Prep U CH 2

One technique of therapeutic communication is silence. What does silence allow the patient to do?

Decide how much information to disclose

hile interviewing a patient, the nurse asks, "What happens when you have low blood glucose?" This type of response to the patient is used for what purpose?

To clarify

When trying to explore a patient's perspective on his or her illness, the question that would best determine the patient's thoughts on the cause of the problem would be

"Why do you think you have (name the specific symptom)?"

A client in the emergency department is short of breath and at risk for becoming fatigued. While collecting the history, what is the nurse's best action?

Ask the client's relatives about the client's history.

What is an appropriate action by a nurse when providing care for an 18-year-old with respiratory problems caused by excessive smoking?

Suggest methods and provide resources to assist with smoking cessation

The nurse is performing a follow-up assessment and interview of a 72-year-old woman with a history of congestive heart failure. The nurse asks the client, "Have you been experiencing any activity intolerance since I last saw you?" What would be a more appropriate way for the nurse to elicit this information?

"Has this been having an effect on your ability to carry out your routines and get around your home?"

A nurse is performing an admission assessment on a new client to the unit. What would be the best way to phrase a question about the client's marital status?

"Do you live alone or with someone?"

After a patient describes abdominal pain to the nurse, which questions can the nurse use to help the patient provide more information about the pain? (Select all that apply.)

"Where do you feel the pain?" "Where does the pain travel?" "What other symptoms do you have with the pain?" "What makes the pain less or worse?

The nurse is preparing to conduct an interview with a hospitalized patient. What nursing intervention can best ensure a confidential and comfortable environment for the patient?

Asking permission to draw the client's privacy curtain.

A client admitted to the health care facility for new onset of abdominal pain expresses to the nurse that she was treated for gastroesophageal reflux disease in the past. In which section of the comprehensive health assessment should the nurse document this information?

Personal health history

The nurse is interviewing a 78-year-old client for the first time. The nurse should first

assess the client's hearing acuity.

A nurse receives report on a client admitted for new onset of lung cancer and reviews the initial comprehensive assessment. The nurse recognizes that which information is subjective and needs validation by further data collection?

Client denies any feelings of anxiety or distress over the diagnosis

A client is being admitted for elective surgery. What should the nurse instruct the client to do to ensure that the medication history is complete?

bring all medications and preparations used to the hospital

The principle of confidentiality is of paramount importance in the nurse-patient relationship. When should you inform the patient of with whom his or her information will be shared?

At the beginning of the interview

The nurse should respond to a client's request to "keep what I'm about to tell you a secret" with which statement?

"I have to share the information if it reveals something that could hurt you."

Which statement made by the nurse demonstrates an understanding of the termination phase of the interviewing process?

"Let me stress the importance of being medication adherent."

During an assessment the client says "I've been having bad pain in my left leg for a week." In which section should the nurse document this information?

Chief complaint

How would the nursing instructor explain the goal of guided questioning to his or her students?

Facilitating the patient's fullest communication

When interviewing, the nurse should logically move from specific to open-ended questions.

False

A client plays doubles tennis every Saturday and golfs on Wednesday afternoons. In which part of the comprehensive health history is this information utilized?

health patterns

What is the best action by a nurse when a client has difficulty describing the chief complaint?

Provide the client with a laundry list of words to choose from

The nurse is interviewing a client in the clinic for the first time. The client appears to have a very limited vocabulary. The nurse should plan to

use very basic lay terminology.

During an interview with an adult client, the nurse can keep the interview from going off course by

using closed-ended questions.

A client is asked to describe "something that brings the most hope." Which functional health pattern is the nurse assessing?

value-belief

A nurse assesses a client who reports the onset of a severe headache. During which phase of the nursing interview should the nurse ask the client about the history of the present health concern and the reasons for seeking care?

working

During an interview between a nurse and a client, the nurse and the client collaborate to identify problems and goals. This occurs during the phase of the interview termed

working

During the interview process, the nurse uses both open-ended and closed-ended questions. During what phase of the interview process does the nurse use these specific types of questions?

working

While conducting a comprehensive health history the client says a few sentences about the current problem but then explains how her deceased mother used to have the same problem because of having diabetes. What action should the nurse take?

begin drawing the genogram

While interviewing an adult client about her nutrition habits, the nurse should

review the ChooseMyPlate information with the client.

"Tell me about your pain" is an example of an open-ended question.

True

During a client interview, the nurse uses nonverbal expressions appropriately when the nurse

avoids excessive eye contact with the client.

During the review of systems a client states that at times both hands feel numb. In which category should the nurse document this information?

neurologic

A client reports difficulty sleeping. Which question would be the most effective way for the nurse to open the interview?

"Can you tell me about your sleep problem from when it started until now?"

A nurse is conducting a review of systems with a client and is asking about his ears. The nurse asks, "Do you have any problems with your ears or your hearing?" The client stares blankly at the nurse a moment and then says, "I'm sorry—could you repeat that?" The nurse repeats the question, to which the client replies, "No." The nurse then asks, "Do you ever experience any trouble hearing or any ringing, buzzing, or earaches?" The client responds, "No." What should the nurse record under "Ears" in the review of systems section of the client's health history?

"Denies any trouble hearing or any ringing, buzzing, or earaches."

A nurse is interviewing a man complaining of a pain in his shoulder. The nurse asks him where exactly the pain is, and he points to a spot on the lateral, posterior upper arm. The nurse has seen similar cases in other clients and recognizes that is likely from prolonged work at a computer, particularly using a mouse. Which of the following is the most effective use of inferring that the nurse might implement in this situation?

"Do you perform any sustained or continually repetitive motions with that arm?"

The nurse is preparing to interview a client with a documented history of mental illness. Which question should the nurse use to begin this interview?

"Have you ever had a problem with mental or emotional illness?"

While interviewing an adult client about the client's stress levels and coping responses, an appropriate question by the nurse is

"How do you manage your stress?"

A nurse is interviewing a client who has recently been diagnosed with terminal disease. In covering the lifestyle and health practices profile, the nurse asks the client, "Are you close to any extended family members in the area?" The client objects to the question and asks why the nurse needs to know that. Which is the best rationale for the nurse posing this question?

"I just wanted to see what kind of social support you might have to help care for you during your illness."

When considering the attributes of a symptom and the OLD CART mnemonic, which questions will the nurse ask a client who is reporting pain in the left knee? Select all that apply.

"Is there a particular action that causes the knee pain?" "Can you point to where you feel the greatest amount of knee pain?" "Do you feel the pain in places other than just your left knee?" "What do you do to make the knee pain less severe?"

Which statements made by the nurse demonstrate utilization of effective therapeutic communication techniques during an assessment interview? Select all that apply.

"Please describe exactly how your knee feels when you walk up the stairs." "Now let me summarize what you've told me about what seems to trigger your headaches." "Having such limited use of your right arm seems to make you angry."

A nurse is discussing with a client the client's personal health history. Which of the following would be an appropriate question to ask at this time?

"What diseases did you have as a child?"

A nurse is collecting data on a client's chief complaint, which is a spell of numbness and tingling on her left side. Which of the following questions would be best for eliciting information related to associated factors?

"What other symptoms occurred during the spell?"

A client with a terminal diagnosis has asked the nurse about the purpose of a durable power of attorney for health care. What explanation will best answer the client's question?

A proxy is identified to make healthcare decisions when the client is no longer able to do so.

"How many steps can you climb before you get short of breath?" is an example of what kind of question?

A question that elicits a graded response

A nurse is interviewing an adult client who had a miscarriage 3 weeks ago. The woman is crying and is having difficulty talking. The nurse moves closer and places a hand on the woman's hand. What type of communication is this?

Active listening

A nurse collects data about a client's family health history. Which family members' health problems should the nurse include when documenting this information in the database?

As many genetic relatives as the client can recall

A nurse collects data about a client's family health history. Which family member's health problems should the nurse include when documenting this information in the database?

As many maternal and paternal relatives as the client can recall

The nurse is caring for a client exhibiting slurred speech after suffering from a cerebrovascular accident. The nurse is unable to completely understand the client. What is the nurse's best action?

Ask the client to repeat the statement or question.

Nurses weave the individualization of the client interview through all aspects of the encounter. The nurse should avoid assuming that clients follow cultural beliefs. In place of making this assumption, what should a nurse do?

Assess the degree to which the client perceives the cultural beliefs

When conducting the health assessment, the nurse interacts with the client in a caring manner. How would the nurse demonstrate caring to the client? Select all that apply.

Being nonjudgmental Showing respect to the client Valuing the client unconditionally

Mrs. T. comes for her regular visit to the clinic. Her regular provider is on vacation, but the client did not want to wait. The nurse has heard about this client many times from colleagues and is aware that she is very talkative. Which of the following is a helpful technique to improve the quality of the interview for both provider and client?

Briefly summarize what the client says in the first 5 minutes and then try to have her focus on one aspect of what she discussed.

A nurse draws a genogram to help organize and illustrate a client's family history. Which shape is a standard format of representing a deceased female relative?

Circle with a cross

During an interview, the nurse remains silent and nods the head periodically while the patient is talking. The therapeutic communication technique the nurse is using would be:

Continuers

The nurse is focusing an interview on a patient's respiratory status. Which question should the nurse ask first to begin this interview?

Describe how you breathe for me?

A nurse is collecting subjective data from a client as part of the assessment process. Which behavior is most appropriate for the nurse to display in this situation?

Explaining the reason for taking down notes

When interacting with a client, what conveys the extent of interest, attention, acceptance, and understanding of the nurse? (Select all that apply.)

Eye contact Gestures Posture Tone of voice

Learning about the effects of the illness does what for the nurse and the patient?

Gives them the opportunity to create a complete and congruent picture of the problem

Suzanne, 25 years old, comes to the clinic to establish care. The student nurse is preparing to enter the examination room to interview the client. Which of the following is the most logical sequence for the client-provider interview?

Greet the client, establish rapport, invite the client's story, establish the agenda, expand and clarify the client's story, and negotiate a plan.

What intervention would be most helpful when conducting an interview with a client who has stated, "I'm a little hard of hearing"?

Introducing hand gestures whenever it is appropriate

A nurse is gathering biographic data from a new client who is visiting the office for the first time. Which of the following pieces of data would likely be included in the biographic section of the client's health history? Select all that apply.

Lamar P. Thompson 1212 South Maple St., Sylvan, VA 23236 Caucasian Occupation: Brick mason

Which action should a nurse implement when assessing a nonnative client to facilitate collection of subjective data?

Maintain a professional distance during assessment.

Nonverbal communication is a very important aspect in nurse-client relationships. What can the nurse do to help gain trust in clients? Select all that apply.

Make sure that dress and appearance are professional Do not use facial expressions such as rolling the eyes or looking bored or disgusted Use gestures intentionally to illustrate points, especially for clients who cannot communicate

When using an interpreter to facilitate an interview, where should the interpreter be positioned?

Next to the client, so the examiner can maintain eye contact and observe the nonverbal cues of the client

A client's spouse answers the interview questions and will not leave the examination room. What should the nurse suspect be occurring with the client?

Physical abuse

What occurs during the termination phase of an interview?

Planning for follow-up care

A nurse is interviewing a client who seems anxious. Which nonverbal communication by the nurse helps to facilitate a relaxed environment for the client during the interview process?

Portraying a neutral and friendly expression

A way to use nonverbal communication is through silence. The purposeful use of silence during the interview allows clients to what?

Provide accurate answers

A client scheduled for surgery tells the nurse that he is very anxious about the surgery. What is an appropriate action by the nurse when interacting with this client?

Provide simple and organized information.

Clients in health care settings often are anxious. What behaviors would lead a nurse to believe that a client is anxious? (Select all that apply.)

Rapid speech Nail-biting Defensive tone Sweating

During a health history a client recalls the date when being first diagnosed with hypertension. Which term should the nurse use to categorize the quality of the client's data?

Reliable

A client is admitted to the health care facility with new onset of abdominal pain. The client becomes angry with the nurse when questions about personal information are asked. How should the nurse proceed with the interview?

Remain in control and allow the client to vent feelings

A nurse is admitting a new client. The client is lying in bed. Where should the nurse be positioned?

Seated in a chair at eye level with the client

A client who only speaks Spanish is admitted to the unit. The client's sister, who speaks English, is in the room when the English-speaking nurse starts the admission assessment. Why would it be inappropriate to use the sister as an interpreter for this client?

The client may not want the sister to know their private information

A nurse who may be shy in social situations may exhibit excellent therapeutic communication by what? Select all that apply.

Using silence Using touch Communicating nonverbally through facial expression

The nurse learns that a client is unable to sleep because of high anxiety. On which category of health patterns should the nurse focus?

coping-stress-tolerance

A client reports the health status of living parents, siblings, and deceased grandparents. What should the nurse do with this information?

create a genogram

The nurse is interviewing a client in the clinic for the first time. When the client tells the nurse that he smokes "about two packs of cigarettes a day," the nurse should

encourage the client to quit smoking.

The nurse is preparing to interview a newly admitted client. What should be done prior to hearing the client's story?

establish the agenda for the interview

The nurse is preparing to interview an adult client for the first time. The nurse observes that the client appears very anxious. The nurse should

explain the role and purpose of the nurse.

The nurse is planning to interview a client who is being treated for depression. When the nurse enters the examination room, the client is sitting on the table with shoulders slumped. The nurse should plan to approach this client by

expressing interest in a neutral manner.

The nurse asks a client "is there any time when you feel unsafe?" On which part of the comprehensive health history is the nurse focusing with this question?

family violence

A client reports experiencing chest pain after eating. Which category within the review of systems should the nurse document this information?

gastrointestinal

A client is unable to recall the last time an immunization was received. Which part of the client's health should the nurse realize is being the most impacted by this practice?

health maintenance

A female client tells the nurse it has been 5 years since her last pap smear examination. Where should the nurse document this information?

health maintenance

The nurse is completing a comprehensive assessment with a newly admitted client. In which area should the nurse document the client's list of immunizations?

health maintenance

A client with abdominal pain says that the last time it the pain occurred, over-the-counter laxatives helped. In which part of the assessment should the nurse document this information?

history of present illness

During a client interview, the nurse asks questions about the client's past health history. The primary purpose of asking about past health problems is to

identify risk factors to the client and his or her significant others.

During an interview, how can the nurse best assist the client as the client tells his or her story?

interrupting only if absolutely necessary

During one of your clinical placements you encounter a patient who becomes silent during the nursing interview. What would be appropriate for you to do? (Mark all that apply.)

ive brief encouragement to the patient Watch the patient closely for nonverbal cues Appear attentive

For a nurse to be therapeutic with clients when dealing with sensitive issues such as terminal illness or sexuality, the nurse should have

knowledge of his or her own thoughts and feelings about these issues.

An older client cannot recall the date of a surgical procedure but the adult daughter interjects with the exact date because it occurred a week before her wedding. How should the nurse document this information?

last surgery date validated by adult daughter

While interviewing a client for the first time, the nurse is using a standardized nursing history form. The nurse should

maintain eye contact while asking the questions from the form.

Which type of question is asked first by the nurse in order to attain a full description of the client's symptoms and to generate and test diagnostic hypotheses?

open-ended questions to encourage the client to tell his or her story

A client has a 10-year history of being treated for hypertension. Where should the nurse document this information?

past medical history

The nurse is planning to interview a client who has demonstrated manipulative behaviors during past clinic visits. During the interview process, the nurse should plan to

provide structure and set limits with the client.

During the interview of an adult client, the nurse should

provide the client with information as questions arise.

During an interview with an adult client for the first time, the nurse can clarify the client's statements by

rephrasing the client's statements.

A client is experiencing a relapse of a urinary tract infection. Which additional information should the nurse collect when discussing this client's present health problem?

sexual history

A student nurse is conducting her first patient interview. The student suddenly draws a blank on what to ask the patient next. What is a useful interview technique for the student to use at this point?

summarization

A nurse has completed assessment of a client and is now validating the information gathered and reviewing goals with the client. Which phase of the interview process is this?

termination

An elderly client with Parkinson's disease and his wife, who appears to be much younger than he, are being interviewed by the nurse to update the client's health history. The nurse also has the client's electronic health record on her tablet computer. Earlier in the day, the nurse had spoken with the client's primary care physician, who had relayed some concerns to the nurse regarding the progression of the client's disease. Which source of biographic information should the nurse view as primary?

the client

The nurse documents information about a client's activity-exercise health pattern. Which information did the nurse most likely document?

unable to go to the gym since having back surgery