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A patient tells the nurse, 'I don't think I will ever get out of here.' Select the nurse's most therapeutic response.
- A. Don't talk that way. Of course, you will leave here.
- B. Keep up the good work and you certainly will.
- C. You don't think you're making progress?
- D. Everyone feels that way sometimes.
Correct Answer: C
Rationale: By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to 'talk that way' is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.
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A patient diagnosed with schizophrenia tells the nurse, 'The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say.' Which response by the nurse would be most therapeutic?
- A. Let's talk about something other than the CIA.
- B. It sounds like you're 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.
Correct Answer: B
Rationale: It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful but uncompassionate.
An African-American patient says to a Caucasian nurse, 'There's no sense talking. You wouldn't understand because you live in a white world.' What would be the nurse's best action?
- A. Explain, 'Yes, I do understand. Everyone goes through the same experiences.'
- B. Say, 'Please give an example of something you think I wouldn't understand.'
- C. Reassure the patient that nurses interact with people from all cultures.
- D. Change the subject to one that is less emotionally disturbing.
Correct Answer: B
Rationale: Having the patient speak in specifics rather than globally helps the nurse understand the patient's perspective. This approach helps the nurse engage the patient.
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.
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.
During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. How should the nurse respond?
- A. You've turned the tables on me.'
- B. Nurses direct the interviews with patients.'
- C. Do not ask questions about my personal life.'
- D. The time we spend together is to discuss your concerns.'
Correct Answer: D
Rationale: 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 nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Saying 'You've turned the tables on me' states the fact but does not refocus the interview.