Question 1

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

Accepted Answer

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 2

A hospitalized client diagnosed with depression asks a nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection?

Accepted Answer

Reflection is used when a client wants a nurse's approval or judgment. The statement by the nurse that uses reflection is "should you go home for the weekend?" This allows the client the opportunity to discuss the matter further. The question, "Home means what to you?" seeks clarification. The statement, "It sounds as if you don't want to go home this weekend," reflects the technique of interpretation. The statement, "I doubt that you really should go home," offers the nurse's opinion and is judgmental.

Question 3

A client who is hospitalized with a diagnosis of depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be most appropriate?

Accepted Answer

The nurse's best response is, "Have you ever thought about hurting yourself?" This response seeks to clarify the client's statement about hurting oneself and opens the door to allow a therapeutic discussion, since clients with depression may have suicidal thoughts. Telling the client to take the medication, agreeing with the client, or giving advice will block therapeutic communication.

Question 4

A psychiatric client is talking to the nurse about the reasons for being hospitalized. The client describes things about a personal relationship that are uncomfortable and asks the nurse, "Should I break up with my partner?" Which response by the nurse would be most effective in building rapport between the client and nurse?

Accepted Answer

Nurses establish rapport through interpersonal warmth, a nonjudgmental attitude, and a demonstration of understanding. The response about the relationship becoming uncomfortable reflects both a nonjudgmental attitude and understanding. Giving advice is judgmental and does not promote the establishment of rapport. Telling the client to focus on one's self ignores the client's concern. A skilled nurse will establish rapport that will alleviate the patient's anxiety in discussing personal problems.

Question 5

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

Accepted Answer

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 6

A nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with a mental disorder. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain?

Accepted Answer

Although information about allergies, hospitalizations, and family history are important in the orientation phase, it is most important for the nurse to ask a client with a mental disorder about the nature of the problem from the client's perspective. Some clients deny that a problem exists; other clients may have misperceptions about the problem.

Question 7

During the termination process, a client brings up resolved problems and presents them as new issues to work toward. The nurse interprets the client's action as indicating what?

Accepted Answer

It is not unusual for clients with mental disorders to bring up resolved problems and present them as new issues during the resolution phase. The client is most likely attempting to prolong the nurse-client relationship. The client may be experiencing anxiety about the relationship ending. Anger typically would be demonstrated toward the nurse or displaced onto others rather than through the use of bringing up resolved problems. The client's actions do not indicate that additional therapy is needed nor that the therapy was ineffective.

Question 8

When engaged in a nontherapeutic relationship, what would a nurse identify as occurring first?

Accepted Answer

In a nontherapeutic relationship, the withholding phase occurs first, in which the nurse fails to recognize that the client is a person with an illness or health needs. The client avoiding the nurse and the nurse being perceived as rude are characteristics of the avoiding and ignoring phase. Feelings of client hopelessness and frustration characterize the end phase of "struggling with and making sense of."

Question 9

When providing care to a client diagnosed with a mental disorder, the client asks the nurse, "Does mental illness run in your family?" Which response by the nurse would be nontherapeutic?

Accepted Answer

The statement about the nurse's sister suffering from depression is inappropriate because it involves self-disclosure that serves no therapeutic purpose. In addition, it ignores the underlying concern of the client's statement: mental illnesses and family. The statements about having experience dealing with mental illnesses, sounding concerned about a family connection, and focusing the discussion on the client serve to redirect the interaction back to the client.

Question 10

A nursing instructor is describing the nurse-client relationship to a group of nursing students. Which would the instructor emphasize as crucial for establishing and maintaining the relationship?

Accepted Answer

Self-awareness is crucial in a nurse-client relationship. Without it, nurses will find it impossible to establish and maintain therapeutic relationships with clients. Although rapport and empathy are important considerations for a nurse-client relationship, self-awareness is key. Values are inherent in nurses, and a nurse must be self-aware of his or her own values.

Question 11

A group of students is reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which as the first component of the process?

Accepted Answer

With verbal communication, typically the person formulates an idea, encodes a message, and then transmits the message with emotion. The message is then received and decoded, and a response is made.

Question 12

A nurse responds to a client's statement with silence based on the rationale that this technique is used for what primary purpose?

Accepted Answer

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 13

When communicating with a client, which would a nurse use to convey positive body language?

Accepted Answer

Positive body language includes sitting at the same eye level as the client with a relaxed posture, leaning slightly forward, with the arms and legs uncrossed.

Question 14

During an interview, a client tells the nurse about a recent job loss. As the interaction continues, the client states, "I was really overqualified for that position anyway. It was definitely below my area of expertise." The nurse interprets this information as a reflection of what?

Accepted Answer

The client is attempting to use abstract thinking or make generalizations to control or minimize feelings associated with the loss of a job. Refusing to acknowledge the painful aspect-for example, "I really didn't want that job"-would reflect denial. With projection, an individual falsely attributes to another person one's own acceptable feelings, thoughts, or impulses. Passive aggression reflects a façade of overt compliance that masks covert resistance, resentment, or hostility.

Question 15

An instructor is educating a nursing student on defense mechanisms. The instructor determines that the education was successful when the student makes which statement?

Accepted Answer

Defense mechanisms (also known as coping styles) are defined in the Diagnostic and Statistical Manual of Mental Disorders-V as "mechanisms that mediate the [client's] reaction to emotional conflicts and to external stressors." Some defense mechanisms (e.g., projection, splitting, acting out) are almost invariably maladaptive. Others (e.g., suppression, denial) may be either maladaptive or adaptive, depending on their severity, their inflexibility, and the context in which they occur. While defense mechanisms might seem to indicate the existence of a problematic mental state, this is not true. Healthy individuals in many different contexts use defense mechanisms. As with some other mental illnesses, the use of defense mechanisms becomes maladaptive when their persistent use reduces the client's quality of life. The degree to which a particular defense mechanism is maladaptive varies.

Question 16

A group of nursing students is role playing situations to practice using therapeutic communication techniques. What would the students identify as verbal communication?

Accepted Answer

Verbal communication, which is principally achieved by spoken words, includes the underlying emotion, context, and connotation of what is actually said. Nonverbal communication includes gestures, expressions, and body language.

Question 17

A psychiatric-mental health nurse is preparing a review class on therapeutic and nontherapeutic techniques of communication. The nurse demonstrates understanding of the information by selecting which techniques to demonstrate as therapeutic? Select all that apply.

Accepted Answer

Therapeutic communication techniques include confrontation, open-ended statements, and reflection. Reassurance, agreement, and challenges are techniques that inhibit communication.

Question 18

A nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. What does this involve? Select all that apply.

Accepted Answer

During the working phase, the client discusses problems underlying the needs, uses the emotional safety of the relationship to examine personal issues, and tests new ways of solving problems. Identifying a need and testing the relationship typically occur during the orientation phase of the relationship.

Question 19

A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply.

Accepted Answer

Through active listening, the nurse focuses on what the client is saying to interpret and respond objectively to the message. While listening, the nurse concentrates only on what the client is saying and on the underlying meaning. The nurse usually responds indirectly, using techniques such as open-ended statements, reflection, and questions that elicit additional responses from the client. Changing the subject is avoided. Allowing the client to talk as the client wishes reflects passive listening, which does not foster a therapeutic relationship.

Quiz 10: Communication and the Therapeutic Relationship