Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?

Correct Answer: D

Rationale: Asking 'why' questions is not considered a therapeutic technique in patient-centered communication as it can make patients feel defensive or judged. 'Why' questions may imply criticism or put the patient on the spot, potentially hindering open and honest communication. Instead, focusing on open-ended questions that encourage patients to express their feelings and thoughts without feeling judged or interrogated is more conducive to therapeutic communication.

Correct Answer: A

Rationale: Choice A, 'Hitting me when you are angry is unacceptable,' demonstrates a well-structured attempt at limit setting because it clearly defines the unacceptable behavior without ambiguity. This statement sets a clear boundary and clearly communicates the consequence for the behavior. In contrast, choices B, C, and D are less effective in setting limits as they are either vague expectations or commands without specific consequences for crossing the limit.

Correct Answer: D

Rationale: Children with ADHD often struggle with sustained attention, impulsivity, and hyperactivity, making it essential to select activities that align with their neurological needs while minimizing frustration. Tennis (D) is the most appropriate choice because it combines physical exertion, structured rules, and intermittent bursts of focused activity, which are well-suited for ADHD. Physical exercise, such as tennis, has been shown to improve executive function, attention, and impulse control by increasing dopamine and norepinephrine levels—neurotransmitters often dysregulated in ADHD. The game’s fast-paced nature provides immediate feedback and rewards, keeping the child engaged without requiring prolonged static focus. Additionally, the social and competitive aspects can reinforce positive behavior and teamwork. Reading an adventure novel (A) is less ideal because it demands sustained silent focus, a challenge for children with ADHD who may struggle with attention spans and sitting still. While some children with ADHD might enjoy stories, the lack of physical engagement and delayed gratification (e.g., waiting for plot developments) can lead to frustration or disengagement. Monopoly (B) is problematic due to its lengthy playtime, complex rules, and turn-based structure, which may exacerbate impulsivity (e.g., acting out of turn) or boredom during waiting periods. The game’s reliance on strategic planning and delayed rewards can also be overwhelming for a child with executive function difficulties. Checkers (C), while simpler than Monopoly, still requires sustained attention and strategic thinking, which can be taxing. The sedentary nature of the game may not accommodate the child’s need for movement, potentially leading to restlessness or impulsivity, such as making hasty moves without planning. Tennis stands out as the best option because it channels the child’s energy productively, provides sensory and motor stimulation, and aligns with evidence-based interventions for ADHD, such as incorporating physical activity into daily routines. The other choices, while potentially enjoyable for some, fail to address the core challenges of ADHD as effectively.

Correct Answer: B

Rationale: In cognitive-behavioral therapy, recognizing and challenging negative thoughts is crucial for progress. Choice B demonstrates the patient's ability to identify and correct distorted thoughts, indicating positive advancement in therapy. This cognitive restructuring is a key component of cognitive-behavioral therapy, helping individuals develop healthier thinking patterns and coping strategies.

Correct Answer: C

Rationale: During an admission assessment and interview, the nurse must actively engage with and monitor multiple communication channels to gather comprehensive patient information. The correct answer is **C: Written**, as it is the least applicable channel during an active, real-time assessment where direct interaction is prioritized. **Why C (Written) is the incorrect choice (and doesn't apply):** Written communication, such as medical records or notes, is passive and retrospective. While it provides valuable background information, it is not a channel the nurse actively *monitors* during the live assessment. The nurse may reference written data, but the assessment primarily relies on real-time, dynamic interactions. Written communication lacks immediacy and does not involve direct patient engagement, making it the least relevant channel for active monitoring in this context. **Why A (Auditory) is essential and applies:** Auditory communication is critical as the nurse listens to the patient’s verbal responses, tone, and speech patterns. This channel provides direct information about the patient’s mental status, emotional state, and subjective symptoms (e.g., pain descriptions). Active listening helps identify inconsistencies, concerns, or cues that require follow-up. Ignoring auditory input would result in missing vital verbalized patient needs or history details. **Why B (Visual) is essential and applies:** Visual observation allows the nurse to assess nonverbal cues, such as body language, facial expressions, and physical appearance. These cues reveal discomfort, anxiety, or signs of illness (e.g., pallor, sweating). Visual monitoring also includes observing the patient’s environment for safety hazards or adaptive equipment use. Without visual attention, the nurse may overlook critical clues that inform care decisions. **Why D (Tactile) is essential and applies:** Tactile communication involves touch, a key component of physical assessment (e.g., palpating pulses, checking skin temperature, or assessing edema). Touch also conveys empathy and reassurance, which can ease patient anxiety. Tactile cues provide objective data (e.g., muscle rigidity or tenderness) that cannot be obtained through other channels. Neglecting tactile monitoring would compromise the accuracy of the physical exam. In summary, while auditory, visual, and tactile channels are actively monitored during the assessment to gather real-time, interactive data, written communication serves as supplemental rather than a primary channel for immediate observation. The nurse’s focus is on dynamic, patient-centered interaction, making written information secondary in this context.