Question 1

A patient expresses a sense of genuineness in the nurse providing care when sharing with family members that:

Accepted Answer

Genuineness is demonstrated by congruence between verbal and nonverbal behavior.Empathy is seeing things from the patient's viewpoint.Clearly stating expectations is a characteristic of clarity.Trustworthiness can be described as dependability.

Question 2

Which statement indicates that a novice nurse understands the purpose of therapeutic communication? "My goal for communication with any patient is to:

Accepted Answer

Therapeutic communication is intended to assist the patient to grow and change.The other options are characteristics of social communication.

Question 3

The nurse is considering the need for both effective means of communication and safety when caring for a patient with impulse control issues and poor social skills.Which nursing intervention is most appropriate to address these needs?

Accepted Answer

Space as a concept of boundaries and safety is important to understand because the nurse and the patient need to respect the distance that each needs.For successful communication to occur,both parties need to feel safe.Some patients have problems with their boundaries and invade other patients' own safe zones; patients who perceive this as threatening react aggressively to such boundary violations.The nurse may need to help the patient understand the need for appropriate distances in order for everyone to feel safe and to communicate effectively.Reminding the patient of what the boundaries are without first discussing the importance of space boundaries is not an effective technique.Having the patient set the boundaries does not take into consideration the needs of others,whereas staff setting the boundaries without patient involvement ignores the needs of the patient and prevents the patient from understanding of the situation.

Question 4

Which nursing response would indicate an empathetic approach to a patient who is depressed over recent losses in her life?

Accepted Answer

Empathy or empathic understanding is the nurse's ability to see things from the patient's viewpoint and to communicate this understanding to the patient.This response focuses on the patient's feelings and encourages further discussion.Minimizing the loss or suggesting a change in focus sounds judgmental or patronizing and will likely cut off communication.Although self-disclosure can be therapeutic,this focuses on the nurse's feelings.

Question 5

A patient indicates that he is about to share information about his illness that is shocking and embarrassing.Which nursing intervention has priority in this situation in facilitating the communication process?

Accepted Answer

Responding to the patient's information in a nonjudgmental,accepting manner will encourage continued therapeutic communication.The remaining options,although appropriate,will not have the same generalized affect on the communication process as the correct option.

Question 6

During the termination phase of the nurse-patient relationship with a dependent patient,the nurse evaluates the effectiveness of coping techniques learned by:

Accepted Answer

Evaluation is a task of the termination phase.Asking such a question encourages patients to evaluate actions and look at the outcomes of behaviors.Role playing to practice the technique,defining the relevant terms,and discussing the effects of the father's behavior would occur during the working phase of the relationship and does not encourage evaluation of the newly learned skills.

Question 7

A nurse is considering the therapeutic value of touch when planning care for an anxious patient.What is the initial question the nurse should answer before initiating this technique?

Accepted Answer

Touch will only communicate warmth and thus be therapeutic if the nurse is comfortable with it.Although the other options are all appropriate,they do not have priority in this situation.

Question 8

The nature of the communication characterized in this exchange between a nurse and a chronically depressed patient is:
Nurse: Is it true that you enjoy knitting?
Patient: Yes,I've done it for years and am pretty good at it.
Nurse: I'm just a beginner.Do you think you could give me some tips?
Patient: I guess so.What would you like to know?

Accepted Answer

Although the conversation takes place between the nurse and a patient,it is of a social nature.It is superficial and benefits both parties mutually by encouraging a relationship based on mutual interest.No expectation of help exists.Therapeutic communication promotes patient growth and is patient-focused.Collegial conversation occurs for the purpose of professional collaboration.Intrapersonal communication takes place within the individual.

Question 9

The nurse has developed a plan in which nursing interventions are used to reinforce the patient's healthy behaviors.Which statement by the nurse will positively reinforce the patient's efforts regarding the plan?

Accepted Answer

This answer offers a positive response to a patient who is trying out new behaviors.This nursing response will serve to encourage the patient's efforts.The remaining options do not provide positive reinforcement but rather are attempts to gather more information or clarify the patient's motivation to change.

Question 10

A nurse has for the past 4 weeks been working with a psychotic patient who has been mute and very withdrawn.The patient suddenly encroaches on the nurse's personal space by touching inappropriately.What is the most therapeutic response by the nurse to address this behavior?

Accepted Answer

The therapeutic response is to clearly communicate appropriate boundaries.There are times when patients misinterpret the nurse's nurturing as an invitation to an intimate relationship.In these instances,boundaries must be firmly,but neutrally,explained.The behavior should not be ignored since doing so may well result in the patient repeating the behavior with others,perhaps with disastrous results.Touch is often misinterpreted by psychotic patients and in this case has no therapeutic value.Nonverbal communication should always be congruent so as to avoid confusing the patient.

Question 11

A novice nurse asks,"What is so wrong about being sympathetic with a patient who has also lost a parent like I did?" The psychiatric nurse manager responds:

Accepted Answer

Empathy should not be confused with sympathy.Sympathy is overinvolvement and sharing your own feelings after hearing about another person's similar experience.It is not objective,and its primary purpose is to decrease one's own personal distress.Although substituting sympathy for empathy does lessen the ability to be therapeutic,that is not the best explanation for avoiding it.Offering to discuss the nurse's loss is a kind gesture but does not address the nurse's question.Providing materials on the subject would be an appropriate reinforcement but does not address the question well.

Question 12

The expected outcome of conducting a periodic self-evaluation of one's own responses to patients is for the nurse to continue:

Accepted Answer

Self-evaluation of responses to patients will reveal whether the nurse is responding with objectivity versus subjectivity,acceptance or rejection,calmly or with anger,and with sympathy or anxiety.The goal is not identify the nurse's need for therapy or to maintain distance for patient problems,but rather to remain objective about them.The purpose of a self-evaluation is to recognize the nurse's responses,not to maintain boundaries.

Question 13

The nurse mentions,"I like to use open-ended questions and statements because they result in fuller,more revealing responses by the patient,and they stimulate discussion." What statement would the nurse ask to best stimulate conversation with a patient about their family?

Accepted Answer

This broad opening will encourage discussion as well as allow the patient to decide what to include about his or her family.The remaining options can all be answered with a "yes or no" response and so do not stimulate communication.

Question 14

A patient whose history includes physically abusing his spouse and children has been admitted to the unit for alcohol and drug dependency.Which nurse will likely experience difficulty establishing a therapeutic relationship with this patient?

Accepted Answer

The therapeutic use of the self begins with knowing yourself.Knowing yourself is a complex and lifelong learning process.At the core of self-knowledge is the nurse's ability to correctly identify his or her own negative or unresolved issues including family backgrounds,dynamic cultural and social issues,values,biases,and prejudices.Having been a victim of physical abuse places this nurse in a situation that can be very harmful to the development of an affective nurse-patient relationship.The novice nurse may lack some of the knowledge and experience necessary to be effective but is not a likely to have intruding biases and prejudices.The experienced nurse is more likely to have worked on the ability to provide effective care in spite of such experience with this type of diagnosis whereas,the nurse having been treated for the diagnosis is most likely to show empathy and caring.

Question 15

When providing discharge teaching to a patient for whom English is a second language,what technique will the nurse use to assess the patient's understanding of the information being shared verbally?

Accepted Answer

Individuals from different cultures or even different generations often misunderstand and misinterpret an unfamiliar language.Being aware of and critically examining cues that result from nonverbal responses is an excellent technique to check their interpretations.Asking if they have questions is an ineffective technique in light of the language barrier.Repeating the information is no guarantee that the patient understands the information.Providing the information in written form reinforces the material but does not ensure understanding especially if the patient has deficiencies related to reading the language.

Question 16

When communicating with a psychotic,schizophrenic patient,the nurse avoids the use of slang phrases most importantly because:

Accepted Answer

Precise verbal communication is important because spoken words often mean different things to different people.Figures of speech,jokes,clichés,colloquialisms,and other terms or special phrases carry a variety of meanings especially to individuals with altered thought processes.A person with schizophrenia interprets concretely and literally whereas psychosis generally brings about loose associations.Although all the options are reasons to avoid the use of slang phrases,the primary reason in this case in to avoid confusing the patient.

Question 17

The nurse suspects that the patient's communication is being negatively influenced by personal attitude when he is heard stating:

Accepted Answer

Attitude determines how one person responds to another.It includes one's biases,past experiences,and openness.People of different socioeconomic backgrounds may have difficulty surmounting this barrier.The remaining options reflect factors that can negatively influence communication but they are environmental,knowledge,and relationship oriented.

Question 18

An example of an environmental factor that would cause a nurse to modify a planned critical interaction occurs when the:

Accepted Answer

Environmental factors include timing.Timing of critical interventions is important.It should occur when the individual can give full attention to the topic.It would be inappropriate to continue with the plan in the face of the patient's distress related to her mother's illness.The remaining options reflect other types of factors that influence communication such as attitudes,knowledge,and relationships.

Question 19

A patient is struggling to explore and solve a problem.The nurse determines that it would be therapeutic to offer alternatives.Which verbal introduction should the nurse incorporate in order to achieve this objective?

Accepted Answer

This encourages the patient to consider alternatives without giving advice.The other options are preludes to giving advice,which is not considered therapeutic.

Question 20

A nurse is contemplating the use of self-disclosure.The expected outcome of this strategy is that the patient will:

Accepted Answer

Self-disclosure should serve one or more of the following purposes: to model and educate; to build the therapeutic alliance; to provide concrete reflection that encourages reality testing.The nurse does not use self-disclosure foster a interdependent relationship that in any way gives support to the nurse.Empathy does not rely upon shared experiences.

Quiz 4: Therapeutic Communication: Interviews and Interventions