Chapter 10 NCLEX questions & rationales

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According to the therapeutic communication theory, what criteria must be met for successful communication?

1. The communication must be intrapersonal, interpersonal, group, or societal in nature.
2. The communication needs to be efficient, appropriate, flexible, and include feedback.
3. The individuals communicating with each other must share a similar perception of the conversation.
4. Nonverbal communication is consistent with verbal communication.

(2)

Rationale:
1. The communication must be intrapersonal, interpersonal, group, or societal in nature. Therapeutic communication theory believes communication occurs in four different settings: intrapersonal, interpersonal, group, and societal.
2. The communication needs to be efficient, appropriate, flexible, and include feedback. The formal criteria for successful communication are efficiency, appropriateness, flexibility, and feedback.
3. Nonverbal communication is consistent with verbal communication. Nonverbal communication can contradict the verbal message.
4. The individuals communicating with each other must share a similar perception of the conversation. Perception is highly personal and internal.

The nonverbal communication that expresses emotion is:

1. Body positioning.
2. Facial expressions.
3. Cultural artifacts.
4. Eye contact.

(2)

Rationale:
1. Body positioning. Body position is an indication of how open one person is to another person or how interested or attractive one person is to another.
3. Cultural artifacts. Cultural artifacts are items in contact with interacting people that may function as nonverbal stimuli, e.g., nose or eyebrow piercing.
2. Facial expressions. Facial expressions communicate emotions and are the single most important source of nonverbal communication.
4. Eye contact. Eye contact projects an interest in communicating with a person; averting eye contact implies rejection.

In the symbolic interactionist view of communication, how is the meaning of the message determined?

1. It is based on the recipient's perception and interpretation.
2. It is transferred from the sender to the receiver.
3. It is mutually negotiated between the individuals involved in the interaction.
4. It is predetermined by the person initiating the interaction.

(3)

Rationale:
1. It is predetermined by the person initiating the interaction. The symbolic interactionist views communication as a simultaneous process that is influenced by both individuals.
2. It is based on the recipient's perception and interpretation. An individual's perception does influence communication, but is not the basis of the interactionist view of communication.
3. It is transferred from the sender to the receiver. Communication is not transferred between people; the meaning of the message is negotiated between the individuals involved in the communication.
4. It is mutually negotiated between the individuals involved in the interaction. The meaning of the message is mutually agreed upon between the individuals involved in the process.

The nurse is discussing problem-solving strategies with a client who recently experienced the death of a family member and the loss of a full-time job. The client says to the nurse, "I hear what you're saying to me, but it just isn't making any sense to me. I can't think straight now." The client is expressing feelings of:

1. Hostility.
2. Rejection.
3. Disqualification.
4. Overload.

(4)

Rationale:
2. Rejection. Rejection conveys the message "you're wrong."
4. Overload. Overload results from sensory input exceeding the tolerance level of the receiver.
3. Disqualification. When a person communicates in such a way as to invalidate messages sent or received from another person, this is known as disqualification.
1. Hostility. The client is expressing a sense of feeling overwhelmed and is not communicating hostile feelings.

The nurse is interacting with a client and observes the client's eyes moving from side to side prior to answering a question. The nurse interprets this behavior as:

1. The client engaging in intrapersonal communication.
2. The client processing auditory information.
3. The client being bored with the interaction.
4. The client responding to auditory hallucinations.

(2)

Rationale:
1. The client responding to auditory hallucinations. Eye movement side to side is an example of eyes accessing cues to an individual's thinking process and is not necessarily indicative of auditory hallucination.
2. The client processing auditory information. An individual processing auditory information usually moves the eyes from side to side.
3. The client being bored with the interaction. Rolling of the eyes is typically observed in an individual who is bored with a situation.
4. The client engaging in intrapersonal communication. A person engaging in intrapersonal communication usually focuses the eyes down in the direction of the nondominant hand.

The nurse is caring for a client who is hard of hearing. To facilitate communication with the client, the nurse will:

1. Stand 5 to 8 feet from the client when speaking.
2. Ask closed-ended questions.
3. Make sure the client can see her lips move when she is speaking.
4. Speak slowly, using monosyllabic words whenever possible.

(3)

Rationale:
1. Stand 5 to 8 feet from the client when speaking. The ideal distance to stand when speaking to a client who is hard of hearing is 3 to 6 feet.
4. Speak slowly, using monosyllabic words whenever possible. It is important to speak at a natural rate. People comprehend faster than they speak. Using monosyllabic words may be insulting to the client.
2. Ask closed-ended questions. Asking closed ended questions will impede communication.
3. Make sure the client can see her lips move when she is speaking. Clients who are hard of hearing may need to see the other person's lips moving to know they are speaking. They may also read lips in an attempt to understand what is being said.

A client with a history of major depression tells the nurse "I wish I weren't alive. I have been a failure my entire life and I am totally useless to anyone." The most therapeutic response to the client is:

1. "You shouldn't talk like that. You're not a failure."
2. "Once the antidepressants start working you will feel better about yourself."
3. "Things could be worse. You should be grateful for what you have."
4. "You've been feeling like a failure your entire life?"

(4)

Rationale:
1. "You shouldn't talk like that. You're not a failure." Telling clients how they should or should not feel invalidates their feelings and is nontherapeutic.
2. "Once the antidepressants start working you will feel better about yourself." The client's depressive symptomatology should improve with antidepressants. However, this response is not the most therapeutic at this time.
3. "Things could be worse. You should be grateful for what you have." This response minimizes the client's feelings and can be perceived as punitive.
4. "You've been feeling like a failure your entire life?" This response restates what the client said and in doing so encourages the client to continue talking.

The nurse is completing the sexual history section of the admission assessment. The client tells the nurse "I don't want to talk about this. This is private between my spouse and me." Which nurse response reflects empathy?

1. "I am a professional nurse and I know what I am doing."
2. "I understand this is difficult for you to talk about, but I have to complete the admission assessment."
3. "Yes, I know just how you feel."
4. "I know some of these questions are difficult for you."

(4)

Rationale:
1. "Yes, I know just how you feel." This response shifts the focus from the client to the nurse, which is nontherapeutic.
2. "I understand this is difficult for you to talk about, but I have to complete the admission assessment." The nurse's need to complete the admission assessment does not take precedence over the client's feelings.
3. "I know some of these questions are difficult for you." This statement is empathic and acknowledges the client's feelings.
4. "I am a professional nurse and I know what I am doing." This statement negates the client's feelings and is nontherapeutic.

To provide effective feedback to a client, the nurse will focus on:

1. Providing solutions to the client.
2. The present and not the past.
3. The client.
4. Making inferences of the behaviors observed.

(2)

Rationale:
1. The client. To provide nonthreatening feedback, the focus should be on the behavior and not the client.
2. The present and not the past. Focusing on the here and now makes the feedback more meaningful. Feedback should be given as soon as it is appropriate to do so.
3. Providing solutions to the client. Assisting the client with identifying possible alternatives or goals for a problem is more effective than giving the client the answers. Providing solutions to the client gives the message that the client is not capable of doing so.
4. Making inferences of the behaviors observed. Inferences imply conclusions and assumptions and don't give the client an opportunity to explain a situation.

The use of facial expressions and gestures communicates:

1. Interest in, and attraction to, another person.
2. Personality traits.
3. Rejection.
4. Emotions.

(4)

Rationales:
1. Personality traits. Voice quality and tone reflect an individual's personality. People who vary their tone and increase their rate of speech are viewed as active and dynamic.
2. Interest in, and attraction to, another person. Body position reveals an individual's interest in or attraction to another person. The person who sits or stands far away from another person attempts interpersonal distance. Sitting in close proximity to another person usually indicates attraction.
3. Emotions. Facial expressions are the most important nonverbal communication and convey emotions.
4. Rejection. Averting eye contact with another individual conveys the message of rejection of the other person's request.

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