Chapter 08: Learning to Communicate Professionally Keltner : Psychiatric Nursing, 8th Edition Test Bank
MULTIPLE CHOICE
1. Which skill is most
... [Show More] important for a nurse preparing to work in the psychiatric setting?
a. Helpful transference
b. Sympathetic listening
c. Supportive confrontation
d. Therapeutic communication
ANS: D
Therapeutic communication provides the basis for effective use of each stage of the nursing process, as explained by the authors. The other options are skills basic to effective use of the nursing process.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
2. When observing and interpreting a patient’s nonverbal communication, which nursing consideration is important?
a. Knowing that patients are usually aware of their nonverbal cues
b. Accepting that verbal responses are more important than nonverbal cues
c. Recognizing that nonverbal cues have obvious meaning and are easily interpreted
d. Validating nonverbal cues to provide significant information
ANS: D
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Body language has meaning, but meaning cannot be globally ascribed. Validation with the individual is necessary to accurate interpretation. The other options are incorrect in the information they provide.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity
3. A patient diagnosed with schizophrenia, paranoid type, frequently gets up, and walks away during interactions with a nurse. How can the nurse best increase the patient’s comfort level and so encourage communication?
a. Arranging the chairs side by side, about 2 feet apart
b. Sitting at eye level across the table from the patient
c. Standing a few feet away from where the patient sits
d. Talking in the patient’s room with the door closed
ANS: B
Suspicious patients require increased personal space. Sitting across the table provides that space. Being at the same eye level fosters communication. Side-by-side placement of chairs might not give the suspicious patient the ability to watch the nurse closely enough for comfort. Being in a closed room might be threatening to the patient.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
4. During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best nursing response to this nonverbal cue.
a. “I notice you keep looking toward the door.”
b. “This is our time together. No one is going to interrupt us.”
c. “It looks as if you are eager to end our discussion for today.”
d. “If you are uncomfortable in this room, we can move someplace else.”
ANS: A
Making observations and encouraging the patient to describe perceptions are useful therapeutic communication techniques for this situation. The other responses are assumptions made by the nurse.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
5. Effective use of the nursing process is dependent on communication that demonstrates what?
a. Structure and goal-direction
b. Meeting the needs of both patient and nurse
c. Being spontaneous and affording mutual self-disclosure
d. Fostering emotional distance between patient and nurse
ANS: A
Therapeutic communication occurs with the purpose of helping patients. It is patient-centered, structured, and goal-directed. It is not expected to meet the needs of the nurse or to include mutual self-disclosure. These are characteristics of social communication. The nurse maintains objectivity, rather than emotional distance.
DIF: Cognitive level: UnderstNandRing I GTOBP:.CNursMing process: Implementation MSC: Client Needs: Psychosocial Integrity
6. A patient is withdrawn, suspicious, and maintains physical distance from staff and other patients. Which intervention demonstrates appropriate use of touch with this patient?
a. Refraining from touch without first obtaining permission
b. Patting the patient’s arm when fear is expressed
c. Reaching out to shake the patient’s hand as an initial greeting
d. Placing an arm around the patient’s shoulders while walking down the hall
ANS: A
Withdrawn, suspicious patients often consider touch a violation of personal space or might misinterpret touch as being sexual or aggressive. Refraining from touching a suspicious patient is wise until there is evidence that the patient can tolerate touch. The more intimate or extensive the touching, the more threatening it might be to the patient.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
7. When assessing a patient’s social skills, which remark would serve best in seeking clarification?
a. “It sounds as if you need to develop some assertiveness skills.”
b. “Describe an example of a time when you felt uncomfortable in a social situation.”
c. “It is not easy to be assertive. We can role-play some situations to give you practice.”
d. “What do you plan to do the next time you find yourself in an uncomfortable social situation?”
ANS: B
The nurse is seeking clarification, a therapeutic technique that is a useful assessment tool. Mention of assertiveness skill development indicates that the assessment has been made. Asking for the patient’s plan would occur during problem-solving rather than assessment.
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity
8. A patient’s plan of care includes this nursing diagnosis: Impaired verbal communication related to lack of assertiveness skills. To include the patient in prioritizing this problem, what statement should the nurse make to the patient?
a. “Who are the people with whom you are most passive?”
b. “How important is it for you to become more assertive?”
c. “Let’s look at how we can address this problem together.”
d. “Are you interested in attending the assertiveness class?”
ANS: B
The technique of encouraging evaluation is useful to the nurse who is attempting to interpret meaning and importance. It seeks the patient’s view of the situation and provides a basis for setting priorities. The other options are not concerned with priority.
DIF: Cognitive level: Analyzing TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity
9. A patient has difficulty expreNssinRg aIngerGappBr.opCriatMely. The nurse encourages the patient to set realistic goals by making what statement?
a. “You seem to have problems expressing anger in a nonaggressive way.”
b. “I thought you sounded angry when I told you it was time for group.”
c. “What do you think needs to change about how you express anger?”
d. “What bothers you about your actions when you get angry?”
ANS: C
Goal-setting is most directly related to the technique of asking patients to decide on the type of change needed. The distracters demonstrate making observations and exploring.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
10. A nurse wants to provide opportunities for a patient to try out new, more assertive behaviors. Which technique should the nurse use?
a. Clarifying
b. Role-playing
c. Giving feedback
d. Encouraging evaluation
ANS: B
Role-playing permits the patient to practice new behaviors in a safe setting and to develop comfort with the use of the new behaviors. The nurse plays a particular role and provides coaching and feedback. The other techniques given as options do not encourage the patient to practice new behaviors.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
11. The nurse tells a patient, “I noticed that you frowned when we discussed your relationship with your family.” Which communication technique is the nurse using?
a. Clarifying
b. Interpreting
c. Giving information
d. Making observations
ANS: D
Making observations is defined as commenting on what is seen or heard to encourage discussion. The nurse’s statement cannot be interpreted as using any of the other techniques listed.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
12. A nurse realizes that the comment just made to a patient was inconsiderate. What is the nurse’s most therapeutic statement in this situation?
a. “How do you feel about what I just said?”
b. “See, even nurses say stupid things sometimes.”
c. “Sorry about that. Let’s cNonUtiRnuSeIwNhGerTe Bw.e CleOft Moff.”
d. “That was an insensitive remark. I’m sorry if it hurt you.”
ANS: A
Acknowledging insensitivity and apologizing for it will usually repair damage. Patients usually evaluate the nurse on overall caring rather than on one single comment. None of the other options includes both acknowledgment and apology.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
13. What is a common mistake nurses make when developing therapeutic communication techniques?
a. Using too many different techniques during an interaction
b. Allowing patients to become too anxious before responding
c. Giving advice rather than encouraging patients to solve problems
d. Focusing on what patients say rather than on communication techniques
ANS: C
Giving advice is a common pitfall for nurses who are unsure of how to encourage patients to become involved in analyzing and problem-solving. The other options are incorrect, because most novice nurses tend to rely heavily on direct questions, avoid anxiety-producing topics, and focus on communication techniques.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation
MSC: Client Needs: Psychosocial Integrity
14. A patient says to the nurse, “My family was mean to me when they visited today. They have no right to treat me like that.” What is the nurse’s best initial response to the patient’s concerns?
a. “Why do you think they were mean?”
b. “Perhaps you overreacted to what they said.”
c. “How do you feel about your family treating you that way?”
d. “Describe what happened when your family visited you today.”
ANS: D
Before proceeding, the nurse needs to have a better understanding of what happened in the interaction between the patient and family. The correct option seeks that clarification, whereas none of the other options takes that approach.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
15. A patient scheduled to attend various group sessions reports, “I’m really mad about having to attend all those groups. No one else spends all day in a circle in a little room.” What is the nurse’s best response to the patient’s concerns?
a. “Why are you upset?”
b. “I can hear that you are upset. Let’s talk about it.”
c. “Just go along with the plan, even if you do not agree.”
d. “The groups are carefully planned by staff to benefit patients.”
ANS: B
This remark exemplifies therNapeRuticIlisteGninBg..ICt ackMnowledges the patient’s negative feelings and the nurse’s willingness to listen as the patient offers his concerns. It implies a willingness
to assist with problem-solving. “Why” questions are not therapeutic, because they often elicit rationalization. Justification is defensive and closes off communication.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
16. A patient states, “I’m tired of all these therapy sessions. It’s just too much for me.” Using supportive confrontation, how should the nurse reply?
a. “It will get better if you just keep trying.”
b. “You are doing fine. Don’t be so hard on yourself.”
c. “Tell me more about how the therapy sessions are too much.”
d. “I know you find this difficult, but I believe you can get through it.”
ANS: D
Supportive confrontation is a technique in which the nurse acknowledges the difficulty in changing, but pushes for action. The other options clarify or give reassurance.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
17. A patient at the crisis intervention clinic states, “When I got up this morning, I realized I could not go on any longer.” What is the nurse’s best response to facilitate analyzing the problem and making a nursing diagnosis?
a. “How long have you been feeling this way?”
b. “What is different about your feelings today?”
c. “We are here to help you. I’m glad you decided to come to the center.”
d. “You said you felt like you could not go on. Tell me more about that.”
ANS: B
Encouraging comparison is a useful technique when the nurse wishes to analyze the problem and draw conclusions to facilitate establishing a nursing diagnosis. None of the other options would be as effective in encouraging the patient to analyze feelings.
DIF: Cognitive level: Applying TOP: Nursing process: Assessment MSC: Client Needs: Psychosocial Integrity
18. A newly admitted patient asks the nurse, “Can you hear those people laughing at me? They are making fun of me.” What is the nurse’s best response?
a. “You are mistaken. No one is laughing at you.”
b. “I know the sound of laughter is real to you, but I don’t hear it.”
c. “Your mind is playing tricks on you, making you think you hear laughter.”
d. “When people are mentally ill, they often experience things that others cannot relate to.”
ANS: B
This reply acknowledges the patient’s perceptions and gently casts doubt on the reality of the patient’s conclusions through the use of an “I” statement. It is not argumentative or accusative as are the distracters.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: PsychosocNiaUl IRntSegIriNtyGTB.COM
19. Which statement, made by a new psychiatric nurse, best describes the therapeutic use of self?
a. “Most nurses have caring personalities that equip them to be helpful to patients.”
b. “It’s mostly about using good verbal and nonverbal communication, objectivity, genuineness, and empathy.”
c. “It means that you keep yourself at a distance so you are not affected by patients’ problems and emotions.”
d. “The most important aspect of practice is when and how much to touch, as well as when to listen and give advice.”
ANS: B
The correct answer lists several of the components of therapeutic use of self. The other options provide less information for the new nurse to use to continue to develop skills.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
20. During an interview with a depressed patient, the nurse sits with folded arms and fidgets when long silences occur. When the patient expresses hopelessness about getting better, the nurse replies, “You will feel better when your medication takes effect.” This interaction demonstrates what characteristic regarding therapeutic response by the nurse?
a. Therapeutic use of limit-setting
b. Minimally therapeutic but effective
c. Therapeutic use of self
d. Nontherapeutic and ineffective
ANS: D
The nurse is demonstrating a closed posture, suggesting lack of interest in the interaction. Fidgeting suggests boredom or lack of comfort during the interaction. The quoted response minimizes the patient’s problem and sounds short. Cumulatively, these indicate that the nurse’s behaviors are nontherapeutic and ineffective.
DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: Client Needs: Psychosocial Integrity
21. What is the best analysis of this described nurse-patient interaction?
Patient: I get discouraged when I realize I’ve been struggling with my problems for over a year.
Nurse: Yes you have, but many people take even longer to resolve their issues. You shouldn’t be so hard on yourself.
a. The nurse has responded ineffectively to the patient’s concerns.
b. The patient is expressing lack of willingness to collaborate with the nurse.
c. The patient is offering the opportunity for the nurse to revise the plan of care.
d. The nurse is using techniques that are consistent with the evaluation step of the nursing process.
ANS: A
In this response, the nurse has minimized the patient’s feelings and problems, used clichés, and given advice—all considered ineffective responses. None of the other options provides an accurate assessment of the interaction.
DIF: Cognitive level: ApplyinNg R I GTOBP:.CNursMing process: Evaluation MSC: Client Needs: Psychosocial Integrity
22. A patient says to the nurse, “I dreamed I could not breathe and was being attacked. When I woke up, I felt emotionally drained, as though I hadn’t rested at all.” Which comment would be appropriate if the nurse seeks to interpret the patient’s experience?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “So you are saying that you were not able to breathe and felt in danger?”
c. “I understand. Thank you for telling me about your bad dream.”
d. “So, you feel as though you had a poor night’s sleep?”
ANS: A
The technique of interpreting is therapeutic and helps the nurse examine meaning and importance of the experience. The distracters use other techniques.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
1. Which techniques are therapeutic when interacting with a patient? (Select all that apply.)
a. Avoiding direct questions
b. Validating and clarifying
c. Using empathy sparingly
d. Assuming an attending posture
e. Maintaining constant eye contact
ANS: B, D
Using validation and clarification ensures that the nurse understands what the patient is saying. Using an attending posture conveys the message that the nurse is interested in what is being communicated. Giving feedback appropriately conveys interest and understanding. The other options are ineffective behaviors.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation MSC: Client Needs: Safe, Effective Care Environment
2. 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 your friend 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.”
ANS: B, C, D
Reflecting and giving information are therapeutic techniques. “Why” questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: Client Needs: PsychosocNiaUl IRntSegIriNtyGTB.COM [Show Less]