Chapter 6
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
The nurse is using a directive role when asking a client which question?
"Are you thinking about hurting someone else right now?"
The nurse is assessing a client who was recently diagnosed with anxiety disorder. Which question asked by the nurse conveys a concrete message?
"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?
"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?
"Don't waste my time asking about your services."
The nurse is caring for a 42-year-old Asian-American client. Which question would assist the nurse in evaluating the client's cultural needs?
"How do you typically respond when people touch you?"
A client has repeatedly been physically abused by the spouse. The client asks the nurse whether to leave the spouse like the mother has demanded. The nurse responds most therapeutically when answering:
"How would leaving your spouse make you feel?" Exploring the client's thoughts about leaving the situation is the priority for the therapeutic communication to be effective in this case. With this response, the interaction remains client centered and goal directed. Giving advice may facilitate dependency, thus it is important to elicit the client's thoughts on the matter; encouraging problem solving and decision making by the client is more constructive than giving advice.
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." Abstract messages are those messages that do not convey the meaning of the message clearly. The information given by the client is not explicit and will need to be interpreted. The statement that the client didn't know how it started may not be clearly interpreted for the meaning of "it." The statement that the chest pain was severe enough to disable the client gives a concrete message
The nurse is talking with a client in the behavioral health unit about what brought them to the unit for admission. Which statement made by the nurse is identified as nontherapeutic and may alter the flow of the conversation and limit information obtained?
"I know you are upset right now about being here, but you will find things always look better after a good night's sleep."
Which statement by the nurse is an example of assertive communication?
"I understand that group can be difficult to attend but coming late is disruptive."
A nurse is caring for a client in a severe anxiety state. What is an important nursing consideration while communicating with the client experiencing anxiety?
using short and simple statements or questions
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."
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?"
The nurse is attempting to develop a therapeutic nurse-client relationship with a newly admitted client. Which statement or question by the nurse will allow the client to initiate the introduction of the topic?
"Is there something you would like to talk about?"
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 mostlikely to elicit an explanation of the client's behavior?
"It looks like you're searching for something. Is that right?" When communicating, it is important to make an observation and then seek clarification and encourage the client to explore his or her behavior.
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."
A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?
"It sounds like you're feeling unappreciated."
A client says, "Nobody listens to me; even you don't!" Which response is most therapeutic?
"It sounds like you're feeling unappreciated." Reflecting feelings is an effective way to show empathy and facilitate the client's further disclosure. Avoid "why" questions, which cause defensiveness, avoid belittling the client's feelings, and do not defend against the client's belief.
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."
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. Setting firm but fair limits in a matter-of-fact and consistent manner helps clients to establish appropriate boundaries and can increase feelings of security.
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 mosttherapeutic?
"No, Joe. Your plan says that you need to attend that group in order to have cigarette breaks."
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?"
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?" Reflection is a therapeutic communication technique used to redirect the idea back to the client for classification of emotional overtones, feelings, and experiences.
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."
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."
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 feedback, sender, receiver, and messages."
A group of nursing students is preparing a presentation about therapeutic communication. As part of the presentation, the group is planning to give examples of maintaining a nonjudgmental attitude. Which would be appropriate to include?
"The client has struggled with domestic violence for a while and is working very hard to make the necessary changes to help oneself."
The nurse is engaging in an interpersonal interaction with the daughter of an older adult client who has dementia. As the client's daughter is sharing her concerns about bringing her father home, she begins to cry. Which response from the nurse demonstrates therapeutic communication?
"This is overwhelming for you, it is okay to cry."
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?"
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?
"What you are saying and how you say it does not seem to match."
Choose the most therapeutic response to the client's statement, "All I feel like doing is screaming as loudly as I can."
"You look like you are very angry this morning." Replying that the client looks very angry this morning provides reflection of the client's affect (angry) and is making an observation
The nurse is educating a group of clients about effective anger management with an emphases on the use of assertive sentences while expressing anger. Which sample statement(s) indicate effective teaching on assertive communication? Select all that apply.
-I am frustrated with the situation -I am feeling disrespected by your comments
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 fearful tone of voice
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.
-learning towards the client -maintaining eye contact with the client Mirroring the client's facial expression
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
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?
3-6 feet
The therapeutic communication interaction is most comfortable when the nurse and the client are how far apart?
3-6 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 fearful tone of voice
"Get the stuff from him" is an example of which type of message?
Abstract
Which form of messaging contain figures of speech that are difficult to interpret and can be a barrier to communication?
Abstract
A nurse engaged in an interaction with a client recognizes body space zones and works to maintain the client's personal zone. The nurse would interpret this zone as which area ?
Beginning at the boundary of the intimate zone and ending at the social zone The four zones are intimate, personal, social, and public. The personal zone begins at the boundary of the intimate zone and ends at the social zone. The intimate zone varies widely in different cultures. The social zone begins at the end of the personal zone and ends at the public zone. The public zone begins at the end of the social zone and extends outward.
Which therapeutic communication technique is being utilized when the nurse asks the client, "Is there something you'd like to talk about?"
Broad opening This is an example of a broad opening, which allows the client to take the initiative in introducing the topic. Accepting is indicating reception. Exploring is delving further into a subject or idea. Focusing is concentrating on a single point.
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?
Consensual validation
Which type of cue is being used when the client states, "Nothing can help me"?
Covert
A client is speaking to the nurse and expressing dissatisfaction about the care that was provided to the client during a hospital stay. The nurse tells the client, "This is the best hospital in the state. You could not expect better care anywhere else." Which type of communication does this indicate?
Defending
Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic?
Emphasis
A nurse is assessing a client with chronic illness when the client begins to cry. The nurse asks the client, "Is something wrong?" This is indicative of which type of therapeutic communication technique?
Encouraging description of perception
A nurse is giving a presentation to colleagues about verbal communication. The audience demonstrates understanding of the information when they identify which component as the first in the process?
Formulation of an idea
The nurse observes that a client has been pacing in the unit's common area in an agitated state for the past 15 minutes. Which is the nurse's priority action?
Explore with the client to determine why they are displaying these behaviors.
When the nurse states, "Tell me more about that," the nurse is utilizing which communication technique?
Exploring Exploring is delving further into a subject or area. Focusing is concentrating on one simple point. Accepting is indicating reception. Formulating a plan of action is asking the client to consider kinds of behavior likely to be appropriate in future situations.
The psychiatric mental health nurse prepares for a new admission and discovers that the client does not speak the dominant language. The client understands some of the dominant language and uses hand signals to point to things they want or need. How should the nurse proceed to complete the admission assessment?
Have a psychiatrist who speaks the same language as the client assist.
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?
Introducing an unrelated topic
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
Which zone is a distance that is comfortable between family and friends who are talking?
Personal
Which zone is a distance that is comfortable between family and friends who are talking?
Personal The personal zone is the distance that is comfortable between family and friends who are talking. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The social zone is the distance acceptable for communication in social, work, and business settings. The public zone is an acceptable distance between a speaker and an audience.
A client diagnosed with schizophrenia is hallucinating. Which communication technique may the nurse use to redirect the client?
Presenting reality
During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which nontherapeutic communication technique?
Probing
The nurse is talking with a married client just diagnosed with syphilis. The nurse talks with the client about disclosing the information to the spouse and/or any other sexual partners. The client cries and asks the nurse, "Have you ever had an affair?" The nurse states, "Yes, it usually doesn't turn out well." The nurse proceeds to answer other questions about the affair. By answering these personal questions the nurse is divulging what?
Self-disclosure Self-disclosure is letting the client know personal information. The conversation should focus on the client, and not the nurse.
Which would not be considered a goal of therapeutic communication?
Self-exploration of feelings by the nurse
Which type of touch, according to Knapp, is used in greeting, such as a handshake?
Social-polite Social-polite touch is used in greeting, such as a handshake. Functional-professional touch is used in examination or procedures. Friendship-warmth touch involves a hug in a greeting. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives
The nurse is working with a client from the Middle East. The nurse maintains a distance of approximately 13 feet from the client while talking. The client says that the client is uncomfortable when the nurse talks to the client from such a long distance. How should the nurse interpret this statement?
The client feels that the nurse is indifferent toward the client.
When engaged in therapeutic communication with a client who has a mental disorder, what is the most important for a nurse to keep in mind?
The client is the primary focus of the interaction.
A psychiatric-mental health nurse has entered a client's room, made an introduction, and asked if the nurse and the client could speak for a few minutes. The clients states, "Yep. Glad to talk." However, the nurse observes that the client is looking at the floor and the client's arms and legs are crossed. How should the nurse best interpret this situation?
The client may be reluctant to dialogue despite the statement to the contrary
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 may have difficulty maintaining spacial boundaries.
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 have suicidal ideations
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
Which is inconsistent with principles of therapeutic communication?
The nurse is the primary focus of the relationship. The client, not the nurse, should be the primary focus of the interaction. The nurse must maintain client confidentiality and use a professional attitude. The interventions are implemented from a theoretical base.
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 may lack confidence in therapeutic communication.
Which is an inaccurate depiction of concrete messages?
They require rephrasing of unclear statements.
A nurse responds to a client's statement with silence to achieve which outcome?
To permit the client to gather their thoughts
When speaking with a client who has a diagnosis of major depression, the nurse has placed a hand lightly on the client's shoulder when responding to one of the client's statements of hopelessness. Which principle should underlie the nurse's use of touch when communicating with clients?
Touch can be a powerful therapeutic tool, but it must be used with caution.
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?
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
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. Self-awareness is a critical prerequisite for therapeutic communication and can only be achieved through critical self-reflection.
A client says to the nurse, "I have done something terrible." The nurse replies, "I would like to hear about it. It's okay to discuss it with me." Which therapeutic communication technique is the nurse utilizing?
acceptance
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
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 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).
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
Which includes the circumstances or parts that clarify the meaning of the content of the message?
context
Which term is used to refer to signals that encourage effective communication?
cue
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:
excessive probing
The nurse is assessing a client who is hospitalized for an episode of mania. When the nurse sits down across from the client to begin the interview, the client moves to sit right less than a foot away from the nurse. The client is positioned in which body space zone of the nurse?
intimate If the client is sitting next to the nurse, there are only a few inches of space between them. This is the intimate zone and is appropriate for parents with young children, people who mutually desire personal contact, or people whispering. Invasion of this intimate zone by anyone else is threatening and produces anxiety.
A client from which cultural background would most likely have an older family member present when discussing health issues with the nurse?
korean
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
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
During a therapy session, the nurse asks the client, "Tell me more about your relationship with your parents." The nurse is using which nontherapeutic communication technique?
probing An example of probing is "tell me more about your relationship with your parents." Reflecting feelings occurs when one identifies feelings that are being expressed. Confrontation is challenging a participant. Clarification is a restatement of the interaction.
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
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
Which is often considered the most difficult yet most effective communication technique?
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?
social Clients with a history of abuse have had others touch them in harmful, hurtful ways, usually without their consent. This client may be hesitant or even unable to tell the nurse when closeness or touch are uncomfortable. The nurse would be sitting 4-12 feet away from the client. The intimate zone would only leave 0-18 inches between the client and the nurse. This would not be appropriate, particularly given the client's history of sexual abuse. The personal zone leaves only 18-36 inches between the nurse and client. It would be more appropriately used between two people who know each other well. The public zone leaves 12-25 feet between the nurse and client. This distance is too far to carry out an assessment and may, in fact, compromise confidentiality.
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
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 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.
Which would be the least optimal environment for therapeutic communication for a client who has difficulty maintaining boundaries?
the client's room
The nurse is caring for a client who is very confused. In addition to verbal communication with the client, which intervention should the nurse use?
using gentle touch during activities of daily living The nurse should supplement verbal communication with therapeutic nonverbal communication, including gentle touch, to reinforce caring feelings for the confused client.
