Nokea
A patient says to the nurse, 'I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well.' Which comment would be appropriate if the nurse seeks clarification?
- A. It sounds as though you were uncomfortable with the content of your dream.
- B. I understand what you're saying. Bad dreams leave me feeling tired, too.
- C. So, all in all, you feel as though you had a rather poor night's sleep?
- D. Can you give me an example of what you mean by 'stoned'?
Correct Answer: D
Rationale: The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement. Asking for a definition of 'stoned' directly asks for clarification. Restating that the patient is uncomfortable with the dream's content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient's comment.
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A patient cries as the nurse explores the patient's relationship with a deceased parent. The patient says, 'I shouldn't be crying like this. It happened a long time ago.' Which responses by the nurse will facilitate communication? (Select all that apply.)
- A. Why do you think you are so upset?'
- B. I can see that you feel sad about this situation.'
- C. The loss of your parent is very painful for you.'
- D. Crying is a way of expressing the hurt you're experiencing.'
- E. Let's talk about something else because this subject is upsetting you.'
Correct Answer: B,C,D
Rationale: Reflecting ('I can see that you feel sad' or 'This is very painful for you') and giving information ('Crying is a way of expressing hurt') are therapeutic techniques. 'Why' questions often imply criticism or seem intrusive or judgmental, and they are difficult to answer. Changing the subject is a barrier to communication.
A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
- A. What are the common elements here?
- B. Tell me again about your experiences.
- C. Am I correct in understanding that...?
- D. Tell me everything from the beginning.
Correct Answer: C
Rationale: 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.
When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is misunderstanding the nurse-patient relationship. Which alternative is a more accurate assessment?
- A. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures.
- B. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
- C. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted.
- D. The nurse is quick to make assumptions.
Correct Answer: A
Rationale: The most likely answer is that the patient's 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.
Documentation in a patient's chart shows, 'Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you."' Which analysis is most accurate?"
- A. Patient is giving positive feedback about the nurse's communication techniques.
- B. Nurse is viewing the patient's behavior through a cultural filter.
- C. Patient's verbal and nonverbal messages are incongruent.
- D. Patient is demonstrating psychotic behaviors.
Correct Answer: C
Rationale: 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 nurse's communication techniques. The concept of a cultural filter is not relevant to the situation; a cultural filter determines what a person will pay attention to and what he or she will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.
While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
- A. Nonverbal communication
- B. A message filter
- C. A cultural barrier
- D. Social skills
Correct Answer: A
Rationale: Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patient's social skills or whether a cultural barrier exists.