PSYCH CHAPTER 9

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic? "Okay, but we are all here to help you, so come get one of the staff if you need to talk." "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." "I don't believe you. You are not being truthful with me." "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

"It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental.

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? "Don't let them beat you! Fight back!" "School is stressful. What do you find most stressful?" "I know just what you are going through. The stress is terrible." "You have only two more semesters. You will be glad if you stick it out."

"School is stressful. What do you find most stressful?" This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

Which of the following statements indicate a nontherapeutic communication technique? (select all that apply): "Why didn't you attend group this morning?" "From what you have said, you have great difficulty sleeping at night." "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today." "You mentioned that you have never had friends. Tell me more about that." "It sounds like you have been having a very hard time at home lately."

"Why didn't you attend group this morning?" "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

Which statement by the nurse reflects the process occurring in the clinical interview? "Give me an example of something your wife does that 'drives you nuts.'" "What makes you think your doctor will give you a pass?" "When is your child custody hearing going to be held?" "You are frowning. What are you feeling?"

"You are frowning. What are you feeling?" Process refers to nonverbal behavior. Nonverbal behavior is often a more accurate gauge of client feelings than what is being verbalized.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A recent immigrant from Russia A deeply depressed client A Chinese American client A tearful client reporting pain

A Chinese American client Chinese Americans may not like to be touched by strangers.

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" Focusing Restating Reflection Clarification

Clarification Clarification verifies the nurse's interpretation of the client's message.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? The mental image of a word may not be the same for both nurse and client. One statement may simultaneously convey conflicting messages. Many of the client's remarks are no more than social phrases. Content of messages may be contradicted by process.

Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message.

Recent immigrants to the United States from which country would find direct eye contact a positive therapeutic technique? Korea Mexico Japan Germany

Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication? Verbal communication is always more accurate than nonverbal communication. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? Giving information and encouraging evaluation Presenting reality and encouraging planning Clarifying and suggesting collaboration Reflecting and exploring

Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible? William did not love his wife. William's response may reflect cultural norms. William's response may reflect guilt. William may have an antisocial personality, which would explain his lack of feeling.

William's response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient did not love his wife, and this would be jumping to conclusions. There is also nothing in the scenario to suggest guilt and there is no evidence in the scenario to suggest antisocial personality disorder.

You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior? You have violated Louisa's personal space by physically being too close. Louisa has issues with sharing personal information. You have not made the patient feel comfortable by explaining the purpose of the admission interview. Louisa is responding to the voices in her head telling her to leave.

You have violated Louisa's personal space by physically being too close. By sitting and leaning in so closely, you have entered into intimate space (0 to 18 inches), rather than social distance and the patient may feel uncomfortable with being so close to someone she does not know. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should quickly break the silence and encourage the client to continue. reassure the client that the abuse was not her fault. reach out and gently touch the client's arm. allow the client to break the silence

allow the client to break the silence Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts.

After a client discusses her relationship with her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" The nurse's purpose is to elicit more information. encourage evaluation. verbalize the implied. clarify message.

clarify message. Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions.

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a safe person to interact with. new friend. stranger. peer.

stranger. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building.