PrepU Ch6-T1

Question 1

The nurse indicates interest in and acceptance of the client by all of the following except:

Answer 1

sitting behind a desk.

Question 2

A client says, “Nobody listens to me; even you don’t!” Which response is most therapeutic?

Answer 2

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.

Question 3

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?

Answer 3

Touch can be a powerful therapeutic tool, but it must be used with caution.

***the nurse should always exercise caution when touching people. Touch can be a powerful component of communication and is appropriate in clinical settings, but it must be used judiciously to avoid negative consequences or impairing therapeutic relationships and communication.

Question 4

A nurse engaged in an interaction with a client recognizes body space zones. Which would the nurse identify as the individual’s personal zone?

Answer 4

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.

Question 5

The nursing instructor is teaching about the importance of communication in nursing and relates it to the family. Which statement by a student nurse would indicate that the teaching has not been effective?

Answer 5

Nonverbal communication is not meaningful.

**Communication theory concerns the sending and receiving of both verbal and nonverbal messages. All nonverbal communication is meaningful, and it is just as important as verbal communication. All communication consists of two levels: content (what is said) and relationship (of those interacting)

Question 6

Which form of nonverbal communication would be least effective for the nurse to engage in to demonstrate interest in and acceptance of the client?

Answer 6

Sitting behind a desk

**Therapeutic nonverbal communication uses positive body language, such as sitting at the same eye level as the client with a relaxed posture that projects interest and attention. Leaning slightly forward helps engage the patient. Generally, the nurse should not cross his or her arms or legs during therapeutic communication because such postures erect barriers to interaction. Uncrossed arms and legs project openness and a willingness to engage in conversation.

Question 7

Which statement by the nurse is an example of assertive communication?

Answer 7

I understand that group can be difficult to attend but coming late is disruptive.”

**Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way. It recognizes the rights of both parties. Losing one’s temper is an example of aggressive communication. The other options demonstrate passive-aggressive and passive communication.

Question 8

A nurse is conducting an initial assessment of a client. When the client enters the nurse’s office, the client finds the nurse sitting with arms folded across the chest and an emotionless facial expression. The nurse is exhibiting which nonverbal communication technique?

Answer 8

closed body position and impassive face

**An impassive face is characterized by an emotionless, deadpan expression similar to a mask. The closed body position entails the nurse sitting with arms folded across the chest. Contrarily, an accepting body position would involve the nurse sitting with hands at the side of the body. This open posture demonstrates unconditional positive regard, trust, care and acceptance. An expressive face portrays the person’s moment-by-moment thoughts, feelings, and needs. A confusing facial expression is one where the person is verbally expressing one emotion but showing a different one.

Question 9

The graduate nurse is working in mental health and is learning about the use of touch with clients that have psychiatric disorders. The seasoned mental health care nurse differentiates information about this part of therapeutic communication by stating which information?

Answer 9

“Touch carries different meanings for different individuals.”

**Touch can elicit both positive and negative reactions. Depending on the people involved and the circumstances of an interaction, touch carries different meanings for different individuals. Although the statements, “Touch is best mixed with compassion when dealing with the anxious client,” “Touch is used in situations in which the client is unstable,” and “Touch is used to express interest and warmth”, can be true and demonstrate how touch can be used, these statements do not demonstrate how touch is interpreted.

Question 10

The nurse is caring for a client with cellulitis. The client responds, “I feel kind of ‘blah’,” after the nurse asks, “How do you feel?” After the client’s reply, the nurse states, “Can you tell me what ‘blah’ feels like?” The client responds, “I don’t have any energy, and I don’t feel like doing anything.” Using therapeutic communication, how should the nurse respond?

Answer 10

Let’s talk about infections, and how they heal.”

**Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals, such as assessing the client’s perception of the problem as it unfolds, teaching the client self-care skills and identifying a plan of action to a satisfying and socially acceptable resolution. “Oh, it is just the infection, in a day or so you’ll feel better,” “Why don’t you just rest in bed?,” and “Call a friend in to watch TV,” are not examples of therapeutic communication between the nurse and client.

Question 11

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?

Answer 11

What specifically makes you uncomfortable?”

**It is important for the novice nurse to identify what it is about discussing sexual abuse that is anxiety producing so that those issues can be addressed and resolved. Asking this question will assist the novice nurse in engaging in self reflection that can lead to a greater awareness of self and thus enhance the ability to be therapeutic. Suggesting the nurse have such abuse victims released from the nurse’s care ignores the problem and minimizes the nurse’s therapeutic effectiveness. Arranging for training is appropriate only if it is discovered that the problem relates to a lack of skills related to the nurse’s therapeutic communication techniques. While prior sexual abuse may be the cause of the nurse’s discomfort, it is not appropriate for the nurse manager to initiate this discussion in that manner.

Question 12

Which zone is an acceptable distance between a speaker and an audience

Answer 12

Public

**The public zone is an acceptable distance between a speaker and an audience. The intimate zone is the amount of space that is comfortable for parents with young children and people who mutually desire personal contact. The personal zone is the distance comfortable between family and friends who are talking. The social zone is the distance acceptable for communication in social, work, and business settings.

Question 13

When the nurse states, “Tell me more about that,” the nurse is utilizing which communication technique?

Answer 13

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.

Question 14

A client is exhibiting anxiety after being told that the client’s spouse has sustained a heart attack. The nurse’s response to the client is “everything will be okay.” Which type of nontherapeutic communication technique is being exhibited by the nurse?

Answer 14

Reassurance

**Clichés such as “everything will be okay” or “don’t worry, the doctor will make you well” are examples of false reassurance. No one can predict or guarantee the outcome of a situation. Failure to listen, giving advice, and having a judgmental attitude are all ineffective communication techniques.

Question 15

When engaged in therapeutic communication with a client who has a mental disorder, which is the most important for a nurse to keep in mind?

Answer 15

The client is the primary focus of the interaction

**A fundamental principle of therapeutic communication is that the client must be the focus of the interaction. Self-disclosure should be avoided. Empathy is important and develops over time as the nurse receives information from the client with open, nonjudgmental acceptance. The nurse communicates this understanding of the experience so that the client feels understood. Conversations with clients should be kept confidential.

Question 16

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?

Answer 16

Defending

**The nurse’s statement conveys that the nurse is trying to defend the hospital from the client’s criticism. The nurse’s statement may not change the client’s feelings toward the hospital but may make the client shy away from communicating further. Agreeing is a type of communication technique through which the nurse indicates accord with the client. Challenging is a type of communication technique through which the nurse tries to obtain proof from the client. Belittling is a type of nontherapeutic conversation in which the nurse misjudges the degree of the client’s discomfort.

Question 17

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?

Answer 17

The client may have suicidal ideations.

**Covert cues are often vague messages that require interpretation from the nurse or other health care professional. As the client has severe depression, it is possible the client is discussing suicide. The nurse needs to ask a direct yes or no question to determine if this is truly the case. The nurse may be able to surmise that this client is not discussing sleep, fatigue, or needing a break from stress.

Question 18

A client who is experiencing depression states, “I can’t seem to do anything to take care of myself, how can I get going?” What is the nurse’s best response?

Answer 18

I notice it has been a while since you have had a shower

**Stating, “I notice it has been a while since you have had a shower,” is the correct option. Making an observation helps the nurse verbalize what is perceived. This is therapeutic because sometimes a client may not be able to verbalize or make themselves understood. Stating, “I think you need to take a shower,” would be a nontherapeutic statement. This is called advising and entails telling the client what to do, communicating the the nurse knows what is best for the client. Stating, “Don’t worry, take as long as you need before you get going,” denotes reassuring by the nurse. By saying this, the nurse is communicating that this is not a problem despite the fact that the client is approaching the nurse for support in problem solving. By asking, “Why haven’t you taken a shower?” the nurse is requesting an explanation. This is intimidating and the client is likely to become defensive or feel judged and vulnerable.

Question 19

The nurse is offering an demonstration session on what is done in group. Which client(s) would the nurse determine as conveying a message? Select all that apply.

Answer 19

a boy displaying a rainbow tattoo on his arm

the teenager who writes “No one loves me” in a journal

the father slapping his son for picking a wallet from a pocket

a girl with headphones playing loud music away from everyone else

Question 20

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?

Answer 20

“I’m concerned that you are not exicited about your mother’s visit, We can talk if you want.”

**Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client’s experience. “Why are you sad about your mother’s visit?,” “I need to know why you are sad” and “Is your mother giving you trouble for being here?” are not examples of therapeutic communication.

Question 21

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:

Answer 21

excessive probing.

**Excessive probing is usually nontherapeutic, except in the process of collecting a history. The here and- now is what the client is experiencing and what the nurse can assist the client in changing.

Question 22

When providing information about anorexia to a client, the nurse can ensure that the client can accurately comprehend the information by doing what?

Answer 22

Presenting the information using language and terms the client will understand

**Being careful not to use technical terms and language that will confuse or intimidate the client will assist the client in grasping and applying the information. While interacting in a nonthreatening, respectful manner is considered expected, it is focused toward establishing a therapeutic relationship and not toward maximizing client learning. Being careful to not overload the client with information is important, but presenting the information in language the client can understand is most important. Giving the client ample opportunity to ask questions is important, too, although the nurse needs to realize that even if given time to ask a question the client may not choose to do so.

Question 23

Which includes the circumstances or parts that clarify the meaning of the content of the message?

Answer 23

Context

**Context includes the circumstances or parts that clarify the meaning of the content of the message. Process denotes all nonverbal messages that the speaker uses to give meaning and content to the message. Congruence occurs when the process and content agree. Proxemics is the study of distance zones between people during communication.

Question 24

“Get the stuff from him” is an example of which type of message?

Answer 24

Abstract

**“Get the stuff from him” is an example of an abstract message. In concrete messages, words are explicit and need no interpretation. Concrete messages are clear, direct, and easy to understand.

Question 25

Which would not be considered a goal of therapeutic communication?

Answer 25

Self-exploration of feelings by the nurse

**Self-exploration of feelings by the nurse is not considered a goal of therapeutic communication. Establishing rapport, active listening, and guiding the client in problem solving are goals of therapeutic communication.

Question 26

A nurse responds to a client’s statement with silence based on the rationale that this technique is used primarily to:

Answer 26

permit the client to gather the client’s thoughts.

**By maintaining silence, the nurse allows the client to gather the client’s thoughts and to proceed at the client’s own pace. Silence may help the nurse determine an appropriate response or engage in self-reflection, but it is more directed toward allowing the client to focus. Silence does not reflect passive listening. Passive listening involves sitting quietly and letting the client talk, rambling without focusing, or guiding the thought process.

Question 27

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?

Answer 27

3 to 6 feet

**A distance of approximately 3 to 6 feet may help facilitate good therapeutic interaction between the client who is Hispanic and the nurse. People from some cultures, including Hispanics, are more comfortable with less than 4 to 12 feet of space between them when talking. A distance of 10 to 12 inches or 15 to 18 inches is considered the intimate communication zone, which may make the nurse and client feel uncomfortable. A distance of 15 to 18 feet between the nurse and the client is considered the public communication zone, which is unlikely to facilitate therapeutic communication.

Question 28

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?

Answer 28

Introducing an unrelated topic

**The nurse has introduced an unrelated topic. Interpreting is a nontherapeutic communication technique through which the nurse makes the client believe the nurse’s perception of the client’s problem. Communication that is of no value to the nurse-client interaction and imitates meaningless chitchat is referred to as making stereotyped comments. Indicating the existence of an external source is a type of nontherapeutic communication in which the nurse attributes the source of thoughts, feelings, and behavior of the client to others or to outside influences.

Question 29

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?

Answer 29

The client may have difficulty maintaining spacial boundaries.

**Sitting behind a table while speaking to a client makes the setting formal. This setting would most likely be required when dealing with clients who have difficulty maintaining boundaries. Such a formal setting would make the client more uncomfortable. In such settings, the client may not be able to share feelings freely or to open up easily. It is not appropriate for the nurse to use this kind of setting if the client is willing to express individual feelings.

Question 30

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?

Answer 30

The client may be reluctant to dialogue despite the statement to the contrary

**In general, nonverbal messages supersede verbal messages. This disconnect between the two types of communication, however, are not limited to persons with mental illness.