A mother rescues two of her four children from a house fire. In the emergency department, she cries, “I should have gone back in to get them. I should have died, not them.” What is the nurse’s best response?
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Solution
“You’re feeling guilty because you weren’t able to save your children.”
The best response by the nurse is, “You’re experiencing feelings of guilt because you weren’t able to save your children.” This response utilizes the therapeutic communication technique of reflection which identifies a client’s emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
Which of the following individuals are communicating a message? (Select all that apply.)
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Solution
Answer: A, B, C, D
The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.
A client slammed a door on the unit several times. The nurse responds, “You seem angry.” The client states, “I’m not angry.” What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating?
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Solution
Verbalizing the implied and the defense mechanism of denial
This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.
Which nursing statement is a good example of the therapeutic communication technique of offering self?
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Solution
“Would you like me to accompany you to your electroconvulsive therapy treatment?”
This is an example of the therapeutic communication technique of offering self. Offering self-makes the nurse available on an unconditional basis, increasing client’s feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.
Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations?
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Solution
“I understand that the voices seem real to you, but I do not hear any voices.”
This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.
A client states, “You won’t believe what my husband said to me during visiting hours. He has no right treating me that way.” Which nursing response would best assess the situation that occurred?
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Solution
“Describe what happened during your time with your husband.”
This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?
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Solution
“Can you tell me why you said that?”
This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking “why” a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.
A client on an in-patient psychiatric unit tells the nurse, “I should have died because I am totally worthless.” In order to encourage the client to continue talking about feelings, which should be the nurse’s initial response?
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Solution
“You’ve been feeling sad and alone for some time now?”
This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.
During a nurse-client interaction, which nursing statement may belittle the client’s feelings and concerns?
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Solution
“Don’t worry. Everything will be alright.”
This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client’s discomfort. Thus a lack of empathy and understanding may be conveyed.
After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, “You are incompetent!” Which is the nurse’s best response?
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Solution
“I see that you are upset, but I feel uncomfortable when you swear at me.”
This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.