Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 6

Type: MCMA

Which of the following interventions are used by the nurse to demonstrate active listening?

Standard Text: Select all that apply.

1. Using silence

2. Covering ones mouth when yawning

3. Leaning in toward the client

4. Nodding ones head in response to clients verbal comments

5. Rocking back and forth in the chair

Correct Answer: 3,4

Rationale 1: Using silence. Using silence is a therapeutic communication technique, but not used to communicate active listening.

Rationale 2: Covering ones mouth when yawning. Covering the mouth when yawning is good manners, but does not communicate active listening.

Rationale 3: Leaning in toward the client. Leaning in is an intervention that communicates one is listening.

Rationale 4: Nodding ones head in response to clients verbal comments. Nodding ones head to a clients verbal response communicates that one is listening.

Rationale 5: Rocking back and forth in the chair. Rocking back and forth in the chair is viewed as a distraction and does not communicate openness.

Global Rationale:

Cognitive Level: Applying

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 7

Type: MCSA

During a group session, the clients are asked to make one positive statement about their home life. The nurse notices that one of the clients begins to fidget in the chair and interprets this behavior as:

1. A form of nonlanguage vocalization.

2. A therapeutic use of space.

3. An expression of discomfort.

4. An excuse to avoid answering the question.

Correct Answer: 3

Rationale 1: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away. Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 2: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away. Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 3: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away. Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Rationale 4: Behavior such as fidgeting communicates an expression of discomfort; the source of the discomfort may be physical or psychological. An example of the therapeutic use of space would be to use the fidgeting as a stimulus, motivating another individual to increase the distance from the client or move away. Fidgeting is a form of body movement or kinesic communication; nonlanguage vocalizations are noises without linguistic structure. Fidgeting is a nonverbal response to a question; there is not enough data to identify if the client is trying to avoid the question; the nurse would need to engage in verbal communication to help the client identify that he or she is avoiding answering the question.

Global Rationale:

Cognitive Level: Evaluating

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 8

Type: MCSA

During a group session, a client expresses anger at the nurse. The nurse sits tensely with arms and legs crossed while verbally agreeing that the clients point of view is correct. Which of the following messages is being sent by the nurse?

1. The nurse is expressing warmth toward the client

2. The nurse is being patient

3. The nurse is demonstrating empathy

4. The nurse is sending a mixed message

Correct Answer: 4

Rationale 1: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 2: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 3: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Rationale 4: The nurses nonverbal communication is incongruent with the verbal message; the closed body position conflicts with the open verbal statements. Because nonverbal cues help people judge the reliability of verbal messages, the incongruence between the nurses verbal and nonverbal communication may confuse the client. Patience, warmth, and empathy are positive messages that are typically expressed by using open body language.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 9

Type: MCSA

The nurse observed that during a teaching session, the overall emotional tone of a client remained unchanged. The nurse documents this as:

1. Affect that has range.

2. Flat affect.

3. Incongruent verbal and nonverbal responses.

4. Muted behavior.

Correct Answer: 2

Rationale 1: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 2: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 3: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Rationale 4: Affect refers to the clients overall emotional tone. Flat affect is used to describe a lack of emotional tone. A client with an affect that has range is interpreted as the client demonstrating a variety of emotions. Muted behavior refers to a client who does not speak or make verbal responses. Incongruent behavior indicates the clients verbal behavior is not correlating with nonverbal behavioral responses.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain why nonverbal communication is important in interpersonal relationships.

Question 10

Type: MCSA

The nurse is working with a teen admitted with a diagnosis of depression. Which of the following interventions demonstrates that the nurse is sensitive to the clients needs?

1. Avoiding the use of silence to decrease anxiety

2. Asking for details to demonstrate interest in the client

3. Using closed-ended questions

4. Listening to the clients feelings

Correct Answer: 4

Rationale 1: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 2: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 3: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Rationale 4: Listening to the clients feelings helps to communicate the clients value and is part of demonstrating sensitivity to the client. Closed-ended questions limit the quality of the clients responses, minimizing opportunity for the client to explore feelings or to develop insight. Avoiding the use of silence does not decrease anxiety, but is often a response to anxiety.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 11

Type: MCSA

A working goal for the nurseclient relationship is to achieve:

1. Facilitative intimacy.

2. Self-disclosure.

3. Interdependence.

4. Social superficiality.

Correct Answer: 1

Rationale 1: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves. Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 2: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves. Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 3: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves. Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Rationale 4: When the nurseclient relationship achieves facilitative intimacy, the relationship moves from the social realm to addressing meaningful areas of concern for the client. Social superficiality usually occurs at the beginning of a relationship. Self-disclosure occurs when the individuals share information about themselves. Social relationships are characterized by interdependence; in the nurseclient relationship, the desire is to move the client toward independence.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 12

Type: MCSA

During the first interaction with a client, the nurse makes an introduction and identifies the purpose of the interaction. This serves to accomplish which of the following in developing a trusting relationship?

1. Setting goals

3. Initiating

4. Maintaining

Correct Answer: 3

Rationale 1: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 2: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 3: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Rationale 4: The initiation phase occurs at the beginning of the relationship. Building occurs as participants establish mutual goals. The relationship is maintained as participants work together. Goals are established to provide direction and purpose.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 13

Type: MCSA

The nurse engaged in a therapeutic relationship with a client uses nonverbal communication to:

1. Enhance verbal messages.

2. Avoid the use of verbal messages.

3. Detract from verbal messages.

4. Terminate the therapeutic relationship.

Correct Answer: 1

Rationale 1: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 2: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 3: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Rationale 4: Nonverbal messages should enhance, not detract from verbal messages. Nonverbal communication is used to clarify or accentuate verbal messages, not to avoid their use. Nonverbal communication is not used to terminate a therapeutic relationship.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 14

Type: MCSA

A nurse acknowledges feeling anxious about meeting new people. By acknowledging feelings to the client, the nurse is demonstrating:

1. Sympathy.

2. Genuineness.

3. Empathy.

4. Superficiality.

Correct Answer: 2

Rationale 1: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 2: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 3: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Rationale 4: The active component of genuineness requires one to be honest with another; an example of this is the nurse acknowledging feelings of anxiety to a client.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Identify the principles of therapeutic communication and explain why they are essential ingredients of interpersonal relationships.

Question 15

Type: MCSA

Psychiatricmental health nursing interventions occur at which of the following levels of communication?

Correct Answer: 3

Rationale 1: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 2: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 3: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Rationale 4: Psychiatricmental health nursing interventions primarily occur at the interpersonal level. The interpersonal level refers to one person communicating with another. Intrapersonal communication occurs when one communicates with oneself. Public communication occurs when communicating with large numbers of people. International communication is a form of public communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 16

Type: MCSA

In planning care for a client who is gaining mental stability, the nurse develops measures to confirm the clients view of self. Which of the following responses made by the nurse would be categorized as disturbed communication?

1. I do not understand what you are telling me.

2. You are wrong.

3. How might you go about that differently?

4. Do you want to try that again?

Correct Answer: 2

Rationale 1: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual. Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 2: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual. Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 3: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual. Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Rationale 4: Telling clients that they are wrong is an example of rejection. Communication that rejects the others sense of self creates a disturbance in communication and can affect the relationship. Indicating that the nurse does not understand what is being said communicates information about the message, not the individual. Asking if the client wants to try again provides the client with control. Asking how the client might do something differently encourages the client to develop another plan, focusing on the action and not the individual.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 17

Type: MCSA

Which of the following communication theories provides the most appropriate rationale for a nursing intervention to utilize the perceived strengths of the client in promoting effective communication?

1. Behavioral Effects and Human Communication Theory

2. Neurolinguistic Programming Theory

3. Theory of Communication Levels

4. Therapeutic Communication Theory

Correct Answer: 4

Rationale 1: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 2: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 3: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Rationale 4: Therapeutic Communication Theory (TCT) includes all the processes by which one human being influences another, taking into account the perceptions and interpretations that influence one persons view of the other.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 18

Type: MCSA

Which of the following is not related to the theory of successful versus disturbed communication patterns during an admission assessment?

1. The appropriateness of the content of the message.

2. The quality of the feedback provided.

3. The language level of the assessment nurse.

4. How efficiently the client delivers a message.

Correct Answer: 3

Rationale 1: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 2: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 3: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Rationale 4: During the assessment, the nurse is attending to the clients response; therefore, the language level of the nurse is not relative. The language level used by the nurse is a stimulus for the response of the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 19

Type: MCSA

A client asks the nurse about the doctors comment that he may have problems due to delayed synaptic transmission in his brain. The nurse explains that the best way to describe a synaptic transmission is which of the following?

1. An electrochemical process called neurotransmission

2. Where the axon is released

3. When the receptors bind to neurons

4. The space where neurotransmitters match up with receptors

Correct Answer: 1

Rationale 1: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 2: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 3: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Rationale 4: In the Neurobiologic Factor Model, the neurons of the brain are responsible for information processing. Neurotransmission is the electrochemical process that explains how the messages move through the communication circuit. Neurotransmission is a process, not a space where the transmitters match up, when receptors bind to neurons, or where the axon is released.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Formulate a strategy for improving your personal ability to communicate therapeutically.

Question 20

Type: MCSA

A client is admitted to the psychiatric unit exhibiting behaviors indicating a high level of anxiety following a personal crisis. Which of the following communication skills should the nurse utilize when interacting with this client?

1. Closed-ended questions

2. Providing reassurance

3. Open-ended questions

4. Providing the client with advice

Correct Answer: 1

Rationale 1: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 2: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 3: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Rationale 4: Closed-ended questions are indicated at this point in time. When communicating with a client in a state of high anxiety, the nurse utilizes communication techniques that do not require the client to engage in reflection or problem solving, as this will cause more anxiety. Open-ended questions will be appropriate once the client is more stable. Providing reassurance and providing advice are not therapeutic in this situation.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 21

Type: MCSA

During a nurseclient interaction, the client tells the nurse, I dont think I can deal with feeling so sad much longer. The nurses best response is which of the following?

1. Is there a history of depression in your family?

2. We all have times of sadness.

3. Are you saying you feel sad?

4. Tell me about your feelings of sadness.

Correct Answer: 4

Rationale 1: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 2: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 3: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Rationale 4: The nurse is using the therapeutic communication technique of encouraging the client to explore feelings when asking the client to talk about the feelings of sadness. The technique of reflecting You feel sad? is therapeutic, but the better response is to encourage the client to explore the feelings about being sad to facilitate developing insight. Restating at this point would prompt a closed-ended response by focusing on the content (sad), as opposed to focusing on the behavior or feelings (sadness). Asking about the clients history provides the client with an opportunity to shift the focus from the feelings to providing information about the clients family; the nurse should review the clients history prior to the interaction. Suggesting that we all have times of sadness discounts the clients feelings.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 22

Type: MCSA

While reviewing therapeutic communication techniques, a nursing student made a list of things not to do or say to a client. Which of the following comments should be on the students list?

1. How do you feel about being discharged today?

2. What happened when you quit taking your medications?

3. What are your concerns about your living situation?

4. Why do you think you will never get well?

Correct Answer: 4

Rationale 1: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 2: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 3: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Rationale 4: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. Asking the client Why do you think you will never get well? is an example of requesting an explanation, which is not therapeutic and requires the client to defend his or her actions. Asking how the client feels about being discharged, what happened when medication was discontinued, or concerns about the clients living situation are examples of therapeutic communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 23

Type: MCSA

A client states, I just know my brother will not come back from the war. Which of the following examples would be used to encourage the client to explore this concern?

1. Maybe he will be one of the lucky ones.

2. How do you know this?

3. Where is your brother going?

4. What do you feel will happen to him?

Correct Answer: 4

Rationale 1: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 2: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 3: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Rationale 4: Therapeutic communication skills are used to foster the nurseclient relationship in the psychiatricmental health setting. It is therapeutic at this point to encourage the client to explore feelings. Asking where the brother is going is not therapeutic as this question prompts an informational response as opposed to encouraging the client to explore feelings about the situation. Stating the brother may be one of the lucky ones is an example of a stereotypical comment that closes the communication loop. Asking how the client knows the brother will not return is an example of requesting an explanation, which is not therapeutic.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 24

Type: MCSA

Which of the following is an example of clarifying a clients verbal response?

1. Are you saying you feel the medicine is helping you?

2. See, the medicine does work.

3. I knew it would work; it just takes time.

4. Everything seems to work out eventually.

Correct Answer: 1

Rationale 1: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 2: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 3: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Rationale 4: Asking if the client thinks the medicine is helping is an example of clarifying, which is therapeutic. I knew it would work; it just takes time and Everything seems to work out eventually are examples of making stereotypical comments and do not provide the client with a sense that the nurse was listening. See, the medicine does work communicates a lack of trust and is not therapeutic.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 25

Type: MCSA

A delusional client walks up to the nurse and says, I am the appointed overseer. Who are you and why are you here? The most therapeutic response is which of the following?

1. I am your nurse and I will be here to help you until suppertime.

2. You dont know who I am?

3. You know who I am.

4. You are not the overseer; you are a client in the hospital.

Correct Answer: 1

Rationale 1: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 2: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 3: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Rationale 4: Responding with I am your nurse is an example of giving information; the nurse responds to the clients request without getting into a confrontation and conveys respect. The responses either asking if the client knows who the nurse is, or stating that the client knows the nurse are not therapeutic and may be perceived as challenging to the client. Stating that the client is not the overseer and reminding the client of inpatient status provides the client with information and presents reality, but the information does not provide the client with a response to the question, Who are you and why are you here?

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Employ the skills discussed here to foster relationships and communication in the psychiatricmental health setting.

Question 26

Type: MCSA

Which of the following interventions promotes mindful listening in any health care setting?

1. Telling the client to get off the phone

2. Encouraging the family to step outside before assessing the client

3. Turning off the television before interviewing a client

4. Asking clients what they would like to drink when taking medication

Correct Answer: 3

Rationale 1: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 2: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 3: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Rationale 4: Mindful listening is best accomplished when removing environmental distractions, such as turning off the television before interviewing a client. Asking clients what they would like to drink when taking medication and encouraging the family to step outside before assessing the client are examples of conveying respect. Telling the client to get off the phone is not a therapeutic intervention.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 27

Type: MCSA

In the immunization clinic, the nurse notices a client displaying tense body posture. Which of the following is the most therapeutic response for the nurse to make?

1. This wont hurt a bit.

2. You need to relax.

3. I can tell youve had a bad experience before.

4. I notice you are clenching your fists.

Correct Answer: 4

Rationale 1: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance. Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 2: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance. Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 3: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance. Directing the client to relax is a form of giving advice, which is not therapeutic.

Rationale 4: The nurses observation about clenched fists is a therapeutic intervention, which conveys the nurse is attending to the nonverbal cues of the client. Making an assumption that the client has had a bad experience before is not therapeutic. Telling the client that the immunization will not hurt is offering false reassurance. Directing the client to relax is a form of giving advice, which is not therapeutic.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 28

Type: MCSA

The nurse gathering data from a client admitted to labor and delivery is overheard making the comment, You are lying. You need to tell me the truth so we can do what is best for your baby. The nurses communication is:

1. A perception check.

2. Nontherapeutic.

3. Necessary.

Correct Answer: 2

Rationale 1: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 2: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 3: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Rationale 4: During admission, the nurse should engage in active listening. This nurse is making an accusatory statement that is nontherapeutic, unnecessary, and will result in a defensive response from the client. This is not a perception check; a perception check provides the client with the opportunity to correct inaccurate perceptions.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 29

Type: MCSA

When considering communication skills, the nurse caring for an older client anticipates that the client will:

1. Interrupt frequently.

2. Take longer to respond.

3. Answer questions with one-word responses.

4. Remain silent.

Correct Answer: 2

Rationale 1: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 2: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 3: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Rationale 4: Elder clients may take longer to respond due to cognitive and neurological delays. The client manifesting muted communication is more likely to respond using one-word responses or remain silent. Elder clients may or may not interrupt or remain silent.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: Explain how the skills discussed here foster relating and communicating in any health care setting.

Question 30

Type: MCSA

The nurse is admitting a client from the emergency room. Which of the following would be used to clarify the nurses understanding of the clients chief complaint?

1. If you are bleeding, where is the blood?

2. I feel your pain when I see you hold your side.

3. Are you saying you feel that you are bleeding inside?

4. Dont worry; we have the technology to take care of you.

Correct Answer: 3

Rationale 1: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic. Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint. Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 2: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic. Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint. Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 3: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic. Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint. Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Rationale 4: Asking if the client feels there is internal bleeding seeks to clarify the clients complaint. Telling the client not to worry is an example of minimizing, it discounts the clients feelings, and is not therapeutic. Stating that the nurse feels the clients pain may be therapeutic but does not clarify the clients complaint.

Demanding that the client show the blood is a form of challenging which may put the client on the defensive and does not clarify the clients complaint.

Chapter 6. Eye Movement Desensitization and Reprocessing Therapy

Question 1

Type: MCSA

What is the history of EMDR?

Global Rationale:

EMDR has created by Francine Shapiro PhD, discovered that moving her eyes in certain directions reduced emotional tension. Francine did further investigation into this phenomenon making EMDR the subject of her doctoral thesis in 1987. Integrating her clinical experience, Francine has formulated a unique method which she calls EMDR.

Question 2

Type: MCSA

Who can benefit from EMDR?

Global Rationale:

Anyone who has ever experienced an upset that they have not recovered from. Often these people have one or more of the following symptoms in varying degrees: feeling “stuck”, excess stress/tension, depression, anxiety, restlessness, sleep trouble, fatigue, appetite disturbances, and ongoing physical health concerns despite treatment. In the more severe cases: panic attacks, flashbacks, nightmares, obsessions, compulsions, eating disorder, and suicidal tendencies.

Question 3

Type: MCSA

How does EMDR treatment work?

Global Rationale:

When an upset is experienced, it can become locked in the nervous system with the original picture, sounds, thoughts, feelings, and body sensations. This upset is stored in the brain (and also the body) in an isolated memory network preventing learning from taking place. Old material just keeps getting triggered over & over again and you end up feeling “stuck” emotionally. In another part of your brain, in a separate network, is most of the information you need to resolve the upset. It’s just prevented from linking up to the old stuff. Once processing starts with EMDR, the 2 networks can link up. New information can then come to mind to resolve the old problems.

Question 4

Type: MCSA

How effective is EMDR?

Global Rationale:

When compared to other methods of therapy (psychoanalysis, cognitive, behavioral, etc), EMDR has been rated as far more effective by mental health professionals. Clients experience emotional healing at an accelerated rate. If we use the metaphor of a driving a car through a tunnel to get to the other side, (where the tunnel represents the journey of healing and the other side of the tunnel represents the healed state), EMDR is like driving your car through the tunnel at very high speeds. Because of this accelerated processing, you should notice improvement within each session.

Question 5

Type: MCSA

Global Rationale:

How does the overall treatment with EMDR look?

EMDR focuses first on the past, second on the present and third on the future. The past is focused on first because it is the past unresolved pain (whether it is childhood or the more recent past) which is causing pain in the present. Dealing with the past is therefore going to the root of the problem. For example, if a client comes in with depression and she has a history of being depressed since a death in her family, we would focus on the time around the death first because it is the root of the depression. To only focus on the symptoms of the depression in the present would be like taking an aspirin for a headache caused by a brain tumor rather than working with the brain tumor.

Chapter 7. Motivational Interviewing

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 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.

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.

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?

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.

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. b. mixed.

ANS: B c. precise. d. inadequate. 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.

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.

4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self.

ANS: D 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.

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.

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

ANS: A 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.

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.

6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

ANS: C 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.

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.

7. A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most therapeutic response.

ANS: C 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.

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.

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?

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. a. Nonverbal communication b. A message filter

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?

ANS: A c. A cultural barrier d. Social skills 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.

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.

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.

ANS: B 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.

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.

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.

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.

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 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.

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.

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?

ANS: D 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.

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.

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?

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.

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.

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 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.

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.

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

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.

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 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.

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.

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.

ANS: D 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.

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

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

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.

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 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

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.

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

ANS: A, B, C 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.

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.

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

ANS: C, D 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?

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.

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

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.

Chapter 8. Cognitive Behavioral Therapy

Multiple Choice

1. Which intervention best reflects the nursing role regarding effective implementation of behavioral therapy goals?

a. Administering the prescribed medications accurately b. Interacting effectively with members of the health care team c. Being aware of all the patient related therapeutic modalities d. Evaluating patient behaviors to reward economic tokens appropriately

ANS: D

The primary role of the nurse who is involved in behavioral therapy is to assess and identify the patients problem behaviors in collaboration with the multidisciplinary team. A token economy is a system of behavior reinforcements in which patients earn tokens by performing predetermined desired behaviors. The remaining options are generalized responsibilities that are relevant to any therapy format.

2. A new nurse asks the mentor, How can I be sure Im developing a therapeutic environment for my unit? The mentor uses as a basis for the response the fact that a therapeutic milieu is characterized by: a. Rigid adherence to timelines and unit routine b. Relaxation of boundaries when doing so is accepted by all c. The focus of the staff is directed to the most critically disturbed patients d. Specific patient-centered goals are established mutually by patient and staff

ANS: D

Factors that determine the therapeutic effectiveness of the social environment includes the presence of two-way communication between the patients and the members of the multidisciplinary team for purposes of goal setting. In a therapeutic relationship, boundaries are established early and maintained throughout and although adherence to routine is important, there is room for adjustment when it benefits the therapeutic nature of the milieu. Although short-term attention may require focus on the patient in crisis, attention of the staff is equally shared.

3. To plan care for a patient with a psychiatric disorder, the nurse keeps in mind that the primary nursing role related to therapeutic activities is: a. Assisting the patient in accomplishing the activity b. Ensuring that the patient will comply with the rules of the activity c. Ensuring that the patient can accomplish the activity in a timely manner d. Providing a support system for the patient if they fail to complete the activity

ANS: A a. Boundaries define responsibilities and duties to ones self in relation to others. b. Boundaries determine objectives of the various working stage of the relationship. c. Boundaries differentiate the assumed roles of both the nurse and of the patient. d. Boundaries prevent undesired material from emerging during the interaction.

The nurses role in therapeutic activities is that of a professional observer and participant who works with the therapist to enhance the patients capabilities and functioning within the parameters of the assigned activity. Assuring accomplishment, compliance, or providing failure support are not nursing roles.

4. Which statement would the nurse use to describe the primary purpose of boundaries?

ANS: A a. Responding positively to the patients demands b. Following through with whatever was promised c. Clarifying with the patient whenever there is doubt d. Staying available to the patient for the entire shift

Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve to define the responsibilities and duties of the nurse in relation to the patient. Objectives and roles are determined during the orientation stage. Emergence of undesired material may be a significant issue for the patient.

5. Which action will best facilitate the development of trust between a nurse and patient?

ANS: B a. Ill work with your doctor to help you get better. b. Ill be working with you to help solve your marital troubles. c. Your medications will help you feel better as soon as they take effect. d. You will be expected to attend the group activities while you are here.

Being consistent in keeping ones word implies that the nurse is trustworthy and does what is agreed upon. Being responsive to demands may not be therapeutic. Instead, the patient will need to learn new techniques for meeting needs. Clarification is important but is not the best method for promoting trust. Trust is better served by shorter contacts at agreed-upon intervals.

6. Which statement best defines the nurses initial role as the patients source of help in addressing interpersonal problems?

ANS: B

This statement clearly specifies the nurses purpose as a helping professional, and establishes the relationship as therapeutic, rather than social. The nurse has independent functions and does not work exclusively with the doctor. Identifying only medication overlooks the contributions of staff and the therapeutic milieu. Giving information is appropriate, but this statement does not define the nurses role as resource.

7. The nurse is determining whether the patients needs could be best met in a task or a process group. The decision is based on the understanding that a task group focuses on: a. Content issues b. The here and now c. Communication styles d. Relations among the members

ANS: A

Content-oriented groups focus on goals and tasks of the group. Thus a task-oriented group would focus on content issues. Process groups focus on interpersonal relationships. Communication styles are not relevant to describing task-oriented groups. Here and now refers to dealing with issues that are taking place at the present time.

8. The treatment team was engaged in planning how group therapy could be included as a part of the structured daily activities of the unit. A new team member asked, Why is it so important to include group therapy for the patients? The most accurate response would be based on the assumption that: a. Hidden agendas frequently surface in group sessions. b. Some persons do not relate well on an individual basis. c. Group therapy is far more cost-effective for the patients. d. Psychopathology has its source in disordered relationships.

ANS: D a. Patient A, who states he realizes he is not the only person who has a problem with loneliness b. Patient B, who displays dysfunctional interaction patterns learned in his family of origin c. Patient C, who states he finally feels a strong sense of belonging d. Patient D, who openly expresses his anger about his work

A key assumption of group therapy is that psychopathology has its source in disordered relationships. It follows that individuals will behave in the group as they do in other settings, so group provides an opportunity to help individuals develop more functional relationships. Ability to relate is not relevant to group work. It is dealt with in one-to-one therapy. Hidden agenda is not a reason to offer group therapy. Cost-effectiveness is not an assumption about the reason group therapy is effective.

9. Which patient would the group co-leaders determine is demonstrating Yaloms therapeutic factor termed universality?

ANS: A a. Attempting to manipulate others b. Mediating conflicts and disagreements c. Criticizing the contributions of others d. Seeking a position between contending sides

Universality is the factor that refers to understanding that one is not unique, that others share thoughts, reactions, and discomforts like your own. Dysfunctional interaction refers to corrective recapitulation of the family group. A strong sense of belonging provides an example of cohesiveness. Display of anger is an example of catharsis.

10. A nurse, leading an inpatient group dealing with womens issues, identifies a patient who is assuming the role of aggressor. Which behavior characterizes this role?

ANS: C a. My dad has finally stopped giving me advice on how to live my life. b. I stopped playing football since practice required me to be away from home so often. c. Since my mother quit her job, she is more available to keep the home running smoothly. d. Eating dinner with my parents on Sunday nights has helped us be more aware of each others needs.

An aggressor acts in negative ways, displaying hostility, attacking the group, or criticizing the members. Seeking a position between contending sides describes the compromiser. Mediating conflicts and disagreements describes the harmonizer. Attempting to manipulate others describes the dominator.

11. Which statement by a 16-year-old is considered as positive evidence that the familys involvement in therapy is moving them towards effective functioning?

ANS: D a. Im so sorry. I didnt realize your family was a problem for you. b. Learning to express negative feelings will assist you in getting well. c. Perhaps you can talk about your feelings to the physician next time you meet. d. That seems to be a difficult subject for you. We can discuss when you are ready.

This statement shows the family has made an effort to improve communication and deal with alienation without any one member bearing complete responsibility. Withdrawing from the team suggests he felt solely responsible for the family problem. Quitting the job suggests the mother saw herself as responsible; however, being home does not guarantee unification. A lack of advisement suggests withdrawal of the father from participation in family matters.

12. In response to the nurses statement, Tell me about your family, the patient became silent and displayed nonverbally that he is uncomfortable. Which statement by the nurse reflects sensitivity to the patient?

ANS: D a. It indicates regression and her lack of readiness to terminate. b. Unconsciously, she is hoping she will be permitted to continue the group. c. She is demonstrating normal feelings associated with termination of therapy. d. She needs further evaluation by her therapist to determine readiness to terminate.

This response acknowledges the situation, is respectful, and allows the patient to choose when to refocus the therapeutic interaction. Referring to the family as a problem is not sensitively worded. Offering false reassurance implies that feelings are negative. Suggesting postponing the discussion represents avoidance of dealing with the patients feelings.

13. When sharing her feelings about separating from a therapy group, the patient stated, I feel a bit sad and empty that I wont be seeing you folks again. What is the most accurate evaluation of the patients statement?

ANS: C a. Encouraging the patient to report the incident to the other patients physician b. Intervening on the patients behalf and sorting out the incident with the other patient c. Suggesting that the patient ignore the situation since the other patient was probably not aware of her behavior d. Offering to be present and help the patient discusses her feelings about the incident with the other patient

The patient is expressing feelings of sadness over the loss of the therapeutic group relationships that have been helpful to her. Such feelings are considered normal, just as they are considered normal when the nurse-patient relationship terminates. The feelings expressed are normal, not regressive. No hidden meaning is present; the patient openly expressed genuine feelings. Further evaluation is not needed.

14. A patient asks the nurse manager to help resolve a situation between her and another patient. Which action would best support the patients feelings of safety when experimenting with new ways of being?

ANS: D

Offering to be with the patient affords her a safe nonthreatening opportunity to assume responsibility for meeting her own needs assertively by encouraging skills that affect positive communication. Intervening removes the responsibility from the patient. Ignoring supports passive behavior. There is no need to bring in another person. The patient is capable of addressing the problem herself.

15. A patient tells the nurse, I really like you. Youre the only true friend I have. The patients remarks call for the nurse to revisit the issue of: a. Trust b. Safety c. Boundaries d. Countertransference

ANS: C

The patients remarks call for the nurse to remind the patient of the parameters of the nurse-patient relationship. The remark would also give the nurse the opening to go on to discuss the matter of friendship. The patients remarks do not suggest the need to deal with trust, safety, or countertransference.

16. By the end of the orientation phase, which outcome can be identified for a newly admitted patient? The patient will demonstrate: a. Ability to problem solve one issue b. Trust in at least one nurse on the unit c. Positive transference with a staff member d. Ability to ask for help in meeting needs

ANS: B a. Nurse-patient roles have not been clearly delineated. b. The nurse should suggest several alternative behaviors. c. The patient must be able to manage emotions before continuing. d. The relationship is moving from orientation to working phase.

Establishing trust in the nurse is a fundamental task of the orientation phase of the relationship; thus it is an appropriate outcome to identify. When trust is present, the patient is free to focus on the work and tasks of therapy. The ability to problem solve is an outcome appropriate for the working phase. Positive transference would not be an identified outcome. The ability to ask for help would not be an identified outcome for the orientation phase.

17. The patient and the nurse have agreed on problems to be addressed during a short course of outpatient therapy. At the beginning of the appointment, the patient states, Id like to work on the issue of relationships today. Which assessment can be made?

ANS: D

Once the patient and nurse have collaborated to define and prioritize problems, the relationship moves from orientation to working phase. The remaining options have no relevance to the scenario since there is no reference to roles, alternative behaviors, or managing behaviors.

18. A nurse and patient are entering the termination phase in the group experience. An important nursing intervention will be to: a. Encourage the group to describe goals for change. b. Inquire whether the group needs more time to accomplish goals. c. Assist the group to explore alternative coping strategies for problems. d. Discuss feelings about leaving the group and the support found with the group.

ANS: D

Healthy termination is facilitated when the group and nurse express reactions to termination. The nurse serves as a role model by being open and genuine as the feelings about the losses incurred with ending are discussed. On a positive note, accomplishments and growth are acknowledged and the transfer of safety and trust to the group members is accomplished. Describing goals is accomplished in the orientation phase. Accomplishing goals is part of the working phase in a relationship that does not have a strict time limit. Exploring alternative coping strategies would be part of the working stage.

19. A patient attending group therapy mentions, In the beginning, I was so sick that everyone had to help me. For the last few days, its felt good to be able to give something back to the group. This statement can be assessed as an example of Yaloms factor of: a. Altruism b. Harmonizing c. Cohesiveness d. Imitative behavior

ANS: A

Altruism refers to the experience of being helpful to others and is clearly what the patient is displaying in the scenario. The other factors are not applicable.

20. During the first family therapy session, the mother of a child being treated for truancy and emotional outbursts asks the nurse, Why are you bothering to ask the rest of us questions? My son is the one with the problems. The best response for the nurse would be: a. Well get more accurate information if the entire family is involved. b. It may seem strange to you, but well get better results doing it this way. c. When one family member is sick, the whole family system is sick as well. d. Every family members perceptions are very important to the total picture.

ANS:

D

This response orients the family to the idea that each persons opinion will be valued. Having the family present for assessment prepares them for working together to identify family issues, identify outcomes, and solve problems. It may or may not be true that this will result in accurate information. Getting better results doesnt convey the real reason. Referring to the family as sick is pessimistic and conveys a threatening message.

21. A novice mental health nurse shares that, Ill never get used to playing cards or other games with patients. It seems like a poor use of scarce nursing time. The best response for the nurses mentor would be: a. Perhaps youll want to rethink your transfer to this unit if youre really uncomfortable. b. Your comments make a point about scarce resources. Ill ask the treatment team to review our position on activities. c. Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks. d. Managed care has cost us activities therapists. Activities are necessary to give patients something to do, so we have to fill in.

ANS: C

Nurses who engage in co-leadership of therapeutic activities recognize that each activity contributes to outcome attainment. During activities, patients practice skills needed in life situations, process emotions, and give and receive validation and feedback. Suggesting a rethink is not supportive of the nurse. The remaining options do not acknowledge the value of activities therapy.

22. What is the primary reason for the nurse to have an understanding of the various types of activity and adjunct therapies?

a. The nurse chooses the most cost-effective therapy group.

b. The nurse is expected to encourage patients involvement in the therapies.

c. The nurse is responsible for placing the patient in the appropriate group.

d. The nurse needs to be supportive of the treatment team members who direct these therapies.

ANS: B a. Psychodrama b. Music therapy c. Dance therapy d. Recreation

The nurse must interpret to patients and others that the purpose of activity therapies is to increase patient awareness of feelings and behaviors and to minimize pathology and promote mental health. Although they are important, supportiveness, encouragement, and economics are not the primary reason.

23. Which activity therapy should the nurse recommend to the treatment team to assist the patient to relieve tension and achieve increased body awareness?

ANS: C

The large movements involved in dance therapy would enable the patient to relieve tension and move with greater body awareness and freedom. The other options will not promote body awareness.

24. To effectively plan care for a patient, the nurse will understand that activity and adjunct therapies may be more useful in some situations than verbal therapies because adjunct therapies: a. Are readily available in the treatment setting b. Do not require specific training or expertise to facilitate c. Provide the patient the opportunity to use ego-protective mechanisms d. Allow the patient to express feelings on multiple levels at the same time

ANS: D a. Isolating him from more seriously ill patients b. Praising him for positive behavioral changes c. Avoiding setting limits that would increase his anxiety level d. Permitting him to make mistakes prior to intervening on his behalf

A patient is able to express feelings on the emotional, physical, and symbolic levels during activity therapy, whereas verbal therapies are limited to one dimension. The primary facilitator of the selected therapy is required to have formal education and supervised experience. Adjunct therapy does not provide this opportunity, which would be considered nontherapeutic. Treatment settings are not always readily available.

25. A patient is scheduled to attend an occupational therapy group to work on the identified goal of recognizing and using more effective coping techniques. What measure can the nurse use to continue to support the patients attainment of this goal after he returns to the unit?

ANS: B a. Offer to dance with the patient. b. Ask the patient if this is the first dance he has attended. c. Sit with the patient away from the group. d. Encourage another patient to ask him to dance.

Recognizing and pointing out positive changes provides encouragement to continue pursuing change. The remaining option would not achieve the nurses goal of supporting the patients use of effective coping techniques.

26. How can the nurse encourage an extremely shy patient to participate therapeutically in a dance activity group?

ANS: A

If trust has been established, the patient may feel safe enough to dance with the nurse. If trust has not yet been established, the patient will see the nurses invitation as demonstrating respect and reaching out to him. Either way, the action will encourage participation. The nurse should not make another patient responsible for this patients participation. The remaining options do not encourage participation.

27. When leading a therapeutic group, the nurse demonstrates an understanding of the need to act as the groups executive when: a. Restating rules when a new member joins b. Being available to orient the new members c. Helping a member defuse the anger they are experiencing d. Working with a member to help improve their communication skills

ANS: A

Executive functioning refers to monitoring and attending to group rules and procedures. Caring demonstrates expressions of kindness. Meaning attribution includes accepting of feelings, although emotional stimulation would reflect working communication skills.

28. When another patient serves as alter ego during an outpatient group session, the nurse documents that the group had been engaged in: a. Role-playing b. Psychodrama c. Cognitive therapy d. Consensus building

ANS: B a. Do you want to complete your painting? b. I see that you dont take this very seriously. c. Can you tell me what happened to prompt such work? d. Thank you. Ill put this away in a safe place for you.

Psychodrama uses spontaneous dramas to act out emotional problems to promote health through development of new perceptions, behaviors, and connections with others. Others in the group take the role of significant others. Role-playing and cognitive therapy do not use the technique of alter egos. Consensus building is not a form of therapy.

29. The nurse is collecting the paintings from the patients after the art session is over. After art therapy, a patient hands the nurse a paper that consists of several black scribbles. Which statement demonstrates the nurse understands the goals and objectives of the therapy?

ANS: D

Art therapy is used to help resolve conflicts and promote self-awareness. The nurse should not comment on the quality of the art or the patients talents, but rather treat the project with respect and value. The work is simply each patients self-expression. The other options make judgments about the work or the patients willingness to participate.

30. When asked, Why do you go to music therapy every morning at 10? The nurse explains that the nurses role in music therapy as: a. Fostering and encouraging performance talent b. Teaching patients about various styles of music c. Noting patient verbal and nonverbal expression of feelings d. Selecting and playing numbers that will reduce anxiety and stress

ANS: C

A goal of music therapy is to promote expression and social connection. The nurse should observe and document expression of feelings as they occur. The observations may be used later, as a basis for further consideration by the nurse and patient. The other options do not reflect aspects of the nurses role in music therapy.

31. When a novice nurse asks why the unit has a multidisciplinary approach to therapeutic activities, the nurse should explain that multidisciplinary collaboration: a. Produces a higher level of insurance reimbursement b. Reduces the incidence of aggressive behavior by patients c. Produces quicker results and earlier discharge to the community d. Produces better outcomes than when only one perspective is used

ANS: D

Broader input in problem identification and resolution enhances patient outcomes. The remaining options are either untrue or irrelevant.

32. When a patient asks the nurse, How can jolting me with an electrical shock possibly do me any good? the answer most reflective of current biologic theory would be: a. ECT must sound like a very frightening treatment alternative to you. b. ECT produces a change in brain chemistry that results in improved mood. c. ECT interrupts brain impulses that are causing hallucinations and delusions. d. ECT provides you with external punishment so you can stop punishing yourself.

ANS: B a. Ill be so glad when this treatment is over. b. Will I remember having this treatment? c. Did eating some crackers cause any problems? d. Im so tired of being depressed; I dont think I can go on.

Current theory regarding use of ECT is that the electrical stimulus causes electrochemical changes within the brain, resulting in increased availability of neurotransmitters at the synapses and improvement of mood. To suggest that the treatment is frightening does not answer the patients question. The treatment is not appropriate for hallucinations or delusions. The remaining option is not appropriate or founded in psychiatric therapy.

33. Which statement made by a patient just prior to being transported for a scheduled ECT treatment would result in cancellation of the treatment?

ANS: C

Because the patient is to receive general anesthesia and has orders to remain without food or liquids (NPO), the nurse should notify the physician immediately. The introduction of food into the stomach could result in aspiration of stomach contents during treatment. An expression of hopelessness related to depression would be reason to continue with the treatment. The other options offer no contraindication to treatment.

34. The physician has ordered atropine 0.5 mg intramuscularly (IM) for a patient to be administered 30 minutes prior to ECT. The rationale for use of this medication is that it reduces secretions and: a. Protects against vagal bradycardia b. Improves the scope of convulsive activity c. Reduces the need for recovery room staff d. Prevents incontinence of bladder and bowel

ANS: A a. I wont remember the pain. b. It will take several weeks before I feel good again. c. My short-term memory loss will be only temporary. d. I will be at increased risk for developing epilepsy later.

Atropine is used for its ability to prevent vagal bradycardia associated with the electrical stimulus. The other options are neither relevant nor true.

35. Which statement by a patient who has given informed consent for ECT confirms that the patient understands the side effects of this treatment?

ANS: C

Temporary impairment of recent memory is an expected side effect that occurs to some degree during the course of ECT. The other options suggest the patients understanding of treatment and side effects is flawed.

36. In the ECT treatment preparation period the morning of treatment, the nurse should: a. Adequately hydrate the patient. b. Assess the patients cognitive function. c. Have the patient exercise for 10 minutes. d. Ensure that the patient produces a urine sample.

ANS: B

Patient assessment is advisable to provide a baseline against which changes resulting from ECT can be measured. Although taking vital signs and performing other preparatory tasks, the nurse can assess orientation, immediate memory, thought processes, and attention span. The other options are interventions the nurse should not undertake.

37. Immediately after electroconvulsive therapy (ECT), nursing care of the patient is most similar to care of a patient: a. With severe dementia b. With delirium tremens c. Recovering from conscious sedation d. Recovering from general anesthesia

ANS: D

The patient who has ECT receives a short-acting IV anesthetic and a skeletal muscle relaxant. Thus care is most similar to the patient recovering from general anesthesia. The nurse will assess vital signs, quality of respirations, presence or absence of the gag reflex, level of consciousness, orientation, and motor abilities during the post-treatment period.

38. A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT) asks her mentor, What sort of memory impairment is present after several ECT treatments? The best response for the mentor would be: a. Its hard to say. Treatment affects everyone differently. b. Usually the patient has severe difficulty remembering remote events. c. Patients have mild difficulty remembering recent events, like what was eaten for breakfast. d. Both recent and remote memory is affected, producing profound confused, cognitive states.

ANS: C

Most patients experience transient recent memory impairment after electroconvulsive therapy (ECT). The cognitive deficit becomes more pronounced as the number of treatments increases. When the course of treatments is completed, cognitive deficit generally improves to the pretreatment level. The other options are incorrect.

39. About an hour after the patient has ECT, he complains of having a headache. The nurse should: a. Notify the physician stat. b. Administer an as needed (prn) dose of acetaminophen. c. Take the patient through a progressive relaxation sequence. d. Advise going to activities to expend energy and relieve tension.

ANS: B a. Patient A, who is newly diagnosed with dysthymic disorder b. Patient B, who has melancholic depression that responded well to ECT 2 years ago c. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy d. Patient D, who has depression associated with diagnosis of inoperable brain tumor

Post-ECT headache is common. Most physicians routinely write an as needed (prn) order for a headache remedy. Notifying the physician is unnecessary, because this is an expected side effect. Options c and d would not be as useful as medication in this instance.

40. For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching?

ANS: B a. Continually stimulate patient to respond, using physical and verbal means. b. Continue bagging patient to improve respiratory function until patient is responsive for 10 minutes. c. Reorient as necessary to time, place, and person as level of consciousness improves. d. Encourage walking and eating breakfast as quickly as possible.

Indications for ECT include patients with major mood disorders; patients who have responded to ECT in the past; patients who are unresponsive to antidepressants or unable to tolerate their side effects; and patients who are acutely suicidal or in danger of fluid and electrolyte imbalance related to inability to eat due to depression, severe mania, or severe catatonia. Patients with dysthymia are not candidates for ECT. The patient has not run out of medication options when prescribed only an SSRI. Patients with space-occupying lesions of the brain are not candidates for ECT.

41. Which intervention will the nurse implement in the first half hour after the patient has received ECT?

ANS: C a. Safety b. Trust attainment c. Therapeutic activities d. Boundary maintenance

Patient memory is likely to be impaired in the immediate post-ECT period. Reorientation will be necessary to help the individual return to a functional state. Continual stimulation is not necessary. Bagging is unnecessary. The patient may be allowed to rest and recover at his own pace.

42. What milieu factor would need most attention from the nurse who is caring for a patient who has received six ECT treatments and has two more scheduled?

ANS: A

To feel safe, patients need to know what is expected of them in their role as patients. The patient receiving ECT often has impaired recent memory and may become confused about the milieu and expectations. The nurse will need to reorient and reteach the patient with cognitive deficit. Options b, c, and d will require attention but not to the same extent as safety.

Multiple Response

1. Which behaviors are reflective of legitimate phases of a groups development? Select all that apply.

a. Stating the goals of the group b. Establishing who will assume the leadership role c. Inviting family members to attend and provide their input d. Feeling safe enough to discuss painful personal situations e. Showing concern about assuming personal responsibility for life

ANS: A, B, E

All groups progress through the phases of development that are governed by group dynamics and include orientation where goals are identified, conflict where leadership is determined and tested, cohesion where a sense of safety is achieved, and termination where discharge concerns are acted out and addressed. Family input may not necessarily be introduced unless it was a defined goal of the group.

Chapter 9. Interpersonal Psychotherapy

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Which question by the nurse would gain the most information from a patient experiencing a marital crisis?

A. Do you hate your spouse?

B. Do you get along with your in-laws?

C. Do you talk out your problems with your spouse?

D. What is it like at home with your spouse?

____ 2. Mrs. R., the mother of a young schizophrenic patient, seeks you out and begins to cry. She expresses concern over her daughters behavior. Your best response to this woman is:

A. What is it that concerns you the most, Mrs. R.?

B. Well, you know, that is part of the illness.

C. Here is a book on schizophrenia. This will help you.

D. Are you afraid your daughter will always be like this?

____ 3. Linda is pacing the floor and appears extremely anxious. The day shift nurse approaches Linda in an attempt to lessen her anxiety. The most therapeutic statement by the nurse would be:

A. How about watching a football game?

B. Tell me how you are feeling today.

C. What do you have to be upset about now?

D. Ignore the client.

____ 4. A patient states, I dont know what the pills are for or why I am taking them, so I dont want them. What therapeutic communication would help this patient?

A. Ask for what you need

B. Silence

C. Using general leads

D. Giving information

____ 5. To practice effectively in mental health, the nurse should be able to:

A. Solve his or her own personal problems without assistance from others.

B. Comfortably point out the patient shortcomings and provide advice about how to improve.

C. Bring patients and coworkers into compliance with societal rules and norms.

D. Demonstrate therapeutic communication.

Completion

Complete each statement.

6. The nurse plans to have a therapeutic communication with the client. To begin that therapeutic communication the nurse must first establish _________________ with the client.

7. Communication has three parts: the sender, the message, and the _____________.

8. When appropriate, the nurse can use _____________________ as part of an interaction when there is no talking. This can communicate support.

9. A theory of communication that emphasizes the three ways to communicatehearing, seeing, and touchingis called _________________________

10. Expressive, receptive, and global are types of _______________.

11. Advising, asking closed-ended questions, and changing the subject are examples of ________________ to therapeutic communication.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 12. A nurse is working with a patient and attempts to communicate effectively with him or her. Techniques the nurse can use to help communication include (select all that apply):

A. Clarifying terms.

B. Remaining silent.

C. Asking open-ended questions.

D. Offering false reassurance

E. Discouraging the person from expressing feelings that are unacceptable.

____ 13. The nurse may find that patients from other countries use different terminology than the nurse born in the United States. The difference in terminology may seem harmless to us but offensive to the foreign patient. Differences noted between different cultures are (select all that apply):

A. Eye contact.

B. Slang terms.

C. Hand gestures.

D. Gender references.

____ 14. The three components of communication are (select all that apply):

A. Impairment.

B. Message.

C. Sender.

D. Receiver.

____ 15. Nurses understand that when caring for patients with mental illnesses, a nurses communication is (select all that apply):

A. An active process that includes participating and listening and speaking.

B. A complex activity.

C. Exchanging information.

D. Verbal and nonverbal.

E. A one way path from nurse to patient.

F. Advising.

____ 16. The patient is concerned about his doctor and what the doctor has prescribed. The nurse making rounds notices the patient sitting on the side of the bed in deep thought. The nurse comes into the room and the patient begins to tell her his concerns about a new order. The nurse advises the patient, If I were you, I would find another doctor.

How does this statement by the nurse block communication (select all that apply)?

A. It tells the patient that his concerns are not valid.

B. It gives the idea that the nurses values are the correct ones.

C. It puts words in the patients mouth.

D. It hurts the nurses credibility if the solution doesnt help the patient.

E. It discourages yes or no answers.

F. It inhibits the patient from telling you what his concerns are.

____ 17. The following types of patients require adaptive communication techniques (select all that apply):

A. A patient who is blind.

B. A patient who has dysphasia.

C. A patient who is schizophrenic.

D. A patient who is elderly.

E. A patient with dysphagia.

F. A patient who has language differences from the staff.

____ 18. Which of the following are characteristics of assertive communication (select all that apply)?

A. Statements begin with the word you.

B. Statements deal with thoughts and feelings.

C. It is a form of blaming.

D. It puts responsibility for the interaction on the other person.

E. It is a technique of personal empowerment.

F. It is self-responsible.

Answer Section

Multiple Choice

1. ANS: D

Encourages expression of feelings rather than a yes/no answer. Use of open-ended questions facilitates more open communication.

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Therapeutic communication | Cognitive Level: Comprehension | Client Need: Psychosocial Integrity: Therapeutic communication

2. ANS: A

The correct response is open ended to seek out more specifically why she is upset. Responses B and C shut down communication. Response D is making an assumption of why she is upset.

KEY: Integrated Processes: Nursing Process: Implementation | Content Area: Mental Health: Psychotic disorders: Therapeutic nursing process | Cognitive Level: Application | Client Need: Psychosocial Integrity: Therapeutic communication

3. ANS: B

To keep open communication with the patient, the nurse should ask open-ended questions.

4. ANS: D

Giving information can increase rapport, reduce patient anxiety, and suggest patient collaboration.

5. ANS: A

Good communication skills are essential for working in mental health. Good communication skills center around being able to promote open communication with such techniques as good listening, use of open-ended questions, and appropriate use of silence to be therapeutic.

Completion

6. ANS: rapport

Rapport implies there is mutual understanding and trust. The communication can be both verbal and nonverbal.

7. ANS: receiver

Communication is not just about getting your message out, it also includes how the message is received.

8. ANS: silence

Silence allows the nurse and the patient time to collect their thoughts. It is a therapeutic technique of communication and demonstrates support and acceptance.

9. ANS: neurolinguistic programming

Neurolinguistic programming (NLP) was developed by Milton Erickson, John Grinder, and Richard Bandler. NLP can be used in conjunction with hypnosis and other treatment modalities giving insight into how one views the world.

10. ANS: aphasia

Patients with speech difficulties or challenges have an aphasic disorder. Expressive is difficulty in verbal expression, receptive is difficulty with interpretation of written or verbal communication, and global is a combination of receptive and expressive.

11. ANS: blocks or barriers

These blocks to communication interfere with patient-nurse interaction to inhibit good communication.

Multiple Response

12. ANS: A, B, C

Effective communication between the nurse and the patient includes approaches that give the patient opportunities to express himself or herself.

13. ANS: A, B, C, D

Verbal and nonverbal communication doesnt always have the same meaning in other cultures. The same communication can be understood by another culture as offensive.

14. ANS: B, C, D

Communication with others requires these three components.

15. ANS: A, B, C, D

Communication is important when determining the patients needs. It is not a passive process but an active, twoway activity between patient and nurse. Generally the nurses role is not to advise patients but to listen and support.

16. ANS: B, C, D, F

Communication with patients should be purposeful and unbiased. Giving advice when the patient has not fully expressed his concerns inhibits and distracts the patient from what he is trying to communicate.

17. ANS: A, B, F

Although communication can be challenging, there may be temporary or permanent techniques to assist with communication. Patients with challenges to sight, sound, and speech require adaptive techniques. Those who speak a different language than the provider also need adaptive techniques.

18. ANS: B, E, F

Assertive communication begins with the word I. Other characteristics include speaking up for oneself in a respectful manner, verbalizing ones thoughts and feelings, and being honest.

Chapter 10. Humanistic–Existential and Solution-Focused Approaches to Psychotherapy

1. Which person is not associated with the existential movement?

a. RolloMay b. Victor Frankl c. IrvinYalom d. B. F. Skinner

ANSWER: d

2. The central goal of existential psychotherapy isto: a. decrease selfawareness. b. increase awareness. c. help clients reject the responsibility ofchoosing. d. keep the client from experiencing authentic existence.

ANSWER: b

3. Finding the "courage to be"involves: a. confronting a specificphobia. b. learning to bealone. c. discarding oldvalues. d. developing a will to move forward in spite of anxietyproducingsituations.

ANSWER: d

4. The British scholar working to develop training programs in existential therapyis: a. RollMay. b. IrvinYalom. c. Emmy van Deurzen. d. J. Michael Russell.

ANSWER: c a. Tohelpclientsbecomemorepresenttoboththemselvesandothers b. Toassistclientsinidentifyingwaystheyblockthemselvesfromfullerpresence c. To disputeclients’irrationalbeliefs d. Tochallengeclientstoassumeresponsibilityfordesigningtheirpresentlives

5. Whichis not anessentialaimofexistential-humanistictherapy?

ANSWER: c

6. Existential therapy is best consideredas: a. an approach to understand the subjective world of theclient. b. a school of therapy. c. a system of techniques designed to create authentichumans. d. a strategy for uncovering dysfunctionalbehavior.

ANSWER: a a. Challenginghis feelings ofloneliness b. Working on his inauthentic relationshipwith hissiblings c. Confronting his responsibility for his drug and alcoholuse d. Exploring Stan’s humanpotential

7. Which of the following was not part of Stan’s work in existentialtherapy?

ANSWER: b

8. Philosophically, the existentialists would agreethat: a. the final decisions and choices rest with the therapist. b. people do not redefine themselves by theirchoices. c. a person cannot go beyond earlyconditioning. d. making choices can create anxiety.

ANSWER: d

9. The characteristic existential theme includes: a. freedom andresponsibility. b. resistance. c. transference. d. examining irrationalbeliefs.

ANSWER: a

10. According to the existential viewpoint,death: a. makes life absurd. b. makes life meaningless and hopeless. c. gives significance toliving. d. should not be explored intherapy.

ANSWER: c

11. In regards to techniques, existential practitionersbelieve: a. free association is essential to the growth and healing of theclient. b. no set of techniques is consideredessential. c. analysis of dysfunctional family patterns isimperative. d. role playing is the most important techniqueused.

ANSWER: b

12. In a group based on existential principles, clients learn all of the following,except: a. that there are no ultimate answers for ultimateconcerns. b. to view themselves through others’ eyes. c. to come to terms with the paradoxes ofexistence. d. that pain is not a reality of the humanexperience.

ANSWER: d a. Existentialanalysis b. Existentialanxiety c. Self-awareness d. Existentialguilt

13. emphasizes the subjective and spiritual dimensions of humanexistence.

ANSWER: a

14. Existential therapyis: a. a deterministic approach to therapy. b. an expansion of the Adlerian school oftherapy. c. a phenomenological approach to therapy. d. a structured approach to therapy.

ANSWER: c

15. Existentialtherapistsprefertobethoughtofas: a. anobserver-technician. b. philosophicalcompanions,notaspeoplewhorepairpsyches. c. a teacher andcoach. d. an advocate for socialchange.

ANSWER: b a. Whentheclientfeelscomfortableenoughtoengageinshame-attackingexercisesoutsideofcounseling sessions. b. Whenthedeepestselfofthetherapistmeetsthedeepestpartoftheclient. c. Whenthetherapistuseshisorherinfluencetoconvincetheclienttoletgoofhisorheranxiety. d. Whensessionsbeginwithprogressivemusclerelaxationexercises.

16. Whenisthecounselingprocessatitsbestfromanexistentialviewpoint?

ANSWER: b

17. Viktor Frankl’s approach to existential therapy is knownas: a. individualpsychology. b. logotherapy. c. reality therapy. d. redecision therapy.

ANSWER: b a. He is most responsible for translating European existentialism into American psychotherapeutic theory and practice. b. He focuses on the subjective dimension oftherapy. c. He is a significant spokesman for the existential approach in the UnitedStates. d. He believes that we can only escape anxiety by exercising ourfreedom.

18. Which of the following is not true about RolloMay?

ANSWER: d a. The freedom to become within the context of natural and self-imposedlimitations b. The capacity to reflect on the meaning of ourchoices c. The capacity to act on the choices we make d. The freedom to choose our past and the choices of ourparents

19. In regards to freedom and responsibility, existential therapy embraces three values. Which of the following is not one of these values?

ANSWER: d

20. UrsulalivedinNewYorkCityon9/11.Eversinceexperiencingtheaftermathoftheterroristattacks,she hasfeltanxietyaboutgoingto the upperlevelfloorsof tallbuildings.As an existentiallyorientedtherapist, youmightconcludethat: a. Ursulais highlyneurotic. b. Ursula’sfears are completelyunfounded. c. Ursula’sanxietyisnormalinlightofthetraumaticexperienceshehadon9/11. d. Ursulaisonthevergeofbecomingpsychotic.

ANSWER: c a. Medard Boss b. JeanPaul Sartre c. Soren Kierkegaard d. Martin Buber

21. Who was the Danish philosopher that addressed the role of anxiety and uncertainty in life?

ANSWER: c

22. Existentialists contend that the experience of relatedness to other human beings: a. is a neurotically dependentattachment. b. should be based on our needs and theirs. c. is healthy when we are able to stand alone and tap into our ownstrength. d. is not necessary, since we are basicallyalone.

ANSWER: c

23. According to existentialists, our search for meaning involves all of these except: a. discarding oldvalues. b. meaninglessness. c. creating our own value system. d. exploring unfinishedbusiness.

ANSWER: d a. socialmicrocosm b. “touchyfeely”encounter c. livinglaboratory d. tension-filledencounter

24. Therapy is viewedasa inthesensethattheinterpersonalandexistentialproblems ofthe clientwillbecomeapparentinthehereandnowofthetherapyrelationship.

ANSWER: a

25. The central theme running through the works of Viktor Franklis: a. that freedom is a myth. b. the will tomeaning. c. selfdisclosure as the key to mentalhealth. d. the notion ofselfactualization.

ANSWER: b

26. According to Yalom, the concerns that make up the core of existential psychodynamics include all of the following,except: a. death. b. freedom. c. togetherness. d. meaninglessness.

ANSWER: c

27. A statement that best illustrates “bad faith” is: a. Naturally I’m this way, because I grew up in an alcoholicfamily. b. I will not consider others in the choices Imake. c. I must live by commitments Imake. d. I am responsible for the choices that Imake.

ANSWER: a

28. For Sartre, existential guilt is what we experience whenwe: a. do not live by the Ten Commandments. b. fail to think about the welfare of others. c. allow others to define us or to make our choices forus. d. reflect on all that we might have done and failed todo.

ANSWER: c

29. The therapist’spresenceis: a. a conditionof therapeuticchange. b. a goal of therapeuticchange. c. bothaconditionandagoaloftherapeuticchange. d. neitheraconditionnoragoaloftherapeuticchange.

ANSWER: c a. It does not have a well-defined set oftechniques. b. It stresses the I/Thou encounter in the therapy process. c. It focuses on the use of the specific techniques created for this theory. d. It allows for incorporation of techniques from many other approaches.

30. Which of the following is not an example of how existential therapy is unlike many other therapies?

ANSWER: c a. Capacity for self-awareness b. Striving for acceptance ofothers c. Establishing meaningful relationships withothers d. Freedom andresponsibility

31. Which of the following is not considered a basic dimension of the humancondition?

ANSWER: b

32. Being alone is a process by which we do all of the followingexcept: a. learn to tolerate feelings ofisolation. b. develop strength and self-reliance. c. develop a deep understanding of ourselves. d. reject the social overtures of others.

ANSWER: d

Chapter 11. Group Therapy

Question 1

Type: MCSA

The student nurse asks if advance practice training is needed to lead psychoeducation groups and assist families. The instructor tells the nurse that all nurses can lead the groups as long as they:

1. Support a loss of autonomy.

2. Promote rigidity and chaos.

3. Understand family and group dynamics.

4. Isolate family members from one another.

Correct Answer: 3

Rationale 1: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 2: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 3: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Rationale 4: Nurses have long been involved in working with clients and their families in small groups brought together for health teaching, psychoeducation, or supportive purposes. All nurses, regardless of level of education, can lead therapeutic groups or psychoeducation groups, and all nurses can assist families, as long as they understand and apply group and family dynamics in their interventions.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub: