Ch 6 Prep U Questions
A client has just been given a diagnosis of cirrhosis of the liver. Which statements by the nurse should be avoided because they could impede communication? Select all that apply.
"Cheer up. Tomorrow is another day." "Your doctor knows best." "Don't worry. You will be just fine in another day or two." "Everything will be all right."
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? (Select all that apply.)
"Does it hurt when I touch you here?" "Is there any chance you might be pregnant?" "Are you ready to get out of bed?" "Do you smoke cigarettes?"
A nurse is caring for a client who is in delirium. The client tells the nurse that there are spiders on the wall and all over the room. What is the most appropriate response by the nurse to the client?
"I know that you are frightened, but there are no spiders on the wall."
A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?
"I think there is a better way to handle this."
A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?
"I understand you have four kids; how many times have you actually been pregnant?"
A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response?
"Share with me the advantages and disadvantages of your options as you see them."
A client comes into the urgent care center to have sutures removed on his right arm. The nurse assesses the sutures and finds significant crusting along the suture line. The client indicates he didn't have time to get his sutures removed a week prior as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls his arm away and tells the nurse, "you do not know what you are doing." In response, the nurse should answer:
"Sir, I understand this is uncomfortable but I assure you I am experienced with this task and would like to continue."
The daughter of an older adult female client has asked the nurse why a urine specimen was collected from her mother earlier that morning. How can the nurse best respond to the daughter's query?
"We want to test your mother's urine to make sure she doesn't have a urinary tract infection."
A client comes to the clinic reporting abdominal pain. Which question would be most appropriate for the nurse to ask to facilitate the assessment?
"What activities exaggerate the pain?"
The nurse is having a discussion with a client diagnosed with breast cancer. Which statement would be most effective in promoting communication?
"What are some of your ideas about how to handle this?"
A nurse is having problems communicating with a client. Which statement by the nurse would open up the most dialogue with the client?
"You are back from therapy; tell me about it."
The wife of a client who is terminally ill expresses to the nurse that she is unable to see her husband die and she may not come to the health care facility anymore. What should the nurse's response to her be?
"You have been coming here every day; are you taking some time for yourself?"
The nurse is preparing to administer meperidine as an intramuscular injection in an adult client's deltoid site. Which needle should the nurse select for this injection?
1 inch, 22 gauge
Which of the following nurses most likely is the best communicator?
A nurse who easily developed a rapport with clients.
A nurse has administered an injection to a client. Which intervention should the nurse perform to reduce discomfort and provide quick relief?
Apply pressure to the site during needle withdrawal.
The nurse is creating a professional development presentation about medication orders. Which teaching will the nurse include? Select all that apply.
Be extra cautious with look-alike and sound-alike drugs. The healthcare providers must sign all orders.
The nurse is reviewing a client's newly written medication order and is unable to read the prescriber's handwriting. Which action by the nurse is most appropriate?
Contact the prescriber to clarify the order.
A student nurse is attempting to improve her communication skills. Which therapeutic communication skill is appropriate?
Control the tone of the voice to avoid hidden messages.
Nurses on a hospital burn unit meet as a group to discuss procedures. Which statements accurately describe the functions of group dynamics? Select all that apply.
Effective groups possess members who elicit mutually respectful relationships. If a group member dominates or thwarts the group process, the leader or other group members must confront her to promote the needed collegial relationship. In an effective group, members support, praise, and critique one another.
A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which intervention is most appropriate?
Encourage family discussions of feelings.
The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique?
Encouraging elaboration
A nurse is discharging a client terminates the nurse-client relationship. Which action should the nurse perform in this phase?
Examine goals of the relationship to determine whether they were achieved
The nurse is teaching a client how to take medications upon discharge. The client is alert and oriented, but unable to articulate teaching back to the nurse. What is the appropriate nursing action?
Give written instructions to the client and caregivers.
A nurse instills eardrops into a client's ear to soften a wax buildup. What is a guideline the nurse should follow?
If both ears are to be treated, wait 5 minutes before instilling drops in the second ear.
A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
Open-ended question
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?
Orientation phase
A nurse is pouring a liquid medication into a medication cup and notices that there is an excess of medication in the cup for the ordered dose. Which action by the nurse would be most appropriate?
Remove the excess by pouring it into the sink.
A nurse is reviewing a client's medication record and notes that the client is receiving a suspension. What would the nurse need to do when administering this medication?
Shake the medication, measuring the dose for administration.
The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?
Speak directly to the client.
A healthcare provider who just arrived on the unit gives a verbal order to the nurse regarding a non-emergent client situation. What is the nurse's appropriate response?
Tactfully request the provider to input the order into the computerized provider order system.
A nurse has been caring for a client who suffered a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how he feels. Which scenario warrants further investigation?
The client stares at the floor and states, "I feel fine."
Why is communication important to the "assessment" step of the nursing process?
The major focus of assessing is to gather information.
A nurse is sitting near a client while conducting a health history. The client keeps edging away from the nurse. What might this mean in terms of personal space?
The nurse is in the client's personal space.
The nurse is using nonverbal communication when caring for a group of clients. Which situation reflects non-verbal communication? Select all that apply.
The nurse is maintaining eye contact when changing a client's dressing The nurse has a smile when being thanked for caring for a family member The nurse is using a quiet tone of voice
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.
The nurse shows patience with the client and gives the client time to respond. The nurse maintains eye contact with the client. The nurse keeps communication simple and concrete.
A nurse and an older adult client with chronic back pain are in the working phase of the nurse-client relationship. Which activity occurs in the working phase?
The nurse tries to avoid hampering the client's independence.
A nurse needs to administer a prescribed injection to a toddler. Which injection site is most suitable for the client?
Vastus lateralis site
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:
aggressive
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
allow the client to set the pace.
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse she is afraid of waking up during surgery. The best response by the nurse is to:
ask the client why she thinks she will wake up during surgery.
A graduate nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the graduate nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to:
ask to speak to the night shift nurse in private and explain how the comment made her feel.
A nurse is on his lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. The nurse recognizes one of the physicians as being in charge of his clients. The nurse witnesses the physician point at the nurse and state, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address any disrespectful remarks or behaviors.
A client arrives at the emergency department after experiencing several black, tarry stools. The nurse will develop a cause and effect by:
asking the client if he or she has recently taken ferrous sulfate (iron) or bismuth subsalicylate.
During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question?
closed question
Which nursing role is primarily performed during the working phase of the helping relationship?
counselor
A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with the diagnosis include:
easy wrinkling of the skin and sunken eyes.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible.
Which term describes a nurse who is sensitive to the client's feelings, but remains objective enough to help the client achieve positive outcomes?
empathetic
Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached?
empathy
A client has just been diagnosed with cancer. As part of the plan of care, the nurse attempts to explore the client's feelings about the diagnosis to foster looking at alternatives. The nurse implements this action based on the understanding that looking at alternatives promotes:
exploration of options for the client's consideration.
A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:
have group members confront the dominant member to promote the needed team work.
Which parenteral route of administration has the longest absorption time?
intradermal
The nurse encourages a client to participate in the communication process by using an opening remark based on observations and assessment. Which approach would be most effective for the nurse to use to promote trust?
neutral
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?
orientation phase
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug abuser. To foster effective communication, the nurse should:
remain honest, open, and frank.
While obtaining a client's past medical history, the nurse repeats the content of the client's message to verify understanding. The nurse is using which technique?
restatement
A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out?
reviewing health changes
The nurse transcribes an order that reads: Colace 100 mg PO daily. This is an example of which type of order?
standing order
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:
"Can you tell me why your physician sent you here to be admitted?"
The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety?
"I will start an IV that will add fluids directly to the blood stream."
A nurse pays a house visit to a client who is on parenteral nutrition (PN). The client expresses that he misses enjoying food with his family. What is the most appropriate response by the nurse?
"Tell me more about how it feels to eat with your family."
The health care provider prescribes ciprofloxacin PO q12h for a client with bronchial pneumonia. The nurse has ciprofloxacin 250 mg on hand. How many tablets would the nurse dispense?
2
The nurse has entered a client's room and observes that the client is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction?
A yes/no question
A nurse is planning care for an adult client with severe hearing impairment that uses sign language and lip reading for communication that has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care?
Arrange for a sign language interpreter when discussing treatment.
A nurse is administering an intradermal injection to a client for a skin allergy test. When the nurse is finished, there is no sign of a wheal or blister at the site of injection. What is the nurse's best action in this situation?
Document the administration and inform the primary care provider.
Mrs. Miller is a 60-year-old woman status post a hip replacement. She has had multiple complications following surgery including a skin infection and a blood clot. As a result, she has been a client on the unit for 6 weeks. The nurse has just returned from vacation and this is her first day caring for Mrs. Miller. A colleagues looks at the nurse and describes Mrs. Miller as "quite difficult to deal with." The nurse knows that all of the following can contribute to difficult behaviors except:
a quiet room
The nurse and the physical therapist discuss the therapy schedule and goals for a client on a rehabilitation unit. What type of communication is occurring between the nurse and the therapist?
interpersonal
Which action by the nurse will facilitate the nurse-client relationship during the orientation phase?
introducing oneself to the client by name
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:
involve the child's stuffed animal in the educational session.
An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should:
recommend 40 mg of furosemide be administered because the client had improvement with past administration.
A nurse tells a client that she will come back in 10 minutes to reassess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing?
trust
A physician uses the standard abbreviation b.i.d. in the medication order to indicate the frequency of administration of the medication. What is the frequency of administration of the medication that the nurse should follow?
twice a day
The nurse is caring for a client who speaks Chinese, and the nurse does not speak Chinese. An appropriate approach for communication with this client includes:
using a caring voice and repeating messages frequently.
An older adult client is advised to undergo a 12-lead ECG assessment. The client seems to be anxious because this is the first time he is undergoing such a procedure. What explanation should the nurse provide to the client?
"The ECG electrodes are painless and will record electrical activity of the heart."
Which statements made by the nurse indicate how insulin pens simplify self-administered insulin for clients? Select all that apply.
"The cylinder of the insulin pen contains a prefilled reservoir of insulin." "The dose of insulin in an insulin pen is displayed in a window of the syringe." "Insulin pen automatically resets the dose window to zero, following the injection."
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?
"The needle causes pain when it goes in, but I will be by your side throughout and will help you hold your position."
A client reports to the primary health care facility reporting chest pain. After the investigations and initial treatment, the client anxiously inquires if he had a heart attack. What should be the nurse's reply?
"The physician wants to monitor you and control your pain."
A client with chronic hyperparathyroidism expresses that she is fed up with her diet and can no longer continue with it. What should the nurse's appropriate response to the client be?
"You may be having a difficult time staying on that diet; let's discuss it."
The nurse has engaged the services of an interpreter when interviewing a client who speaks a language that the nurse does not understand. The interpreter is functioning in which role during the communication process?
Communication channel
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?
The working phase
A nurse needs to combine two different prescribed drugs in a syringe and then administer them to a client with influenza. Which precaution should the nurse take when combining drugs?
Withdraw exact amounts of each drug from each container.
The nurse is reporting to an oncoming nurse about the care of a client using the SBAR format. The nurse informs the oncoming nurse that the client should continue to have neurolgoical checks every 2 hours and the nurse should report any alterations to the health care provider. In which section should this information be relayed?
recommendation
What is the goal of the nurse in a helping relationship with a client?
to assist the client to identify and achieve goals
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:
"Were you tired and depressed before starting the new medication?"
Which of the following are examples of nonprofessional involvement? (Select all that apply.)
Asking a patient if they would like to go out for dinner after they are discharged. Discussing your recent breakup with your boyfriend with a patient who is also going through a difficult breakup.
A nurse needs to administer a prescribed dosage of oral medication to a client with influenza. Which action should the nurse perform when administering oral medication to the client?
Avoid administering medication prepared by another nurse.
A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?
Be silent and allow the client to continue speaking when ready.
A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
open-ended question
A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:
sit at the bedside and allow the client to explain the statement.
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because she has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should:
tell herself to "remain calm" and remember that she was trained to perform this skill.
A group of students is reviewing information about important components of the nurse-client relationship. The students demonstrate understanding of the information when they describe positive regard as:
viewing the client unconditionally.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?
working phase