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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.
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A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies about giving advice?
- A. It is rarely helpful.
- B. It fosters independence.
- C. It lifts the burden of personal decision making.
- D. It helps the patient develop feelings of personal adequacy.
Correct Answer: A
Rationale: Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.
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.
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.
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.
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.