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A client who has recently lost her spouse says, "No one cares about me anymore. All the people I loved are dead." Which response demonstrates an understanding of therapeutic communication when dealing with a grieving client?
1."I certainly care about you."
2."You must be feeling all alone at this point."
3."I don't believe that and neither should you."
4."It isn't unusual to feel alone when you are grieving."
- 2.
- Rationale: The client is experiencing loss and is feeling hopeless. The therapeutic response by the nurse is the one that attempts to translate words into feelings. None of the remaining options encourage the client to discuss feelings but rather minimize and/or trivialize the feelings expressed.
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A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication?
1."You have everything to live for."
2."Why do you see yourself as a failure?"
3."Feeling like this is all part of being depressed."
4."You've been feeling like a failure for a while?"
4.
Rationale: Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. In addition, use of the word why is nontherapeutic because clients frequently interpret why questions as accusations. Why questions can cause resentment, insecurity, & mistrust.
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The client who is actively hallucinating is fearful that the voices will direct him to kill himself. Which therapeutic statement should the nurse make at this time?
1."I can hear the voices too, but ignore them and just go to bed now."
2."I know whose voices you are hearing, & I told them not to hurt you."
3."I know you believe they are going to cause you harm, but it's not true."
4."I don't hear them, but it must be frightening to hear voices that others can't hear."
- 4.
- Rationale: It is important for the nurse to let the client know that what the client is hearing is not heard by the nurse and to avoid reinforcing the client's altered reality. The nurse should avoid confronting the client. The nurse should say supportive things such as, "This must be very frightening to you" or "It's difficult to understand all that you are experiencing right now." The remaining options reinforce the client's altered reality.
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Laboratory work is prescribed for a client who has been experiencing delusions. When the nurse approaches the client to obtain a specimen of blood, the client begins to shout, "You're all vampires. Let me out of here!" Which nursing response addresses the client's anxiety?
1." What makes you think that I am a vampire?"
2."I'll leave and come back later for the specimen."
3."Do you remember discussing the lab work earlier?"
4."It must be frightening to think that others want to hurt you."
- 4.
- Rationale: The correct option helps the client focus on the emotion underlying the delusion but does not argue with it. Avoid statements that place the client in a position that requires a response. Attempting to avoid the situation will not address the client's anxiety. The incorrect responses may cause the client to hold the delusion more strongly.
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A client states to the nurse, "My life has been such a failure. Nothing I do turns outright." Which response by the nurse will best address the client's low sense of self-esteem?
1."You can't really believe that about yourself."
2."I know just how you feel. I have those days myself once in a while."
3."I disagree with you; we all have some value and accomplishments in life."
4."You seem very discouraged. Let's identify something that you are proud of doing."
- 4.
- Rationale: Depressed clients frequently exhibit feelings of low self-esteem and worthlessness. An effective plan of care should be designed for the client to provide experiences that are challenging but successful to enhance the client's self-esteem. Reminders of the client's past accomplishments or personal successes are ways to interrupt the client's negative self-talk and distorted cognitive view of self. The nurse should not devalue the client's feelings or challenge the client's statements. The nurse should not focus on oneself.
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The nurse visits a client at home. The client states, "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates therapeutic communication?
1."I see."
2." Really?"
3."You're having difficulty sleeping?"
4." Sometimes I have trouble sleeping too."
- 3.
- Rationale: The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the client's major theme, which assists the nurse to obtain a more specific perception of the problem from the client. The remaining options are not therapeutic responses since none encourages the client to expand on the problem. Offering personal experiences moves the focus away from the client and onto the nurse.
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The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response?
1."I cannot discuss any client situation with you."
2."If you want to know about Carol, you need to ask her yourself."
3."Only because you're worried about a friend, I'll tell you that she is improving."
4."Being her friend, you know she is having a difficult time and deserves her privacy."
- 1.
- Rationale:The nurse is required to maintain confidentiality regarding the client and the client's care. Confidentiality is basic to the therapeutic relationship and is a client's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality.
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The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? Select all that apply.
1.Restating
2.Listening
3.Asking the client "Why?"
4.Maintaining neutral responses
5.Providing acknowledgment and feedback
6. Giving advice and approval or disapproval
- 1., 2., 4, 5.
- Rationale: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Asking why is often interpreted as being accusatory by the client and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.
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A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
1.Using open-ended questions and silence
2.Sharing personal preference regarding food choices
3.Documenting reasons why the client does not want to eat
4.Offering opinions about the necessity of adequate nutrition
- 1.
- Rationale: Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior.
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A hospitalized client experiencing delusions reports to the nurse, "I know that the doctor is talking to the top man in the mob to get rid of me." Which response should the nurse make to the client?
1."I don't believe this is true."
2."The doctor is not talking to the mob."
3."Do you feel afraid that people are trying to hurt you?"
4."What makes you think the doctor wants to get rid of you?"
- 3.
- Rationale: When delusional, a client truly believes what he or she thinks to be real is real. The client's thinking often reflects feelings of great fear and aloneness. It is most therapeutic for the nurse to empathize with the client's experience. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusions is inappropriate.
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The nurse is working with a client who is demonstrating delusional thinking. The client says to the nurse, "The leaders of a religious cult are being sent to assassinate me." Which is the best response by the nurse?
1."I don't believe that what you are telling me is true."
2."There are no religious cults in this area that are going to kill you."
3."What makes you think that cult members are being sent to hurt you?"
4."I don't know about a religious cult. Are you afraid that people are trying to hurt you?"
- 4.
- Rationale: The nurse who disagrees with a client's delusions may make the client more defensive and cling to the delusions even more firmly. It is most therapeutic for the nurse to empathize with the client's experience. The nurse can also use the opportunity to try to explore further the meaning of the experience for the client. The correct option presents reality to the client and then focuses on the client's feelings. None of the other options provide this support.
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What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session?
1.Ask the client to leave the group for this session only.
2.Refer the client to another group that includes other manic clients.
3.Tell the client to stop monopolizing in a firm but compassionate manner.
4.Thank the client for the input, but inform the client that others now need a chance to contribute.
- 4.
- Rationale: If a client is monopolizing the group, the nurse must be direct and decisive. The best action is to thank the client and suggest that the client stop talking and try listening to others. Although telling the client to stop monopolizing in a firm but compassionate manner may be a direct response, the correct option is more specific and provides direction for the client. The remaining options are inappropriate because they are not directed toward helping the client in a therapeutic manner.
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A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat?
1.Using open-ended questions and silence 2.Sharing personal preferences regarding food choices 3.Documenting reasons why the client does not want to eat 4.Offering opinions about the necessity of adequate nutrition
- 1.
- Rationale: Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior.
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The nurse working in a detoxification unit is admitting a client for alcohol withdrawal. The client's spouse states, "I don't know why I don't get out of this rotten situation." Which response by the nurse addresses the spouse's concerns?
1."This is not a good time to make that decision."
2."What would your spouse think about your decision?"
3."What aspects of this situation are the most difficult for you?"
4."You seem to have a good grip on this situation. You probably should get out."
- 3.
- Rationale:The most helpful response is one that encourages the spouse to explore the problem and problem-solve. The correct response should not disregard or redirect focus away from the spouse's concern. The nurse should appear neither to disagree nor agree with the spouse. Giving advice implies that the nurse knows what is best and can also foster dependency.
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A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern?
1."I don't believe this is true."
2."The guards are not out to kill you."
3."Do you feel afraid that people are trying to hurt you?"
4."What makes you think the guards were sent to hurt you?"
- 3.
- Rationale: It is most therapeutic for the nurse to empathize with the client's experience. The remaining options lack this connection with the client. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.
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A client who has just received a diagnosis of asthma says to the nurse, "This condition is just another nail in my coffin." Which response by the nurse is therapeutic?
1."Do you think that having asthma will kill you?"
2."You seem very distressed over learning you have asthma."
3."Asthma is a treatable condition when medications are taken properly, so let's practice with your inhalant."
4."It will be difficult to work with you if you can't view this as a challenge rather than a nail in your coffin."
- 3.
- Rationale: Clients who have learned that they have a chronic illness may exhibit denial, anger, or sarcasm because of fear associated with the chronic illness. It is important for the nurse to convey an accepting attitude to enhance mutual respect and trust. Eliminate options that are sarcastic or punitive. The only correct option is the one that respectfully addresses the concern presented by the client.
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A client who is recovering from benzodiazepine dependence says, "I've lost so many people. First, my brother dies of cancer; then my husband leaves me for a 20-year-old. I wish I had 1 of those pills right now." Which statement by the nurse would be therapeutic?
1."Can you tell me what you think the pills can do for you?"
2."It sounds as if you feel that all of this has just happened to you."
3."It must have been a terrible loss for you when your brother died."
4."How did your husband's interest in a younger woman make you feel?"
- 1.
- Rationale: In the correct option, the nurse reflects back to the client what she is verbalizing and assists her to assess coping strategies. It is nontherapeutic for the nurse to change the focus from the client's expression of feelings related to the benzodiazepine. Asking the client to self-assess her own behavior in events is premature.
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The husband of an alcohol-dependent wife says, "If anyone had said I'd be henpecked, I'd have called them a liar, but now I realize that I'm codependent." Which statement by the nurse would be therapeutic?
1."Did you know that more people identify with just what you are saying?"
2."Which of the features that describe codependence caused you to recognize that?"
3."Can you tell me more about that? You see yourself as being codependent with your wife?"
4."Have you discussed your feelings with your wife? What does your wife think about what you've said?"
- 3.
- Rationale: This question describes the husband of an alcohol-dependent wife who is developing awareness of his codependency. Codependency consists of an individual's becoming preoccupied with the needs and concerns of another to the exclusion of his or her own needs. The therapeutic statement seeks clarification and summarizes and focuses the client on his own concerns and discoveries. When the nurse provides a social response that is nontherapeutic, it does not focus on the client's feelings. Intellectual questioning does not facilitate expression of feelings. Asking questions that are off-focus from the client's feelings are nontherapeutic because they constitute probing. The nurse will gather this information, but by gaining the trust of the client, not by probing.
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A client whose spouse of 42 years recently died shares with the nurse, "My sister came over yesterday and started talking about how I need to move on with my life. I feel badly, but I got mad and told her to mind her own business." Which response by the nurse would be therapeutic?
1."I know just how you feel; I lost my husband last summer."
2."You need to grieve, and expressing anger can be part of grieving."
3."Although she means to help, you need to do what feels right for you."
4."Focusing on the many good years you both enjoyed together will help."
- 2.
- Rationale: The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest. The remaining options are all nontherapeutic. They do not encourage the client to express feelings.
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The client says to the nurse, "I wish you would just be my friend." Which is the appropriate response by the nurse?
1."I am your friend."
2."Our relationship is a therapeutic and helping one."
3."I can't be your friend. I'm the nurse, and you're the client."
4."You have plenty of friends. You don't need me to be your friend, too."
- 2.
- Rationale: Nurses may struggle with requests by clients to "be my friend." When this occurs, the nurse should make it clear that the relationship is a therapeutic and helping one. This does not mean that the nurse is not friendly toward the client at times. It does mean, however, that the nurse follows the stated guidelines regarding a therapeutic relationship. The remaining options are inappropriate, particularly in their failure to define the relationship.
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A battered wife says, "My husband is a bully and a womanizer and certainly doesn't provide for his family, but he's never beat me up, so I don't think I can say he's abusive." Which response by the nurse is therapeutic?
1."Don't be so gullible. Your husband is an abuser."
2."How is it that he can maneuver you like he has?"
3."Do you believe that there are other forms of abuse besides the physical kind?"
4."Most emotionally battered spouses begin to heal once they start to identify the abusive behaviors."
- 3.
- Rationale: This question describes the victimized spouse of a perpetrator who uses multiple ways to control his victim. The correct option reflects and then provides an opportunity to share feelings. It is inappropriate for the nurse to chastise the client or respond in a sarcastic manner. It is nontherapeutic for the nurse to offer an observation that intellectualizes the situation since it does not facilitate the expression of feelings. Probing may cause the client to feel belittled.
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The nurse tells the client that a music therapy session has been scheduled as part of the treatment plan. The client tells the nurse, "I can't sing," and refuses to attend. Which nursing response is most likely to meet the client's needs?
1."Why don't you want to attend? What is the real reason?"
2."You don't have to sing. Just listen and enjoy the music."
3."You must go. You have no choice if you want to get better."
4."Your primary health care provider has prescribed this therapy for you."
- 2.
- Rationale: The correct option encourages the client to socialize and indicates that it is not necessary to sing. Avoid the use of the word why since it can be insulting to the client. Don't make or imply a demand. Focus on addressing the client's concern. The correct option is the only one that addresses the client's concern.
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A preoperative client expresses anxiety to the nurse about upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse?1."If it's any help, everyone is nervous before surgery."
2."I will be happy to explain the entire surgical procedure to you."
3."Can you share with me what you've been told about your surgery?"
4."Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate."
- 3.
- Rationale: Explanations should begin with the information that the client knows. By providing the client with individualized explanations of care and procedures, the nurse can assist the client in handling anxiety and fear for a smooth preoperative experience. Clients who are calm and emotionally prepared for surgery withstand anesthesia better and experience fewer postoperative complications. Option 1 does not focus on the client's anxiety. Explaining the entire surgical procedure may increase the client's anxiety. Option 4 avoids the client's anxiety and is focused on postoperative care.
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An older resident in a long-term care facility prepares to walk out into a rainstorm after saying, "My father is waiting to take me for a ride." Which is the appropriate response by the nurse?
1."I need you to sign a form before leaving."
2."You will get sick if you go out in the rain."
3."How old are you? Your father must no longer be living."
4."Let's have a cup of coffee, and you can tell me about your father."
- 4.
- Rationale: The correct response acknowledges the client's comment and behavior. Allowing the client to leave after forms are signed fails to protect the client from possible harm. The remaining options do not preserve the client's dignity.
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