Chapter 8: Therapeutic Communication

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.

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.

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 diagnosed with a mental illness asks the nurse, "Does mental illness run in your family?". Which response to the client by the nurse would be therapeutic?

"Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses." Explanation: One of the most important principles of therapeutic communication for the nurse to follow is to focus the interaction on the client's concerns. Self-disclosure, telling the client personal information, generally is not a good idea. If the client asks the nurse personal questions, the nurse should elicit the underlying reason for the request. The nurse can then determine how much personal information to disclose, if any. Therefore, the nurse's response of "Mental illness does run in families. I've had a lot of experience caring for people with mental illnesses" would be therapeutic to say to the client. The nurse's responses of "Actually, my sister is being treated for schizophrenia. It's been hard on our whole family" and "I struggle with anxiety and depression at times. I have learned a lot from the group sessions here" are providing too much self-disclosure and are inappropriate in a therapeutic nurse-client relationship. The nurse's response of "That's not an appropriate question for me. Let's talk about something else" is giving disapproval and changing the subject, which are both nontherapeutic techniques for the client.

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 trying to obtain some information about family relationships from the client. Which statement is best to obtain the information?

"Tell me your feelings about your family situation." Explanation: This statement asks the client to describe or discuss family by expressing their feelings and perceptions. Asking if this is upsetting or whether the family is ready for the client to come home are close-ended questions that elicit just a one-word answer. Asking "how is your family" does not address the nurse's focus, which is family relationships.

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?

"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.

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. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse's therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse's discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.

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 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?

"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.

During the admission interview, the nurse asks the client about what led to their hospitalization. The client responds, "They lied about me. They said I murdered my mother. You're the killers. You all killed my mother. She died before I was born." Which is the best response by the nurse?

"You're having very frightening thoughts. Let's talk about them." Explanation: When the nurse states, "You're having very frightening thoughts," the nurse is verbalizing the implied or voicing what the client has hinted or suggested. Confrontation or rationalization are likely to make the client agitated and will ultimately harm the therapeutic relationship and communication.

The nurse and the client are using therapeutic communication skills. Which statements are true of concrete and abstract messages? Select all that apply.

Abstract messages include figures of speech that are difficult to interpret. Concrete messages are clear, direct, and easy to understand. Explanation: Abstract messages include figures of speech that are difficult to interpret. Concrete messages are clear, direct, and easy to understand. Concrete (not abstract) messages are important for accurate information exchange. Abstract (not concrete) messages require the listener to interpret what the speaker says. Concrete (not abstract) messages are best used for persons who are anxious.

A teenager is mad at the teenager's parents about not being able to drive the father's car. The teenager begins to stay out late with friends after curfew. What defense mechanism is the teenager using?

Acting out Explanation: The teenager is acting out. Acting out is using actions rather than reflections or feelings during periods of emotional conflict. Denial is refusing to acknowledge some painful aspect of external reality or subjective experience that is apparent to others. Displacement is the transference of a feeling about (or a response to) one object onto another (usually less threatening) substitute object. Devaluation is attributing exaggerated negative qualities to the self or others.

The nurse uses a variety of therapeutic communication skills when working with clients. Which is a therapeutic goal that can be accomplished through the use of therapeutic communication skills?

Assess the client's perception of a problem Explanation: Therapeutic communication can help nurses to accomplish many goals, including identifying the most important concern to the client at that moment, assessing the client's perception of the problem, facilitating the client's expression of emotions, and guiding the client toward identifying a plan of action. The nurse should normally facilitate the client's expression of emotions more than the control of emotions. The nurse must collaborate with the client to develop a plan of action, not simply provide one to the client. Similarly, problem identification must be a collaborative process, not something that the nurse informs the client of.

The nurse is admitting a client into the behavioral health unit that has sexually assaulted several people. How will the nurse avoid finding the client's behavior unacceptable and distasteful?

Be aware of the client's behavior and background before beginning the relationship, and exploring with a colleague the potential for a conflict. Explanation: The nurse-client relationship can be jeopardized if the nurse finds the client's behavior unacceptable or distasteful and allows these feelings to show by avoiding the client or making verbal responses or facial expressions of annoyance or turning away from the client. The nurse should be aware of the client's behavior and background before beginning the relationship; if the nurse believes there may be conflict, they must explore this possibility with a colleague. Overusing the technique of silence does not help the nurse provide therapeutic responses. Showing annoyance and turning away from the client inhibit therapeutic rapport and communication.

A psychiatric-mental health nurse is interacting with a client experiencing depression. The nurse is vigilant in observing the nonverbal communication of the client based on the understanding about which aspect associated with clients with mental illness?

Clients have difficulty verbally expressing themselves and interpreting others' emotions Explanation: People with psychiatric problems often have difficulty verbally expressing themselves and interpreting the emotions of others. Because of this, nurses need to continually assess the nonverbal communication needs of clients. The disorders may or may not affect the ability to verbally communicate or make the client more guarded about what he or she says. Although thoughts and thinking may be impaired, this is not always the case.

During a conversation with a client, the client asks the nurse what should be done about the client's "cheating" spouse. The nurse replies, "You should divorce. You deserve better than that." Which nontherapeutic communication technique did the nurse use in the response to the client?

Giving advice Explanation: The nurse should not give advice or tell the client what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the client needs facts, but the nurse's statement is suggesting course of action, not objective information. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the client has suggested, but this client has not suggested divorce. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the client is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

The nurse fails to assess personal values surrounding a client's gender assignment before caring for a client who is transgender. Which issue is the nurse at most at risk for that may hinder development of the nurse-client relationship?

Holding a prejudice toward this client Explanation: A person who does not assess personal attitudes and beliefs may hold a prejudice or bias toward a group of people because of preconceived ideas or stereotypical images of that group. This oversight may or may not cause the nurse to overlook the client's expressed desires. Manipulation results from a failure to maintain boundaries. Shock is unlikely because the nurse is evidently aware of the client's sexual orientation before caring for the client.

The nurse says to the client, "You become very anxious when we start talking about your drinking." Which of the following techniques is the nurse using?

Making an observation Explanation: The nurse is stating what he or she sees; the client can validate it or reject it. The nurse is not confronting the behavior in this situation. The nurse is not translating the message into feelings, nor is he verbalizing the implied.

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.

The nurse is conducting a presentation on the importance of medication compliance to a community group. 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 of the following statements is true about a nurse's self-disclosure?

Self-disclosure on the nurse's part should benefit the client. Explanation: The nurse should determine what benefit any given client will gain from nurse self-disclosure; only when that benefit can be clearly identified should self-disclosure be used, and then it should be used judiciously and within the boundaries of the relationship.

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.

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 most therapeutic?

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 sitting down with a client to begin a conversation. Which position will the nurse take to convey acceptance of the client?

Sitting upright facing the client with both feet on the floor Explanation: Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle. Leaning forward toward the client may be perceived as invasive.

Which communication technique involves expressing uncertainty about the reality of the client's perception?

Voicing doubt Explanation: Voicing doubt is expressing uncertainty about the reality of the client's perceptions. Silence is the absence of communication. Restating is repeating the main idea expressed. Reflecting is directing client actions, thoughts, and feelings back to the client.

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.

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 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 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. Explanation: Self-awareness is a critical prerequisite for therapeutic communication and can only be achieved through critical self-reflection. Knowledge of disease processes is important but does not necessarily facilitate therapeutic communication. Self-disclosure is a comparatively minor variable and is provided cautiously on a case-by-case basis. A mentor is also useful but does not replace self-reflection as a precondition for therapeutic communication.

The nurse is talking with the client about lowering cholesterol and raising high density lipoproteins (HDLs). The nurse states, "In my personal experience, niacin with applesauce helps to prevent the flushing sensation that often accompanies taking this drug." What is the nurse providing with this statement?

self-disclosure Explanation: Self-disclosure is revealing personal information (biographical information, personal ideas, thoughts and feelings) about oneself to clients. Purposeful, well-planned disclosure, can improve rapport between the nurse and client. The nurse can use self-disclosure to convey support, educate clients and demonstrate that a client's anxiety is normal and that many people deal with stress and problems in their lives. The nurse is not providing empathetic linkages, active listening or self-awareness in this statement.

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.

Which nursing actions, if shared with clients, suggest self-disclosure? Select all that apply.

showing family photos telling the client the nurse attended a weight loss meeting directing the client to the nurse's Facebook page Explanation: Self-disclosure is revealing personal information, personal ideas, thoughts and feelings about oneself to clients. Self-disclosure may help the client feel more comfortable and more willing to share thoughts and feelings, or help the client gain insight into his or her situation. Wearing the color blue or taking the elevator are not considered self-disclosure.

A client diagnosed with borderline personality disorder is pitting one nurse against the other, calling one a best friend and declaring that the other is horrible. The client is using which defense mechanism?

splitting Explanation: Splitting is compartmentalizing opposite affect states, and failing to integrate the positive and negative qualities of the self or others into cohesive images. Sublimation is the channeling of potentially maladaptive feelings or impulses into socially acceptable behavior. Self-observation is the reflecting of feelings, thoughts, motivation, and behavior and responding to them appropriately. Suppression is intentionally avoiding thoughts about disturbing problems, wishes, feelings, or experiences.

The nurse is discussing self-awareness during a group therapy session with clients on the behavioral health unit. Which statement(s) by the nurse best depicts self-awareness? Select all that apply.

"I'm tired and hungry. I need to take a break and get something to eat." "I asked to be transferred because the nurses on the unit make me feel inadequate when I work with them." Explanation: Self-awareness is the process of understanding one's own beliefs, thoughts, motivations, biases, and limitations. A well-defined sense of self-awareness can only come after nurses carry out self-examination. Being self-aware is depicted in a statement that the nurse makes by identifying that their needs must be met by taking a break. That the nurse feels inadequate and incompetent and seeks a change in the present job is an indication that the nurse understands that their feeling of self-worth will be further diminished by staying in the same position. Stating, "Yes, I'll work again this evening," "I don't need any more than four hours of sleep," "I worry about interrupting the doctor's sleep when I call them at home" or "Yes, I can help with the nurse retention committee, but I don't know when I'll find the time" are not depicting self-awareness.

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.

A nurse has invited a client to sit down and have therapeutic communication. Approximately how far from the client will the nurse place the chair to facilitate this conversation comfortably?

3 to 6 feet Explanation: The therapeutic communication interaction is most comfortable when the nurse and client are 3 to 6 feet apart; 0 to 18 inches is comfortable for parents with young children, people who mutually desire personal contact, or people whispering; 2 to 3 feet is comfortable between family and friends who are talking; 4 to 12 feet is acceptable for communication in social, work, and business settings.

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.

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 nurse is caring for a client during a counseling session. Which approach made the nurse is utilizing active listening toward the client?

listening to what the client is saying and interpreting or responding objectively Explanation: Through active listening, the nurse focuses on what the client is saying, interprets the underlying meaning, and responds to the message objectively. In active listening, the nurse responds with open-ended statements, reflection, and questions that elicit additional responses from the client. The nurse should avoid changing the subject and instead follow the client's lead. Therefore, the nurse is utilizing active listening when the nurse is listening to what the client is saying and interpreting or responding objectively. Allowing the client to express their ideas without interrupting the client is passive listening, not active listening. Asking the client closed-ended questions and changing the subject to guide the client are not active listening techniques.

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.