Therapeutic Communication (EAQ's)

The nurse educator is presenting to a group of nurses about the use of de-escalatory techniques. Which actions would the nurse include in the presentation? Select all that apply 1. Identify clients needs 2. Stand close to the client 3. Use a loud and commanding voice 4. Determine stressors and triggers 5. Refrain from arguing with the clients

1, 4, 5. Rationale: De- escalatory techniques that should be included in the presentation include identifying clients needs, determining stressors and triggers and refraining from arguing with the client. These techniques can help prevent the situation from becoming worse . The nurse would keep a safe distance from the client, because getting too close to the client can increase anxiety. The nurse would use a calm, clear tone of voice when talking with the client.

Which interventions would the nurse implement when a client who attempted suicide by slashing the wrist is transferred from the emergency department to a mental health unit? 1. Obtain vital signs 2. Assess for suicidal thoughts 3. Institute continuous monitoring 4. Initate a therapeutic relationship 5. Inspect the bandages for bleeding 6. Say "You have so much to live for"

1,2,3,4,5. Rationale: Too long to write

Which action would a group of nursing students take when a client diagnosed with bipolar disorder, manic episode, tells them, I'm being held against my will, and I plan to escape later today? 1. Inform the primary of the client's behavior and plan 2. Wait to discuss the issue during post conference with the nursing instructor 3. Meet with the hospital security staff to alert them of the client's vague espcape plan 4. Introduce the interaction during the afternoon community group meeting

1. Rationale: The group of nursing students would inform the primary nurse of the client's behavior and plan. Communication of signifcant information to the appropriate health team member as soon as possible facilitates immediate assessment and a possible change in the plan of care to maintain the client's safety.

Which therapeutic communication techniques is demonstrated when the nurse says, I'm confused about exactly what is upsetting you. Would you go over that again, please? 1. Clarifying 2. Structuring 3. Confronting 4. Paraphrasing

1. Rationale: The nurse is asking for clarification to better understand the intended message.

Which nursing approach would encourage a socially withdrawn client to talk? 1. Focusing on nonthreatening subjects 2. Trying to get the client to discuss feelings 3. Asking simple yes-or-no questions of the client 4. Sitting quietly while looking through magazines with the client

1. Rationale: The nursing approach is focusing on nonthreatening subjects. The focus is to get the client to talk. Nursing care involves a steady attempt to draw the client into some response. This can best be accomplished by focusing on nonthreatening subjects that do not demand a specific response.

Which behaviors by the client exhibits denials after a recent diagnosis? 1. Attempt to minimize the illness 2. Lack an emotional response to the illness 3. Refuses to discuss the conditions with the client's spouse 4. Expresses displeasure with the prescribed activity program

1. Rationale: Attempt to minimize the illness is a classic sign of denial; by reducing the importance or extent of the problem, the individual is able to cope.

Which action would the nurse take when working with a client who is depressed? 1. Accept what the client says 2. Attempt to keep the client occupied 3. Keep the client's surrounding cheery 4. Try to prevent the client from talking too much

1. Rationale: The action is to accept what the clients says. Because clients cannot be argued out of their feelings, it is best to initially accept what they say: it also encourages communication.

The nurse is caring for a client who is displaying increased agitation and anger that is not responding to de- escalatory techniques. Which interventions would the nurse perform next to maintain client and staff safety? Select all that apply 1. Apply restraints 2. Place in seclusion 3. Administer medication 4. Notify HCP 5. Discuss situation with client

1, 2, 3, Rationale: when a client becomes increasingly agitated and does not respond to de-escalatory techniques, the nurse may have to use restraints, seclusions or medication to prevent injury to other clients and staff. The HCP should be notified, but this not promote client and staff safety. De- escalatory techniques include discussing the current situation with the client through therapeutic communication. These have failed, so the nurse would use other methods to protect the safety of the clients and staff.

During an admission interview, a client is expansive and distractible and demonstrates a fragmented, pressured, consequential pattern of speech. Which communication techniques would the nurse? 1. Closed questions 2. Active listening 3. Paraphrasing 4. Open-ended questions

1. Rationale: The client demonstrates flight of ideas and other behaviors seen in the manic phase of bipolar disorder. The nurse must highly structured closed questions to help the client focus on a single topic.

Which response would the nurse say to an older adult client whose spouse has died and who says. I'm all alone; no one has any use for me? 1. You seem upset. Let's talk about what's bothering you 2. We need to be alone sometimes. It helps us get to know ourselves better 3. Try doing something to avoid feeling lonely. I think you should socialize more 4. Let's focus on ways to change this. How about playing some games to improve your morale?

1. Rationale: Is a therapeutic response. This response indicates an awareness of the client's feelings and encourages verbalization.

Which therapeutic communication strategy is involved when the older client is recalling the past? 1. Touch 2. Reminiscence 3. Reality orientation 4. Validation therapy

2. Rationale: Reminiscence involves recalling and discussing past experiences.

Which nursing objective would be essential in the therapeutic psychiatric environment for a confused client? 1. Assisting the client to relate to others 2. Making the hospital atmosphere more homelike 3. Helping the client become accepted in a controlled setting 4. Maintaining the highest level of safe, independent

4 Rationale: The essential nursing objective is to maintain the highest level of safe, independent function. The therapeutic milieu is directed toward helping the client effective ways of functioning safely and independently.

Which outcomes is directly affected by effective therapeutic communication for a client who has the diagnosis of schizophrenia? Select all that apply 1. Becomes capable of part-time employment 2. effectively expresses emotional and physical needs 3. Demonstrates wellness reflective of physical potential 4. Demonstrates an understanding of the mental health disorder 5. Recognizes the issues most important to managing this disorder

2, 4, 5, Rationale: Effective communication would affect the following; effectively expressing emotional and physical needs, demonstrating an understanding of the mental health disorders and recognizing the issues most important to managing this disorder.

Which issue is the main problem for a client who is withdrawn and declines participation in situations that require communication with others? 1. Personal identity 2. Social interaction 3. Sensory Perception 4. Verbal communication.

2. Rationale: Characteristics of clients with problems with social interaction include avoidance of others, problematic patterns of interaction and an inability to establish or maintain stable, supportive relationships.

Which response would the nurse make to a client diagnosed with schizophrenia who stays in the bedroom expect to eat and walks away from the nursing saying, "Just leave me alone" when the nurse approaches? 1. We need to talk 2. I'll talk to you later 3. What are you angry about? 4. Is there a reason to be so upset?

2. Rationale: The nurse would respond I'll talk to you later when a client with schizophrenia walks away from the nurse, saying that they want to be left alone. This response allows the client to have the choice of communicating and leaves channels of communication open.

Which response would the nurse make to a client who overdosed on sedatives and says "Let me die. I'm no good"? 1. Tell me why you did this 2. You must have been upset to try to take your life 3. Of course you're good; we'll take excellent care of you 4. You've been through a rough time let me take care of you

2. Rationale: The nurse would respond by saying You must have been upset to try to take your life. Identifying and showing understanding of the clients feelings by giving feedback help establish a therapeutic relationship and promote exploration of feelings.

Which response would the nurse make to a client who has just experienced a panic attack? 1. I would have been upset, too 2. You are concerned that this might happen again 3. Episodes like this will always come to an end 4. Your family must have thought that you were having a heart attack

2. Rationale: The nurse would say You are concerned that this might happen again. Recurrence of attacks is a common concern.

Which response would the nurse make to a client who has been on suicidal precaution for 4 days and says, "Hey, look! I was feeling pretty depressed for a while, but I'm certainly not going to kill myself"? 1. You do seem to be feeling better 2. We should talk some more about this 3. We have to observe you until you're better 4. I don't understand what you mean by killing yourself

2. Rationale: The statement "We should talk some more about this" encourages the client to talk about feelings without the nurse setting the focus for the discussion.

Which therapeutic communication techniques is a coping strategy to help the nurse and client adjust to stress? 1. Sharing hope 2. Sharing humor 3. Sharing empathy 4. Sharing observations

2. Rationale: Sharing humor is a therapeutic communication technique that involves using a coping strategy that adds perspective and helps the nurse and client adjust to stress.

What initial nursing approach would the nurse take for a self- accusatory, guilt-ridden, delusional client? 1. Contradicting the client's persecutory beliefs 2. Accepting the clients statements as real to the client 3. Medicating the client when these thoughts are expressed 4. redirecting the client whenever a negative topic is mentioned

2. Rationale: The nurse must accept the client's statements as real to the delusional client to develop trust and move toward a therapeutic relationship.

Which initial intervention would be implemented when a depressed client says, I'm no good, I'm better off dead? 1. Respond I'll stay with you until you're less depressed 2. Reply, I think you're good; you should think about living? 3. Alert the staff to a schedule a 24 hour observation of the client 4. Unobtrusively remove those articles that may be used in a suicide attempt

3. Rationale: It's the most therapeutic approach to preventing suicide.

Which communication techniques would the nurse be using when he or she states, " Let's see whether we mean the same thing," to a client who is not making sense? 1. Reflecting feelings 2. Making observations 3. Seeking consensual validation 4. Attempting to place events in sequences

3. Rationale: The phrase "Let's see whether we mean the same thing" reflects seeking consensual validation. Seeking consensual validation is a techniques that prevents misunderstanding so that both the client and the nurse can work toward a common goal in the therapeutic relationship.

Which response would the nurse make to a client with an obsessive-compulsive disorder who completes a counting ritual and says to the nurse, Boy you must really think I'm weird? 1. Are you weird? 2. Do you really think I feel that way? 3. It sounds like you're concerned about my feelings toward you 4. You do have a serious problem, but I don't think that you're weird

3. Rationale: The response it sounds like you're concerned about four my feelings towards you dresses the client's concern and provides an opportunity to clarify the nurses's role in the therapeutic process.

A woman who is frequently physically abused says "It's my fault that my husband beats me". Which response would the nurse use? 1. Maybe, but it's likely that your husband Is also at fault 2. I can't agree with that no one should be beaten 3. Tell me why you believe that you deserve to be beaten 4. You say that it was your fault help me understand that

4. Rationale: Paraphrasing and clarifying are interviewing techniques that promote communication between the nurse and client and help the client hear and explore her words and gain insight into her behavior.

An older client is able to perform activities of daily living, but has vague physical complaints and has experienced multiple deaths of friends and family and has lost their social roles. Which questions is the most therapeutic? 1. Can you cope with being alone? 2. Have you considered assisted living? 3. What is the main problem today? 4. How do you feel about your life now?

4. Rationale: An open- ended question is the most therapeutic invitation to encourage the client to discuss hopes and frustrations without being threatening or probing.

Which factor causes the most difficulty for nurses who care for severely depressed clients? 1. Client's lack of energy 2. Negative cognitive processess 3. Client's psychomotor retardation 4. Contagious quality of depression

4. Rationale: It affects the nurse as well as the client. The insidious nature of contagious depression can leave the nurse feeling drained and exhausted. Negative thinking gradually resolves with consistent use of therapeutic communication.

Which response would the nurse make to a confused, hallucinating client who says, "My arms are turning to stone"? 1. May I examine your arms? 2. When did this feeling first start? 3. That's a rather unusual sensation 4. It can be frightening to feel that way

4. Rationale: The nurse respond, "It can be frightening to feel that way". Depersonalization communication is the result of a high anxiety level ; projecting empathy to the client will facilitate exploration of concerns.

A client who has been sexually assaulted says, "I should have fought back." Which response is the most therapeutic? 1. You're feeling guilty about submitting because you feel like you just gave in 2. You may have submitted, but did you really have any other choice at the time? 3. It's over let's not talk about what you could have done to prevent the assault 4. Whatever action you took, it was the right action because it saved your life

4. Rationale: This observation is supportive and reaffirms the woman's action (it was the right action).

Which response would the nurse make while speaking to a client diagnosed with schizophrenia who keeps interjecting sentences that have nothing to do with the main thoughts being expressed? 1. You aren't making any sense; let's talk about something else 2. You're confused; I can't understand what you're saying to me 3. Why don't you take a rest? We can talk again later this afternoon 4. I'd like to understand what you're saying, but I'm having difficulty following you.

4. Rationale: This response lets the client know the nurse is trying to understand: it increases the client's self-esteem and points out reality.

Which therapeutic communication techniques would be useful for a client with a major depressive disorder? Select all that apply 1. Reflecting 2. Offering self 3. Using silence 4. Paraphrasing 5. Asking open-ended questions 6. Encouraging comparison

ALL Rationale: Reflection helps clients better understand their own thoughts and feelings. Offering self means nurse demonstrates interest and desire to understand. Silence gives clients time to collect their thoughts. Paraphrasing means to restate the basic content of a client's message in different, usually fewer, words. The nurse may confirm an interpretation of the client's message by using simple, precise, and culturally relevant terms, before the interview continues. Open- ended questions encourage clients to share information about experiences. Encouraging comparison brings out recurring themes and helps clients clarify similarities and differences.