Unit III Chapter 20 Communication PrepU
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? (Select all that apply.)
"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?" Explanation: The closed-ended question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed-ended questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed-ended questions are often a barrier to effective communication. Asking what the client does for fun or what future plans are facilitates communication between the client and the nurse.
A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which of the following statements conveys empathy on part of the nurse?
"I know this is hard for you. Is there any way I can help?"
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?
"I understand you have four kids; how many times have you actually been pregnant?"
Orientation phase Explanation: During the orientation phase, the nurse will discuss with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the conclusion of the initial agreement is acknowledged.
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?
have group members confront the dominant member to promote the needed team work
A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
Analysis
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?
Be silent and allow the client to continue speaking when ready.
A student nurse is attempting to improve her communication skills. Which therapeutic communication skill is appropriate?
Control the tone of the voice to avoid hidden messages. Explanation: Conversation skills involve controlling the tone of one's voice so that exactly what is intended is conveyed, and there is no hidden message. Periods of silence have an important role in conversations because they allow for periods of reflection. Cliches should be avoided, and the conversation should be flexible.
The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique?
Encouraging elaboration
When assessing a client's nonverbal communication, the nurse will assess which characteristic as the most expressive part of the body?
Facial expressions Explanation: The face is the most expressive part of the body. Eye contact, the lack of eye contact, posture, gesture, and silence are other methods of nonverbal communication.
A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?
Open-ended question Explanation: The nurse's question allows for a wide range of responses and encourages free verbalization, characteristics of a useful open-ended question. Validating questions allow the nurse to confirm what was previously said, while closed questions necessitate a "yes" or "no" answer. A reflective question or comment repeats what the client has recently said.
Which activity takes place during the working phase of the nurse-client relationship? Select all that apply
The client participates actively in the relationship. The client genuinely expresses concerns to the nurse. Explanation: The working phase of the nurse-client relationship involves active participation toward goals and genuine expression of concerns and feelings. Identification of goals and relationships occurs in the orientation phase. Identifying that goals have been accomplished is characteristic of the termination phase.
guilt inducement or approval/disapproval Explanation: This response by the nurse attempts to induce guilt on the parent to make what the nurse views as the best choice. Authoritarian responses dictate what the client should do based on the health care worker's professional opinion. An advocacy response supplies the client with information to make the decision.
The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate?
Which technique would a nurse employ when using listening skills appropriately when interviewing a client?
The nurse would listen to the themes in the client's comments. Explanation: The technique that a nurse would employ when using listening skills would be to listen to the themes in the client's comments. The nurse would not stand close to the client and maintain eye contact in all situations of listening. The nurse would possibly use positive body gestures and nonverbal communication when listening. The nurse could use periods of silence in therapeutic communication to allow the client to reflect.
Orientation phase Explanation: The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are used as a therapeutic tool to help a client develop more insight and control over his or her own behavior.
The nursing instructor is discussing communication with a student. The student identifies that a contract is made with the client during which phase of the nurse-client relationship?
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Working phase
A nurse is caring for a client admitted to the hospital for dehydration. The physical findings consistent with the diagnosis include:
easy wrinkling of the skin and sunken eyes.
metacommunication
interpersonal bridge between verbal and nonverbal communication.
Which activity takes place during the working phase of the nurse-client relationship? Select all that apply.
• The patient genuinely expresses his or her concerns to the nurse. • The patient participates actively in the relationship.
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:
"Were you tired and depressed before starting the new medication?" Explanation: Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect.
Working phase Explanation: During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions.
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Encouraging elaboration Explanation: Encouraging elaboration helps the client to describe more fully the concerns or problems under discussion.
The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique?
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:
aggressive.
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:
"Can you tell me why your physician sent you here 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. It allows the client to express what he understands to be true, yet is specific enough to prevent digressing from the issue at hand. It encourages free verbalization. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer that has the effect of limiting the client's response. Eliciting medication use, allergies, or advanced directive determination are examples of closed communication where only one or a few words are required for an answer.
"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." Explanation: Touch can be a powerful therapeutic tool when used at the right time; it can provide reassurance and emotional support to the client. The nurse should provide correct knowledge as well as reassurance. Thoracentesis is a painful procedure and it is important to sit still to avoid injuring the pleura. The nurse should reassure the client that she will be present during the procedure and help her throughout. Likewise, the nurse should avoid giving false reassurance about the procedure being painless. Additionally, the nurse should abstain from stating reasons that could scare the client.
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?
Which of the following nurses most likely is the best communicator?
A nurse who easily developed a rapport with clients. Explanation: Rapport, a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication. Advanced practice does not make an individual an effective communicator. Although being bilingual or proficient in sign language allows a nurse to communicate with more people, its does not necessarily make the communication meaningful or effective.
A nursing instructor is discussing differences between nurse-client relationships and social relationships with a group of nursing students. Which statement is a characteristic of a person-centered or helping relationship?
A person-centered or helping relationship is characterized by an unequal sharing of information. Explanation: A helping relationship is characterized by an unequal sharing of information. The client shares information related to personal health problems, and the nurse shares information in terms of a professional role. The helping relationship does not occur spontaneously and occurs for a specific purpose, with a specific person, and for a specific period of time. The person providing the assistance is professionally accountable for the outcomes of the relationship, and the relationship is built on the needs of the person being helped.
Speak directly to the client.
The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?
allow the client to set the pace. Explanation: It would be ineffective to rush through a list of questions when obtaining a nursing history; it is more effective to let the client set the pace. Let the client know at the beginning of the interaction if time is limited so that the client does not feel that you are rushing because of a lack of concern or personal interest. Open-ended questions do not apply to "yes or no" answers. The client should be the person answering the questions unless unable to.
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
In which of the following situations would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a client's new onset of chest pain. Explanation: There are numerous applications of the SBAR technique of communication, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.
Pull the curtain dividing the two beds, maintain eye contact, and speak in a low, audible voice.
A nurse is caring for a client in a semi-private room. The nurse is preparing to discuss the medical treatment plan with the client. To best ensure privacy the nurse should:
eliminate as many distractions as possible. Explanation: Factors that distort the quality of a message can interfere with communication at any point in the process. These distractors might be from the television, or from pain or discomfort experienced by the client. Visitors may remain in the room as long as the mother agrees and they do not interfere with the education session. It may also be beneficial for others to learn the care in the event that they too will be caregivers for the infant. For this reason, it is best for the client's partner to remain in the room.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. What is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. What is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views expressed on Facebook are his or hers alone and not the employer's. Explanation: A proper use of social media by a nurse would be the use of a disclaimer to verify that any views expressed on Facebook are the nurse as an individual and not the employer's. The nurse should not use social media in any way to describe a client by room number, medical diagnosis, or by accomplished medical goal of any type. Serious consequences can result from a nurse not using social media correctly.
The client stares at the floor and states, "I feel fine." Explanation: It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, a nurse asks the client, "How do you feel today?" and the client responds, "I feel all right." However, the nurse notes the client does not maintain eye contact and his facial expression is tense. This would indicate that the nurse should investigate further because of the incongruence of the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication was effective and no further investigation was warranted.
A nurse has been caring for a client who suffered a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how he feels. Which scenario warrants further investigation?
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information?
"Could you tell me more about how you are feeling right now?" Explanation: Using an open-ended question is the most effective way to elicit further conversation and information. Asking the client to tell the nurse more about how they are feeling does not allow for a yes or no response, such as asking if the client had chest pain prior to the admission or if the client took any medication during the pain. When the nurse informs the client about chest pain that was experienced by the nurse, it takes the focus off of the client and does not obtain information that could be helpful.
A 70-year-old female client had a cholecystectomy four days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask in order to assess the client's orientation?
"What day of the week is it?" Explanation: Asking the client to identify the day of the week 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 close-ended questions, which are answered with a simple yes or no response. The remaining responses are all close-ended questions and therefore would not provide an accurate assessment of the client's orientation.
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse?
"You're worried about how you will tolerate the pain associated with labor." Explanation: Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.
ask the client why she thinks she will wake up during surgery. Explanation: Making a sweeping generalization that does not necessarily apply to a specific client hinders communication. It also tends to make the person feel as though she is just another insignificant being. Restating the client's concern is inappropriate at this time. The surgeon should not be asked to reassure the client. The nurse could ask the anesthesiologist to speak with the client to help alleviate any fears the client has. Asking the client why she thinks she will wake up during surgery opens the lines of communication.
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse she is afraid of waking up during surgery. The best response by the nurse is to
A nurse gives a speech on nutrition to a group of pregnant women. What is the speech itself known as?
Message Explanation: The message is the actual physiologic product of the source. It might be a speech, interview, conversation, chart, gesture, memorandum, or nursing note. This communication process is initiated based on a stimulus. The sender or source of the message is a person or group who initiates or begins the communication process. The channel of communication is the medium the sender has selected to send the message.
A nurse who is caring for newborn infants delivers care by utilizing the sense that is most highly developed at birth. Which example of nursing care achieves this goal?
The nurse gently strokes the baby's cheek to facilitate breastfeeding. Explanation: The sense most highly developed at birth would be the sense of neurological reflex. The nurse gently stroking the baby's cheek to have the baby turn toward the stroke is a developmental reflex. The nurse would not use a loud voice or wear colorful clothing while caring for a newborn. The infant is not at the stage of development where playing "peek-a-boo" would be appropriate.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.
The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete. Explanation: There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client.
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?
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 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.
Mrs. Miller is a 60-year-old woman status post a hip replacement. She has had multiple complications following surgery including a skin infection and a blood clot. As a result, she has been a client on the unit for 6 weeks. The nurse has just returned from vacation and this is her first day caring for Mrs. Miller. A colleagues looks at the nurse and describes Mrs. Miller as "quite difficult to deal with." The nurse knows that all of the following can contribute to difficult behaviors except:
a quiet room Explanation: Language barrier, fatigue, and having too many family members are not conducive to good communication and can lead to what is perceived as difficult behaviors in a client. Taking time to reflect on one's own triggers, as well as environmental triggers, leads to reduction of difficulties.
A nurse is on his lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. The nurse recognizes one of the physicians as being in charge of his clients. The nurse witnesses the physician point at the nurse and state, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address any disrespectful remarks or behaviors.
Each of the following facilitates a therapeutic nurse-client relationship except:
closed-ended questions. Explanation: Rephrasing, reflection, and active listening are essential for accurate assessment and interventions.
A nurse is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which information will the nurse consider when deciding what nursing actions to delegate to the LPN/LVN?
hospital policy client stability scope of practice LPN/LVN proficiency level Explanation: As nurses perform the role of delegators, they must know which tasks are legal and appropriate for particular healthcare providers to perform, or the scope of practice. They must also know the policy for the facility at which they are employed. Nurses must ensure that the person they are delegating the task to has the expertise and knowledge to perform it correctly, that the client is stable, and the task does not require the expertise of the registered nurse to perform. Teaching is not in the current scope of practice for a LPN/LVN.
A nurse is performing a wet to dry dressing change on a client's lower abdomen. The nurse should be aware that which zone is the nurse encroaching on?
intimate zone Explanation: The intimate zone refers to interactions between parents and children or people who desire close personal contact. The personal zone refers to the distance when interacting with close friends. The social zone refers to the space when interacting with acquaintances, such as in a work or social setting. The public zone refers to communication when speaking to an audience or small groups.
When communicating with clients nurses need to be very careful in their approach. This is particularly true when communicating using:
medical terminology. Explanation: Another filter is the particular language system into which the person is socialized. Nurses are socialized into health care or medical jargon. To effectively educate and communicate, the nurse should limit medical jargon.
A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse
sits at the client's bedside and faces the client. Explanation: When possible, sit when communicating with a client. Do not cross the arms or legs because that body language conveys a message of being closed to the client's comments. Constant eye contact may be culturally inappropriate. Visitors may remain in the room if allowed by the client and if they do not obstruct history gathering.
When communicating with a client, the nurse uses reflection for which purpose?
to have the client elaborate on thoughts and feelings Explanation: The reflective question technique involves repeating what the person has said or describing the person's feelings. It encourages patients to elaborate on their thoughts and feelings. Exploring helps clients express their concerns and solve their problems by investigating the situation, exploring how they feel about it, and what some alternatives might be. Focusing helps the client stay on the topic. Sequencing determines events in chronological order.
