Prep U Chap 6 Psych-Therapeutic Communication

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process?

"Can you explain to me what made you so angry?"

A client has repeatedly been physically abused by the spouse. The client asks the nurse whether to leave the spouse like the mother has demanded. The nurse responds most therapeutically when answering:

"How would leaving him make you feel?"

A nurse is assessing an elderly client with a cardiac disorder. Which statement given by the client conveys an abstract message? Choose the best answer.

"I don't really know how it all started. It just happened."

A client who is experiencing depression states, "I can't seem to do anything to take care of myself, how can I get going?" What is the nurse's best response?

"I notice it has been a while since you have had a shower."

Which statement by the nurse is an example of assertive communication?

"I understand that group can be difficult to attend but coming late is disruptive."

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

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

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

"It looks like you're searching for something. Is that right?" When communicating, it is important to make an observation and then seek clarification and encourage the client to explore his or her behavior.

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?

"It sounds like you're feeling unappreciated." Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.

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

"Let's talk about infections, and how they heal." Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals, such as assessing the client's perception of the problem as it unfolds, teaching the client self-care skills and identifying a plan of action to a satisfying and socially acceptable resolution.

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic?

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security. The nurse describes the client's unacceptable behavior, communicates expected behavior, and offers acceptable alternatives, such as walking with the nurse, talking about feelings and thoughts, or participating in recreational therapy.

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

"What specifically makes you uncomfortable?"

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

"What specifically makes you uncomfortable?" It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic.

A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response?

"What you are saying and how you say it does not seem to match."

A nurse is speaking to a client with a smiling expression. Which statement by the nurse would promote the most congruent communication?

"You hard work and determination has really helped you succeed."

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

"You look upset. Would you like to talk about it?"

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply.

-A fearful tone of voice -A sad facial expression

A psychiatric-mental health nurse is working with several clients and decides to use silence during the interaction. In which situation would it be therapeutically appropriate to use silence? Select all that apply.

-Client who is experiencing depression -Client who is lost in own thoughts -Client who is constructingh a response -Client who is pondering the question

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply.

-Leaning toward the client -Maintaining eye contact with the client

A client has been brought to the psychiatric care unit. During the assessment, the nurse observes the client uses ineffective communication skills. Which are interpersonal factors that may influence the client's mental health? Select all that apply.

-Proxemics -Silence -Inability to use feeling words

Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can." 1-"You look like you are very angry this morning." 2-"Who has made you so upset?"

1-"You look like you are very angry this morning."

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication?

3' to 6'

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

3' to 6'

Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?"

Broad openings allows the client to take the initiative in introducing the topic

High-pitched, rapid delivery of a message often indicates what?

Anxiety

When interviewing a young adult Asian client who immigrated to the United States as a child, the nurse best addresses the impact that culture has on the client's perceptions and beliefs by doing what?

Assessing to what degree the client has embraced the American culture

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone?

Beginning at the boundary of the intimate zone and ending at the social zone

A psychiatric-mental health nurse is interacting with a client experiencing depression. The nurse is vigilant in observing the nonverbal communication of the client based on the understanding about which aspect associated with clients with mental illness?

Clients have difficulty verbally expressing themselves and interpreting others' emotions

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

Context

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

Cue -A cue is a verbal or nonverbal message that signals key words or issues for the client.-An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret.-In a concrete message, words are explicit and need no interpretation.-A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.

A client is speaking to the nurse and expressing dissatisfaction about the care that was provided to the client during a hospital stay. The nurse tells the client, "This is the best hospital in the state. You could not expect better care anywhere else." Which type of communication does this indicate?

Defending

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?

Emphasis

A nursing student is caring for a client who has been arrested for child abuse. The nurse is very curious about what the client must have done to get into so much trouble, so the nurse asks the client to tell the nurse about the various activities that got the client arrested. This is an example of:

Excessive probing

The client tells the nurse, "My mom is coming in to see me today," while sighing and looking out the window. The nurse states, "You don't seem very excited about the visit, is everything OK?" The client affirms. Using therapeutic communication, how should the nurse respond?

I'm concerned that you are not excited about your mother's visit, We can talk if you want.

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited?

Impassive

A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response?

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

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to:

Permit the client to gather the client's thoughts

Which zone is a distance that is comfortable between family and friends who are talking?

Personal

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

Presenting reality Presenting reality is offering for consideration of what is real. Reflecting is directing client actions, thoughts, and feelings back to the client. Making observations is verbalizing what the nurse perceives. Seeking information is seeking to make clear something that is not meaningful or that is vague

When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what?

Presenting the information using language and terms the client will understand

A psychiatric-mental health nurse is working to develop a therapeutic relationship with a client. When doing so, which element would the nurse integrate as critical to building this relationship?

Self-awareness

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse

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

Silence

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

Sitting behind a desk

The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement?

The client feels that the nurse is indifferent toward the client.

When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind?

The client is the primary focus of the interaction.

The nurse is sitting behind a table while speaking to a client on the other side of the table. What is the most appropriate reason for this nurse's action?

The client may have difficulty maintaining spacial boundaries.

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue?

The client may have suicidal ideations.

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

The client's room

Which is an inaccurate depiction of concrete questions?

They require rephrasing of unclear questions.

Which is an inaccurate depiction of concrete messages?

They require rephrasing of unclear statements.

When speaking with a client who has a diagnosis of major depression, the nurse has placed a hand lightly on the client's shoulder when responding to one of the client's statements of hopelessness. Which principle should underlie the nurse's use of touch when communicating with clients?

Touch can be a powerful therapeutic tool, but it must be used with caution.

Which question should be avoided because it may be perceived as criticism by the client?

Why?

"Get the stuff from him" is an example of which type of message?

abstract

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

active listening Active listening is refraining from other internal mental activities and concentrating exclusively on what the client says. Self disclosure, empathetic linkages and self awareness are not communication techniques. Empathetic linkages are the communication of feelings

The nurse therapist calls a client to reschedule their appointment for the following week. When the client arrives at the appointment, she is uncommunicative and avoids eye contact with the nurse. When asked how things have been going, she answers, "Fine." How should the nurse confront this behavior? a) "I'm sorry I had to reschedule our appointment. It really couldn't be helped. Is that what's bothering you? "b) "You seem angry. Would you like to talk more about how you're feeling?" c) "You appear to be angry. Perhaps you are angry with me for rescheduling our appointment or something else has happened. Tell me more about what you are feeling." d) "You seem angry, and I understand that you have been depressed, but I feel like you are avoiding speaking to me. Can you explain why you're acting this way?"

c) "You appear to be angry. Perhaps you are angry with me for rescheduling our appointment or something else has happened. Tell me more about what you are feeling."

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

closed body position and impassive face

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication?

emotion underlying the words

The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what?

self disclosure

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

self-disclosure

Which type of touch, according to Knapp, is used in greeting, such as a handshake?

social - polite

Which behavior of the nurse indicates that the nurse has a therapeutic relationship with the client?

the nurse expresses empathy to a client who has recently lost his son in an accident