310 CH 8
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?
Contact a professional interpreter
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"
A client who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if I'll still feel like a woman." Which response would most likely encourage the client to expand on this and express concerns in more specific terms?
"Feel like a woman.."
A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?
"Have you ever thought of laser surgery?"
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 statement conveys empathy by the nurse?
"I know this is hard for you. Is there any way I can help?"
A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?
"I think there is a better way to handle this."
An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is nervous about the surgery. The best response by the nurse is to:
Ask the client, "Can you tell me more about what is worrying you"
Which is a skill appropriate to use in therapeutic communication?
Control the tone of the voice to avoid hidden messages
The nurse makes a contract with the client during which phase of the nurse-client relationship?
Orientation Phase
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?
Orientation phase
A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response?
Place a chair next to the bed and encourage the parent to hold the client's hand.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should:
Remain open, honest and frank
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?
Speak directly to the client
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.
To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others?
Therapeutic communication
A nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the new nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to:
ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel.
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible.
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
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should:
tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.
A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response?
"Share with me the advantages and disadvantages of your options as you see them."
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:
"What did your health care provider tell you about your need to be admitted?"
The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.
"Is there any chance you might be pregnant?" "Do you smoke cigarettes?" "Does it hurt when I touch you here?" "Are you ready to get out of bed?"
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?
"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."
When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is:
"The thought of having surgery is keeping you awake."
The nurse is communicating with a client following a routine physical examination. Which statement best demonstrates summarization of the appointment?
"We reviewed your plans for your new diet and medications. Do you have any other questions?"
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?
"You seem unsure, tell me your concerns about your surgery"
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."
A nurse enters the client's room and begins the process of establishing a nurse-client relationship. The nurse introduces oneself and informs the client how long the nurse will be caring for the client. What additional statement does the nurse need to communicate with the client?
"let me know if you have any concerns regarding your care"
A nurse touches the client's hand while discussing the client's diagnosis. This action is:
A communication channel
In which situation 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.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
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
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?
Approach the client with empathy and understanding and allow the client to share feelings without being judged.
A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?
Assertive
The nurse communicates with a newly admitted client. Which nonverbal behavior will the nurse note?
Client's gestures
Each of the following facilitates a therapeutic nurse-client relationship except:
Close-ended questions
Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?
Empathy
The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?
Encouraging elaboration
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?
Facial Expressions
A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?
The client stares at the floor and states, "I feel fine."
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Working phase
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?
Arrange for a sign language interpreter when discussing treatment
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
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:
have group members confront the dominant member to promote the needed team work.
A nurse is calling a physician to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation?
"My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital."
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
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:
Allow the client to set the pace
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?
Assess how the client would like to communicate
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 nurse is experiencing difficulty obtaining the client's cooperation in performing exercises after surgery. Which would be the best method for the nurse to obtain the client's cooperation?
Explain the purpose and benefit of the postsurgical exercises
A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?
Being sensitive to the client's emotional barriers
What nursing care behavior by the nurse engenders a client's trust in the nurse?
A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client.
The client is an 18-month-old in the pediatric intensive care unit. The client is scheduled to have a subgaleal shunt placed tomorrow, and the client's mother is quite nervous about the procedure. The nurse tells the client's mother, "The surgeon has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication?
False reassurance
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:
involve the child's stuffed animal in the educational session.