Chapter 09: Communication and the Clinical Interview My Nursing Test Banks

Chapter 09: Communication and the Clinical Interview

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 response should the nurse use to clarify the patients comment?

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 you feel as though you did not get enough quality sleep last night?

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 non-therapeutic technique. The other responses fail to clarify the meaning of the patients comment.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: 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 non-therapeutic. 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

3. The patient says, My marriage is just great. My spouse and I always agree. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patients communication is:

a.

clear.

c.

precise.

b.

mixed.

d.

inadequate.

ANS: B

Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patients verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 150-151 TOP: Nursing Process: Assessment

MSC: Client Needs: 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 to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and non-therapeutic. The other incorrect response is therapeutic but is an example of offering hope.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

5. Which technique will best communicate to a patient that the nurse is interested in listening?

a.

Restating a feeling or thought the patient has expressed.

b.

Asking a direct question, such as Did you feel angry?

c.

Making a judgment about the patients problem.

d.

Saying, 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. Close-ended questions such as Did you feel angry? ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patients words, the patient has no way of measuring the understanding.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: 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 . . .

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

7. A patient tells the nurse, I dont think Ill 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 non-therapeutic 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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: 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.

The patient is giving positive feedback about the nurses communication techniques.

b.

The nurse is viewing the patients behavior through a cultural filter.

c.

The patients verbal and nonverbal messages are incongruent.

d.

The 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 because a cultural filter determines what we will pay attention to and what we will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 150-151 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

9. While talking with a patient diagnosed with major 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

c.

A cultural barrier

b.

A message filter

d.

Social skills

ANS: A

Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patients social skills or whether a cultural barrier exists.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 150-152 TOP: Nursing Process: Assessment

MSC: Client Needs: 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. Psychiatric patients 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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 150 (Table 9-1) | Page 158-159 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

11. During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.

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.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 153-154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

12. A black patient says to a white 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 will help the nurse understand the patients perspective. This approach will help the nurse engage the patient. Reassurance and changing the subject are not therapeutic techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) | Page 158-159

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

13. A Filipino American patient had a nursing diagnosis of 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, but 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 were unaddressed.

d.

The nurse should have assessed the patients culture before making this diagnosis and plan.

ANS: D

The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 158-159 TOP: Nursing Process: Evaluation

MSC: Client Needs: 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. Which analysis is most accurate?

a.

The patient is accustomed to touch during conversation, 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 patient is trying to manipulate the nurse using nonverbal techniques.

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 150 (Table 9-1) | Page 159-160

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

15. A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient:

a.

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.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 150 (Table 9-1) | Page 159-160

TOP: Nursing Process: Assessment MSC: Client Needs: 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.

Why do you keep asking about 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. Why questions are probing and non-therapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

a.

A nurse is 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 was 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. It is inaccurate to say that patients withdraw during long silences or that silence helps patients know that they are understood. Feedback helps patients know they have been understood.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 151-154 (Table 9-2) TOP: Nursing Process: Planning

MSC: Client Needs: 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. It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 156 (Table 9-3) | Page 157-158

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

19. A school age child tells the school nurse, Other kids call me mean names and will not sit with me at lunch. Nobody likes me. Select the nurses most therapeutic response.

a.

Just ignore them and they will leave you alone.

b.

You should make friends with other children.

c.

Call them names if they do that to you.

d.

Tell me more about how you feel.

ANS: D

The correct response uses exploring, a therapeutic technique. The distracters give advice, a non-therapeutic technique.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 153-154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

20. A patient with acute depression states, God is punishing me for my past sins. What is the nurses most therapeutic response?

a.

You sound very upset about this.

b.

God always forgives us for our sins.

c.

Why do you think you are being punished?

d.

If you feel this way, you should talk to your minister.

ANS: A

The nurse reflects 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 non-therapeutic.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 153-154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. A patient cries as the nurse explores the patients feelings about the death of a close friend. The patient sobs, I shouldnt 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 a close friend is very painful for you.

d.

Crying is a way of expressing the hurt you are 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, 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. They are difficult to answer. Changing the subject is a barrier to communication.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154 (Table 9-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

2. Which benefits are most associated with use of telehealth technologies? Select all that apply.

a.

Cost savings for patients

b.

Maximize 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

Telehealth has shown it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those 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 technologies have not shown rapid development of trusting relationships.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 159-160 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

3. Which comments by a nurse demonstrate use of therapeutic communication techniques? Select all that apply.

a.

Why do you think these events have happened to you?

b.

There are people with problems much worse than yours.

c.

Im glad you were able to tell me how you felt about your loss.

d.

I noticed your hands trembling when you told me about your accident.

e.

You look very nice today. Im proud you took more time with your appearance.

ANS: C, D

The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate minimizing feelings, probing, and giving approval, which are non-therapeutic techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154-155 (Table 9-2) | Page 156 (Table 9-3)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

4. A nurse is interacting with patients in a psychiatric unit. Which statements reflect use of therapeutic communication? Select all that apply.

a.

Tell me more about that situation.

b.

Lets talk about something else.

c.

I notice you are pacing a lot.

d.

Ill stay with you a while.

e.

Why did you do that?

ANS: A, C, D

The correct responses demonstrate use of the therapeutic techniques making an observation and showing empathy. The incorrect responses demonstrate changing the subject and probing, which are non-therapeutic techniques.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 154-155 (Table 9-2) | Page 156 (Table 9-3)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

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