Therapeutic Communication and Nurse-Client Relationships

During which phase does a provider establish rapport, set boundaries, and discuss confidentiality?

• Orientation phase

• Working phase

• Pre-orientation phase

• Termination phase

Answer explanation

The orientation phase covers introductions, rapport, boundaries, and confidentiality. Pre-orientation happens before meeting the patient and involves chart review only.

Why should a provider allow extra time at the end of the termination phase?

• To establish new treatment goals for future care

• To let the patient express feelings about ending care

• To complete a final review of the patient's chart

• To formally introduce the patient to the next provider

Answer explanation

Ending a care relationship can trigger grief, so the provider must allow time for the patient to share those feelings. Setting new goals belongs to the orientation phase of a new relationship.

A patient is hostile toward a provider because the provider resembles an abusive parent. What is this called?

• Transference from the patient toward the provider

• A therapeutic boundary violation by the provider

• Countertransference from the provider toward the patient

• A non-therapeutic communication pattern by the provider

Answer explanation

Transference occurs when a patient redirects feelings about a past person onto the provider. Countertransference is the reverse, where the provider's own past relationships influence their feelings toward the patient.

A provider responds to a patient's question by asking, 'What are your thoughts on that?' Which technique is this?

• Offering self to support the patient's needs

• Clarifying the patient's statement for understanding

• Reflecting the question back to the patient

• Restating the patient's own words back to them

Answer explanation

Reflection turns the patient's question back to them, encouraging self-directed thinking about their own decision. Restating is a close distractor but involves repeating the patient's words to confirm understanding, not redirecting a question.

When presenting reality to a patient who reports hearing voices, what should the provider do?

• Ask an open-ended question about what the voices say

• Change the subject to redirect the patient's attention

• Confirm the voices are real to avoid upsetting the patient

• Acknowledge the experience while stating no voices are heard

Answer explanation

Presenting reality means acknowledging the patient's perception without validating the delusion, such as saying the provider does not hear any voices. Confirming the voices are real reinforces the delusion.

Which of the following is a non-therapeutic communication technique?

• Reflecting a question back to encourage patient thinking

• Asking an open-ended question about the patient's symptoms

• Sharing an observation about the patient's current mood

• Telling a patient that everything will be just fine

Answer explanation

Telling a patient everything will be fine is false reassurance and is non-therapeutic because the provider cannot guarantee that outcome. The other options are all recognized therapeutic communication techniques.

Why are 'why' questions considered non-therapeutic when talking with a patient?

• They put the patient on the defensive and hinder open communication

• They validate the patient's feelings instead of correcting misconceptions

• They lead the patient toward a provider-preferred answer

• They require a yes or no answer and shut down conversation

Answer explanation

Why questions make patients feel judged or accused, putting them on the defensive. Close-ended questions are the ones that produce yes/no answers and shut down conversation.