Communication Concept

10. A nurse has been gathering physical assessment data on a patient and is now listening to the patient's concerns. The nurse sets a goal of care that incorporates the patient's desire to make treatment decisions. This is an example of the nurse engaged in which phase of the nurse-patient relationship? 1. Working phase 2. Preinteraction phase 3. Termination phase 4. Orientation phase

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11. A group of nurses is discussing the advantages of using comput¬erized provider order entry (CPOE). Which of the following statements indicates that the nurses understand the major advantage of using CPOE? 1. "CPOE reduces transcription errors." 2. "CPOE reduces the time needed for health care providers to write orders." 3. "CPOE eliminates verbal and telephone orders from health care providers." 4. "CPOE reduces the time nurses use to communicate with health care providers."

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3. A new nurse complains to her preceptor that she has no time for therapeutic communication with her patients. Which of the following is the best strategy to help the nurse find more time for this communication? 1. Include communication while performing tasks such as changing dressings and checking vital signs. 2. Ask the patient if you can talk during the last few minutes of visiting hours. 3. Ask Pastoral care to come back a little later in the day. 4. Remind the nurse to complete all her tasks and then set up remaining time for communication.

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A nurse is receiving a provider's prescription by telephone for morphine for a client who is reporting moderate to severe pain. Which of the following nursing actions are appropriate? (select all that apply) 1. Repeat the details of the prescription back to the provider 2. Have another nurse listen to the telephone prescription 3. Obtain the provider's signature on the prescription within 24 hr 4. Decline the verbal prescription because it is not an emergency situation 5. Tell the charge nurse that the provider has prescribed morphine by telephone

1,2,3

A nurse is discussing occurrences that require completion of an incident report with a newly licensed nurse. Which of the following should the nurse include in the teaching? (select all that apply) 1. Medication error 2. Needlesticks 3. Conflict with provider and nursing staff 4. Omission of prescription 5. Complaint from a client's family member

1,2,4

9. The nurse is transferring a patient to a long-term, skilled care facility and has just given a telephone report to a registered nurse (RN) who works at that facility and who will be receiving the patient. In documenting this call, the nurse begins by writing the date and time the report was given and the name of the RN taking the report. Which of the following pieces of information does the nurse include in the documentation of this telephone call? (Select all that apply.) 1. The patient's name, age, and admitting diagnoses 2. The discussion of any allergies to food and medications that the patient has 3. That the nurse receiving the report was advised that the patient is "needy" and "on the call light all the time" 4. That the patient's pain rating went from 8 to 2 on a scale of 1 to 10 after receiving 650 mg of Tylenol 5. Description of any unresolved problems and current interventions in place

1,2,4,5

13. Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? (Select all that apply.) 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

1,3

1. When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.) 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1,3,4

4. Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavior changes. What are other benefits of using MI techniques? (Select all that apply.) 1. Gaining an understanding of patient's motivations 2. Focusing on opportunities to avoid poor health choices 3. Recognizing patient's strengths and supporting their efforts 4. Providing assessment data that can be shared with families to promote change 5. Identifying differences in patient's health goals and current behaviors

1,3,5

10. The nurse is supervising a beginning nursing student and allowing the student to complete documentation of care under direct observation. Which of the following actions are not appropriate and would require intervention? The nursing student: (Select all that apply.) 1. Documents a medication given by another nursing student. 2. Includes the date and time of the entry into the medical record. 3. Enters assessment data into the electronic medical record using the computer mounted on the wall in the patient's room. 4. Leaves a slip of paper with her user name and password in the patient's room. 5. Starts to enter "Docusate sodium 100 mg ordered at 08:00 held. Patient declined to take dose stating, "I had several loose stools yesterday, and I'm afraid if I take this dose the problem will get worse," as a narrative comment.

1,4

12. The nurse is working the evening shift at a hospital that uses military time for documentation. The nurse administered morphine 2 mg intravenously (IV) for pain at 3:45 PM, changed the dressing over the patient's abdominal incision at 5:34 PM, and administered Ancef 1 g IV at 8:00 PM. Using correct military time, label the documentation for each task with the time that it was completed. 1. ______ Morphine 2 mg IV given for pain rating of 8/10 2. ______ Dressing changed over midline abdominal incision using aseptic technique 3. ______ Ancef 1 g given IVPB over 30 minutes.

1=15:45, 2=17:34, 3=20:00

7. Label each line of documentation with the appropriate SOAP category (Subjective {S}, Objective {O}, Assessment {A}, Plan {P}). 1. ______ Repositioned patient on right side. Encouraged patient to use patient-controlled analgesia (PCA) device. 2. ______ "The pain increases every time I try to turn on my left side." 3. ______ Acute pain related to tissue injury from surgical incision. 4. ______ Left lower abdominal surgical incision, 3 inches in length, closed, sutures intact, no drainage. Pain noted on mild palpation.

1=P, 2=S, 3=A, 4=O

14. While reviewing the pulmonary assessment entered by a nurse in a patient's electronic medical record (EMR), a physician notices that the only information documented in that section is "WDL" (within defined limits). The physician also is not able to find a narrative description of the patient's respiratory status in the nurse's progress notes. What is the most likely reason for this? 1. The nurse caring for the patient forgot to document on the pulmonary system. 2. The EMR uses a charting-by-exception format. 3. The computer shut down unexpectedly when the nurse was documenting the assessment. 4. Because of HIPAA regulations, physicians are not authorized to view the nursing assessment.

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5. A nurse is talking with a young-adult patient about the purpose of a new medication. The nurse says, "I want to be clear. Can you tell me in your words the purpose of this medicine?" This exchange is an example of which element of the transactional communication process? 1. Message 2. Obtaining feedback 3. Channel 4. Referent

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5. A patient states, "I would like to see what is written in my medical record." What is the nurse's best response? 1. "Only your family can read your medical record." 2. "You have the right to read your record." 3. "Patients are not allowed to read their records." 4. "Only health care workers have access to patient records."

2

15. The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence? (Select all that apply.) 1. Prevent the nurse from saying the wrong thing 2. Prompt the patient to talk when he or she is ready 3. Allow the patient time to think and gain insight 4. Allow time for the patient to drift off to sleep 5. Determine if the patient would prefer to talk with another staff member

2,3

A nurse is reviewing documentation with a group of newly licensed nurses. Which of the following legal guidelines should be followed when documenting in a client's record? (select all that apply) 1. Cover errors with correction fluid and write in the correct information 2. Put the date and time on all entries 3. Document objective data, leaving out opinions 4. Use as many abbreviations as possible 5. Wait until the end of shift to document

2,3

2. Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.) 1. Improve the nurse's status with the health team members 2. Reduce the risk of errors to the patient 3. Provide optimum level of patient care 4. Improve patient outcomes 5. Prevent issues that need to be reported to outside agencies

2,3,4

A nurse is discussing the HIPAA Privacy Rule with nurses during new employee orientation. Which of the following information should the nurse include? (select all that apply) 1. A single electronic records password is provided for nurses on the same unit 2. Family members should provide a code prior to receiving client health information 3. Communication of client information can occur at the nurse's station 4. A client can request a copy of her medical record 5. A nurse may photocopy a client's medical record for transfer to another facility

2,3,4,5

11. A patient is evaluated in the emergency department after causing an automobile accident while being under the influence of alcohol. While assessing the patient, which statement would be the most therapeutic? 1. "Why did you drive after you had been drinking?" 2. "We have multiple patients to see tonight as a result of this accident." 3. "Tell me what happened before, during, and after the automobile accident tonight." 4. "It will be okay. No one was seriously hurt in the accident."

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13. The nurse is caring for a patient with a nasogastric feeding tube who is receiving a continuous tube feeding at a rate of 45 mL per hour. The nurse enters the patient assessment data and information that the head of the patient's bed is elevated to 20 degrees. An alert appears on the computer screen warning that this patient is at a high risk for aspiration because the head of the bed is not elevated enough. This warning is known as which type of system? 1. Electronic health record 2. Clinical documentation 3. Clinical decision support system 4. Computerized physician order entry

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15. What is the appropriate way for a nurse to dispose of information printed out from a patient's electronic health record? 1. Rip the papers up into small pieces and place the pieces into a standard trash can 2. Place all papers in the flip-top binder designated for that patient that is located in the nurse's station on the patient care unit 3. Place papers with patient information in a secure canister marked for shredding 4. Burn documents with patient information in the steel sink located within the dirty supply room on the patient care unit

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2. A preceptor observes a new graduate nurse discussing changes in a patient's condition with a physician over the phone. The new graduate nurse accepts telephone orders for a new medication and for some laboratory tests from the physician at the end of the conversation. During the conversation the new graduate writes the orders down on a piece of paper to enter them into the electronic medical record when a computer terminal is available. At this hospital new medication orders entered into the electronic medical record can be viewed immediately by hospital pharmacists, and hospital policy states that all new medications must be reviewed by a pharmacist before being administered to patients. Which of the following actions requires the preceptor to intervene? The new nurse: 1. Reads the orders back to the health care provider to verify accuracy of transcribing the orders after receiving them over the phone. 2. Documents the date and time of the phone conversation, the name of the physician, and the topics discussed in the electronic record. 3. Gives a newly ordered medication before entering the order in the patient's medical record. 4. Asks the preceptor to listen in on the phone conversation.

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4. The nurse is reviewing the Health Insurance Portability and Accountability Act (HIPAA) regulations with the patient during the admission process. The patient states, "I'm not familiar with these HIPAA regulations. How will they affect my care?" Which of the following is the best response? 1. HIPAA allows all hospital staff access to your medical record. 2. HIPAA limits the information that is documented in your medical record. 3. HIPAA provides you with greater protection of your personal health information. 4. HIPAA enables health care institutions to release all of your personal information to improve continuity of care.

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6. A patient who is Spanish-speaking does not appear to understand the nurse's information on wound care. Which action should the nurse take? 1. Arrange for a Spanish-speaking social worker to explain the procedure 2. Ask a fellow Spanish-speaking patient to help explain the procedure 3. Use a professional interpreter to provide wound care education in Spanish 4. Ask the patient to write down questions that he or she has for the nurse

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9. A new nurse is experiencing lateral violence at work. Which steps could the nurse take to address this problem? 1. Challenge the nurses in a public forum to embarrass them and change their behavior 2. Talk with the department secretary and ask if this has been a problem for other nurses 3. Talk with the preceptor or manager and ask for assistance in handling this issue 4. Say nothing and hope things get better

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A nurse is preparing information for change-of-shift report. Which of the following information should the nurse include in the report? 1. Input and output for the shift 2. Blood pressure from the previous day 3. Bone scan scheduled for today 4. Medication routine from the medication administration record

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1. A manager is reviewing the nursing documentation entered by a staff nurse in a patient's electronic medical record and finds the following entry, "Patient is difficult to care for, refuses suggestion for improving appetite." Which of the following statements is most appropriate for the manager to make to the staff nurse who entered this information? 1. "Avoid rushing when documenting an entry in the medical record." 2. "Use correction fluid to remove the entry." 3. "Draw a single line through the statement and initial it." 4. Enter only objective and factual information about a patient in the medical record.

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12. A nursing student is reviewing a process recording with the instructor. The student engaged the patient in a discussion about availability of family members to provide support at home once the patient is discharged. The student reviews with the instructor whether the comments used encouraged openness and allowed the patient to "tell his story." This is an example of which step of the nursing process? 1. Planning 2. Assessment 3. Intervention 4. Evaluation

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3. As the nurse enters a patient's room, the nurse notices that the patient is anxious. The patient quickly states, "I don't know what's going on; I can't get an explanation from my doctor about my test results. I want something done about this." Which of the following is the most appropriate way for the nurse to document this observation of the patient? 1. "The patient has a defiant attitude and is demanding test results." 2. "The patient appears to be upset with the nurse because he wants his test results immediately." 3. "The patient is demanding and is complaining about the doctor." 4. "The patient stated feelings of frustration from the lack of information received regarding test results."

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6. Which of the following documentation entries is most accurate? 1. "Patient walked up and down hallway with assistance, tolerated well." 2. "Patient up, out of bed, walked down hallway and back to room, tolerated well." 3. "Patient up, walked 50 feet and back down hallway with assistance from nurse. Spouse also accompanied patient during the walk." 4. "Patient walked 50 feet and back down hallway with assistance from nurse; HR 88 and regular before exercise, HR 94 and regular following exercise."

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8. A nurse is assigned to care for a patient for the first time and states, "I don't know a lot about your culture and want to learn how to better meet your health care needs." Which therapeutic communication technique did the nurse use in this situation? 1. Validation 2. Empathy 3. Sarcasm 4. Humility

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7. A nurse prepares to contact a patient's physician about a change in the patient's condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication. 1. "She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on Levaquin at 5 PM yesterday. She complains of a poor appetite." 2. "The patient reported feeling very nauseated after her dose of Levaquin an hour ago." 3. "Would you like to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started complaining of nausea yesterday evening and has vomited several times during the night."

4S, 1B, 2A, 3R

8. Fill in the Blank. While working on a unit within a hospital, the nurse was able to access a patient's medical record and review the education that other nurses provided during an initial hospitalization and three subsequent clinic visits that occurred in different provider's offices over the past 6 months. This type of feature is most common in a(n) __________________________.

Electronic Health Record

14. A nurse is explaining to a patient how to follow infection control practices at home. During the discussion the nurse touches the patient on the shoulder. Explain which zone of touch the nurse should be practicing and what problems the action might cause.

Normally patient education occurs in a personal zone (18 inches to 4 feet) and not in the intimate zone where direct touch has occurred. The nurse must be respectful of this patient. Touch is something that might make the patient uncomfortable. The nurse needs to learn to be sensitive to others' reactions to touch and use it wisely. It should be as gentle or as firm as needed and delivered in a comforting, nonthreatening manner. The nurse should confirm that touching the patient is acceptable.