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When the nurse suggests to a client that “You and I need to take a walk,” the client responds with “walk, walk, walk….” The nurse documents this as which speech pattern?
A. Flight of ideas
B. Echolalia
C. Neologism
D. Loose association
Answer: B
Rationale: Echolalia occurs when the client vocally repeats the last word heard. Flight of ideas occurs when the client rapidly shifts between topics that are unrelated to each other. When the client coins new words and definitions, this is termed neologism. Loose association occurs when the client exhibits continuous speech, shifting between loosely related topics.
. A nurse is engaged in therapeutic communication with a client. Which technique, if used by the nurse, would interfere with achieving client goals?
A. Clarification
B. Validation
C. Giving advice
D. Using silence
Answer: C
Rationale: Giving advice blocks therapeutic communication because it implies that the nurse's values are correct and devalues the client's actions. Asking for clarification, validating what the client says, and using silence during active listening are all parts of therapeutic communication.
While interacting with a client, which behavior by the nurse would negatively impact the interaction?
A. Smiling when greeting the client arriving for therapy
B. Sitting with crossed legs and arms during a group session
C. Sitting across the table from a client during the assessment process
D. Using therapeutic touch as the client discusses the loss of a parent
Answer: B
Rationale: Crossing one's legs and arms conveys a lack of openness to the client and so would be a barrier to effective therapeutic communication. A facial expression that is congruent with other gestures assures the client of the nurse’s interest and attention. Respecting the physical or personal space between the client and the nurse helps the client feel safe. The use of therapeutic touch can help to communicate caring and understanding.
While working with a client, the client states, “I am hungry. Will you buy me a car? Can we go to the movie?” When documenting the interaction, which terminology would the nurse use to describe the client’s statements?
A. Word salad
B. Loose association
C. Neologism
D. Flight of ideas
Answer: D
Rationale: Flight of ideas occurs when the client rapidly shifts between topics that are unrelated to each other. Word salad refers to an incoherent mixture of words and phrases that have no connection. When the client exhibits continuous speech, shifting between loosely related topics, loose association occurs. Neologism is when a client coins new words and definitions.
The nurse misinterprets the meaning of a female client's statement about their feelings related to the client's recent divorce. To correct the miscommunication and restore the benefits of active listening between the client and nurse, which action would be appropriate for the nurse to do initially?
A. Ask the client to clarify what they meant by the verbalized statement.
B. Suggest that the client write down the feelings the client intended to express.
C. Role model for the client by apologizing for the misunderstanding.
D. Explain that mistakes are common and both need to work on communicating.
Answer: C
Rationale: Active listening is a learned skill that includes observing nonverbal behaviors, giving critical attention to verbal comments, listening for inconsistencies that may need clarification, and attempting to understand the client's perception of the situation. Active listening allows the client to express feelings and thoughts without fear of being judged or criticized. Some responses by the nurse may not be effective or correct. The intended message can be misread by either the client or the nurse and it is important that both participants remain open to the possibility of error. Sometimes this actually allows the nurse to apologize and model appropriate behavior. Clarification can be effective after the mistake has been acknowledged. While writing about one's feelings is appropriate, doing so in this situation would undermine the communication between the nurse and the client. While it is always useful to work on one's communication skills, the nurse made the mistake, not the client, and should take responsibility for acknowledging it.
A nurse is overheard responding to a client, saying, “Why would you think that was acceptable?” Which statement by the nurse manager to the nurse would be most effective in addressing the nurse's response to the client?
A. “When you respond with a cliché, the client generally views it as a lack of interest.”
B. “Your response conveyed the attitude to the client that the client's feelings are not important.”
C. “The client won't likely feel comfortable sharing thoughts and feelings with you.”
D. “Such a response puts the client on the defensive, making him embarrassed and ashamed.”
Answer: D
Rationale: The use of the word “why” is nontherapeutic. It generally causes the client to feel attacked and thus causes the client to react defensively. Such a response is also often interpreted as being invasive and excessively probing. The statement is not a cliché, which is a stereotypical phrase or opinion that is overused in conversation. The statement did not attempt to change the subject or minimize the situation; both of which would serve to devalue the importance of the client's statement. While it is true that the nurse's statement would make the client uncomfortable and less likely to engage in meaningful conversation, that fact does not address the actual barrier to communication that occurred.
While interviewing a client, a nurse asks “Let me make sure that I understood you correctly. When you said that….” The nurse is using which communication technique?
A. Validation
B. Clarification
C. Reflection
D. Restating
Answer: B
Rationale: Clarification clears up any possible misunderstanding and assures that message intended is the message received. Validation attempts to verify the nurse's perception of feeling conveyed by client's verbal or nonverbal message. Reflection shows the nurse's perception of the client's message in both content and feeling areas. Restating repeats to the client the content of the interaction and serves to encourage further discussion.
The nurse says to the client, “It is time for your dinner.” The client responds, “Dinner and winner but sinner makes thinner and inner.” The nurse interprets this as which type of speech pattern?
A. Neologism
B. Echolalia
C. Clang association
D. Loose association
Answer: C
Rationale: Clang association or rhyming involves the use of words that rhyme but do not have meaning. A neologism is a new word or definition coined by the client. Echolalia occurs when the client vocally repeats the last word heard. Loose association occurs when the client exhibits continuous speech, shifting between loosely related topics.
A nurse is providing care to a client who is demonstrating paranoid behavior. Which communication technique would be best to use to foster a sense of safety for the client?
A. Respecting an expanded area of personal space when interacting with the client
B. Making an effect to establish intermittent eye contact when speaking with the client
C. Routinely patting the client's shoulder when giving them medication
D. Purposefully keeping arms uncrossed when engaging the client in a conversation
Answer: A
Rationale: Respecting the physical or personal space between the client and the nurse helps the client feel safe. The anxiety level, suspiciousness, distorted thinking, and personal comfort zone of the client, like those demonstrating paranoid tendencies, will all influence the proximity of this distance. Intermittent eye contact helps provide reassurance that the nurse is interested and concentrating on what the client is saying but would not help foster a sense of safety. Uncrossed arms or legs convey a sense of openness to the client, but not necessarily a sense of safety. While the use of touch helps convey caring and understanding, this gesture can be misinterpreted as being aggressive by a client who is suspicious.
When communicating with a client diagnosed with a mental health disorder, which action would be most effective to achieve client outcomes?
A. Observing the client's verbal and nonverbal communication to update assessment data
B. Communicating with the client on a regular basis to demonstrate availability
C. Using therapeutic communication to build a trusting nurse–client relationship
D. Sharing client-focused information with the health care team
Answer: C
Rationale: In nursing, communication is purposeful and is centered on the needs and problems of the client. Through communication, the nurse builds the therapeutic relationship and establishes trust. To do this effectively, the nurse must develop effective therapeutic communication skills. Communication is a nursing tool but it involves various aspects only one of which is regular conversations. Although observing the client, communicating on a regular basis and sharing client-focused information are important, the key to outcome achievement is the establishment of a therapeutic relationship. And while communication is involved in assessment and information sharing, the nurse's primary role is to develop a therapeutic relationship with the client.
A registered nurse (RN) is discussing a client’s care with a licensed practical/vocational nurse (LPN/VN). Which statement by the RN best demonstrates the goal of therapeutic communication?
A. “Please let the client know that you will help them get ready for their family's visit.”
B. “Can you talk to the client about what they would like to eat for dinner?”
C. “Share with the client that they need to be ready to go to therapy by 1115.”
D. “Has the client talked with you about how they feel about being hospitalized?”
Answer: D
Rationale: Therapeutic communication is an interaction between the nurse or other team personnel and the client that is conducted with the specific goal of learning about the client and their problem. The goal is to use both verbal and nonverbal techniques to facilitate active involvement by the client and to encourage the client to express feelings and thoughts that are contributing to their problem. While the other options involve communication, they are related to details and facts rather than feelings.
A nurse is working with a client diagnosed with depression. Which statement by the nurse demonstrates an understanding of the most serious barrier to communication when attempting to establish a therapeutic relationship?
A. “The client's lack of energy makes carrying on a meaningful conversation difficult.”
B. “I can't quite get a clear understanding of how the client expresses sadness.”
C. “The depression makes the client really disinterested in talking.”
D. “The real communication will happen once the medication decreases the depression.”
Answer: B
Rationale: Differences in communication style or expression of one's feelings can be easily misinterpreted and must be considered integral to establishing trust within the nurse–client relationship. It is true that the client's ability and willingness to participate in the communication are relevant; these problems are manageable if the expression of feelings is not being misinterpreted. The therapeutic relationship needs to be established early and should not be postponed until the client’s condition improves.
Which statement by a nurse demonstrates an understanding of the impact of personal space on a conversation?
A. “The client appears more relaxed and willing to talk when we sit across from each other at the table.”
B. “Personal space is usually considered to be 2 to 4 feet around the individual.”
C. “I’ve explained the concept of personal space to the clients so they can learn to respect each other effectively.”
D. “It’s important to keep out of the personal space of a client who is angry.”
Answer: A
Rationale: Respecting the physical or personal space between the client and yourself helps the client feel safe. The anxiety level, suspiciousness, distorted thinking, and personal comfort zone of the client will all influence the proximity of this distance. While the remaining options are true statements regarding personal space, they fail to describe an understanding about how respecting the concept affects both the client and the communication process.
A nurse uses focusing to communicate with a client about their relationships with family members. Which statement would be appropriate for the nurse to use?
A. “You’ve said that you find your mother to be very controlling.”
B. “Did I understand you correctly when you said you were abused by your father?”
C. “Can you tell me more about how you reacted when your spouse asked for a divorce?”
D. “Let’s get back to how you feel about your son’s decision to leave school.”
Answer: D
Rationale: Focusing brings the conversation back to its primary topic; encourages the client to bring back attention to that topic. Restating repeats what a client said while clarification clears up possible misunderstandings. Using a general lead encourages the client to provide more information.
After reading a journal article about therapeutic communication, a nurse demonstrates understanding of the information by identifying which aspect(s) as reflecting the topic? Select all that apply.
A. The focus is on the client.
B. It is planned by the client.
C. The goal is expression of the nurse's feelings.
D. It does not encompass values and beliefs.
E. It requires practice.
Answer: A, E
Rationale: During therapeutic communication, the focus is on the client, and the exchange is planned and directed by the nurse. One of the goals is to encourage the client to express feelings and thoughts that are contributing to their problem. It is important to view the relationship between the nurse and the client as part of a complex environment influenced by individual experiences, culture, values, and beliefs. This type of skilled communication is learned and requires practice.
When initiating a therapeutic conversation with a client, a nurse establishes a clear understanding of the client’s message by using which therapeutic communication technique? Select all that apply.
A. Clarification
B. Validation
C. Using a general lead
D. Focusing
E. Reality reinforcement
Answer: A, B
Rationale: Clarification clears up any possible misunderstanding and assures the message intended is the message received. Validation is an effective verbal communication technique in which there are attempts to verify the nurse's perceptions of feeling conveyed by the client's verbal or nonverbal message. Using a general lead shows the nurse is listening and interested---encourages the client to continue talking. Focusing helps the client concentrate on a specific issue while reality reinforcement provides reassurance to the client who is hallucinating that voices are symptoms of illness thus helping the client to trust the nurse as real.
When using active listening, which action(s) would be appropriate for the nurse to do? Select all that apply.
A. Give critical attention to verbal comments
B. Attempt to understand the client's perception of the situation
C. Judge the client’s perception of the illness
D. Review client comments and behaviors before responding
E. Model appropriate behaviors such as apologizing
Answer: A, B, D, E
Rationale: Active listening allows the client to express feelings and thoughts without fear of being judged or criticized. It involves giving critical attention to verbal comments, attempting to understand the client's perception of the situation. It is important to review the client's comments and behaviors before responding and to use the opportunity to role model appropriate behaviors.
A nurse is providing care to several clients. For which client(s) would the nurse be extremely cautious when using touch? Select all that apply.
A. Client being readied for discharge
B. Client with depression
C. Client diagnosed with schizophrenia
D. Client who is sexually preoccupied
E. Client exhibiting suspiciousness
Answer: D, E
Rationale: A client who is sexually preoccupied might misinterpret any form of touch as having seductive connotation. A client who is suspicious, for example, might react with aggressive actions toward a simple pat on the shoulder. While the touch may be misinterpreted by any client of the options, the greatest risk is among the client who is sexually preoccupied or suspicious.
A nurse uses silence to demonstrate which behavior(s)? Select all that apply.
A. Willingness to listen
B. Control over the conversation
C. Understanding of the client's needs
D. Mastery of therapeutic communication
E. Respect for the client's conversation
Answer: A, E
Rationale: Silence conveys a willingness to continue listening. It allows both the nurse and the client to collect thoughts. Silence shows respect for the emotions and offers the client time to regain control and continue the conversation and is a way of showing respect and concern for what the client has to say. It is not the nurse's role to control the conversation but rather direct and help the client focus. Silence does not assure an understanding of the client's needs nor does it demonstrate a mastery of therapeutic communication skills.
A nurse is incorporating nonverbal communication techniques when interviewing a newly admitted client with a mental health disorder. Which technique(s) would be most effective in promoting therapeutic communication? Select all that apply.
A. Using touch frequently throughout the interview
B. Emphasizing key areas by pointing at the client
C. Having the client sit in a chair while the nurse stands with legs spread apart
D. Maintaining an arm’s length distance between the nurse and client
E. Keeping intermittent eye contact with the client
Answer: D, E
Rationale: Maintaining an arm’s length distance between the client and nurse demonstrates respect for the physical or personal space between the client and the nurse and helps the client feel safe. Intermittent eye contact helps provide reassurance that the nurse is interested and concentrating on what the client is saying. Although the use of therapeutic touch can help to communicate caring and understanding, when working with a client who has a mental illness, the nurse must use caution and forethought about how the client might interpret actions. Pointing has different meanings in different cultures. The nurse needs to learn more about the client before using this technique. Vertical conversations (the nurse is standing while the client is sitting or lying down) can be intimidating and block further communication. Lateral conversations with both the nurse and client at eye level are more conducive to therapeutic communication.