Chapter 7 NCLEX Styles Questions

A nurse is interviewing a client who has come to the clinic for a follow-up visit. The nurse notices the client does not make eye contact and speaks while looking down. How should the nurse respond? A. Assume a position at eye level with the client and continue with the interview B. Stop the interview and ask, "How are you feeling?" C. Sit silently until the client looks up and makes eye contact. D. Touch the client's hand and say, "You seem upset, is there something bothering you?"

A. Assume a position at eye level with the client and continue with the interview RATIONALE: When communicating with most clients, it is best to position oneself at the client's level and make frequent eye contact. Eye contact is perhaps among the most culturally variable nonverbal behaviors, and can be misunderstood as embarrassment, nervousness, or a problem with the client.

A nurse is caring for a terminally ill client whose death is imminent. The nurse has developed a close relationship with the family. Which intervention is most appropriate? A. Encourage family discussions of feelings. B. Make decisions for the family in difficult situations. C. Remain with the family but maintain silence. D. Tell the family to leave the client alone.

A. Encourage family discussions of feelings. RATIONALE: The nurse should facilitate open and effective communication among those threatened by the loss of a family member. The nurse should abstain from making decisions on the family's behalf.

A nursing student is conducting a client interview in order to determine the client's health history. The student's instructor observes that the student frequently twists her hair with her fingers while asking the client questions. What is the most plausible meaning of the student's nonverbal communication? A. The student feels insecure during the interview. B. The student is unconsciously conveying authority. C. The student is unsure how to interpret the client's responses. D. The student feels superior to the client in some way.

A. The student feels insecure during the interview. RATIONALE: If the nurse plays with her hair during a client interaction, this can communicate insecurity. Superiority or confusion is less likely to underlie this form of nonverbal communication.

A nurse is asking a client health-related questions during a medical assessment. The client has developed lesions on the skin and warts around the mouth. Which factor affects oral communication? A. attention and concentration B. cultural differences C. nursing skills D. client's lifestyle

A. attention and concentration RATIONALE: Factors affecting oral communication between the client and the nurse include attention and concentration; language compatibility; verbal skills; hearing and visual acuity; motor functions involving the throat, tongue, and teeth; sensory distractions; interpersonal attitudes; literacy; and cultural similarities.

The nurse has requested that the unlicensed assistive personnel (UAP) turn and reposition a client as well as change the bed linens. What is the appropriate action by the nurse after delegating this task? A. verify that the task has been completed and determine the client outcome B. request that the other UAP check to be sure that the task was completed C. inform the UAP that there are other tasks that must be completed for the remainder of the shift D. tell the UAP that you trust that the task was completed as requested and the client is comfortable

A. verify that the task has been completed and determine the client outcome RATIONALE: The person requesting who assigns the task will verify that the task is completed as requested and that the client has received the outcome that was expected. The nurse should not simply "rust" that the task was completed because the nurse retains responsibility for completion and positive outcomes.

A nurse is caring for a client with depression. The nurse finds that the client is withdrawn and does not communicate with others. What is the most appropriate response by the nurse? A. "Did you sleep well last night?" B. "Is that a new shirt you're wearing?" C. "Did you like the dinner yesterday?" D. "I guess you don't feel like talking today."

B. "Is that a new shirt you're wearing?" RATIONALE: When the client is not talking, the nurse should use the observation technique of therapeutic communication. The nurse should complement the client to get the client's attention.

A client reports to a primary care physician with aggravated chest pain. The physician orders a stress test. The client tells the nurse that the client does not want to take the test and would prefer instead to continue taking medication a little longer. Understanding that the client is anxious, what is the most appropriate response by the nurse? A. "Emergency equipment is always kept ready during stress tests." B. "Tell me more about how you are feeling." C. "Don't you want to improve your health?" D "Most people tolerate the procedure quite well."

B. "Tell me more about how you are feeling." RATIONALE: The client's desire to not undergo the stress test may be due to fear and anxiety related to the test. The nurse should try to explore the client's feelings by inviting the client to express them.

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? A. "I will be by your side throughout the procedure; the procedure will be painless if you don't move. B. "The needle causes pain when it goes in, but I will be by your side throughout and will, help you hold your position. C. "The procedure may take only 2 to 3 minutes, so you might get through it by mentally counting up to 120." D. "You might feel a little bit uncomfortable when the needle goes in, but you should breathe rhythmically; I will be here to coach you."

B. "The needle causes pain when it goes in, but I will be by your side throughout and will, help you hold your position. RATIONALE: 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 throughout.

A nurse and an older adult client with chronic back pain are in the working phase of the nurse-client relationship. Which activity occurs in the working phase? A. The client identifies one or more health problems. B. The nurse tries to avoid hampering the client's independence. C. The nurse is courteous and actively listens to the client. D. The nurse ensures that the client manages independently.

B. The nurse tries to avoid hampering the client's independence. RATIONALE: In the working phase of a nurse-client relationship, the nurse tries not to hamper the client's independence, because doing too much for the client is as harmful as doing too little.

The child of a client who just died in a hospice unit arrives and asks, "May I please stay and sit at the bedside? I really wanted to be here so my dad would not die alone." Which statement made by the nurse best demonstrates the use of empathy? A. "You are too late for that, but you may stay for a while if you would like." B. "I tried to contact you earlier, but you did not answer your phone." C. "I will close the door so you can spend some quiet time at the bedside." D. "I understand. I lost my dad last year, and he died alone."

C. "I will close the door so you can spend some quiet time at the bedside." RATIONALE: Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Empathy helps nurses become effective at providing for the client's needs while remaining compassionately detached.

The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety? A. "I will start an IV, which should not take much time B. "I will start an IV with the number 18 catheters. C. "I will start an IV that will add fluids directly to the blood stream." D. "I will start an IV, which should not cause you too much pain."

C. "I will start an IV that will add fluids directly to the blood stream." RATIONALE: The nurse should explain the procedure and its purpose. The nurse telling the client that it should not take much time does not convey the purpose of the procedure. It is unnecessary for the nurse to inform the client about the technical details of the catheter. Additionally, the nurse should not give false reassurance by telling the client that the procedure will not be painful.

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? A. "Don't worry about labor, I have been through it and it is not so bad." B. "There are many good medications to decrease the pain; it will not be so bad." C. "You're worried about how you will tolerate the pain associated with labor." D. "I would recommend keeping a positive attitude.

C. "You're worried about how you will tolerate the pain associated with labor." RATIONALE: Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further.

A nurse is caring for an older adult client. Which strategy should the nurse utilize to confirm the client's understanding of instructions? A. Use active listening during communication. B. Ask open-ended questions. C. Ask the client to repeat the instructions. D. Provide written instructions.

C. Ask the client to repeat the instructions. RATIONALE: Rationale: By asking the client to repeat instructions, the nurse can confirm a client's understanding. During all communications the nurse should use active listening and ask open-ended questions to learn more, but this alone does not confirm learning.

A nurse is caring for an older adult client hospitalized following a hip fracture. Which actions by the nurse will promote the development of a therapeutic relationship? Select all that apply. A. Talking with another nurse during a bedside change of shift report B. Addressing the client by the client's first name C. Asking the client when the client would like to have the bed linens changed D. Encouraging the client to talk about the client's life F. Assisting the client with the completion of all activities of daily living

C. Asking the client when the client would like to have the bed linens changed D. Encouraging the client to talk about the client's life RATIONALE: The nurse can promote the development of a therapeutic relationship by asking the client about personal preferences, such as when the bed linens should be changed, as well as encouraging the client to share personal stories.

A nurse who has been practicing for three decades has seen significant changes in the roles that clients are expected to perform in the course of their care. What is a role that clients are normally expected to perform while they are receiving care? A. bring a high level of knowledge about their disease or health problem B. avoid consuming an inordinate amount of caregivers' time C. participate actively in the planning and execution of their care D. defer to the nurse's knowledge and authority

C. participate actively in the planning and execution of their care RATIONALE: Clients are generally expected to participate in their care in an active way. A passive and deferent demeanor is not encouraged, though cooperation and adherence to treatment are expected.

The nurse is caring for a client who had a stroke with residual affective aphasia. What is an effective method(s) for the nurse to communicate with the client? Select all that apply. A. speak loudly and clearly to the client. B. finish the sentence for the client when the client is unable to express a word C. provide the client with a tablet or whiteboard to attempt communication D. patiently await the client's responses after asking question E. have the client point to common phrases or spell with alphabet letters on a laminated form

C. provide the client with a tablet or whiteboard to attempt communication D. patiently await the client's responses after asking question E. have the client point to common phrases or spell with alphabet letters on a laminated form RATIONALE: There are several methods that the nurse can use to communicate with a verbally impaired client. Creativity with methods will include offering the client a whiteboard to write down responses if able or to make requests. Giving the client a laminated form so that the client may be able to point to letters of the alphabet or commonly used phrases may be helpful.

The client confronts the nurse, stating, "No one has come into my room to give me the pain medication I requested 2 hours ago. I am in pain!" Which response by the nurse indicates the nurse is using a "defending" communication technique? A. "You could not be huring that much if you are able to watch television." B. "That is not true, you did not indicate that you were in need of pain medication that immediately." C. "Why did not you put your light on again and remind me?" D. "I have been busy with other clients that required my immediate attention."

D. "I have been busy with other clients that required my immediate attention." RATIONALE: The nurse is demonstrating defending behaviors and statements when attempting to justify the reason for not returning with a client's pain medication. This response places the client in the defensive stance as well.

A nurse is collecting a health history on a client. When asked about alcohol, tobacco, and drug use, the client states, "I quit smoking 10 years ago." However, the nurse observes an open package of cigarettes in the client's shirt pocket. What is the most appropriate response by the nurse? A. "I know that you are lying about not smoking, so tell me how much you smoke each day." B. "Are you having difficulty quitting smoking?" C. "Why did you tell me you quit smoking?" D. "You said that you do not smoke, but you have an open package of cigarettes in your pocket."

D. "You said that you do not smoke, but you have an open package of cigarettes in your pocket." RATIONALE: Confrontation calls attention to manipulation, inconsistencies, or lack of responsibility. Verbal techniques such as disapproval, belittling, and demanding an explanation are non-therapeutic communication styles.

A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? A. Indifference B. Pity C. Sympathy D. Empathy

D. Empathy RATIONALE: The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition.

A nurse is working with an adult client who has been admitted with hyperglycemia following a period of poor glycemic control. The nurse has many similarities to the client with regard to age, gender, and socioeconomic status but is careful to utilize therapeutic communication techniques rather than social communication. How does therapeutic communication differ from social communication? A. Therapeutic communication relies heavily on technical medical vocabulary while social communication uses colloquialisms. B. Therapeutic communication focuses primarily on problems while social communication addresses positive aspects of the client's life. C. Therapeutic communication focuses on the requirements of the nurse while social communication is more reciprocal. D. Therapeutic communication is focused on a particular goal while social communication is more superficial in content.

D. Therapeutic communication is focused on a particular goal while social communication is more superficial in content. RATIONALE: Social communication is superficial; it includes common courtesies and exchanges about general topics. Therapeutic verbal communication involves the use of words and gestures to accomplish a particular objective.

A nurse is working with a client who is in postoperative day 2 following a total knee replacement. The client has briefly mobilized using a wheeled walker and with the assistance of the physical therapist. However, the client is reluctant to progress further with mobilization for fear of injuring herself. In response to this, the nurse has liaised with the physical therapist to create a plan of care that creates specific goals for the client's mobility. In doing so, this nurse has exemplified what role? A. nurse as educator B. nurse as caregiver C. nurse as delegator D. nurse as collaborator

D. nurse as collaborator RATIONALE: The nurse acts as a collaborator when he or she works with others to achieve a common goal. This is especially evident when the nurse works cooperatively with members of other health disciplines.

A nurse pays a house visit to a client who is on parenteral nutrition. The client reports missing enjoying food with the client's family. What is the most appropriate response by the nurse? A. "Tell me more about how it feels to eat with your family." B. "You can sit with your family at meal times, even though you don't eat C. "In a few weeks you may be allowed to eat a little; you may enjov it then D. "I know that you must be missing your favorite foods"

A. "Tell me more about how it feels to eat with your family." RATIONALE: The nurse should help the client to verbalize feelings and cope with aspects of illness and treatment. Asking open-ended questions is most appropriate as the nurse encourages the client to express feelings.

A client reports to the primary health care facility reporting chest pain. After the investigations and initial treatment, the client anxiously inquires if he had a heart attack. What should be the nurse's reply? A. "The physician wants to monitor you and control your pain. B. "Yes, you had a heart attack; this is why you are here with us. C."Yes, you had a heart attack, but the damage is very minimal" D. "No; we can assure you that you will not have a heart attack."

A. "The physician wants to monitor you and control your pain. RATIONALE: The nurse should give true information to the client. Stating that the physician wants to monitor the client and control his pain is true information.

A nurse is examining a 3-year-old child with conjunctivitis. During the examination, the child starts crying and refuses to sit still. Which statement is appropriate for the nurse to tell the child? A. "Would you like to see my flashlight?" B. "Don't be scared, the light will not hurt you." C. "I know you are upset; we can do this later." D. "If you sit still, this will be over in no time."

A. "Would you like to see my flashlight?" RATIONALE: Toddlers are scared of procedures. To decrease the fear, children should be actively involved. Asking the child if he or she wants to see the flashlight would be most appropriate, as it engages the child in an activity.

A nurse needs to complete an assessment and vital signs on a client who has Alzheimer disease. How should the nurse approach this client to gain cooperation? Select all that apply. A. Approach the client from the front. B. Use the client's name. C. Focus on the nursing tasks. D. Speak loudly and clearly. E. Smile and maintain eye contact.

A. Approach the client from the front. B. Use the client's name. E. Smile and maintain eye contact. RATIONALE: Techniques that facilitate communicating with a client who has Alzheimer's disease include gaining the client's attention by approaching from the front and using the client's name, smiling to convey friendliness, maintaining eye contact to evaluate the client's attention and comprehension, assuming a relaxed posture to avoid agitating the client, and speaking naturally at a normal rate and volume.

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? A. Assess how the client would like to communicate B. Use facial and hand gestures C. Contact a person skilled in sign language D. Provide paper and pencil for written communication

A. Assess how the client would like to communicate RATIONALE: Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication.