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A patient with severe depression states, 'God is punishing me for my past sins.' What is the nurse's best response?
- A. Why do you think that?'
- B. You sound very upset about this.'
- C. You believe God is punishing you for your sins?'
- D. If you feel this way, you should talk to a member of your clergy.'
Correct Answer: B
Rationale: The nurse reflects on the patient's 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 nontherapeutic.
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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.
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.
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.
During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior.
- A. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
- B. The gesture is premature. The patient's 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. Patients in a psychiatric setting should not be touched.
Correct Answer: B
Rationale: 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.
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.