Ch. 9 Therapeutic & Communication
A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? a. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." b. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." c. "I don't believe you. You are not being truthful with me." d. "It looks as though you are saying one thing but
"It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" Rationale This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental. None of the other options provides this support.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity
A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? a. Verbal communication is always more accurate than nonverbal communication. b. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. c. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. d. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.
Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Rationale Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.DIF: Cognitive Level: Analyze (Analysis)REF: pages 7-9TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity
When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? a. The nurse violated the client's personal space by physically being too close. b. The client has issues with sharing personal information. c. The nurse failed to explain the purpose of the admission interview. d. The client is responding to the voices by ending the conversation.
a. The nurse violated the client's personal space by physically being too close. Rationale By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the patient may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the patient's behavior.DIF: Cognitive Level: Analyze (Analysis)REF: page 34TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
What is the focus during clinical supervision? a. The nurse's behavior in the nurse-client relationship b. Analysis of the client's motivation for transferences c. Devising alternative strategies for client growth d. Assisting the client to develop increased independence
a. The nurse's behavior in the nurse-client relationship Rationale Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. None of the other options are associated with clinical supervision.REF: 151
Which of the following statements represent a nontherapeutic communication technique? Select all that apply. a. "Why didn't you attend group this morning?" b. "From what you have said, you have great difficulty sleeping at night." c. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" d. "If I were you, I would quit the stressful job and find something else." e. "I'm really proud of you for the way you stood up to your brother when he visited today." f. "You mentioned that you have never had friends. Tell me more about that." g. "It sounds like you have been having a very hard time at home lately."
a. Why didn't you attend group this morning?" c. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" d. "If I were you, I would quit the stressful job and find something else." e. "I'm really proud of you for the way you stood up to your brother when he visited today." Rationale All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.DIF: Cognitive Level: Apply (Application)REF: pages 18, 19TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity
What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful? a. "Don't let them beat you! Fight back!" b. "School is stressful. What do you find most stressful?" c. "I know just what you are going through. The stress is terrible." d. "You have only two more semesters. You will be glad if you stick it out."
b. "School is stressful. What do you find most stressful?" Rationale This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.REF: 142
The preferred seating arrangement for a nurse-client interview should incorporate which positioning? a. The nurse behind a desk and the client in a chair in front of the desk. b. The nurse and client sitting at a 90-degree angle to each other. c. The client sitting in a chair and the nurse standing a few feet away. d. The nurse and client sitting facing each other.
b. The nurse and client sitting at a 90-degree angle to each other. Rationale This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.REF: 150
A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? a. The patient in denial. b. The response may reflect cultural norms. c. The response may reflect personal guilt. d. The patient may have an antisocial personality.
b. The response may reflect cultural norms. Rationale Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient's lack of emotion is a result of any of the other options.DIF: Cognitive Level: Analyze (Analysis)REF: page 9TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Please tell me what was happening that led to your hospitalization here?" a. Using a minimal encourager b. Using an open-ended question c. Paraphrasing d. Reflecting
b. Using an open-ended question Rationale Open-ended questions require more than one-word answers. This question encourages the patient to provide a narrative concerning the circumstances surrounding the need for admission.REF: 143
With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? a. A recent immigrant from Russia b. A deeply depressed client c. A Chinese American client d. A tearful client reporting pain
c. A Chinese American client Rationale Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.REF: 148
Of the following environments, which would be most conducive to a therapeutic session? a. The nurses' station b. A table in the coffee shop c. A quiet section of the day room d. The utility room
c. A quiet section of the day room Rationale Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter. None of the other options offer these characteristics.REF: 140-149
The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? a. The nurse is a safe person to interact with. b. The nurse is a new friend. c. They view the nurse as a stranger. d. They view the nurse as a peer.
c. They view the nurse as a stranger. Rationale Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.REF: Page 151
During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? a. Quickly break the silence and encourage the client to continue. b. Reassure the client that the abuse was not her fault. c. Reach out and gently touch the client's arm. d. Allow the client to break the silence.
d. Allow the client to break the silence. Rationale Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.REF: 141-142
Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings? a. Using emotionally charged words and gestures b. Offering opinions and avoiding periods of silence c. Asking closed-ended questions requiring "yes" or "no" answers d. Asking open-ended questions and seeking clarification
d. Asking open-ended questions and seeking clarification Rationale Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.REF: 142-143
When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?" a. Focusing b. Restating c. Reflection d. Clarification
d. Clarification Rationale Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.REF: 142
After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? a. Eliciting more information b. Encouraging evaluation c. Verbalizing the implied d. Clarifying the message
d. Clarifying the message Rationale Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.REF: 142
During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? a. The mental image of a word may not be the same for both nurse and client. b. One statement may simultaneously convey conflicting messages. c. Many of the client's remarks are no more than social phrases. d. Content of messages may be contradicted by process.
d. Content of messages may be contradicted by process. Rationale Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.REF: 140-141
A recent immigrant to the United States from which country would find direct eye contact a positive therapeutic technique? a. Korea b. Mexico c. Japan d. Germany
d. Germany Rationale Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.REF: Page 147-148
During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using? a. Giving information and encouraging evaluation b. Presenting reality and encouraging planning c. Clarifying and suggesting collaboration d. Reflecting and exploring
d. Reflecting and exploring Rationale Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.REF: 142
