Question 1

The patient says, &#34;My marriage is just great. My spouse and I always agree.&#34; The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is&#10;A) clear.&#10;B) distorted.&#10;C) incongruous.&#10;D) inadequate.

Accepted Answer

The patient's verbal and nonverbal communication in this scenario are incongruous. Incongruous messages involve transmission of conflicting messages by the speaker. The patient's verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

Question 2

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?&#10;A) &#34;What are the common elements here?&#34;&#10;B) &#34;Tell me again about your experiences.&#34;&#10;C) &#34;Am I correct in understanding that.&#34;&#10;D) &#34;Tell me everything from the beginning.&#34;

Accepted Answer

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.

Question 3

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. Which analysis is most accurate?

A) The patient is accustomed to touch during conversation, 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 patient is trying to manipulate the nurse using nonverbal techniques.

Accepted Answer

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.

Question 4

A school age child tells the school nurse, &#34;Other kids call me mean names and will not sit with me at lunch. Nobody likes me.&#34; Select the nurse's most therapeutic response.&#10;A) &#34;Just ignore them and they will leave you alone.&#34;&#10;B) &#34;You should make friends with other children.&#34;&#10;C) &#34;Call them names if they do that to you.&#34;&#10;D) &#34;Tell me more about how you feel.&#34;

Accepted Answer

The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.

Question 5

A black patient says to a white nurse, &#34;There's no sense talking about how I feel. You wouldn't understand because you live in a white world.&#34; The nurse's best action would be to&#10;A) explain, &#34;Yes, I do understand. Everyone goes through the same experiences.&#34;&#10;B) say, &#34;Please give an example of something you think I wouldn't understand.&#34;&#10;C) reassure the patient that nurses interact with people from all cultures.&#10;D) change the subject to one that is less emotionally disturbing.

Accepted Answer

Having the patient speak in specifics rather than globally will help the nurse understand the patient's perspective. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

Question 6

A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful what you say." Which response by the nurse is 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."

Accepted Answer

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.

Question 7

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) The patient is giving positive feedback about the nurse's communication techniques.
B) The nurse is viewing the patient's behavior through a cultural filter.
C) The patient's verbal and nonverbal messages are incongruent.
D) The patient is demonstrating psychotic behaviors.

Accepted Answer

When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. 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 because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

Question 8

A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but 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 were unaddressed.
D) The nurse should have assessed the patient's culture before making this diagnosis and plan.

Accepted Answer

The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

Question 9

While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest. 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

Accepted Answer

Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or an existing cultural barrier.

Question 10

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice&#10;A) is rarely helpful.&#10;B) fosters independence.&#10;C) lifts the burden of personal decision making.&#10;D) helps the patient develop feelings of personal adequacy.

Accepted Answer

Giving advice fosters dependence on the nurse and interferes with a patient's right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient's feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

Question 11

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?&#10;A) A nurse is responsible for breaking silences.&#10;B) Patients withdraw if silences are prolonged.&#10;C) Silence can provide meaningful moments for reflection.&#10;D) Silence helps patients know that what they said was understood.

Accepted Answer

The answer of Which principle should guide the nurse in...

Question 12

A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behavior? The patient&#10;A) has a histrionic personality disorder.&#10;B) believes dramatic body language is sexually appealing.&#10;C) wishes to impress staff with the degree of emotional pain.&#10;D) belongs to a culture in which dramatic body language is the norm.

Accepted Answer

The answer of A Puerto Rican American patient uses dramatic...

Question 13

A patient says to the nurse, &#34;I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well.&#34; Which response should the nurse use to clarify the patient's comment?&#10;A) &#34;It sounds as though you were uncomfortable with the content of your dream.&#34;&#10;B) &#34;I understand what you're saying. Bad dreams leave me feeling tired, too.&#34;&#10;C) &#34;So you feel as though you did not get enough quality sleep last night?&#34;&#10;D) &#34;Can you give me an example of what you mean by 'stoned'?&#34;

Accepted Answer

The answer of A patient says to the nurse, &#34;I...

Question 14

A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of &#34;offering self.&#34;&#10;A) &#34;I've also had traumatic life experiences. Maybe it would help if I told you about them.&#34;&#10;B) &#34;Why do you think you had so much difficulty adjusting to this change in your life?&#34;&#10;C) &#34;I hope you will feel better after getting accustomed to how this unit operates.&#34;&#10;D) &#34;I'd like to sit with you for a while to help you get comfortable talking to me.&#34;

Accepted Answer

The answer of A nurse interacts with a newly hospitalized...

Question 15

A patient with acute depression states, &#34;God is punishing me for my past sins.&#34; What is the nurse's most therapeutic response?&#10;A) &#34;You sound very upset about this.&#34;&#10;B) &#34;God always forgives us for our sins.&#34;&#10;C) &#34;Why do you think you are being punished?&#34;&#10;D) &#34;If you feel this way, you should talk to your minister.&#34;

Accepted Answer

The answer of A patient with acute depression states, &#34;God...

Question 16

Which technique will best communicate to a patient that the nurse is interested in listening?&#10;A) Restating a feeling or thought the patient has expressed.&#10;B) Asking a direct question, such as &#34;Did you feel angry?&#34;&#10;C) Making a judgment about the patient's problem.&#10;D) Saying, &#34;I understand what you're saying.&#34;

Accepted Answer

The answer of Which technique will best communicate to a...

Question 17

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:&#10;A) &#34;Why do you keep asking about me?&#34;&#10;B) &#34;Nurses direct the interviews with patients.&#34;&#10;C) &#34;Do not ask questions about my personal life.&#34;&#10;D) &#34;The time we spend together is to discuss your concerns.&#34;

Accepted Answer

The answer of During an interview, a patient attempts to...

Question 18

A patient tells the nurse, &#34;I don't think I'll ever get out of here.&#34; Select the nurse's most therapeutic response.&#10;A) &#34;Don't talk that way. Of course you will leave here!&#34;&#10;B) &#34;Keep up the good work, and you certainly will.&#34;&#10;C) &#34;You don't think you're making progress?&#34;&#10;D) &#34;Everyone feels that way sometimes.&#34;

Accepted Answer

The answer of A patient tells the nurse, &#34;I don't...

Question 19

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.&#10;A) It shows empathy and compassion. It will encourage the patient to continue to express feelings.&#10;B) The gesture is premature. The patient's cultural and individual interpretation of touch is unknown.&#10;C) The patient will perceive the gesture as intrusive and overstepping boundaries.&#10;D) The action is inappropriate. Psychiatric patients should not be touched.

Accepted Answer

The answer of During the first interview with a parent...

Question 20

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.&#10;A) &#34;I notice you keep looking toward the door.&#34;&#10;B) &#34;This is our time together. No one is going to interrupt us.&#34;&#10;C) &#34;It looks as if you are eager to end our discussion for today.&#34;&#10;D) &#34;If you are uncomfortable in this room, we can move someplace else.&#34;

Accepted Answer

The answer of During a one-on-one interaction with the nurse,...

Question 21

Which comments by a nurse demonstrate use of therapeutic communication techniques? (Select all that apply.)&#10;A) &#34;Why do you think these events have happened to you?&#34;&#10;B) &#34;There are people with problems much worse than yours.&#34;&#10;C) &#34;I'm glad you were able to tell me how you felt about your loss.&#34;&#10;D) &#34;I noticed your hands trembling when you told me about your accident.&#34;&#10;E) &#34;You look very nice today. I'm proud you took more time with your appearance.&#34;

Accepted Answer

The answer of Which comments by a nurse demonstrate use...

Question 22

A nurse interacts with patients diagnosed with various mental illnesses. Which statements reflect use of therapeutic communication? (Select all that apply.)&#10;A) &#34;Tell me more about that situation.&#34;&#10;B) &#34;Let's talk about something else.&#34;&#10;C) &#34;I notice you are pacing a lot.&#34;&#10;D) &#34;I'll stay with you a while.&#34;&#10;E) &#34;Why did you do that?&#34;

Accepted Answer

The answer of A nurse interacts with patients diagnosed with...

Question 23

A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication? (Select all that apply.)

A) "Why do you think you are so upset?"
B) "I can see that you feel sad about this situation."
C) "The loss of a close friend is very painful for you."
D) "Crying is a way of expressing the hurt you are experiencing."
E) "Let's talk about something else because this subject is upsetting you."

Accepted Answer

The answer of A patient cries as the nurse explores...

Question 24

Which benefits are most associated with use of telehealth technologies? (Select all that apply.)&#10;A) Cost savings for patients&#10;B) Maximize care management&#10;C) Access to services for patients in rural areas&#10;D) Prompt reimbursement by third-party payers&#10;E) Rapid development of trusting relationships with patients

Accepted Answer

The answer of Which benefits are most associated with use...

Deck 9: Therapeutic Communication