Foundations of Psychiatric Mental Health Nursing A Clinical Approach 5th Edition by Elizabeth M. Varcarolis Test Bank

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Foundations of Psychiatric Mental Health Nursing A Clinical Approach 5th Edition by Elizabeth M. Varcarolis Test Bank

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Varcarolis: Foundations of Psychiatric Mental Health Nursing: A
Clinical Approach, 5th Edition

Test Bank

Chapter 11: The Clinical Interview and Communication Skills

MULTIPLE CHOICE

1) As a client converses with the nurse, she states I dreamed I was stoned. When I woke up, I was feeling emotionally drained, as though I hadnt rested well. If the nurse needs clarification of stoned, it would be appropriate to say
A. It sounds as though you were quite uncomfortable with the content of your dream.
B. Can you give me an example of what you mean by stoned?
C. I understand what youre saying. Bad dreams leave me feeling tired, too.
D. So, all in all, you feel as though you had a rather poor nights sleep?

ANS: B
The technique of exploring is useful because it helps the nurse examine meaning. Option 2 directly asks for clarification. Option A focuses on client feelings. Options C and D fail to clarify the meaning of the word in question.

DIF: Cognitive Level: Application REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2) At the beginning of a clinical interview the nurse tells a teenaged client While Im here with you I will focus on the content and process of our communication as a participant observer. The client looks blankly at the nurse. The nurse can make the assessment that communication was not understood because of
A. a personal factor: the use of terms not understood by the client.
B. a social factor: the socioeconomic difference between nurse and client.
C. an environmental factor: lack of privacy.
D. incongruent verbal and nonverbal communication.

ANS: A
Various personal, environmental, and social factors may be responsible for ineffective communication. In this case, a personal factor is involved. The nurse used a highly technical explanation of his purpose for talking with the client. Data are not present in the scenario to support the choice of any other option.

DIF: Cognitive Level: Application REF: Text Page: 178
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

3) The client remarks My husband and I get along just fine. We usually agree on everything. As the client speaks her foot is moving continuously and she twirls a button on her blouse. What assessment can the nurse make? The clients communication is
A. clear.
B. explicit.
C. inadequate.
D. mixed.

ANS: D
Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The clients verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

DIF: Cognitive Level: Application REF: Text Page: 180, Text Page: 181
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4) During the first interview with a restless young man, the nurse notices that he does not make eye contact throughout most of the interview. The nurse can correctly assume that
A. he is not to be trusted in what he says because he is evasive.
B. he is feeling sad and cannot look the nurse in the eye.
C. he is shy and the nurse must move slowly.
D. more information is needed to draw a conclusion.

ANS: D
The data presented are insufficient to draw a conclusion. The nurse must continue to gather information.

DIF: Cognitive Level: Application REF: Text Page: 181, Text Page: 184
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5) Which statement made by a nurse during a nurse-client interaction may underrate a clients feelings and belittle his or her concerns?
A. You appear tense.
B. Everything will be all right.
C. I notice you are biting your lip.
D. Im not sure I follow you.

ANS: B
Option B offers false reassurance. This is a nontherapeutic technique that suggests to a client that his or her views and feelings are not being taken seriously. Options A, C, and D use therapeutic techniques.

DIF: Cognitive Level: Analysis REF: Text Page: 191, Text Page: 192
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

6) The nurse is talking with a young male client and has 5 minutes to go in the session with him. He has been silent and sullen most of the session and has been staring at the floor for the last 10 minutes. A troubled young woman comes to the door of the room and says to the nurse, I really need to talk to you. The nurse should
A. tell the woman she is busy at the present time.
B. end the session and spend time with the young woman.
C. invite the woman to sit down and join in the session with the other client.
D. tell the woman that the session with this client will take 5 more minutes, after which the nurse will talk with her.

ANS: D
When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first client would be equivalent to abandonment and would destroy any trust the client had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the client and the sessions are viewed as important. Option A preserves the nurse-client relationship with the young male client but may seem abrupt to the young female client. Option B abandons the young male client. Option C does not observe the contract with the young male client.

DIF: Cognitive Level: Application REF: Text Page: 177
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7) Which remark by the nurse would be an appropriate way to begin a clinical interview session?
A. How shall we start today?
B. Shall we talk about losing your privileges yesterday?
C. What happened when your husband came to visit yesterday?
D. Lets get started trying to unravel your marital relationship.

ANS: A
The interview is client centered; thus the issues are chosen by the client. The nurse assists the client by using communication skills and actively listening to provide opportunities for the client to reach goals. In options B, C, and D the nurse selects the topic.

DIF: Cognitive Level: Application REF: Text Page: 173
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8) The nurse can best communicate to the client that she or he is interested in listening by
A. restating the feeling or thought the client has expressed.
B. making a judgment about the clients problem.
C. asking a direct question, such as Did you feel angry?
D. saying I understand what youre saying.

ANS: A
Restating allows the client to validate the nurses understanding of what has been communicated. Restating is an active listening technique. Option B: Judgments should be suspended in a nurse-client relationship. Option C: Closed-ended questions ask for specific information rather than showing understanding. Option D states that the nurse understands, but the client has no way of measuring the understanding.

DIF: Cognitive Level: Application REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9) The client has disclosed several of his concerns and associated feelings. If the nurse wishes to seek clarification he could say
A. What are the common elements here?
B. Tell me again.
C. Am I correct in concluding that . . .
D. Tell me everything from the beginning.

ANS: C
Option C permits clarification to ensure that both the nurse and client share mutual understanding of the communication. Option A is a closed-ended question. Options B and D are implied questions.

DIF: Cognitive Level: Application REF: Text Page: 189, Text Page: 190
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10) A client tells the nurse I dont think Ill ever get out of here. A therapeutic response would be
A. You shouldnt talk that way. Of course youll leave here!
B. Everyone feels that way sometimes.
C. You dont think youre making progress?
D. Keep up the good work and you certainly will.

ANS: C
In option C the nurse is reflecting by putting into words what the client is hinting. By making communication more explicit, issues are easier to identify and resolve. Options A, B, and D are nontherapeutic techniques. Option A is disapproving. Option B minimizes feelings. Option D is falsely reassuring.

DIF: Cognitive Level: Application REF: Text Page: 191, Text Page: 192
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11) Documentation in a clients chart includes the following information: Throughout a 5-minute interaction the client fidgeted and tapped his left foot, periodically covered his face with his hands, looked under his chair, all while stating he was enjoying spending time with this nurse. Of the following assessments, which is most accurate?
A. The client is giving positive feedback about the nurses communication techniques.
B. The nurse is viewing the clients behavior through a cultural filter.
C. The clients verbal and nonverbal messages are incongruent.
D. The client is demonstrating psychotic behaviors.

ANS: C
When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a mixed message. Option A is an inaccurate statement. Option B: A cultural filter determines what we will pay attention to and what we will ignore. This concept is not relevant to the situation presented. Option D: Data are insufficient to draw this conclusion.

DIF: Cognitive Level: Application REF: Text Page: 180, Text Page: 181
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

12) The nurse finds himself feeling angry with a client. The nurse should
A. tell the nurse manager to assign the client to another nurse.
B. suppress the angry feelings.
C. express the anger openly.
D. discuss the anger with a clinician during a supervision session.

ANS: D
The nurse is accountable for the relationship. Objectivity is threatened by strong positive or negative feelings toward a client. Supervision is necessary to work through negative feelings. Option A: This is not a first-line solution. Option B: Suppression rarely results in a satisfactory outcome for client or nurse. Option C: Open expression of anger will confuse a client who has been unaware of the nurses feelings.

DIF: Cognitive Level: Application
REF: Text Page: 173, Text Page: 174, Text Page: 175
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment;

13) As she talks with a deeply depressed client, the nurse notices that the client is unable to maintain eye contact. The client drops her chin to her chest and looks down. The nurse has made an assessment of the clients
A. nonverbal communication.
B. mental status.
C. nursing diagnosis.
D. social skill.

ANS: A
Eye contact and body movements are considered nonverbal communication.

DIF: Cognitive Level: Application REF: Text Page: 180
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

14) During a therapy session a client cries as the nurse explores the relationship of the client and her now-deceased mother. The client sobs I shouldnt be blubbering like this. A response by the nurse that will hinder communication is
A. The relationship with your mother is very painful for you.
B. I can see that you feel sad about this situation.
C. Why do you think you are so upset?
D. Crying is a way of expressing the hurt youre experiencing.

ANS: C
Why questions often imply criticism or seem intrusive or judgmental. They are difficult to answer; thus they are barriers to communication. The other options are therapeutic in nature.

DIF: Cognitive Level: Application REF: Text Page: 193
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15) During the first interview with a woman who has just lost her son in a car accident, the nurse feels so sorry for the woman that she reaches out and touches her. The nurses response
A. is empathetic and will encourage the woman to continue to express her feelings.
B. will be perceived by the client as intrusive and overstepping boundaries.
C. is inappropriate because a no touch rule should be applied to all psychiatric clients.
D. may be premature as the cultural and individual interpretation of touch is unknown.

ANS: D
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 client will perceive touch. The other options present prematurely drawn conclusions.

DIF: Cognitive Level: Application REF: Text Page: 184
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

16) The nurse working with a young woman who is depressed tries to cheer the client by being casual and humorous. At one point the client smiles. What assessment can be made?
A. The nurse has succeeded in reaching the client and is on the way to cheering her.
B. The use of distraction and humor can be added to the intervention list in the plan of care.
C. The nurse has identified an approach that may prove useful in other, similar situations.
D. The nurse needs to seek supervision because the approach described is not acceptable.

ANS: D
Clinical supervision will review the nurses actions and thoughts and help the nurse arrive at a more therapeutic approach. Attempts at cheering up a depressed client serve only to emphasize the disparity between the clients mood and that of others. Active listening should be the technique used by the nurse. Options A, B, and C suggest the approach is therapeutic when it is not.

DIF: Cognitive Level: Application
REF: Text Page: 186, Text Page: 187, Text Page: 188
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

17) A male African American client says to a white male nurse Theres no sense in talking with you. You wouldnt understand because you live in a white world. The best response for the nurse would be to
A. explain that the nurse can understand because everyone goes through the same experiences.
B. ask the client to give an example of something he thinks the nurse wouldnt understand.
C. reassure him that nurses are trained to deal with people from all cultures.
D. gently change the subject to one that is less emotionally charged.

ANS: B
Having the client speak in specifics rather than globally will help the nurse understand the clients perspective. This approach will help the nurse draw out the client.

DIF: Cognitive Level: Application REF: Text Page: 189
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18) A nurse working with a Filipino American client has noted that the client rarely makes eye contact during their interactions. The nurse hypothesizes that the reason for lack of eye contact is client low self-esteem and plans interventions designed to raise the clients self-esteem. After 3 weeks the clients eye contact has not improved. The nurses clinical supervisor suggests that a problem exists with the assessment and plan. The most accurate formulation of the problem is
A. the clients poor eye contact is indicative of anger and hostility that are going unaddressed.
B. the clients eye contact should have been directly addressed by role playing to increase comfort with eye contact.
C. the nurse should have considered the clients culture during the assessment and before making a plan.
D. the nurse should not have independently embarked on assessment and planning.

ANS: C
The amount of eye contact a person engages in is often culturally determined. In some cultures eye contact is considered insolent, whereas in others eye contact is expected. Filipino Americans often prefer not to engage in direct eye contact.

DIF: Cognitive Level: Analysis REF: Text Page: 184
TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

19) When a Mexican American client and the primary nurse are sitting together, the client often takes the nurses hand and holds it. The client also takes the nurses hand or links her arm through the nurses when they are walking. The nurse has made the assessment that the client is a lesbian and is quite uncomfortable with the behavior. Which of the following alternatives might be a more accurate assessment?
A. The client is accustomed to touch during conversation, as are members of many Hispanic subcultures.
B. The client understands that touch makes the nurse uncomfortable and controls the relationship based on that factor.
C. The client is afraid of being alone. When touching the nurse, the client is reassured that she is not alone.
D. The nurse is homophobic.

ANS: A
The most likely answer is that the clients behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are much less likely.

DIF: Cognitive Level: Application REF: Text Page: 184
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

20) A Puerto Rican American client uses dramatic body language whenever describing emotional discomfort. Of the possibilities below, which is most likely to be an accurate explanation of the clients behavior? The client
A. wishes to impress staff with her degree of emotional pain.
B. has a histrionic character disorder and uses this behavior habitually.
C. believes dramatic body language has high sexual appeal.
D. is a member of a culture in which dramatic body language is the norm.

ANS: D
Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

DIF: Cognitive Level: Application REF: Text Page: 183, Text Page: 184
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

21) What would be the preferable remark for a student nurse to use after introductions have been made to begin the first nurse-client interview?
A. So tell me, do you like having students here?
B. Id like to have you tell me your problems.
C. Perhaps you would like to begin by telling me about some of the stresses youve experienced recently.
D. I read your chart and understand that you would like to focus on new ways to improve your self-esteem.

ANS: C
The nurse-client interview should be client centered and client paced. Option C is the least directive approach and turns the interview over to the client. Option A is student focused. Option B is a demand for immediate information. Option D takes the pacing of the interview away from the client.

DIF: Cognitive Level: Application REF: Text Page: 173
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22) During a nurse-client interview the client attempts to shift the session focus from himself to the nurse by asking personal questions. The nurse should respond by saying
A. You have no right to ask questions about my personal life.
B. Nurses prefer to direct the interview.
C. Youve turned the tables on me.
D. This time we spend together is for you to discuss your concerns.

ANS: D
When a client chooses to focus on the nurse, the nurse should refocus the discussion back onto the client. Option D refocuses discussion in a neutral way. Option A shows indignation. Option B reflects superiority. Option C states the fact but does not refocus the interview.

DIF: Cognitive Level: Application REF: Text Page: 177
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

23) The nurse interviewing a client who is having difficulty staying focused could best help the client by saying
A. Go on.
B. What would you like to discuss?
C. Tell me what is happening right now.
D. It seems as though you are having trouble staying focused.

ANS: C
Closed-ended questions may be necessary to elicit information from a client who is having difficulty concentrating.

DIF: Cognitive Level: Application REF: Text Page: 190
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

24) The nurse records the following data about a client: Client has not spoken despite repeated efforts to elicit speech by nurse and other staff. Makes no eye contact and is inattentive to staff who attempt to engage him, gazing off to the side or looking upward rather than at speaker. A possible nursing diagnosis that deserves more investigation is
A. defensive coping.
B. risk for violence.
C. decisional conflict.
D. impaired verbal communication.

ANS: D
The defining characteristics are more related to the nursing diagnosis of impaired verbal communication than to the other nursing diagnoses.

DIF: Cognitive Level: Analysis REF: Text Page: 179
TOP: Nursing Process: Nursing Diagnosis
MSC: NCLEX: Psychosocial Integrity

25) The remark by the nurse that gives the client verbal tracking feedback is
A. Describe your relationship with your wife.
B. Am I correct in stating you are feeling angry with your wife?
C. Youre saying you do not have a good relationship with your wife.
D. Give me an example of not getting along with your wife.

ANS: C
Verbal tracking simply keeps track of what the client is saying. It is giving neutral feedback in the form of restating or summarizing what the client has said. Option B seeks validation. Options A and D are examples of exploring.

DIF: Cognitive Level: Application REF: Text Page: 183
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26) A principle that should guide the nurse in determining the extent of silence to allow during client interview sessions is that
A. the nurse is responsible for breaking silences.
B. clients withdraw if silences are prolonged.
C. silence provides meaningful moments for reflection.
D. silence helps clients know that what they said was understood.

ANS: C
Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. Option A is not a principle related to silences. Options B and D are not true statements. Feedback helps clients know they have been understood.

DIF: Cognitive Level: Analysis REF: Text Page: 185, Text Page: 186
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27) During a session with a client who seems bewildered by his predicament, the nurse is conflicted about whether to provide advice. The rule of thumb that should be followed is that giving advice to a client
A. is rarely helpful.
B. fosters independence.
C. lifts the burden of personal decision making.
D. helps the client develop feelings of personal adequacy.

ANS: A
Giving advice fosters dependence on the nurse and interferes with the clients right to make personal decisions. It robs clients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to client feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

DIF: Cognitive Level: Comprehension REF: Text Page: 192, Text Page: 193
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

28) The relationship between a nurse and a client as it relates to status and power is best described by the term
A. symmetrical.
B. complementary.
C. incongruent.
D. paralinguistic.

ANS: B
When a difference in power exists, as between a student and teacher or nurse and client, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.

DIF: Cognitive Level: Comprehension REF: Text Page: 178
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

29) A client seeks to elicit personal information about the nurse by asking several direct questions about the nurses living arrangements. To refocus the interview the nurse should say
A. I am uncomfortable when you ask me personal questions, so please stop.
B. It seems a bit odd that you are focusing on me rather than on yourself.
C. Your questioning is manipulative and distracting us from our purpose.
D. This is your time to focus on your situation. Tell me about your concerns.

ANS: D
Option D restates the purpose of the interview, shifting the focus off the nurse and back to the client while remaining neutral. Option A remains nurse focused. Option B challenges the client. Option C is accusatory.

DIF: Cognitive Level: Application REF: Text Page: 177
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

OTHER

1) A new nurse tells a mentor I want to convey to my clients that I am interested in them and that I want to listen to what they have to say. The behaviors helpful in meeting the nurses goal include the nurse (more than one answer may be correct)
A. sitting behind a desk, facing the client.
B. introducing herself to the client and identifying her staff role.
C. using facial expressions that convey interest and encouragement.
D. assuming an open body posture and sometimes mirror imaging.
E. maintaining control of the topic under discussion by asking direct questions.

ANS:
B, C, D
Rationale: Options B, C, and D are helpful behaviors. Trust is fostered when the nurse introduces herself and identifies her role. Facial expressions that convey interest and encouragement support the nurses verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the client has to say. Mirror imaging enhances client comfort. Option A: The desk places a physical barrier between the nurse and client. A face-to-face stance should be avoided when possible and a less intense 90- or 120-degree angle used to permit either party to look away without discomfort. Option E: Once introductions have been accomplished the nurse should turn the interview over to the client by using an open-ended question such as Where should we start?

DIF: Cognitive Level: Application REF: Text Page: 172, Text Page: 173
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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