Fundamental: chapter 8; communication
A client, who was recently diagnosed with diabetes, has been coming to the emergency room every day for hyperglycemia. The client reports not being able to self-administer insulin injections. What strategy would best educate the client and improve the client's ability to self-administer insulin? A. Explain the importance of being able to control blood glucose levels with the injections. B. Refer to client to a diabetes educator and nutritionist. C. Demonstrate the proper method and have the client mimic the demonstration. D. Offer encouragement to boost the client's self-confidence.
C. Demonstrate the proper method and have the client mimic the demonstration The best strategy for this client is to demonstrate the proper administration and have the client mimic the demonstration to ensure the client is confident and knowledgeable on self-administration. Offering encouragement and explaining the importance of self-administration is important, but not the best method to ensure compliance. The client may or may not need to be referred to a nutritionist, and the nurse should be considered the diabetes educator. Chapter 8: Communication - Page 158-159
A nurse is communicating the plan of care for a client who is unconscious. Which nursing actions best facilitate this process? Select all that apply. A. The nurse speaks to the client in a louder-than-normal voice. B. The nurse does not use touch to communicate with the client. C. The nurse assumes the client can hear and discusses things that would ordinarily be discussed. D. The nurse is careful what is said in the client's presence because hearing is the last sense to go. E. The nurse raises environmental noises to help stimulate the client. F. The nurse speaks with the client before touching the client.
C. The nurse assumes the client can hear and discusses things that would ordinarily be discussed D. The nurse is careful what is said in the client's presence because hearing is the last sense to go. F. The nurse speaks with the client before touching the client. The nursing actions that best facilitate communication with a client who is unconscious would include being careful what is said in the client's presence because hearing is believed to be the last sense to go. The nurse would assume the client can hear and discuss things that would ordinarily be discussed. The nurse would speak with the client before touching the client. The nurse would not speak to the client in a louder-than-normal voice. The nurse would minimize environmental noises to facilitate communication. The nurse would use touch to communicate with the client. Chapter 8: Communication - Page 176
Each of the following facilitates a therapeutic nurse-client relationship except: A. closed-ended questions. B. reflection. C. rephrasing. D. active listening.
A. closed-ended questions. Rephrasing, reflection, and active listening are essential for accurate assessment and interventions. Chapter 8: Communication - Page 170
A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question? A. "I understand you have four kids; how many times have you actually been pregnant?" B. "How old are your children?" C. "All right, you have four children, is that correct?" D. "Were these term births?"
A. "I understand you have four kids; how many times have you actually been pregnant?" The use of the clarifying question or comment allows the nurse to gain an understanding of a client's comment. In this scenario, the nurse is asking how many times the client has been pregnant. Gravida refers to the number of pregnancies, whereas para refers to the total number of live births. Confirming the client has four children is a form of validating what the client said. The age and/or term of the children does not clarify the original question asked by the nurse. Chapter 8: Communication - Page 170
Which statements describe the qualities of a helping relationship? Select all that apply. A. A helping relationship is dynamic. B. The helping relationship occurs spontaneously. C. The helping relationship is built on the client's needs, not on those of the helping person. D. The helping relationship is characterized by an equal sharing of information. E. A friendship must develop from an effective helping relationship. F. A helping relationship is purposeful and time limited.
A. A helping relationship is dynamic. C. The helping relationship is built on the client's needs, not on those of the helping person. F. A helping relationship is purposeful and time limited. Several statements accurately describe the qualities of a helping relationship. The helping relationship is built on the client's needs, not on those of the helping person. A helping relationship is dynamic. A helping relationship is purposeful and time limited. The helping relationship does not occur spontaneously. The helping relationship is not characterized by an equal sharing of information. A friendship should not develop from an effective helping relationship. Chapter 8: Communication - Page 161
A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech? A. Assertive B. Nonassertive C. Therapeutic D. Aggressive
A. Assertive The communication is an example of assertive speech. Assertive communication is the ability to stand up for oneself and others using open, honest, and direct communication. Aggressive communication involves asserting one's rights in a negative manner that violates the rights of others. Therapeutic speech is speech a nurse uses when communicating with a client that has a specific purpose or goal. Nonassertive speech would be the opposite of assertive speech, as described above. Chapter 8: Communication - Page 171
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication? A. Assess how the client would like to communicate B. Provide paper and pencil for written communication C. Use facial and hand gestures D. Contact a person skilled in sign language
A. Assess how the client would like to communicate Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge. Chapter 8: Communication - Page 176
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask: A. "Have you tried exercising at all in the last week or two?" B. "Were you tired and depressed before starting the new medication?" C. "Do you check your blood pressure and pulse before you take your medication?" D. "Tell me about the foods you are eating."
B. "Were you tired and depressed before starting the new medication?" Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect. Chapter 8: Communication - Page 170
A nurse gives a speech on nutrition to a group of pregnant women. Within the model of the communication process, what is the speech itself known as? A. Source B. Message C. Stimulus D. Channel
B. Message The message is the actual physiologic product of the source. It might be a speech, interview, conversation, chart, gesture, memorandum, or nursing note. This communication process is initiated based on a stimulus. The sender or source of the message is a person or group who initiates or begins the communication process. The channel of communication is the medium the sender has selected to send the message. Chapter 8: Communication - Page 150
An experienced nurse is orienting a new nurse to the unit. Which activity demonstrates the nurse is an effective caregiver? A. The nurse leaves the room when a client is crying to provide privacy. B. The nurse uses open-ended questions when working with a crying client. C. The nurse calls the hospital chaplain to talk with the client. D. The nurse documents the client was crying at the end of the shift.
B. The nurse uses open-ended questions when working with a crying client. Any nurse who wishes to be an effective caregiver must first learn how to be an effective communicator. Good communication skills enable nurses to get to know their clients and, ultimately, to diagnose and to meet their needs for nursing care. By asking open-ended questions the nurse can gain more information as to why the client is crying. Without understanding the "why" behind the crying the nurse cannot determine if the hospital chaplain might be needed. Providing privacy for the client can be thoughtful but not a way to learn more. Chapter 8: Communication - Page 148
A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be: A. passive. B. assertive. C. nurturing. D. aggressive.
B. assertive. Aggressive behavior involves asserting one's rights in a negative manner that violates the rights of others. Comments such as "do it my way" or "that's just enough out of you" are examples of aggressive verbal statements. In this scenario, the preceptor is neither nurturing the new nurse nor being passive. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. Chapter 8: Communication - Page 171
A nurse has developed strong rapport with the spouse of a client who has been receiving rehabilitation following a debilitating stroke. The spouse has just been informed that the client is unlikely to return home and requires care that can only be provided in a facility with constant nursing care. The client's spouse tells the nurse, "I can't believe it's come to this." How should the nurse best respond? A. "Do you understand that everyone here has your spouse's best interest at heart?" B. "Why do you think that the care team has made this recommendation?" C. "This must be very difficult for you to hear. How do you feel right now?" D. "What would help you accept that this is best for both of you?"
C. "This must be very difficult for you to hear. How do you feel right now?" Acknowledging the difficulty of the situation for the spouse is empathetic, and asking the spouse to elaborate on feelings may be therapeutic as well as provide insight into the spouse. Asking about the reasons underlying the care team's recommendation is less likely to be of benefit and may encourage the spouse to find fault with the recommendation. Attempting to redirect the spouse to a positive outlook at this early point is insensitive. Pointing out that the health care team has the client's best interest at heart might come across as defensive, and questioning what would help the spouse accept the situation is dismissive of the spouse's feelings and discourages the spouse from sharing feelings. Chapter 8: Communication - Page 166-167
A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation? A. "Is your name Evelyn?" B. "Is today the first day of the month?" C. "What is your name?" D. "Are you in a hospital?"
C. "What is your name?" Asking the client to state their name represents an open-ended question and allows the nurse to assess the client's level of consciousness without ambiguity. Asking the client open-ended questions is a better way to assess level of consciousness than asking closed-ended questions, which are answered with a simple yes or no response. The remaining responses are all closed-ended questions and therefore would not provide an accurate assessment of the client's orientation. Chapter 8: Communication - Page 163
Which is a skill appropriate to use in therapeutic communication? A. Avoid the use of periods of silence. B. Use cliches to enhance a client's understanding of information. C. Control the tone of the voice to avoid hidden messages. D. Be precise and inflexible regarding the intent of the conversation.
C. Control the tone of the voice to avoid hidden messages. Conversation skills used in therapeutic communication include controlling the tone of one's voice so that exactly what is intended is conveyed and not any hidden message. Periods of silence have an important role in conversations because they allow for reflection. The nurse should avoid using cliches, and the conversation should be flexible. Chapter 8: Communication - Page 167
A registered nurse (RN) working with an experienced licensed practical/vocational nurse (LPN/LVN) delegates the task of administering oral medications to a group of clients. The LPN/LVN documents a client's medication administration before entering the client's room. What action will the LPN/LVN anticipate? A. The RN will check all client's medication records to make sure the appropriate drugs were given. B. The RN will contact the nurse manager to discuss the actions of the LPN/LVN. C. The RN will stop the LPN/LVN immediately and discuss the possible consequences of this action. D. The RN will continue to supervise the LPN/LVN as medications are being administered.
C. The RN will stop the LPN/LVN immediately and discuss the possible consequences of this action. Administration of oral medication is within the scope of practice for a LPN/LVN. However, the LPN/LVN has violated one of the rights of medication administration and is practicing unsafe care. The RN's responsibility requires that he or she stop the LPN/LVN immediately and discuss the possible consequences of this action. The RN will not check all the client's medication records, contact the nurse manager, or continue to supervise the LPN/LVN; these are inappropriate actions. Chapter 8: Communication - Page 520-522
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should: A. show the child the intravenous catheter and explain how it works. B. provide both verbal and written information to the child. C. involve the child's stuffed animal in the educational session. D. ask the child's parents to leave the room while the nurse and child talk.
C. involve the child's stuffed animal in the educational session. Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child. Chapter 8: Communication - Page 158
What nursing care behavior by the nurse engenders a client's trust in the nurse? A. A nurse tells the client, "My shift will be over in 45 minutes, I will let the oncoming nurse know you have questions about tomorrow's test." B. A nurse answers the client's questions about an upcoming test while completing documentation in the EHR. C. A nurse tells the client, "Do not worry about the test, I have never cared for anyone that had problems with it." D. A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client.
D. A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client. It is important to remember that helping relationships are professional relationships. Telling a client not to worry about the test because others have not had problems with it undermines trust by belittling the client's concerns. A nurse that answers the client's questions while documenting or defers the questions to the oncoming nurse gives the impression that the client's questions or concerns are not important. Answering the client's questions while making eye contact instils trust by showing that the nurse is competent to answer the questions and cares about the client in their care. Chapter 8: Communication - Page 162
The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique? A. Restating B. Reflection C. Clarification D. Encouraging elaboration
D. Encouraging elaboration Encouraging elaboration involves making simple statements that indicate active listening and comprehension on the part of the nurse and that prompt the client to continue talking. This technique helps the client to describe more fully the concerns or problems under discussion. Clarification involves asking a follow-up question about a statement made by the client to clear up some point that the nurse is not sure about or to elicit more specific details. Reflection and restatement involve the nurse repeating back to the client a comment made by the client to ensure that the nurse has correctly heard or understood the client. Chapter 8: Communication - Page 166-167
A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should: A. tell the client to rest and allow a family member to answer. B. ask questions as quickly as possible. C. use only open-ended questions. D. allow the client to set the pace.
D. allow the client to set the pace. It would be ineffective to rush through a list of questions when obtaining a nursing history; it is more effective to let the client set the pace. Let the client know at the beginning of the interaction if time is limited so that the client does not feel that you are rushing because of a lack of concern or personal interest. Open-ended questions do not apply to "yes or no" answers. The client should be the person answering the questions unless unable to. Chapter 8: Communication - Page 166
A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should: A. inform the client that the unit was very busy that day. B. smile at the client and apologize. C. ignore the statement and empty the urinary catheter. D. sit at the bedside and allow the client to explain the statement.
D. sit at the bedside and allow the client to explain the statement. Clients may or may not feel able to speak freely to the nurse. Often, the signals indicating their readiness to talk are subtle. Don't miss valuable opportunities for important communication by approaching clients with a closed mind or focusing on your own needs rather than on the client's needs. Nurses who lack confidence in their own ability to meet the challenges a client presents might become defensive in response to a client's comments. Nurse defensiveness is a huge barrier to open and trusting communication. Smiling and apologizing and ignoring the client close lines of communication. Although the unit may have been busy, it is best to listen to the client express feelings. Chapter 8: Communication - Page 172
