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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.
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The patient says, 'My marriage is just great. My spouse and I usually agree on everything.' The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. What type of communication is the patient presenting?
- A. Clear
- B. Mixed
- C. Precise
- D. Inadequate
Correct Answer: B
Rationale: Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.
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 nurse's most therapeutic response.
- 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.
Correct Answer: D
Rationale: The correct response uses exploring, a therapeutic technique. The distracters give advice, a nontherapeutic technique.
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.
Which technique will best communicate to a patient that the nurse is interested in listening?
- A. Restate a feeling or thought the patient has expressed.
- B. Ask a direct question, such as, 'Did you feel angry?'
- C. Make a judgment about the patient's problem.
- D. Say, 'I understand what you're saying.'
Correct Answer: A
Rationale: Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions such as 'Did you feel angry?' ask for specific information rather than show understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.
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.