CH 9 - Therapeutic Communication (1)

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

Two main principles that can guide the communication process during the nurse-client interview are A. clarity and giving recognition. B. personal and environmental factors. C. passive listening and cultural caution. D. interpreting and speculating on client meaning

A. clarity and giving recognition.

What is the most helpful nursing response to a client who reports he is thinking of dropping out of nursing school 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?"

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? A. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." B. "You said you are looking forward to the meeting, but I noticed you frowned as you said it." C. "I notice that you frowned and avoided eye contact just now; don't you feel well?" D. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"

B. "You said you are looking forward to the meeting, but I noticed you frowned as you said it."

A nurse should perceive an intense, highly emotional communication style as culturally appropriate for a client who is A. African American. B. Hispanic American. C. Asian American. D. British American.

B. Hispanic American.

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction? Select all that apply. A. Apologize for the differential in height and proceed while standing to avoid delay. B. If permitted, raise the head of the bed and, with the patient's permission, sit on the bed. C. If permitted, raise the head of the bed to approximate the nurse's height while standing. D. Sit in whatever chair is available in the room to convey informality and increase comfort. E. Locate a chair or stool that would place the nurse at approximately the level of the patient. F. Remain standing and proceed so as not to create distraction by altering the arrangements.

B. If permitted, raise the head of the bed to approximate the nurse's height while standing. E. Locate a chair or stool that would place the nurse at approximately the level of the patient.

Which student behavior is consistent with therapeutic communication? A. Offering your opinion when asked in order to convey support. B. Summarizing the essence of the patient's comments in your own words. C. Interrupting periods of silence before they become awkward for the patient. D. Telling the patient he did well when you approve of his statements or actions.

B. Summarizing the essence of the patient's comments in your own words.

The content and direction of the clinical interview is determined by: A. The nurse B. The client C. The physician D. The health care team

B. The client

What therapeutic communication technique is the nurse using when asking a newly admitted patient "Can you tell me what was happening to you that led to your being hospitalized here?" A. Using a minimal encourager B. Using an open-ended question C. Paraphrasing D. Reflecting

B. Using an open-ended question

The preferred seating arrangement for a nurse-client interview is with the A. nurse behind a desk and the client in a chair in front of the desk. B. nurse and client sitting at 90-degree angles to each other. C. client sitting in a chair and the nurse standing a few feet away. D. nurse and client sitting facing each other.

B. nurse and client sitting at 90-degree angles to each other

Nonverbal behaviors

Body behaviors Facial expressions Eye Cast Voice-related behaviors Observable autonomic physiological responses Personal appearance Physical characteristics

A patient with schizophrenia approaches staff arriving for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be most therapeutic? A. "There are no such things as demons; what you saw were hallucinations." B. "It is not possible for anyone to enter your room at night; you are safe here." C. "You seem very upset; please tell me more about what you experienced last night." D. "That must have been very frightening, but we'll check on you at night and you'll be safe."

C. "You seem very upset; please tell me more about what you experienced last night."

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? A. Ms. E, a client from Russia B. Mrs. F, a deeply depressed client C. Ms. G, a Chinese American client D. Mr. H, a tearful client reporting pain

C. Ms. G, a Chinese American client

Student nurses on psychiatric units may not have the luxury of seeing patients in a private office or conference room. Of the following environments, which would be most conducive to a therapeutic session? A. Nurse's station B. A table in the coffee shop C. Quiet section of the day room D. Utility room

C. Quiet section of the day room

When the client sits about 5 feet away from the nurse during the assessment interview, the nurse interprets that the client views the nurse as a: A. Safe person to interact with B. New friend C. Stranger D. Peer

C. Stranger

Which statement about nonverbal behavior is accurate? A. A calm expression means that the patient is experiencing low levels of anxiety. B. Patients respond more consistently to therapeutic touch than to verbal interventions. C. The meaning of nonverbal behaviors varies with cultural and individual differences. D. Eye contact is a reliable measure of the patient's degree of attentiveness and engagement.

C. The meaning of nonverbal behaviors varies with cultural and individual differences.

The best rule of thumb related to touching psychiatric clients is A. follow your instincts. B. touch the elderly, but avoid touching the young. C. check the facility's policy on the acceptability of touch. D. touch is perceived as a gesture of warmth and friendship that fosters a relationship.

C. check the facility's policy on the acceptability of touch.

When considering the interaction between verbal and nonverbal communication, what is the best word to complete this analogy? Verbal communication relates to content as nonverbal communication relates to A. touch. B. conflict. C. process. D. double messages.

C. process.

Which statement by the nurse reflects the process occurring in the clinical interview? A. "Give me an example of something your wife does that 'drives you nuts.'" B. "What makes you think your doctor will give you a pass?" C. "When is your child custody hearing going to be held?" D. "You are frowning. What are you feeling?"

D. "You are frowning. What are you feeling?"

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

A client shares that, "I can't stand his controlling ways. 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 nursing 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

After a client discusses her relationship with her father, the nurse asks "Tell me if I am understanding your relationship with your father. You feel dominated and controlled by him?" The nurse's purpose is to A. elicit more information. B. encourage evaluation. C. verbalize the implied. D. Clarify message.

D. Clarify message.

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.

With which client would making direct eye contact help further the nurse-client relationship? A. Mrs. A, a recent immigrant from Korea B. Ms. B, a recent immigrant from Mexico C. Mr. C, a recent immigrant from Japan D. Mr. D, a recent immigrant from Germany

D. Mr. D, a recent immigrant from Germany

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

During a clinical interview with a male nurse, the client falls silent after disclosing that she was sexually abused as a child. The nurse should 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.

Nontherapeutic Communication Techniques

Giving premature advice Minimizing feelings Falsely reassuring Making value judgments Asking "why" questions Asking excessive questions Giving approval, agreeing Disapproving; disagreeing Changing the subject

Therapeutic Communication Techniques

Using silence Active listening Listening with empathy Clarifying techniques

Double-blind message

a mix of content (what is said) and process (what is conveyed nonverbally) that has both nurturing and hurtful aspects.

Cultural Filters

form of cultural bias or cultural prejudice that determine what we pay attention to and what we ignore.

"You feel _______(name the emotion) because of ______(describe the experiences, thoughts, and behaviors."

listening with empathy

Clarifying techniques

paraphrasing restating reflecting exploring

The nature of the feedback often indicates _________.

whether the meaning of the message sent has been correctly interpreted by the receiver.

Active Listening

• Observing the patient's nonverbal behaviors • Understanding and reflecting on the patient's verbal message • Understanding the patient in the context of the social setting of the patient's life • Detecting "false notes" (e.g., inconsistencies or things the patient says that need more clarification) • Providing feedback about himself or herself of which the patient might not be aware