Caring PrepU Questions
The nurse is collecting health data and avoids using closed-ended questions such as (select all that apply): "Are you ready to get out of bed?" "What sorts of things do you do for fun?" "What plans do you have after you are discharged?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?"
"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 question provides the receiver with limited choices of possible responses and might often be answered by one or two words: ?yes? or ?no.? Closed questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. Closed 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.
During the interview component of the health assessment, the nurse conveys to the client that the information is important by A. Nodding frequently during the interview B. Sitting at eye level with the client C. Standing next to the client while interviewing D. Limiting questions to those with yes or no answers
B. Sitting at eye level with the client Explanation : When the client responds to a question, convey interest by maintaining eye contact, occasionally nodding or verbally responding to his or her remarks.
Which statement accurately describes therapeutic communication? A. Offering advice and your opinion B. Not verbalizing your feelings C. Avoiding advice, judgment, false reassurance, and approval D. Telling the client how to cope
C. Avoiding advice, judgment, false reassurance, and approval Explanation : The goal of therapeutic communication is to help the client develop insight and skills to solve his own problems. The nurse can achieve this goal by avoiding advice, judgment, false reassurance, and approval. Pointing out mistakes can make a client defensive. The client-nurse relationship isn't the situation in which the nurse should offer advice or an opinion, nor is it the situation in which the nurse should verbalize her own feelings. The client needs assistance in developing coping skills, not someone to solve his problems for him.
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: A. stands at the foot of the bed and maintains constant eye contact. B. sits at the client's bedside and faces the patient. C. asks all visitors to leave the room. D. holds the medical record while sitting at the bedside and crossing the legs.
C. sits at the client's bedside and faces the patient. Explanation : When possible, sit when communicating with a client. Do not cross your 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.
A community nurse is making a home visit to an elderly, depressed client. During the assessment, the client experiences periods of silence. What would be the appropriate nursing response during these periods of silence? A. Leave the client's home because the conversation is obviously finished. B. Change the subject by introducing a new topic of interest for the nurse. C. Inform the client that the day is too busy to sit there in silence. D. Sit quietly and allow the client to think.
D. Sit quietly and allow the client to think. Explanation : Silence should be respected as an integral quality of therapeutic communication. Clients often need brief periods of time to process their thoughts and develop answers to questions. The nurse should allow brief periods of silence to occur. The other options are not correct because they do not promote a therapeutic nurse-client relationship.
Which of the following are the best examples of the role of the nurse as a communicator? Select all that apply. Telling a client their blood pressure Calling a physician about a client's blood pressure Informing the physical therapist that client's therapy was discontinued Telling a friend about something that happened to a client that day
Telling a client their blood pressure Calling a physician about a client's blood pressure Informing the physical therapist that client's therapy was discontinued Explanation : When acting in the role of communicator, the nurse is using effective interpersonal and therapeutic communication skills to establish and maintain helping relationships for clients. Examples include telling a client their blood pressure, calling a physician regarding a client condition, and communication pertinent information with members of the allied discipline team, such as the physical therapist. Telling a friend something that happened to a client that day is not the role of the nurse as communicator, in fact it may be a violation of the client's privacy and confidentiality.
Which of the following are examples of virtues that can exemplify character and conduct as a professional nurse? Select all that apply. Trustworthiness Humility Deception Conflict Compassion
Trustworthiness Humility Compassion Explanation : Trustworthiness, humility, and compassion are all examples of professional virtues and cultivated dispositions of character and conduct that motivate and enable us to be good human beings. Deception and conflict are not positive examples so are not correct choices.
A client admitted for treatment of a colon tumor, asks, "Do I have cancer?" Which response by the nurse would be best? A. "Most people your age develop some type of colon problem." B. "Your physician can discuss this in more detail." C. "You sound concerned about what's happening." D. "You'll have to have some tests before the physician can rule out cancer."
C. "You sound concerned about what's happening." Explanation : This response conveys empathy and invites further discussion of the client's concerns. The other options block communication by failing to address the client's concerns and feelings.
What quality do clients most value in nurses? A. Trustworthiness B. Technical skill C. Educational level D. Efficiency
A. Trustworthiness Explanation : Clients value trustworthiness most in a nurse. It is assumed that if a nurse is trustworthy, the nurse would only provide skills that the nurse is competent in. The client is not necessarily aware of the nurse's educational level. The efficiency of the nurse is not most important to the client.
A nurse is preparing to interview a client as part of the assessment. The nurse demonstrates knowledge of communication skills when the nurse: A. agrees with client. B. takes diligent notes during discussion. C. uses broad, open statements. D. uses reassuring cliches.
C. uses broad, open statements. Explanation : The nurse should use broad, open statements to facilitate communication during an interview. Agreeing with the client and using reassuring cliches are inappropriate because they may block the communication. Full attention should be paid to the client; paying too much attention to note taking will interfere with good communication.
A nurse is assessing a patient's nutritional intake prior to admission based upon information that indicates the patient has lost 10 pounds over the last 2 months. An appropriate therapeutic communication technique to gain information is which of the following? A. "What factors have contributed to your weight loss over the last few months?" B. "You are thin, so why did you lose 10 pounds over the last 2 months?" C. "You have lost a lot of weight. Do you neglect your nutrition at home?" D. "I hear from your husband that you have recently lost a lot of weight. Is that true?"
A. "What factors have contributed to your weight loss over the last few months?" Explanation : An appropriate way to gain assessment information is to ask an open-ended, nonjudgmental question such as, "What factors have contributed to your weight loss over the last few months?" Barriers to communication include the use of clichs, rumors, giving false assurance, questions that use the words "how" or "why," questions that require "yes" or "no" answers, and leading questions that suggest a response the interviewer wishes to hear.
The nurse has entered a patient's room and observes that the patient is hunched over and appears to be breathing rapidly. What type of question should the nurse first implement in this interaction? A. A yes/no question B. A directing question C. An open-ended question D. A reflective question
A. A yes/no question Explanation : There are times when yes/no questions are appropriate. In this case, the nurse may want to ask, "Do you feel short of breath?" or something similar. Directing questions and reflective questions follow up on earlier communication. An open-ended question may elicit the necessary assessment data but a yes/no question accomplishes this goal more directly.
While caring for a Native American client, the nurse notices that the client does not make eye contact, even when the nurse is providing education. The nurse responds appropriately to this behavior by doing which of the following? A. Being aware that eye contact may be culturally determined and adjusting her teaching accordingly B. Asking the client to look at the nurse during the education session C. Assuming that perhaps some form of abuse may be the cause for this behavior D. Asking a family member why the client avoids eye contact
A. Being aware that eye contact may be culturally determined and adjusting her teaching accordingly Explanation : The nurse who is aware that eye contact may be culturally determined can better understand the client's behavior and provide an atmosphere in which the client can feel comfortable.
When caring for a client at the health care facility, the nurse observes that the client is having difficulty understanding the health teaching. Which appropriate action should the nurse take when conducting the health teaching for this client? A. Check for cultural differences. B. Boost the morale of the client. C. Vary the tone and pitch of her voice. D. Implement health teaching in parts.
A. Check for cultural differences. Explanation : When the client is having difficulty learning, it may be possible that the client does not understand the language that the nurse speaks. In such a case, the nurse should take the necessary steps to break the cultural barrier and then proceed with the teaching. Boosting the morale of the client, varying the tone and pitch of voice to stimulate the client aurally, and implementing health teaching in parts are only effective when the client understands the language being spoken.
A student nurse is attempting to improve her communication skills. Which of the following is an appropriate therapeutic communication skill? A. Control the tone of the voice to avoid hidden messages. B. Avoid the use of periods of silence. C. Use clichs to enhance a patient's understanding of information. D. Be precise and inflexible regarding the intent of the conversation.
A. 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. Clichs should be avoided, and the conversation should be flexible.
A nurse is interviewing a hospitalized patient. Which nurse-patient positioning facilitates an easy exchange of information? A. If the patient is in bed, the nurse stands at the foot of the bed. B. If both the nurse and patient are seated, their chairs are at right angles to each other, 1 foot apart. C. If the patient is in bed, the nurse sits in a chair placed at a 45-degree angle to the bed. D. If the patient is in bed, the nurse stands at the side of the bed.
A. If the patient is in bed, the nurse sits in a chair placed at a 45-degree angle to the bed. Explanation : If the patient is in bed, the nurse sitting in a chair placed at a 45-degree angle to the bed ensures the nurse is sitting at eye-level with the patient, which promotes communication. If the nurse is standing at the foot or at the side of the patient's bed, an authoritative position is established, which does not promote good communication. If both the nurse and the patient are seated, being 1 foot apart intrudes upon personal space; ideally the nurse and patient should be about 3 to 4 feet apart.
Personal space and distance is a cultural perspective that can impact nurse-patient interactions. What is the best way for the nurse to interact physically with a patient who has a different cultural perspective on space and distance than their patient? A. Know the patient's cultural personal space preferences. B. Realize that sitting close to the patient is an indication of warmth and caring. C. Sit 3 to 6 feet away from the patient in an attempt to not offend. D. Remember not to intrude into the personal space of the elderly.
A. Know the patient's cultural personal space preferences. Explanation : When providing nursing care that involves physical contact, you should know the patient's cultural personal space preferences. Sitting close or too far away from the patient may be interpreted as offensive. Age is not necessarily a deciding factor in regards to a person's cultural practices.
A nurse is assigned the care of a client who speaks only French. The nurse does not know the language. What action is appropriate for the nurse in this case? A. Request a professional interpreter B. Refuse to take charge of the client C. Communicate with the client non-verbally D. Ask another nurse to take care of the client
A. Request a professional interpreter Explanation : In a situation in which the nurse is assigned care of a non-English speaking client, the nurse should request a professional interpreter. However, the nurse should not refuse to take charge of the client because the nurse cannot refuse his or her duty. Non-verbal communication with the client through gestures would not give complete information, and therefore it is not appropriate for this situation. The nurse may take help from another nurse if the nurse is appropriately bilingual.
The nurse employs interpersonal skills of communication when caring for and interacting with patients. Which of the following is the best example of establishing a therapeutic nurse-patient relationship? A. Respect for the patient and open communication to engage in getting to know the patient. B. Approach the patient as part of your job, and complete nursing care quickly to promote comfort. C. Recognize how your approach affects patient care and describe why you have to do things the nursing way. D. Introduce yourself and then accomplish nursing care activities efficiently to allow the patient to rest.
A. Respect for the patient and open communication to engage in getting to know the patient. Explanation : A. is the best response, respect for the patient's dignity, and establishing a caring relationship is furthered by mutual interchange of communication. Approaching care/patient as a job, doing things without patient input, and doing things your way and efficiently are not necessarily therapeutic or open up communication.
The nurse has entered a patient's room after receiving morning report, rapidly assessed the patient's airway, breathing, and circulation and greeted the patient by saying "good morning." The patient has made no reciprocal response to the nurse. How should the nurse best respond to the patient's silence? A. The nurse should ask appropriate questions to understand the reasons for the patient's silence. B. The nurse should apologize for bothering the patient, perform necessary assessments efficiently and leave the room. C. The nurse should document the patient's withdrawal and diminished mood in the nurse's notes. D. The nurse should ask the patient if he feels afraid or angry.
A. The nurse should ask appropriate questions to understand the reasons for the patient's silence. Explanation : Silence can have many meanings, and the nurse should attempt to identify the meaning of the patient's silence in a tactful manner. Directly asking if the patient is angry or fearful is likely presumptuous and may harm rapport. The nurse should not make assumptions around the patient's mood nor should the nurse cease to engage with the patient.
A nurse is caring for a client who has had a massive stroke. The family communicates concern about the actions of the nurse on the previous shift. The family reports that the nurse didn't administer medications properly or maintain client privacy. When responding to complaints about a colleague, the nurse should say: A. "We've had some problems with her lately. She never seems to get to work on time." B. "I'd be happy to get the charge nurse to see what we can do for the client." C. "I think you're right. I'll let the physician know this has happened so that nurse will get in trouble." D. "I understand your concern, but I'm sure she didn't do those things."
B. "I'd be happy to get the charge nurse to see what we can do for the client." Explanation : The nurse should follow the facility's policy and chain of command for handling complaints, which commonly begins with the charge nurse. The nurse should avoid trying to handle a problem involving another employee because doing so will only aggravate the issue. The nurse shouldn't side with the family or with the other nurse.
A client has been placed on a ventilator, and the spouse is visiting for the first time. The spouse begins to cry. The best statement by the nurse is A."If this upsets you, it may be better to not visit." B. "Tell me what you are feeling." C. "He is going to get better" D. "I know what you are going through."
B. "Tell me what you are feeling." Explanation : The best option is to have the spouse verbalize feelings. The other statements are not therapeutic. The first option does not allow the family to participate in the care of the client; it also does not allow the client to benefit from family visitation. The nurse does nto know the third option is true. Clients can get worse and die. The fourth option minimizes what the client is experiencing. Each person's experience and perception is unique.
A depressed client tells a nurse, "I want to die. Life just isn't worth living." Which response by the nurse is most appropriate? A. "Of course life is worth living. You'll feel better soon." B. "This must be a very difficult time for you." C. "No one really wants to die." D. "Why do you want to die?"
B. "This must be a very difficult time for you." Explanation : An empathetic response such as "This must be a very difficult time for you" is nonjudgmental and allows the client to express his feelings. Saying that the client will feel better soon or that no one really wants to die is belittling and implies that the client's feelings are inappropriate or wrong. When asked a "why" question a client may intellectualize or become defensive.
Which interaction is an example of social interaction, rather than a therapeutic professional nursing interaction, between a nurse and a client? A. Considering the verbal and nonverbal messages and meaning expressed by a client B. Equal sharing of time for discussion of problems so there is mutuality in the relationship C. An interaction that involves facilitative qualities of caregivers, including empathy, respect, and empowerment D. An interaction used to assess the coping abilities of the person and views regarding health
B. Equal sharing of time for discussion of problems so there is mutuality in the relationship Explanation : With a therapeutic relationship, there needs to be a client-centered approach, with the focus being on the client. A social relationship involves more equal sharing of concerns.
Which of the following is the reason for the nurse to be empathetic when caring for a patient? A. Helps reserve the right of the patient in making choices B. Helps become effective while remaining detached C. Supports the patient's ultimate decision D. Empowers patients to become involved with self-help groups
B. Helps become effective while remaining detached Explanation : Empathy helps the nurse become effective in providing for the patient's needs while remaining detached. In the role as an educator, the nurse avoids giving advice, reserves the right of each person to make his or her own choices, shares information on potential alternatives, and supports the patient's ultimate decision. Typically, the nurses have all the information about health services available in the community. Such information empowers patients to become involved with self-help groups.
A nurse is caring for a client who suffered a head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's mother is at the bedside in tears. The mother states, "I just want him to know I am here with him." To address the needs of the mother and the client, the nurse should: A. Place a chair next to the bed and encourage the mother to hold the son's hand. B. Place his hand on the mother's shoulder and reassure the mother that things will be fine. C. Leave the room and allow the mother to grieve. D. Encourage the mother to bring in pictures of the family that can be displayed in the room.
B. Place a chair next to the bed and encourage the mother to hold the son's hand. Explanation : Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. The nurse may feel it is appropriate to place his hand on the mother's shoulder; however, the nurse should not provide false hope. The nurse should not leave the mother alone to grieve, the nurse should show the mother how to use comforting communication. The client is in a chemically induced come and will not be able to see pictures that are displayed in the room.
A client reports to the primary health care facility for routine physical examination after cardiac rehabilitation that followed myocardial infarction. Keeping in mind that the client speaks English as a second language, how should the nurse conduct the interview? A. The nurse should ask the client to express himself emotionally. B. The nurse should avoid using complex medical terminology. C. The nurse should sit at a long distance from the client. D. The nurse should ask closed-ended questions.
B. The nurse should avoid using complex medical terminology. Explanation : The nurse should avoid using medical terminology and make the examination as simple as possible. People who speak English as a second language may not understand medical terminology. They may feel embarrassed to ask the nurse to repeat the information again. It is not necessary to sit at a long distance and the questions may be either closed-ended or open-ended. The acceptability of emotion is rooted in culture not necessarily in language.
An experienced nurse is orienting a new nurse to the unit. The experienced nurse tells the new nurse that to be an effective caregiver, the new nurse needs to: A. attempt to obtain a specialty certification. B. develop good communication skills. C. read client medical records thoroughly. D. spend as much time as possible with clients.
B. develop good communication skills. Explanation : Any nurse who wishes to be an effective caregiver must first learn how to be an effective communicator. Good communication skills enable nurses to get to know their clients and, ultimately, to diagnose and to meet their needs for nursing care. Obtaining a specialty certificate should be encouraged but is not as important as effective communication. Reading a client's chart thoroughly does not necessarily contribute to being an effective caregiver. Nurses should use their judgment in determining how much time to spend with each client.
A nurse working in a community clinic is discussing lifestyle modifications with a client. The client has been advised to lose weight because of a BMI greater than 25. Which statement by the nurse would be most therapeutic in helping the client? A. "I know it is hard. I needed to lose weight last year too." B. "Just skipping your between-meal snacking is the solution." C. "I can offer you some information outlining a variety of ways to lose weight." D. "There are herbal preparations for weight loss that are very effective."
C. "I can offer you some information outlining a variety of ways to lose weight." Explanation : The therapeutic response should put the client in the position to make an individual choice. The nurse should offer options to allow for choice. The other options are incorrect because they either place the emphasis back on the nurse rather than on the client or they provide a solution that the nurse feels is best without allowing the client to make the choice.
"The nurse is conducting an interview with a newly admitted client. Which listening behavior guideline should the nurse implement in order to have a successful interview? A. Focus mainly on verbal comments B. Fill in the words for the client C. Avoid the impulse to interrupt D. Fill in quiet spaces and pauses
C. Avoid the impulse to interrupt Explanation : When doing an interview with a client, the nurse must also listen actively for feelings, in addition to the verbal comments made by the client. The nurse should demonstrate patience if the client has a memory block, and should avoid the impulse to fill in words or interrupt the client. Pauses in the conversation should be allowed as silence gives both parties time to gather thoughts.
While talking to her husband, who is caring for their children, a 52-year-old client slams the phone down. She begins to cry and states that she is feeling guilty for being hospitalized. Which nursing action will best support the client emotionally? A. Ask the client if she would like to speak with a grief counselor. B. Call the health care provider (HCP), and request an antidepressant. C. Sit with the client and help her acknowledge and discuss her feelings. D. Suggest the client call her husband when she is calmer.
C. Sit with the client and help her acknowledge and discuss her feelings. Explanation : Acknowledgment and discussion of the client's feelings begin the establishment of a therapeutic relationship between nurse and client. It also acknowledges the seriousness of the current situation and validates the client's feelings. Grief counseling and antidepressant medication may be options if the depression is severe and prolonged. The client is not ready at this point to continue the conversation with her husband.
On the second day of hospitalization, the nurse and the client are discussing concerns about unhealthy family relationships. During a nurse-client interaction, the client changes the subject to a job situation. The nurse responds, "Let's go back to what we were just talking about." What therapeutic communication technique did the nurse use? A. reflecting B. restating C. focusing D. summarizing
C. focusing Explanation : The therapeutic communication technique the nurse used to direct the client back to the original topic of discussion is called focusing. Focusing fosters the client's self-control and helps avoid vague generalizations, so the client can accept responsibility for facing problems. Reflecting directs the idea back to the client. Restating involves repeating the main idea back to the client. This technique lets the client know what the nurse heard. With summarizing, the nurse gives a brief synopsis of what was covered in the conversation.
