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The nurse must be alert to the nonverbal expressions of the client. Because the meaning attached to nonverbal behavior is subjective, it is important for the nurse to
- A. Increase the client's awareness of nonverbal behavior.
- B. Investigate the source of nonverbal behavior.
- C. Validate the client's feelings.
- D. Validate the meaning of the nonverbal behavior.
Correct Answer: D
Rationale: Validating the meaning of nonverbal behavior ensures the nurse accurately interprets the client's cues, avoiding assumptions before exploring sources or feelings.
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Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff?
- A. Because some clients with mental illness have difficulty knowing when touch is or is not appropriate
- B. Because clients often perceive being touched as a threat and may attempt to protect himself or herself by striking the staff person
- C. Because it can be threatening to both the client and the nurse
- D. Because touching always leads to more touching
Correct Answer: A
Rationale: Policies against touching in psychiatric units address clients' difficulty with understanding appropriate boundaries, reducing risks of misinterpretation or escalation.
A patient states, 'I feel fine. It's a good day.' The nurse notes the patient looking away, and a decreasing pitch in his voice while speaking. Which of the following is the most therapeutic response by the nurse?
- A. I'm glad you are feeling good today.
- B. I'm not sure I believe you.
- C. Tell me what is good about today.
- D. You say you feel fine, but you don't really sound fine.
Correct Answer: D
Rationale: Verbalizing the implied by noting the incongruence between the client's words and nonverbal cues encourages clarification and deeper discussion, making it the most therapeutic response.
The nurse should use clear concrete messages when working with patients displaying which of the following conditions?
- A. Anxiety
- B. Anorexia
- C. Dementia
- D. Schizophrenia
- E. Hypochondriasis
Correct Answer: A,C,D
Rationale: Clear, concrete messages are essential for clients with anxiety, dementia, or schizophrenia, who may struggle with abstract thinking due to cognitive or emotional impairments.
The nurse asks the patient what he would like to talk about. This is an example of
- A. Broad opening
- B. Encouraging expression
- C. Focusing
- D. Offering self
Correct Answer: A
Rationale: Broad openings allow the client to initiate and direct the conversation, encouraging them to choose the topic, unlike focusing or offering self, which have different purposes.
A patient asks the nurse what she should do about her 'cheating' husband. The nurse replies, 'You should divorce him. You deserve better than that.' The nurse used which communication technique?
- A. Giving information
- B. Verbalizing the implied
- C. Giving advice
- D. Agreeing
Correct Answer: C
Rationale: Giving advice, as in suggesting divorce, is nontherapeutic as it assumes the nurse knows best, limiting the client's autonomy in decision-making.