Western acculturation their diet is changing to include the consumption of meat and fats. Because many Asian Americans are lactose intolerant, they seldom drink milk or consume dairy products. ✅4. Foods such as tortillas, black beans, rice, corn, beef, pork, poultry, and a variety of fruits make up the preferred Latino American diet. Many Latino Americans are lactose intolerant. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand that there is much variation in diets across cultures, and that the interaction of certain foods with medica- tions or mood is of great importance in psychi- atric care.

19. Demanding proof from the client is to "challenging" as persistent questioning of the client and pushing for answers the client does not wish to discuss is to: 1. "Advising." 2. "Defending." 3. "Rejecting." 4. "Probing."

"Challenging" and "probing" are blocks to ther- apeutic communication. Challenging by the nurse puts the client on the defensive by calling into question the client's feelings and demanding proof of the client's expressions. Example: "If you are dead, why is your heart still beating?" 1. "Advising" by the nurse assumes that the "nurse knows best" and the client cannot think for himself or herself. Example: "I think youshould..."or"Whydon'tyou...." 2. "Defending" by the nurse attempts to protect someone or something from verbal attack. It implies that the client has no right to express ideas, opinions, or feelings. Example: "I'm sure your psychiatrist has only your best interest in mind." 3. "Rejecting" occurs if the nurse refuses to consider or shows contempt for the patient's ideas or behavior. Example: "Let's not discuss ..."or"Idon'twanttohearabout...." ✅4. Probing by the nurse involves persistently questioning the client and pushing for answers the client does not wish to reveal. Example: "Give me the details about your sexual abuse." TEST-TAKING HINT: The test taker must under- stand that because "probing" causes the client to feel used and valued only for what is shared with the nurse, it is considered a block to therapeutic communication.

11. Delving further into a subject, idea, experience, or relationship is to "exploring" as taking notice of a single idea, or even a single word, is to: 1. "Broad opening." 2. "Offering general leads." 3. "Focusing." 4. "Accepting."

"Exploring" by the nurse helps the client feel free to talk and examine issues in more depth. Example: "Tell me about what happened before your admission." 1. "Broad opening" by the nurse allows the client to take the initiative in introducing the topic, and emphasizes the importance of the client's role in the interaction. Example: "Tell me what you're thinking." 2. "Offering general leads" by the nurse encour- ages the client to continue. Example: "Yes, I understand." "Go on." "And after that?" ✅3. "Focusing" by the nurse allows the client to stay with specifics and analyze prob- lems without jumping from subject to subject. Example: "Could we continue talking about your infidelity right now?" 4. "Accepting" conveys to the client that the nurse comprehends the client's thoughts and feelings. This also is one of the ways that the nurse can express empathy. Example: "It sounds like a troubling time for you." TEST-TAKING HINT: When answering an analogy, it is important to recognize the relationships of subject matter within the question. In this question, delving further into a subject, idea, experience, or relationship is the definition of "exploring."

50. A kosher diet is to the Jewish client as a halal diet is to the: 1. Mormon (the Church of Jesus Christ of Latter Day Saints) client. 2. Muslim client. 3. Asian/Pacific Island client. 4. Native American client.

"Kosher" refers to a diet that is clean or fit to eat according to Jewish dietary laws (Leviticus 11). The dietary laws forbid eating pork and crustaceans, such as shellfish, lobster, crab, shrimp, or crawfish. 1. In addition to alcohol, coffee and tea, which contain caffeine, are considered taboo for members of the Mormon religion. For some Mormons, this taboo extends to cola and other caffeinated beverages, but usually not to chocolate. ✅2. In Arabic-speaking countries, the term "halal" refers to anything permissible under Islamic law. In the English language, it most frequently refers to food or dietary laws. Muslims who adhere to these dietary laws eat only meats that have been slaughtered according to traditional guidelines. Similar to Jewish dietary laws, Islamic law also forbids the consumption of pork. 3. Although rice, vegetables, and fish are the main staple foods of Asian Americans, with Western acculturation their diet is changing to include the consumption of meat and fats. Because many Asian Americans are lactose intolerant, they seldom drink milk or con- sume dairy products. 4. Meat and corn products have been identified as preferred foods of Native Americans. Fruits and vegetables are often scarce in their defined Indian geographical regions. Because fiber intake is low, and saturated fat intake is increasing, nutritional deficiencies are com- mon among tribal Native Americans. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand that there is much variation in diets across cultures, and that the interaction of certain foods with medica- tions or mood is of great importance in psychi- atric care.

18. Indicating that there is no cause for anxiety is to "reassuring" as sanctioning or denouncing the client's ideas or behaviors is to: 1. "Approving/disapproving." 2. "Rejecting." 3. "Interpreting." 4. "Probing."

"Reassuring"and"approving/disapproving"are blocks to therapeutic communication. Reassurance by the nurse indicates to the client that there is no cause for anxiety. Devaluing the client's feelings may discourage the client from further expression of feelings. Example: "I wouldn't worry about that if I were you. ✅1. "Approving/disapproving" implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are good or bad. Example: "That's good. I'm glad that you . . . or "That's bad. I'd rather you wouldn't . . . ." 2. "Rejecting" occurs if the nurse refuses to con- sider or shows contempt for the client's ideas or behavior. Example: "Let's not discuss . . ."or "Idon't want to hear about...." 3. "Interpreting" by the nurse seeks to make conscious that which is unconscious by telling the client the meaning of his or her experi- ences. Example: "What you really mean is. . . " or "On an unconscious level you really wantto...." 4. "Probing" by the nurse persistently questions the client and pushes for answers the client does not wish to reveal. Example: "Tell me how you feel about your mother now that she's dead." TEST-TAKING HINT: When answering an analogy, it is important for the test taker to recognize the relationships of subject matter within the question. In this question, indicating that there is no cause for anxiety is an example of "reassuring."

13. The nurse's lack of verbal communication for therapeutic reasons is to "silence" as the nurse's ability to process information and examine reactions to the messages received is to: 1. "Focusing." 2. "Offering self." 3. "Restating." 4. "Listening."

"Silence" by the nurse gives the client an oppor- tunity to collect and organize thoughts, think through a point, or consider reprioritizing subject matter. Example: Sitting with a client and nonver- bally communicating interest and involvement. 1. "Focusing" by the nurse allows a client to stay with specifics and analyze problems without jumping from subject to subject. Example: "Could we continue talking about your concerns with your family?" 2. "Offering self" by the nurse offers the client availability and emotional support. Example: "I'm right here with you." 3. "Restating" by the nurse repeats to the client the main thought expressed. Example: "You say that you're angry at your husband?" ✅4. "Listening" by the nurse is the active process of receiving information and examining one's reaction to the messages received. Example: Maintaining eye contact, open posture, and receptive nonverbal communication TEST-TAKING HINT: When answering an analogy, it is important to recognize the relationships of subject matter within the question. In this question, the nurse's lack of verbal communication for therapeutic reasons is the definition of "silence."

44. A Native American client comes to the emergency department with signs and symp- toms of double pneumonia. The client states, "I will not agree to hospital admission unless my shaman is allowed to continue helping me." Which would be an appropriate way for the nurse to handle this situation? 1. Tell the client that the shaman is not allowed in the emergency department. 2. Contact the shaman and have the shaman meet the attending physician in the emergency department. 3. Have the shaman talk the client into admission without the shaman. 4. Explain to the client that the shaman is responsible for the client's condition.

. 1. Religion and health practices are intertwined in the Native American culture, and the med- icine man (or woman), called a "shaman," is part of the belief system. Refusing to allow the shaman to be a part of the client's health care may result in the client's refusing needed treatment. ✅2. U.S. Indian Health Service and Native American healers have respectfully collab- orated regarding health care for many years. Physicians may confer with a shaman regarding the care of hospitalized Native American clients. The nurse should comply with the client's request and make contact with the shaman. 3. Acting in this manner shows disrespect for the client's culture and may result in the client's refusing needed treatment. 4. Research studies have shown the importance of the dual health-care system with regard to the overall wellness of Native Americans. Putting blame on the shaman for the client's condition would alienate the client and undermine the client's belief system. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must analyze, compare, and evaluate worldviews to apply the concepts of cul- ture to psychiatric/mental health nursing assess- ment and practice.

16. Which of the following are examples of therapeutic communication techniques? Select all that apply. 1. "Tell me about your drunk driving record." 2. "How does this compare with the time you were sober?" 3. "That's good. I'm glad that you think you can stop drinking." 4. "I think we need to talk more about your previous coping mechanisms." 5. "What led up to your taking that first drink after 5 sober years?"

. 1. This is an example of the nontherapeutic technique of "probing." This approach may put the client on the defensive and block fur- ther interaction. It would be better to say, "Tell me how your drinking is affecting your life." ✅2. This is an example of the therapeutic technique of "encouraging comparisons," which asks that similarities and differ- ences be noted. 3. This is an example of the nontherapeutic tech- nique of "approving/disapproving," which sanc- tions or denounces the client's ideas or behav- iors. It would be better to say, "Let's explore ways that you can successfully stop drinking." ✅4. This is an example of the therapeutic technique of "focusing," which poses a statement that helps the client expand on a topic of importance. ✅5. This is an example of the therapeutic tech- nique of "placing the event in time or sequence," which clarifies the relationship of events in time so that the nurse and client can view them in perspective TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review therapeutic and nontherapeutic communication techniques

47. Culture-specific syndromes occur in individuals who are especially vulnerable to stressful life events. Which culture-specific syndrome would be reflective of the term "voodoo"? 1. With symptoms of terror, nightmares, delirium, anxiety, and confusion, witches are believed to induce this illness. 2. With symptoms of sudden collapse, a person cannot see even though his eyes are wide open. 3. With hexing, witchcraft, and the evil influences of another person, illness and even death may result. 4. With a fixed stare by an adult, a child or another adult may become ill.

1 This Native American culture-specific syn- drome is considered an illness of attribution induced by witchcraft and is called "ghost sickness." 2. This culture-specific syndrome is a dissocia- tive phenomenon known as "falling out." This syndrome is indigenous to the southern United States and the Caribbean. ✅3. This culture-specific syndrome is consid- ered an illness of attribution induced by witchcraft and is called "voodoo." This syndrome is indigenous to the southern United States, the Caribbean, and Latin America. 4. This culture-specific syndrome is considered an illness of attribution induced by witchcraft and is called "evil eye." This syndrome is indigenous to the Mediterranean area and Latin America. TEST-TAKING HINT: It is important for the test taker to understand that certain forms of mental distress are restricted to specific areas of culture. The test taker must become familiar with and study culture-specific syndromes to answer this question correctly.

53. A health-care team, an Asian American client, and several members of the client's family are meeting together to discuss the client's imminent discharge. During this time, the client does not speak and makes eye contact only with family members. From a cul- tural perspective, which nursing assessment accurately describes the client's behavior? 1. The client has a lack of understanding of the disease process. 2. The client is experiencing denial related to the client's condition. 3. The client is experiencing paranoid thoughts toward authority figures. 4. The client has respect for members of the health-care team.

1. Although this client may have a knowledge deficit related to the disease process experienced, this assessment is not from a cultural perspective. 2. Although this client may be experiencing denial related to imminent discharge, this assessment is not from a cultural perspective. 3. If this client is experiencing paranoid thoughts, imminent discharge may not be appropriate. Also, this assessment is not from a cultural perspective. ✅4. Nonverbal communication is very important to the Asian American culture. Maintaining distance, avoiding direct eye contact, and silence are signs of respect. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must analyze, compare, and evaluate worldviews to apply the concepts of cul- ture to psychiatric/mental health nursing assess- ment and practice.

10. A client admitted for alcohol detoxification states, "I don't think my drinking has any- thing to do with why I am here in the hospital. I think I have problems with depres- sion." Which statement by the nurse is the most therapeutic response? 1. " I think you really need to look at the amount you are drinking and consider the effect on your family." 2. "That's wrong. I disagree with that. Your admission is because of your alcohol abuse and not for any other reason." 3. "I'm sure you don't mean that. You have to realize that alcohol is the root of your problems." 4. "I find it hard to believe that alcohol is not a problem because you have recently lost your job and your driver's license."

1"Giving advice" is a nontherapeutic block to communication. By telling the client what to do, the nurse takes away the client's ability to sort out options and determine the pros and cons of various choices. 2. By indicating opposition to the client's ideas or opinions, the nurse is using the communi- cation block of "disagreeing." 3. "Interpreting" is a block to communication by telling the client the meaning of the client's experiences. This puts the control of the com- munication process in the hands of the nurse, rather than exploring and assessing the client's true meaning of what is being communicated. ✅4. When using the therapeutic communication technique of "voicing doubt," the nurse expresses uncertainty as to the reality of what is being communicated. TEST-TAKING HINT: The test taker should review definitions and purposes of therapeutic communi- cation techniques to answer this question correctly.

55. A bouquet of roses delivered to a psychiatric unit is for a young Vietnamese American woman who has been admitted with a general anxiety disorder. When presented with the roses, the startled client bursts into tears. What understanding does the nurse have regarding the Vietnamese culture that would explain this response? 1. The client is overwhelmed by the sender's thoughtfulness. 2. The client is allergic to roses. 3. The client dislikes any flowers that have thorns. 4. The client feels that flowers are only for the dead.

1. Being overwhelmed by thoughtfulness is not reflective of just one culture. 2. Allergies have nothing to do with cultural diversity. 3. Thorns have nothing to do with cultural diversity. ✅4. In the Vietnamese American culture, sending flowers may be startling because flowers are reserved for the rites for the dead. TEST-TAKING HINT: To answer this question cor- rectly, it is important for the test taker to under- stand how death and dying practices may affect individuals

28. Which nurse-client communication-centered skill implies "empathic understanding"? 1. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification. 2. The nurse communicates an understanding of the client's world from the client's internal frame of reference, with sensitivity to the client's current feelings, and the ability to communicate this understanding in a language attuned to the client. 3. The nurse communicates that the nurse is an open person who is self-congruent, authentic, and transparent. 4. The nurse communicates specific terminology rather than abstractions in the discussion of the client's feelings, experiences, and behaviors.

1. "Respect," not empathic understanding, is the responsive dimension that is characterized in this example. ✅2. "Empathetic understanding" is the responsive dimension that is characterized in this example. Empathetic understand- ing views the client's world from the client's internal frame of reference. 3."Genuineness," not empathetic understand- ing, is the responsive dimension that is char- acterized in this example. 4. "Correctness," not empathetic understanding, is the responsive dimension that is character- ized in this example. TEST-TAKING HINT: To answer this question cor- rectly, the test taker first must understand the nurse-client communication-centered skill "empathetic understanding," and then be able to choose the answer that supports this term.

31. Which nurse-client communication-centered skill implies "genuineness"? 1. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification. 2. The nurse communicates an understanding of the client's world from the client's internal frame of reference, with sensitivity to the client's current feelings, and the ability to communicate this understanding in a language attuned to the client. 3. The nurse communicates that the nurse is an open person who is self-congruent,authentic, and transparent. 4. The nurse communicates specific terminology rather than abstractions in the discussion of the client's feelings, experiences, and behaviors.

1. "Respect," not genuineness, is the responsive dimension that is characterized in this example. 2. "Empathetic understanding," not genuine- ness, is the responsive dimension that is char- acterized in this example. ✅3. "Genuineness" is the responsive dimen- sion that is characterized in this example. 4. "Correctness," not genuineness, is the responsive dimension that is characterized in this example TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review responsive and action dimensions for therapeutic nurse-client relationships.

42. The place where communication occurs influences the outcome of the interaction. Which of the following are aspects of the environment that communicate messages? Select all that apply. 1. Dimension. 2. Distance. 3. Territoriality. 4. Volume. 5. Density.

1. A measurement of length, width, and depth is the definition of "dimension" according to Webster's Dictionary and has nothing to do with the effect of environment on communication. ✅2. "Distance" is the means by which various cultures use space to communicate. The following are four kinds of distances: inti- mate distance, personal distance, social distance, and public distance. ✅3. "Territoriality" influences communication when an interaction occurs in the territory "owned" by one or the other. For example, a nurse may choose to conduct a psychosocial assessment in an interview room as opposed to the client's room ✅4. Increased noise volume in the environ- ment can interfere with receiving accurate incoming verbal messages. ✅5. "Density" refers to the number of people within a given environmental space and has been shown to influence interaction. Some studies show that high density is associated with aggression, stress, crimi- nal activity, and hostility toward others TEST-TAKING HINT: To answer this question cor- rectly, the test taker must note important words in the question, such as "environment." Because dimension has nothing to do with the environment in which communication takes place, "1" can be eliminated.

41. A client on a psychiatric unit is telling the nurse about losing an only child in a plane crash and about anger toward the airline. In which situation is the nurse demonstrat- ing active listening? 1. Agreeing with the client. 2. Repeating everything the client says to clarify. 3. Assuming a relaxed posture and leaning toward the client. 4. Expressing sorrow and sadness regarding the client's loss.

1. Agreeing or disagreeing sends the subtle mes- sage that nurses have the right to make value judgments about client decisions. 2. Repeating everything the client says is called "parroting." This is considered an automatic response and is not an effective communica- tion technique. ✅3.Active listening does not always require a response by the nurse. Body posture and facial expression may be all that are required for the client to know that the nurse is listening and interested in what is going on with the client. 4. Sympathy is a subjective look at another per- son's world that prevents a clear perspective of the issues confronting that person. Saying, "The loss of your child is a major change for you. How do you think it will affect your life?" shows empathy, which views the person's world from the person's internal reference, and verbalizes this understanding in a lan- guage attuned to the TEST-TAKING HINT: It is important for the test taker to understand that being attentive to what the client is saying verbally and nonverbally is the foundation for active listening.

45. On an in-patient psychiatric unit, an Asian American client states, "I must have warm ginger root for my migraine headache." The nurse, understanding the effects of cultural influences, attaches which meaning to this statement? 1. The client is being obstinate and wants control over his or her care. 2. The client believes that ginger root has magical qualities. 3. The client believes that health restoration involves the balance of yin and yang. 4. Asian Americans refuse to take traditional medication for pain.

1. Although any member of any cultural back- ground may become obstinate and controlling, this behavior is not traditionally associated with the Asian American culture. 2.Magical healing is not traditionally associated with the Asian American culture. Some tradi- tional Latino Americans have folk beliefs that include a folk healer known as a "curandero" (male) or "curandera" (female). When illness is encountered, treatments may include mas- sage, diet, rest, indigenous herbs, magic, and supernatural rituals. ✅3. Restoring the balance of yin and yang is the fundamental concept of Asian health practices. Yin and Yang represent opposite forces of energy, such as hot/cold, dark/light, hard/soft, and masculine/femi- nine. The balance of these opposite forces restores health. In the question scenario, the client believes that the warm ginger root will bring the forces of hot and cold into balance and relieve her headache symptoms. 4. There is no evidence that Asian Americans have adverse reactions to or show reluctance in taking pain medications. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must analyze, compare, and evaluate worldviews to apply the concepts of cul- ture to psychiatric/mental health nursing assess- ment and practice.

56. An elderly Vietnamese man is admitted to a psychiatric unit with a diagnosis of major depression. The client is despondent over the recent death of his wife. The nursing student suggests calling a member of the clergy for him. The client vehemently refuses. What understanding does the nursing student need to have regarding this Vietnamese client? 1. The client has, for the most part, atheistic beliefs. 2. The client is associating clergy visitation with last rites. 3. The client is having a difficult time understanding English. 4. The client has little respect for Western medicine or hospital employees.

1. Buddhism is the predominant religion among the Vietnamese. Nowhere in the stem is athe- ism mentioned or suggested. ✅2. Clergy visitation is usually associated with the last rites by Vietnamese individuals, especially those influenced by Catholicism, and can be upsetting to hos- pitalized clients. 3. There is no mention of a language barrier in the stem, and this cannot be assumed. 4. Although restoring the balance of yin and yang, or cold and hot, is the fundamental concept of Asian health practices, this practice is respectfully intertwined with Western medicine. TEST-TAKING HINT: To answer this question cor- rectly, it is important for the test taker to under- stand how certain cultural influences may affect individuals.

22. A client on a psychiatric unit says, "It's a waste of time to be here. I can't talk to you or anyone." Which would be an appropriate therapeutic nursing response? 1. "I find that hard to believe." 2. "Are you feeling that no one understands?" 3. "I think you should calm down and look on the positive side." 4. "Our staff here is excellent, and you are in good hands."

1. Expressing uncertainty as to the reality of the client's perceptions is the therapeutic communication technique of "voicing doubt." This technique is used most often when a client is experiencing delusional thinking, not frustration as in the question. ✅ 2. Putting into words what the client has only implied or said indirectly is "verbaliz- ing the implied." This clarifies that which is implicit rather than explicit by giving the client the opportunity to agree or dis- agree with the implication. 3. "Giving advice" tells the client what to do or how to behave, and implies that the nurse knows what is best. It also reinforces that the client is incapable of any self-direction. It nurtures the client in the dependent role by discouraging independent thinking. 4. "Defending" attempts to protect someone or something from verbal attack. Defending does not change the client's feelings and may cause the client to think the nurse is taking sides against the client TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to distinguish the use of therapeutic and nontherapeutic com- munication techniques. The question is asking for a therapeutic technique, and so "3" and "4" can be eliminated immediately.

4. Which statement is an example of the therapeutic communication technique "focusing"? 1. "You say you're angry, but I notice that you're smiling." 2. "Are you saying that you want to drive to Hawaii?" 3. "Tell me again about Vietnam and your feelings after you were wounded." 4. "I see you staring out the window. Tell me what you're thinking."

1. Here the nurse uses a therapeutic technique of "confrontation" to bring incongruence or inconsistencies into awareness. 2.This therapeutic technique of "clarification" is an attempt by the nurse to check the understanding of what has been said by the client and helps the client make his or her thoughts or feelings more explicit. ✅3. This is an example of the therapeutic communication technique of "focusing." The nurse uses focusing to direct the conversation on a particular topic of importance or relevance to the client. 4. The nurse is "making an observation" and using the therapeutic communication tech- nique of "broad opening," which helps the client initiate the conversation and puts the client in control of the content. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be familiar with the ther- apeutic communication technique of "focusing."

27. In dealing therapeutically with a variety of psychiatric clients, the nurse knows that incorporating humor in the communication process should be used for which purpose? 1. To diminish feelings of anger. 2. To refocus the client's attention. 3. To maintain a balanced perspective. 4. To delay dealing with the inevitable.

1. Humor has a high potential for being misin- terpreted as uncaring by individuals not involved in the situation. Humor used inap- propriately can increase, suppress, or repress anger. 2. Humor is a distraction and is not effectively used to refocus a client's attention. ✅3. Humor is an interpersonal tool, is a healing strategy, and assists in maintaining a balanced perspective. The nurse's goal in using humor is to bring hope and joy to the situation and to enhance the client's well-being and the therapeutic relationship. Humor should not be used to delay dealing with the inevitable because procrastination increases stress and anxiety and prolongs the healing process TEST-TAKING HINT: The test taker must review the appropriate uses of humor to answer this question correctly.

54. A depressed middle-aged Navajo woman with metastatic breast cancer refuses to discuss her grave condition with the attending physician. Which understanding does the nurse have regarding the cultural aspects of death and dying in this client's culture? 1. The client believes that talking about death will lead to "falling out." 2. The client has an intuitive fear of death and is avoiding references to it. 3. The client believes that discussion with the physician will cause her to die. 4. The client believes that discussion will prevent her reincarnation.

1. In the African American, not the Navajo, culture, one response to hearing about the death of a family member is "falling out," which is manifested by sudden collapse and paralysis and the inability to see or speak. 2. In the Chinese American, not the Navajo, cul- ture, death and bereavement are centered on ancestor worship. Chinese people have an intu- itive fear of death and avoid references to it. ✅3. In the Native American culture, one death taboo involves health-care providers' talking to clients about fatal disease or illness. Presentation in the third person is helpful in managing these discussions. The health-care provider must never suggest that the client is dying. To do so would imply that the provider wishes the client dead. If the client does die, it would imply that the provider has evil powers. 4. In the Vietnamese American, not the Navajo, culture, Buddhism is the predominant religion. Attitudes toward death are influenced by the Buddhist emphasis on cyclic continuity and reincarnation. Many Vietnamese believe that birth and death are predestined. TEST-TAKING HINT: It is important for the test taker to understand that bereavement practices are greatly influenced by the enormous variety of cultural and religious backgrounds.

48. An African American client on a psychiatric unit has been diagnosed with postpartum depression. During an interaction with the nurse, the client states, "No one can help me. I was an evil person in my youth and now I must pay." The nurse, understanding the effects of cultural influences, attaches which meaning to this statement? 1. The client is having delusions of persecution. 2. The client is depressed and just wants to be left alone. 3. African Americans do not believe in psychiatric help. 4. The client believes that illness is God's punishment for sins.

1. In this case, the client is not suffering from delusions of persecution. Rather, the client is incorporating the belief that ill- ness is a punishment from God. This health belief system is part of the African American culture. 2.There is no indication in the question stem that the client wants to be left alone. 3. The African American health belief system does not preclude psychiatric care or treatment. ✅4. Some African Americans receive their health care from local folk practitioners. Incorporated into this system is the belief that health is a gift from God, whereas ill- ness is a punishment from God or a retri- bution for sin and evil. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must analyze, compare, and evaluate worldviews to apply the concepts of cul- ture to psychiatric/mental health nursing assess- ment and practice

9. The client states, "I'm not sure the doctor has prescribed the correct medication for my sad mood." Which would be a therapeutic response? 1. "A lot of clients are nervous about new medications. I'll get you some information about it." 2. "So you think that this medication is not right for you?" 3. "Why do you think that this medication won't help your mood?" 4. "Your doctor has been prescribing this medication for years, and it really does help people."

1. In this statement, the nurse is lumping the client with "a lot of clients" and has belittled this individual client's feelings. "Belittling" is a nontherapeutic block to communication. ✅2. By "verbalizing the implication" that the client thinks the medication is not good for the client's problem, the nurse puts into words what the nurse thinks the client is saying. If the implication is incorrect, it gives the client an opportunity to clarify the statement further 3. By asking a "why" question, the nurse is "requesting an explanation," which the client may not be able to give and which may put the client on the defensive in the process. Asking for reasons for thoughts, feelings, or behaviors can be frustrating for the client and detrimental to the establishment of the nurse-client relationship. Requesting an explanation is a nontherapeutic block to communication. 4. This statement defends the physician. "Defending," a nontherapeutic technique, is an attempt to protect someone or something from verbal attack and depreciates the concerns of the client. Defending hampers the establish- ment of trust in the nurse-client relationship. TEST-TAKING HINT: To answer this question correctly, the test taker must review the names and definitions of therapeutic communication techniques and be able to use them in situations.

57. A religious Jewish client on a psychiatric unit pushes the tray away without eating any of the ham, rice, and vegetable entrée. Which information about Jewish culture would the nurse attribute to this behavior? 1. The client is allergic to the rice. 2. The client is a vegetarian. 3. The client follows religious dietary laws. 4. The client follows the dietary laws of Islam.

1. Information about food allergies would have been presented in the stem and provided to the nurse in the intake interview. 2. Information about vegetarianism would have been presented in the stem and provided to the nurse in the intake interview. ✅3. The client is following Jewish dietary law, which forbids the consumption of pork, which includes ham. Swine are considered unclean in Judaism. 4. A Jewish client would not follow the dietary laws of Islam; however, pork also is forbidden according to Islamic dietary law TEST-TAKING HINT: It is important for the test taker to understand which foods and drinks are considered taboo and must be abstained from for religious or cultural reasons.

29. A client on an in-patient psychiatric unit has pressured speech and flight of ideas and is extremely irritable. During an intake assessment, which is the most appropriate nurs- ing response? 1. "I think you need to know more about your medications." 2. "What have you been thinking about lately?" 3. "I think we should talk more about what brought you into the hospital." 4. "Yes, I see. And go on please."

1. It is important to note that the question is asking what the nurse is supposed to do dur- ing an intake assessment. Teaching during an intake assessment and when the client is exhibiting signs of mania and is unable to learn would be inappropriate. 2. Asking a "broad opening" question about what the client has been thinking about would not assist the nurse in gathering infor- mation specific to an intake assessment and is inappropriate. ✅3. The nurse in this example is using the therapeutic communication technique of "focusing." Focusing is an important facilitator when doing an assessment and when dealing with a client exhibiting flight of ideas. 4. The nurse in this example is using the thera- peutic communication technique of "general leads." Although this is a therapeutic commu- nication technique, it is inappropriate to use when dealing with a client exhibiting signs of mania. It encourages the client to continue his or her scattered thought pattern and does not allow the nurse to gather the needed information for the intake assessment. TEST-TAKING HINT: It is important when using ther- apeutic communication techniques that the test taker understand the circumstances in which they are used most effectively. Offering general leads may be used best in situations in which a client is less likely to talk, such as with a client with major depression, and focusing would help when working with a client exhibiting flight of ideas.

58. An Orthodox Jewish client is upset. The client's son has recently committed suicide. The client tearfully tells the nurse that the son has disgraced the family and cannot be buried with honors. Which intervention should the nurse implement? 1. Ask the client why the son won't be buried with honors. 2. Accept that the client is upset and just needs time alone. 3. Call the psychiatrist for an antianxiety medication. 4. Sit with the client and allow expression of loss and sorrow.

1. Requesting an explanation by asking this client to provide reasons for this event might put the client on the defensive, and close the door to further communication. 2. The nurse cannot assume that when a client is upset he or she benefits by being alone. Although this sometimes may be the case, most upset clients appreciate being listened to and allowed to verbalize their concerns. 3. Treating the client's symptoms with medications, instead of exploring the underlying problem, is of no value to the client and should be considered a counterproductive method of treatment ✅4. Sitting with a client and nonverbally com- municating interest and involvement is a nonthreatening therapeutic technique that allows the client to be comfortably introspective and gives the client the opportunity to collect and organize thoughts. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must appreciate cultural diversity, and recognize that being present and silent may offer the comfort that is needed.

21. Which is an example of the nontherapeutic technique of "requesting an explanation"? 1. "Who made you so angry last night?" 2. "Do you still have the idea that . . .?" 3. "How could you be dead, when you're still breathing?" 4. "Why do you feel this way?"

1. The nontherapeutic technique of "indicating the existence of an external source" attributes thoughts, feelings, and behavior to others or outside influences. 2. The nontherapeutic technique of "testing" involves appraising the client's degree of insight. Testing the client is considered non- therapeutic except when conducting a mental status examination. 3. The nontherapeutic technique of "challenging" demands proof and may put the client on the defensive. ✅4. "Requesting an explanation" is a nonther- apeutic technique that involves asking the client to provide reasons for thoughts, feelings, behaviors, and events. Asking why a client did something or feels a cer- tain way can be intimidating and implies that the client must defend his or her behavior or feelings. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be familiar with the many blocks to therapeutic communication and be able to recognize the nontherapeutic tech- nique of requesting an explanation.

25. The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. Which is the most appropriate nursing intervention? 1. Work on establishing a friendship with the client. 2. Use humor to defuse emotionally charged topics of discussion. 3. Show respect that is not based on the client's behavior. 4. Sympathize with the client when the client shares sad feelings.

1. The nurse should maintain a professional relationship with the client. Although being friendly toward a client is appropriate, establishing a friendship is considered unprofessional. 2. When emotionally charged issues are dealt with by using humor, the response may be viewed as minimizing the concerns and creat- ing a barrier to further communication. ✅3. Emotionally charged topics should be approached with respectful, sincere inter- actions. Therapeutic communication tech- niques are specific responses that encour- age the expression of feeling or ideas and convey the nurse's acceptance and respect. 4. Sympathy is a subjective look at another per- son's world that prevents a clear perspective of the issues confronting that person. Sympathy denotes pity, which should be avoided. The nurse should empathize, not sympathize, with the client. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand how to address an angry and depressed client appropri- ately. The use of humor may minimize concern, and the nurse is not to sympathize with the client; so "2" and "4" can be eliminated.

59. An elderly male client of Mexican heritage is upset and tells the nurse that the unlicensed nursing assistant attempted to help him with his morning bath. Which intervention should the nurse implement? 1. Ask the client why he refused her help. 2. Assure the client that the nursing assistant is qualified and capable. 3. Notify the physician of the client's hygiene resistance. 4. Explain to the nursing assistant that the client may be expressing modesty and embarrassment.

1. The nurse should not ask the client "why"; the client has a right to his or her feelings. Asking "why" may place the client on the defensive and may negatively affect future communication with the nurse. 2 . Assurance of the nursing assistant's capabili- ties does not address the client's actions or feelings. 3.There is no reason to call the physician at this time. ✅4. The nursing assistant should be informed that although touch is a common form of communication among Latinos, they are very modest and are likely to withdraw from any infringement on their modesty. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review culturally diverse attitudes and perceptions related to touch.

43. Culture-specific syndromes occur in individuals who are especially vulnerable to stress- ful life events. Which culture-specific syndrome would be reflective of the term "falling out"? 1. With symptoms of terror, nightmares, delirium, anxiety, and confusion, this illness is believed to be induced by witches. 2. With symptoms of sudden collapse, a person cannot see even though his or her eyes are wide open. 3. With hexing, witchcraft, and the evil influences of another person, illness and even death may result. 4. With a fixed stare by an adult, a child or another adult may become ill.

1. This Native American culture-specific syn- drome is considered an illness of attribution induced by witchcraft and is called "ghost sickness." ✅2. This culture-specific syndrome is a disso- ciative phenomenon. This syndrome, which is known as "falling out," is indige- nous to the southern United States and the Caribbean. 3. This culture-specific syndrome is considered an illness of attribution induced by witchcraft and is called "voodoo." This syndrome is indigenous to the southern United States, the Caribbean, and Latin America. 4. This culture-specific syndrome is considered an illness of attribution induced by witchcraft and is called "evil eye." This syndrome is indigenous to the Mediterranean and Latin America. TEST-TAKING HINT: It is important for the test taker to understand that certain forms of mental distress are restricted to specific areas of culture. The test taker must study and know culture-specific syndromes to answer this question correctly.

14. A client on an in-patient psychiatric unit asks the evening shift nurse, "How do you feel about my refusing to attend group therapy this morning?" The nurse responds, "How did your refusing to attend group make you feel?" Which communication technique is the nurse using in this situation? 1. Therapeutic use of "restatement." 2. Nontherapeutic use of "probing." 3. Therapeutic use of "reflection." 4. Nontherapeutic use of "interpreting."

1. This exchange is not "restatement." An exam- ple of restatement would be, "You want to know how I feel about your refusing to attend group? 2."Probing," a nontherapeutic technique, is the persistent questioning of the client and push- ing for answers that the client does not wish to discuss. This exchange is not reflective of probing. ✅3. "Reflection" therapeutically directs back to the client his or her ideas, feelings, questions, and content. Reflection also is a good technique to use when the client asks the nurse for advice. 4. This exchange is not reflective of the non- therapeutic technique of "interpreting." Interpreting seeks to make conscious that which is unconscious by telling the client the meaning of his or her experiences. An exam- ple of interpreting would be, "What you're really asking is if I approve of your not attending group therapy." TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to note the dif- ference between reflection and restatement. If the same or similar words are repeated to the client, the nurse is using restatement. If the communication directs the statement or feeling back to the client, it is reflection.

1. A client states, "I don't know what the pills are for or why I am taking them, so I don't want them." Which is an example of the therapeutic communication technique of "giving information"? 1. "You must take your medication to get better." 2. "The doctor wouldn't prescribe these pills if they were harmful." 3. "Do you feel this way about all your medications?" 4. "Let me tell you about your medication."

1. This is an example of "giving advice," which is nontherapeutic because the statement does not allow the client to make personal decisions. 2. This is an example of "defending," which is nontherapeutic because this statement would put the client on the defensive. 3. This is an example of "exploring," which is incorrect because the client has provided you with information by stating, "I don't know what the pills are for." ✅4. The nurse is offering to "give informa- tion" about the medications because the nurse has assessed from the client's state- ment that information is needed. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to distinguish the difference between "giving information," which is therapeutic, and "giving advice," which is nontherapeutic.

30. A client in an out-patient clinic states, "I am so tired of these medications." Which nursing response would encourage the client to elaborate further? 1. "I see you have been taking your medications." 2. "Tired of taking your medications?" 3. "Let's discuss different ways to deal with your problems." 4. "How would your family feel about your stopping your medications?"

1. This is an example of "giving recognition" and does not encourage the client to elaborate further, but reinforces with the client that the nurse notices the work the client is doing. ✅2. This is an example of "restating" and encourages the client to continue to talk about the topic being discussed. Restating lets the client know that the nurse has understood the expressed statement. 3. This is an example of "formulating a plan" and does not encourage the client to elabo- rate further, but does encourage the client to begin thinking of a plan on discharge. 4. This is an example of "encouraging evalua- tion." Although it can encourage the client to think about all aspects of a situation, it does not encourage the client to talk further about why the client is tired of taking the medication. TEST-TAKING HINT: The test taker must review therapeutic communication skills and understand how the different techniques can assist the nurse in different situations.

20. Which is an example of the nontherapeutic technique of "giving reassurance?" 1. "That's good. I'm glad that you. . . ." 2. "Hang in there, every dog has his day." 3. "Don't worry, everything will work out." 4. "I think you should. . . ."

1. This is an example of the nontherapeutic technique of "approving/disapproving," which sanctions or denounces the client's ideas or behaviors 2. This is an example of the nontherapeutic technique of "making stereotyped/superficial comments," which offers meaningless clichés or trite expressions. ✅3. "Giving reassurance" is a nontherapeutic technique indicating there is no cause for client anxiety. This technique involves giving the client a false sense of confi- dence and devaluing the client's feelings. It also may discourage the client from fur- ther expression of feelings if the client believes those feelings would only be downplayed or ridiculed. 4. When the nurse uses the nontherapeutic technique of "giving advice," the nurse tells the client what to do. This implies that the nurse knows what is best, and that the client is incapable of any self-direction. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be familiar with the many blocks to therapeutic communication and be able to recognize the nontherapeutic tech- nique of "giving reassurance."

8. Which is an example of the therapeutic communication technique of "clarification"? 1. "Can we talk more about how you feel about your father?" 2. "I'm not sure what you mean when you use the word 'fragile.'" 3. "I notice that you seem angry today." 4. "How does your mood today compare with yesterday?"

1. This is an example of the therapeutic com- munication technique of "focusing." The nurse uses focusing to direct the conversation on a particular topic of importance or rele- vance to the client. ✅2. This example of "clarification" is an attempt by the nurse to check the nurse's understanding of what has been said by the client and helps the client to make his or her thoughts or feelings more explicit. 3. This is an example of the therapeutic com- munication technique of "making observa- tions." This technique lets the client know that the nurse is attentive and aware of the client's situation, actions, and emotional expressions. It is the verbalization of what is perceived. 4. This is an example of the therapeutic com- munication technique of "encouraging com- parison." This technique assists the client to note similarities and differences TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review therapeutic communication techniques to pair the technique presented in the question with the examples presented in the answer choices.

17. Which is an example of the therapeutic technique of "voicing doubt"? 1. "What I heard you say was . . . ?" 2. "I find that hard to believe." 3. "Are you feeling that no one understands?" 4. "Let's see if we can find the answer."

1. This is an example of the therapeutic tech- nique of "seeking consensual validation," which searches for mutual understanding for accord in the meaning of words. ✅2. This is an example of the therapeutic technique of "voicing doubt." Voicing doubt expresses uncertainty as to the reality of the client's perceptions and is often used with clients experiencing delusional thinking. Although it may feel uncomfortable, this is a necessary technique to present reality. 3 . This is an example of the therapeutic technique of "verbalizing the implied," and voices what the client has directly hinted at or suggested. 4. This is an example of the therapeutic tech- nique of "suggesting collaboration," which is used by the nurse to work together with the client for the client's benefit. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must recognize "voicing doubt" as a therapeutic communication technique.

35. The nurse's focus on client behavior rather than on the client himself or herself is one of the many strategies of nonthreatening feedback. What is the reason for using this particular strategy? 1. This strategy reports what occurred, rather than evaluating it in terms of right or wrong or good or bad. 2. This strategy refers to what the client actually does, rather than how the nurse perceives the client to be. 3. This strategy refers to a variety of alternatives for accomplishing a particular objective and impedes premature acceptance of solutions or answers that may not be appropriate. 4. This strategy implies that the most crucial and important feedback is given as soon as it is appropriate to do so.

1. This rationale refers to the strategy where feedback focuses on description, rather than on opinion. ✅2. This is the correct rationale for this strat- egy. Feedback is descriptive rather than evaluative and focuses on the client's behavior, rather than on how the nurse conceives the client to be. When the focus is on the client, and not the behavior, the nurse may make judgments about the client. "Feedback" is a method of commu- nication for helping the client consider a modification of behavior and gives infor- mation to clients about how they are per- ceived by others. 3. This rationale focuses not on the solution, but rather on the exploration of alternatives. 4. This rationale focuses on current behavior, rather than on past behavior. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand the appro- priate use of "feedback."

33. A client who has been scheduled for electroconvulsive therapy (ECT) in the morning tells the nurse, "I'm really nervous about having ECT tomorrow." Which would be the best nursing response? 1. "I'll ask the doctor for a little medication to help you relax." 2. "It's okay to be nervous. What are your concerns about the procedure?" 3. "Clients who have had ECT say there's nothing to it." 4. "Your doctor is excellent and has done hundreds of these procedures."

1. This response avoids the client's feelings and puts the client on the defensive. ✅2. This response recognizes the client's feel- ings of nervousness and encourages more communication with regard to the ECT procedure itself. 3. This is a generalization that minimizes the client's concern and should be avoided. 4. This response offers false reassurance, which indicates that there is no need for anxiety, and discourages further discussions of thoughts and fears TEST-TAKING HINT: To answer this question cor- rectly, the test taker must review communication techniques that encourage a client's expressions of anxiety.

40. A nurse is communicating with a client on an in-patient psychiatric unit. The client moves closer and invades the nurse's personal space, making the nurse uncomfortable. Which is an appropriate nursing intervention? 1. The nurse ignores this behavior because it shows the client is progressing. 2. The nurse expresses a sense of discomfort and limits behaviors. 3. The nurse understands that clients require various amounts of personal space and accepts the behavior. 4. The nurse confronts and informs the client that the client will be secluded if this behavior continues.

1. When a nurse becomes uncomfortable by a client's invasion of personal space, the nurse should communicate and not ignore these feelings . ✅2. The nurse should express feelings of discomfort and ask the client to move back. If the nurse allows the client to invade the nurse's personal space, the nurse has missed the opportunity to role-play appropriate interpersonal boundaries. 3. Although different circumstances allow for different space lengths, communication in a professional setting should be at a distance that provides comfort for the client and the nurse. 4. Although the nurse should set limits on inap- propriate behaviors, threatening the client with seclusion would cause resentment and hostility. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the appropriate interventions for clients invading personal space. The test taker must use the least restrictive measures first, so"4" can be eliminated.

3. A client states to the nurse, "I'm thinking about ending it all." Which response by the nurse would be an example of therapeutic communication? 1. "I'm sure you won't hurt yourself." 2. "Wasn't your wife just here during visiting hours?" 3. "Why would you want to do something like that?" 4. "You must be feeling very sad right now."

1.The nurse, in "disapproving" of what the client will or will not do, denounces the client's ideas or behaviors. 2. This implies that the nurse has the right to pass judgment. "Introducing an unrelated topic" is nontherapeutic and puts the nurse, instead of the client, in control of the direction the conver- sation should go. This may occur when the nurse is feeling uncomfortable with the topic being discussed. 3. "Requesting an explanation," by asking the client to provide reasons for thoughts, feelings, behaviors, and events, can be intimidating and implies that the client must defend his or her behavior or feelings. ✅4. This is the therapeutic technique of "attempting to translate words into feel- ings," by which the nurse tries to find clues to the underlying true feelings and at the same time validates the client's statement. The nurse might then explore and delve more deeply by responding, "Can you tell me more about this sadness you feel?" TEST-TAKING HINT: The test taker first must become familiar with therapeutic communication techniques and blocks to communication. Then the test taker can distinguish between the many techniques to answer the question correctly.

2. A depressed client discussing marital problems with the nurse says, "What will I do if my husband asks me for a divorce?" Which response by the nurse would be an example of therapeutic communication? 1. "Why do you think that your husband will ask you for a divorce?" 2. "You seem to be worrying over nothing. I'm sure everything will be fine." 3. "What has happened to make you think that your husband will ask for a divorce?" 4. "Talking about this will only make you more anxious and increase your depression."

1.This is an example of "requesting an explanation," which requests the client to provide the reasons for thoughts, feeling, and behaviors, and which can be an unrealistic expectation. It also may put the client on the defensive. 2. This is an example of "giving false reassur- ance" by indicating to the client that there is no cause for fear or anxiety. This blocks any further interaction and expression of feelings by the client. ✅3 The therapeutic technique of "exploring," along with reflective listening, draws out the client and can help the client feel val- ued, understood, and supported. Exploring also gives the nurse necessary assessment information to intervene appropriately. 4. This is an example of "rejection," which shows contempt for the client's need to voice and express fears and anxiety. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must distinguish between therapeutic and nontherapeutic communication facilitators. In this question, "1," "2," and "4" all are nontherapeutic communication techniques and can be eliminated immediately.

17. The nurse is sitting with a patient who is crying. After a few minutes the nurse places one hand on the patient's shoulder. Which of the following best describes the purpose of the nurse's touch with this patient? A) To express sympathy to the patient B) To assess the patient's skin temperature and circulation status C) To offer comfort and support for the patient D) To extend an offer of friendship to the patient

Ans: C Feedback: Touching a client can be comforting and supportive when it is welcome and permitted. The nurse should not express sympathy to patients, nor should attempt to be ìfriendsî with patients. Physical assessment is not indicated at this time.

18. Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff? A) Because some clients with mental illness have difficulty knowing when touch is or is not appropriate B) Because clients often perceive being touched as a threat and may attempt to protect himself or herself by striking the staff person C) Because it can be threatening to both the client and the nurse D) Because touching always leads to more touching

Ans: A Feedback: Some clients with mental illness have difficulty understanding the concept of personal boundaries or knowing when touch is or is not appropriate. Consequently, most psychiatric inpatient, outpatient, and ambulatory care units have policies against clients touching one another or staff. When a staff member is going to touch a client while performing nursing care, he or she must verbally prepare the client before starting the procedure. A client with paranoia may interpret being touched as a threat and may attempt to protect himself or herself by striking the staff person. Both the client and the nurse can feel threatened if one invades the other's personal or intimate zone, which can result in tension, irritability, fidgeting or even flight. Touching can be comforting and supportive when it is welcome and permitted.

20. Which of the following distance zones is acceptable for people who mutually desire personal contact? A) Social B) Intimate C) Personal D) Public

Ans: B Feedback: The intimate zone is the amount of space that is comfortable for parents with young children and those who desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The personal zone is comfortable between family and friends who are talking. The public zone is an acceptable distance between a speaker and an audience.

14. Which of the following statements about verbal and nonverbal communication skills is accurate? A) One third of meaning is transmitted nonverbally and two thirds is communicated verbally. B) Nonverbal communication is as important, if not more than, verbal communication. C) Verbal communication is most important because it is what the patient says. D) Verbal communication involves the unconscious mind.

Ans: B Feedback: Nonverbal communication is as important as, if not more so than, verbal communication. It is estimated that one third of meaning is transmitted by words and two thirds is communicated nonverbally. Verbal communication is often what the patient says but is not the most important. Nonverbal communication involves the unconscious mind acting out emotions related to the verbal content, the situation, the environment, and the relationship between the speaker and the listener.

16. A nurse has invited a patient to sit down and have a conversation. The patient takes the first seat. The nurse pulls up another chair to sit with the patient. Approximately how far from the patient should the nurse place her chair? A) 1 to 2 feet B) 3 to 4 feet C) 6 to 8 feet D) 8 to 10 feet

Ans: B Feedback: The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings.

19. A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the patient while respecting the patient's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client? A) In the patient's room when the patient's roommate is present and 3 feet away B) At the nurse's station when other clients and visitors are less than 4 feet away C) In an interview room in a remote section of the unit with the nurse 1 foot away from the patient D) In a quiet corner of the dayroom at least 4 feet away from others

Ans: D Feedback: A quiet corner of the dayroom at least 4 feet away from others would allow the patient privacy while being to deter any inappropriate activity would be the most appropriate setting. Being in the patient's room when the patient's roommate is present and 3 feet away or at the nurse's station when other patients and visitors are less than 4 feet away would not allow for the patient's privacy. An interview room in a remote section of the unit would not be a good choice as the area is too isolated. Additionally, the nurse should maintain a distance of more than 1.5 feet away from the patient as closer distances are within the intimate zone.

15. The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to A) increase the client's awareness of nonverbal behavior. B) investigate the source of nonverbal behavior. C) validate the client's feelings. D) validate the meaning of the nonverbal behavior

Ans: D Feedback: It is essential to validate the meaning of nonverbal behavior (rather than assuming what it means) before proceeding with anything else. This item is about the nurse's understanding of nonverbal behavior, not the client's. Before the nurse can investigate the source of nonverbal behavior or validate the client's feelings the nurse must be clear about the meaning of the nonverbal behavior.

13. A patient states, "I feel fine. It's a good day." The nurse notes the patient looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse? A) "I'm glad you are feeling good today." B) "I'm not sure I believe you." C) "Tell me what is good about today." D) "You say you feel fine, but you don't really sound fine."

Ans: D Feedback: This client's verbal and nonverbal communication seems incongruent. To ensure the accuracy of the patient's messages, the nurse identifies the nonverbal communication and checks its congruency with the content. An example is ìMr. Jones, you said everything is fine today, yet you frowned as you spoke. I sense that everything is not really fineî (verbalizing the implied). ìI'm glad you are feeling good today,î is agreeing or indicating accord with the client. Agreeing leaves no opportunity for the client to change his or her mind without being ìwrong.î ìI'm not sure I believe you could be interpreted as challenging or demanding proof from the client. Challenging causes the client to defend the misperceptions more strongly than before. ìTell me what is good about today,î seems to be asking the client to defend his or her statement.

32. A client diagnosed with major depression after a stroke has been admitted to the psychiatric unit. The report indicates that the client has special communication needs because of aphasia and dysarthria. Which communication adaptation technique by the nurse would be most helpful to this client? 1. Using simple sentences and avoiding long explanations. 2. Speaking to the client as though the client could hear. 3. Listening attentively, allowing time, and not interrupting. 4. Providing an interpreter (translator) as needed.

Aphasia is defined as the absence or the impair- ment of the ability to communicate through speech. Dysarthria is defined as difficult and defective speech because of impairment of the tongue or other muscles essential to speech. 1. Using simple sentences and avoiding long explanations is appropriate when the client is cognitively impaired. This client has difficulty with expression, not understanding. 2. Speaking to the client as though the client could hear is appropriate when the client is unrespon- sive, but is inappropriate in this situation. ✅3. Clients who cannot speak clearly require special thought and sensitivity. When a client has aphasia and dysarthria, the nurse needs to listen intently, allow time, and not interrupt the client. Effective commu- nication is critical to nursing practice. 4. Providing an interpreter or translator is appro- priate when a client does not speak English, but is inappropriate in this situation. TEST-TAKING HINT: To answer this question cor- rectly, the test taker first must review the med- ical terminology of aphasia and dysarthria and be able to note an appropriate intervention.

12. Allowing the client to take the initiative in introducing the topic is to "broad opening" as the nurse's making self available and presenting emotional support is to: 1. "Focusing." 2. "Offering self." 3. "Restating." 4. "Giving recognition."

By giving a "broad opening," the nurse encour- ages the client to select topics for discussion. Example: "What are you thinking about?" 1. "Focusing" by the nurse allows a client to stay with specifics and analyze problems without jumping from subject to subject. Example: "Could we continue talking about your infi- delity right now?" ✅2. "Offering self" by the nurse offers the client availability and emotional support. Example: "I'll stay with you awhile." 3. "Restating" by the nurse repeats to the client the main thought the client has expressed. Example: "You say that your mother aban- doned you when you were 6 years old." 4. "Giving recognition" by the nurse is acknowl- edging something that is occurring at the present moment for the client. Example: "I see you've made your bed." TEST-TAKING HINT: When answering an analogy, the test taker must be able to recognize the rela- tionships of subject matter within the question.

7. The nurse states to the client, "You say that you are sad, but you are smiling and laugh- ing." Which describes the purpose of this therapeutic communication technique? 1. To provide suggestions for coping strategies. 2. To redirect the client to an idea of importance. 3. To bring incongruencies or inconsistencies into awareness. 4. To provide feedback to the client.

Here the nurse is using the therapeutic commu- nication technique of "confronting." 1. Here the nurse uses the therapeutic technique of "suggesting" to provide the client with suggestions for coping strategies and to assist the client to consider alternative options. 2. The nurse uses the therapeutic technique of "focusing" to redirect the client to an idea of importance. ✅3. The nurse uses the therapeutic technique of "confronting" to bring incongruencies or inconsistencies into awareness 4. The nurse uses the therapeutic technique of "restating" to provide feedback to the client. Restating lets the client know that the nurse is attentive, and that the message is understood TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to recognize the use of the therapeutic communication tech- nique of "confronting."

6. The nurse states to a client on an in-patient unit, "Tell me what's been on your mind." Which describes the purpose of this therapeutic communication technique? 1. To have the client initiate the conversation. 2. To present new ideas for consideration. 3. To convey interest in what the client is saying. 4. To provide time for the nurse and client to gather thoughts and reflect.

Here the nurse is using the therapeutic communication technique of "broad opening." ✅1. A "broad opening" helps the client initiate the conversation and puts the client in control of the content 2. Presenting new ideas for consideration is the purpose of the therapeutic technique of "sug- gesting." Example: "Have you considered the possibility of attending AA meetings?" 3. Conveying interest in what the client is saying is the purpose of the therapeutic technique of "listening." Example: Being fully present and listening while maintaining eye contact. 4. Providing time for the nurse and client to gather thoughts and reflect is the purpose of the therapeutic technique of "silence." The quiet is not broken, providing time for the nurse and the client to reflect TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to recognize the use of the therapeutic communication tech- nique of "broad opening."

51. A diet free of pork is to the Muslim client as a diet free of dairy products is to the: 1. Native American client. 2. Mormon (the Church of Jesus Christ of Latter Day Saints) client. 3. Asian/Pacific Island client. 4. African American client.

Islamic law forbids Muslims to eat pork. In Arabic-speaking countries, the term "halal" refers to anything permissible under Islamic law. In the English language, it most frequently refers to food or dietary laws. Muslims who adhere to these dietary laws eat only meats that have been slaughtered according traditional guidelines. 1. Native Americans have no dietary dairy or pork restrictions. Meat and corn products have been identified as preferred foods of Native Americans. Fruits and vegetables are often scarce in their defined Indian geograph- ical regions. Because fiber intake is low, and saturated fat intake is increasing, nutritional deficiencies are common among tribal Native Americans. 2. Mormons have no dietary dairy or pork restrictions. In addition to alcohol, coffee and tea, which contain caffeine, are considered taboo for members of the Mormon religion. For some Mormons, this taboo extends to cola and other caffeinated beverages, but usually not to chocolate. ✅3. Although rice, vegetables, and fish are the main staple foods of Asian Americans, with Western acculturation their diet is changing to include the consumption of meat and fats. Because many Asian Americans are lactose intolerant, they seldom drink milk or consume dairy products. 4. African Americans have no dietary dairy or pork restrictions. Their diet differs little from that of the mainstream culture. Some African Americans follow their heritage and enjoy what has come to be known as "soul" food. Included are poke salad, collard greens, okra, beans, corn, black-eyed peas, grits, cornbread, and fried chicken. These foods also are enjoyed by most of the population of the southern United States. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand that there is much variation in diets across cultures, and that the interaction of certain foods with medica- tions or mood is of great importance in psychi- atric care.

34. An instructor overhears the nursing student ask a client, "This is your third admission. Why did you stop taking your medications?" Which statement by the instructor would be appropriately related to the student's question? 1. "Your question implied criticism and could have the effect of making the client feel defensive." 2. "Your question invited the client to share thoughts and feelings regarding the client's noncompliance." 3. "Your question recognized and acknowledged the client's reasons for his or her actions." 4. "Your question pursued the topic to make the client's intentions clear."

The nursing student's question illustrates the nontherapeutic technique of "requesting an explanation." ✅1. "Why" questions put the nurse in the role of an interrogator, demanding information without respect for the client's readiness or willingness to respond. It would be better to say, "Tell me about your concerns regarding your medications." 2. The student's question did not invite the client to share personal experiences and feelings. 3. Recognizing and acknowledging reasons for actions describes the therapeutic technique of "empathy." The student's statement was not empathic. 4. Taking notice of a single idea, or even a sin- gle word, and pursuing this until its meaning or importance is clear describes the therapeu- tic technique of "focusing." The student did not use the technique of focusing. TEST-TAKING HINT: To answer this question cor- rectly, the test taker first must note the use of the nontherapeutic communication technique of "requesting an explanation" in the student's statement. Then the test taker must under- stand the impact the use of requesting an explanation has on developing a relationship with the client.

24. A client on a psychiatric unit tells the nurse, "I'm all alone in the world now, and I have no reason to live." Which response by the nurse would encourage further communica- tion by the client? 1. "You sound like you're feeling lonely and frightened." 2. "Why do you think that suicide is the answer to your loneliness?" 3. "I live by myself and know it can be very lonely and frightening." 4. "Just hang in there and, you'll see, things will work out."

✅ 1. By understanding the client's point of view, the nurse communicates empathy with regard to the client's feelings. An empathic response communicates that the nurse is listening and cares, and encour- ages the client to 2. Asking "why" demands an answer to some- thing the client may not understand or know. "Why" questions can cause resentment, insecurity, and mistrust. 3. Sympathy is concern, sorrow, or pity felt for the client generated by the nurse's personal identification with the client's needs. Sympathy focuses on the nurse's feelings instead of the client's. 4. Offering reassurances not supported by facts or based in reality can do more harm than good. Although it may be intended kindly, it is often used to help the nurse avoid the client's personal distress. TEST-TAKING HINT: The test taker first must review therapeutic and nontherapeutic commu- nication techniques. The question is asking for a statement that would "encourage further com- munication," or a therapeutic communication technique. Answers "2," "3," and "4" all are non- therapeutic communication techniques and can be eliminated.

36. When the nurse focuses on a client's specific behavior rather than on the client himself or herself, the nurse is using a strategy of nonthreatening feedback. Which nursing statement is an example of this strategy? 1. "It's okay to be angry, but throwing the book was unacceptable behavior." 2. "I can't believe you are always this manipulative." 3. "You are an irresponsible person regarding your life choices." 4. "Asking for meds every 2 hours proves you are drug seeking."

✅ 1. When the nurse focuses on the client's behavior versus assumptions about the client, the nurse gives nonthreatening feedback, facilitating the communication process. 2. In this interchange, the nurse is focusing on the client's being manipulative, rather than separating the manipulative behaviors from the client himself or herself. A better response would be, "I feel manipulated when you . . . ." 3. In this interchange, the nurse is focusing on the client's being irresponsible, rather than separating the irresponsible behaviors from the client himself or herself. A better response would be, "Let's look at how your choices have affected your life . . . ." 4. In this interchange, the nurse is focusing on the client's being a drug seeker, rather than separating the behaviors from the client himself or herself. A better response would be, "Let's explore your need for medications every 2 hours. . . ." TEST-TAKING HINT: To answer this question cor- rectly, the test taker must understand the reason- ing behind addressing a client's inappropriate behaviors versus making value judgments about the client himself or herself.

39. To understand and participate in therapeutic communication, the nurse must understand which of the following? Select all that apply. 1. More than half of all messages communicated are nonverbal. 2. All communication is best accomplished in a "social" space context. 3. Touch is always a positive form of communication to convey warmth and caring. 4. The physical space between two individuals has great meaning in the communication process. 5. The use of silence never varies across cultures

✅1. "Nonverbal communication" refers to all of the messages sent by other than verbal or written means. It is estimated that more than half of all messages communicated are nonverbal, which include behav- iors, cues, and presence. 2. Studies of interactions of people in North America indicate that a person has four zones of interaction defined by the distance between two people. The zones are defined as: public space, 12 feet; social space, 9-12 feet; personal space, 4 feet to 18 inches; and intimate space, closer than 18 inches. Some clients may feel that social interactions in a social space context are too invasive and cause discomfort, whereas other clients may interpret an interaction in this space as supportive. 3. Touch can convey warmth and positive regard, but also may be interpreted in many other ways depending on the client's percep- tion of the intended message. ✅4. The physical space between two individu- als has great meaning in the communica- tion process. Space between two individu- als gives a sense of their relationship and is linked to cultural norms and values. 5. The use of silence varies across cultures: for instance, among European Americans, one stops talking when the other starts; but among Hispanic Americans, one does not stop speaking before the other begins; and among Asian Americans, a few moments elapse between responses. TEST-TAKING HINT: The test taker must note words such as "always," "never," "none," and "all." When superlatives such as these are used as part of an answer, the test taker should con- sider that this answer may be incorrect.

23. Which nurse-client communication-centered skill implies "respect"? 1. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification. 2. The nurse communicates an understanding of the client's world from the client's internal frame of reference, with sensitivity to the client's current feelings, and the ability to communicate this understanding in a language attuned to the client. 3. The nurse communicates that the nurse is an open person who is self-congruent authentic, and transparent. 4. The nurse communicates specific terminology rather than abstractions in the discussion of the client's feelings, experiences, and behaviors.

✅1. "Respect" is the responsive dimension that is characterized in this example. Respect suggests that the client is regarded as a person of worth who is valued and accepted without qualifications. 2. "Empathetic understanding," not respect, is the responsive dimension that is characterized in this example. 3. "Genuineness," not respect, is the responsive dimension that is characterized in this example. 4. "Correctness," not respect, is the responsive dimension that is characterized in this example TEST-TAKING HINT: To answer this question correctly, the test taker first must understand the nurse-client communication-centered skill "respect," and then be able to choose the answer that supports this term.

26. On a substance abuse unit, a client diagnosed with cirrhosis of the liver tells the nurse, "I really don't believe that my drinking a couple of cocktails a night has anything to do with my liver problems." Which is the best nursing response? 1. "You find it hard to believe that drinking alcohol can damage the liver?" 2. "How long have you been drinking a couple of cocktails a night?" 3. "If not alcohol, explain how your liver became damaged." 4. "It's common knowledge that consuming alcohol continually over a long period of time can damage the liver."

✅1.Paraphrasing is restating another's mes- sage more briefly using one's own words. Through paraphrasing, the nurse sends feedback that lets the client know that the nurse is actively involved in the search for understanding. 2. This response does not address the content of the client's statement. In addition, this probing question may be a barrier to further communication. 3. This confronting, judgmental response may put the client on the defensive, cutting off further communication. 4. This response is condescending, judgmental, and confrontational, putting the client on the defensive. It does not encourage further interactions. TEST-TAKING HINT: To answer this question cor- rectly, the test taker might want to look first at all the possible choices. Answer choice "4" is confrontational and can be eliminated first.

49. A Latino American client who has a 10:00 a.m. appointment at an out-patient psychiatric clinic arrives at noon, stating, "I was visiting with my mother." How should the nurse interpret the client's failure to arrive on time? 1. The client is a member of a cultural group that is present oriented. 2. The client is being passive-aggressive by arriving late. 3. The client is a member of a cultural group that rejects traditional medicine. 4. This is the client's way of defying authority.

✅1. All cultures have past, present, and future time dimensions. It is important for a nurse to understand a client's time orientation. Latino Americans tend to be present oriented. The concept of being punc- tual is perceived as less important than present-oriented activities, such as the client's visiting with mother. 2. It is necessary for a nurse to understand that a Latino American generally operates in a pres- ent time dimension, and the fact that he or she does not show up at the designated time does not indicate passive-aggressive behavior. This information can be useful in planning a day of care, setting up appointments, and helping the client separate social and business priorities. 3. Generally, the Latino American culture does not reject traditional medicine. 4. Tardiness is a part of the present time dimen- sion and is not intended to reflect animosity, anger, or defiance. TEST-TAKING HINT: It is important for the test taker to understand issues related to cultural time orientation to answer this question correctly.

60. In some cultures, therapeutic touch can be perceived as uncomfortable. Which of the following cultures might interpret touch in this manner? Select all that apply. 1. Norwegians, Swedes, and Danes. 2. French, Italians, and Russians. 3. Germans, British Americans, and Swiss. 4. Asian Indians, Chinese Americans, and Native Americans. 5. African Americans, Haitians, and people from the Dominican Republic.

✅1. Generally, Scandinavians are loving peo- ple, but not demonstrative, particularly with strangers or in public. 2.Generally, the French, Italians, and Russians are accustomed to frequent touching during conversation and consider touching an important part of nonverbal communication. Generally, ✅3. Germans, British Americans, and Swiss use a handshake at the begin- ning and end of a conversation; other than that, touching is infrequent. ✅4. Generally, Asian Indian men may shake hands with other men, but not with women. Chinese Americans may not like to be touched by strangers. Some Native Americans may extend their hand and lightly touch the hand of the person that they are greeting rather than actually shaking hands. Generally, African Americans, Haitians, and people from the Dominican Republic are comfortable with close personal space and touch. Touching also is considered an impor- tant part of nonverbal communication. TEST-TAKING HINT: To answer culturally based questions, it is necessary to understand that the response to touch is often culturally defined

37. The nurse understands that one of the many strategies of nonthreatening feedback is to limit the feedback to an appropriate time and place. While in the milieu, which nursing statement is an example of this strategy? 1. "Let's talk about your marital concerns in the conference room after visiting hours." 2. "I know your mother is visiting you, but I need answers to these questions." 3. "Why don't we talk about your childhood sexual abuse?" 4. "Let's talk about your grievance with your doctor during group."

✅1. Providing a private place and adequate time for successful interactions is essential to nonthreatening feedback. 2. Inappropriate timing is not conducive to successful, open, complete, and accurate exchange of ideas. 3. Because this exchange occurs in the milieu, and there is no mention of providing privacy, this is an inappropriate place for feedback. Discussion of this topic is inappropriate in a group setting. TEST-TAKING HINT: To answer this question correctly, the test taker must remember that client comfort is a priority. To gain appropriate feedback, the nurse must provide privacy and adequate time, and ensure client readiness.

5. Which therapeutic communication exchange is an example of "reflection?" 1. Client: "I get sad because I know I'm going to fail in school." Nurse: "So, you start feeling depressed every time a new semester begins?" 2. Client: "I forgot to get my prescription refilled." Nurse: "It is important for you to take your medication as prescribed." 3. Client: "I hate my recent weight gain." Nurse: "Have you considered Overeaters Anonymous?" 4. Client: "I'm happy that I poisoned my husband." Nurse: "You're happy to have poisoned your husband?"

✅1. Reflection" is used when directing back what the nurse understands in regard to the client's ideas, feelings, questions, and content. Reflection is used to put the client's feelings in the context of when or where they occur. 2. When the nurse gives valuable information to the client, the nurse is using the therapeutic technique of "informing." 3. Providing suggestions for coping strategies is a way that the nurse assists the client to con- sider alternative options. This is the thera- peutic technique of "suggesting." 4.By restating what the client has said, the nurse has the opportunity to verify the nurse's understanding of the client's message. The therapeutic technique of "restating" also lets the client know that the nurse is listening and wants to understand what the client is saying TEST-TAKING HINT: To answer this question cor- rectly the test taker must review therapeutic communication techniques and note the differ- ences between "restating" and "reflection."

46. On an in-patient psychiatric unit, an African American client states, "Granny told me to eat a lot of collard greens and I would feel better." The nurse, understanding the effects of cultural influences, attaches which meaning to this statement? 1. The client has been receiving health care from a "folk practitioner." 2. The client's grandmother believes in the healing power of collard greens. 3. The client believes everything her grandmother tells her. 4. The client is trying to determine if the nurse agrees with her grandmother.

✅1. Some African Americans, as is the case with this client, receive their medical care from the local folk practitioner known as "granny," "the old lady," or a "spiritualist." Folk medicine incorporates the belief that health is a gift from God, whereas illness is a punishment and retribution from God for sin and evil. These practices vary in different cultures and warrant respect and consideration from the health-care team. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must analyze, compare, and evaluate worldviews to apply the concepts of cul- ture to psychiatric/mental health nursing assess- ment and practice.

15. A client on an in-patient psychiatric unit states, "My mother hates me. My father is a drunk. Right now I am homeless." The nurse responds, "Let's talk more about your feelings toward your mother" Which is a description of the technique used by the nurse? 1. The nurse uses questions or statements that help the client expand on a topic of importance. 2. The nurse encourages the client to select a topic for discussion. 3. The nurse delves further into a subject or idea. 4. The nurse is persistent with the questioning of the client.

✅1.This is a description of "focusing," which is the therapeutic technique presented in the question stem. Focusing can be help- ful when clients have scattered thoughts, flight of ideas, or tangential thinking. 2. This is a description of the therapeutic tech- nique of "broad opening." 3. This is a description of the therapeutic tech- nique of "exploring." This is a description of the nontherapeutic technique of "probing," which pushes for answers the client may or may not wish to discuss. TEST-TAKING HINT: To answer this question cor- rectly, the test taker must be able to note the dif- ference between "focusing" and "exploring." When the nurse explores, the nurse is gathering information about the client's thoughts and feelings. Focusing is used to assist the nurse to gather further information on a particular subject.

A nurse is caring for a client who has been physically abused and threatened by her partner. Which of the following describes what the client would most likely experience during the tension-building phase of the relationship? Hitting, kicking, and battering of the victim A feeling that the abuser will soon abuse the victim Angry and explosive responses Loving and apologetic behavior

✅A feeling that the abuser will soon abuse the victim An abusive relationship tends to follow a cyclical pattern of abuse that involves a tension-building phase, an acute battering phase, and a honeymoon phase. During the tension-building phase, the nurse may note that the client and her partner are tense and anxious, and the client may feel like she is 'walking on eggshells'. The partner's anger is building up but does not evolve to full-out battering until the acute stage. Hitting, kicking, and battering of the victim This describes the abusive incident. Loving and apologetic behavior This describes the honeymoon phase. Angry and explosive responses This describes the abusive incident.

4. The nurse asks the patient what he would like to talk about. This is an example of A) broad opening. B) encouraging expression. C) focusing. D) offering self.

✅Ans: A Feedback: Broad openings allow the client to take the initiative in introducing the topic. Encouraging expression involves asking the client to appraise the quality of his or her experiences. The nurse uses focusing when concentrating on a single point. Offering self occurs when making oneself available.

8. The nurse asks the client what that experience was like. Which communication skill is the nurse using? A) Encouraging expression B) Encouraging description of perceptions C) Exploring D) Requesting an explanation

✅Ans: A Feedback: Encouraging expression is a therapeutic technique and involves asking the client to appraise the quality of his or her experiences. Encouraging description of perceptions is a therapeutic technique and involves asking the client to verbalize what he or she perceives. Exploring is a therapeutic technique that involves delving further into a subject or an idea. Requesting an explanation is a nontherapeutic verbal communication technique that involves asking the client to provide reasons for thoughts, feelings, behaviors, events.

2. Which one of the following goals of therapeutic communication would the nurse strive to attain first? A) Facilitate the client's expression of emotions. B) Establish a therapeutic nurseñclient relationship. C) Teach the client and family necessary self-care skills. D) Implement interventions designed to address the client's needs.

✅Ans: A Feedback: Establishing a therapeutic relationship is one of the most important responsibilities of the nurse when working with clients.

5. A patient says, "Its' been so long since I've been with my family." Which statement by the nurse is an example of restating? A) "You say you haven't seen your family in a while." B) "Tell me when you last saw your family." C) "Go on. Tell me more." D) "When was the last time you saw your family?"

✅Ans: A Feedback: Restating is repeating the main idea expressed. Restatement lets the client know that he or she communicated the idea effectively. This encourages the client to continue. Focusing or concentrating on a single point encourages the client to concentrate his or her energies on a specific point, which may prevent a multitude of factors or problems from overwhelming the client. General leads give encouragement to continue. They indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Placing events in sequence clarifies the relationship of events in time. This helps both the nurse and the client to see them in perspective.

10. Which of the following statements would be an empathetic response in a client interaction? A) ìYou must have been embarrassed when your father yelled at you in the grocery store.î B) ìYou really should find your own housing and get out of the situation with your father.î C) ìWell, it sounds like your father has difficulty controlling his temper.î D) ìWhy do you think your father chose that time and place to yell at you?î

✅Ans: A Feedback: This statement conveys the nurse's understanding of the client's feelings. Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. The other choices do not convey empathy.

3. Which of the following statements is true of empathy? Select all that apply. A) It is the ability to place oneself into the experience of another for a moment in time. B) It involves interjecting the nurse's personal experiences and interpretations of the situation. C) It is developed by gathering information from the client. D) It results in negative therapeutic outcomes. E) The client must learn to develop empathy for the nurse.

✅Ans: A, C Feedback: Empathy is the ability to place oneself into the experience of another for a moment in time. Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their personal experiences and interpretations of the situation. It does not result in negative therapeutic outcomes. The nurse must develop empathy with the client.

6. The patient expresses frustration that the doctor does not spend enough time with the patient when making rounds. The nurse replies, ìThe doctors are very busy. What can I help you with?î The nurse incorporated which nontherapeutic technique in this response? A) Belittling B) Defending C) Disagreeing D) Introducing an unrelated topic

✅Ans: B Feedback: Defending attempts to protect someone or something from verbal attack. This implies that the client has no right to express impressions, opinions, or feelings. Belittling is misjudging the degree of the client's discomfort, which implies that the discomfort is temporary, mild, self-limiting, or not very important. Disagreeing is opposing the client's ideas, which may cause the client to feel defensive about his or her point of view or ideas. Introducing an unrelated topic is evidenced when the nurse changes the subject. This takes away the initiative for the client to interact.

1. The nurse uses a variety of therapeutic communication skills when working with patients. Which of the following is a therapeutic goal that can be accomplished through the use of therapeutic communication skills? A) Inform the patient of priority problems B) Assess the patient's perception of a problem C) Assist the patient to control emotions D) Provide the patient with a plan of action

✅Ans: B Feedback: Therapeutic communication can help nurses to accomplish many goals including identifying the most important concern to the client at that moment, assessing the client's perception of the problem, facilitating the client's expression of emotions, and guiding the client toward identifying a plan of action.

11. The nurse says to the client, ìYou become very anxious when we start talking about your drinking.î Which of the following techniques is the nurse using? A) Confronting behavior B) Making an observation C) Translating into feelings D) Verbalizing the implied

✅Ans: B Feedback: The nurse is stating what he or she sees; the client can validate it or reject it. The nurse is not confronting the behavior in this situation. The nurse is not translating the message into feelings (seeking to verbalize client's feelings that he or she expresses only indirectly), nor is the nurse verbalizing the implied (voicing what the client has hinted at or suggested).

7. A patient asks the nurse what she should do about her ìcheatingî husband. The nurse replies, ìYou should divorce him. You deserve better than that.î The nurse used which communication technique? A) Giving information B) Verbalizing the implied C) Giving advice D) Agreeing

✅Ans: C Feedback: The nurse should not give advice, or tell the patient what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the patient needs facts. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the patient has suggested. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the patient is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

9. Which of the following are nontherapeutic techniques? Select all that apply. A) Silence B) Voicing doubt C) Agreeing D) Challenging E) Giving approval F) Accepting

✅Ans: C, D, E Feedback: Silence is a therapeutic technique that involves the absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking. Voicing doubt is a therapeutic technique that involves expressing uncertainty about the reality of the client's perceptions. Agreeing is a nontherapeutic technique that involves indicating accord with the client. Agreeing indicates the client is ìrightî rather than ìwrong,î and there is no opportunity for the client to change his or her mind without being ìwrong.î Challenging is a nonverbal communication technique that involves demanding proof from the client, and this may cause the client to defend delusions or misperceptions more strongly than before. Giving approval is a nontherapeutic communication technique that involves sanctioning the client's behavior or ideas. Accepting is a therapeutic technique that involves indicating reception.

12. The nurse is sitting down with a patient to begin a conversation. Which of the following positions should the nurse take to convey acceptance of the patient? A) Leaning forward with arms on the table sitting directly across for the patient B) Turned slightly to the side of the patients with arms folded across the chest C) Leaning back in the chair next to the patient with legs crossed at the knees D) Sitting upright facing the patient with both feet on the floor

✅Ans: D Feedback: Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.

A client who delivered a baby 6 weeks ago is a victim of intimate partner violence. Which of the following psychological conditions is also associated with victims of domestic abuse? Depressive disorder Obsessive-compulsive disorder Antisocial personality disorder Schizoaffective disorder

✅Depressive disorder Intimate partner violence can happen to anyone, including men, and postpartum women. Intimate partner violence refers to abuse by a spouse or partner. It is associated with mental health problems, including depressive disorder, anxiety and posttraumatic stress disorder. Obsessive-compulsive disorder This disorder is not correlated with intimate partner violence. Schizoaffective disorder This disorder is not correlated with intimate partner violence. Antisocial personality disorder This disorder is not correlated with intimate partner violence

A client with lung cancer tells the nurse about how difficult it has been to go through cancer treatment. Which response from the nurse best demonstrates therapeutic communication? Tell me more about what has been difficult with treatment Why do you believe it is so difficult to undergo treatment for your condition? You seem upset about your diagnosis Don't worry, everything will be okay

✅Tell me more about what has been difficult with treatment Nurses are in an important role to recognize signs of psychological distress, and how they communicate with a client can either enhance or create a barrier to the care of the client with cancer. Therapeutic communication can be used to get the client to talk more about their condition or feelings so that the nurse can provide appropriate care and address the client's needs. You seem upset about your diagnosis This response is dismissive of the client's feelings, and would likely cause the client to close down communication with that nurse. Why do you believe it is so difficult to undergo treatment for your condition? In this response the nurse is minimizing the difficulty of cancer treatments, and demonstrates a lack of understanding of what the client is experiencing. Don't worry, everything will be okay Everything may NOT be okay, so the nurse is giving the client false reassurance.

Explain the difference between environmental and individual risk factors in a perpetrator of sexual abuse. Environmental factors are associated with violence while individual factors are associated with mental illness Environmental factors cannot be controlled while individual factors can be modified Environmental factors are those surrounding factors that contribute to abuse while individual factors are within the perpetrator Environmental factors contribute to the abuse while individual factors tend to prevent the abuse

✅Environmental factors are those surrounding factors that contribute to abuse while individual factors are within the perpetrator There are many reasons why a perpetrator of abuse may choose to abuse another person. Environmental factors are those external stimuli that contribute to abuse and may include poverty or lack of support, while individual factors occur within the person and include such factors as substance abuse, delinquency, and prior sexual victimization. Environmental factors contribute to the abuse while individual factors tend to prevent the abuse Both types of risk factors increase the risk of abuse. Environmental factors are associated with violence while individual factors are associated with mental illness Individual factors are not associated with mental illness. Individual factors are generally associated with aggression and hostility towards women, an early-onset sexual history, substance use, and delinquency. Environmental factors cannot be controlled while individual factors can be modified Individual factors cannot necessarily be modified, but environmental factors can be improved.

A client and her spouse are seen at the primary care clinic for assessment for infertility. The client becomes tearful as she tells the nurse that she has been trying to become pregnant for over a year without success. The client says, "I do not think I could handle it if I knew I could never start a family." Which intervention by the nurse best demonstrates therapeutic communication to assist the client with coping with her situation? Is there something you are doing that you think might be keeping you from getting pregnant? I know it is difficult, but if it is meant to be, it will happen Have you had other struggles that you were able to successfully cope with in the past? Keep repeating to yourself that you can get pregnant and use your positive energy to cope

✅Have you had other struggles that you were able to successfully cope with in the past? When a client is struggling to cope with a difficult situation, it helpful to assist the client in recalling a time when she was able to cope successfully. The client can use the same tactics that she used in the past. This is a good place to start for the client struggling with infertility. I know it is difficult, but if it is meant to be, it will happen The goal of supportive communication is to empower the client, but this statement by the nurse removes the notion of empowerment, which can be discouraging. Keep repeating to yourself that you can get pregnant and use your positive energy to cope This is unreasonable positive thinking, and is not a helpful strategy to assist the client to cope Is there something you are doing that you think might be keeping you from getting pregnant? The nurse is placing blame on the client in an indirect way, which is not helpful.

Which is an example of a qualitative open-ended question that the nurse may use in therapeutic communication with the client? How are you feeling about your job? So you are saying that you want to try to visit your sister again Can you tell me what voices you are hearing? Are you sure that you do not want to talk about this?

✅How are you feeling about your job? An open-ended question is one that requires the person to answer in a descriptive or open method. Alternatively, a closed-ended question typically produces a 'yes' or 'no' response. In this situation, the nurse may ask a client, "How are you feeling about your job?" which prompts the client to discuss feelings and thoughts. Can you tell me what voices you are hearing? This is an open-ended quantitative question, which elicits specific details and facts, rather than a qualitative question, which seeks to gain the client's perspective and seek understanding. Are you sure that you do not want to talk about this? This is a closed-ended question. So you are saying that you want to try to visit your sister again This is not a question.

A nurse is preparing to discharge a client with bronchitis to home from the hospital. The nurse has the client demonstrate that he understands how to use his inhaler appropriately. After successfully demonstrating use of the inhaler, the nurse says, "You seem pretty confident about using that inhaler." This is an example of which type of therapeutic communication? Giving recognition Making observations Offering hope Active listening

✅Making observations When using therapeutic communication, a nurse may make observations about the client's behavior or actions. These observations are designed to encourage the client to speak more about the situation. In the above example, the client may relay information to the nurse as to why he is proficient with using an inhaler. This information helps the nurse better understand the client's condition to provide more appropriate care Giving recognition An example of giving recognition is the following statement; "I noticed you took all your medications." This statement recognizes the client's accomplishments without giving an overt compliment, because compliments can sometimes be viewed as condescending. Active listening An example of active listening occurs when the nurse encourages the client to continue to talk, with nodding and statements such as, "I see." Offering hope An example of offering hope is the following statement; "I will be here to help you get through this.

A 39-year-old client is talking with a nurse about the client's sexual relationship with a committed partner. Which describes how the nurse should discuss an awkward topic with a client? Provide brochures of information to have the client read State that it is normal to feel awkward discussing this topic Bring another nurse or professional in for support when starting the conversation Ask the client to watch a video and then see if questions arise

✅State that it is normal to feel awkward discussing this topic There may be times when discussing certain subjects with clients is naturally awkward. Although nurses often see and hear many things while providing client care, direct discussion of sensitive subjects can be embarrassing. Before starting the conversation or educational component, the nurse may acknowledge right away that the topic is somewhat awkward, which can free both the client and the nurse from feeling that initial discomfort. Ask the client to watch a video and then see if questions arise The nurse is a great resource for a client. A face-to-face discussion is so much more valuable than a video or brochure. Provide brochures of information to have the client read The nurse is a great resource for a client. It is better to discuss face-to-face than provide a brochure of information. Bring another nurse or professional in for support when starting the conversation This would decrease the client's sense of confidentiality.

A nurse is caring for a client who may be in a domestic violence situation. What actions can the nurse perform that would uphold this client's privacy? Select all that apply. Placing the client in a private room and keeping the door closed Avoiding contact with authorities to disclose the information Not calling the client's spouse to notify of the client's suspected situation Only giving updates to the attending provider and those directly involved with the client's care

✅Placing the client in a private room and keeping the door closed A nurse has a duty to uphold a client's privacy, but a client in a domestic violence situation also needs to be protected. The nurse must report the situation to the authorities, but can do so while still protecting the client. Ensuring the client is provided a private room in which to discuss the violence is one way in which the nurse can uphold the client's privacy. ✅Not calling the client's spouse to notify of the client's suspected situation Calling the client's spouse is not the nurse's responsibility and has the potential to endanger the client if the spouse is the abuser. ✅Only giving updates to the attending provider and those directly involved with the client's care The nurse should maximize client privacy by only discussing the client's care with those who are directly involved in the case. Avoiding contact with authorities to disclose the information This is not an option. The authorities MUST be contacted when domestic violence is suspected, because nurses are mandatory reporters. Filing an incident report about the client instead of contacting hospital administration A report must be filed with authorities, but this is not the type of information that goes in an incident report

The nurse is caring for a 90-year-old client with a potential fracture of the radius. The client was brought in by the caregiver, is wearing a brief that is soiled with urine and feces, and there is a pattern of multiple finger-sized bruises on the client's body. Which of the following are appropriate actions by the nurse? Select all that apply. Report incident to the state Facilitate a client bath Document that the client has been falling at home Provide a safe environment Discharge the client home after a negative X-ray

✅Provide a safe environment Due to the pattern of bruising and poor hygiene, it is likely this client is being abused and/or neglected by the caregiver and the situation should be investigated. The nurse should clean the client and make sure the client is safe first, then fill out the appropriate forms to report the suspected abuse to the state. The nurse can also question the family and/or caregivers if the nurse determines this would be helpful. ✅Facilitate a client bath This client needs to be clean, so a bath is appropriate for the nurse to facilitate. ✅Report incident to the state The nurse is a mandatory reporter, and must report suspected abuse. Discharge the client home after a negative X-ray Because the client has a specific pattern of bruising and demonstrates poor hygiene, the nurse would suspect that the client is neglected or abused and would follow the protocol for reporting. Sending the client home would go against the nurse's role as a mandatory reporter. Document that the client has been falling at home The client's bruises are indicative of abuse. The nurse cannot assume the client's bruises are from falling at home.

A nurse is caring for a client who is experiencing severe stress associated with her family. The nurse knows that which form of non-verbal communication would most likely indicate interest in what the client is trying to say? Giving the client space Steepling the fingers Providing eye contact Leaning back in the chair

✅Providing eye contact Non-verbal communication sends an important message without saying any words at all. The nurse can demonstrate that he or she is listening to the client by using non-verbal communication such as giving eye contact, nodding the head, and using facial expressions that convey interest in the topic. Steepling the fingers "Steepling" conveys authority and sometimes overconfidence, and should be avoided in this context. Giving the client space This can be taken as disinterest. Leaning back in the chair This makes it seem like the person is not listening.

A nurse is caring for a 79-year-old client whom she suspects is being abused by his daughter. Which of the following situations are risk factors for elder abuse? The older adult being female Shared living situation with a caregiver The caregiver also having the role of power of attorney Scheduled weekly activities to which the caregiver is the only source of transportation

✅Shared living situation with a caregiver Older adult abuse is a growing public health problem in the United States and encompasses many forms, including physical, emotional, financial and sexual abuse. There is evidence that a shared living situation with a caregiver is a risk factor for older adult abuse, likely due to the increased contact the abuser has with the older adult. Other risk factors include dementia and/or social isolation of the older adult, and a mental illness and/or alcohol abuse on the part of the abuser. Scheduled weekly activities to which the caregiver is the only source of transportation Scheduled activities for the older adult increases wellness and is not a risk factor for abuse, even if the caregiver is the only source of transportation. The older adult being female Female sex has not been shown to be a risk factor in the frequency of older adult abuse. The caregiver also having the role of power of attorney This is not a risk factor for older adult abuse.

Which of the following is a true statement regarding communication between the nurse and the client? Communication is affected by personal and social factors but is usually unrelated to ethnic background Environmental factors that affect communication include the emotions and knowledge level of the nurse Social factors that impact communication include health beliefs and practices of the client Communication is 90 percent verbal and 10 percent non-verbal

✅Social factors that impact communication include health beliefs and practices of the client Communication is an essential element of the nurse-client relationship. Communication may consist of non-verbal or verbal communication methods. The social factors, such as the client's cultural background, relationships, patterns of relating, and family circumstances, all affect the health practices of the client. Communication is 90 percent verbal and 10 percent non-verbal Communication is about 7 percent verbal, and 93 percent non-verbal. Communication is affected by personal and social factors but is usually unrelated to ethnic background Ethnic background also affects communication Environmental factors that affect communication include the emotions and knowledge level of the nurse These are intrinsic factors, not environmental factors.

A 3-year-old client is being seen in the healthcare clinic for a fractured arm. The nurse suspects that the child is being neglected. Which of the following signs indicates potential child neglect? Select all that apply. The child has a wound that was never treated The child has more than one injury The child is dehydrated or malnourished The child does not have a coat on a day in which the temperature is below freezing The child has an injury in a hidden area

✅The child is dehydrated or malnourished Malnutrition and/or dehydration are signs of neglect in a child. ✅The child does not have a coat on a day in which the temperature is below freezing When a child is inappropriately dressed for the weather, it is a sign of neglect. ✅The child has a wound that was never treated Neglect is a form of abuse that may be difficult to recognize. If the client is not showing signs of physical abuse, neglect could be overlooked. A child who is neglected may show evidence of non-healing wounds, lack of medical care, poor hygiene, inappropriate dress and malnutrition or dehydration. The child has an injury in a hidden area An injury in a hidden area may indicate abuse, but not neglect. The child has more than one injury This does not indicate neglect and may or may not indicate abuse, based on the origin of the injuries.

A nurse is performing an intake interview on a client who has come to the hospital for abdominal pain. Which action demonstrates that the nurse is actively listening during the client interview? The nurse closes the doors and the blinds and dims the lights in the room The nurse waits to interrupt until after the client has reached a pause in speaking The nurse occasionally nods while the client is talking The nurse mentally prepares a response while the client is talking

✅The nurse occasionally nods while the client is talking Active listening is a form of non-verbal communication that the nurse can employ while listening to another person talk. Active listening conveys the message that the nurse is interested in what the client has to say. The nurse can demonstrate active listening by leaning forward while the other person is talking, making eye contact, and making small comments such as, "I see," or "I understand." The nurse closes the doors and the blinds and dims the lights in the room While minimizing distractions helps, making the area dark and has nothing to do with active listening. The nurse mentally prepares a response while the client is talking If the nurse is not listening, then the nurse is not actively listening, and clients can tell when they are not being listened to. Mentally doing something other than listening is not active listening. The nurse waits to interrupt until after the client has reached a pause in speaking There is no evidence of active listening in this answer. Additionally, this demonstrates that the nurse is not engaged in what the client is saying.

While talking to a patient about how she lost her job, the nurse utilizes clarifying techniques as therapeutic communication. Which of the following are examples of clarifying during the conversation? Select all that apply. Do you have a plan for the future? Are you saying you do not regret this? Would you like to sit or stand while you talk? Do you have to use the restroom? What would you say is most important about this?

✅What would you say is most important about this? A nurse may use clarifying techniques as a form of therapeutic communication to demonstrate listening. Clarifying questions center on the current topic of conversation in which the nurse asks the client to explain a little further to clarify what was just said. Clarifying questions do not focus on topics outside of the conversation, or subjects that have not been brought up in the conversation. ✅Are you saying you do not regret this? A nurse may use clarifying techniques as a form of therapeutic communication to demonstrate listening. Clarifying questions center on the current topic of conversation in which the nurse asks the client to explain a little further to clarify what was just said. Clarifying questions do not focus on topics outside of the conversation, or subjects that have not been brought up in the conversation. Do you have a plan for the future? This question is introducing a new topic that the client has not discussed, so this is not a clarifying question. Do you have to use the restroom? This question is unrelated to the topic of conversation. If the nurse asked, "Are you saying you have to use the restroom?" this would be a clarifying question related to the conversation Would you like to sit or stand while you talk? This question is unrelated to the topic of conversation. If the nurse asked, "Are you saying you have to use the restroom?" this would be a clarifying question related to the conversation

A school nurse suspects a 12-year-old student is a victim of child abuse. The nurse contacts child protective services and then the police. Following the incident, the child's parent approaches the nurse and says, "Why did you call child protective services? Now I'll be suspended from my job!" Which response from the nurse is most appropriate? You should have considered that before hitting your child You are responsible for your job, and I am responsible to report suspected violence in my job I'm sorry if this will hurt your job. I hope you will continue to bring your child to this school I am not allowed to talk about this situation with you since I am the reporter and you are the perpetrator

✅You are responsible for your job, and I am responsible to report suspected violence in my job In a school, students who are victims of child abuse may be seen by the school nurse. The nurse needs to understand the process of reporting suspected abuse when this occurs. A parent accused of child abuse may be angry or upset at the nurse for making a report, but the nurse is in a position in which it is mandatory to report suspected abuse to the authorities. You should have considered that before hitting your child The nurse should remain non-emotional when interacting with the suspected perpetrator I'm sorry if this will hurt your job. I hope you will continue to bring your child to this school The nurse should remain non-emotional when interacting with the suspected perpetrator I am not allowed to talk about this situation with you since I am the reporter and you are the perpetrator The nurse should remain non-emotional when interacting with the suspected perpetrator