Psychiatric-Mental Health Nursing Varcarolis Ch. 9

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

Answer: Reflecting and exploring Reflecting conveys the nurse's observations of the client when a sensitive issue is being discussed. Exploring seeks to examine a certain idea more fully.

A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? a) "Okay, but we are all here to help you, so come get one of the staff if you need to talk." b) "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." c) "I don't believe you. You are not being truthful with me." d) "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

Answer: "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the patient's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the patient's obvious distress or are confrontational and judgmental. None of the other options provides this support.

What is the most helpful nursing response to a client who reports thinking of dropping out of college 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."

Answer: "School is stressful. What do you find most stressful?" This response acknowledges the speaker's perception of school as difficult and asks for further information. This response suggests the nurse is listening actively and is concerned.

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? a) The nurse behind a desk and the client in a chair in front of the desk. b) The nurse and client sitting at a 90-degree angle to each other. c) The client sitting in a chair and the nurse standing a few feet away. d) The nurse and client sitting facing each other.

Answer: The nurse and client sitting at a 90-degree angle to each other. This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither is in an inferior position. Face-to-face seating is a more confrontational arrangement and therefore more anxiety producing.

Which of the following statements represent a nontherapeutic communication technique? Select all that apply. a) "Why didn't you attend group this morning?" b) "From what you have said, you have great difficulty sleeping at night." c) "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" d) "If I were you, I would quit the stressful job and find something else." e) "I'm really proud of you for the way you stood up to your brother when he visited today." f) "You mentioned that you have never had friends. Tell me more about that." g) "It sounds like you have been having a very hard time at home lately."

Answer: "Why didn't you attend group this morning?" "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? a) A recent immigrant from Russia b) A deeply depressed client c) A tearful client reporting pain d) A Chinese American client

Answer: A Chinese American client Chinese Americans may not like to be touched by strangers since it is a cultural characteristic.

Of the following environments, which would be most conducive to a therapeutic session? a) The nurse's station b) A table in a coffee shop c) A quiet section of the day room d) The utility room

Answer: A quiet section of the day room Of the options provided, a quiet corner of the day room offers the safest, quietest, most private environment for a therapeutic encounter. None of the other options offer these characteristics.

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence? 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.

Answer: Allow the client to break the silence. Silence is not a "bad" thing. It gives the speaker time to think through a point or collect his or her thoughts. None of the other options will assist with further communication with this client.

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

Answer: Asking open-ended questions and seeking clarification Open-ended questions give the client the widest possible latitude in answering. Also, the client can take the lead in the interview. Seeking clarification helps the client clarify his or her own thoughts and promotes mutual understanding. None of the options provide this support.

When discussing her husband, a client shares that "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 nurse using when responding, "Are you saying that things would be better if you left your husband?" a) Focusing b) Restating c) Clarification d) Reflection

Answer: Clarification Clarification verifies the nurse's interpretation of the client's message. None of the other options are associated with the verification of the client's meaning.

After a client discusses his/her relationship with his/her father, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by him?" What is the purpose of the nurse's question? a) Eliciting more information b) Encouraging evaluation c) Verbalizing the implied d) Clarifying the message

Answer: Clarifying the message Clarification helps the nurse understand and correctly interpret the client's message. It gives the client the opportunity to correct misconceptions. This is not the purpose of any of the other options.

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.

Answer: Content of messages may be contradicted by process. Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated with assuring congruency.

A recent immigrant to the United States from which country would find direct eye contact a positive therapeutic technique? a) Korea b) Mexico c) Japan d) Germany

Answer: Germany Eye contact conveys interest to most northern European individuals. Eye contact would be considered intrusive to the others.

A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? a) Verbal communication is always more accurate than nonverbal communication. b) Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. c) Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. d) Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

Answer: Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the patient is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? a) The nurse violated the client's personal space by physically being too close. b) The client has issues with sharing personal information. c) The nurse failed to explain the purpose of the admission interview. d) The client is responding to the voices by ending the conversation.

Answer: The nurse violated the client's personal space by physically being too close. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the patient may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the patient's behavior.

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

Answer: The nurse's behavior in the nurse-client relationship Clinical supervision helps the nurse look at his or her own behavior and determine more effective approaches to working with clients. None of the other options are associated with clinical supervision.

A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? a) The patient is in denial. b) The response may reflect cultural norms. c) The response may reflect personal guilt. d) The patient may have an antisocial personality.

Answer: The response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the patient's lack of emotion is a result of any of the other options.

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse? a) The nurse is a safe person to interact with. b) The nurse is a new friend. c) They view the nurse as a stranger. d) They view the nurse as a peer.

Answer: They view the nurse as a stranger. Social distance (4-12 feet) is reserved for strangers or acquaintances. This is often the client's perception of staff during the initial phase of relationship-building. This behavior is not associated with any perception provided by any other option.

What therapeutic communication technique is the nurse using by asking a newly admitted patient, "Please tell me what was happening that led to your hospitalization here?" a) Using a minimal encourager b) Using an open-ended question c) Paraphrasing d) Reflecting

Answer: Using an open-ended question Open-ended questions require more than one-word answers. This question encourages the patient to provide a narrative concerning the circumstances surrounding the need for admission.