Deck 10: Communication and the Clinical Interview

Question 1

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

A) Patients withdraw if silences are prolonged.
B) The nurse is responsible for breaking silences.
C) Silence provides meaningful moments for reflection.
D) Silence helps patients know that they are understood.

Answer 1

Silence provides meaningful moments for reflection.

Question 2

A patient discloses several concerns and associated feelings.If the nurse wishes 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…"
D) "Tell me everything from the beginning."

Answer 2

"Am I correct in understanding that…"

Question 3

During the first interview with a parent whose child died in a car accident,the nurse feels sorry for the patient and reaches out to take the parent's hand.Select the correct analysis of the nurse's behavior.

A) The parent will perceive the gesture as intrusive and overstepping boundaries.
B) It shows empathy and compassion.It will encourage the parent to continue to express feelings.
C) The action is inappropriate."No touch" rules are important in all psychiatric interactions.
D) The gesture is premature.The patient's cultural and individual interpretation of touch is unknown.

Answer 3

The gesture is premature.The patient's cultural and individual interpretation of touch is unknown.

Question 4

An Asian American patient rarely showed eye contact.This nursing diagnosis was formulated: Situational low self-esteem related to poor social skills as evidenced by lack of eye contact.Interventions to raise the patient's self-esteem were not successful;the patient's eye contact did not improve.Select the best analysis of this scenario.

A) The patient's poor eye contact is indicative of anger and hostility that have not been addressed.
B) The nurse should not have independently assessed,diagnosed,and planned for this patient.
C) The patient's eye contact should have been addressed by role-playing to increase comfort.
D) The nurse should have assessed the patient's culture before making this diagnosis and plan.

Question 5

A nurse documents: "Patient mute despite repeated efforts to elicit speech.No eye contact.Short attention span;less than 1 minute." Which nursing diagnosis should be considered?

A) Defensive coping
B) Risk for violence
C) Decisional conflict
D) Impaired verbal communication

Question 6

A nurse working with a depressed patient used humor to lift the patient's spirits.At one point,the patient smiled.Select the best analysis.

A) Humor should be added to interventions in the plan of care.
B) The nurse helped the patient.The technique was successful.
C) The nurse needs supervision.The communication technique is not appropriate.
D) The nurse identified an approach that may prove useful in other,similar situations.

Question 7

A nurse interacts with a newly hospitalized patient.Select the example 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."

Question 8

Which statement by a nurse may underrate a patient's feelings and belittle the patient's concerns?

A) "You appear tense."
B) "I'm not sure I follow you."
C) "Everything will be all right."
D) "I notice you are biting your lip."

Question 9

A patient tells the nurse,"I don't think I'll ever get out of here." Select the nurse's most therapeutic response.

A) "Everyone feels that way sometimes."
B) "Don't talk that way.Of course you will leave here!"
C) "Keep up the good work and you will be discharged."
D) "It sounds like you don't feel like you're making progress."

Question 10

An African American patient says to a white nurse,"You wouldn't understand me because you live in a white world." Select the nurse's best response.

A) "I understand.All people go through the same experiences."
B) Reassure the patient that nurses deal with people from all cultures.
C) Gently change the subject to one that is less emotionally charged.
D) "Please describe an example of something you think I would not understand."

Question 11

A patient with paranoid schizophrenia tells the nurse,"The FBI is listening through 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 FBI."
B) "It sounds like you're concerned about your privacy."
C) "The FBI is prohibited from operating in health care facilities."
D) "You have lost touch with reality,which is a symptom of your illness."

Question 12

A nurse can best communicate to a patient an interest in listening by:

A) restating the feeling or thought the patient has expressed.
B) asking a direct question,such as "Do you feel guilty?"
C) expressing an opinion about the patient's problem.
D) saying "I understand what you're saying."

Question 13

A patient is having difficulty making a decision.The nurse is conflicted about whether to provide advice.Which principle usually applies? Giving advice:

A) is rarely helpful.
B) fosters independence.
C) lifts the burden of personal decision making.
D) helps the patient develop feelings of personal adequacy.

Question 14

A nurse interviews a patient who is having difficulty with self-expression and staying focused.Select the nurse's most helpful comment.

A) "Go on."
B) "What would you like to discuss?"
C) "Tell me what is happening right now."
D) "It seems you are having trouble staying focused."

Question 15

A patient says,"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?"

Question 16

Which remark by the nurse would be an appropriate way to begin an interview session?

A) "How shall we start today?"
B) "Shall we talk about losing your privileges yesterday?"
C) "Let's get started discussing your marital relationship."
D) "What happened when your family visited yesterday?"

Question 17

Documentation in a patient's record shows: During 5-minute interaction,patient fidgeted,tapped foot,periodically covered face with hands,looked under chair.Stated,"I enjoy spending time with you." Which assessment is most accurate?

A) The patient gave 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 were incongruent.
D) Psychotic thought processes are likely.

Question 18

During an interview,a patient attempts to change the focus from self to the nurse by asking personal questions.Select the nurse's most therapeutic response.

A) "Are you trying to avoid answering these questions?"
B) "I am uncomfortable talking to patients about my personal life."
C) "I am sure we can solve your problems if you describe them to me."
D) "The time we spend together is for you to discuss your problems and concerns."

Question 19

A depressed patient is unable to maintain eye contact with the nurse.The patient's chin drops,and 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

Question 20

A patient says,"My marriage is great.My spouse and I usually agree on everything." The nurse observes the patient's foot moving continuously and fingers twirling a shirt button.What assessment can the nurse make? The patient's communication is:

A) clear.
B) mixed.
C) explicit.
D) inadequate.

Question 21

Which remark by the nurse gives a patient verbal tracking feedback?

A) "Describe your relationship with your children."
B) "Give me an example of not getting along with your children."
C) "Am I correct in stating you are feeling angry with your children?"
D) "You're saying you do not have a good relationship with your children?"

Question 22

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"You look very nice today.I'm proud you took more time with your appearance."

Question 23

The relationship between a nurse and patient as it relates to status and power is best described by which term?

A) Incongruent
B) Symmetrical
C) Paralinguistic
D) Complementary

Question 24

During a therapy session,a patient cries as the nurse explores the relationship of the patient and her now-deceased mother.The patient sobs,"I shouldn't be blubbering like this." A response by the nurse that will hinder communication is:

A) "The relationship with your mother is very painful for you."
B) "I can see that you feel sad about this situation."
C) "Why do you think you are so upset?"
D) "Crying is a way of expressing the hurt you're experiencing."

Question 25

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"There are people with problems much worse than yours."

Question 26

Sequence these descriptions of personal space from close to far away.

A) Social distance
B) Public distance
C) Intimate distance
D) Personal distance

Question 27

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"I'm glad you were able to tell me how you felt about your loss."

Question 28

Which technique communicates to a patient that a nurse is listening?

A) Saying,"You said you were unsure how to handle your feelings."
B) Commenting,"I understand what you're saying."
C) Stating,"Your behavior was inappropriate."
D) Asking,"Do you feel angry?"

Question 29

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"I'd like to hear more about your difficult relationships at work."

Question 30

A Puerto Rican American patient uses dramatic body language when describing recent life events.Select the most accurate explanation of the patient's behavior.

A) The nurse has misinterpreted the behavior.
B) The patient has a histrionic personality disorder.
C) Members of this culture use dramatic body language as the norm.
D) The patient believes dramatic body language is sexually appealing.

Question 31

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"I noticed your hands trembling when you told me about your accident."

Question 32

A patient cries as the nurse explores the patient's relationship with a deceased parent and says,"I shouldn't be crying like this.It happened a long time ago." Which response(s)by the nurse will 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 your parent is very painful for you."
D) "Crying is a way of expressing the hurt you're experiencing."
E) "Let's talk about something else,since this subject is upsetting you."

Question 33

For each statement by a nurse engaged in an interaction with a patient, mark A if the statement is therapeutic and B if it is not therapeutic
"Why do you think these events have happened to you?"