Varcarolis Ch 9 -- Therapeutic
Communication
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 response should the nurse use to clarify the patient's
comment?
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 you feel as though you did not get enough quality sleep last night?"
d. "Can you give me an example of what you mean by 'stoned'?" - ANS D
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.
A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is
monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful
what you say." Which response by the nurse is 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." - ANS B
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.
The patient says, "My marriage is just great. My spouse and I always agree." The nurse
observes the patient's foot moving continuously as the patient twirls a shirt button. The
conclusion the nurse can draw is that the patient's communication is
a. clear.
b. distorted.
c. incongruous.
d. inadequate. - ANS B
The patient's verbal and nonverbal communication in this scenario are incongruous.
Incongruous messages involve transmission of conflicting messages by the speaker. The
, patient's 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.
A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies 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." - ANS D
"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 to build trust and convey
that the nurse cares about the patient. Two incorrect responses are ineffective and
nontherapeutic. The other incorrect response is therapeutic but is an example of "offering hope."
Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as "Did you feel angry?"
c. Making a judgment about the patient's problem.
d. Saying, "I understand what you're saying." - ANS A
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. Close-ended questions such as "Did you feel angry?" ask for specific
information rather than showing 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 discloses several concerns and associated feelings. If the nurse wants to seek
clarification, which comment would be appropriate?
a. "What are the common elements here?"
b. "Tell me again about your experiences."
c. "Am I correct in understanding that."
d. "Tell me everything from the beginning." - ANS C
Asking, "Am I correct in understanding that ..." permits clarification to ensure that both the nurse
and patient share mutual understanding of the communication. Asking about common elements
encourages comparison rather than clarification. The remaining responses are implied
questions that suggest the nurse was not listening.
A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most
therapeutic response.
a. "Don't talk that way. Of course you will leave here!"
b. "Keep up the good work, and you certainly will."
c. "You don't think you're making progress?"
d. "Everyone feels that way sometimes." - ANS C
Communication
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 response should the nurse use to clarify the patient's
comment?
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 you feel as though you did not get enough quality sleep last night?"
d. "Can you give me an example of what you mean by 'stoned'?" - ANS D
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.
A patient diagnosed with schizophrenia tells the nurse, "The Central Intelligence Agency is
monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be careful
what you say." Which response by the nurse is 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." - ANS B
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.
The patient says, "My marriage is just great. My spouse and I always agree." The nurse
observes the patient's foot moving continuously as the patient twirls a shirt button. The
conclusion the nurse can draw is that the patient's communication is
a. clear.
b. distorted.
c. incongruous.
d. inadequate. - ANS B
The patient's verbal and nonverbal communication in this scenario are incongruous.
Incongruous messages involve transmission of conflicting messages by the speaker. The
, patient's 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.
A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies 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." - ANS D
"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 to build trust and convey
that the nurse cares about the patient. Two incorrect responses are ineffective and
nontherapeutic. The other incorrect response is therapeutic but is an example of "offering hope."
Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as "Did you feel angry?"
c. Making a judgment about the patient's problem.
d. Saying, "I understand what you're saying." - ANS A
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. Close-ended questions such as "Did you feel angry?" ask for specific
information rather than showing 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 discloses several concerns and associated feelings. If the nurse wants to seek
clarification, which comment would be appropriate?
a. "What are the common elements here?"
b. "Tell me again about your experiences."
c. "Am I correct in understanding that."
d. "Tell me everything from the beginning." - ANS C
Asking, "Am I correct in understanding that ..." permits clarification to ensure that both the nurse
and patient share mutual understanding of the communication. Asking about common elements
encourages comparison rather than clarification. The remaining responses are implied
questions that suggest the nurse was not listening.
A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most
therapeutic response.
a. "Don't talk that way. Of course you will leave here!"
b. "Keep up the good work, and you certainly will."
c. "You don't think you're making progress?"
d. "Everyone feels that way sometimes." - ANS C
