TERM 3- MY NOTES MENTAL HEALTH NURSING CARE CH.5 "THE NURSE-CLIENT RELATIONSHIP AND COMMUNICATION" Flashcards
Therapeutic Use of Self
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The therapeutic use of self is the ability to use the self, consciously and in full awareness, to structure nursing interventions.
A)true
B)false
A
Nurses who are aware of their own real selves are in a better position to help their clients
A)true
B)false
A
If nurses are to have open, authentic communication with clients, they must be able to examine their own feelings and appreciate how their feelings interact with those of clients
A)true
B)false
A
Nurse-Client Relationship
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You talk to a friend about your troubles and she calks about hers. There is mutual satisfaction. In a social relationship there is no goal except friendship or socializing. There is no time limit. Both parties freely express feelings and opinions
A)true
B)false
A
The features of the professional therapeutic relationship are as follows:
• Client centered
• Goal directed
• Time limited
True
In the professional relationship, the nurse may take on different roles (such as socializing agent, advocate, counselor, or reacher), but the relationship always focuses on the cLient’s needs. The professional relationship is also goal directed. The purpose of these relationships is to help the client meet adaptive (healthy) goals.
A)true
B)false
A
Unlike the social relationship, the professional relationship is time limited. The nurse and client define how much time they are willing and able to spend. When the nurse is off work or the client is discharged from the facility, the relationship is over.
A)true
B)false
A
The appropriate degree of objectivity (detachment or neutrality, without emotion) is also important to the professional relationship. A common but erroneous assumption is that nurses must remain completely objective. If nurses were completely objective, they would be detached from concern about clients. Nurses should be open and aware of their own feelings to be able to help clients.
A)true
B)false
A
Sometimes what the client needs is a social conversation. People with chronic mental illnesses often have poor social skills and need practice. People in long-term care may have few social contacts. In these situations, the nurse uses social interaction with clients as a nursing intervention to meet client needs. This is not the time for nurses to discuss their own personal problems.
A)true
B)false
A
PHASES OF THE RELATIONSHIP
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The nurse-client relationship has three phases: the orientation phase, the working phase, and the termination phase.
A)true
B)false
A
In the orientation phase, the nurse and the client set the stage for the relationship to follow. They introduce themselves and set goals for the interaction. In the medical-surgical setting, a goal may be to learn about a new medication or treatment, or perhaps to discuss how the client feels about a surgical procedure. In the psychiatric setting, a goal may be to explore feelings or to develop problem-solving strategies. The time limit of the relationship is stated during this phase.
A)true
B)false
A
In the working phase, the nurse implements interventions to reach the goals set during the orientation phase. The nurse and client work together to achieve the client’s optimal level of functioning and self-care, based on the client’s strengths and challenges. One important possible nursing intervention in this phase is therapeutic communication.
A)true
B)false
A
After the work of the working phase is done, the termination phase begins. In this phase the nurse and the client summarize their progress and evaluate the achievement of the client’s goals. The nurse learns from this process about which interventions are effective and which are not. The client then moves on to other relationships.
A)true
B)false
A
ELEMENTS OF THE NURSE-CLIENT RELATIONSHIP
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The qualities of trustworthiness, caring , empathy, genuineness, respect, and concreteness empower the nurse to excel in the art of nursing.
A)true
B)false
A
Elements of the Therapeutic Nurse-Client Relationship
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Trustworthiness
Trustworthiness is behavior that is predictable, competent, and in the client’s best interest. Trust is the foundation of the nurse-client relationship.
Caring
Caring is the concern for the well-being of another. It includes commitment, compassion, competence, confidence, and conscience. Caring is the basis for nursing itself.
Empathy
Empathy is the ability to understand a situation from the client’s point of view and to communicate this understanding to the client. Empathy is necessary for the client to feel understood.
Genuineness
Genuineness is honesty, sincerity, openness, and congruence in verbal and nonverbal messages.
Respect
The nurse gives respect (unconditional positive regard without judgment, regardless of the client’s situation or past behavior). This does not imply that the nurse condones inappropriate behavior, but assumes that the nurse will accept the client as a person, exactly as she/he is.
Concreteness
Concreteness is the use of realistic language, rather than jargon or medical terminology. The client is assisted to do realistic problem solving and to develop insight.
True
Communication Process
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Communication involves sending and receiving a message. This seemingly simple process is really very complex. The sender of the message may express spoken or written words, body gestures or movements, music, art, or touch.
The way the receiver accepts the message depends on the receiver’s culture, language, gender, sensory function, cognitive abilities, experiences, and expectations.
The sending and receiving of messages are affected by the environment and by the circumstances in which the message is sent .
True
Feedbctck is the response of the receiver to the message. The receiver’s feedback alerts the sender to how the receiver perceived the message. Feedback may be verbal or nonverbal. Assessing the client’s feedback is important for the nurse, because it allows the nurse to clarify misunderstandings or unclear messages as soon as possible.
A)true
B)false
A
TYPES OF COMMUNICATION
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Written communication includes handwriting, typing, pictures, and inanimate messages, without interpersonal contact. The Internet has shown us how much can be communicated in this way.
A)true
B)false
A
Verbal communication includes spoken messages. lt includes both what we say and how we say it. Cultural Pulse Points provides an explanation of how factors such as rare and loudness of speech can affect its meaning. Think about the limitation of messages transmitted by radio or what can be sent and received by telephone.
A)true
B)false
A
Nonverbal communication refers to all of the messages that are sent without words and makes up the majority of the communication process. Yes, most communication is nonverbal. Nonverbal communication includes body movements, actions, posture, and gestures; body position and closeness; and facial expressions, and touch
A)true
B)false
A
Touch is an important aspect of nonverbal communication. Touch is frequently used by nurses to convey reassurance, support, and caring. Like other forms of communication, the meaning of touch lies not only in the sender’s intentions but also in the receiver’s perception. For this reason nurses must use touch carefully.
A)true
B)false
A
Touch can be professional/functional (client care), social/polite (a handshake), friendship/warmth (hugs between friends or a pat on the back), loving/intimate (kissing or hugging relatives or close friends), or sexual/ arousing (between lovers). Considering all the potential errors in communication, it is possible that the sender could intend one meaning of touch and the receiver could perceive a different meaning
A)true
B)false
A
When it comes to touching people, the perception of the receiver is more important than the sender’s intent.
A)true
B)false
A
PERSONAL SPACE
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The amount of space that people need in order to feel comfortable is determined by their culture and their personality.
A)true
B)false
A
In the United Stares and Canada, which are generally low-touch cultures, there are generally four zones of personal space that represent the comfortable distance between people communicating with each other:
- Public space (more than 10-12’): A comfortable distance between strangers, for example, between a teacher and a class.
- Social space (4-12’): Comfortable distance for work, social, and business settings, for example, at a restaurant.
- Personal space (18”-4’): Acceptable distance for people who have some connection with each other, such as students in a class.
- Intimate space (less than 18”): Comfortable only for people with a close relationship, such as family and friends
True
Nurses are often expected to enter the intimate zones of clients, who are likely to feel anxious and threatened by the intrusion. The nurse should warn the client: “Im going to take your blood pressure now,” or “I need to lift up your gown to change your dressing.” Be careful not to give the client choices if there is no real choice. If you must take the client temperature, do not say “Is it OK for me to take your temperature now?” To give the client a sense of control, the nurse may offer a real choice: “Would you like to have your dressing changed now or after breakfast?”
A)true
B)false
A
Personal space attitudes are based on cultural expectations. When the nurse and the client are from different cultures with different standards for touching, misunderstandings can occur. The nurse must be sensitive to the client’s feedback (which will often be nonverbal) about touching and personal space.
A)true
B)false
A
SELF-DISCLOSURE
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Self-disclosure is any verbalization or behavior that reveals personal information about the self to another person. Some self-disclosure by the nurse can help clients to disclose their own feelings; however, the nurse muse use self-disclosure carefully
A)true
B)false
A
Ultimately, the nurse’s motivation for disclosing personal feelings muse be for the client’s benefit, not for the benefic of the nurse
A)true
B)false
A
Effective Communication Strategies
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ACTIVE LISTENING
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One of the most important is active listening, which is careful attending to the sender’s whole message, both the verbal and the nonverbal. The active listener also uses attending behaviors, which communicare the listener’s attention and interest:
- Facing the other person (with body and face)
- Open posture (arms loose, nor folded in from of chest)
- Leaning forward
- Giving verbal and nonverbal feedback to indicate interest and encouragement for the sender to continue
True
CONGRUENCE
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Congruence exists when the verbal and nonverbal messages are the same. Consider these two scenarios:
The first nurse says to the client, “I would like ro talk with you about how you are recovering from your hip surgery.” While she says this, the nurse is picking up extra linens in the room, standing with her back to the client. When the client says nothing, she quickly walks out of the room.
The second nurse sits in the client’s bedside chair and says, “I would like to talk with you about how you are recovering from your hip surgery.” This nurse looks at the client, leans forward, and waits quietly for a response. In the first scenario, the verbal and nonverbal messages are incongruent. What does this nurse really mean? Congruence really makes a difference.
A)true
B)false
A
CONCRETE MESSAGES
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Anxiety can impair cognitive functioning (the ability to learn, remember, and process new information)
A)true
B)false
A
A concrete message is clear, realistic, and does not require interpretation. Many clients have special needs for concrete communication, such as people who have limited English language skills, cognitive impairment, anxiety, or severe mental illness. If the nurse says: “We’ll deal with your Montgomery strap situation later,” who knows what he meant? If he said: ‘Til come back after lunch and change the dressing on your side. I’ll also replace chose ties that hold it on,” the message would be a lot clearer.
A)true
B)false
A
EMPATHY
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Empathy is the ability to enter into the life of others, perceive their feelings, and communicate their understanding. It requires the nurse to put aside personal values and judgments, become aware of the client’s feelings, and confirm with the client the accuracy of the nurse’s perceptions. The experience of empathy may give clients the feeling that they are not alone in the world, that they are understood by someone, and that their worrh is increased because of this.
A)true
B)false
A
Empathy is not the same as sympathy, which is feeling sorry for someone. The nurse is not expected to, and in fact should not, feel the same feelings as the client. The empathic nurse understands and appreciates the client’s feelings, while maintaining the role of the professional nurse.
A)true
B)false
A
Nursing Self-Disclosure
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Fostering the therapeutic relationship
Client:”Do you have time to talk to me?” Nurse: “Sure. I have 15 minutes, and I always enjoy talking with you.”
True
Assisting the client to express feelings
Nurse:”How do you feel when your husband says embarrassing things about you in public?”
Client:”Not so good, I guess.”
Nurse:”l think many people would feel angry in a situation like that.”
Client:”Yes, I do feel angry! I feel so humiliated and powerless, too.”
True
Modeling behavior change
Client:”When a clerk gives me the wrong change, I think she might get mad if I tell her about it, so I don’t.”
Nurse:”l might say nicely, ‘I gave you a fivedollar bill, and you gave me change for a one. Would you please give me the rest of my change?
True
Helping the client to see his or her own feelings as normal or rational
Client: “My cat died, and I don’t know if I can go on.lt seems stupid.”
Nurse: “I felt very bad when my dog died. Pets are very important to people. I felt better over time, though.”
True
Encouraging the client’s autonomy
Client: “I don’t know if I’m ready to be responsible for my own meds.”
Nurse:”You’ve told me how they work, and you’ve made a schedule for taking them. I think you’re ready.”
True
Barriers to Communication
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GIVING ADVICE
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The client is the decision maker, based on the ethical principle of autonomy
A)true
B)false
A
The client will be the one to experience the consequences of any healthcare decision, therefore the client should be given information by the staff, and then allowed to make the final decision. The role of the nurse is to support clients’ self-care, not to take away their control by making decisions for them.
A)true
B)false
A
AGREEING
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Generally, it seems like a good idea to agree with people. However, in the therapeutic nurse-client relationship, the nurse’s responsibility is not to decide whether the client is right or wrong. By agreeing with the client, the nurse suggests that the client should seek the nurse’s approval. The client is trying to make the best decisions for rhe client’s well-being, not for the nurse’s approval.
A)true
B)false
A
GENERALIZED STATEMENTS OR CLICHES
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Some examples of these generalized sraremenrs are: “‘That’s nice, dear,” “Don’t worry; everything will be all righr,” “God will nor give you more than you can handle,” and “Cheer up.” Such generalized statements are used in any variety of situations. They are like the shredded paper in a box of new shoes: they just take up space. Avoid them-they are meaningless and encourage the receiver to feel that the nurse did not care enough to say something real.
A)true
B)false
A
DEFENSIVENESS
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If the client has a problem and the nurse responds with excuses, communication becomes a contest. This is not good communication. Even if the client’s problem is with the nurse, free expression of feelings is what opens communication. Allow the client to express both positive and negative feelings. This is what respect and acceptance are about.
A)true
B)false
A
CHANGING THE SUBJECT
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If the client changes the subject, the nurse says: “Let’s get back to what we were talking about,” because we know that clients often do not want to talk about challenging or threatening issues.
A)true
B)false
A
Examples of threatening or difficult issues are the client’s behavior, embarrassing bodily functions, and serious disease processes. Sometimes these issues must be addressed. We should not turn away when the subject becomes stressful for us either.
A)true
B)false
A
Changing the subject when the client presents a legitimate concern communicates that the nurse is not willing to talk about the client’s problem. The topic often is stressful when significant or threatening issues are being discussed. To meet the client’s need, nurses muse keep their objectivity and continue the conversation.
A)true
B)false
A
DISRESPECTING
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Nurses usually do not intentionally disrespect a client, but when the nurse belittles a client’s concerns, it is disrespectful. Even if the issue seems small to the nurse, the nurse should respect that it is a significant concern to the client and treat it as important.
A)true
B)false
A
The European American culture may have the least formal social behavior in the world. You might expect the staff to call you by your first name if you were a client in a healthcare setting. Many people would find this disrespectful. Especially if clients are older than you or are from other countries, address them by their tide, such as Mr. X or Ms. Y, and ler them cell you if they prefer to be addressed by their first names.
A)true
B)false
A
TRANSFERENCE
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In transference the client feels emotions from the past and applies (or transfers) them to the therapeutic relationship. A client may have feared for years that he would develop diabetes because a family member suffered from diabetes complications. He may transfer his considerable fear and anger onto the nurse who tries to help him learn to test his blood glucose.
A)true
B)false
A
Transference can cause the client to have strong positive or negative feelings for the nurse or to overvalue or ignore the nurse’s expertise.
A)true
B)false
A
It is also important for the nurse not to take a client’s transference reactions personally. If a client is exaggerating about how much trouble the nurse is, the nurse is probably not the real problem.
A)true
B)false
A
When it is the nurse who has feelings toward the client based on the nurse’s previous experiences, the process is called countertransference. Some nurses experience countertransference when they care for specific kinds of clients.
A)true
B)false
A
The best preventive strategy for countertransference is for nurses to develop self-understanding (insight)
A)true
B)false
A
Recognizing Countertransference
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The following feelings by the nurse may suggest countertransference (transferring feelings from previous experiences onto the client):
- The client reminds you of yourself or someone else you know.
- You think about the client frequently outside the work setting.
- You feel uneasy about the relationship with this client.
- You feel angry about the client’s behavior.
- You feel proud of the client.
- You believe that you are the only one who really understands this client.
- You have personal feelings toward the client.
True
NURSING CARE
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DIAGNOSING, PLANNING, AND IMPLEMENTING
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The following nursing diagnoses often respond well to psychosocial nursing inrervenrions:
- Deficient Knowledge
- Social isolation or Loneliness or Impaired Social Interaction
- Ineffective Coping
- Powerlessness or Hopelessness
- Anxiety
- Situational Low Self-Esreem or Chronic Low SelfEsteem
- Ineffective Role Performance
True
Therapeutic Communication
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therapeutic communication can be used as a nursing intervention, and is shown when the nurse uses communication techniques to help the client achieve desired outcomes. Desired outcomes that may be achieved through therapeutic communication are that the client will:
- Develop insight into self.
- Engage in problem solving.
- Build self-esteem.
- Plan adaptive coping skills.
- Express and examine feelings.
True
Therapeutic Communication Techniques
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Broad Opening
A general statement that allows the client to select the topic of discussion.
Examples;
How has life been treating you?
“How are you dealing with being in the hospital?
True
Clarifying
The nurse may restate the client’s message in the nurse’s own words, or ask about the client’s message for the purpose of ensuring that sender and receiver understand the same message.
Examples;
What do you mean by that?”
“Did you say that you are uncomfortable?”
“I think you said that you are afraid of alligators, is that right?”
True
Encouraging Evaluation
The nurse encourages clients to evaluate their feelings and experiences for the purpose of insight development.
Examples;
How were you feeling when your mother called the police?”
“What happened after you quit taking your meds?”
“What did you learn from your experience with … ?”
True
Sharing Observations
The nurse expresses client behavior in words to call attention to implied meanings or to bring awareness of incongruence between client words and actions.
Examples;
“When you cover your head with the sheets, it looks like you don’t want to talk.”
“You say you feel fine, but you are crying.
True
Validation
The nurse recognizes and acknowledges the client’s feelings verbally to show that the nurse understands that the client is experiencing a challenge or accepts the client’s feelings. Shows empathy
Examples;
This must be very hard for you.”
“Being in the hospital away from your family can be lonely.”
True
Process Recordings
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A process recording is a written record of a conversation between a nursing student and a client. The verbal communication is written from the student’s memory. Using tape recorders or taking notes tends to make people nervous, so they should be avoided. Both verbal and nonverbal cues are noted.
A)true
B)false
A
Promoting Healthy Professional Boundaries
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It is very rewarding for people to have a caring, non judgmental listener. Sometimes, though, clients misinterpret the nurse’s attention and caring as social interest. The nurse may need to clarify that she/he is doing a job and not trying to start a friendship. There are a few measures nurses can take to promote clear boundaries and do make it clear that the nurse’s role is professional.
A)true
B)false
A
There are four areas that create problems with personal boundaries: • Touch • Self disclosure • Gifts • Contact with clients outside work
True
Be especially careful about using touch in the psychiatric setting. Psychiatric clients may have a distorted reality or a history of abuse that gives touch other meanings. Be careful with self-disclosure.
A)true
B)false
A
Do not accept gifts from clients. Some clients believe that the nurse expects a gift in return for care, or that care will be improved if a gift is given. Others may hope to continue their relationship with the nurse after their discharge. Use common sense in this area also. If a clients family member brings a box of candy for the entire staff, this would be acceptable. If an individual gives the nurse a gift of jewelry or money, it is not appropriate for the nurse to accept it.
A)true
B)false
A
Clients may ask for your telephone number or your address. Maybe they just want to call with some medical questions, or to send a card to express their thanks. Do not give this information about yourself or other nurses to clients or families. It is not appropriate for the nurse to maintain contact with clients outside the work setting
A)true
B)false
A
KEYTERMS
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validation- Verbal recognition and acknowledgment of the client feelings
A)true
B)false
A
KEY Points
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- Professional and social relationships are different. A professional relationship focuses on client needs, is goal directed, and is time limited.
- The phases of the nurse-client relationship are orientation, working, and termination.
- The essential elements of the nurse-client relationship are trustworthiness, caring, empathy, genuineness, respect, and concreteness.
- When clients base their responses to the nurse on their previous experiences, it is called transference.
- It is called countertransference when the nurse reacts to a client because of the nurse’s previous experiences, not because of this client.
- Nurses need to recognize what factors make communication effective and what factors are barriers to communication.
- Therapeutic communication is a nursing intervention used to reach client goals such as exploration of feelings, insight development, problem solving, and planning for adaptive coping.
True
- Issues that can affect the personal boundaries of professional nurses are touching clients, self-disclosure, accepting gifts, and continuing relationships with clients outside work.
- Self-disclosure by the nurse is only appropriate when it is for the purpose of helping the client.
True
NCLEX PREP
,
Which of the following statements about a therapeutic interaction is false?
- A therapeutic interaction facilitates growth, developmental maturity, improved functioning, and improved coping.
- A therapeutic interaction requires that there be a sender, message, and receiver.
- It is unnecessary to validate the receiver’s perception of the message for a therapeutic interaction to occur.
- The receiver may have to restate the message to the sender to ensure understanding.
3
Which of the following comments by the nurse indicates that the nurse is being empathetic?
- “Oh, I feel so sorry for you!”
- “I can’t understand how you can handle so much pain and still be cheerful.”
- “How can you tolerate your roommate?”
- “I know how it feels to lose someone you love. Would you like to talk about it?”
4
Which of the following statements about active listening is false?
- It is difficult to listen actively when you do not value what the other person is saying.
- Active listening requires practice.
- It is possible to listen actively and still plan what you will say in response.
- You can let the “sender” know you are listening by nodding your head and maintaining eye contact.
3
To communicate a willingness to discuss a topic with a client who is in bed, the best body position for the nurse is:
- Sitting in a chair pulled up close to the client’s bedside, so the nurse is at eye level.
- Standing at the foot of the bed.
- Standing at the bedside but leaning on the table over the bed.
- Sitting in a chair about 4 feet away from the client with the nurse’s arms folded.
1
Which of the following is a true statement about nonverbal communication?
- Nonverbal communication is interpreted the same by all observers.
- A client who avoids eye contact with you has something to hide.
- Touch is not always associated with comforting and caring by all clients.
- The hands are the most expressive part of the body.
3
A female client is crying quietly in her room. When the nurse asks what is wrong, she does not answer. The best response by the nurse in this situation would be:
- “I can see you’re in no mood for company now. I’ll come back later.”
- “I can see you’re upset about something. I would really like to help you, but I can’t do anything for you if you won’t talk to me. When you’re ready, put on your call light, and I’ll come back.”
- “I see you’re sad. You know every cloud has a silver lining, so I’m sure things will get better for you too.”
- “I see that you’re sad. I’ll sit right here by your bed just to be with you. If you feel like talking, that’s okay; if not, that’s okay too. I just want you to know I care.
4
Which of the following is an open-ended question?
- “How do you feel about being in traction for a month?”
- “Is the traction comfortable?”
- “Will you lose your job while you’re in traction for a month?”
- “Can you brush your teeth while you’re in traction?”
1
If a client says to the nurse, “I feel like I’m going to die,” and the nurse wants to use the reflecting technique to respond, she/he might say:
- “You’re not feeling well today?”
- “Tell me about that feeling.”
- “You feel like you’re going to die.”
- “I can see you’re depressed today.”
3
A client is having difficulty deciding what to do after leaving the hospital and asks the opinion of the nurse. The nurse’s best response would be:
- “I know exactly what you should do. Have your doctor order home health for you and get your daughter to move in with you for a little while.”
- “What do you see as your options when you go home? Let’s talk about those.”
- “I don’t have a clue what you should do.”
- “Oh, I don’t get involved with discharge stuff. My job stops here at the hospital.”
2
A client says to the nurse, “I have nobody any more. I wish I could just die.”Which response by the nurse would block further communication?
- “Oh, don’t think about that. it’s just too depressing.”
- “You would like to die?”
- “Tell me more about those feelings.”
- “You have no one?”
1
Touch is not always associated with comforting and caring by someone who has been abused or by a mentally ill person with a psychosis. Use touch with care
A)true
B)false
A
Some cultures consider touch to be intrusive and direct eye contact to be rude
A)true
B)false
A
The reflection technique uses the clients own words to open up the communication
A)true
B)false
A
This choice will block further discussion, as the nurse has essentially told the client he does not want to discuss the clients feelings and that the client was wrong to even think about it
A)true
B)false
A
When a nurse engages in a professional therapeutic relationship with a client, s/he will do which of the following things
A)Base interactions on meeting a preset goal(s)
B)false
A
In which of the following situations would it most clearly be professional and therapeutic for the nurse to make an appointment with a client and talk socially?
A)A client on the unit has poor social skills and few social contacts.
B)false
A
Which of the following things will the nurse definitely do in the orientation phase of the nurse-client relationship described by Hildegard Peplau?
A)Review any past medical problems
B)Set the time limit of the relationship
B
The most important factor that the nurse considers when dressing for work with clients is which of the following factors?
A)What will it likely communicate to the client?
B)false
A
Nurses enter the intimate space of clients frequently as part of their job. What must the nurse do when entering this space to do a procedure such as assessing a rectal abscess?
A)Warn the client: “I am going to look at your rectal area now.”
B)false
A
Which of the following actions best describe the nurse who is using attending behaviors as a communication strategy?
A)Facing the client with open posture and leaning forward
B)false
A
In the health care setting, the nurse needs to communicate with many people including people under stress, people who are anxious, and people who have limited English. Which of the following strategies would be most necessary for the nurse to use in communicating in these situations?
A)Always repeat what is said.
B)Use concrete language
B
Clients who are under stress, who are anxious or who speak English as a second language need to hear messages in concrete form. A concrete message is clear, realistic, and does not require interpretation
A)true
B)false
A
The client is talking with the nurse and says: “My mother was not very nice to me. When is supper?” Which one of the following responses would be most therapeutic on part of the nurse?
A)”Yes, let’s talk about supper. It sounds like you might be hungry tonight.”
B)”Supper is at 6 pm. Let’s go back to what you were saying about your mother.”
B
Changing the subject is often a ploy of clients who have challenging or threatening issues they do not want to talk about. In this case, it is important for the nurse to refocus the conversation on that issue. The nurse answered the question and then directed the client back to his/her original statement. The nurse should not avoid the issue. The client should be allowed to direct the path s/he originally started down without the nurse interjecting another track.
A)true
B)false
A
Before working with assigned psychiatric clients, a student nurse is told how to do a process recording by the instructor. The student understands when he/she writes the process recording he/she is to do which of the following things?
A)Write log or journal type entries about experiences
B)Write from memory a conversation with the client
B
A process recording is a written record of a conversation between a nursing student and a client. The verbal communication is written from the student’s memory. Using tape recorders or taking notes tends to make people nervous
A)true
B)false
A
A client is having difficulty deciding on having chemotherapy for a second time after his cancer returned. He says to the nurse, “I was miserable the first time. If I’m going to die, I would like some quality of life until I do. What do you think I should do?” Which of the following would be the most appropriate response by the nurse?
A)”This is a difficult decision for you, but it has to be your decision. Is there any information the staff can provide you to help you clarify your thoughts on this”
B)false
A
THE NURSE CLIENT-RELATIONSHIP AND COMMUNICATION
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