Chapter 8 - Communication
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive? A. Facial expressions B. Posture C. Hand gestures D. Eye contact
A. Facial expressions Explanation: The face is the most expressive part of the body. Eye contact or the lack thereof, posture, hand gestures, and silence are other methods of nonverbal communication but do not provide as much information about what the person is communicating as do facial expressions.
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes? A. contacting the interprofessional care team to discuss alternative treatment options B. explaining the health consequences of refusing to undergo the prescribed treatment C. asking the client's family to discuss the importance of the prescribed treatment with the client D. recommending assessment of the client's cognitive capacity to make health care decisions
A. contacting the interprofessional care team to discuss alternative treatment options Explanation: Nursing responsibilities in the nurse-client relationship entail advocating on the client's behalf. For a client who does not consent to a particular type of treatment, for which there may be alternative treatments available, the nurse can establish trust in the nurse-client relationship by advocating for the client's care needs to the client's interprofessional care team.
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic? A. "My grandfather also benefited from laser surgery." B. "Have you ever thought of laser surgery?" C. "You should try laser surgery." D. "Why don't you try laser surgery?"
B. "Have you ever thought of laser surgery?" Explanation: "Have you ever thought of laser surgery?" is a therapeutic response and encourages the client to express the client's own views.
A nurse is calling a physician to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation? A. "Good morning, I am calling about Mrs. Jones, who is a client of yours." B. "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." C. "My name is Sue, and I am calling about Mrs. Jones, a client of yours at Jefferson Hospital." D. "I have a client of yours at Jefferson Hospital who is experiencing a change in condition and needs to be seen immediately!"
B. "My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." Explanation: The nurse should identify oneself and one's role during the initial conversation with the physician, as in the answer in which the nurse states the full name and degree. This allows the physician to understand the role of the nurse should the physician need to provide orders or instructions regarding the client.
A client scheduled to have hip replacement surgery states, "I am so scared of the surgery and of the anesthetic." What is the best response by the nurse? A. "Your wife will be in the surgery waiting room the entire time." B. "What questions do you have about the surgery?" C. "You really don't have anything to worry about." D. "What will happen if you don't have surgery?"
B. "What questions do you have about the surgery?" Explanation: The nurse should allow the client time to express fears about the anesthesia and the surgery. Telling the client that the client's wife will be waiting or not to worry or asking what will happen if the client doesn't have the surgery does not address the client's concerns.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: A. "Do you have an advanced directive or a living will?" B. "Are you allergic to any medications?" C. "What did your health care provider tell you about your need to be admitted?" D. "Can you tell me the medications you take on a daily basis?"
C. "What did your health care provider tell you about your need to be admitted?" Explanation: 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.
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? A. "It sounds as though you are most concerned about how your children will feel." B. "I am so sorry that I am crying with you when you need my support the most." C. "This just is not fair at all and I do not understand why this is happening to you." D. "This is so sad and I feel so bad that you are in this situation."
A. "It sounds as though you are most concerned about how your children will feel." Explanation: The nurse is demonstrating empathy when reiterating what the client is saying. This helps the nurse become effective at providing for the client's emotional needs while maintaining detachment. The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client.
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: A. Aggressive B. Assertive C. Passive D. Nurturing
A. Aggressive Explanation: Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements.
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? A. Assess how the client would like to communicate B. Use facial and hand gestures C. Contact a person skilled in sign language D. Provide paper and pencil for written communication
A. Assess how the client would like to communicate Explanation: Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important.
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? A. Be silent and allow the client to continue speaking when ready. B. Smile and say, "Don't worry, I am sure the physician is doing a good job." C. Nod and say, "I agree. If I were you, I would get a new doctor." D. Stand and say, "I can see this interview is making you uncomfortable, so we can continue later."
A. Be silent and allow the client to continue speaking when ready. Explanation: 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. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication.
Which nurse would most likely be the best communicator? A. An advanced practice nurse B. A nurse who easily develops a rapport with clients C. A nurse who is bilingual D. A nurse who is proficient in sign language
B. A nurse who easily develops a rapport with clients Explanation: Rapport, a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication.
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? A. The introduction phase B. The working phase C. The orientation phase D. The termination phase
B. The working phase Explanation: 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 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? A. "Is your name Evelyn?" B. "Are you in a hospital?" C. "What is your name?" D. "Is today the first day of the month?"
C. "What is your name?" Explanation: Asking the client to state their name represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response.
A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase? A. Create a contract regarding the relationship B. Provide assistance to achieve goals C. Examine goals of the relationship to determine whether they were achieved D. Make formal introductions
C. Examine goals of the relationship to determine whether they were achieved Explanation: In the termination phase, the nurse and client examine the goals of the nurse-client relationship for indications of their attainment or evidence of progress toward them.
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? A. Involve a friend who speaks both the dominant and the client's languages. B. Contact a professional interpreter. C. Allow the client's child to interpret. D. Ask a fellow nurse who knows some words in the client's language to help.
C. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Explanation: If an interpreter is necessary, the nurse should use a professional interpreter recommended by the facility or agency. It is inappropriate to rely on the client's family members or friends for this service. If the fellow nurse is not fluent in the language, then this nurse is not likely to be effective as an interpreter.
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 the nurse has not often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should: A. ask the charge nurse to change the assignment. B. inform the client that several nurses will be needed to care for this wound. C. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. D. tell the unlicensed assistive personnel (UAP) to gather supplies and to prepare to cleanse and dress the wound.
C. tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Explanation: Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities.
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? A. "Were these term births?" B. "How old are your children?" C. "All right, you have four children, is that correct?" D. "I understand you have four kids; how many times have you actually been pregnant?"
D. "I understand you have four kids; how many times have you actually been pregnant?" Explanation: The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse.
A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response? A. Place a chair next to the bed and then leave the room to allow the parent to grieve. B. Encourage the parent to bring in pictures of the family that can be displayed in the room. C. Place the client's hand on the parent's hand and reassure the parent that things will be fine. D. Place a chair next to the bed and encourage the parent to hold the client's hand.
D. Place a chair next to the bed and encourage the parent to hold the client's hand. Explanation: Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. The nurse may feel it is appropriate to place the client's hand on the parent's hand; however, the nurse should not provide false hope.
A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult: A. a clinical psychologist. B. an optometrist. C. an ophthalmologist. D. an audiologist.
D. an audiologist. Explanation: A nurse who suspects a speech, language, or hearing problem should refer the client to a speech-language pathologist or audiologist. A speech-language pathologist is a professional educated in the study of human communication, its development, and its disorders. An audiologist is a professional educated in the study of normal and impaired hearing.
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: A. ask the child's parents to leave the room while the nurse and child talk. B. show the child the intravenous catheter and explain how it works. C. provide both verbal and written information to the child. D. involve the child's stuffed animal in the educational session.
D. involve the child's stuffed animal in the educational session. Explanation: Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy.
