Relationship development and therapeutic comunication

Which therapeutic communication technique would the nurse use for a client who is moving rapidly from one thought to another? 1. Focusing 2. Restating 3. Exploring 4. Reflecting

1 Focusing is the therapeutic communication technique that should be used in a client who is rapidly moving from one thought to another. It helps keep the client stable in one thought.

Which precaution should the nurse follow while caring for an Asian American client? 1. Limit touch with this client. 2. Refrain from taking financial gifts from the client. 3. Refrain from collecting background data of the client. 4. Refrain from giving excuses about the client's inappropriate behavior to others.

1 In Asian American culture, touch is not considered acceptable. The nurse should particularly be careful while taking care of an Asian American client.

A client with depression says, "I feel like I am alone out in the ocean." What would the nurse say in response to this statement using a therapeutic communication technique? 1. "You must be feeling very lonely." 2. "Are you feeling that no one understands you?" 3. "You are feeling like nobody cares about you." 4. "Please explain the situation more clearly."

1 In response to the client's statement, the nurse should try to desymbolize the statement and find an underlying clue in it. This statement is attempting to do so.

The nurse tells an angry client, "I see you have been walking back and forth frequently." Which therapeutic communication technique should the nurse follow while communicating with the client? 1. Making observations 2. Giving broad openings 3. Offering general leads 4. Placing the event in a timeline

1 Making observations or verbalizing the perceived behavior encourages the client to recognize specific behavior and evaluate the observation with the nurse. This gives the client an opening to discuss issues.

While caring for a client with deficit knowledge, the nurse says, "I will clarify all your questions about the therapy." What is the rationale behind this statement by the nurse? 1. To protect himself or herself from any verbal attack of the client 2. To present reality to the client 3. To prevent unmanageable anxiety of the client 4. To facilitate understanding between the client and the nurse

1 The statement by the nurse indicates defending. When the nurse speaks in a defending way, it protects from verbal attack.

Which category of touch does the nurse exhibit while greeting a client with a handshake? 1. Social-polite 2. Love-intimacy 3. Friendship-warmth 4. Functional-professional

1 Touch is a powerful communication tool that elicits negative and positive reactions. Social-polite touch is an impersonal touch that conveys an acceptance toward another person. The nurse accepting the client and giving a handshake is an example of social-polite touch.

The client becomes angered when a nurse comes in wearing a hat that reminds the client of the his abusive mother used to wear. Which term describes this emotion? 1. Transference 2. Countertransference 3. Overcoming resistance 4. Reality perception

1 Transference occurs when the client unconsciously displaces (or "transfers") feelings formed toward a person from his or her past onto another.

Which therapeutic communication technique is often used with clients experiencing delusional thinking? 1. Voicing doubt 2. Exploring 3. Verbalizing the implied 4. Belittling feelings expressed

1 Voicing doubt allows the client to express uncertainty of the reality about the client's perception. This technique is often used with clients experiencing delusion thinking.

The nurse is disciplined for having dinner after hours with a client. Which type of boundary was breached? 1. Material boundaries 2. Professional boundaries 3. Personal boundaries 4. Social boundaries

2 Professional boundaries limit and outline expectations for appropriate professional relationships with clients.

When the client begins speaking in a session, the nurse says, "Let's not discuss that today." This is an example of which type of nontherapeutic communication technique? 1. Disapproving 2. Rejecting 3. Defending 4. Probing

2 Refusing to consider or showing contempt for a client's ideas or behavior may cause the client to discontinue interaction with the nurse for fear of further rejection.

Which actions of the nurse convey an attitude of respect towards the client? Select all that apply. 1. Being honest while interacting with the client 2. Calling the client by name 3. Spending time with the client 4. Understanding the situation from the client's point of view 5. Promoting an atmosphere of privacy during therapeutic interaction

1, 2, 3, 5 Option 1: Being honest while interacting with the client even when the truth may be difficult to discuss conveys respect. Option 2: Calling the client by name conveys respect towards the client. Option 3: Spending time with the client conveys respect towards the client. Option 4: Understanding the situation from the client's point of view conveys empathy. Option 5: Promoting an atmosphere of privacy during therapeutic interactions with the client conveys respect towards the client.

While obtaining data from a client, the nurse observes that the client's eyebrows are in the frowning position. Which type of associated feelings could the nurse interpret in the client? Select all that apply. 1. Anger 2. Surprise 3. Enthusiasm 4. Unhappiness 5. Concentration

1, 4, 5 When a client shows a facial expression with frowning eyebrows, it indicates that the client is angry. Frowning eyebrows indicate that the client is unhappy. When a client is concentrating on something, then an expression of frowning eyebrows is maintained.

While collecting the history of a client with anger, the nurse observes that the client is blinking his or her eyes continuously. Which associated feeling does the nurse expect from the client's facial expression? 1. Surprise 2. Dislike 3. Low self-esteem 4. Frustration

2 A client who dislikes something often blinks his or her eyes or looks away from the nurse.

The nurse is caring for a psychiatric client who is experiencing concrete thinking. Which nursing intervention is most essential to develop a therapeutic relationship with the client? 1. Establishing an acquaintance with the client 2. Keeping promises made to the client 3. Considering the client's ideas when planning care 4. Being open and real while interacting with the client

2 A client who is experiencing concrete thinking focuses on specifics rather than generalities. Therefore, keeping promises made to the client helps the nurse fulfill the specifics and also develop trust.

The nurse knows touch is a powerful method of communication. Which type of physical contact is considered functional-professional? 1. A handshake 2. Nurse examining a client 3. Engaging in a strong embrace 4. Touching in the genital region

2 A nurse examining a client is functional-professional; it is impersonal and businesslike. It is used to accomplish a task.

A client's spouse presents a bouquet of flowers and chocolates to the nurse for taking care of the client. What is the most appropriate response of the nurse? 1. "I do not accept gifts." 2. "Thank you. I will share your gift with my colleagues." 3. "It is against the rules of the hospital to accept gifts." 4. "The flowers and chocolates are wonderful. Thank you for them."

2 Accepting small gifts as a token of appreciation from the client may be considered appropriate. If the nurse responds, "Thank you. I will share it with my colleagues," it would be more appropriate because the nurse is acknowledging the effort of other staff members involved in caring for the client.

What is an example of a negative attitude? 1. Having an idea that alcoholism is a disease 2. The negative stigma associated with mental illness 3. Conveying the truth to all psychotic clients about their medical illness 4. Conjecturing that all people with mental illness are dangerous

2 An attitude is a way of thinking, which can be selective and biased. The negative stigma associated with mental illness is an example of a negative attitude.

The nurse is caring for a client who is depressed due to the death of his or her partner. At dinnertime the nurse asks the client, "Can I sit and eat with you?" What is the rationale behind this nursing intervention? 1. To emphasize the client's importance 2. To increase the feeling of self-worth 3. To encourage a like response from the client 4. To increase the understanding between the nurse and the client

2 Asking the client to join for dinner indicates that the nurse is making him or herself available to the client and, therefore, increases the feeling of self-worth in the client.

The nurse begins a session with the client by saying, "What would you like to discuss today?" This is an example of which communication technique? 1. Offering general leads 2. Giving broad openings 3. Encouraging the description of perceptions 4. Offering self

2 Broad openings allow the client to take the initiative in introducing the topic.

A client with low self-esteem tells the nurse, "I am of no value to anybody." Which statement by the nurse in response to the client indicates a better example of therapeutic communication? 1. "Of course you are something. Everyone is something." 2. "You are feeling like nobody cares about you right now." 3. "What makes you say this?" 4. "You must be feeling very lonely right now."

2 Denial of the problem blocks discussion with the client and avoids helping the client identify the areas of difficulty. This statement made by the nurse is a better way of responding to the client.

In a therapeutic relationship empathy is extremely important. Which does the nurse know describes empathy? 1. Sharing the feelings of another person 2. Accurately perceiving and understanding another person's feelings 3. Identifying with what another is feeling 4. Experiencing a need to alleviate another's distress.

2 Empathy involves understanding what another person is feeling while staying emotionally separate.

The nurse is developing a therapeutic relationship with the client. Which statement made by the nurse indicates an empathetic response? 1. "I understand your feelings because I have gone through the same thing." 2. "If you felt bad about those harsh comments, it is ok to be sad and cry." 3. "I will surely incorporate your ideas and preferences when planning your care." 4. "Be assured that whatever we discuss will not leave the boundaries of our health-care team."

2 In an empathetic response, the nurse understands and perceives the feelings of the client accurately. The nurse encourages the client to explore his or her feelings. Therefore, this statement indicates an empathetic response.

Which therapeutic technique should the nurse use to encourage a client to recognize specific behaviors and compare perceptions with the nurse? 1. Giving recognition 2. Making observations 3. Giving broad openings 4. Encouraging comparison

2 Making observations is a therapeutic technique that involves what is observed or perceived. This will encourage the client to recognize specific behaviors and compare those perceptions with the nurse.

The nurse accepts a client unconditionally and regards him or her as a worthy person. Which characteristic is exhibited by the nurse? 1. Trust 2. Respect 3. Empathy 4. Genuineness

2 Respect is to acknowledge the client's dignity, value, and worth. Therefore, if the nurse accepts the client unconditionally and regards him or her as a worthy person, it is a characteristic of respect exhibited by the nurse.

The client says, "All men are messy and untidy." What type of belief does the client have? 1. Faith 2. Stereotype 3. Rational belief 4. Irrational belief

2 Stereotypes are socially shared beliefs, which categorize all individuals with a common factor like age, sex, race, into one group. Therefore, the client's statement represents a stereotype.

The registered nurse is teaching a student nurse about skills for active listening. Which statement made by the student nurse needs correction? 1. "Always maintain an open posture while listening to someone." 2. "Maintain constant eye contact while listening to others." 3. "Always sit squarely facing the client while listening to him or her." 4. "Lean forward toward the client while listening to him or her."

2 The eye contact of the nurse should be intermittently directed, which shows the willingness of the nurse to listen. Thus, this statement needs correction.

The nurse is caring for a client with anxiety. The client asks the nurse, "Will I be normal?" Which nurse's statement reassures the client? 1. "Let's not discuss your thoughts." 2. "Don't worry about it. We can work on that as a team." 3. "Let's talk about how your behavior caused anxiety." 4. "What do you think you should do to become normal?"

2 The nurse reassures the client that there is no need to worry, thereby reassuring the client's feelings and discouraging further anxiety.

Which phase of the nurse-client relationship development deals with creating an environment for the establishment of trust and rapport with the client? 1. The working phase 2. The orientation phase 3. The termination phase 4. The preinteraction phase

2 The orientation phase is the introductory phase where the nurse and client get acquainted. Therefore, if the nurse is creating an environment to establish trust and rapport with the client, then it is the orientation phase.

The nurse is caring for a client who is in the isolation room. Which statement made by the nurse indicates that the nurse is trying to increase the client's feeling of self-worth? 1. "I see you put away your clothes." 2. "I'll sit in here with you for a while." 3. "I notice you are pacing a lot." 4. "Yes, I understand what you said."

2 This statement helps increase the client's feeling of self-worth.

A client who separated from his or her spouse tells the nurse, "I don't know why I am living. There is nothing to live for." Which statement made by the nurse serves as the best nontherapeutic communication technique? 1. "Tell me why you separated." 2. "You appear to be upset. Can you tell me how you're feeling?" 3. "Everybody gets down sometimes. I also feel this sometimes." 4. "It must have been very difficult for you when you separated from your spouse."

2 This statement made by the nurse is the best nontherapeutic communication technique because it conveys understanding and empathy to the client.

The nurse remains respectful of a client who is engaging in behaviors opposed to the nurse's religious beliefs. Which describes the nurse's response? 1. Confidentiality 2. Unconditional positive regard 3. Genuineness 4. Concrete thinking

2 To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior.

While collecting data from the client, the nurse observes that the client is communicating superficially. Which therapeutic communication technique should the nurse apply to respond to this client? 1. "Let's look at this a little more closely." 2. "Please explain the situation more clearly." 3. "Tell me if my understanding agrees with yours." 4. "I am not sure that I understood what you just told me. Would you please explain it again?"

2 When the client is communicating superficially, the nurse should respond by asking the client to explain the situation more clearly. This will make the client improve his or her communication.

When should an individual maintain a distance of 4 to 12 feet while communicating with others? Select all that apply. 1. While communicating with friends 2. While communicating with strangers 3. While communicating with colleagues 4. While communicating at a cocktail party 5. While communicating with others in a public building

2, 4 While interacting with strangers, an individual should maintain a social distance of 4 to 12 feet. While communicating with others at a cocktail party, an individual should maintain a social distance of 4 to 12 feet. (5)?(p.118)An individual while communicating with others in a public building should maintain a pubic distance of more than 12 feet.

Which client's facial expression is associated with a feeling of low self-esteem? 1. Frowning eyebrows 2. Sneered lips 3. Downcast eyes 4. Wrinkling nose

3 A client with low self-esteem will have downcast eyes or will lack eye contact while communicating with another person.

The nurse is caring for a psychiatric client who has been rejected by his partner. Which nursing intervention will increase feelings of self-worth in the client? 1. Expressing empathy towards the client 2. Getting acquainted with the client 3. Recognizing and respecting the client 4. Providing a safe environment to the client

3 A psychiatric client will have low self-esteem after being rejected by others. Recognizing and respecting the client will increase feelings of self-worth.

A client is crying to the nurse because someone made a joke about her being overweight. Which of the nurse's responses is an example of empathy? 1. "I can identify with what you are feeling. I am overweight too." 2. "I get so angry when people are insensitive like that." 3. "You feel angry and embarrassed. It is alright to cry." 4. "It's typical of skinny people to be so rude."

3 Because the nurse identifies the client's feelings and makes it safe for the client to express those feelings, this is an example of empathy.

While escorting a client to the examination room, the nurse observes a smile on the client's face when the primary health-care provider approaches. What emotion is the client expressing? 1. Frustration 2. Disagreement 3. Happiness 4. Low self-esteem

3 Happiness is satisfaction or contentment. A smile on the client's face indicates that he or she is happy when looking at the primary health-care provider, whom he or she has met before.

Which phase of development of the therapeutic relationship involves the evaluation of goals attained by the client after the therapy? 1. The working phase 2. The orientation phase 3. The termination phase 4. The preinteraction phase

3 In the termination phase, a conclusion is brought to the relationship. Therefore, if the nurse is evaluating the goals attained by the client after the therapy, it is the termination phase.

Which action of the nurse indicates the working phase of relationship development with a client? 1. Formulating nursing diagnoses 2. Examining the client's feelings, fears, and anxieties 3. Continuously evaluating the client's progress towards goal attainment 4. Developing a plan of action that is realistic for meeting the goals

3 In the working phase, the nurse continuously evaluates the progress of the client towards goal attainment.

The nurse is caring for a client during an anger-management program. Which action represents the working phase of therapeutic relationship management? 1. The nurse preparing a plan for continuing care. 2. The nurse assessing the client's previous medical records. 3. The nurse helping the client practice various adaptive procedures to control anger. 4. The client and nurse setting goals to develop some adaptive ways to handle anger.

3 In the working phase, the therapeutic work of the relationship between the nurse and client is carried out. Therefore, the nurse helping the client practice various adaptive procedures to control anger represents the working phase.

A client in group therapy is uncomfortable speaking in front of other members but communicates openly in a one-to-one session with the nurse. Which element is contributing to the client's anxiety? 1. Religion 2. Values 3. Environment 4. Culture

3 Some individuals who feel uncomfortable and refuse to speak during a group therapy session may be open and willing to discuss problems privately on a one-to-one basis with the nurse because the environment feels safer.

While caring for a client with persistent depressive disorder, the nurse says, "I can understand what you are feeling now. I too have been in this same situation before." Which feeling of the nurse is indicated by these statements? 1. Rapport 2. Empathy 3. Sympathy 4. Genuineness

3 Sympathy is the ability to share the feelings of the client. In this case, the nurse is trying to share his or her feelings with the client about a similar situation that was experienced earlier.

The nurse is in the first phase of relationship development with a client who is an alcoholic. What should be the goal of the nurse during this phase? 1. Establishing trust 2. Promoting client change 3. Exploring self-perceptions 4. Ensuring therapeutic closure

3 The first phase is the preinteraction phase, where the nurse prepares for the first encounter with the client. Everyone brings attitudes and feelings from their own experiences to the clinical setting. Therefore, it is necessary to be aware of self-perceptions so as to not let them affect providing care to clients.

The nurse is counseling a group of clients on a one-to-one basis to obtain information regarding their current health situation. Which type of distance should the nurse maintain while communicating with the clients? 1. Public 2. Social 3. Personal 4. Intimate

3 The nurse can have a close conversation with the client in a personal distance while maintaining a distance of 18 to 40 inches.

The nurse is caring for a client with situational low self-esteem. Which statement made by the nurse helps the client recognize his or her life experiences? 1. "Explain what happened when you felt that way." 2. "I understand that you are telling me this happened." 3. "How did you respond when this happened in the past?" 4. "What might you do to handle this more appropriately?"

3 The nurse encourages the client to compare the similarities and differences of experiences and ideas, which helps the client recognize that life experiences may recur.

What is the minimum distance that the nurse should maintain while interacting with a client? 1. 18 inches 2. 30 inches 3. 60 inches 4. 156 inches

3 The nurse should communicate with a stranger within social distance by maintaining a distance of 4 to 12 feet.

The nurse is caring for a client who unconsciously transfers his or her feelings for a person in the client's past towards the nurse because the nurse's appearance reminds the client of that person. Which outcome in the client would indicate the effectiveness of the nursing care? 1. The client will formulate a plan with the nurse. 2. The client will develop problem-solving skills. 3. The client will assume responsibility for his or her own behavior. 4. The client will discuss and compare the exhibited behaviors with the nurse.

3 When the client assumes responsibility for his or her own behavior, it indicates that the client no longer shows the transference behavior and that the nursing care is effective.

Which facial expressions of a client may indicate disgust? Select all that apply. 1. Raised brows 2. Sticking out the tongue 3. Wrinkling up the nose 4. Eyelids squeezed shut 5. Canine-type snarl

3, 5 The facial expression of wrinkling up the nose indicates disgust. Canine-type snarl indicates disgust.

Which represents love-intimacy in an individual? 1. Accepting the hand of a person during a handshake 2. Expressing physical attraction towards others 3. Having a strong desire towards a person 4. Being emotionally attached to a person

4 Emotional attachment or attraction to a person represents love-intimacy in an individual.

While caring for an angry client, the nurse makes empty conversation. What could be the rationale behind this nursing intervention? 1. To explore the client's areas of difficulty 2. To tell the client about the meaning of the experience 3. To take over the direction of the discussion from the client 4. To encourage a like response from the client

4 Empty conversation from the nurse encourages a like response from the client. It is practiced as a nontherapeutic communication technique in which stereotyped comments are made to encourage a like response from the client.

Which is a task completed in the preinteraction phase of the client relationship? Gathering assessment information to build a strong client database 2. Promoting the client's insight and perception of reality 3. Using the problem-solving model 4. Examining one's own feelings, fears, and anxieties about working with a particular client

4 Examining one's own feelings, fears, and anxieties about working with a particular client happens in the preinteraction phase.

While caring for a client with anger, the nurse formulates a plan of action with the client. What would be the rationale behind this nursing intervention? 1. To nurture the client in the dependent role 2. To find clues to the underlying true feelings of the client 3. To encourage a like response from the client 4. To prevent anxiety or anger from escalating to an unmanageable level

4 Formulating a plan of action with the client helps prevent anxiety or anger from escalating to an unmanageable level.

The nurse tells the client the truth. What is this characteristic of the nurse called? 1. Respect 2. Empathy 3. Sympathy 4. Genuineness

4 Genuineness is the ability of the nurse to interact with the client by being honest and real. Therefore, if the nurse is telling the truth to the client, it represents genuineness.

The nurse knows which is an important characteristic of the therapeutic relationships? 1. Self-directed 2. Goal-oriented 3. One-sided 4. Collaborative

4 Ideally, the nurse and client 'decide together' what the goal of the therapeutic relationship will be.

A client with depression says, "Everyone has deserted me. I feel that my life has no value." Which nontherapeutic technique would the nurse use to take over this discussion? 1. Interpreting the situation 2. Using denial technique 3. Expressing belittling feelings 4. Introducing an unrelated topic

4 Introducing an unrelated topic allows the nurse to take over the discussion.

Which nonverbal behavior of the nurse indicates an open posture for attentive listening? 1. Establishing eye contact 2. Sitting squarely facing the client 3. Leaning forward toward the client 4. Keeping the arms and legs uncrossed

4 Keeping the arms and legs uncrossed indicates an open posture for attentive listening.

Which gesture exemplifies the "O" in the acronym SOLER for nonverbal behaviors involved in active listening? 1. Sitting in front of the client 2. Lean in toward the client 3. Establish eye contact 4. Client sitting in a chair with arms and legs uncrossed

4 Posture is considered "open" when arms and legs remain uncrossed; observing this is the "O" in SOLER.

The nurse is standing in front of a room of clients. Which term describes the distance between the nurse and the clients? 1. Intimate 2. Social 3. Personal 4. Public

4 Public distance is one that exceeds 12 feet. Examples include speaking in public or yelling to someone from a distance.

The nurse tells a client with a history of violence, "Let's discuss your behavior and see if we can clarify the situation." What could be the rationale behind this statement? 1. To help recognize life experiences that tend to recur 2. To define the perception of the situation for the client 3. To delve further into the subject with the client, beyond a superficial level of communication 4. To facilitate and increase the rapport for both client and nurse

4 Seeking clarification and validation facilitates and increases the mutual understanding between the nurse and the client. Therefore, this statement facilitates and increases the rapport for both client and nurse.

The nurse is conducting a process recording of a client with a history of anger. The nurse asks the client, "What were your feelings before taking all those pills the other night?" The client replies, "I was just so angry thinking that my husband wants a divorce." What may likely be the nurse's thoughts after the client's reply? 1. Feeling sorry 2. Feeling uncomfortable 3. Trying hard to remain objective 4. Feeling more comfortable

4 The nurse likely begins to feel comfortable after the client's reply because the client is willing to talk to the nurse and trusts him or her. This change in behavior helps the nurse to explore and understand the client.

The nurse is conducting a process recording of a client with anger who has attempted suicide. Which statement or question made by the nurse may make the nurse uncomfortable? 1. "How are you feeling about the situation now?" 2. "Seems like a pretty drastic way to make your point." 3. "You wanted to hurt yourself because you were cheated." 4. "Do you still have thoughts of harming yourself?"

4 The nurse may feel uncomfortable asking the client about thoughts of harming himself or herself. This question is asked to know whether the client has suicidal tendencies.

A client who lost his or her spouse in an accident tells the nurse, "Leave me alone. I can't talk to you." How should the nurse respond to this client using therapeutic communication techniques? 1. "Everything will be fine." 2. "Tell me what you are thinking?" 3. "I think you should come in here and discuss your feelings." 4. "Are you feeling that no one understands your feelings?"

4 The nurse should put into words what the client has implied or said indirectly. This statement made by the nurse is the best response to the client.

A client tells the nurse, "I can't concentrate on anything. My mind keeps wandering." How should the nurse respond to convey to the client that he or she has understood the client's statement? 1. Referring questions back to the client 2. Taking notice of a single idea of the client 3. Researching further into the client's feelings 4. Repeating the main idea of what the client has said

4 The nurse should repeat the main idea of what the client has said to make the client know that the statement is understood. Repeating the main idea will help both the client and the nurse to validate the statement.

The nurse is caring for a client with chronic low self-esteem. Which statement made by the nurse indicates an accepting attitude? 1. "I want to listen to what you have to say." 2. "Explain to me what you are feeling now." 3. "We can sit in the dayroom and eat dinner together." 4. "I understand what you're saying."

4 This statement indicates an accepting attitude of reception to and regard for the client.