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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.
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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 nurse interacts with a newly hospitalized patient. Which nursing statement reflects the communication technique of 'offering self'?
- A. I've 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. I'd like to sit with you for a while to help you get comfortable talking to me.
Correct Answer: D
Rationale: 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 build trust and conveys that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but an example of 'offering hope.'
Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?
- A. Nurses are 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 is understood.
Correct Answer: C
Rationale: 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. Saying that patients withdraw during long silences or that silence helps patients know that they are understood are both inaccurate statements. Feedback helps patients know they have been understood.
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.
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.