Chapter 10: Therapeutic Communication Nursing School Test Banks

Chapter 10: Therapeutic Communication
Test Bank

MULTIPLE CHOICE

1. A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Rueschs theory of communication, this unsuccessful interaction is called _____ communication.
a. Disturbed
b. Nontherapeutic
c. Blocked
d. Therapeutic
ANS: A
Ruesch called this type of interrupted communication disturbed communication. In addition to interference with receiving a message, as in the case of this client, the term applies to interference with the sending of messages, problems in language between people, insufficient information, and lack of the opportunity for feedback. Rueschs theory did not coin the term nontherapeutic or blocked communication, and this interaction would not be considered therapeutic.

DIF: Cognitive Level: Comprehension REF: p. 104 OBJ: 1
TOP: Rueschs Theory KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

2. The theorist Eric Berne theorized that an individuals three ego states of parent, child, and adult make up ones:
a. Conscience
b. Personality
c. Thought processes
d. Ability to communicate
ANS: B
The three ego states, according to Berne, make up an individuals personality. The parent ego focuses on rules and values, the child ego focuses on emotions and desires, and the focal point of the adult ego is previous observations. He did not address any of the other three options.

DIF: Cognitive Level: Knowledge REF: p. 104 OBJ: 1
TOP: Transactional Analysis KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

3. The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique?
a. I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something.
b. Can you tell me more about how you feel when you are arguing with your daughter?
c. I would like to talk with you about your plan of care.
d. Tell me if I understand you correctly.
ANS: A
Sharing perceptions lets the client know that you are listening and ensures that you understand what he or she is communicating. Asking the client to describe how he or she feels when arguing with his or her daughter describes focusing. Speaking to the client about the plan of care describes informing, and the nursing student is using clarification when asking whether he or she understands the client correctly.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 7
TOP: Interacting Skills KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

4. The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification?
a. You said that the fight you had with your wife caused you to start drinking again?
b. Lets discuss what made you feel the need to drink.
c. Could you tell me again when and what happened that you feel caused you to start drinking again?
d. Tell me what your childhood was like.
ANS: C
Clarification helps to confirm feelings, ideas, and perceptions. The other options are examples of restating, focusing, and changing the topic.

DIF: Cognitive Level: Application REF: p. 105 OBJ: 7
TOP: Interacting Skills KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

5. A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response?
a. Tell me more about the feelings you have regarding their relationship.
b. I think that you should tell them how you feel.
c. Lets not talk about that right now.
d. Dont you think that you should be thankful that your daughter has a good relationship with her grandmother?
ANS: D
Defensive, challenging statements such as this one will block communication with the client because she will feel that she needs to respond defensively and answer to the nurse for her feelings. The therapeutic communication response that includes a broad opening statement is used when the nurse asks the client to tell more about her feelings. When the nurse tells the client that she should tell the mother and daughter how she feels, it describes giving advice. The nurse uses the nontherapeutic technique of belittling the client when the nurse states that the clients feelings are childish.

DIF: Cognitive Level: Application REF: p. 113 OBJ: 7
TOP: Nontherapeutic Messages KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

6. A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just cant find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique?
a. I cant believe that you would want your daughter to grow up in this environment.
b. I understand your concern. Let me give you some information on our local council for domestic abuse.
c. Im sure it wont be that bad to be out on your own. I know you can do it.
d. I think you should not think about leaving and should just do it.
ANS: C
This is an example of the nontherapeutic technique of falsely reassuring the client. It dismisses the clients concerns and does not support her. The nurse is showing disapproval in stating that she cant believe that the client would want her daughter to grow up in such an environment. The nurse gives an appropriate therapeutic statement when she acknowledges the clients concern and then provides the client with helpful information. The nurse is giving advice in offering her thoughts that the client should just leave.

DIF: Cognitive Level: Application REF: p. 111 OBJ: 7
TOP: Nontherapeutic Messages KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

7. Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client?
a. Broad openings, restating, and advising
b. Clarification, focusing, and confrontation
c. Listening, silence, and reflection
d. Humor, informing, and reassuring
ANS: C
The techniques of listening, silence, and reflection are all therapeutic. Advising, confronting, and reassuring are all examples of nontherapeutic techniques.

DIF: Cognitive Level: Comprehension REF: p. 111 OBJ: 7
TOP: Interacting Skills KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

8. While the nurse is talking with a female client, the client becomes silent for several seconds. Which is the nurses best response?
a. To interpret this action as an indication that the client is finished with the conversation
b. To ask the client a question so the interaction can continue
c. To remain silent and be attentive to the clients nonverbal communication
d. To tell the client that help can be more effective if she shares her feelings
ANS: C
This is an example of the therapeutic communication technique of silence. It allows the client time to collect her thoughts. Although most people want to talk away the silence, it is important for the caregiver to become comfortable with the effective technique of silence. The three incorrect options prevent silence from occurring.

DIF: Cognitive Level: Application REF: p. 111 OBJ: 7
TOP: Interacting Skills KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

9. A client who usually is very active in her therapy group tells the nurse that she really does not feel well today and would rather not attend the group therapy session. Which is the nurses most appropriate response?
a. You dont feel like attending the group therapy today?
b. I will just stay with you for a while.
c. Its okay to skip a session every once in a while.
d. Why dont you want to attend group therapy?
ANS: A
The nurse is restating what the client said, which verifies what the client communicated and lets the client know that the nurse listened and understood her. The client did not ask the nurse to sit with her, so this action is inappropriate. Telling the client that it is okay to skip a session is giving advice and is not conveying an understanding of what the client really said. Asking the client why she doesnt want to attend group therapy clearly conveys that the nurse did not listen to what the client communicated.

DIF: Cognitive Level: Application REF: p. 111 OBJ: 7
TOP: Interacting Skills KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

10. The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should:
a. Sit with the client and encourage him to not verbalize.
b. Do most of the talking.
c. Discuss several different topics to keep the clients attention.
d. Use simple, concrete language.
ANS: D
Because this client has been given the diagnosis of schizophrenia and frequently has auditory hallucinations, his perception of the communication must be considered. Use of simple, concrete language will assist the client in following the conversation without having to interpret what the nurse means during the interaction. Encouraging the client not to verbalize and doing most of the talking do not allow the client to express himself, and discussing several different topics will be confusing and may cause the client undue stress during the interaction.

DIF: Cognitive Level: Application REF: p. 107 OBJ: 8
TOP: Verbal Communication KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

11. The nurses ability to interpret communication effectively in the mental health setting depends mostly on:
a. How well the client communicates
b. The nurses relationship with the client
c. The nurses understanding of mental health disorders
d. The nurses ability to listen to and observe the clients verbal and nonverbal messages
ANS: D
Accurate interpretation of the clients communication cannot occur if the nurse does not listen to and observe the client. It is not dependent on how well the client communicates because the nurse has no control over the client. The nurses relationship with the client and understanding of mental health disorders are important but will not supersede good observation and listening.

DIF: Cognitive Level: Comprehension REF: p. 110 OBJ: 6
TOP: Therapeutic Communication KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

12. Which nurse response is the best example of the therapeutic principle of respect?
a. Im interested in what you have to say.
b. Describe how you are feeling for me.
c. I hear how worried you are about your future and can imagine how you feel.
d. You signed a contract stating that you would let me know when you have those thoughts.
ANS: C
Although all of these responses are examples of therapeutic principles, this option best describes respect because it shows consideration and acceptance. The other options convey interest, the principle of concreteness, and honesty.

DIF: Cognitive Level: Application REF: p. 109 OBJ: 6
TOP: Therapeutic Communication KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

13. A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of:
a. Permission
b. Respect
c. Interest
d. Protection
ANS: D
A protective response such as, Lets look together again at what we have planned for you when you go home, will help the client feel more confident in her ability to do well once she is discharged. The other options are examples of therapeutic principles but do not address the needs of this client at this time.

DIF: Cognitive Level: Application REF: p. 110 OBJ: 6
TOP: Therapeutic Communication KEY: Nursing Process Step: Intervention
MSC: Client Needs: Psychosocial Integrity

14. A nurse has just graduated from nursing school and has been hired on a mental health unit. The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves:
a. Focusing
b. Parroting
c. Restating
d. Clarifying
ANS: B
Parroting is the extreme form of the therapeutic communication skill of restating. It becomes very annoying to clients when the nurse continually repeats the clients statements in an attempt to show understanding of the clients message. The other options are therapeutic communication skills.

DIF: Cognitive Level: Knowledge REF: p. 113 OBJ: 7
TOP: Nontherapeutic Messages KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

15. A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating?
a. Aphasia
b. Dyslexia
c. Speech cluttering
d. Incongruent communications
ANS: C
Rapid, confusing delivery of speech patterns is called speech cluttering and can result in the clients inability to focus on verbal communication as the main form of interaction. Aphasia refers to the inability to speak, dyslexia refers to mixing of letters when reading that sometimes results in mixing of syllables when speaking, and incongruent communications occur when verbal messages do not match nonverbal messages.

DIF: Cognitive Level: Knowledge REF: p. 112 OBJ: 8
TOP: Problems with Communication KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

16. When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills?
a. Finishing the clients sentences to indicate listening
b. Not clarifying messages to avoid interrupting
c. Avoiding taking notes to detract from listening
d. Changing the environment to decrease distractions
ANS: D
Effective listening improves the ability to meet client needs. Changing the environment to decrease distractions is a practice important to listening skills. Finishing client sentences, not clarifying messages, and avoiding taking notes are barriers to listening and may prevent the nurse from picking up hidden messages, which could minimizing minimize misunderstandings if perceived.

DIF: Cognitive Level: Knowledge REF: p. 110 OBJ: 7
TOP: Problems with Communication KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

17. The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of:
a. Echolalia
b. Circumstantiality
c. Neologism
d. Perseveration
ANS: B
Circumstantiality is a speech pattern in which the client describes in too much detail and cannot be selective. Echolalia is repeating the last word heard, neologism is the coining of new words or expressions and perseveration is the repeating of a single activity and the inability to shift from one topic to another.

DIF: Cognitive Level: Knowledge REF: p. 115 OBJ: 8
TOP: Speech Patterns Associated with Psychiatric Problems
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

18. The client tells the nurse that she believes there is no improvement in her manic episodes. Her clothing matches, and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate?
a. Verbal communication takes priority.
b. Verbal communication is not congruent with nonverbal communication.
c. Nonverbal communication indicates the client is lying.
d. Nonverbal communication should take priority.
ANS: B
Verbal and nonverbal communication sends and receives messages with every interaction. Neither verbal nor nonverbal communication takes priority over the other. In this case the verbal communication of the client that her episodes are not improving is belied by the obvious improvement in her dress and behavior (nonverbal communication).

DIF: Cognitive Level: Knowledge REF: p. 107 OBJ: 8
TOP: Levels of Communication KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

19. When the adolescent client is asked about the magazine she is reading, she responds, Its an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night. Which speech pattern is this an example of?
a. Echolalia
b. Flight of ideas
c. Loose association
d. Neologism
ANS: C
Loose association is a pattern in which the speaker shifts between loosely related topics such as movie star, stars in the sky at night, and darkness at night.

DIF: Cognitive Level: Knowledge REF: p. 115 OBJ: 8
TOP: Speech Patterns Associated with Psychiatric Problems
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

20. Which elements must be present for communication to occur? (Select all that apply.)
a. Feedback
b. Transmission
c. Sender
d. Clarification
e. Receiver
f. Focusing
g. Context
ANS: A, B, C, E, G
Feedback, transmission, sender, receiver, and context are the five elements that must be in place for communication to occur. The sender transmits the message to the receiver, resulting in feedback between them. The context, or setting, is where the communication takes place. Clarification and focusing are types of therapeutic communication.

DIF: Cognitive Level: Knowledge REF: p. 105 OBJ: 3
TOP: Process of Communication KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

21. Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.)
a. The nurse adapts his or her behavior to accommodate the difference in communication styles.
b. The nurse identifies and clarifies confusion during the interaction.
c. The nurse recognizes the difference between communication styles and assists the client to change to the nurses communication style.
d. The nurse uses a limited number of slang terms when communicating with the client.
ANS: A, B
Adaptation of behavior to accommodate differences in communication is effective because it is less difficult for the nurse to adapt to differences in communication, as with the use of an interpreter. Identifying and clarifying confusion prevent misinterpretation during the interaction. Recognizing differences in communication style is correct, but assisting the client to change to the communication style of the nurse is incorrect. Using a limited number of slang words indicates that some slang terms are acceptable; however, no slang terms should be used because these may block communication.

DIF: Cognitive Level: Application REF: p. 108 OBJ: 5
TOP: Intercultural Difference KEY: Nursing Process Step: Planning
MSC: Client Needs: Psychosocial Integrity

22. Which nurse responses could block effective communication with a client? (Select all that apply.)
a. This is what I think you should say
b. Dont stress over it. Everything will turn out fine.
c. Why did you do that?
d. Most people in your circumstance
ANS: A, B, C, D
All of these options are nontherapeutic and should be avoided. When the nurse offers what she thinks the client should say, she is giving the client advice. Telling the client not to stress is giving the client false reassurance. Asking the question Why did you do that? will make the client defensive. When the nurse says Most people in your circumstance, she is generalizing.

DIF: Cognitive Level: Application REF: p. 113 OBJ: 7
TOP: Nontherapeutic Messages KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

23. In order to be therapeutic when communicating with a client living in a homeless shelter, it is important to apply which techniques? (Select all that apply.)
a. Show acceptance and respect.
b. Avoid clarifying terms.
c. Use medical terminology to avoid talking down.
d. Consider the clients environment.
e. Assess clients pattern of verbal and nonverbal communication.
ANS: A, D, E
Showing acceptance and respect, considering the clients environment, and assessing verbal and nonverbal patterns of communication are effective ways of communicating with clients of different social classes. Avoiding clarifying terms and using medical terminology provide barriers to communication.

DIF: Cognitive Level: Application REF: p. 106 OBJ: 6
TOP: Communicating with Clients of Different Social Classes
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity

COMPLETION

24. __________ is the transferring between people of information, including ideas, beliefs, feelings, and attitudes.

ANS:
Communication
For communication to be effective, information must be understood by all parties. Therapeutic communication is necessary if the interaction between the nurse and the client is to achieve successful outcomes.

DIF: Cognitive Level: Knowledge REF: p. 103 OBJ: 1
TOP: Therapeutic Communication KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity

OTHER

25. During the process of communication, a chain of events occurs as soon as the message is sent. Steps in this chain include transmission, perception, and evaluation. Place these steps in proper chronological order. (Separate letters by a comma and space as follows: A, B, C.)
A. Transmission
B. Perception
C. Evaluation

ANS:
B, C, A
Perception of the message happens first because it is the step when recognition of a message occurs. Vision, hearing, and touch are used to perceive the message. Evaluation occurs next and is the internal assessment of the message. The last step, transmission, consists of conscious and unconscious responses to the message.

DIF: Cognitive Level: Comprehension REF: p. 105 OBJ: 3
TOP: Process of Communication KEY: Nursing Process Step: Evaluation
MSC: Client Needs: Psychosocial Integrity

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