communication chapter 21 & 22
A nurse visits a female victim of sexual assault for the fourth visit. The client expresses that she is unable to cope with the trauma. Even though the assault occurred quite some time ago, she feels as if it just happened yesterday. What is the most appropriate response by the nurse? a) "Tell me more about the aspects that makes you feel as if it happened yesterday." b) "In reality, the rape did not occur yesterday; it has been over one month now." c) "Can you do something to alleviate the fear of being assaulted again?" d) "We should move on from the strong feelings associated with this incident."
a) "Tell me more about the aspects that makes you feel as if it happened yesterday." --The nurse should make statements that would facilitate an expression of feelings from the client. The nurse should encourage the client to express her fears and insecurity. This conveys that the nurse is there to provide support. The nurse should avoid giving an opinion and should in fact allow the client to hold on to the feelings; it is a non-therapeutic approach. Making the client realize that the rape occurred a month ago would block communication.
A nurse has developed strong rapport with the wife of a patient who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The patient's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond? a) "This must be very difficult for you to hear. How do you feel right now?" b) "What would help you accept that this is best for both of you?" c) "Why do you think that the care team has made this recommendation?" d) "Do you understand that everyone here has your husband's best interests at heart?"
a) "This must be very difficult for you to hear. How do you feel right now?" --Asking the wife to elaborate on her feelings may be therapeutic as well as insightful. Asking about the reasons underlying the care team's recommendation is less likely to be of benefit and attempting to redirect the wife to a positive outlook at this early point is insensitive.
A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique? a) Giving false reassurance b) Seeking clarification c) Giving information d) Encouraging elaboration
a) Giving false reassurance --False reassurance means giving reassurance that is not based on the real situation. It is a way of minimizing the client's situation and violates the client's trust
A nurse enters the client's room and introduces himself stating, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." He then gives the client a printed card with this information. In the helping relationship, what does this represent? a) Orientation phase b) Intimate phase c) Working phase d) Termination phase
a) Orientation phase --The orientation phase consists of introductions and an agreement between the nurse and the client about their mutual roles and responsibilities.
The nurse is assisting a male client 55 years of age to understand the anatomy and physiology of the heart following a heart attack. What type of learning is taking place? a) Pedagogy b) Andragogy c) Affective d) Psychomotor
b) Andragogy
The nurse needs to understand the teaching-learning process when administering a) Physician-initiated interventions b) Educational interventions c) Technical interventions d) Psychosocial interventions
b) Educational interventions --Educational interventions require the application of the teaching-learning process.
What is the most appropriate teaching strategy for the nurse to use for a 1-hour presentation on the prevention of osteoporosis to a group of 30 college-age women? a) Role play b) Lecture/discussion c) Demonstration d) Test taking
b) Lecture/discussion --Lecture/discussion is appropriate for this topic, audience, and group size. A lecture is a formal presentation of information by a teacher to a group of learners. This format is most effective when communicating facts.
A nursing instructor is discussing differences between helping relationships and social relationships with a group of nursing students. Which statement is a characteristic of a helping relationship? a) A helping relationship is built on the needs of the helping person. b) The person being helped in the helping relationship is accountable for the outcomes of the relationship. c) A helping relationship is characterized by an unequal sharing of information. d) A helping relationship occurs spontaneously with random individuals.
c) A helping relationship is characterized by an unequal sharing of information. --A helping relationship is characterized by an unequal sharing of information. The patient shares information related to personal health problems, and the nurse shares information in terms of a professional role.
Which of the following guidelines is most important for the nurse to keep in mind when planning to teach an exercise class to a group of older adults? a) Allow for long-term memory loss b) Keep the session at 2 to 3 hours c) Allow ample time for psychomotor skills d) Provide information in a structured format
c) Allow ample time for psychomotor skills --Older adults need more time to learn psychomotor skills. Sessions of 2 to 3 hours are too long; short-term rather than long-term memory loss affects older adults; and information can be structured or non-structured, depending on the content.
The nurse is caring for a 70-year-old client with a fractured wrist. Which of the following is the best method to determine if the client has retained the information taught? a) Ask the client to administer the doses of drug himself or herself. b) Observe the change in client's behavior for a month. c) Ask the client to recall after approximately 15 minutes. d) Test the client on the health teaching and information imparted.
c) Ask the client to recall after approximately 15 minutes. --Asking a client to recall what has been discussed after approximately 15 minutes have passed helps determine what information the client has actually retained.
To meet accreditation standards regarding client care, a health care facility must show evidence of what? a) Documentation of indigent care b) Financial accounts and statements c) Client education documentation d) Employee satisfaction surveys
c) Client education documentation
When caring for a client, the nurse observes that the client enjoys reading books and magazines. In which of the following learning domains does the client's learning style fall? a) Interpersonal domain b) Psychomotor domain c) Cognitive domain d) Affective domain
c) Cognitive domain --As the client enjoys reading books and magazines, the client's learning style would fall in the cognitive domain, where information is processed by listening or reading facts and descriptions.
A pediatric nurse provides teaching to numerous patients in her care. Which group of children benefits most from being involved in the teaching-learning process? a) Infants b) Toddlers c) School-aged children d) Preschoolers
c) School-aged children --Teaching related to infants, toddlers, and preschool children should be directed at the parents. School-aged children are capable of logical reasoning and should be included in the teachinglearning process whenever possible.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted in 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. What phase of the working relationship is best described in this scenario? a) The orientation phase b) The introduction phase c) The working phase d) The termination phase
c) 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 will introduce herself 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 tone and guidelines for the relationship are established. The termination phase occurs when the conclusion of the initial agreement is acknowledged.
When the preoperative client tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is what? a) "Sounds as if your surgery is a pretty scary procedure." b) "You have a great surgeon. You have nothing to worry about." c) "You shouldn't be nervous. We perform this procedure every day." d) "The thought of having surgery is keeping you awake."
d) "The thought of having surgery is keeping you awake." --Reflection means identifying the main emotional themes.
Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached? a) Sympathy b) Kindness c) Commiseration d) Empathy
d) Empathy --Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform his or her activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and his or her performance may be affected. Kindness and commiseration also have an emotional component attached to them.
The nurse has entered a client's room after receiving a morning report. The nurse rapidly assessed the client's airway, breathing, and circulation and greeted the client by saying "Good morning." The client has made no reciprocal response to the nurse. How should the nurse best respond to the client's silence? a) The nurse should ask the client if he feels afraid or angry. b) The nurse should document the client's withdrawal and diminished mood in the nurse's notes. c) The nurse should apologize for bothering the client, perform necessary assessments efficiently and leave the room. d) The nurse should ask appropriate questions to understand the reasons for the client's silence.
d) 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. Directly asking if the client is angry or fearful is likely presumptuous and may harm rapport. The nurse should not make assumptions around the client's mood nor should the nurse cease to engage with the client.