Chapter 14 Communication in Nurse Patient relationship

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?

Encouraging elaboration

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.

"Don't worry. You will be just fine in another day or two." "Everything will be all right." "Your doctor knows best." "Cheer up. Tomorrow is another day."

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?" Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence.

A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?

Contact a professional interpreter.

Which term describes a nurse who is sensitive to the client's feelings, but remains objective enough to help the client achieve positive outcomes?

Empathic Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes

Which action by the nurse would facilitate the nurse-client relationship during the orientation phase?

Introducing oneself to the client by name

A nurse administers pain medication to a client. Which action should the nurse take to facilitate trust?

Return in 30 minutes for follow-up per previous communication with the client.

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 during this phase of the relationship?

Reviewing health changes During the termination phase of the nurse-client relationship, the nurse and the client review health changes and how the client has dealt with physical and emotional responses

A nurse is caring for a client who sustained a spinal cord injury and has paraplegia. The client is frustrated, crying, and tells the nurse, "I just want to die." What is the nurse's best response to the client?

The nurse says, "I can only imagine how hard this is on you. How can I help you?"

An experienced nurse is orienting a new nurse to the unit. Which activity demonstrates the nurse is an effective caregiver?

The nurse uses OPEN-ENDED questions when working with a crying client.

A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult:

an audiologist.

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.

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 user. To foster effective communication, the nurse should:

remain honest, open, and frank.

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.

When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?

Facial expressions

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?"

Which is a characteristic of a person-centered or helping relationship?

An unequal sharing of information

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 should facilitate open and effective communication among those threatened by the loss of a family member. The nurse should abstain from making decisions on the family's behalf.

A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment?

Pull the curtain dividing the two beds. It might not always be possible to carry on conversations alone with the client in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital is enough

What is the goal of the nurse in a helping relationship with a client?

To assist the client to identify and achieve goals

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. Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship.

The nurse is caring for a client with different cultural practices and beliefs regarding health care. In which manner can the nurse ensure health disparities are reduced and the client receives equitable care?

Adapt care to encourage a collaborative, client-centered relationship that ensures safe practice.

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." When a client is hallucinating, the nurse should constantly orient him to reality, addressing his feelings simultaneously. The nurse should avoid statements that disregard the client's feelings. Also, the nurse should not use statements that are not reality-based.

A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the 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 the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response?

"It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." Sharing information about why the removal of the sutures hurts and is taking longer is a teaching moment which helps the client make better decisions about health care.

The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client?

"It sounds as though you are most concerned about how your children will feel." The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client.

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?

"You seem unsure. Tell me your concerns about your surgery."

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?

Empathy

The nurse enters a client's room after receiving a morning report. The nurse rapidly assesses the client's airway, breathing, and circulation and greets the client by saying "Good morning." The client makes no reciprocal response to the nurse. How should the nurse best respond to the client's silence?

The nurse should ask appropriate questions to understand the reasons for the client's silence. Silence can have many meanings, and the nurse should attempt to identify the meaning of the client's silence in a tactful manner

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. Positive regard refers to warmth, caring, interest and respect for the person, and seeing the person unconditionally or nonjudgmentally. It does not depend on the client's behavior; instead, the person is regarded as worthwhile simply for being human.

Paramedics arrive in the emergency department with a client who was in a motor vehicle collision. The paramedic reports that the driver was restrained, the car was traveling about 30 miles per hour (48 km/hr), and the air bags were not deployed. The paramedic continues to report that the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic?

"All of the people got themselves out of the car?" A validation question or comment serves to validate what the nurse believes the nurse has heard or observed.

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

"Have you ever thought of laser surgery?" "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views. Statements such as, "You should try laser surgery"; "Why don't you try laser surgery"; and "My grandfather also benefited from laser surgery" are nontherapeutic and are equivalent to giving advice. You cannot give advice

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you." Nurses often rely on verbal and nonverbal cues from clients to verify whether client objectives or goals have been achieved. It is therapeutic to allow for a pause in the communication by giving the client time to think about the situation and what has happened.

An older adult client has given medical power of attorney to her adult daughter. The daughter asks the nurse why a urine specimen was collected from the client earlier that morning. How can the nurse best respond to the daughter's query?

"We want to test the urine to make sure your mother doesn't have a urinary tract infection." To communicate effectively, the nurse should avoid the use of jargon or abbreviations (e.g., "C&S") that are unfamiliar to those outside the health care system. At the same time, accuracy is important, and vague and "dumbed-down" answers (e.g., "we want to do everything we can," "sick urine") are inappropriate.

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?" The nurse should ask, "What are some of your ideas about how to handle this?" to promote communication and foster the client's ability look at alternatives to arrive at a decision. "You

During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:

"What did your health care provider tell you about your need to be admitted?" When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer, which limits the client's response.

A nurse is conducting a health history. The client's spouse is answering the interview questions. What question would be appropriate to ask the client before proceeding with the remainder of the interview?

"Who manages health care-related issues in your family?" It is important to establish who makes those decisions and to be respectful of the client's culture. It is best to take cues from the client. A client that is allowing another family member to answer questions may be doing so based upon the culture and roles in the family; it is important to clarify.

The nurse enters 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 ask the client in this interaction?

A yes or no question Sometimes a yes or no question is appropriate. In this case, the nurse may want to ask, "Do you feel short of breath?" or something similar. Directing questions and reflective questions follow up on earlier communication. An open-ended question may elicit the necessary assessment data, but a yes or no question accomplishes this goal more directly.

A client reports to a primary health care provider with aggravated chest pain. The health care provider prescribes a stress test. The client tells the nurse about not wanting to take the test and wanting to continue taking medication for now. Understanding that the client is anxious, which action should the nurse take first to provide education needed for this client?

Ask the client "What has your health care provider shared with you about stress tests?" To reassure the client, the nurse should provide education about the stress test so the client can make an informed decision. The nurse should not assume the health care provider has provided complete information about the stress test. By first inquiring with an open-ended question, the nurse allows the client to share his or her knowledge.

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. When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints.

Which is a skill appropriate to use in therapeutic communication?

Control the tone of the voice to avoid hidden messages. Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message.

While communicating with a client, the nurse uses words and gestures to get the purpose translated. The nurse is engaged with which element of communication?

Encoding All communication has a sender whose purpose must be translated into a code with language and nonverbal signals. The process is called encoding.

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 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 There are three phases of a helping relationship: the orientation phase, the working phase, and the termination phase. The introduction phase is not a valid phase, yet the nurse introduces oneself during the orientation phase. The scenario defines characteristics of the working phase, during which the nurse and client work together to meet the client's physical and psychosocial needs. During the orientation phase, the nurse and client establish the tone and guidelines for the relationship . The termination phase occurs when the nurse and client acknowledge that they have met the goals of the initial agreement or that the client would be better served by another nurse or health care provider.

A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse:

sits at the client's bedside and faces the client. When possible, sit when communicating with a client. Do not cross the arms or legs because that body language conveys a message of being closed to the client's comments.