Chapter 10

Question 1

A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Ruesch’s theory of communication, this unsuccessful interaction is called:

a. Disturbed communication
b. Nontherapeutic communication
c. Blocked communication
d. Therapeutic communication

Answer 1

ANS: A

Ruesch called this type of interrupted communication disturbed communication. In addition to interference with receiving a message, as in the case of this client, the term applies to interference with the sending of messages, problems in language between people, insufficient information, and lack of the opportunity for feedback. Ruesch’s theory did not coin the term nontherapeutic or blocked communication, and this interaction would not be considered therapeutic.

Question 2

The theorist Eric Berne theorized N U R that S I N an G individual’s T B.C O M three ego states of parent, child, and adult make up one’s:

a. Conscience
b. Personality
c. Thought processes
d. Ability to communicate

Answer 2

ANS: B

The three ego states, according to Berne, make up an individual’s personality. The parent ego focuses on rules and values, the child ego focuses on emotions and desires, and the focal point of the adult ego is previous observations. He did not address any of the other three options.

Question 3

The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique?

a. “I noticed that you pace the halls, and you have a tense look on your face. I sense

that you are anxious about something.”

b. “Can you tell me more about how you feel when you are arguing with your

daughter?”

c. “I would like to talk with you about your plan of care.”
d. “Tell me if I understand you correctly.”

Answer 3

ANS: A

Sharing perceptions lets the client know that you are listening and ensures that you understand what he or she is communicating. Asking the client to describe how he or she feels when arguing with his or her daughter describes focusing. Speaking to the client about the plan of care describes informing, and the nursing student is using clarification when asking whether he or she understands the client correctly.

Question 4

The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification?

a. “You said that the fight you had with your wife caused you to start drinking

again?”

b. “Let’s discuss what made you feel the need to drink.”
c. “Could you tell me again when and what happened that you feel caused you to

start drinking again?”

d. “Tell me what your childhood was like.”

Answer 4

ANS: C

Clarification helps to confirm feelings, ideas, and perceptions. The other options are examples of restating, focusing, and changing the topic.

Question 5

A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response?

a. “Tell me more about the feelings you have regarding their relationship.”
b. “I think that you should tell them how you feel.”
c. “Let’s not talk about that right now.”

d. “Don’t you think that you should be thankful that your daughter has a good
relationship with her grandmother?”

Answer 5

ANS: D

Defensive, challenging statements such as this one will block communication with the client because she will feel that she needs to respond defensively and answer to the nurse for her feelings. The therapeutic communication response that includes a broad opening statement is used when the nurse asks the client to tell more about her feelings. When the nurse tells the client that she should tell the mother and daughter how she feels, it describes giving advice. The nurse uses the nontherapeutic technique of belittling the client when the nurse states that the client’s feelings are childish.

Question 6

A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just can’t find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique?

a. “I can’t believe that you would want your daughter to grow up in this
environment. ”
b. “I understand your concern. Let me give you some information on our local

council for domestic abuse.”

c. “I’m sure it won’t be that bad to be out on your own. I know you can do it.”
d. “I think you should not think about leaving and should just do it.”

Answer 6

ANS: C

This is an example of the nontherapeutic technique of falsely reassuring the client. It dismisses the client’s concerns and does not support her. The nurse is showing disapproval in stating that she “can’t believe” that the client would want her daughter to grow up in such an environment. The nurse gives an appropriate therapeutic statement when she acknowledges the client’s concern and then provides the client with helpful information. The nurse is giving advice in offering her thoughts that the client should just leave.

Question 7

Therapeutic communication N techniques U R S I N G support T B.C effective O M communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client?

a. Broad openings, restating, and advising
b. Clarification, focusing, and confrontation
c. Listening, silence, and reflection
d. Humor, informing, and reassuring

Answer 7

ANS: C

The techniques of listening, silence, and reflection are all therapeutic. Advising, confronting, and reassuring are all examples of nontherapeutic techniques.

Question 8

While the nurse is talking with a female client, the client becomes silent for several seconds.

Which is the nurse’s best response?

a. To interpret this action as an indication that the client is finished with the

conversation

b. To ask the client a question so the interaction can continue
c. To remain silent and be attentive to the client’s nonverbal communication
d. To tell the client that help can be more effective if she shares her feelings

Answer 8

ANS: C

This is an example of the therapeutic communication technique of silence. It allows the client time to collect her thoughts. Although most people want to talk away the silence, it is important for the caregiver to become comfortable with the effective technique of silence. The three incorrect options prevent silence from occurring.

Question 9

A client who usually is very active in her therapy group tells the nurse that she really does “not feel well today” and would “rather not attend the group therapy session.” Which is the nurse’s most appropriate response?

a. “You don’t feel like attending the group therapy today?”
b. “I will just stay with you for a while.”
c. “It’s okay to skip a session every once in a while.”
d. “Why don’t you want to attend group therapy?”

Answer 9

ANS: A

The nurse is restating what the client said, which verifies what the client communicated and lets the client know that the nurse listened and understood her. The client did not ask the nurse to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session is giving advice and is not conveying an understanding of what the client really said. Asking the client why she doesn’t want to attend group therapy clearly conveys that the nurse did not listen to what the client communicated.

Question 10

A client who usually is very active in her therapy group tells the nurse that she really does “not feel well today” and would “rather not attend the group therapy session.” Which is the nurse’s most appropriate response?

a. “You don’t feel like attending the group therapy today?”
b. “I will just stay with you for a while.”
c. “It’s okay to skip a session every once in a while.”
d. “Why don’t you want to attend group therapy?”

Answer 10

ANS: A

The nurse is restating what the client said, which verifies what the client communicated and lets the client know that the nurse listened and understood her. The client did not ask the nurse to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session is giving advice and is not conveying an understanding of what the client really said. Asking the client why she doesn’t want to attend group therapy clearly conveys that the nurse did not listen to what the client communicated.

Question 11

The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should:

a. Sit with the client and encourage him to not verbalize
b. Do most of the talking
c. Discuss several different topics to keep the client’s attention
d. Use simple, concrete language

Answer 11

ANS: D

Because this client has been given the diagnosis of schizophrenia and frequently has auditory hallucinations, his perception of the communication must be considered. Use of simple, concrete language will assist the client in following the conversation without having to interpret what the nurse means during the interaction. Encouraging the client not to verbalize and doing most of the talking do not allow the client to express himself, and discussing several different topics will be confusing and may cause the client undue stress during the interaction.

Question 12

The nurse’s ability to interpret communication effectively in the mental health setting depends mostly on:

a. How well the client communicates
b. The nurse’s relationship with the client
c. The nurse’s understanding of mental health disorders

d. The nurse’s ability to listen to and observe the client’s verbal and nonverbal
messages

Answer 12

ANS: D

Accurate interpretation of the client’s communication cannot occur if the nurse does not listen to and observe the client. It is not dependent on how well the client communicates because the nurse has no control over the client. The nurse’s relationship with the client and understanding of mental health disorders are important but will not supersede good observation and listening.

Question 13

Which nurse response is the best example of the therapeutic principle of respect?

a. “I’m interested in what you have to say.”
b. “Describe how you are feeling for me.”
c. “I hear how worried you are about your future and can imagine how you feel.”

d. “You signed a contract stating that you would let me know when you have those
thoughts. ”

Answer 13

ANS: C

Although all of these responses are examples of therapeutic principles, this option best describes respect because it shows consideration and acceptance. The other options convey interest, the principle of concreteness, and honesty.

Question 14

A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of:

a. Permission
b. Respect
c. Interest
d. Protection

Answer 14

ANS: D

A protective response, such as “Let’s look together again at what we have planned for you when you go home,” will help the client feel more confident in her ability to do well once she is discharged. The other options are examples of therapeutic principles but do not address the needs of this client at this time.

Question 15

A nurse has just graduated from nursing school and has been hired on a mental health unit.

The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves:

a. Focusing
b. Parroting
c. Restating
d. Clarifying

Answer 15

ANS: B

Parroting is the extreme form of the therapeutic communication skill of restating. It becomes very annoying to clients when the nurse continually repeats the client’s statements in an attempt to show understanding of the client’s message. The other options are therapeutic communication skills.

Question 16

A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating?

a. Aphasia
b. Dyslexia
c. Speech cluttering
d. Incongruent communications

Answer 16

ANS: C

Rapid, confusing delivery of speech patterns is called speech cluttering and can result in the client’s inability to focus on verbal communication as the main form of interaction. Aphasia refers to the inability to speak, dyslexia refers to the mixing of letters when reading that sometimes results in the mixing of syllables when speaking, and incongruent communications occur when verbal messages do not match nonverbal messages.

Question 17

When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills?

a. Finishing the client’s sentences to indicate listening
b. Not clarifying messages to avoid interrupting
c. Avoiding taking notes to detract from listening
d. Changing the environment to decrease distractions

Answer 17

ANS: D

Effective listening improves the ability to meet client needs. Changing the environment to decrease distractions is a practice important to listening skills. Finishing the client’s sentences, not clarifying messages, and avoiding taking notes are barriers to listening and may prevent the nurse from picking up hidden messages, minimizing misunderstandings.

Question 18

The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of:

a. Echolalia
b. Circumstantiality
c. Neologism
d. Perseveration

Answer 18

ANS: B

Circumstantiality is a speech pattern in which the client describes in too much detail and cannot be selective. Echolalia is repeating the last word heard, neologism is the coining of new words or expressions, and perseveration is the repeating of a single activity and the inability to shift from one topic to another.

Question 19

The client tells the nurse that she believes there is no improvement in her manic episodes. Her clothing matches and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate?

a. Verbal communication takes priority
b. Verbal communication is not congruent with nonverbal communication
c. Nonverbal communication indicates the client is lying
d. Nonverbal communication

Answer 19

ANS: B

Verbal and nonverbal communication send and receive messages on every interaction. Neither verbal nor nonverbal communication takes priority over the other. In this case the verbal communication of the client that her episodes are not improving is belied by the obvious improvement in her dress and behavior (nonverbal communication).

Question 20

When asking the adolescent client about the magazine she is reading, she responds, “It’s an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night.” Which speech pattern is this an example of?

a. Echolalia
b. Flight of ideas
c. Loose association
d. Neologism

Answer 20

ANS: C

Loose association is a pattern in which the speaker shifts between loosely related topics such as a movie star, stars in the sky at night, and darkness at night.

Question 21

Which elements must be present for communication to occur? (Select all that apply.)

a. Feedback
b. Transmission
c. Sender
d. Clarification
e. Receiver
f. Focusing
g. Context

Answer 21

ANS: A, B, C, E, G

Feedback, transmission, sender, receiver, and context are the five elements that must be in place for communication to occur. The sender transmits the message to the receiver, resulting in feedback between them. The context, or setting, is where the communication takes place. Clarification and focusing are types of therapeutic communication.

Question 22

Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.)

a. The nurse adapts his or her behavior to accommodate the difference in
communication styles.

b. The nurse identifies and clarifies confusion during the interaction.
c. The nurse recognizes the difference between communication styles and assists the client to change to the nurse’s communication style.

d. The nurse uses a limited number of slang terms when communicating with the
client.

Answer 22

ANS: A, B

Adaptation of behavior to accommodate differences in communication is effective because it is less difficult for the nurse to adapt to differences in communication, as with the use of an interpreter. Identifying and clarifying confusion prevents misinterpretation during the interaction. Recognizing differences in communication style is correct, but assisting the client to change to the communication style of the nurse is incorrect. Using a limited number of slang words indicates that some slang terms are acceptable; however, no slang terms should be used because these may block communication.

Question 23

Which nurse responses could block effective communication with a client? (Select all that apply.)

a. “This is what I think you should say…”
b. “Don’t stress over it. Everything will turn out fine.”
c. “Why did you do that?”
d. “Most people in your circumstance…”

Answer 23

ANS: A, B, C, D

All of these options are nontherapeutic and should be avoided. When the nurse offers what she thinks the client should say, she is giving the client advice. Telling the client not to stress is giving the client false reassurance. Asking the question “Why did you do that?” will make the client defensive. When the nurse says “Most people in your circumstance…,” she is generalizing.

Question 24

In order to be therapeutic when communicating with a client living in a homeless shelter, it is important to apply which techniques? (Select all that apply.)

a. Show acceptance and respect
b. Avoid clarifying terms
c. Use medical terminology to avoid talking down
d. Consider the client’s environment
e. Assess the client’s pattern of verbal and nonverbal communication

Answer 24

ANS: A, D, E

Showing acceptance and respect, considering the client’s environment, and assessing verbal and nonverbal patterns of communication are effective ways of communicating with clients of different social classes. Avoiding clarifying terms and using medical terminology provide barriers to communication.

Question 25

__________ is the transferring between people of information, including ideas, beliefs, feelings, and attitudes.

Answer 25

ANS: Communication

For communication to be effective, information must be understood by all parties. Therapeutic communication is necessary if the interaction between the nurse and the client is to achieve successful outcomes.

Question 26

During the process of communication, a chain of events occurs as soon as the message is sent.

Steps in this chain include transmission, perception, and evaluation. Place these steps in proper order.

a. Transmission
b. Perception
c. Evaluation

Answer 26

ANS:

B, C, A

Perception of the message happens first because it is the step when recognition of a message occurs. Vision, hearing, and touch are used to perceive the message. Evaluation occurs next and is the internal assessment of the message. The last step, transmission, consists of conscious and unconscious responses to the message.