Chapter 8: Communication Skills: Medium for All Nursing Practice Nursing School Test Banks

Chapter 8: Communication Skills: Medium for All Nursing Practice
Varcarolis: Essentials to Psychiatric Mental Health Nursing, 2nd Edition Revised Reprint

MULTIPLE CHOICE

1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which comment would be appropriate if the nurse seeks clarification?
a. It sounds as though you were uncomfortable with the content of your dream.
b. I understand what youre saying. Bad dreams leave me feeling tired, too.
c. So, all in all, you feel as though you had a rather poor nights sleep?
d. Can you give me an example of what you mean by stoned?
ANS: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the patients statement. Asking for a definition of stoned directly asks for clarification. Restating that the patient is uncomfortable with the dreams content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patients comment.

DIF: Cognitive Level: Application (Applying) REF: Pages: 122-123
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic?
a. Lets talk about something other than the CIA.
b. It sounds like youre concerned about your privacy.
c. The CIA is prohibited from operating in health care facilities.
d. You have lost touch with reality, which is a symptom of your illness.
ANS: B
It is important not to challenge the patients beliefs, even if they are unrealistic. Challenging undermines the patients trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patients message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful but uncompassionate.

DIF: Cognitive Level: Application (Applying) REF: Pages: 121-127
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. The patient says, My marriage is just great. My spouse and I usually agree on everything. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patients communication is:
a. clear.
b. mixed.
c. precise.
d. inadequate.
ANS: B
Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patients verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 120
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self.
a. Ive also had traumatic life experiences. Maybe it would help if I told you about them.
b. Why do you think you had so much difficulty adjusting to this change in your life?
c. I hope you will feel better after getting accustomed to how this unit operates.
d. Id like to sit with you for a while to help you get comfortable talking to me.
ANS: D
Offering self is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of offering self, helps build trust and conveys that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but an example of offering hope.

DIF: Cognitive Level: Application (Applying) REF: Pages: 124-125
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restate a feeling or thought the patient has expressed.
b. Ask a direct question, such as, Did you feel angry?
c. Make a judgment about the patients problem.
d. Say, I understand what youre saying.
ANS: A
Restating allows the patient to validate the nurses understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions such as Did you feel angry? ask for specific information rather than show understanding. When the nurse simply states that he or she understands the patients words, the patient has no way of measuring the understanding.

DIF: Cognitive Level: Application (Applying) REF: Page: 122
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
a. What are the common elements here?
b. Tell me again about your experiences.
c. Am I correct in understanding that?8??
d. Tell me everything from the beginning.
ANS: C
Asking, Am I correct in understanding that? permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

DIF: Cognitive Level: Application (Applying) REF: Pages: 124-125
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. A patient tells the nurse, I dont think I will ever get out of here. Select the nurses most therapeutic response.
a. Dont talk that way. Of course you will leave here!
b. Keep up the good work and you certainly will.
c. You dont think youre making progress?
d. Everyone feels that way sometimes.
ANS: C
By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to talk that way is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

DIF: Cognitive Level: Application (Applying) REF: Pages: 124-125
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate?
a. Patient is giving positive feedback about the nurses communication techniques.
b. Nurse is viewing the patients behavior through a cultural filter.
c. Patients verbal and nonverbal messages are incongruent.
d. Patient is demonstrating psychotic behaviors.
ANS: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a mixed message. It is inaccurate to say that the patient is giving positive feedback about the nurses communication techniques. The concept of a cultural filter is not relevant to the situation; a cultural filter determines what a person will pay attention to and what he or she will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

DIF: Cognitive Level: Application (Applying) REF: Page: 120
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
d. Social skills
ANS: A
Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patients social skills or whether a cultural barrier exists.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 119-120
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patients cultural and individual interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Patients in a psychiatric setting should not be touched.
ANS: B
Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 119-120 | Page: 129
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. A Mexican-American patient puts a picture of the Virgin Mary on the bedside table. Under which section of the assessment should the nurse document this behavior?
a. Culture
b. Ethnicity
c. Verbal communication
d. Nonverbal communication
ANS: A
Cultural heritage is expressed through language, works of art, music, dance, ethnic clothing, customs, traditions, diet, and expressions of spirituality. This patients prominent placement of the picture is an example of expression of cultural heritage. Verbal and nonverbal communications apply to all areas of an assessment.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 127-129
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12. An African-American patient says to a Caucasian nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to:
a. explain, Yes, I do understand. Everyone goes through the same experiences.
b. say, Please give an example of something you think I wouldnt understand.
c. reassure the patient that nurses interact with people from all cultures.
d. change the subject to one that is less emotionally disturbing.
ANS: B
Having the patient speak in specifics rather than globally helps the nurse understand the patients perspective. This approach helps the nurse engage the patient.

DIF: Cognitive Level: Application (Applying) REF: Pages: 127-129
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

13. A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem; however, after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario?
a. The patients eye contact should have been directly addressed by role-playing to increase comfort with eye contact.
b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient.
c. The patients poor eye contact is indicative of anger and hostility that remain unaddressed.
d. The nurse should have assessed the patients culture before making this diagnosis and plan.
ANS: D
The amount of eye contact in which a person engages is often culturally determined. In some cultures, eye contact is considered insolent, whereas in other cultures, eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 127-129
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

14. When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is homosexual. Which alternative is a more accurate assessment?
a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures.
b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
d. The nurse is homophobic.
ANS: A
The most likely answer is that the patients behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

DIF: Cognitive Level: Application (Applying) REF: Pages: 127-129
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. A Puerto RicanAmerican patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient:
a. likely has a histrionic personality disorder.
b. believes dramatic body language is sexually appealing.
c. wishes to impress staff with the degree of emotional pain.
d. belongs to a culture in which dramatic body language is the norm.
ANS: D
Members of Hispanic-American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 128
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:
a. Youve turned the tables on me.
b. Nurses direct the interviews with patients.
c. Do not ask questions about my personal life.
d. The time we spend together is to discuss your concerns.
ANS: D
When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurses personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Saying Youve turned the tables on me states the fact but does not refocus the interview.

DIF: Cognitive Level: Application (Applying) REF: Pages: 121-122
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?
a. Nurses are responsible for breaking silences.
b. Patients withdraw if silences are prolonged.
c. Silence can provide meaningful moments for reflection.
d. Silence helps patients know that what they said is understood.
ANS: C
Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. Saying that patients withdraw during long silences or that silence helps patients know that they are understood are both inaccurate statements. Feedback helps patients know they have been understood.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 121
TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

18. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice:
a. is rarely helpful.
b. fosters independence.
c. lifts the burden of personal decision making.
d. helps the patient develop feelings of personal adequacy.
ANS: A
Giving advice fosters dependence on the nurse and interferes with the patients right to make personal decisions. Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 127
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

19. The relationship between a nurse and patient as it relates to status and power is best described by which term?
a. Symmetric
b. Complementary
c. Incongruent
d. Paralinguistic
ANS: B
When a difference in power exists, as between a student and teacher or between a nurse and patient, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 119
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. A patient with severe depression states, God is punishing me for my past sins. What is the nurses best response?
a. Why do you think that?
b. You sound very upset about this.
c. You believe God is punishing you for your sins?
d. If you feel this way, you should talk to a member of your clergy.
ANS: B
The nurse reflects on the patients comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic.

DIF: Cognitive Level: Application (Applying) REF: Pages: 124-125
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. A patient cries as the nurse explores the patients relationship with a deceased parent. The patient says, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse will 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 parent is very painful for you.
d. Crying is a way of expressing the hurt youre experiencing.
e. Lets talk about something else because this subject is upsetting you.
ANS: B, C, D
Reflecting (I can see that you feel sad or This is very painful for you) and giving information (Crying is a way of expressing hurt) are therapeutic techniques. Why questions often imply criticism or seem intrusive or judgmental, and they are difficult to answer. Changing the subject is a barrier to communication.

DIF: Cognitive Level: Application (Applying) REF: Pages: 124-125
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. Which benefits are most associated with the use of telehealth? Select all that apply.
a. Cost savings for patients
b. Maximization of care management
c. Access to services for patients in rural areas
d. Prompt reimbursement by third-party payers
e. Rapid development of trusting relationships with patients
ANS: A, B, C
Use of telehealth technologies has shown that it can maximize health and improve disease management skills and confidence with the disease process. Many rural patients have felt disconnected from services; telehealth technologies can solve these problems. Although telehealths improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth is not associated with rapid development of trusting relationships.

DIF: Cognitive Level: Comprehension (Understanding) REF: Pages: 129-130
TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

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