NURS 230 Ch. 6 - Therapeutic Communication

The nurse is performing an admission assessment for a client on the behavioral health unit with depression and anxiety. Which goal of therapeutic communication will the nurse prioritize?

A. Facilitate the client's expression of emotions.

B. Establish a therapeutic nurse-client relationship.

C. Teach the client and family necessary self-care skills.

D. Implement interventions designed to address the client's needs.

B. Establish a therapeutic nurse-client relationship.

The nurse observes a client begins to cry after a visitor leaves. Which question is best to ask the client to take the initiative in discussing what is bothering them?

A. "Is there something you would like to talk about?"

B. "What is happening with you?"

C. "I notice that you are crying."

D. "Would it be alright if I sit here with you?"

A. "Is there something you would like to talk about?"

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?

A. "You say you haven't seen your family in a while."

B. "Tell me what happened when you last saw your family."

C. "Go on. Tell me more."

D. "When was the last time you saw your family?"

A. "You say you haven't seen your family in a while."

The client expresses frustration that the health care provider does not spend enough time with the client when making rounds. The nurse replies, "The providers are very busy. What can I help you with?" Which nontherapeutic technique is the nurse using in response to the client?

A. Belittling

B. Defending

C. Disagreeing

D. Introducing an unrelated topic

B. Defending

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?

A. Giving information

B. Verbalizing the implied

C. Giving advice

D. Agreeing

C. Giving advice

The nurse is talking with a client about their mild anxiety and the client starts discussing that the spouse is not visiting. Which technique(s) will the nurse use to determine which is the most important topic? Select all that apply.

A. While documenting in the computer, determine if the client will say more.

B. Continue asking other questions about the anxiety to the client.

C. Bring the topic up related to the anxiety at a later time.

D. Ask the client which issue is more important at this time.

E. Reflect on the client's nonverbal behavior looking for clues.

C. Bring the topic up related to the anxiety at a later time.

D. Ask the client which issue is more important at this time.

E. Reflect on the client's nonverbal behavior looking for clues.

A mental health nurse is working toward the avoidance of using nontherapeutic communication techniques when engaging with clients. Which technique(s) will the nurse most likely avoid using in order to use more therapeutic responses to clients? Select all that apply.

A. Silence

B. Voicing doubt

C. Agreeing

D. Challenging

E. Disapproving

F. Exploring

C. Agreeing

D. Challenging

E. Disapproving

A client states to the nurse, "my parent screamed at me in front of several people in the grocery store when I dropped the eggs." Which statement will be an empathetic response to this client?

A. "You must have been embarrassed when your parent yelled at you in the grocery store."

B. "You really should find your own housing and get out of the situation with your parent."

C. "Well, it sounds like your parent has difficulty controlling their temper."

D. "Why do you think your parent chose that time and place to yell at you?"

A. "You must have been embarrassed when your parent yelled at you in the grocery store."

While the nurse and client are in a therapy session, the nurse says to the client, "You become very anxious when we start talking about your drinking." Which technique is the nurse using with this statement?

A. Confronting behavior

B. Making an observation

C. Translating into feelings

D. Verbalizing the implied

B. Making an observation

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

A. Leaning forward with arms on the table sitting directly across from the client

B. Turned slightly to the side of the client with arms folded across the chest

C. Leaning back in the chair next to the client with legs crossed at the knees

D. Sitting upright facing the client with both feet on the floor

D. Sitting upright facing the client with both feet on the floor

A client states, "I feel fine. It's a good day." The nurse observes the client looking away and decreasing voice pitch while speaking. Which is the most therapeutic response by the nurse?

A. "I'm glad you are feeling good today."

B. "I'm not sure I believe you since you don't act fine."

C. "Tell me what is good about today."

D. "You say you feel fine, but you don't really sound fine."

D. "You say you feel fine, but you don't really sound fine."

The nurse is talking with a client that states, "I am so sad today. It is the anniversary of my parent's death." Which response by the nurse may impede the communication process between the nurse and client?

A. "I am sorry you feel sad. Would you like to talk?"

B. "You will feel better tomorrow."

C. "It's okay to feel sad about your parents."

D. "I will sit here with you for a while."

B. "You will feel better tomorrow."

The client states to the nurse, "I am just not sure about what to do with my adult child who is taking drugs at my home." Which is the most therapeutic response by the nurse?

A. "It is your home and you should ask them to move out."

B. "As long as they aren't doing anything to harm you, let them stay."

C. "If you kicked them out, you would feel bad if something happened."

D. "It is a difficult decision. Let's discuss some of your choices."

D. "It is a difficult decision. Let's discuss some of your choices."

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?

A. 1 to 2 feet

B. 3 to 6 feet

C. 6 to 8 feet

D. 8 to 10 inches

B. 3 to 6 feet

The nurse is sitting with a client who is crying. After a few minutes, the nurse places one hand on the client's shoulder. Which situation does the nurse use touch with for this client?

A. To express sympathy to the client

B. To assess the client's skin temperature and circulation status

C. To offer comfort and support for the client

D. To extend an offer of friendship to the client

C. To offer comfort and support for the client

The client frequently attempts to touch the nurse and the nurse has explained the prohibition against this. Which response by the nurse will convey the appropriate boundaries?

A. "It makes me uncomfortable to be touched. Please refrain from doing so."

B. "I don't like you touching me so do not do it again."

C. "Why do you continue to touch me when you know I don't like it."

D. "I have asked you before not to touch me, and I will call security if you do it again."

A. "It makes me uncomfortable to be touched. Please refrain from doing so."

A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the client while respecting the client's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client?

A. In the client's room when the client's roommate is present and 3 feet away

B. At the nurse's station when other clients and visitors are less than 4 feet away

C. In an interview room in a remote section of the unit with the nurse 1 foot away

from the client

D. In a quiet corner of the dayroom at least 4 feet away from others

D. In a quiet corner of the dayroom at least 4 feet away from others

The nurse observes the parent of a child client holding the child close on the lap during the initial assessment. Which distance zone is the parent exhibiting for people who mutually desire personal contact?

A. Social

B. Intimate

C. Personal

D. Public

B. Intimate

The nurse is talking with a client that is having a difficult time solving a personal problem regarding staying together with a partner. Place in order the problem-solving process to assist the client in making a decision. All options must be used.

A. Evaluate the situation.

B. Implement the selected alternative.

C. Brainstorm all possible solutions.

D. Identify the problem.

E. If dissatisfied with the results, select another alternative and continue the process.

F. Select the best alternative

D. Identify the problem.

C. Brainstorm all possible solutions.

F. Select the best alternative

B. Implement the selected alternative.

A. Evaluate the situation.

E. If dissatisfied with the results, select another alternative and continue the process.

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?

A. Divert the subject to something the client will readily discuss.

B. Encourage the client to express any unpleasant feelings.

C. Apologize for asking such a personal and intrusive question.

D. Sit quietly until the client responds.

D. Sit quietly until the client respond

A client remarks, "You know, it's the same thing every time." Which is the most therapeutic response by the nurse?

A. "I understand what you mean."

B. "I'm sure everyone is doing their best."

C. "I'm not sure what you mean. Please explain."

D. "It's the same thing every time?"

C. "I'm not sure what you mean. Please explain."

A client states, "Right before I got here I was doing all right. My job was going well, my spouse and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your spouse were happy. Tell me more about that." Which therapeutic communication is the nurse using with the client?

A. Encouraging comparison

B. General lead

C. Restating

D. Exploring

D. Exploring

A client is sitting alone, slouched, with eyes closed. The nurse approaches. Which statement by the nurse is most likely to encourage the client to communicate?

A. "If you are sleepy, would you like me to help you back to your room?"

B. "You look like you are deep in thought."

C. "Is something wrong?"

D. "Why are you sitting with your eyes closed?"

B. "You look like you are deep in thought."

A client yells, "All the nurses here are so mean. None of you really care about us!" Which is the most therapeutic response by the nurse?

A. "I cannot allow you to yell like that."

B. "We care about you."

C. "Oh, really?"

D. "You seem very irritated."

D. "You seem very irritated."

The client says to the nurse, "I wonder what's playing at the movies tonight." Which response by the nurse would be most therapeutic?

A. "Are you telling me you would like to go to the movies?"

B. "Why don't you look in the newspaper."

C. "There's nothing worth watching."

D. "We may have some DVDs available."

A. "Are you telling me you would like to go to the movies?"

The client says to the nurse, "I have special powers because I am the mother of God. I can heal everyone in the hospital." Which is the best response by the nurse?

A. "That sounds interesting. But how can that be true?"

B. "I am having a difficult time believing that."

C. "You could not heal everyone. No one has that much power."

D. "Well, you can certainly try."

B. "I am having a difficult time believing that."

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?

A. "I just saw your mother. She's fine."

B. "You're having very frightening thoughts. Let's talk about them."

C. "We'll put you in a private room until you're in better control."

D. "If your mother died before you were born, you wouldn't be here."

B. "You're having very frightening thoughts. Let's talk about them."

The client stated, "I was so upset about my friend ignoring me when I was talking about being ashamed." Which nontherapeutic communication technique should the nurse be using when stating, "How are your stress reduction classes going?"

A. Changing the subject

B. Offering advice

C. Challenging

D. Disapproving

A. Changing the subject

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?

A. "That makes no sense at all."

B. "You can tell me about that after I finish asking these questions."

C. "What kinds of things have been happening?"

D. "Why would the CIA be interested in you?"

C. "What kinds of things have been happening?"

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

A. "Is it upsetting for you to talk about your family?"

B. "Is your family ready for you to come home?"

C. "So, how is your family?"

D. "Tell me your feelings about your family situation."

D. "Tell me your feelings about your family situation."

A client is fearful and reluctant to talk after a traumatic event. Which technique will the nurse employ that is most effective when trying to engage the client in interaction?

A. Broad opening

B. Focusing

C. Giving information

D. Silence

A. Broad opening

The nurse has an admission interview with a client receiving counseling. Which statement reflects the orientation phase of the nurse-client relationship?

A. "I would like for you to begin a diary of situations and feelings that trigger your

anger."

B. "It seems as though you have developed insight into your situation and feeling

stronger."

C. "We will be concluding our sessions in 2 weeks since you have achieved your

goal."

D. "Hello, I am the nurse that will be performing your admission interview today."

D. "Hello, I am the nurse that will be performing your admission interview today."

A nurse is working with a client whose background is very different from the nurse. Which is a good question to ask to assure the nurse can be effective working with this client?

A. "Can this person understand me?"

B. "Do I understand this client's expectations of me?"

C. "What experiences do I have with people with different backgrounds?"

D. "Is this person going to be able to relate to me?"

C. "What experiences do I have with people with different backgrounds?"

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?

A. Holding a prejudice toward this client

B. Neglecting to include the client's desires in the plan of care

C. Being manipulated by this client

D. Expressing shock when assessing the client's history

A. Holding a prejudice toward this client

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

A. Be aware of the client's behavior and background before beginning the relationship, and exploring with a colleague the potential for a conflict.

B. Use silence instead of verbal responses for all instances of the client describing their behavior.

C. Use facial expressions of annoyance if the client expresses behavior that the nurse disapproves of.

D. Turn away from the client when the nurse does not want the client to see their facial expression.

A. Be aware of the client's behavior and background before beginning the relationship, and exploring with a colleague the potential for a conflict.

A nurse has interactions with several clients throughout the day. The nurse would require a formal setting for discussion for which client?

A. A client that is displaying aggressive behaviors

B. A client with difficulty maintaining boundaries

C. A client showing signs of sadness

D. A client that is displaying hearing voices

B. A client with difficulty maintaining boundaries

A nurse is having a discussion with a client. What may be the reason for the nurse not utilizing active listening skills?

A. The nurse is thinking about issues in their personal life.

B. The nurse is uncomfortable with the client and situation.

C. The nurse is thinking ahead for answers for the client.

D. The nurse is unable to understand cues.

C. The nurse is thinking ahead for answers for the client.

The nurse is attempting to develop empathy for a client but is not completely feeling empathetic. Which factor might be hindering the nurse from developing empathy for this client?

A. Interjecting personal experiences into the interactions

B. Be sure to ask the client to restate statements for clarity

C. Asking leading questions to obtain the most information

D. Focusing on one issue

A. Interjecting personal experiences into the interactions

A nurse is developing a therapeutic relationship with a client from a cultural background different from the nurse. Which will occur if the nurse does not show this cultural competence?

A. Frustration for the client

B. Longer rehabilitation

C. Leads to mental health relapse

D. Eroding trust

D. Eroding trust

A nurse has been waiting for over an hour for the laboratory to draw blood on a client with bipolar disorder in the ED. Which response is an example of assertive communication from the nurse to the laboratory personnel?

A. "So nice of you to join us, it's about time."

B. "When you are late to draw blood the family gets upset, and I don't like having to repeat that you are on your way."

C. "When you work, we never get blood drawn on time."

D. "It's about time, we were beginning to think I would have to do your job and mine

too."

B. "When you are late to draw blood the family gets upset, and I don't like having to repeat that you are on your way."