Prep U Psychiatric-Mental Health Nursing Chapter 6: Therapeutic Communication

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.

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

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

The nurse is using a directive role when asking a client which question?

"Are you thinking about hurting someone else right now?"

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?

"At what time did you take the last dose of the antianxiety drugs?"

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?"

The nurse is asking a client for feedback on the services provided in the hospital. The client responds, "Yeah. It was great." The client spoke in a disgusted and hurried tone and did not make eye contact with the nurse. What is the message conveyed here?

"Don't waste my time asking about your services."

A client who is hospitalized with depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate?

"Have you ever thought about hurting yourself?"

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 your spouse make you feel?"

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and check on me after dinner yesterday but never came." What is the nurse's most therapeutic response?

"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you."

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."

The nurse is assessing the behavior of a client. The client has a cheerful expression, erect posture, and a confident tone. Which statement made by the client along with these nonverbal cues conveys a congruent message?

"I feel great and am able to do my exercises properly."

A nurse is engaging in an interpersonal interaction with a young adult client who is admitted to the hospital with suicidal ideation. The client states, "I am really not good at anything." How should the nurse respond to the client's statement?

"I have a really difficult time believing that."

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."

During a client interview, the client tells the psychiatric-mental health nurse, "If I told you what I did to my son, you'd never want to speak to me again." What is the nurse's most therapeutic response?

"I'd very much like to hear about that, and it is okay for you to talk about it with me."

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?"

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

"It sounds like you're feeling unappreciated."

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."

A client is speaking with the nurse about the client's difficult relationship with the client's father. The client states, "He never showed me love or approval unless I was perfect." Which response is most likely to encourage the client to continue elaborating?

"Tell me more about that."

The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication?

"This is overwhelming for you, it is okay to cry."

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?"

The nurse therapist calls a client to reschedule their appointment for the following week. When the client arrives at the appointment, the client is uncommunicative and avoids eye contact with the nurse. When asked how things have been going, the client answers, "Fine." How should the nurse confront this behavior?

"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."

Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can."

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

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

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

A client who has tried several different antidepressant medications tells the nurse that uncomfortable side effects make the client want to stop taking medication altogether. What is the nurse's best response?

'Tell me what is it about the medication that is troubling you the most."

The nurse is engaging in assertive communication when which communication approach is used? (Select all that apply.)

1. expressing feelings attached to the concern 2. using "I" statements 3. using direct language

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

Abstract

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?

Abstract

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 feet

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

3 to 6 feet

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

Anxiety

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 sad facial expression A fearful tone of voice

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

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

Broad openings

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 expresses to the nurse that the client has been unable to sleep due to work. The nurse asks the client, "Do you mean that the work in the office is causing stress, which is why you are not able to sleep?" Which type of therapeutic communication technique is this conversation indicative of?

Consensual validation

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

Context

Which type of cue is being used when the client states, "Nothing can help me"?

Covert

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

Cue

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

Emphasis

A nurse is assessing a client with chronic illness. The client is whimpering. The nurse asks the client, "Is something wrong?" Which type of therapeutic communication technique is this indicative of?

Encouraging description of perception

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

The nurse observes that a client has been pacing in the unit's common area with pursed lips and a furrowed brow for the past 15 minutes. What is the psychiatric-mental health nurse's best action?

Engage with the client i to validate why the client is doing this

After reviewing the client's chart, the nurse sets up a time to speak with the client. The client has a history of severe psychological abuse by the client's mother, who has schizophrenia. The nurse plans to ask the client about the abuse and how it has affected the client's sense of self-esteem. This is an example of what kind of intervention?

Excessive probing

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?

Exploring

The nurse is caring for a client with schizophrenia. The client says, "Somebody is trying to kill me." The nurse responds by saying, "Isn't the weather nice? You should sit outside for a while." Which type of communication does this indicate?

Introducing an unrelated topic

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

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

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?

Korean

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

After spending 15 minutes talking with a client, the client leaves the interaction feeling defensive. This is evidence that the communication can be described as what?

Nontherapeutic

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

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

During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which therapeutic communication technique?

Probing

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

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse?

Public

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

Public

A client begins discussing frankly the client's history of sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. The nurse does this for what reason?

To reduce the nurse's own anxiety

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 arrangement is likely to be the least threatening to a psychiatric-mental health client?

Sitting at an angle, 4 to 5 feet apart

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

A mental health nurse is discussing the schedule of events for the day on the unit with a client. The nurse therapeutically communicates within which zone of distance awareness?

Social

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

Social-polite

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.

A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation?

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

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

A nurse is caring for a client who is experiencing a decline in the client's chronic illness. The nurse feels that the nurse should speak to the client's spouse, who is extremely worried and anxious, and provide the spouse with support. Which setting should the nurse select to speak to the spouse? Choose the best answer.

The consultation room

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 the client's son in an accident.

The nurse is speaking with a client. While listening, the nurse faces the client and leans slightly toward the client. How does the client interpret this gesture?

The nurse is keenly interested in the client's concerns.

Which is inconsistent with principles of therapeutic communication?

The nurse is the primary focus of the relationship.

During client assessment, the nurse asks the next question as soon as the client finishes answering the previous question. Which most likely explains why the nurse is interacting with the client this way?

The nurse may lack confidence in therapeutic communication.

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?

A psychiatric-mental health advanced practice nurse is mentoring a newly hired psychiatric-mental health nurse and role modeling therapeutic communication techniques. The advanced practice nurse observes the new nurse and determines the need for additional role modeling when the new nurse uses which technique? Select all that apply.

advice reassurance disapproval

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

After discussing feeling guilty about having trouble looking after her children, the client states, "They would be better off if I wasn't around." The client's statement is an example of a(n):

covert cue.

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.

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

A nurse is meeting with a client who just attended a group therapy session. The nurse asks, "How was group for you today?" The client is silent longer than the amount of the time the nurse expected. What can the nurse assume the client needs?

more time to think

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

silence

A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment?

social

A nurse has been in a therapeutic relationship with a client for several weeks. When the client comes in for the weekly appointment, the nurse touches the client's arm when saying hello. The nurse has used which form of touch?

social-polite

The nurse is caring for a 42-year-old Asian-American client. Which question would assist the nurse in evaluating the client's cultural needs?

"How do you typically respond when people touch you?"

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply.

"I am frustrated with the situation." "I am feeling disrespected by your comments."