Chapter 6

A client is discussing the client's problems at the workplace. Which nonverbal cues would indicate that the nurse is attentive to the client? Select all that apply. Looking down to the floor Leaning toward the client Mirroring the client's facial expression Maintaining eye contact with the client Sitting with closed arms and crossed legs

Leaning toward the client Maintaining eye contact with the client

A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client? Presenting reality Reflecting Making observations Seeking information

Presenting reality

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 Interacting with the client in a nonthreatening, respectful manner Being careful not to overload the client with too much information at one time Giving the client ample opportunity to ask questions

Presenting the information using language and terms the client will understand

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

Probing

When considering the zones of distance awareness, the nurse expects that initially the client who exhibits paranoia will be most comfortable interacting within which zone of proximity with the nurse? Public Social Intimate Personal

Public

Which zone is a distance that is comfortable between family and friends who are talking? Personal Intimate Social Public

Public

Which zone is an acceptable distance between a speaker and an audience? Public Intimate Personal Social

Public

Which would not be considered a goal of therapeutic communication? Self-exploration of feelings by the nurse Establishing rapport Active listening Guiding the client in problem solving

Self-exploration of feelings by the nurse

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 can open up easily. The client may have difficulty maintaining spacial boundaries. The client may be physically expressive.

The client may have difficulty maintaining spacial boundaries.

The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message? "If you just learn how to breathe, you can manage better." "When did you last take drugs?" "How can you make your anxiety better?" "At what time did you take the last dose of the antianxiety drugs?"

"At what time did you take the last dose of the antianxiety drugs?"

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process? "What could you do when you are angry that doesn't involve throwing things?" "Can you explain to me what made you so angry?" "What are you going to do the next time you get angry?" "What do you think is the best thing to do when you are angry?"

"Can you explain to me what made you so angry?"

Which statement by the nurse demonstrates an understanding of the first step in helping a client learn the problem solving process? "What could you do when you are angry that doesn't involve throwing things?" "Can you explain to me what made you so angry?" "What are you going to do the next time you get angry?" "What do you think is the best thing to do when you are angry?"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 Psychiatric disorders generally affect a client's ability to communicate verbally Clients are guarded with both verbal and nonverbal communication Psychiatric disorders are more likely to affect thoughts than physical behaviors

"Can you explain to me what made you so angry?"

The nurse is asking a client for feedback on the services provided in the hospital. The client responds, "Yeah. It was great." The client spoke in a disgusted and hurried tone and did not make eye contact with the nurse. What is the message conveyed here? "Your services were not good at all." "Don't waste my time asking about your services." "Your services were wonderful. Keep up the good work." "Your services were good, but you could provide much better service."

"Don't waste my time asking about your services."

The nurse is teaching effective anger management. The nurse emphasizes the use of assertive sentences while expressing anger. Which are examples of assertive communication? Select all that apply. "You are making me very angry." "Why are you not listening to me?" "I am frustrated with the situation." "How can you behave like this with me?" "I am feeling disrespected by your comments."

"I am frustrated with the situation." "I am feeling disrespected by your comments."

A psychiatric-mental health client tells the nurse, "The doctor hates me. The doctor promised to try to come and 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 come, but I can reassure you that it's not because she hates you." "Since the doctor didn't come yesterday, would you like me to page the doctor to come see you right now?" "Unfortunately, the doctor has an extremely busy schedule and the doctor doesn't always keep up the promises." "I'm sure that the doctor will come and see you as soon as the doctor is free and able to come see you."

"I don't know why the doctor didn't come, but I can reassure you that it's not because she hates you."

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." "I think you need to take a shower." "Don't worry, take as long as you need before you get going." "Why haven't you taken a shower yet?"

"I notice it has been a while since you have had a shower."

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." "The chest pain is severe enough to disable me from doing my work." "I suddenly had dull pain around the jaw and neck region." "The sudden onset of my chest pain got my spouse extremely stressed out."

"I don't really know how it all started. It just happened."

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." "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."

"I understand that group can be difficult to attend but coming late is disruptive."

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?" "I'm not at liberty to talk about my personal life outside of work, unfortunately. How have you been?" "How do you like to spend your time when you're able to do whatever you like?" "If you had to guess, what do you think I might have done on my days off?"

"I've been off for the past four days. What have you done since I last saw you?"

The nurse has entered a client's room and observed that the client has removed the mattress from the bed and is closely scrutinizing the spaces in the bed frame. Which statement is most likely to elicit an explanation of the client's behavior? "What's wrong with your bed?" "It looks like you're searching for something. Is that right?" "What are you looking for in the bed? There's nothing hidden there." "Are you having any delusions or hallucinations right now?"

"It looks like you're searching for something. Is that right?"

A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic? "Why do you say I don't listen to you?" "It sounds like you're overreacting somewhat." "It sounds like you're feeling unappreciated." "I listen to you."

"It sounds like you're feeling unappreciated."

The nurse is caring for a client with cellulitis. The client responds, "I feel kind of 'blah'," after the nurse asks, "How do you feel?" After the client's reply, the nurse states, "Can you tell me what 'blah' feels like?" The client responds, "I don't have any energy, and I don't feel like doing anything." Using therapeutic communication, how should the nurse respond? "Oh, it is just the infection; in a day or so you'll feel better." "Let's talk about infections, and how they heal." "Why don't you just rest in bed?" "Why don't you call a friend in to watch TV with you?"

"Let's talk about infections, and how they heal."

A client is speaking with the nurse about the client's difficult relationship with the client's father. The client states, "He never showed me love or approval unless I was perfect." Which response is most likely to encourage the client to continue elaborating? "Tell me more about that." "You must feel rejected." "Really?" "I'm sure he loved you, though it sounds like he had trouble expressing it."

"Tell me more about that."

A client on the psychiatric mental health unit has a care plan that includes a break for cigarettes every hour during the afternoon if the client follows the behavioral plan to attend the morning group on anger management. The client asks, "I couldn't get to my group this morning because I overslept. Can I just this one time go for a cigarette now?" Which response by the nurse is most therapeutic? "No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks." "Well, I know you were tired from last night. You can go at 2 p.m." "Why do you think you should be allowed to go for a break?" "Joe, let's review your care plan and discuss whether or not it needs to be revised."

"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks."

A nurse is meeting with a client prior to discharge from the hospital. The client tells the nurse he is "really worried about returning home." Which response indicates the nurse is employing therapeutic communication? "Please share with me what is worrying you right now." "Home is a much better place for you." "It is best to complete your recovery surrounded by loved ones." "Most clients have anxiety before they return home."

"Please share with me what is worrying you right now."

The nurse educator is teaching the class about communication. Which statement by the student nurse best describes the basic elements of communication? "The basic elements of communication include sender, receiver, flow and message." "The basic elements of communication include receiver, feedback, flow, and expression." "The basic elements of communication include feedback, sender, receiver, and messages." "The basic elements of communication include message, sender, feedback, and gesture."

"The basic elements of communication include feedback, sender, receiver, and messages."

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?" "I can take that client off of your assignment this shift." "It would be great if you could attend an in-service on therapeutic communication." "Have you ever been sexually abused?"

"What specifically makes you uncomfortable?"

A nurse is seeing a client who has recently been discharged from the hospital for a suicide attempt. When asked about the quality of her relationship with her husband, the client becomes silent, diverts eye contact and says, "It's okay." What is the nurse's best response? "I am glad to hear that." "A good relationship is a sign of recovery." "I don't think you are telling me the truth." "What you are saying and how you say it does not seem to match."

"What you are saying and how you say it does not seem to match."

Which statement by the nurse reflects the use of a therapeutic statement? "You look upset. Would you like to talk about it?" "I'd like to know more about your children. Tell me about them." "I understand your husband passed away. I couldn't bear that." "You look very sad. How long have you been this way? Have you been taking care of yourself?"

"You look upset. Would you like to talk about it?"

The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart? 0 to 18 inches 18 to 36 inches 3 to 6 feet 12 to 25 feet

3 to 6 feet

A nurse needs to encourage a client who is Hispanic and has severe depression to express the client's feelings. What distance between the nurse and the client may help facilitate therapeutic communication? 3 to 6 feet 10 to 12 inches 15 to 18 inches 15 to 18 feet

3 to 6 feet

A client has recently been diagnosed with cancer. The client says, "What did I do wrong to get such a disease?" Which nonverbal processes, along with the client's statement, would convey a congruent message? Select all that apply. A sad facial expression A cheerful expression A fearful tone of voice A sarcastic tone of voice An erect, confident posture

A sad facial expression A fearful tone of voice

"Get the stuff from him" is an example of which type of message? Abstract Concrete Clear Direct

Abstract

Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication? Abstract Cliché Proverb Overt cue

Abstract

When interviewing a young adult Asian client who immigrated to the United States as a child, the nurse best addresses the impact that culture has on the client's perceptions and beliefs by doing what? Assessing to what degree the client has embraced the American culture Asking the client to explain what the client thinks is causing the client's panic attacks Researching the physiological and emotional response to anxiety traditionally exhibited by Asians Inquiring how the client feels symptoms should be managed

Assessing to what degree the client has embraced the American culture

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual's personal zone? Beginning at the boundary of the intimate zone and ending at the social zone Extending outward from the border to the public zone Surrounding and protecting an individual from others, especially outsiders The most distant boundary that can be used for recognizing intruders

Beginning at the boundary of the intimate zone and ending at the social zone

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

Broad opening

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? Accepting Broad openings Consensual validation Encouraging comparison

Consensual validation

Which includes the circumstances or parts that clarify the meaning of the content of the message? Context Process Congruence Proxemics

Context

Which type of cue is being used when the client states, "Nothing can help me"? Covert Overt Intentional Clear

Covert

Which term is used to refer to signals that encourage effective communication? Abstract messages Concrete messages Cues Metaphors

Cues

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

Emphasis

The nurse observes that a client has been pacing in the unit's common area with pursed lips and a furrowed brow for the past 15 minutes. What is the psychiatric-mental health nurse's best action? Engage with the client to validate why the client is doing this. Redirect the client to an activity that is likely to alleviate the client's agitation. Assess the client to determine why the client is feeling anxious. Encourage the client to participate in a group activity to provide a therapeutic distraction.

Engage with the client to validate why the client is doing this.

A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process? Formulation of an idea Message encoding Message transmission Message reception

Formulation of an idea

When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique? Exploring Focusing Accepting Formulating a plan of action

Exploring

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation and indicting that the nurse is listening? General leads Focusing Accepting Exploring

General leads

A client who is schizophrenic is catatonic and has a mask-like face. Which facial expression is being exhibited? Impassive Expressive Confusing Incongruent

Impassive

The nurse is caring for a client with schizophrenia. The client says, "Somebody is trying to kill me." The nurse responds by saying, "Isn't the weather nice? You should sit outside for a while." Which type of communication does this indicate? Interpreting Introducing an unrelated topic Making stereotyped comments Indicating the existence of an external source

Introducing an unrelated topic

A nurse enters the room of a client who has been on the unit for several weeks. The client states, "I haven't seen you for a while. How were your days off?" What is the nurse's most appropriate response? It's important to get a break from time to time. How have the last few days been for you? I'm really not at liberty to talk about my activities outside of work. I hope you understand. I didn't do anything particularly special, but it's always nice to spend time with my family. Well, if you had to guess, what do think that I might do in my time outside of work?

It's important to get a break from time to time. How have the last few days been for you?

A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse? French Australian Korean Italian

Korean

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 Psychiatric disorders generally affect a client's ability to communicate verbally Clients are guarded with both verbal and nonverbal communication Psychiatric disorders are more likely to affect thoughts than physical behaviors

Nonverbal communication provides additional client information that is acted out unconsiously

Which arrangement is likely to be the least threatening to a psychiatric-mental health client? Sitting at an angle, 4 to 5 feet apart Sitting face to face, 4 to 5 feet apart Sitting at an angle, 1 to 2 feet apart Sitting face to face, 1 to 2 feet apart

Sitting at an angle, 4 to 5 feet apart

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 Leaning slightly forward to the client Facing the client at eye level Keeping arms and legs uncrossed

Sitting behind a desk

Which type of touch, according to Knapp, is used in greeting, such as a handshake? Social-polite Functional-professional Friendship-warmth Love-intimacy

Social-polite

When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind? The nurse should self-disclose when indicated. The client is the primary focus of the interaction. The nurse should have an empathetic relationship with the client. The client's conversations should be recorded.

The client is the primary focus of the interaction.

The nurse is caring for a client with severe depression. The client tells the nurse, "I really just want to sleep and not have to wake up." What may the nurse interpret from this covert cue? The client may want to sleep. The client may be extremely fatigued. The client may have suicidal ideations. The client may need a break to reduce stress.

The client may have suicidal ideations.

Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries? The client's room An interview room A conference room The end of a hall

The client's room

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 client's room The hallway The consultation room

The consultation room

Which behavior of the nurse indicates that the nurse has a therapeutic relationship with the client? The nurse asks the client if the client prefers to have the nurse as a nurse over other staff. The nurse speaks with the client on topics such as fashion and sports. The nurse expresses empathy to a client who has recently lost the client's son in an accident. The nurse gives the nurse's phone number and asks the client to give a call whenever needed.

The nurse expresses empathy to a client who has recently lost the client's son in an accident.

A client with a history of depression has told the nurse that the client is feeling especially "low" this morning. The nurse has responded by stating, "Try thinking about some of the blessings you have in your life." How should the nurse's statement be best interpreted? The nurse has inhibited therapeutic communication by giving advice The nurse made an inappropriate suggestion because it was not preceded by assessment The nurse has inhibited the nurse-client relationship by challenging the client The nurse has violated the ethical principles of beneficence and nonmaleficence

The nurse has inhibited therapeutic communication by giving advice

Which is inconsistent with principles of therapeutic communication? The nurse is the primary focus of the relationship. The nurse must maintain client confidentiality. Interventions are implemented from a theoretical base. A professional attitude sets the tone of the therapeutic relationship.

The nurse is the primary focus of the relationship.

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 has difficulty with conducting an assessment. The nurse is accurately observing the client's nonverbal communication. The nurse may lack confidence in therapeutic communication. The nurse can gain information about the client without wasting time.

The nurse may lack confidence in therapeutic communication.

Which is an inaccurate depiction of concrete messaging? They require rephrasing of unclear messaging. They elicit more accurate responses. They are easy to understand. There is no need for interpretation.

They require rephrasing of unclear messaging.

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

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 self awareness self disclosure active listening

active listening

After discussing feeling guilty about having trouble looking after her children, the client states, "They would be better off if I wasn't around." The client's statement is an example of a(n): covert cue. overt cue. abstract message. concrete message.

covert cue.

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication? emotion underlying the words gestures body language expressions

emotion underlying the words

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. genuineness and caring. gathering assessment data. excessive probing.

excessive probing.

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 to avoid the topic to discuss it at another time to disengage from the interaction

more time to think

A nurse responds to a client's statement with silence based on the rationale that this technique is used primarily to: allow the nurse to determine an appropriate response. permit the client to gather the client's thoughts. encourage self-reflection by the nurse. demonstrate passive listening.

permit the client to gather the client's thoughts.

A student nurse is preparing for a clinical placement in a psychiatric-mental health context. In order to best prepare to engage in therapeutic communication with clients, the student should: reflect critically on the student's own life experiences, perspectives, and characteristics. diligently study the pathophysiology, epidemiology, and nursing diagnoses related to mental illness. seek out a mentor who has extensive experience in the psychiatric-mental health area. decide what aspects of the student's life and experience the student is willing to disclose to clients.

reflect critically on the student's own life experiences, perspectives, and characteristics.

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 self-awareness social zone exploitation

self-disclosure

The nurse is meeting a client for the first time. Which action should the nurse take to establish a rapport with this client? Select all that apply. shaking the client's hand when greeting defending the healthcare provider's choice of treatment asking the client to further explain a recurring symptom suggesting the client obtain a second opinion if care is not satisfactory remaining neutral when the client states a lack of faith in medical care

shaking the client's hand when greeting asking the client to further explain a recurring symptom remaining neutral when the client states a lack of faith in medical care

Which is often considered the most difficult yet most effective communication technique? silence restating reflecting clarifying

silence

A nurse reviews a client's psychiatric and medical history before approaching the client for an assessment. The history reveals the client has a history of sexual abuse from a caregiver in early adolescence. Which zone would be the best place for the nurse to sit the nurse to begin the assessment? intimate personal social public

social

A nurse has been in a therapeutic relationship with a client for several weeks. When the client comes in for the weekly appointment, the nurse touches the client's arm when saying hello. The nurse has used which form of touch? functional-professional social-polite friendship-warmth love-intimacy

social-polite

The nurse is caring for a client that is very confused. What intervention should be included with the nurses' non-communication with the client? instructions for feeding the confused client speaking louder so the client can hear a flat affect so the client will not be misinterpreted use of gentle touch during activities of daily living

use of gentle touch during activities of daily living