6: Therapeutic Communication

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?" Explanation: Concrete messages use explicit wording and need no interpretation. Asking the client about the time of the last dose of the antianxiety drugs conveys the most accurate information. Asking the client about when the client stopped taking the drugs fails to specify the type of drug, and using the word "when" will not help the client give the accurate response. Asking the client when the client took them last would confuse the client, as "them" may not be interpreted as 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?" Explanation: Identifying the problem (trigger for the anger) is the initial step in the problem solving process followed by brainstorming all possible solutions (different ways to manage the anger). Selecting the best alternative, implementing the selected alternation, and then evaluating the situation are the remaining steps in the process.

The nurse is talking with a client about their use of alcohol as an ineffective coping mechanism. Which statement made by the client indicates that the client is experiencing denial related to their alcohol use?

"I don't have a problem, I can quit whenever I want." Explanation: The client is experiencing denial when stating that they can stop drinking whenever they want. The client is not taking responsibility for their drinking by having the spouse monitor them, but this does not indicate that the client is in denial. Using the coping skills obtained in rehab demonstrates the client is willing to make changes but is not in denial about the alcohol use. Going to AA and obtaining a sponsor is acknowledging that the client requires help with drinking cessation.

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to come 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 check on you yesterday, but I think it's unlikely that the doctor hates you." Explanation: One therapeutic communication technique is to express doubt. This is appropriate when the client expresses a thought that stretches credibility. The nurse does not agree or disagree but does express skepticism, which encourages the client to reconsider. It would be inappropriate for the nurse to characterize the health care provider to the client as someone who "doesn't keep promises." The nurse cannot justifiably reassure the client that the health care provider will come as soon as she is able; the nurse cannot make commitments for the provider. Similarly, it would likely be inappropriate for the nurse to page the health care provider solely in response to the client's statement.

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." Explanation: Abstract messages are those messages that do not convey the meaning of the message clearly. The information given by the client is not explicit and will need to be interpreted. The statement that the client didn't know how it started may not be clearly interpreted for the meaning of "it." The statement that the chest pain was severe enough to disable the client gives a concrete message. The statement that the client suddenly had dull pain around the jaw and neck region conveys a concrete message. The statement that the sudden onset of chest pain got the client's spouse extremely stressed out conveys a concrete message.

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." Explanation: Stating, "I notice it has been a while since you have had a shower," is the correct option. Making an observation helps the nurse verbalize what is perceived. This is therapeutic because sometimes a client may not be able to verbalize or make themselves understood. Stating, "I think you need to take a shower," would be a nontherapeutic statement. This is called advising and entails telling the client what to do, communicating the the nurse knows what is best for the client. Stating, "Don't worry, take as long as you need before you get going," denotes reassuring by the nurse. By saying this, the nurse is communicating that this is not a problem despite the fact that the client is approaching the nurse for support in problem solving. By asking, "Why haven't you taken a shower?" the nurse is requesting an explanation. This is intimidating and the client is likely to become defensive or feel judged and vulnerable.

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." Explanation: Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way. It recognizes the rights of both parties. Losing one's temper is an example of aggressive communication. The other options demonstrate passive-aggressive and passive communication.

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 exicited about your mother's visit, We can talk if you want." Explanation: Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client's experience. "Why are you sad about your mother's visit?," "I need to know why you are sad" and "Is your mother giving you trouble for being here?" are not examples of therapeutic communication.

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?" Explanation: The nurse should avoid self-disclosure. Whenever possible, it is more therapeutic to redirect the conversation rather than setting an explicit boundary. Saying, "How do you like to spend your time when you're able to do whatever you like?" redirects the conversation but is less therapeutic because the nurse has ignored the client's question. Asking the client to speculate serves no therapeutic purpose.

A client was admitted to the psychiatric-mental health unit 2 days ago. Upon assessment, the client states, "You locked me up and threw away the key." What is the most therapeutic response made by the nurse to the client?

"It must be frustrating to feel locked up." Explanation: Nurses should not necessarily take verbal messages literally, especially when a client is upset or angry. If the nurse takes the comment literally, the nurse may respond defensively, and communication would likely be blocked. The nurse must identify the desired client outcome by engaging with the client and attempt to interpret the client's feelings. Therefore, the nurse's response of "It must be frustrating to feel locked up" would be most therapeutic in this situation. The nurse's response, "Are you feeling angry?" is a closed-ended question and is not as therapeutic as interpreting their emotions. The nurse's responses of "We don't ever throw away the keys" and "I wasn't working when you got admitted" are defensive comments, which would block communication.

A client is being counseled by the nurse about family conflict. The client asks the nurse, "Should I go home for the weekend?" Which response by the nurse would demonstrate using the reflection communication technique?

"Should you go home for the weekend?" Explanation: Reflection is a therapeutic communication technique used to redirect the idea back to the client for classification of emotional overtones, feelings, and experiences. The nurse's response, "Should you go home for the weekend?" is utilizing the reflection technique. The nurse's statement, "Let me see if I understand" is utilizing the validation technique. The nurse's statements, "Yes, so that you can talk to your family" and "I don't think you should, you might not be ready" is giving advice, which is a block in communication.

A client diagnosed with depression is being counseled by the nurse for cognitive distortions. The client says, "Bad things always happen to me." Which response by the nurse would be therapeutic?

"Tell me about a time when things went your way." Explanation: Clients diagnosed with depression may use communication styles such as overgeneralizations ("This always happens to me..., everything always turns out for the worse..."). The nurse can assist the client to be more specific, such as asking about a specific time or a specific exception. The client in the scenario is overgeneralizing; therefore, the nurse's response, "Tell me about a time when things went your way" would be therapeutic for the client. The nurse's responses, "Did you sleep last night?", and "Are you feeling more depressed today?" are changing the subject, which is not therapeutic. The nurse's response, "There must have been some good things in your life" is minimizing the client's feelings, which is not therapeutic.

The nurse is working in the mental health clinic communicating with a client who is having auditory hallucinations. Which response by the nurse indicates effective communication with this client?

"The voices seem real to you, but I don't hear them." Explanation: An example of a therapeutic communication technique is presenting reality. The nurse should define reality or indicate perception of the situation for the client. "Don't worry about the voices. Medication will help" is condescending and not therapeutic. Asking about recognition of the voices is a closed question eliciting a yes/no response; this is not therapeutic communication. The nurse telling the client about an aunt does not address the client's needs and is not a therapeutic communication technique.

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?" Explanation: 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. Suggesting the nurse have such abuse victims released from the nurse's care ignores the problem and minimizes the nurse's therapeutic effectiveness.

A client with a personality disorder tells the nurse, "I absolutely will not get on a plane. I just know it will crash." Which response(s) by the nurse would be appropriate? "Why do you think you will have this experience on a plane?" "The chances of crashing are really low with new technology." "You know in reality that won't happen to you, don't you?" "Maybe you should take a bus instead or other means to travel." "Are you afraid you won't survive if you do crash in the plane?"

"Why do you think you will have this experience on a plane?" Explanation: During interaction with the client, therapeutic communication is best with active listening and further clarification of statements. Use direct questions to find out what events or behaviors led to the admission; questions that elicit yes/no responses do not. The distractors regarding technology and other means of travel are inappropriate statements, not questions, and do not require the client to respond. Asking the client about surviving or not surviving may increase apprehension because it suggests that the plane will crash.

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." Explanation: Replying that the client looks very angry this morning provides reflection of the client's affect (angry) and is making an observation. Telling the client to calm down is a platitude, telling the client that there is nothing to be upset about denies the client's feelings, and urging the client to be positive is stated in terms of the nurse's needs and ignores the feelings of the client. Reflection of the client's feelings, mood, and affect is therapeutic in assisting the client to understand himself or herself.

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

"You look upset. Would you like to talk about it?" Explanation: The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.

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

"You look upset. Would you like to talk about it?" Explanation: The correct answer reflects validation of the client's feelings and further exploration. Asking about the client's children seeks more information, while discussing the death of the client's husband reveals personal information and a nonhelpful personal reflection by the nurse. Asking multiple questions may be confusing.

A nurse responds to a client's statement with silence to achieve which outcome?

To permit the client to gather their thoughts Explanation: By maintaining silence, the nurse allows the client to gather the client's thoughts and to proceed at the client's own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process.

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 Explanation: The most important principles of therapeutic communication is to focus the interaction on the patient's concerns. Self-disclosure is telling the client personal information. The nurse can determine how much personal information, if any, to disclose. In revealing personal information, the nurse should be purposeful and have identified therapeutic outcomes. Self-awareness, social zone and exploitation are not principles of therapeutic communication.

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

3 to 6 feet Explanation: The therapeutic communication interaction is most comfortable when the nurse is 3 to 6 feet away from the client.

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

Abstract Explanation: "Get the stuff from him" is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.

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

Broad opening Explanation: This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.

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 Explanation: The nurse's statement indicates that the nurse is trying to create mutual understanding about the client's concern, to prevent any misunderstanding. This type of communication is an example of consensual validation. Accepting is a type of communication in which the nurse indicates receiving the message that the client wanted to convey. Broad openings are a type of communication through which the nurse tries to encourage the client to express his or her concerns and feelings. Encouraging comparison is a type of communication technique in which the nurse explains the similarities and differences in a situation that the client can relate to.

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

Context Explanation: Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.

A client is admitted to an inpatient unit with an acute exacerbation of multiple sclerosis. The nurse observes the client crying frequently when visitors leave and the client states, "I just feel so hopeless." The nurse should implement which intervention?

Encourage therapeutic communication. Explanation: The nurse should implement therapeutic communication by encouraging verbalization of feelings of hopelessness. The nurse will help the client express and work through these feelings and problems related to the client's situation or condition. Administering drugs may be helpful but is not an appropriate intervention until ordered by the health care provider. Limiting visits may or may not help the feelings of the client. Arranging for client communication with family members will not address the client's feelings either.

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 Explanation: The nurse's statement conveys that the nurse is trying to defend the hospital from the client's criticism. The nurse's statement may not change the client's feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client's discomfort.

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

Emphasis Explanation: Emphasis refers to accents on words or phrases that highlight the subject or give insight on the topic. Tone can indicate whether someone is relaxed, agitated, or bored. Pitch carries from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words.

The nurse observes that a client has been pacing in the unit's common area in an agitated state for the past 15 minutes. Which is the nurse's priority action?

Explore with the client to determine why they are displaying these behaviors. Explanation: The nurse will attempt to have the client validate their feelings and must precede any interventions such as redirection, relaxation techniques, or group activities. The nurse should avoid presuming that the client's behavior is motivated by anxiety and must validate whether this is the case.

A nurse is giving a presentation to colleagues about verbal communication. The audience demonstrates understanding of the information when they identify which component as the first in the process?

Formulation of an idea Explanation: With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.

Nurses are encouraged to constantly be aware of the nonverbal communication of a client with mental illness primarily for which reason?

Nonverbal communication provides additional client information that is acted out unconsiously Explanation: Nurses are encouraged to be very observant of a psychiatric client's nonverbal communication behavior, primarily because nonverbal communication can indicate the client's thoughts, feelings, needs, and values when the trust in the relationship has not yet been established. At this point, the client may not be willing to disclose all information that is required for the nurse to be able to engage in the nursing process and offer the self therapeutically. It is not always the case that psychiatric illness affects a clients ability to communicate verbally. Often times when clients are guarded with verbal communication, the nonverbal provides covert cues to meanings for the client. Psychiatric disorders affect both thoughts and physical behaviors.

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 Explanation: Being careful not to use technical terms and language that will confuse or intimidate the client will assist the client in grasping and applying the information. While interacting in a nonthreatening, respectful manner is considered expected, it is focused toward establishing a therapeutic relationship and not toward maximizing client learning. Being careful to not overload the client with information is important, but presenting the information in language the client can understand is most important. Giving the client ample opportunity to ask questions is important, too, although the nurse needs to realize that even if given time to ask a question the client may not choose to do so.

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

Probing Explanation: An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.

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

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

Which would not be considered a goal of therapeutic communication?

Self-exploration of feelings by the nurse Explanation: Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem solving are goals of therapeutic communication.

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 Explanation: Sitting behind a desk imposes a barrier between the nurse and the client and is therefore the least effective technique listed here. Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward also helps engage the client. Generally, the nurse should not cross the arms or legs during therapeutic communication because such postures erect barriers to interaction; uncrossed arms and legs project openness and a willingness to engage in conversation.

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

Social-polite Explanation: Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives.

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. Explanation: People from cultures in the Middle East, Asia, and the Mediterranean often are more comfortable with less than 4 to 12 feet of space between them while talking. Thus, it is likely the Middle Eastern client feels that the nurse is behaving indifferently toward the client. If the nurse is aware of behaviors in various cultures, the nurse would interpret it this way. The client not maintaining boundaries is an incorrect interpretation of the client's statement. The client does not convey that the nurse is not doing the job properly. The client does not feel that the nurse is invading the client's personal zone.

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

The client is the primary focus of the interaction. Explanation: A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

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 Explanation: In general, nonverbal messages supersede verbal messages. This disconnect between the two types of communication, however, are not limited to persons with mental illness.

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. Explanation: Sitting behind a table while speaking to a client makes the setting formal. This setting would most likely be required when dealing with clients who have difficulty maintaining boundaries. Such a formal setting would make the client more uncomfortable. In such settings, the client may not be able to share feelings freely or to open up easily. It is not appropriate for the nurse to use this kind of setting if the client is willing to express individual feelings.

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

The client's room Explanation: If the client is unable to maintain boundaries by expressing inappropriate conversation or physical actions, a more formal or public setting such as an interview room, conference room, or at the end of the hall would be a more appropriate place to maintain therapeutic communication.

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. Explanation: Asking questions as soon as the client finishes answering responding to the previous question is an indicator the nurse is not actively listening to the client's responses. This reflects the nurse's limited confidence in the ability to utilize therapeutic communication skills. The nurse may not understand the client's concerns and may need to spend more time completing the assessment. The nurse should ensure the client is given an adequate amount of time to speak, and the nurse should listen actively and attentively.

A psychiatric-mental health is completing a self-reflection with the goal of "know thyself" in order to care for their clients better. What is a question that the nurse can reflect on that encourages self-reflection?

What significant traumatic life events have you experienced? Explanation: Knowing thyself as a nurse provides the necessary space to be accepting and respectful of other's choices, beliefs, and practices. Questions for self-reflection include asking what physical problems or illnesses have you experienced; what significant traumatic life events have you experienced; what prejudiced or embarrassing beliefs and attitudes about groups different from yours can you identify from your family, significant others, and yourself; what sociocultural factors in your background could contribute to being rejected by members of other cultures; and how would the above experiences affect your ability to care for clients. Therefore, exploring the question "what significant traumatic life events have you experienced?" would encourage knowing thyself. The questions, "What careers did you do before becoming a nurse?", "How do you feel about working long shifts?", and "How do you get along with your colleagues?" are not questions of self-exploration to know thyself.

A client has learned about defense mechanisms. Which behavior of the client would demonstrate the effective use of sublimination defense mechanism?

When the client is angry about their boss, they go to a boxing class. Explanation: Sublimination defense mechanism is channeling potentially maladaptive feelings or impulses into socially acceptable behavior. When the client goes to a boxing class when they are angry about their boss, this demonstrates the sublimination defense mechanism. The example of the client viewing one friend as being perfect and viewing another friend as evil is demonstrating the splitting defense mechanism. The example of the client reaffirming what they want to with social activities is the self-assertion defense mechanism. The example of the client noticing their feelings and informing their friend of their feelings is demonstrating the self-observation defense mechanism.

A nurse is conducting a group session with multiple clients. Which client scenario would the nurse follow-up with the client regarding conflicting verbal and non-verbal messages?

a client stating, "I am doing great" and is slouched in their seat Explanation: Verbal communication, which is primarily achieved by spoken words, includes the underlying emotion, context, and connotation of what is said. Nonverbal communications include gestures, expression, and body language. Verbal and non-verbal language should be congruent, or aligned. If it is conflicting, such as the client who is stating, "I am doing great" and is slouched in their seat, the nurse should follow-up with that client. The client who is stating, "I'm feeling sad today" and is crying, the client who is stating, "I want to go home" and appears distracted, and the client who is stating, "I want to feel better" and is engaged in the session are all congruent with their verbal and non-verbal language, which would not require follow-up from the nurse.

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

silence Explanation: Although restating, reflecting, and clarifying are effective therapeutic communication techniques, one of the most difficult but often most effective communication techniques is the use of silence during verbal interactions. By maintaining silence, a nurse allows the client to gather thoughts and to proceed at his or her own pace.

A client says to the nurse, "I have done something terrible." The nurse replies, "I would like to hear about it. It's okay to discuss it with me." Which therapeutic communication technique is the nurse utilizing?

acceptance Explanation: The therapeutic technique of acceptance involves encouraging and receiving information in a nonjudgmental and interested manner. The statement from the nurse of "I would like to hear about it. It's okay to discuss it with me" demonstrates the use of the acceptance therapeutic communication technique. The technique of interpretation is putting into words what the client is implying or feeling. The open-ended statements technique introduces an idea and lets the client respond. The restatement technique repeats the main idea expressed and lets the client know what was heard. The techniques of restatement, open-ended statements, and interpretation are not utilized with the nurse's statement.

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 Explanation: 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. Self-awareness is having a clear perception of your personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. Self-disclosure is communication by which one person reveals information like thoughts, feelings, aspirations, goals, failures, successes, fears and dreams, as well as one's likes, dislikes and favorites.

A nurse is caring for a client who is crying and describes an argument that they had with their spouse. The client expressed that after the argument with the partner, the client turned to their friend for emotional support. Which defense mechanism will the nurse document that the client is using?

affiliation Explanation: The defense mechanism, affiliation, is turning to others for help or support (sharing problems with others without implying that someone else is responsible for them). The client turning to their friend for emotional support after the argument is demonstrating affiliation. Anticipation is experiencing emotional reactions in advance or anticipating consequences of possible future events and considering realistic, alternative responses or solutions. Acting out is using actions rather than reflections or feelings during periods of emotional conflict. Dissociation is experiencing a breakdown in the usually integrated functions of self or the environment, or sensory and motor behavior.

A psychiatric-mental health nurse must perform a physical examination on a newly admitted client. What is the nurse's priority action before entering the client's personal space for the examination?

asking for the client's permission Explanation: Physical boundaries are those established in terms of physical closeness to others, such as who we allow to touch us or how close we want others to stand near us. When boundaries are infringed upon, the client feels threatened and responds to the perceived threat. Before implementing interventions that invade the client's personal space, the nurse must elicit permission from the client. Therefore, the priority intervention by the nurse is to ask for the client's permission before conducting a physical examination on the client. Assessing the client's mental status and emotional state is important to conduct, but the priority action is to ask the client's permission before conducting an examination on the client. Asking the client's family for permission would not be appropriate if the client is able to give permission for themselves.

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 Explanation: An impassive face is characterized by an emotionless, deadpan expression similar to a mask. The closed body position entails the nurse sitting with arms folded across the chest. Contrarily, an accepting body position would involve the nurse sitting with hands at the side of the body. This open posture demonstrates unconditional positive regard, trust, care and acceptance. An expressive face portrays the person's moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one where the person is verbally expressing one emotion but showing a different one.

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. Explanation: Excessive probing is usually nontherapeutic, except in the process of collecting a history. The here and- now is what the client is experiencing and what the nurse can assist the client in changing.

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 Explanation: Sometimes silence or long pauses indicate the client is thoughtfully considering the question before responding. In this situation, it would be most therapeutic if the nurse could provide the client more time to think. Talking about the issue another time, avoiding the topic or disengaging from the interaction can only be confirmed if the nurse asks questions. However, it is important to allow the client sufficient time to respond, even if it seems like a long time.

A student nurse has completed a process recording of an interaction that they had with a client. When is a process recording useful for nurses?

when communication is a problem Explanation: The complexity of communication with clients prompts mental health professionals to monitor their interactions using various methods, including audio recording, video recording, and process recording, which entails writing a verbatim transcript of the interaction. A process recording is one of the easiest methods to use and is adequate in most situations. Nurses should use it when first learning therapeutic communication and during times when communication becomes a problem. Using a process recording only when learning therapeutic communication, with every client interaction, or not with actual clients is not inaccurate.

A nurse is interviewing a client who is describing difficulties with their family. The client begins crying and says, "I don't want to talk about this anymore." What boundary would the nurse be mindful to avoid crossing with the client?

psychological Explanation: Boundaries are the defining limits of individuals, objects, or relationships. Boundaries mark territory, distinguishing what is "mine" from what is "not mine". Humans have many different types of boundaries. Material boundaries, such as fences or property, artificially imposed state lines, and bodies of water, define territory as well as provide security and order. Personal boundaries include physical, psychological, and social dimensions. Physical boundaries are those established in terms of physical closeness to others, such as who we allow to touch us or how close we want others to stand near us. Psychological boundaries are established in terms of emotional distance from others, such as how much of our innermost feelings and thoughts we want to share. Social boundaries, such as norms, customs, and roles, help us establish our closeness and place within the family, culture, and community. Therefore, the client in the scenario is establishing physiological boundaries that the nurse must be careful not to cross. Physical, social, or material boundaries are not at risk being crossed in the scenario.

A nurse is caring for a client on the unit who is attempting to manipulate the staff. Which description of the client made by a nurse demonstrates strength-based communication?

resourceful Explanation: Strength-based communication should be supportive, focusing on the client's strengths instead of potential deficits. Language that promotes acceptance and respect should be favored over language that distracts from acceptance of the person. For example, instead of perceiving a client to be "manipulative," an alternative consideration is that the client is "resourceful and trying to get help." Therefore, the client being described as resourceful by the nurse is utilizing strength-based communication. Being described as aggressive, noncompliant, or argumentative is not utilizing strength-based communication.

A psychiatric-mental health nurse approaches a new client sitting in the dayroom to establish a relationship. The nurse notes that the client's facial expression and body posture appear guarded. Applying an understanding of proxemics, the nurse chooses which zone of physical space between themselves and the client?

social Explanation: The intimate zone (0-18 in. between people) and personal zone (18-36 in.) is the amount of space that is comfortable for people who mutually desire personal contact. The client and the nurse do not know each other and invasion of these zones is likely to produce anxiety. A social zone (4-12 ft) is acceptable for communication in social, work, and business settings. The nurse and client are in the dayroom and the purpose of the communication is to greet each other and begin to establish a relationship. Choosing a distance based on the public zone (12-25 ft), which is an acceptable distance between a speaker and an audience in an inpatient dayroom, is likely to make the client feel that the nurse is afraid of them and will not contribute to the development of a therapeutic relationship.

The nurse asks a client diagnosed with bipolar disorder how they are feeling today. The client replies, "guns and bombs are exploding". Which documentation by the nurse would be appropriate for the client?

symbolism Explanation: In people with mental illnesses, the use of words to symbolize events, objects, or feelings is often idiosyncratic, and they cannot explain their choices. For example, a person who is feeling scared and anxious may tell the nurse that bombs and guns are exploding. Therefore, the client in the scenario is utilizing symbolism and the nurse would document that observation. Concrete thinking is a type of thinking that the client with a mental illness may have and demonstrates a literal interpretation of the conversation or question. Self-observation is a defense mechanism that occurs when the client notices and expresses their feelings. Autistic fantasy is a defense mechanism that includes excessive daydreaming as a substitute for human relationships, more effective action, or problem solving.

A client begins discussing frankly experiencing sexual abuse as a child. The nurse listens for awhile and then asks the client about the client's stressful job situation. Which is the explanation for why the nurse changed the subject?

to reduce the nurse's own anxiety Explanation: The nurse has used the nontherapeutic communication technique of introducing an unrelated topic to reduce the nurse's anxiety. The nurse has effectively taken the initiative away from the client because the nurse is uncomfortable and does not know how to respond. People often change the subject in efforts to avoid discussing a topic with which they feel uncomfortable. If the client feels the need to bring up an issue, generally the nurse should resolve personal anxieties and facilitate client exploration. There is no indication that the nurse is attempting to have the client understand boundaries for the nurse-client relationship. Modelling social skills does not correlate with the client scenario related to sexual abuse. The nurse must deliver care in a non-judgmental manner in order to develop a therapeutic nurse-client relationship.

The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use?

using gentle touch during activities of daily living Explanation: The nurse should supplement verbal communication with therapeutic nonverbal communication, including gentle touch, to reinforce caring feelings for the confused client. Providing instructions for feeding oneself and speaking louder are aspects of verbal communication and, in addition, would not be helpful. Displaying a flat affect is not an aspect of therapeutic nonverbal communication.

The nurse is interviewing a client and states to the client, "I notice your foot is tapping. Do you feel nervous?" Which interview behavior is the nurse using?

validation Explanation: The nurse is making an observation when drawing attention to a client's behavior that will allow the client to address the behavior. If the purpose is to encourage the client to discuss feelings about a current problem, the nurse would use a method of validation, which verifies the nurse's perception of the verbal and nonverbal message conveyed by the client. If giving recognition, the nurse would be listening actively to the client and would demonstrate this by asking the client to continue talking, and the nurse would appear open and interested. The nurse who restates would be trying to clarify what the client is saying. The nurse would re-focus the client (who may go off on a tangent and needs to be brought back to the questions being asked).