ch 6
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 mosttherapeutically when answering: "How would leaving your spouse make you feel?" "What do you think your spouse would do if you leave?" "Your mother doesn't have the right to demand that; it's your decision." "Your mother may be right; I'd consider what she is saying."
"How would leaving your spouse make you feel?" Explanation: Exploring the client's thoughts about leaving the situation is the priority for the therapeutic communication to be effective in this case. With this response, the interaction remains client centered and goal directed. Giving advice may facilitate dependency, thus it is important to elicit the client's thoughts on the matter; encouraging problem solving and decision making by the client is more constructive than giving advice.
Which statement by the nurse is an example of assertive communication? "You are so rude; I just won't tolerate that in my group." "I'm so happy that you finally decided to join us here in group." "I understand that group can be difficult to attend but coming late is disruptive." "Oh, you must be really busy to be this late getting to group."
"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.
A client remarks, "You know, it's the same thing every time." Which is the most therapeutic response by the nurse? "It's the same thing every time?" "I'm not sure what you mean. Please explain." "I'm sure everyone is doing their best." "I understand what you mean."
"I'm not sure what you mean. Please explain." Explanation: Sometimes, words, phrases, or slang terms have different meanings and can be easily misunderstood. In this case, it is important for the nurse to clarify the meaning in order to avoid making assumptions. Stating that everyone is doing their best is a response that is based on an assumed meaning. Restating the client's statement will not necessarily provide clarification. Stating, "I understand" is simplistic and inaccurate because the nurse cannot claim to fully understand the client's situation.
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'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" "I've been off for the past four days. What have you done since I last saw you?" "If you had to guess, what do you think I might have done on my days off?" "How do you like to spend your time when you're able to do whatever you like?"
"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.
The client states to the nurse, "I am just not sure about what to do with my adult child who is taking drugs at my home." Which is the most therapeutic response by the nurse? "It is a difficult decision. Let's discuss some of your choices." "It is your home and you should ask them to move out." "As long as they aren't doing anything to harm you, let them stay." "If you kicked them out, you would feel bad if something happened."
"It is a difficult decision. Let's discuss some of your choices." Explanation: The nurse is not expected to be an expert or to tell the client what to do to fix their problem. Rather, the nurse should help the client explore possibilities and find solutions to their problem. Often just helping the client discuss and explore their perceptions of a problem stimulates potential solutions in the client's mind. The nurse should introduce the concept of problem-solving and offer to assist in this process. By informing the client that they can discuss various options, the nurse is allowing the client the opportunity to solve their own problems. Giving advice is a nontherapeutic response or making them feel guilty for a choice that is made.
During the mental status assessment, the client whispers, "The CIA is stalking and planning to kidnap me." Which is the best response by the nurse? "That makes no sense at all." "You can tell me about that after I finish asking these questions." "What kinds of things have been happening?" "Why would the CIA be interested in you?"
"What kinds of things have been happening?" Explanation: When the nurse responds, "What kinds of things have been happening?" the nurse is seeking information. "That makes no sense at all," is inappropriate because it may make perfect sense to the client. "You can tell me about that after I finish asking these questions," shows that the nurse is not interested in what the client has to say. "Why would the CIA be interested in you?" feeds into the notion that the CIA is stalking the client.
The nurse is performing a morning assessment on a client. When asked how they are feeling, the client hesitantly responds in a slow rate of speech "I think I am okay, is that alright?" Which response is appropriate for this speech pattern? "Take a deep breath and try again." "You sound confused. Is that how you are feeling?" "Everything is alright." "You're speaking slowly today; did you get enough sleep?"
"You sound confused. Is that how you are feeling?" Explanation: Clients' rate and quality of speech are useful assessment data for interpreting client mood, level of orientation, and cognitive processes. This client's slow rate of speech, hesitancy, and indirect answer to the question can indicate that the person is depressed, confused, searching for the correct words, or having difficulty finding the right words to describe an incident. It is important for the nurse to validate these nonverbal indicators rather than to assume that they know what the client is thinking or feeling. Asking the client about sleep does not give the client the opportunity to clarify their thinking. Telling the client to take a deep breath is recommended if the nurse assesses anxiety; this client's slow rate of speech would be incongruent if feeling anxious. Telling the client that everything is alright is nontherapeutic because it falsely reassures the client.
Which term is used to refer to signals that encourage effective communication? Abstract messages Metaphors Cues Concrete messages
Cues Explanation: A cue is a verbal or nonverbal message that signals key words or issues for the client. An abstract message is an unclear pattern of words that often contains figures of speech that are difficult to interpret. In a concrete message, words are explicit and need no interpretation. A metaphor is a phrase that describes an object or situation by comparing it to something else familiar.
A client is fearful and reluctant to talk after a traumatic event. Which technique will the nurse employ that is most effective when trying to engage the client in interaction? Giving information Silence Broad opening Focusing
Broad opening Explanation: Broad openings allow the client to say as much or little as they want. Focusing (concentrating on a single point) can be intimidating for a client who is fearful; giving information and silence do not encourage client interaction are likely to hinder communication with a reluctant client, not enhance it.
Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?" Focusing Accepting Exploring Broad opening
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.
Which type of cue is being used when the client states, "Nothing can help me"? Intentional Covert Overt Clear
Covert Explanation: Cues are considered to be either covert or overt. Covert cues are vague or hidden messages that need interpretation and exploration. Overt cues are clear statements of intent, such as "I want to die."
A nurse is developing a therapeutic relationship with a client from a cultural background different from the nurse. Which will occur if the nurse does not show this cultural competence? Frustration for the client Eroding trust Longer rehabilitation Leads to mental health relapse
Eroding trust Explanation: As the therapeutic relationship develops, the nurse must be aware of and respect the client's religious and spiritual beliefs. Ignoring or being judgmental will quickly erode trust and could stall the relationship. The client's responses may be varied, not just limited to frustration. This may or may not cause the client to require longer rehabilitation or to relapse.
The nurse is attempting to develop empathy for a client but is not completely feeling empathetic. Which factor might be hindering the nurse from developing empathy for this client? Be sure to ask the client to restate statements for clarity Asking leading questions to obtain the most information Focusing on one issue Interjecting personal experiences into the interactions
Interjecting personal experiences into the interactions Explanation: Nurses develop empathy by gathering as much information about an issue as possible directly from the client to avoid interjecting their own personal experiences and interpretations of the situation. Asking for restatement is often beneficial to communication. Leading questions and an excessive focus on one issue can inhibit communication but are less likely to have an effect on empathy.
A client is exhibiting anxiety after being told that the client's spouse has sustained a heart attack. The nurse's response to the client is "everything will be okay." Which type of nontherapeutic communication technique is being exhibited by the nurse? Failure to listen Judgmental attitude Giving advice Reassurance
Reassurance Explanation: Clichés such as "everything will be okay" or "don't worry, the doctor will make you well" are examples of false reassurance. No one can predict or guarantee the outcome of a situation. Failure to listen, giving advice, and having a judgmental attitude are all ineffective communication techniques.
The nurse asks the client, "What was it like for you when you first realized you had no place to go?" The client looks down and pauses for quite some time. Which action by the nurse is mosttherapeutic? Apologize for asking such a personal and intrusive question. Encourage the client to express any unpleasant feelings. Sit quietly until the client responds. Divert the subject to something the client will readily discuss.
Sit quietly until the client responds. Explanation: Silence or long pauses in communication may indicate many different things. It is important to allow the client sufficient time to respond, even if it seems like a long time. Prompting, apologizing, and changing the subject do not allow the client time to respond.
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 not doing the job properly. The client feels that the nurse is indifferent toward the client. The client feels that the nurse is invading the client's personal zone. The client is not maintaining boundaries.
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.
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 is eager to dialogue with the nurse but is unsure how best to proceed The client is glad to talk to the nurse because that is what the client stated The client may be reluctant to dialogue despite the statement to the contrary The disconnect between the client's verbal and nonverbal messages confirms the presence of mental illness
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 can communicate freely. The client may have difficulty maintaining spacial boundaries. The client can open up easily. The client may be physically expressive.
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.
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 cafeteria The hallway The client's room The consultation room
The consultation room Explanation: The nurse has to speak to and assess the client's spouse, who is worried and anxious. The nurse should find a secluded place to discuss the spouse's problems. The consultation room would be the best place for the nurse to talk with the client's spouse. The cafeteria is usually crowded and the spouse would not feel comfortable discussing worries there. The client's room is not the appropriate place to speak to the spouse as the spouse may not be willing to discuss fears in front of the client. The hallway is not an appropriate setting, as the spouse may not feel comfortable talking about concerns in the presence of other nurses.
A nurse responds to a client's statement with silence to achieve which outcome? To permit the client to gather their thoughts To demonstrate passive listening To allow the nurse to determine an appropriate response To encourage self-reflection by the nurse
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 psychiatric mental health nurse prepares for a new admission and discovers that the client does not speak the same language and the medical staff. The client understands some of the language and uses hand signals to point to things they want or need. How should the nurse proceed to complete the admission assessment? Try asking questions and using the hand signals the client knows. Use the medical history and transfer notes to complete as much as possible. Wait to complete until the translation service can provide an interpreter. Have a psychiatrist who speaks the same language as the client assist.
Wait to complete until the translation service can provide an interpreter. Explanation: One of the primary goals of therapeutic communication is the support of effective interpersonal interaction between the nurse and the client so that information can be exchanged. The use of a translator who is not qualified or relies on hand gestures risks inaccurate exchange of information. When caring for people who do not speak the same language as the medical staff, the services of a qualified translator who is skilled at obtaining accurate data are necessary. The individual should be able to translate technical words into another language while retaining the original intent of the message and not injecting their own biases. The nurse is responsible for knowing how to contact a translator, regardless of whether the setting is inpatient, outpatient, or in the community.
The psychiatric mental health nurse prepares for a new admission and discovers that the client does not speak the same language and the medical staff. The client understands some of the language and uses hand signals to point to things they want or need. How should the nurse proceed to complete the admission assessment? Use the medical history and transfer notes to complete as much as possible. Wait to complete until the translation service can provide an interpreter. Have a psychiatrist who speaks the same language as the client assist. Try asking questions and using the hand signals the client knows.
Wait to complete until the translation service can provide an interpreter. Explanation: One of the primary goals of therapeutic communication is the support of effective interpersonal interaction between the nurse and the client so that information can be exchanged. The use of a translator who is not qualified or relies on hand gestures risks inaccurate exchange of information. When caring for people who do not speak the same language as the medical staff, the services of a qualified translator who is skilled at obtaining accurate data are necessary. The individual should be able to translate technical words into another language while retaining the original intent of the message and not injecting their own biases. The nurse is responsible for knowing how to contact a translator, regardless of whether the setting is inpatient, outpatient, or in the community.
A client states, "It's been so long since I've been with my family." Which statement by the nurse demonstrates restating of the client's sentence? "Go on. Tell me more." "Tell me what happened when you last saw your family." "You say you haven't seen your family in a while." "When was the last time you saw your family?"
You say you haven't seen your family in a while." Explanation: Restating is repeating the main idea expressed and allowing the client know that they communicated the idea effectively. Each of the other listed statements prompts to the client to address another aspect of the situation, but none restate the essence of the client's statement.
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? open-ended statements acceptance restatement interpretation
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? empathetic linkages active listening self disclosure self awareness
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 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: lack of awareness. excessive probing. gathering assessment data. genuineness and caring.
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 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? physical psychological material social
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.
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? exploitation self-awareness social zone self-disclosure
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 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 autistic fantasy concrete thinking self-observation
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.
