Chapter 8 Flashcards
- A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So, all in all, you feel as though you had a rather poor night’s sleep?”
d. “Can you give me an example of what you mean by ‘stoned’?”
ANS: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient’s statement. Asking for a definition of “stoned” directly asks for clarification. Restating that the patient is uncomfortable with the dream’s content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient’s comment.
- A patient diagnosed with schizophrenia tells the nurse, “The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?
a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
ANS: B
It is important not to challenge the patient’s beliefs, even if they are unrealistic. Challenging undermines the patient’s trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient’s message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful but uncompassionate.
- The patient says, “My marriage is just great. My spouse and I usually agree on everything.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patient’s communication is:
a. clear.
b. mixed.
c. precise.
d. inadequate.
ANS: B
Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient’s verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.
- A nurse interacts with a newly hospitalized patient. Select the nurse’s comment that applies the communication technique of “offering self.”
a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
b. “Why do you think you had so much difficulty adjusting to this change in your life?”
c. “I hope you will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”
ANS: D
“Offering self” is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of “offering self,” helps build trust and conveys that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but an example of “offering hope.”
- Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restate a feeling or thought the patient has expressed.
b. Ask a direct question, such as, “Did you feel angry?”
c. Make a judgment about the patient’s problem.
d. Say, “I understand what you’re saying.”
ANS: A
Restating allows the patient to validate the nurse’s understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions such as “Did you feel angry?” ask for specific information rather than show understanding. When the nurse simply states that he or she understands the patient’s words, the patient has no way of measuring the understanding.
- A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that?8??”
d. “Tell me everything from the beginning.”
ANS: C
Asking, “Am I correct in understanding that…?” permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.
- A patient tells the nurse, “I don’t think I will ever get out of here.” Select the nurse’s most therapeutic response.
a. “Don’t talk that way. Of course you will leave here!”
b. “Keep up the good work and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”
ANS: C
By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to “talk that way” is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
- Documentation in a patient’s chart shows, “Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘I enjoy spending time with you.’” Which analysis is most accurate?
a. Patient is giving positive feedback about the nurse’s communication techniques.
b. Nurse is viewing the patient’s behavior through a cultural filter.
c. Patient’s verbal and nonverbal messages are incongruent.
d. Patient is demonstrating psychotic behaviors.
ANS: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a “mixed message.” It is inaccurate to say that the patient is giving positive feedback about the nurse’s communication techniques. The concept of a cultural filter is not relevant to the situation; a cultural filter determines what a person will pay attention to and what he or she will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.
- While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills
ANS: A
Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patient’s social skills or whether a cultural barrier exists.
- During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Patients in a psychiatric setting should not be touched.
ANS: B
Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.
- A Mexican-American patient puts a picture of the Virgin Mary on the bedside table. Under which section of the assessment should the nurse document this behavior?
a. Culture
b. Ethnicity
c. Verbal communication
d. Nonverbal communication
ANS: A
Cultural heritage is expressed through language, works of art, music, dance, ethnic clothing, customs, traditions, diet, and expressions of spirituality. This patient’s prominent placement of the picture is an example of expression of cultural heritage. Verbal and nonverbal communications apply to all areas of an assessment.
- An African-American patient says to a Caucasian nurse, “There’s no sense talking. You wouldn’t understand because you live in a white world.” The nurse’s best action would be to:
a. explain, “Yes, I do understand. Everyone goes through the same experiences.”
b. say, “Please give an example of something you think I wouldn’t understand.”
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing.
ANS: B
Having the patient speak in specifics rather than globally helps the nurse understand the patient’s perspective. This approach helps the nurse engage the patient.
- A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient’s self-esteem; however, after 3 weeks, the patient’s eye contact did not improve. What is the most accurate analysis of this scenario?
a. The patient’s eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
c. The patient’s poor eye contact is indicative of anger and hostility that remain unaddressed.
d. The nurse should have assessed the patient’s culture before making this diagnosis and plan.
ANS: D
The amount of eye contact in which a person engages is often culturally determined. In some cultures, eye contact is considered insolent, whereas in other cultures, eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.
- When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurse’s hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is homosexual. Which alternative is a more accurate assessment?
a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures.
b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
d. The nurse is homophobic.
ANS: A
The most likely answer is that the patient’s behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.
- A Puerto Rican–American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient’s behavior? The patient:
a. likely has a histrionic personality disorder.
b. believes dramatic body language is sexually appealing.
c. wishes to impress staff with the degree of emotional pain.
d. belongs to a culture in which dramatic body language is the norm.
ANS: D
Members of Hispanic-American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.
