M38 Communication
An older adult client is in tears upon receiving a diagnosis of terminal cancer. Which nonverbal communication from the nurse shows empathy? A.Using touch B.Crying with the client C.Wiping the client's tears D.Being silent
A Rationale: The use of touch is nonverbal communication that often conveys more about what an individual is feeling than what the person actually says. Being silent may come across as not caring. Crying with the client and wiping the client's tears may be nice gestures but are not the best options to show empathy.
The nurse is admitting a client who reports chest pains. The nurse noticed that the client is very anxious and worried. The nurse tells the client "not to worry" and that "it is going to be okay." Which barrier to communication is the nurse using? A.Giving unwarranted reassurance B.Changing topics and subjects C.Giving common advice D.Agreeing and disagreeing
A Rationale: Giving unwarranted reassurances, which are comforting statements of advice, as a means to assure the client should be avoided. Nurses need to be cognizant of these barriers and avoid them. Nurses also need to recognize the barriers when they occur and change to more effective means of communication. Giving common advice is telling the client what to do. These responses deny the client's right to be an equal partner. Agreeing and disagreeing deters clients from thinking through their position and may cause a client to become defensive. Changing topics and subjects implies that what the nurse considers important will be discussed and that clients should not discuss certain topics.
Which type of communication should the nurse use to promote a helping nurse-client relationship? A.Therapeutic communication B.Documentation C.Handoff communication D.Group communication
A Rationale: Therapeutic communication is an essential tool for developing a helping nurse-client relationship. Therapeutic communication can be used to gather assessment data, teach, collaborate with other healthcare professionals, advocate for clients, express caring, and provide comfort. Other types of communication that are helpful in the nursing process but do not necessarily help the nurse-client relationship and are not the best option for this scenario are as follows: (1) Documentation is the primary form of written communication used by nurses in all aspects of healthcare, (2) group communication is used in the process of making decisions in the current healthcare system, and (3) handoff communication is the continuity of care for the client from one shift change or visit to another.
Which action is appropriate when the nurse is communicating with a client whose primary language is not English? (Select all that apply.) A.Avoid using slang. B.Avoid using medical jargon. C.Use an interpreter. D.Emphasize words with gestures. E.Speak slowly.
A,B,C Rationale: When communicating with a client whose primary language is not English, the nurse should avoid the use of slang and medical jargon. The nurse should pace the conversation so that the client can follow, but not speak too slowly because the client's attention may be lost. Gestures should be used cautiously because they can have different meanings in different cultures. Consider using an interpreter, such as a bilingual staff member.
Which approach by the nurse is appropriate to use to communicate with pediatric clients? (Select all that apply.) A.Read a story. B.Use word games. C.Draw pictures. D.Engage in play. E.Use reminiscing.
A,B,C,D Rationale: Communication techniques that the nurse can use to work effectively with pediatric clients include playing, drawing pictures, storytelling, word games, and reading books with a theme similar to the child's condition or problem and then discussing the meaning. Reminiscing is a strategy used with older adults.
Which communication technique should the nurse evaluate when caring for clients from different cultures? (Select all that apply.) A.Use of gestures B.Use of touch C.Use of elderspeak D.Use of facial expressions E.Use of eye contact
A,B,D,E Rationale: Nonverbal communication characteristics such as body language, eye contact, and touch are influenced by cultural beliefs about appropriate communication behavior. Consider using the following strategies when caring for clients from different cultures: (1) Be aware of what a smile or other facial expressions mean in the client's culture, (2) remember that not all gestures have a universal meaning, and (3) be aware of what eye contact means. Many cultures have specific rules or practices regarding the use of touch, especially between individuals of different genders. Elderspeak is not a good strategy to use in any culture because it implies that the client is dependent and incompetent. The nurse who is culturally competent will be appreciated by the client.
An older adult client is very friendly and likes to talk to the staff. Which action should the nurse take to avoid using elderspeak? (Select all that apply.) A.Use the client's full name. B.Use the word "you" when asking questions. C.Use communication aids. D.Speak slowly and loudly. E.Avoid using baby talk.
A,B,E Rationale: Strategies to avoid elderspeak include referring to the client by the full name; speaking to the client by using the word "you," not "we"; asking direct questions; speaking in a normal tone of voice; and avoiding the use of baby talk. Although the use of communication aids may be helpful when working with an older adult, their use does not help the nurse avoid using elderspeak.
The nurse is preparing to teach a client who speaks limited English. Which should the nurse do to convey the information to the client? (Select all that apply.) A.Use appropriate layman's terminology. B.Have the client search the internet. C.Use an interpreter. D.Show a video. E.Use written illustrations.
A,C,E Rationale: When communicating with a client who does not understand English, the nurse may use written illustrations. Simple layman's terminology and an interpreter may also be helpful in conveying the correct information to the client. Although videos and the internet may be good sources of additional information, these are not the best option for this scenario. Furthermore, videos and internet resources are mostly presented in English and will not benefit this client.
When communicating discharge instructions to a client, the nurse states exactly what needs to be done using the fewest number of words. Which characteristic of verbal communication is the nurse using? (Select all that apply.) A.Clarity B.Simplicity C.Intonation D.Pace E.Brevity
A,E Rationale: Clarity is saying exactly what is meant. Brevity is using the fewest number of words to convey the message. Simplicity is using words that are not associated with medical jargon. The pace, rhythm, or intonation of speech affects the meaning and impact of the message.
The client is a business professional who is used to giving orders and making important decisions. The client tends to argue and challenge the nurses. Which technique is appropriate for the nurse use to present assertive communication? (Select all that apply.) A.Negative assertion B.Avoidance C.Submission D.Name calling E.Fogging
A,E Rationale: Strategies associated with assertive communication include fogging, which involves finding a point of agreement from which to start, and negative assertion, which is agreeing with criticism without becoming upset. Avoidance and submission are characteristics of passive communication. Name calling is characteristic of aggressive communication.
A client recovering from abdominal surgery reports pain. The nurse tells the client that the pain medication will be prepared and that the nurse will return in 10 minutes to administer it. Which characteristic of verbal communication is the nurse using? A.Intonation B.Credibility C.Humor D.Pace
B Rationale: By assessing the client's pain and stating a return time to administer the pain medication, the nurse is relaying credibility. The nurse is being trustworthy and reliable in responding to the client's report of postoperative pain. Pace and intonation are often used when communicating with a client who is anxious, but this scenario does not indicate that the client has anxiety. There is no indication that the nurse is using humor while communicating with this client.
Which behavior by the nurse indicates that the nurse is an aggressive communicator? (Select all that apply.) A.Denying feelings of anger B.Stating that a nursing assistant is "worthless" C.Expressing feelings using "I" language D.Blaming others for errors E.Telling a staff member to move out of the way
B,D,E Rationale: Aggressive individuals tend to focus on their own needs and become impatient when needs are not met. Examples of this type of communication are screaming, sarcasm, rudeness, belittling jokes, and direct personal insults. The word "you" is frequently used in aggressive communication. Passive communicators tend to deny their feelings and put others first. This style is used to avoid conflict. Expressing feelings or asking for help using the word "I" is an example of assertive communication.
The nurse is planning to assess a client's communication approach. Which client characteristic should the nurse consider when conducting this assessment? (Select all that apply.) A.Primary health problem B.Developmental level C.Employment status D.Age E.Culture
B,D,E Rationale: The nurse needs to consider the client's age, developmental level, and culture when determining the client's communication approach. Employment status may or may not affect the client's approach to communication. The client's primary health problem may or may not influence the client's approach to communication.
The nurse at the clinic greeted a visiting client happily, but the client did not respond. As they got to the treatment room, the nurse noticed that the client seemed upset and sad. The nurse changed the tone and emphatically asked the client the reason for the visit. Which type of verbal communication is the nurse using in this scenario? A.Brevity B.Simplicity C.Adaptability D.Relevance
C Rationale: Adaptability is when a nurse adjusts and alters spoken messages in response to the behavioral cues from the client. Nurses carefully consider and individualize what they say and how they say it. This requires both astute assessment and sensitivity. Simplicity of speech refers to the use of commonly understood words to relay the message. Brevity is using the fewest words necessary to relay a message that is simple and clear. Relevance means that the message relates to the person who is the receiver or to the person's interests.
Toward the end of the shift, the nurse is communicating a client's status to the nurse who will be taking over. Which client outcome is enhanced by the use of handoff communication? A.Nurse-client relationship B.Therapeutic communication C.Continuity of care D.Communication by nurses in all aspects of healthcare
C Rationale: Reporting through handoff communication is the process of nurse-to-nurse communication that ensures continuity of care for the client from one shift to another. The nurse-client relationship is the outcome of therapeutic communication. Although communication is used by nurses in all aspects of healthcare, this option is too general, and it has no relationship with the scenario.
A client comes to the clinic to pick up a report from the nurse. Which distance should the nurse use when communicating with a client sitting in a waiting room? A.Intimate B.Personal C.Social D.Public
C Rationale: Social distance is 4-12 feet. At this distance, the entire person can be seen. Eye contact is increased, and verbal communication is loud enough for others to hear. This is the distance the nurse uses when communicating with a client sitting in a waiting room, such as the client who has come to pick up a report. Intimate distance is touching to 1½ feet. This distance is used when providing care that involves touching the client. Personal distance is 1.5-4 feet. This distance is used to provide medications or administer an intravenous infusion. Public distance is 12-15 feet. Nurses rarely communicate across this distance, which is typical in a crowded hallway or community setting.
The nurse at a local clinic is determining the best way to communicate abnormal test results to a client who has requested that all communication be sent by email. Which option should the nurse select in this situation? A.Send the test results by regular mail. B.Ask the healthcare provider to email the test results to the client. C.Email the test results directly to the client. D.Email the client with a request to call the office.
D Rationale: Email should not be used to communicate abnormal laboratory data or highly sensitive information about which the client may have questions. The best option in this situation is to email the client with a request to call the office. Sending the test results by regular mail may result in unnecessary delays and would not be following the client's request to use email.
The nurse is caring for an adolescent client who is alert but unable to speak due to being intubated and on a respirator. Which communication strategy is the most developmentally appropriate for the nurse to use? A.Grease pencil and whiteboard B.Flash cards C.Hand signals D.Text messages
D Rationale: Text messaging, popular among adolescents, would be the best communication method for this client. Flash cards, hand signals, and grease pencil with a whiteboard might work as a method of communication to some extent; however, these may or may not support the client's physical and developmental needs. With text messaging, the client will be able to communicate needs to the healthcare staff as well as communicate with friends and family.
An unlicensed assistive personnel (UAP) is overheard telling a client, "I don't have all day. Let me put those shoes on you." Which type of communication style is the UAP demonstrating? A.Assertive B.Passive-aggressive C.Passive D.Aggressive
D Rationale: The UAP is impatient and is displaying aggressive communication. Passive communication involves a nurse being focused on the needs, demands, and requests of the client without regard for the nurse's own feelings and needs. Assertive communication conveys concern for the needs of others. Passive-aggressive communication combines the attributes of focusing on the needs of others and then lashing out and being impatient when personal needs are not met.
A healthcare provider yells at a nurse for not knowing a client's latest laboratory values. Which response by the nurse demonstrates assertive communication? (Select all that apply.) A."I can't do anything right for you." B."I'm sorry. I'll see where those results are." C."You can look them up on the computer." D."The lab has not phoned in the results yet." E."I will locate the values and get them to you."
D,E Rationale: Assertive communication is demonstrated by using "I" statements, such as "I will locate the values and get them to you." Fogging is a technique that causes both parties to focus on something that is agreed. In this case, the statement "The lab has not phoned in the results yet" takes the focus off the healthcare provider's anger toward the nurse and places it on the fact that the values are not yet available. Saying "I can't do anything right for you" and "I'm sorry" are both passive responses. Saying "You can look them up on the computer" is an aggressive response.
