Communications questions

A nurse manager seeks to reduce staff nurses' stress and promote retention. It is most important for the nurse manager to take which action? A. Develop a mentoring program to provide cognitive and affective support. B. Focus on cognitive support instead of affective or physical support. C. Limit affective support to annual recognition of nurses' accomplishments. D. Place the highest priority on purchasing equipment to provide for physical support.

ANS: A A mentoring program can provide cognitive and affective support; mentor programs have improved retention of nurses. Cognitive, affective, and physical support are equally important to reduce stress and promote retention of nurses. Affective support is acknowledgment for the work nurses do; respect, honor, and recognition should be continually provided and not just during annual reviews or evaluations. Physical support is provided with having the staff, materials, and processes to complete the work; however, staffing is an essential component of physical support and directly linked to retention of nurses.

The nurse greets a patient who is admitted to the hospital. Which action by the nurse displays warmth and concern? A. Use a soft and relaxed tone of voice when speaking. B. Maintain a distance of 6 to 8 feet from the patient. C. Avoid attentive behaviors when interacting with the patient. D. Engage in a verbal exchange without physical contact.

ANS: A A soft, modulated tone of voice conveys warmth; warmth is also conveyed with relaxed, rhythmic speech. The spatial distance between the nurse and the patient can affect the perception of warmth; a comfortable, social distance for Americans is an arm's length to 4 feet. Touching (e.g., brief pat on the shoulder, embracing hug, or extended hand) is another way to transmit warmth. A relaxed person conveys warmth. The nurse communicates warmth when there is a genuine interest and attentiveness in the interaction with the patient.

A non-Hispanic white nurse provides care to mostly Hispanic patients. It would be most important for the nurse to take which action? A. Discover cultural influences on healthcare perceptions and behaviors. B. Assist the patients to adapt to American culture and health beliefs. C. Avoid confrontation of underlying issues of discrimination. D. Improve communication by learning how to speak Spanish.

ANS: A As our society becomes more global and diverse, cultural competence is a dynamic concept that must be evaluated continuously as it relates to patient outcomes (Waite et al., 2014). Nurses need to know about culture because it influences both nurses' and clients' healthcare perceptions and behaviors. Nurses should learn about the culture of diverse clients and communities. Nurses need to recognize and overcome certain attitudes basic to the American culture. To provide culturally competent care, the nurse must address issues of discrimination. Learning how to speak another language is important, but it is more important to seek understanding of cultural influences on health

The author describes the patient journey as driving down a country road and somehow getting lost. At that moment and time, all that is needed is clear directions about how to get to your destination, not about types of entertainment in the area. The same is true for patients. Accordingly, a part of each nursing assessment should include: a. Patient's need for information and level of understanding b. Detailed overview of disease process c. Specific examples from other patients with same disease d. Nurse's feelings about newest treatment modality

ANS: A Assessment of patient's need for information and level of understanding helps the nurse choose the right amount of detail and appropriate language level (Black, 2014).

Which patient would most likely be uncomfortable with close personal space during an interaction with the nurse? A. A 19-year-old white female patient who is standing 2 feet in front of the nurse. B. A 40-year-old African-American male patient who is sitting next to the nurse. C. A 60-year-old Latin-American female patient who is seated across from the nurse. D. An 82-year-old patient from France who is lying in bed with the nurse sitting next to the bed.

ANS: A Different cultures prefer different degrees of closeness in personal space. Optimal distance for a therapeutic conversation is usually 3 to 4 feet. Generally, middle-class Americans feel uncomfortable when standing close to people they do not know well. Latin Americans, African Americans, and the French welcome physical closeness. In most cultures, men need more space than women do. Usually people will tolerate a person standing close to them at their side more readily than directly in front of them. Direct eye contact usually requires more space. Placing oneself at the same level (e.g., sitting while the client is sitting or standing at eye level when the client is standing) is usually perceived as less threatening. Nurses should sit at eye level with bedridden clients.

The nurse is a member of a quality improvement project team to improve communication when a patient is transferred to another unit. Which statement by the nurse is appropriate to demonstrate positive regard for the team members? A. "We have done an excellent job." B. "We still have so much work to do." C. "Most of our suggestions did not work." D. "We won't win a prize for our work."

ANS: A Giving specific positive feedback is another form of expressing opinions that can demonstrate an assertive communication style. Sharing positive opinions helps team members feel comfortable, share ideas, and promote creativity and teamwork

A nurse manager asks a colleague for advice on strategies to improve communication with staff nurses. Which response by the nurse manager's colleague is best? A. "Be sensitive, show respect, and be genuine." B. "You need to be consistently nice to the staff nurses." C. "Work as a staff nurse every month to develop empathy." D. "Staff nurses need a leader who is not emotional."

ANS: A Improved communication with colleagues can be enhanced by expression of warmth. Warmth enhances closeness, creates a better work environment, and makes a colleague more approachable. A nurse manager needs to avoid insensitivity to co-workers and demonstrating aloofness and arrogance. Warmth, respect, genuineness, and empathy are needed to improve communication with colleagues. Being nice is not equivalent to expressing warmth. Empathy is not learned by performing the job of a colleague. Expression of warmth is an emotion.

The nurse has implemented a plan to improve expression of warmth to other nurses. It is most important for the nurse to include which evaluation method? A. Self-monitor interactions with colleagues for feelings of relaxation and caring. B. Ask patients for their perception of the interactions that occur among nurses. C. Invite a supervisor to evaluate interactions and provide suggestions for improvement. D. Seek nominations for an award at the organizational level or from an association.

ANS: A One of the most important measures of warmth is the individual's inner feelings; the nurse should monitor for more relaxed, caring feelings toward others and for free-flowing affection and engagement with others. The patients would not be able to reliably evaluate interactions between nurses or other healthcare professionals. Specific feedback about warmth ability can be obtained by asking a colleague (or supervisor) to evaluate the interactions with colleagues and to let them provide constructive feedback. An award nomination is not a suggested evaluation method to measure warmth

The nurse cares for a patient who has just been diagnosed with lung cancer. Which statement by the nurse is therapeutic? A. "You sound really frightened about your diagnosis of cancer." B. "You will get better because the treatment will be started this week." C. "I think you should take a vacation and try to forget about the cancer." D. "An apple a day will keep the doctor away."

ANS: A Reflecting helps the patient to clarify feelings and is a therapeutic communication technique. Reassuring (i.e., "you will be okay") negates fears and feelings of the patient. Getting advice (i.e., declaration to the patient of what the nurse thinks) negates the worth of the patient as a mutual partner in decision making. Making stereotyped responses (i.e., trite, meaningless verbal expressions) negates the significance of the patient's communication.

Which nurse is being fully present with the patient to provide spiritual care? a. The nurse sits quietly with a patient and uses therapeutic touch. b. The nurse gathers a complete health history from a patient. c. The nurse asks if the patient would like the chaplain to visit. d. The nurse reassures a patient while giving medications.

ANS: A Spiritual care begins with being fully present; nursing presence is a conscious act of being fully present in body, mind, emotions, and spirit with a patient. Being silent and use of therapeutic touch are examples of being present. Performing tasks or assessments (e.g., obtaining a health history, administering medications) are not examples of being fully present. Spiritual care is more than religion or visitation from a chaplain.

One study of Italian primary care physicians caring for diabetic patients showed that those scoring highest on the empathy test had patients with: A. Significantly fewer acute diabetic complications B. Statistically fewer acute diabetic complications C. Higher rates of chronic diabetic complications D. Statistically higher poor outcomes for patients with diabetes

ANS: A The Cleveland Clinic convened its fifth Annual Patient Experience: Empathy and Innovation Summit in 2014. Two videos showcased there are referenced in Exercise 1 in this chapter. Empathy research is demonstrating a correlation between empathy and healthcare outcomes (Riess and Reinero, 2014). In a study of 242 Italian primary care physicians caring for a total of 20,961 diabetic patients, patients of physicians scoring highest on an empathy test had significantly fewer acute diabetic complications (Bloomfield, 2013).

The nurse prepares to administer the first chemotherapy treatment to a patient. Which statement by the nurse encourages a positive attitude? A. "What brings joy to your life?" B. "Will you be upset if you lose your hair?" C. "What are your concerns about your treatment?" D. "How do you usually cope with stress?"

ANS: A The nurse can encourage a positive attitude by asking patients appropriate questions such as (1) "What brings joy to your life?" (2) "What do you do for fun?" or (3) "What is going well for you today?" Asking a patient about being upset, concerns, or stress does not focus on generating a positive attitude.

The nurse cares for a patient with urinary incontinence after a stroke. Which response by the nurse is best? A. "You seem upset about this. We can work together on a bladder retraining program." B. "I don't mind cleaning up your mess. I am used to it because my child does this at night." C. "Don't be embarrassed. A lot of patients have this problem after a stroke." D. "I will bring you some diapers to wear instead of having you wet the bed all the time."

ANS: A The nurse must consider the client's self-esteem and preserve the client's dignity. Clients want to preserve or manage their image of self or "face." How the nurse handles a situation can influence the client's willingness to problem-solve.

The nurse cares for a patient who becomes confused and a vest restraint is applied. The nurse should take which action when notifying the patient's family? A. Avoid discussing the treatment plan to reduce anxiety and worry. B. Ask another nurse who has rapport with the family to be present. C. Use medical terms to demonstrate competence. D. Assume that the family wants a detailed explanation.

ANS: B Rapport should be established before bad news is shared with the family; if rapport has not been developed, the nurse may ask team members who have established rapport with the family to be present. The nurse should use language that the family will understand. Find out how much detail the family wants to know. Explain the treatment plan to the family.

Which statement, if made by the nurse, could positively affect the course of the patient's situation by suggestibility? A. "Breastfeeding will provide time to bond with your baby." B. "Breastfeeding will take longer than giving your baby a bottle." C. "You will need to be careful about taking medications while breastfeeding." D. "Breastfeeding mothers can develop infections that are serious."

ANS: A The placebo effect is language or expectations of a nurse that positively affect the course of the patient's illness by suggestibility, and the nurse is sending a positive message (e.g., increased time for bonding). When considering bottle preparation, storage, and cleanup, it is inaccurate to say that breastfeeding will take more time. The nocebo effect can occur when a nurse sends a negative message through choice of language, words, or tone of voice that produces negative responses (e.g., breastfeeding takes time, limits medication options, and causes infections).

The nurse cares for a patient who has type 2 diabetes mellitus and does not consistently follow the dietary restrictions and exercise recommendations. The patient takes a daily oral hypoglycemic agent as prescribed. Which statement by the nurse is most appropriate? A. "It is great that you take your medicine as prescribed." B. "It wouldn't be that hard to walk a few blocks every other day." C. "You are definitely not one of my good patients." D. "It is a waste of time to help you because you will never change."

ANS: A There are guidelines for nurse conduct in client-nurse helping relationships. The nurse should praise and encourage clients in their efforts to take better care of themselves. The nurse should not patronize clients, pigeonhole clients with labels (e.g., good, lazy, or uncooperative), or put down clients by making them feel inadequate or estranged.

It would be most important for the nurse to temporarily withdraw expressions of warmth to which patient? A. A 20-year-old patient who is angry and throwing objects. B. A 32-year-old patient who is withdrawn and refuses nursing care. C. A 48-year-old patient who is extremely anxious about surgery. D. A 56-year-old patient who has a history of violent behavior.

ANS: A When the nurse feels hurt, bitter, irritated, or enraged with a patient, trying to convey warmth would be insincere. It would be appropriate to express warmth to patients who are withdrawn and anxious. Expression of warmth is appropriate for a patient with a history of violence; the patient is not exhibiting the violent behavior at this time

Which nonverbal action(s) would be consistent with an assertive style of communication? (Select all that apply) A. Relaxed posture B. Established eye contact C. Hands placed on hips D. Distant, soft voice E. Mask-like facial expression

ANS: A, B Assertive styles of communication that are nonverbal include a relaxed stance and eyes that are warm, in contact, and frank. Aggressive styles of communication that are nonverbal include expressionless, cold, narrowed, or staring eyes and hands placed on hips. A weak, distant, soft voice is a nonassertive style of nonverbal communication.

A nurse who frequently corrects other staff nurses is trying to avoid making comments when it really does not matter. In which three situation(s) would it be appropriate for the nurse to remain silent and not share an opinion? (Select all that apply) A. A staff nurse reports a blood pressure as 110/60, but it is recorded in the chart as 114/62. B. A staff nurse takes a lunch break for 33 minutes instead of 30 minutes. C. A staff nurse gives a medication orally instead of by injection. D. A staff nurse reports no discrepancy for the narcotic count, but one is missing. E. A staff nurse does not pronounce the generic name of a medication correctly.

ANS: A, B Nurses need to know when to express opinions and when not to share opinions and have the strength not to always be right. The nurse should not share opinions when it does not make a difference (e.g., insignificant differences in blood pressure readings, taking an extra 3 minutes for lunch, and mispronunciation of medical terms with colleagues). Opinions should be expressed if patient safety is involved (e.g., administering medication by the wrong route) or there are legal ramifications (e.g., a controlled substance is missing).

According to the Workplace Bullying Institute, nurses are also exposed to this type of behavior within their professional environment. In teaching the possibility to an incoming graduate nurse, you know that the nurse understands when he or she includes which of the following as abusive conduct? (Select all that apply) A. Threats B. Humiliation C. Intimidation D. Physical abuse E. Sabotage

ANS: A, B, C, E The Workplace Bullying Institute defines workplace bullying as "repeated, health harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct, that is, threatening, humiliating or intimidating, workplace interference (sabotage), or verbal abuse (2014). Physical abuse would be assault.

As an experienced staff nurse, you have been asked to create a teaching guide for nursing orientation on respect. Accessing the list from Ehow about being genuine, you would include all of the following. (Select all that apply) A. Acting natural around others B. Listening when others are speaking C. Denying your mistakes D. Compliment only when you sincerely mean it E. Lying to make friends F. Skipping invitations to event you wouldn't genuinely enjoy

ANS: A, B, D, F According to the Ehow link provided on "How to Be Genuine," these were some of the recommendations: acting natural around others, listening when others are speaking, admitting when you have made a serious mistake, complimenting only when you sincerely mean it, avoiding lying just to make friends, and skipping invitations for any event that you simply wouldn't enjoy.

The nurse cares for an adult client who is diagnosed with active tuberculosis. Which action, if performed by the nurse during introductions, shows respect for the client? (Select all that apply) A. Maintain eye contact by looking at the client. B. Avoid touch to reduce transmission of the disease. C. Stay at least 4 to 6 feet away from the client. D. Briefly converse about the weather to break the ice. E. Determine how the client would like to be addressed.

ANS: A, D, E Respect is demonstrated by acknowledgment. Actions during an introduction that show respect include looking at the client and maintaining eye contact, using a brief period of impersonal or trivial exchanges (such as the weather) to break the ice, or determining how the client likes to be addressed. The nurse can touch and move close to a patient with active tuberculosis if appropriate precautions are taken (i.e., airborne infection isolation and a high-efficiency particulate air mask).

REAL conversations, as described by John Stoker (2013), should contain multiple facets. As a nurse, we know when approaching patients, our care should be REAL, meaning we should do all of the following except: A. Recognize judgments B. Express biased thoughts C. Ask questions D. Listen for verbal and nonverbal messages

ANS: B "REAL conversation: Recognize judgments. Express thoughts neutrally. Ask questions. Listen for verbal and nonverbal messages" (John Stoker, 2013).

The hospital nurse educator develops an educational session for staff nurses on how to clearly record data in a patient's electronic medical record. Which key point should the nurse educator include in the teaching plan? (Select all that apply) a. A patient who is at high risk for falls will require more frequent documentation. b. The nurse should avoid labels (e.g., good, drug seeking, and lazy) to describe patients. c. Detailed and specific documentation is only required if a malpractice suit is expected. d. Each entry by the nurse in the electronic medical record should be clear and concise. e. Documentation cannot be used to determine reimbursement for healthcare services. f. Exact statements (in quotations) from patients are more accurate than paraphrasing.

ANS: A, B, D, F The complexity of the health problems and the level of risk posed by patients, by their condition, or by the use of medical, nursing, or other therapies dictate the detail and frequency of documentation. The higher the risk to which a particular patient is exposed, the more comprehensive, in depth, and frequent should be the nursing recordings. Effective recording shuns bias, avoiding tendencies to prejudge or label patients. Avoidance of a malpractice suit is a valid reason for documentation to be detailed and specific, but documentation should be detailed and specific for every patient. Clear, concise documentation is vital for every entry into the electronic medical record. Careful documentation affects the ability of a healthcare agency to be reimbursed for services. Effective documentation tends toward quantitative expression, avoiding vague generalizations.

The nurse manager decides to initiate a mentoring program for new graduate nurses on a medical unit. The nurse manager should consider asking which of the following three nurses to serve as mentors? (Select all that apply) A. A nurse who excels in nursing knowledge and skills and has a positive attitude. B. A nurse who has excellent communication skills and a positive outlook. C. A nurse who is certified in psychiatric care and works in a mental health setting. D. A nurse who excels as a manager and has an advanced degree in administration. E. A nurse who is warm, empathetic, and has a passion for nursing and helping others.

ANS: A, B, E A mentor in nursing represents excellence in knowledge, skill, and competence; affective components are warmth, acceptance, friendliness, empathy, compassion, patience, a willingness to learn and share, and generosity. Mentors have a positive outlook, are loyal and nurturing, enjoy nursing, and have superior communication skills. A nurse with an advanced degree or with certification in a specialty area will not necessarily have the characteristics of a good mentor

The nurse cares for a client with hypertension, and a nurse-client contract is developed outlining the activities and responsibilities of each. Which would be appropriate to include in this contract? (Select all that apply) A. The outcomes should be realistic and measurable. B. Progress should be reviewed at regular intervals. C. The contract should be written and signed. D. The nurse should keep the information confidential. E. The nurse and client should mutually evaluate progress.

ANS: A, B, E The contract should be realistic and spell out measurable behaviors. The nurse and client should mutually evaluate outcome achievement at regular intervals. The contract may be either verbal or written. The nurse should not promise to keep information confidential; nurses must share information that is important to the well-being of the client or others (e.g., plans to harm self or others).

Which three nurse statements are examples of expressing opinions in an assertive way with colleagues? (Select all that apply) A. "Do you think this project will help you learn about evidence-based practice?" B. "I will tell you about the evidence-based project, and you will want to help." C. "I recently attended an evidence-based conference. Can I share the highlights?" D. "I think we should be paid because this project will save money. What do you think?" E. "I really think you should read more evidence-based journal articles."

ANS: A, C, D To avoid generating feelings of hostility or resentment, the nurse should ask colleagues if they are interested in hearing the nurse's viewpoint. The nurse should avoid being dogmatic or using strong phrases when expressing opinions. The nurse should be tentative about offering persuasions to show consideration of others' special circumstances. When offering an opinion, the nurse should give others a fair chance to accept or reject ideas. When expressing opinions to colleagues, the nurse should give the rationale in a responsible way; the nurse should offer a reason for his or her preferences and then turn the final decision back to the client.

The nurse cares for a client with abdominal pain who is scheduled for exploratory surgery. Which statement(s), if made by the nurse, indicates that the client's rights in the helping relationship have been violated? (Select all that apply) A. "I do not have time right now to help you call your family." B. "I am available to answer questions that you may have about your surgery." C. "You seem frightened. I will stay with you until your family arrives." D. "Your neighbors called, and I told them that you will have surgery." E. "If you do not let me start your IV, I will not give you pain medication."

ANS: A, D, E Client rights that were violated are: (1) to secure help conveniently, without hassles or roadblocks; (2) to trust that the confidentiality of any personal information will be respected; and (3) to refuse or consent to nursing treatments without jeopardizing their relationship with their nurses. Client rights that were respected are: (1) to be informed about their health status and have all their questions answered so that they clearly understand what nurses mean and (2) to feel confident that they will be treated courteously and that their nurses show genuine interest in them.

Which characteristic would the nurse use to define culture? (Select all that apply) A. Learned and shared lifeways of a particular group. B. Social identity influenced by language and religion. C. Belief in superiority of one's own ethnic group. D. Values influence both thinking and actions. E. Several generations share the same beliefs.

ANS: A, D, E Culture is the learned and shared beliefs, values, and lifeways of a particular group that are generally transmitted intergenerationally and influence one's thinking and actions. Ethnicity refers to the social identity and origins of a social group due largely to language, religion, and national origin. Ethnocentrism is the universal tendency of people to believe that one's own race or ethnic group is the most important and/or that some or all aspects of its culture are superior to those of other groups.

A nurse instructs colleagues about the use of humor with patients. Which statement, if made by a colleague, indicates that the teaching is effective? A. "Telling a joke is the best way to use humor." B. "Humor can help patients to be less afraid." C. "I should avoid humor when giving a bath." D. "Patients will not talk to me if I use humor."

ANS: B Humor improves the patient's ability to cope with stress and fear. Droll humor is more effective than formal jokes. Humor may help to put a patient at ease during a bath. Humor invites interaction.

A nurse manager offers a staff nurse a choice between working 8- or 12-hour shifts. Which statement, if made by the staff nurse, is nonassertive and may result in a frustrated response from the nurse manager? A. "I want to decide the shifts for all of the other staff nurses." B. "Do whatever you want. It doesn't really matter to me." C. "Thank you for offering me a choice. I prefer 12-hour shifts." D. "You will never be able to give me what I really want to work."

ANS: B A statement that allows others to make decisions for a person is an example of a nonassertive style of communication; the response of others to a nonassertive statement may include disrespect, guilt, anger, or frustration. Statements that make choices for others or that are accusations are examples of aggressive styles of communication; the response of others to an aggressive statement may include hurt, defensiveness, or humiliation. A statement that allows making one's own decisions is an example of assertive style of communication; the response of others to an assertive statement may include mutual respect.

The author said that laughter is an instant vacation, but as nurses, incorporating humor into our daily work can be a challenge. One of the reasons for this, according to Povine's research as presented by Dutton (2012), is that for adults, laughter does not come as easily as it did for them when they were young. How much more do babies laugh than adults? A. 50 times more B. 15 times more C. 10 times more D. 100 times more

ANS: B According to Povine conducting laughter research, babies laugh 300 times each day (Dutton, 2012). How often does a typical adult laugh? About 20 times per day.

As a part of the F.O.C.U.S. model, the "C" stands for A. Communicate B. Connect C. Concern D. Convince

ANS: B According to the author, F.O.C.U.S. is a model she created to help nurses connect with the current moment in which they are serving. The model contains the following elements: Feel, Observe, Connect, Understand, and Share.

According to Swanson's theory, there are five caring processes, one of which is "knowing." What are the other four? A. Communication, assertiveness, responsibility, and caring B. Maintaining belief, being with, doing for, and enabling C. Understanding, action, information, and comfort D. Maintaining belief, being with, enabling, and supporting

ANS: B Caring is an essential ingredient in life and must characterize the nurse-client relationship.... Consider Swanson's five caring processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the capacity of others to care for themselves and family members

The home health nurse visits a client with heart failure who has increased dyspnea and peripheral edema and weight gain. The nurse suspects the client is not restricting fluids as prescribed. Which action by the nurse is most appropriate? a. Teach the client about the consequences of not following the fluid restrictions. b. Ask the client to report the amount of fluid intake for the past 24 hours. c. Provide the client with sugarless candy or gum to decrease the thirst sensation. d. Consult with the healthcare provider about increasing the dose of the diuretic

ANS: B Client validation of the assessment data leads to mutual problem solving with the nurse. Incorporating validation keeps nurses focused on the rights and obligations of clients to make their own decisions about their health. Validation means consciously seeking out the client's opinions and feelings, unearthing questions or concerns related to plans for their healthcare, and securing an understanding and willingness to proceed to the next step. Incorporating validation into problem solving ensures that the nurse obtains complete agreement and commitment from the client about the nursing care plan.

The nurse is providing care to a patient who was admitted with heart failure. The patient has not been following the prescribed diet or taking the prescribed medications. Which type of communication approach is most important for the nurse to use with this patient to facilitate a change in self-care behavior? A. Authoritative, honest, and outright communication B. Assertive, responsible, and caring communication C. Aggressive, sympathetic, and realistic communication D. Positive, expert, and focused communication

ANS: B Communication must be technically responsible, assertive, and caring to facilitate a change in behavior.

The nurse cares for a patient with a terminal illness. Which way would be the most therapeutic for the nurse to communicate with this patient? A. Use an honest, judgmental attitude. B. Demonstrate understanding with empathy. C. Acknowledge hope by expressions of sympathy. D. Consistently evaluate the patient's feelings.

ANS: B Empathy is feeling with a deep understanding and awareness of the client's experiences. The nurse should develop a nonjudgmental attitude. Evaluation of feelings does not convey understanding or empathy. Sympathy focuses on the nurse and not the patient's feelings.

Which individual is displaying thoughts or actions that are genuine? A. A nurse who advocates for clients in order to qualify for a raise in personal hourly pay. B. A nurse who takes action to increase awareness of the need for cultural sensitivity. C. A nurse who supports a change in a project in front of supervisors but complains to staff. D. A nurse who verbally supports a new policy but does not follow the policy in practice.

ANS: B Expression of genuine thoughts and feelings about issues results in clear messages to clients and colleagues. Genuineness has positive therapeutic outcomes. When a mismatch exists between nurses' thoughts and feelings and actions, falseness or deceit occurs.

The nurse is interviewing a Native American client. It is most important for the nurse to take which action? A. Maintain eye contact to show respect and interest. B. Assess whether the client is comfortable with eye contact. C. Avoid prolonged eye contact with this client. D. Sit next to the patient to avoid any eye contact

ANS: B Eye contact is often cultural; some Native Americans believe that prolonged eye contact is rude and intrusive. However, it is important to assess each individual patient for preferences and comfort with eye contact.

According to Kimble and Bamford-Wade, what distinguishes the behavior of one caring and competent nurse from another nurse who is simply competent but not engaged with the patient? A. Immediacy, the availability of the nurse B. Warmth, the hallmark of compassion C. Attention, the focus of the nurse D. Communication, the instructional side of the nurse

ANS: B Healy, a nurse patient, recounts a long wait before surgery, ponders what it was that distinguished the behavior of one caring nurse, and identifies warmth as the hallmark of compassion, also a quality of compassionate listening

A nurse is breastfeeding but has no private, sanitary area to pump breast milk while working. She also discovers that at least 10 other employees at the hospital have the same problem. Which action by the nurse would most likely result in acquiring a clean, private area to pump breast milk as required by law? A. The nurse demands that the nursing director provide a private area within 1 week. B. The nurse develops a clear, detailed plan and suggests several possible private areas. C. The nurse sends an e-mail to the nursing supervisor with a description of the problem. D. The nurse writes a letter to the nurse manager and asks others to add their signatures.

ANS: B If the nurse develops a specific and clear plan with sufficient detail, the greater are the chances of obtaining physical support (e.g., a private area). Demanding a space is an aggressive approach that does not give respect to the nursing director. The nurse should make an appointment with the nursing supervisor or manager and not communicate by e-mail or letter. The nurse should not just describe the problem but also offer solutions.

A client has high blood pressure and needs to learn about a low-sodium diet. Which question if asked by the client would be an indirect request for information? A. "How should I prepare food without adding salt?" B. "What will I do to make food taste better?" C. "What diet changes are needed to control my blood pressure?" D. "What foods should I avoid that are high in sodium?"

ANS: B Indirect requests for information are not obvious, and the meaning must be interpreted by the nurse. "What will I do to make food taste better?" is an indirect request for information; the nurse must interpret this question as a request for information about a low-sodium diet. The other questions are direct requests for information on a low-sodium diet.

The nurse provides care for a male patient. When the nurse addresses the patient, which would be most appropriate? A. Use both first and last name with each encounter. B. Ask the patient how he prefers to be addressed. C. Call the patient by his first name. D. Address the patient by his last name.

ANS: B It is important to call the patient by the name he or she prefers. The nurse should ask a person how he or she prefers to be addressed because considerable cultural variation exists. Most Americans are comfortable with calling people by their first names. This is perceived by some, however, as a failure to show respect.

A teacher at a local elementary school asks a nurse to talk to the students about nutrition. Which response by the nurse is most appropriate? A. "I will teach the students how to read nutrition labels." B. "What would you like the students to learn about nutrition?" C. "The students need to know about the consequences of obesity." D. "I will enjoy teaching the students everything I know about nutrition."

ANS: B It is important to focus on the aspects of nutrition that the teacher wants the students to know and that are most important for them. The nurse should not assume the students need to learn about nutrition labels or obesity. Comprehensive nutrition information may waste time, be irrelevant, or focus on material that is too frightening or too advanced

A patient is irritable and complains to the nurse about difficulty sleeping last night. Which response by the nurse is most appropriate? A. "I know you will sleep better tonight." B. "Tell me more about what happened last night." C. "Did you drink too much caffeine yesterday?" D. "No one sleeps well in the hospital."

ANS: B Kindness and warmth in health caring relationships are important to customer service. Responses that demonstrate warmth (i.e., "Tell me about your concerns") are important when a patient makes a complaint. Nontherapeutic responses that do not convey warmth include reassurance (i.e., "I know you will sleep better tonight"); failure to probe (i.e., "Did you drink too much caffeine yesterday?"); and making stereotyped responses (i.e., "No one sleeps well in the hospital").

Andy Andrews, a well-known author and speaker, was once homeless and lived on the streets for a season of his life. Discussing the lessons learned as he looked back over his journey, he was quoted as recommending one of the following as a key to moving forward: a. Ruminating about alternatives b. Asking proper questions c. Utilizing negative self-talk d. Increasing your self-advocacy

ANS: B Many of life's treasures remain hidden from us simply because we never search for them. Often we do not ask the proper questions that might lead us to the answer to all our challenges (Andy Andrews, 2011). He did not recommend ruminating about alternatives, utilizing negative self-task, or increasing your self-advocacy.

The nurse cares for an adult client diagnosed with type 1 diabetes mellitus. Which is essential in building mutuality in the nurse-client relationship? A. The nurse controls the relationship by retaining the power to make judgments about diabetes education. B. The nurse teaches diabetes management by involving the client in making decisions about self care. C. The nurse has expert knowledge of diabetes and formulates appropriate learning outcomes for the client. D. The nurse demonstrates trust and respect by solving problems for the client when issues occur with self-management.

ANS: B Mutuality is an essential element in building relationships with the client and is characterized by empathy, collaboration, equality, and interdependency. Mutuality is a sharing of collective knowledge and decision making.

The nurse provides spiritual care for hospice patients. Which action by the nurse should be completed first? A. Perform spiritual assessments with hospice patients. B. Practice techniques to enrich your personal spirituality and centeredness. C. Determine available resources in the community. D. Practice the art of presence with the patients.

ANS: B Nurses must nurture their own spirit before being able to stay connected to the experience of a patient because it helps them to be in touch with their own spirituality and with becoming centered. It is only then that nurses are effective in spiritual assessments, being present, and identifying resources

The nurse makes a home visit to a client with chronic kidney disease. The client asks the nurse to make the decision about whether or not to start dialysis. Which action by the nurse is most appropriate? A. Encourage the client to appoint a durable power of attorney. B. Invite the client to make a decision after reviewing options. C. Direct the client to have the physician make a decision. D. Have the client visit with an individual receiving dialysis.

ANS: B Nurses should encourage clients to be active, responsible partners in their care; the nurse encourages a mutual problem-solving process by inviting or requesting the full participation of clients. A durable power of attorney can be authorized to make healthcare decisions if clients are no longer able to speak for themselves. Having the physician make decisions for the client places the client in a passive role. The client may visit with another person receiving dialysis, but the decision should be made by the client.

A female nurse discusses a concern related to client care with a male physician. Which communication strategy, if used by the nurse, is most effective? A. Assume a subservient role to the physician. B. Use a direct approach with succinct sentences. C. Ask questions instead of making recommendations. D. Be polite and expect politeness from the physician.

ANS: B Simplicity of speech is recommended; use direct communication with few words. The nurse should not assume a subservient role to the physician; there needs to be a connection between communication, collaboration, and teamwork in the nurse-physician relationship to provide quality care. The nurse should be assertive, expect professional respect, and exude expertise.

The nurse cares for a client who is scheduled for a breast biopsy. Which is the main purpose of the client-nurse relationship? A. To develop a mutually satisfying experience for the client and nurse. B. To assist the client in achieving and maintaining optimal health. C. To provide excellent client service and improve quality of care. D. To allow the client to receive important health information.

ANS: B The client-nurse relationship is established primarily to help the client achieve and maintain optimal health. The client-nurse relationship is entered for the benefit of the client but is more effective if the relationship is mutually satisfying. The ability to communicate clearly and with compassion is central to excellent customer (or client) service. The client is not just a passive receiver of health information; the client-nurse relationship refers to the interaction between the nurse and the client.

The nurse cares for an elderly patient in a long-term care center. Which would be inappropriate for the nurse to share with the client? A. Reminisce about birthday celebrations and inquire about the client's traditions. B. Use high levels of intimacy to help the client feel more comfortable with the nurse. C. Establish a helping relationship based on trust by sharing a personal story with the client. D. Share with the client how meditation decreased nausea during chemotherapy treatment.

ANS: B The following are recommendations for the sharing of self in a geriatric practice: (1) self-disclosure helps the client get to know the nurse without the burden of high levels of intimacy; (2) reminiscence is enhanced in elders when they are encouraged to share specific events (e.g., speak of personal holiday traditions and question clients about theirs); (3) understand that the connection between nurse and patient is dynamic, and the perception of the nurse as a real person aids in establishing the helping relationship; and (4) the nurse's sharing of self may help decrease the client's anxiety and diminish the stress of illness and treatment.

The home care nurse is assigned to make the first home visit to a new client who has been discharged from the hospital. After initial introductions, the nurse should take which action to convey respect? A. Ask the client to develop a list of needs to discuss at the next visit. B. Wear a name badge that clearly identifies the home care agency. C. Provide contact information for several other clients who can serve as references. D. Tell the client that information obtained will not be shared with others.

ANS: B The home care nurse can convey respect at the initial visit by wearing a name badge that clearly identifies the home care agency. Another action that conveys respect during the initial visit is to determine the client's needs; the nurse should not wait until the next visit. In addition, the nurse must respect the client's right to confidentiality; client contact information should not be shared with other clients. Also, the nurse should not promise to keep secrets because the nurse must use clinical judgment about shared information that might cause potential harm to the client or someone else.

Several studies have demonstrated that perceived social support is related to improved outcomes. When assessing your patients, you remembered that the textbook author had described research involving several different groups that had greater outcomes when social support was present. Which of the following was not one of those groups? A. Secondary school teachers B. Neighbors C. Veterans D. Stroke survivors

ANS: B The literature suggests that a positive relationship exists between the presence of social support and health and coping with illness (Komblith et al., 2001; Adams et al., 2000). A study of veterans demonstrated that perceived social support was associated with decreased incidence of post-traumatic stress disorder (Duax, Bohnert, Rauch, et al., 2014). Stroke survivors with higher perceived levels of social support scored higher on a health-related quality of life instrument (Kruithof, van Mierlo, Visser-Meily, et al., 2013). In a study of the work environment of secondary school teachers, co-worker support had an inverse relationship to anxiety and depression (Mahan et al., 2010).

The nurse cares for elderly clients in an assisted living center. Which action by the nurse would best show respect for these clients? A. Patronize clients who share ideas or voice concerns. B. Identify healthcare needs by listening to the clients. C. Address the clients formally by their last names. D. Limit the clients' opportunities to express opinions.

ANS: B The nurse shows respect by listening to clients discuss ideas, concerns, or healthcare needs. The nurse should not belittle, judge, demean, or patronize clients; these actions are disrespectful. The nurse demonstrates respect by asking the clients their preferences for being addressed; not all elderly clients want to be called by their last names. The nurse demonstrates respect by providing opportunities for the clients to express opinions

According to the ANA's Standards of Clinical Nursing Practice, there are several steps within the nursing process that surround patient care. However, one of the most important steps is the one in which the nurse partners with the patient, family, and other caregivers to create an acceptable path that meets the patient's needs and is specific to the disease process. This important step is identified as: A. Evaluation B. Planning C. Implementation D. Nursing diagnosis

ANS: B The standards set forth in Standards of Clinical Nursing Practice by the American Nurses Association (2010)—assessment, diagnosis, outcome identification, planning, implementation, and evaluation—provide support for a mutual problem-solving approach with clients. During planning, the registered nurse develops an individualized plan in partnership with the person, family, and others considering the person's characteristics

The nurse plans to use self-disclosure to aid a mother and father in the grieving process after the death of their child. The steps of a helpful self-disclosure appear below. What is the first step? A. Succinctly share a personal experience that is a similar grieving experience. B. Listen to the parents talk about their child and observe their movements and gestures. C. Reflect upon the parent's statements to communicate understanding. D. Seek verification that the self-disclosure was helpful to the child's parents.

ANS: B The steps to successfully implement helpful self-disclosure are (1) actively listen to the parents' verbal and nonverbal messages; (2) reply with an empathic response; (3) self-disclose for the benefit of the parents; and (4) check to see if the empathic response and self-disclosure were effective.

The community health nurse is listening to a client talk about a personal problem. Which of these actions by the nurse is most appropriate? A. The nurse should increase the physical distance from the client. B. The nurse should lean toward the client and make eye contact. C. The nurse should periodically interrupt the client to ask questions. D. The nurse should initiate the physical assessment to distract the client.

ANS: B To actively listen to a client, the nurse should use open body language, arms open—not crossed; make eye contact without staring; echo words or paraphrase facts and feelings; lean toward the person speaking; do not interrupt; pay attention; and try to relax.

A nurse is uncomfortable when asking patients about their sexual practices and behaviors. It is most appropriate for the nurse to take which action? A. Avoid asking these questions unless the patient initiates a discussion on sexual behaviors. B. Practice asking these types of questions in a simulated situation with a colleague. C. Ask a nurse who is comfortable with these types of questions to interview the patient. D. Tell the patient that asking sexual questions is difficult and uncomfortable for a nurse.

ANS: B To improve the ability to be at ease when asking questions in a variety of areas, the nurse may rehearse with friends or colleagues. If the nurse cannot overcome being uncomfortable with asking sexual questions, the nurse should be honest with the patient or have another nurse interview the patient. The nurse should not avoid asking questions regarding sexual behavior.

The nurse provides care to a client from Nigeria who is visiting the United States. Which should the nurse use to communicate with this client? A. Review the predominant health beliefs of the Nigerian population. B. Appraise the client's health beliefs and behaviors with a cultural assessment. C. Consult with other nurses who have taken care of clients from other countries. D. Use standard communication techniques to establish a helping relationship.

ANS: B Tripp-Reimer and Afifi (1989) suggest two processes that nurses may use to communicate with clients from diverse cultures: cultural assessment and cultural negotiation. Cultural assessment refers to the appraisal of a client's health beliefs and behaviors. The information is then used to determine appropriate nursing interventions. Cultural negotiation refers to the process of negotiating with the client regarding differences in the lay and professional belief systems concerning appropriate care. Information obtained from other sources (e.g., written documents, other nurses, experts, and standards) is not specific to this client's health beliefs and behaviors.

Which are examples of a nurse who is communicating responsibly? (Select all that apply) A. The nurse uses profanity to respond to a client who is intoxicated and verbally abusive. B. The nurse helps a client talk to family members about discontinuing chemotherapy. C. The nurse uses interpersonal strategies to help a client develop methods of coping. D. The nurse provides a client's health information to a close relative who is visiting. E. The nurse listens carefully to the client's concern about inadequate pain relief.

ANS: B, C, E A nurse who communicates responsibly will perform the role of a client advocate, will consider the world of the client and the client's family, and will naturally focus on the nursing process and problem-solving process. The nurse is responsible for maintaining the professional conduct of the relationship. Examples of unprofessional conduct would include breaching client confidentiality or verbally abusing a client.

Which three technique(s) should be avoided when the nurse questions patients? (Select all that apply) A. Use questions that are worded clearly with words the patient understands. B. Provide a detailed explanation to introduce the rationale for the questions. C. Offer the patient options and tell the patient which option is preferred. D. Avoid asking a patient "why" by rephrasing the question if possible. E. Ask three to five questions at a time, and then allow the patient to answer.

ANS: B, C, E The nurse should provide a concise statement as a rationale for questioning. If the nurse offers the patient options, the nurse should allow the patient time to speak and make a decision without interruptions. The nurse should not ask a string of questions because the patient may become confused and not know what information is important or where to begin answering. The nurse should not use medical terminology, abbreviations, or medical jargon that the patient does not understand. When asking the patient questions, the nurse should refrain from using "why" by rephrasing the question so it is softer and more receivable.

The nurse is taking a spiritual history from a patient with a terminal illness. Using the FICA tool, which question(s), if asked by the nurse, would be appropriate? (Select all that apply) a. "Would you like me to serve as your spiritual counselor?" b. "What gives your life meaning?" c. "What importance does your faith have for you? d. "Why do you think your spirituality has not saved you?" e. "Are you part of a religious community?" f. "How can I help you address your spiritual needs?"

ANS: B, C, E, F The Faith and Belief: Importance, Community, and Address in Care (FICA) tool suggests appropriate questions for taking a spiritual history (see Box 16-1). The nurse may assume the role of spiritual guide to extend love, compassion, and empathy but not to become the patient's spiritual counselor. It is usually best to refrain from using "why" to ask questions because patients may feel threatened; it is better to rephrase the question so it is softer and more receivable.

The nurse discusses smoking cessation with a client. Which action, if taken by the nurse, would most likely result in a behavior change? A. The nurse should advise the client to contact the national telephone quitline. B. The nurse should recommend nicotine replacement and behavioral interventions. C. The nurse should collaborate with the client to develop an individualized plan of action. D. The nurse should implement a strategy that has been validated by research.

ANS: C The nurse should include validation in the nursing process; validation and collaboration with the client increase the probability of a successful change in behavior (e.g., smoking cessation). Specific interventions that are evidence based are appropriate, but the nurse should include the client in the nursing process or the problem-solving process.

The home health nurse cares for a patient who is diagnosed with chronic obstructive pulmonary disease. Which response(s) and behavior(s) by the nurse would indicate that bonding between nurse and patient has occurred? (Select all that apply) A. Expects the patient to meet the goals for exercise as determined by the nurse. B. Listens to the patient describe the feelings of anxiety related to severe dyspnea. C. Develops teaching plan based on the learning preferences of the patient. D. Refrains from touching the patient unless performing physical assessment techniques. E. Requests that the patient wait to ask questions until the end of the home visit. F. Learns the names of the patient's family members and close friends and neighbors.

ANS: B, C, F Responses and behaviors of the nurse that indicate bonding between the nurse and the patient include listening to verbalization of the patient's feelings, asking for the patient's input on learning styles and needs, and listening to the patient talk about support persons. Other indicators (responses and behaviors by the nurse) of bonding include touching a patient for reassurance when appropriate, including the patient in the plan of care (and developing goals), and encouraging inquiries from the patient.

A nurse openly and genuinely discusses thoughts and feelings about sexually transmitted infections with a group of college students. Which benefit(s) may occur for these college students? (Select all that apply) A. The college students are reluctant to continue discussions with the nurse. B. The college students develop a trusting relationship with the nurse. C. The college students question the nurse's credibility. D. The college students believe the information is reliable and accurate. E. The college students are able to express important concerns.

ANS: B, D, E If a nurse is genuine, clients may benefit by (1) developing a feeling of trust for the nurse; (2) being able to express true thoughts and emotions; and (3) receiving helpful information that is credible

In which situation(s) would it be appropriate for the nurse to communicate with empathy? (Select all that apply) A. An acquaintance who seeks a long-standing social relationship that is superficial. B. A patient who is anxious about a change in body image after a mastectomy. C. A supervisor who is searching for approval and recognition from staff. D. A colleague who expected a promotion but was not awarded the promotion. E. A client who has been alienated from family because of sexual orientation.

ANS: B, D, E It is appropriate to communicate with empathy when clients or colleagues are hurting, confused, troubled, anxious, alienated, terrified, doubtful of self-worth, or uncertain as to identity. The nurse should be cautious if the relationship involves a person in power such as an employer or superficial or romantic relationships

Which describes characteristics of mutuality in the nurse-client relationship? (Select all that apply) A. Dependency B. Collaboration C. Paternalism D. Acceptance of differences E. Empathy

ANS: B, D, E Mutuality is characterized by empathy, collaboration, and equality (i.e., acceptance of differences). Mutuality is characterized by interdependency, not dependency. Paternalism is the practice of managing or governing other individuals; shared decision making is a characteristic of mutuality.

The nurse cares for a patient who has metastatic cancer. Which action(s) by the nurse conveys warmth? (Select all that apply) A. Avoid distracting actions such as hand gestures. B. Show interest by occasional head nodding. C. Lean forward toward the patient at a 45-degree angle. D. Place arms across the chest to prevent fidgeting. E. Sit or stand to keep eyes level with the patient's eyes.

ANS: B, E The nurse displays warmth by certain body postures. Body postures that convey warmth include the following: (1) the nurse's head should be kept at the same level as the client's head; (2) hand gestures should be natural, with no clenching or grasping of objects and avoiding distracting mannerisms; (3) arms are kept loose and able to move smoothly, rather than held stiffly; (4) periodic nodding shows interest and attentiveness; and (5) the chest should be kept open with slight forward leaning to show interest.

A new graduate nurse feels that the staff nurses are not empathetic and do not provide reassurance or positive feedback. Which action by the graduate nurse is appropriate? A. Use an antagonistic approach to seek support from a nurse who is a mentor. B. Use a nonassertive approach to seek physical support from the staff nurses. C. Use an assertive approach to seek affective support from the nurse manager. D. Use an aggressive approach to seek cognitive support from other graduate nurses

ANS: C Affective support is acknowledgment for the work a nurse does and a feeling of nurturance; the graduate nurse would seek affective support using an assertive approach if a lack of empathy, reassurance, and positive feedback were identified. Cognitive support helps the nurse think intelligently and solve problems. Physical support is the provision of staff, materials, and processes needed to get the work done. Nonassertive, aggressive, or antagonistic approaches are not effective to gain support

The nurse plans to delegate a client's personal hygiene to a nursing assistant. Which statement if made by the nurse to the nursing assistant is assertive? A. "Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself." B. "You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write you up." C. "The client needs help with bathing. I want you to assist the client now, and you can go to lunch when you are finished." D. "I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished."

ANS: C An assertive statement is clear, direct, and respectful; the nurse should use assertive rights, avoid irrational beliefs, and use the Describe Express Specify Consequence script to formulate an assertive response. Describe: "The client needs help with bathing. "Express and Specify: "I want you to assist the client now. "Consequence: "You can go to lunch when you are finished. "The other statements are nonassertive or aggressive. "Would you mind helping the client with a bath when you have time? If not, I will skip my lunch and do it myself." is nonassertive, hesitant, and apologetic. "You never get your work done and are always on the phone. You need to help the client right now with a bath, or I will write you up." is aggressive, blaming, and negative. "I have important work to complete this morning. You will assist the client with a bath. Do not take a break until you have finished." is aggressive, sarcastic, uncaring, and superior.

A young mother who fractured her leg is sobbing with her face hidden behind her hands. She says to the nurse, "I will not be able to work for at least 2 months. Without my job, I cannot pay my bills or take care of my baby. I am alone and do not have anyone to help me." Which response by the nurse accurately conveys empathy? A. "Why do you think that no one cares about you or will refuse to help you?" B. "I can see that you are hesitant about relying on others because of low self-esteem." C. "You seem worried about how you will be able to take care of yourself and your baby." D. "I am sorry that you are uncomfortable with asking others for help right now."

ANS: C An empathetic response is accurate and specific. The word "worry" accurately reflects verbal and nonverbal cues from the mother. The other statements by the nurse do not accurately reflect the mother's verbal and nonverbal cues.

A patient is attracted to the nurse and attempts to initiate a social relationship. It is most appropriate for the nurse to take which action? A. Encourage the client's behavior to develop a trusting nurse-client relationship. B. Inform the charge nurse of the situation and ask for a different patient assignment. C. Tell the patient that the relationship must remain professional at all times. D. Determine if the patient can be transferred to another nursing care unit.

ANS: C Attraction may occur if the client attempts to turn a professional relationship into a social relationship. Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. The nurse should tell the client that it is important for the relationship to remain professional. The nurse should not encourage the client's behavior; attraction does not build trust in the nurse-client relationship. The nurse should attempt to talk with the patient instead of avoidance by either requesting a different patient assignment or transferring the patient to another unit.

An experienced nurse is supervising a student nurse in an acute care setting. Which statement, if made by the experienced nurse, would be most appropriate to help the student nurse establish credibility with other nurses on the unit? A. "It is impossible to be credible when you are a student because you lack experience." B. "Try to hide your feelings of inadequacy and portray a sense of confidence." C. "Be honest with the nurses about your strengths and about areas that need improvement." D. "It would help if you bring special treats for the nurses so that they will like you."

ANS: C Building of trust is the most important reason for being genuine; being genuine is important in gaining credibility with colleagues. An individual can be genuine and credible without extensive experience. Genuineness occurs when both verbal and nonverbal behaviors are congruent. Being liked is not equivalent to being genuine or being honest.

A hospital nurse is concerned about the demands of providing safe care to clients who are seriously ill. The nurse manager should suggest which intervention to effectively help the nurse balance the demanding work in the hospital setting? a. Delegate more tasks to the unlicensed nursing personnel on the unit. b. Request a transfer to another nursing care unit with patients who are stable. c. Write down stories in a journal about how caring makes a difference for patients. d. Use an assertive communication style for every patient-nurse interaction.

ANS: C Caring is the moral ideal that guides nurses through the caregiving process. Although there is satisfaction in being technologically competent, that satisfaction is not as lasting as the satisfaction derived from meaningful moments of connection with clients, family, and colleagues.

The home care nurse visits a mother and her newborn 2 days after discharge from the hospital. The mother states, "My baby cries all the time. I must not be a very good mother." Which response by the nurse is nontherapeutic? A. "It sounds as if you are concerned about your ability to care for your baby." B. "The nurse moves closer to the mother and places a hand on her shoulder." C. "You just need to get away for a few hours. Find a babysitter and go to a movie." D. "I am not sure that I understand what you mean. Tell me more about how you feel."

ANS: C Giving advice (i.e., declaring to the patient what the nurse thinks) negates the worth of the patient as a mutual partner in decision making and is a nontherapeutic communication technique. Restating is repetition to the client of what the nurse believes is the main thought or idea expressed; restating asks for validation of the nurse's interpretation of the message. Reducing distance between the nurse and the client nonverbally communicates that the nurse wants to be involved with the client. Seeking clarification demonstrates the nurse's desire to understand the client's communication.

A nurse manager has set a goal to improve professional communication on the unit. The staff nurses have attended a session on how to distinguish between expressing opinions and giving advice. Which statement, if made by a staff nurse, indicates that further teaching is needed? A. "Nurses who express opinions give patients the opportunity to make choices." B. "Patient safety is enhanced if nurses have confidence in their ability to communicate." C. "Giving advice leads to independent decision making by patients." D. "Expressing opinions or recommendations is an assertive behavior."

ANS: C Giving advice is a unilateral process of solving problems or making decisions for others; giving advice prevents patients from becoming independent. Assertive communication occurs when nurses express opinions or offer recommendations. Expressing opinions assists patients in their decision making and fosters independence. Having confidence in the ability to communicate can help prevent miscommunication, a significant threat to the safety of hospitalized patients.

A patient who is scheduled for open heart surgery is nervous and tense. The nurse tries to use humor to reduce tension, but the patient seems offended. Which response by the nurse is most appropriate? A. "That joke usually works to relieve tension. Let me try another one to make you laugh." B. "You need to lighten up a little bit because patients who are anxious have more pain." C. "I was trying to ease your tension about surgery, and I am sorry for my insensitivity." D. "Haven't you ever heard that laughter is the best medicine? Just try to at least smile."

ANS: C If humor is used, and it offends the patient, the nurse should apologize and explain that the intention was to be helpful. If the patient is offended, the nurse should not continue to use humor. The nurse should not tell a patient how to feel or behave (e.g., "you need to lighten up" or "try to at least smile") or suggest that certain behaviors will increase pain

A patient asks the nurse to make a decision for her about whether or not to continue taking hormone replacement therapy (estrogen). Which response by the nurse is most appropriate? A. "You should check with a doctor; I cannot give you advice about drugs." B. "My friend has taken estrogen for more than 5 years without any problems." C. "I can answer any questions you have but it is up to you to make this decision." D. "Herbal supplements were much better for me than prescription-strength estrogen."

ANS: C Immediacy is direct, mutual talk about the interpersonal relationship in a helping relationship. Dependency is a situation in which immediacy is appropriate in the nurse-client relationship. If the patient is unable to make a decision and wants advice from the nurse, the nurse should acknowledge the dependency and state that information can be provided, but the decision needs to be made by the patient. It is within the scope of practice of a nurse to provide information about medications. The nurse should not disclose personal information or experiences in situations of dependency.

Which statement describes the affective aspect of learning effective communication strategies? A. "The nurse should use clear, direct statements using objective words." B. "The nurse uses body language that is congruent with the verbal message." C. "The nurse believes that positive communication strategies build confidence." D. "The nurse practices assertive and responsible communication strategies."

ANS: C Learning involves three domains: the cognitive aspects (understanding and meaning), affective aspects (feelings, values, and attitudes), and psychomotor aspects (physical capability).Learning basic communication skills involves the cognitive domain; building confidence through a belief in the value and impact of positive communication is the affective domain; and putting skills into action is the psychomotor domain.

A new blood glucose bedside monitoring system is introduced at a staff meeting. A nurse who has previously used this system remembers that the meter would show error messages frequently. Which statement by the nurse demonstrates assertiveness? A. "Why did no one ask for my opinion? I should have been involved in this decision." B. "This meter does not work like it should, and I refuse to use this system ever again." C. "I had problems with this meter before, but I will use it and let you know what I think." D. "I have experience with this system, and there were never any serious problems."

ANS: C Nurses may feel powerless if decisions are made without their input or with which they disagree. Nurses can make a choice about when to share their disagreement even if they see no choice but to comply with the decision. Voicing disagreement makes the nurse feel more authentic and assertive. Assertiveness is a matter of choice and is not necessary or appropriate in every situation.

The nurse is performing a well-child assessment on a 15-month-old child. The child's mother and father are present. Which action by the nurse will best determine the health beliefs and values of the parents? A. Have the parents independently complete the Myers-Briggs Type Indicator survey. B. Read the documented health histories of the child's parents and grandparents. C. Actively listen to the parents talk about their lives and health concerns. D. Review the traditional health practices of the ethnic group identified by the parents.

ANS: C Nurses should listen to their client's story to gain insight and knowledge into how a person defines "health." The Myers-Briggs Type Indicator identifies a person's preferences in regard to perception and judgment. Review of health histories or traditional health practices will not provide as much insight on health beliefs and values as allowing the client to tell his or her story.

The nurse questions a patient with hypertension before developing a teaching plan. Which question, if asked by the nurse, is most appropriate? A. "How long have you had hypertension?" B. "Are you taking any blood pressure medications?" C. "What do you know about hypertension?" D. "Do you understand why salt is bad for you?"

ANS: C Open questions (e.g., "What do you know about hypertension?") invite respondents to elaborate in whatever direction they choose. Closed questions are focused and posed to elicit specific and brief responses from clients. Questions (e.g., "Are you taking any blood pressure medications?" or "Do you understand why salt is bad for you?") that only require a "yes" or "no" do not invite the patient to elaborate further about the experience. Questions that require a short answer (e.g., "How long have you had hypertension?") do not provide an opportunity for the patient to elaborate further about hypertension.

The nurse needs to obtain a health history from a Spanish-speaking patient. Which action by the nurse is best? A. Ask a bilingual friend of the patient to interpret. B. Use nonverbal communication and draw pictures. C. Request a Spanish-speaking medical interpreter. D. Interview the patient's English-speaking daughter.

ANS: C Professional interpreters are able to communicate medical terms and can be of assistance in reducing the risks of breaches in patient privacy and confidentiality. Also, information can be directly obtained from the patient. When family members or volunteers serve as the interpreter, patients are often uncomfortable sharing sensitive information. Family members in a stressful situation may have difficulty being the interpreter. Although nonverbal communication is important, this method should only be used if an interpreter is not available.

The nurse instructs a client who is diagnosed with hypertension about weight reduction and dietary guidelines. Which action by the nurse would most likely improve the client's willingness to lose weight and eat healthy foods? A. Avoid interacting with the client during meals to prevent embarrassment. B. Ignore the client's requests for foods that are high in fat or calories. C. Give genuine praise to the client for trying to improve dietary habits. D. Warn the client that individuals who are overweight will be treated differently.

ANS: C Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is given when the nurse recognizes the client for efforts to improve health. The nurse who either avoids or ignores the client is demonstrating disrespectful behavior. Treating a client differently because of noncompliance is disrespectful.

The nursing supervisor instructs a group of novice nurses about the appropriate use of self-disclosure with patients. The nursing supervisor determines that teaching was successful if the novice nurse makes which statement? a. "Self-disclosure provides an opportunity for the patient to understand the nurse." b. "It is better to disclose stories about others to maintain professional boundaries." c. "Self-disclosure may be used to build a trusting relationship with the patient." d. "A fabricated personal experience can be shared if the patient remains the main focus."

ANS: C Self-disclosure is used to help the nurse understand the patient better; the goal is not to help the client understand the nurse better. Self-disclosure should be used only if the experience is similar and the experience actually happened.

The nurse cares for a client who has several options for cancer treatment. Which document supports the client's right to have access to information about treatment options? A. The Standards of Clinical Practice B. An Advance Health Care Directive C. The Patient's Bill of Rights D. A Client's Living Will

ANS: C The Patient's Bill of Rights (presented by the American Hospital Association) describes the expectations for respect, knowledge, privacy and confidentiality, and access to any information essential for adequate treatment. The Standards of Clinical Practice (by the American Nurses Association) provide standards for quality of care, diagnosis, outcome identification, planning, implementation, and evaluation. A Client's Living Will is a document that identifies healthcare preferences (related to care intended to sustain life) if the client is incapacitated. An Advance Health Care Directive is a legal document that indicates a client's wishes about healthcare.

The nurse cares for diverse clients in a community health setting. Which action should the nurse take first to learn about delivering care to diverse clients? A. Adopt a transcultural framework to develop culturally appropriate care. B. Ask clients about their personal healthcare beliefs. C. Develop a self-awareness of personal healthcare beliefs. D. Recognize ethnocentric beliefs of minorities in the community.

ANS: C The initial action that the nurse should take to learn about delivering care to diverse clients is to become familiar with personal healthcare beliefs and behaviors. Self-awareness helps nurses recognize that their beliefs and behaviors are not necessarily common to all. Nurses' lack of knowledge about their own culture can distort their perceptions of the beliefs and behaviors of clients from diverse cultures. Transcultural frameworks have been developed to help nurses provide culturally appropriate nursing care. Ethnocentrism interferes with the appreciation of diverse cultures and their healthcare beliefs and behaviors.

The nurse cares for a client who does not follow dietary recommendations for treatment of heart failure. Which statement, if made by the nurse, demonstrates respect for the client? A. "It doesn't make any difference to me whether you decide to eat healthy or not." B. "You will get more attention from your physician, if you follow diet restrictions." C. "I care about you even if you are not following your dietary restrictions." D. "Have you noticed that patients who eat healthy foods receive better healthcare?"

ANS: C The nurse demonstrates respect by giving unconditional acceptance of the client's ideas, feelings, and experiences without conditions. The nurse demonstrates respect with statements that convey caring; respectful statements make the client feel important and valued. The nurse is not demonstrating respect if conditions for acceptance (i.e., "more attention" or "better healthcare") are required.

The nurse cares for a patient who is scheduled for abdominal surgery. Which action, if taken by the nurse, is most appropriate? A. Mandate the use of a complementary therapy such as guided imagery. B. Administer opioids for pain rated more than 3 (on a 0 to 10 pain scale). C. Ask the patient about expectations for postoperative pain management. D. Provide pain management based on a standardized nursing care plan.

ANS: C The nurse in collaboration with the patient should set priorities and determine expected and desired outcomes related to management of pain after surgery. Interventions to manage postoperative pain should be discussed with the patient. The patient and nurse should collaborate and determine appropriate pain management interventions. In addition, the pain management interventions should be individualized for each patient.

The nurse prepares to obtain a health history from a hospitalized patient. Which action by the nurse is appropriate? A. Set time limits for the interview to reduce cost. B. Avoid asking questions that may upset the patient. C. Respect the patient's privacy by closing the door. D. Stand at the foot of the bed to maintain eye contact.

ANS: C The nurse should ensure privacy before engaging in a discussion of confidential matters when obtaining a health history. The nurse should allow for adequate time for the client to discuss the health history. The nurse must be able to discuss sensitive health issues with clients; the nurse should establish rapport and respectfully discuss sensitive subjects. The nurse should avoid standing over the patient; the nurse should be at eye level with the patient.

The nurse cares for a young adult patient in the emergency room after a sexual assault. Which action by the nurse is appropriate? A. Avoid situations in which the patient will be involved with decision making. B. Tell the patient to join a local support group for sexual assault victims. C. Actively listen to the patient express feelings related to the sexual assault. D. Provide detailed information about evidence collection and invasive procedures.

ANS: C The nurse should exhibit polite behaviors when interacting with patients who are fearful, embarrassed, or angry. Polite behaviors lessen the threat of intimate or invasive nursing actions (e.g., questions about behavior, physical assessment, and treatments). Active listening is an example of polite behavior. When discussing a potentially embarrassing situation, the nurse should be careful about the language used and ask questions gently. Nurses may tactfully encourage the patient's participation in decision making and problem solving. Nurses should avoid a direct order (e.g., joining a support group) because it is considered impolite and inappropriate

An experienced nurse supervises a novice nurse interviewing a patient. The experienced nurse should intervene if which is observed? A. The novice nurse uses simple language instead of medical terms. B. The novice nurse avoids asking the patient "why" questions. C. The novice nurse leaves the patient without providing feedback. D. The novice nurse asks mostly open-ended health history questions.

ANS: C The nurse should give patient feedback after an interview to help the patient feel connected and respected. Patients feel left out when nurses end an interview without giving them any indication of the assessment. Informing patients of what is happening, including plans and what patients can expect, provides helpful transitions so that they can map their progress, feel included, and minimize worrying about erroneous assumptions. The nurse should use simple language, avoid "why" questions, and use mostly open-ended questions.

The nurse observes a student nurse who demonstrates nonverbal expressions that are cold and convey disinterest when caring for patients. Which statement, if made by the nurse, is best? A. "Patients will complain about you because your behaviors are unprofessional." B. "Have you noticed that your patients do not like you very much?" C. "For the next few shifts, closely observe how I display warmth to patients." D. "You need to change your behavior when interacting with your patients."

ANS: C The nurse should recommend an exercise that will help the student nurse identify nonverbal behaviors that convey warmth before the student nurse observes or changes his or her own behaviors. The term "unprofessional" indicates conduct, behavior, or language that is not befitting to a profession. The nurse should help the student nurse to recognize nonverbal behaviors that convey warmth instead of focusing on consequences (i.e., patient complaints) or likeability. Telling the student nurse to change behavior is not helpful; the nurse should initially focus on helping the student to identify behaviors that display warmth.

Three emergency department (ED) nurses are interested in initiating a new policy related to family presence during cardiopulmonary resuscitation (CPR). The steps a nurse would utilize to request support for initiation of this policy are listed below. What is the first step? A. The nurses review literature and survey ED nurses about family presence during CPR. B. The nurses practice their presentation to the nurse manager. C. The nurses identify the need to gain support from the nurse manager for this policy. D. The nurses decide to approach the nurse manager with their idea. E. The nurses develop a specific strategy to present the information to the nurse manager.

ANS: C The nurses should follow the steps for requesting cognitive support: (1) the first step is to identify their need for support; (2) the next step is to decide if they wish to pursue this support; (3) once they have decided to try to obtain the support, they must obtain information (e.g., literature review, survey ED nurses); (4) the next step is to design their strategy to present the information; and (5) the nurses should prepare for the presentation to the nurse manager.

The nurse manager asks the staff nurse to work an extra shift. Which response by the staff nurse is assertive and based on rational beliefs? A. "I don't want you upset, so I will work extra." B. "Why do I always have to cover extra shifts?" C. "I am not able to work an extra shift." D. "If you can't find anyone else, I will do it."

ANS: C The staff nurse may turn down even a reasonable request; an assertive response avoids irrational beliefs. Irrational beliefs occur as a result of being anxious about assertiveness or focusing on possible negative outcomes.

The nurse senses the patient has more to say and wants to encourage the patient to continue talking. It is most appropriate for the nurse to state: A. "I think you may not be telling me everything." B. "How does that make you feel?" C. "Oh ... ?" and wait for the patient to continue. D. "Why do you feel that way?"

ANS: C Use encouraging or questioning sounds or body language as cues to encourage the patient to continue talking. Try "Oh ... ?" when you sense that the client has more to say and then be quiet. Avoid the question "How does that make you feel?" which may make patients believe they are being analyzed. Refrain from using "why" because doing so tends to make patients feel threatened. It is better to rephrase the question so it is softer and more receivable. The nurse should not indicate that the patient may be lying or withholding information

The nurse instructs the nursing assistant to obtain temperatures on four patients and report abnormal findings immediately. Two hours later the nurse discovers that one of the patients had a fever that was not reported. The nurse is upset with the nursing assistant. Which statement, if made by the nurse, is concrete and specifically explains the nurse's feelings? A. "I am not dissatisfied with your performance, because we all make mistakes." B. "You must have misunderstood. I wanted to know about any elevated temperatures." C. "I am disappointed because you did not follow my directions." D. "You have made me so angry. Why did you not report the fever to me?"

ANS: C When communicating feelings clearly and specifically, the individual must choose the descriptor that exactly conveys the intended emotion. Adding a rationale for the feeling enhances the sincerity of the message. If the emotion is one of feeling upset, the term "disappointed" is clear and specific. The descriptor "not dissatisfied" is the opposite of the feeling of "upset." The descriptor "angry" is a much stronger feeling than "upset." The statement "you must have misunderstood" does not convey the nurse's feelings about the situation.

As initiated at one children's hospital, Wacky Wednesday successfully decreased anxiety levels for children facing surgery, as well as their parents. As such, the nursing instructor encourages students to include an element of this into their nursing care plan. Wacky Wednesday is an example of a: A. Social experiment B. Empathic response C. Humorous addition D. Humor intervention

ANS: D "Wacky Wednesday" is a humor intervention successfully used to decrease the anxiety levels of children having outpatient surgery and their parents. A mother who had previously lost her daughter to cancer initiated a day for staff, patients, and family to get "wacky" by dressing in costumes and using other props from her humor cart. From the positive results of an 18-month study of this intervention, a Child Life Specialist was placed in the out-patient department full time, and the staff, too, continued using humor interventions (Berger, Wilson, Potts, and Polivka, 2014).

A nurse preceptor is assigned to help several graduate nurses assess their ability to convey warmth to patients. Which activity, if selected by the nurse preceptor, is best? A. Set up sessions for the graduate nurses to practice various nonverbal gestures. B. Ask the graduate nurses to record the behaviors of experienced nurses on the unit. C. Provide the graduate nurses with a list of nonverbal behaviors that convey warmth. D. Have the graduate nurses evaluate each other during simulated patient interviews.

ANS: D A simulated patient interview that is evaluated would provide the best opportunity for the graduate nurses to develop skills to assess warmth and to receive feedback on personal warmth skills. A list of nonverbal behaviors does not foster active learning. Nonverbal gesture practice does not help graduate nurses learn how to assess warmth skills with a patient. Recording nonverbal behaviors is observation and does not give the graduate nurses a specific experience in assessment of warmth skills

The charge nurse informs a staff nurse that it is her turn to float to another unit. Which response by the staff nurse is aggressive? A. "I had such a bad experience last time. Please send another nurse instead of me." B. "I will miss working with you today, but I understand that it is my turn to float." C. "I will not survive on the other unit. The staff are always too busy to help me." D. "I will float, but you'll be sorry. You cannot handle emergencies without me."

ANS: D An aggressive response is forceful and confrontational; the person using an aggressive approach will place his or her needs first and respect for others is lacking. A nonassertive response is apologetic; the person frequently puts himself or herself down. An assertive response is clear, direct, confident, and honest.

A patient reports to the nurse, "My doctor is not doing anything about my pain." Which response by the nurse is assertive and expresses warmth? a. "If I were you, I would see a different doctor." b. "What you really mean is you do not like your doctor." c. "It is wrong for you to blame your doctor." d. "You seem frustrated with your doctor."

ANS: D An assertive statement that expresses warmth (i.e., "You seem frustrated with your doctor") engages in direct, fair confrontation with clear, honest statement of feelings; when the nurse conveys warmth and is assertive, a position of "I'm OK, you're OK" is assumed. Aggressive statements that lack expression of warmth include outright assaults or accusations (i.e., "It is wrong for you to blame your doctor"), making decisions for others (i.e., "If I were you, I would see a different doctor"), and labeling the other person (i.e., "What you really mean is you do not like your doctor").

According to Swanson's theory, there are five caring processes, one of which is "being with." Which of the responses by the nurse portrays an understanding of the concept of "being with" a client? A. The nurse charting in the room to spend more time with the client B. The nurse wearing locator badge so you can quickly respond any time patient would call front desk and ask to page you C. The nurse requesting one-on-one nurse staffing D. The nurse being emotionally present to the client

ANS: D Caring is an essential ingredient in life and must characterize the nurse-client relationship.... Consider Swanson's five caring processes (Swanson, 1993):1) Maintaining belief—sustaining faith in the capacity of others to transition and have meaningful lives2) Knowing—striving to understand events as they have meaning in the life of the other3) Being with—being emotionally present to the other4) Doing for—doing for others what they would do for themselves if possible5) Enabling—facilitating the capacity of others to care for themselves and family members

Which facial feature, if displayed by the nurse, best conveys warmth? A. Small pupils and a fixed gaze B. Furrowed brow and a wrinkled forehead C. Pursed lips and a forced smile D. Relaxed muscles and a concerned expression

ANS: D Facial features that convey warmth include the following: (1) face moves in a relaxed, fluid way; worried, distracted, or fretful looks are absent; face shows interest and attentiveness; (2) pupils are dilated; gaze is neither fixed nor shifting and darting; (3) lips are loose and relaxed, not tight or pursed; smile is not forced, jaw is relaxed and mobile, not clenched; and (4) forehead muscles are relaxed, and forehead is smooth; there is no furrowing of the brow.

Which demonstrates the nurse's genuine concern for clients? A. Tell a patient who has a terminal illness that everything will be fine. B. Delay notifying the patient about the death of a dependent child. C. Provide a placebo to a patient in severe pain to assess for substance abuse. D. Inform the patient about a medication error along with symptoms to report.

ANS: D Genuineness is the presentation of one's true thoughts and feelings. Nurses should be genuine (or honest) when appropriate; honesty is appropriate if there is benefit to the patient (i.e., medication error with potential adverse effects). The nurse should not speak a falsehood (i.e., "everything will be fine") or withhold the truth (i.e., information about a child, placebo use).

According to a study by Robinson (2014), three parts of our true presence (how we connect with patients) are found in being: A. Friendly, kind, and sweet B. Genuine, gifted, and creative C. Humorous, partial, and grateful D. Genuine, attentive, and immersed

ANS: D If we say a person is genuine, what does it mean? Why is it important to be "your natural self" in human relationships? We connect with patients by being genuine, attentive, and immersed in the moment with the person ... true presence (Robinson, 2014).

The nurse cares for a female patient who is trying to gain understanding of her life and her diagnosis of metastatic breast cancer. Which approach by the nurse would best meet this patient's needs? A. Suggest the patient join a breast cancer support group. B. Provide the patient with reading material on death and dying. C. Contact the patient's spiritual leader to request daily visits. D. Listen to the patient's stories about her past experiences.

ANS: D Listening to the patient's story is an important assessment tool; the nurse can assess a patient's self-care knowledge and gain greater understanding of the patient. The nurse is able to learn what is important to the patient and create a personalized plan of care.

The nurse supervises the care of residents in an assisted living center. The nurse should intervene if which is observed? A. A nursing assistant remains silent when a resident tells a demeaning joke. B. A nursing assistant and resident laugh together while watching television. C. Two nursing assistants laugh at themselves after spilling a pitcher of water. D. A nursing assistant makes a joke about a confused resident to other residents.

ANS: D Medical humor that is used by healthcare providers to cope is appropriate when kept among staff because it permits sharing of frustration and promotes group cohesion; this type of humor is negative if used with clients (e.g., other residents) and is demeaning and inappropriate. If demeaning humor is used, an assertive response is to remain quiet. It is appropriate for a healthcare worker to share positive humor (e.g., laugh while watching a television show) with clients. The highest form of positive humor is the ability to laugh at ourselves.

An elderly patient asks the nurse if faith and regular prayer have any effect on health and longevity. Which response by the nurse is most appropriate? A. "It doesn't matter what I think, because your beliefs about religion are most important." B. "You will need to ask a chaplain because I am not allowed to discuss religion." C. "Health benefits are only associated with individuals who attend church every week." D. "There is evidence that religious practices are associated with health and living longer."

ANS: D Over 250 studies show that religious practice (e.g., faith and regular prayer) is correlated with greater health and increased longevity. The patient is not asking what the nurse believes about prayer; the patient is asking about evidence relating faith and prayer to health and longevity. It is within the scope of practice for the nurse to address spiritual issues in clinical practice. Findings from over 70 data-based, peer-reviewed published papers show that people who attend religious services on a regular basis have better health outcomes, stronger immune systems, lower stress, and recover from hip fractures and open-heart surgeries more quickly than do less religious people.

The nurse is caring for a client who is diagnosed with type 1 diabetes mellitus. Which nursing action would most likely improve client compliance with the therapeutic regimen? A. Consistently ignore negative statements made by the client. B. Avoid touching the client to reduce tension and uneasiness. C. Focus on the physical aspects of care such as insulin administration. D. Listen attentively to the client's perception of having a chronic illness.

ANS: D Respect has a beneficial influence on client compliance with the therapeutic regimen. Respect is communicated by giving the client undivided attention and listening to the client's perceptions. Other actions that demonstrate respect include appropriate contact by gently touching the client, listening to both positive and negative client statements without judgments, and giving attention to the client as a whole (body, mind, and spirit)

According to the NCSBN, appropriate self-disclosure is a part of maintaining professional boundaries. Appropriate self-disclosure includes the following: A. Discussing intimate or personal values with patients B. Keeping secrets with a patient or for a patient C. Expressing you are the only one who truly understands patient D. Brief, focused, and only used if experience is similar

ANS: D Self-disclosure should be brief and should be used only if your experience is similar. It is better to choose not to use this technique if you have not had the experience. The NCSBN brochure described some of the red flag behaviors, warning signs that the relationship could be crossing a boundary and violating patient rights.

The nurse observes a nursing assistant interacting with an elderly patient. Which statement by the nursing assistant requires an immediate intervention by the nurse? A. "I will help you remember where your room is located." B. "Would you like me to read from your Bible today?" C. "Tell me a story about when you were young." D. "Sweetie, I will bring your coffee in a few minutes."

ANS: D The elderly should not be addressed using disrespectful terms such as "honey," "sweetheart," "gramps," and "granny" and other patronizing forms of speech. Short-term memory may decline with age; healthcare providers may assist patients as needed. The elderly may express their spirituality through prayer and reading the Bible. Sharing stories helps an elderly patient to review life and establish meaning

The nurse cares for the mother of a child who died in the emergency room as a result of an accidental poisoning. Which response by the nurse is appropriate? A. Place a greater emphasis on nonverbal aspects of empathy over verbal. B. Accurately reflect on the mother's feelings to convey understanding and concern. C. Repeat exact phrases stated by the mother to aid in expressions of grief. D. Reflect on the expressed feelings of the mother but with the nurse's own words.

ANS: D The nurse conveys empathy by offering a verbal reflection that is accurate and specific but is delivered in the words of the nurse not the patient. Nonverbal features of empathy are just as important as verbal aspects. It is unrealistic for the nurse to expect to completely know and understand the mother's feelings. Empathy does not mean repeating verbatim what others have said; this method may lead to irritation and lessen understanding.

While admitting a patient to the medical unit, the nurse should take which action? A. Demonstrate human caring by hugging the patient for brief intervals. B. Disclose shared intimate details with other healthcare providers. C. Maintain a physical distance of at least 3 to 4 feet at all times. D. Develop the plan of care and measurable objectives with the patient.

ANS: D The patient and nurse should develop the plan of care together; attainment of objectives should be evaluated with the patient. Nurses may have strong feelings for their patients and express caring, but the nurse should maintain adequate objectivity and perspective to provide therapeutic assistance. Patients should have a sense of privacy, and confidentiality should be maintained. The nurse should not share intimate patient details with others.

The nurse cares for a patient who complains of back pain. Which question should the nurse ask to obtain specific information about the back pain? A. "Would you like medication for the pain?" B. "What have you been doing in the last few days?" C. "Do you have a family history of osteoporosis?" D. "What do you think caused the back pain?"

ANS: D To obtain specific information, the nurse must specifically ask for it (e.g., ask the patient about possible causes for the pain). It is more appropriate for the nurse to initially ask for the patient's perspective than about specific causes (e.g., osteoporosis or activity). The nurse should assess before taking action (e.g., offering pain medication); the intervention does not provide specific information about the back pain.

Throughout this chapter, many recommendations were given on how to first nurture yourself so you could be fully present with your patients. Which one of the following would not help you accomplish that goal? A. Gratefulness reflection B. Completing a self-spiritual assessment C. Utilizing the FICA acronym with your patients C. Journaling D. Ignoring your own spirituality E. Participating in the "Blessing of the Hands"

ANS: E To have the ability to stay connected to the experience of another, you must pay attention to nurturing your own spirit. Moore (1998) and others speak of living artfully as a necessity for the care of the soul or spirit. To take pause, take time for self, be mindful, focus on moment, practice spiritual self care, practice gratitude, or even keep a journal are all recommended to help nurses get in touch with themselves