PNE 103. Ch. 7: The Nurse-Client Relationship. Intro. Med-Surg. Nursing. Timby/Smith. 12th. Ed.

During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:

"Can you tell me why your physician sent you here to be admitted?"

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?

"I understand you have four kids; how many times have you actually been pregnant?"

The client is talking to the nurse about recent health problems of immediate family members and the strain she has been under trying to care for them. She begins to cry between sentences. What response by the nurse demonstrates the most empathy?

"Just take your time. I am listening."

Nurses focus on the whole client. Which statements acknowledge the client as a human being? Select all that apply.

"Mr. Smith, I will be taking you to x-ray now." "I have your medications ready for you Ms. Jackson."

A nurse has developed strong rapport with the wife of a client who has been receiving rehabilitation following a debilitating stroke. The wife has just been informed that her husband will be unlikely to return home and will require care that can only be provided in a facility with constant nursing care. The client's wife tells the nurse, "I can't believe it's come to this." How should the nurse best respond?

"This must be very difficult for you to hear. How do you feel right now?"

The nurse is communicating with a client following a routine physical examination. Which statement best demonstrates summarization of the appointment?

"We reviewed your plans for your new diet and medications. Do you have any other questions?"

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview, the client states, "I don't know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?

"You seem unsure. Tell me your concerns about your surgery."

Which of the following are examples of nonprofessional involvement? (2)

1. Discussing your recent breakup with your boyfriend with a patient who is also going through a difficult breakup. 2.Asking a patient if they would like to go out for dinner after they are discharged.

Nurse-Client Relationship

Affiliation that exists during the period when a nurse interacts with clients, sick or well, to promote or restore their health, help them to cope with their illness, or assist them to die with dignity.

NCLEX-Style Review Questions (PrepU)#4: The nurse is caring for a client with limited English proficiency. What is the least desirable approach for communicating with an LEP client?

Ask a family member to translate.

NCLEX-Style Review Questions (PrepU)#5: The nurse teaches a client how to perform breathing exercises. What is the best method for the nurse to evaluate the effectiveness of the teaching?

Ask the client to perform breathing exercises.

NCLEX-Style Review Questions (PrepU)#1: The nurse has been employed in an extended care facility. What outcome is the best evidence that the nurse's caregiving skills have been effective?

Clients with chronic physical problems maintain independence.

Learning Readiness

Degree to which a person is in an optimal position to process new information.

Motivation

Desire to acquire new information or implement a new activity.

Public Space

Distance between people that is appropriate for large group interactions such as speeches and meetings with strangers.

Social Space

Distance between people that is appropriate in small group interactions such as lecturing or non-private conversations.

Personal Space

Distance between two people that is appropriate for one-on-one interactions like interviewing and physical assessment.

Ch. 7 Learning Objectives questions #6: Give at least five examples of therapeutic and nontherapeutic communication techniques

Examples of therapeutic verbal communication techniques include: 1. questioning 2. reflecting 3. paraphrasing 4. sharing perceptions 5. and clarifying. Examples of nontherapeutic verbal communication techniques include: 1. giving false reassurance 2. using clichés 3. giving approval or disapproval 4. demanding an explanation 5. and giving advice.

Hard of Hearing

Having hearing that is limited but allows for communication.

Deaf

Inability to hear well enough to process information.

Listening

Intaking of information.

What is a therapeutic use of silence?

It encourages a client's verbal communication.

Hearing

Perceiving sounds.

Certified Interpreter

Person who is certified by a professional organization through rigorous testing based on appropriate and consistent criteria.

Caregiver

Person who performs health-related activities that a sick person cannot perform independently.

Psychomotor Learner

Person who processes information best by doing.

Cognitive Learner

Person who processes information best by listening to or reading facts and descriptions.

Affective Learner

Person who processes information best when it appeals to his or her feelings, beliefs, and values.

Ch. 7 Learning Objectives questions #3: List at least five principles that form the basis of the nurse-client relationship.

Some principles underlying a therapeutic nurse-client relationship include: 1. treating each client as a unique person 2. respecting the client's feelings 3. striving to promote the client's physical, emotional, social, and spiritual well-being 4. encouraging the client to participate in problem solving and decision making 5. and accepting that a client has the potential for growth and change.

Introductory Phase

Stage of the nurse-client relationship during which a nurse and a client get acquainted and the client identifies one or more health problems for which he or she is seeking care.

Kinesics

Study of nonverbal techniques of communication such as facial expressions, postures, gestures, and body movements.

When the nurse communicates with a newly admitted client, the nurse must pay particular attention to nonverbal behaviors. The nurse considers which characteristic as nonverbal communication?

The client's tone of voice

Ch. 7 Learning Objectives questions #9: Describe the four forms of nonverbal communication.

The four forms of nonverbal communication are 1. kinesics (body language) 2. paralanguage (vocal sounds) 3. proxemics (how space is used in communication) 4. and touch.

Learning Needs

Those skills and concepts that a client and family must acquire to restore, maintain, or promote health.

Delegator

Transferring to a competent individual the authority to perform a selected task in a selected situation while retaining accountability for the delegation.

Informal Teaching

Unplanned, spontaneous conveying of information, usually at the client's bedside or while caring for the client at home. See also formal teaching.

A nurse is performing an admission assessment with a non-English speaking client. Which actions can the nurse take to enhance communication? (Select all that apply.)

Use an electronic translator. Contact a telephone-based medical interpreter. Request assistance from an agency interpreter.

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse she is afraid of waking up during surgery. The best response by the nurse is to:

ask the client why she thinks she will wake up during surgery.

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?

be silent and allow the client to continue speaking when ready

Each of the following facilitates a therapeutic nurse-client relationship except:

closed-ended questions.

A client has just learned that she has Stage 2 breast cancer. She appears distant and withdrawn. Her shoulders are slumped. She explains "I just never thought this could happen to me." Which answer best describes the client's response?

congruent communication

A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:

eliminate as many distractions as possible.

Nonverbal Communication

exchange of information without using words.

A nurse on a subacute geriatric ward is working with a male client who has a diagnosis of Alzheimer disease. How can the nurse best enhance therapeutic communication with this client?

give the client plenty of time to make responses to questions that the nurse asks

The term metacommunication is best defined as:

interpersonal bridge between verbal and nonverbal communication

When communicating with clients nurses need to be very careful in their approach. This is particularly true when communicating using:

medical terminology

A nurse gives a speech on nutrition to a group of pregnant women. What is the speech itself known as?

message

Which is a component of the termination phase of the nurse-client relationship?

mutual agreement that the client's health problem has improved

The nurse encourages a client to participate in the communication process by using an opening remark based on observations and assessment. Which approach would be most effective for the nurse to use to promote trust?

neutral

A male client has always prided himself in maintaining good health and is consequently shocked at his recent diagnosis of diabetes. The nurse has asked the client, "How do you think your diabetes is going to affect your lifestyle?" The nurse has utilized which of the following interviewing techniques?

open-ended question

A nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out?

reviewing health changes

A nurse enters a client's room to complete an admission history. The nurse will convey interest in the client's story if the nurse:

sits at the client's bedside and faces the client.

A palliative care nurse possesses numerous skills that have enhanced the nurse-client relationship and communication in the past. One of these skills that has benefited previous clients is affective touch. Before using this technique, the nurse must consider:

the client's culture

What is an example of positive body language?

tilt of head

What is the goal of the nurse in a helping relationship with a client?

to assist the client to identify and achieve goals

Sympathy

understanding between people; common feeling

Ad hoc interpreter

untrained person who is called upon to interpret

The nurse educator on a busy medical unit that serves a diverse population is discussing the importance of therapeutic nurse-client relationships with a group of recent nursing graduates. What principle should the nurse educator promote?

view each client as a unique individual with unique needs and priorities

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?

working phase

Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?

working phase

A client has been recently diagnosed with diabetes. He is seen in the emergency room every day with high blood sugar. The client apologizes to the nurses for bothering them every day, but he cannot give himself insulin injections. What should the nurse's response be?

"Has someone taught you how to take them?"

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

"Have you ever thought of laser surgery?"

The nurse is having a discussion with a client diagnosed with breast cancer. Which statement would be most effective in promoting communication?

"What are some of your ideas about how to handle this?"

A client with chronic hyperparathyroidism expresses that she is fed up with her diet and can no longer continue with it. What should the nurse's appropriate response to the client be?

"You may be having a difficult time staying on that diet; let's discuss it"

Which of the following nurses most likely is the best communicator?

A nurse who easily developed a rapport with clients.

Fingerspelling

Alphabetical substitute for words that have no sign.

Comfort Zone

That area of a client's personal space which, when intruded, does not create anxiety.

Which activity takes place during the working phase of the nurse-client relationship? (2)

The client participates actively in the relationship The client genuinely expresses concerns to the nurse

A client is having difficulty with self-administration of insulin. The nurse states, "Many people learn to give themselves insulin." The nurse is using which nontherapeutic communication technique?

belittling

An RN is discussing the medication regimen with a client. The client is exhibiting negative body language. Which is an example of negative body language?

downcast eyes

Which term describes a nurse who is sensitive to the client's feelings, but remains objective enough to help the client achieve positive outcomes?

empathic

Which qualities in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached?

empathy

The client is an 18-month-old in the pediatric intensive care unit. He is scheduled to have a subgaleal shunt placed tomorrow, and his mother is quite nervous about the procedure. The nurse feels for the mother and tells her that the surgeon "has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication?

false reassurance

The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate?

guilt inducement or approval/disapproval

A nurse enters the client's room and introduces himself stating, "Hello, Mr. Alonso. My name is Anthony Bader. I will be your registered nurse today. I will be providing your nursing care and I will be with you until 3:30 PM. If you need anything, please call me on my phone or put your light on." He then gives the client a printed card with this information. In the helping relationship, what does this represent?

orientation phase

When caring for a psychiatric client, a formal contract is made with the client during which phase of the nurse-client relationship?

orientation phase

Paramedics arrive in the emergency department with a victim of a motor vehicle collision. The paramedic reports the driver was restrained, the car was traveling about 30 miles per hour (48 Km/hour) , and the air bags were not deployed. The paramedic continues to report the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic?

"All of the victims got themselves out of the car?"

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? (4)

"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?"

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? (Select all that apply.)

"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?"

A client tells the nurse that he is very worried about his surgery. Which response by the nurse is a cliché?

"Don't worry, everything will be fine."

When the preoperative client tells the nurse that he cannot sleep because he keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is:

"The thought of having surgery is keeping you awake."

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:

"Were you tired and depressed before starting the new medication?"

A nurse is assessing a client's nutritional intake prior to admission based upon information that indicates the client has lost 10 pounds over the last 2 months. Which therapeutic communication technique is appropriate to gain information?

"What factors have contributed to your weight loss over the last few months?"

Ch. 7 Learning Objectives questions #1: List four roles that nurses perform in nurse-client relationships.

1. caregiver 2. educator 3. collaborator 4. delegator.

Ch. 7 Learning Objectives questions #11: List at least five situations in which affective touch may be appropriate.

Affective touch is appropriate in many situations. Examples include caring for clients who are 1. lonely 2. uncomfortable 3. near death 4. anxious 5. and those with sensory deprivation.

Ch. 7 Learning Objectives questions #5: Differentiate between social communication and therapeutic verbal communication.

Communication involves sending and receiving messages between two or more people followed by feedback indicating that the information was understood or requires further clarification. Therapeutic communication refers to using words and gestures to accomplish a particular objective.

NCLEX-Style Review Questions (PrepU)#2: The nurse is notified that a new client will be admitted. What characteristic correlates with the introductory phase of a nurse client relationship?

Gathering health related data.

Empathy

Intuitive awareness of what a client is experiencing (the ability to understand and SHARE the feelings of another)

Expressive Aphasia

Neurologic impairment of a person's ability to speak.

Educator

Person who provides information.

Learning Capacity

Person's intellectual ability to understand, remember, and apply new information.

Task-oriented touch

Personal contact with a client that is required when performing nursing procedures.

Affective Touch

Personal contact with a client that is used to communicate concern, caring, and support. See also task-oriented touch.

Intimate Space

Physical closeness between two people, which is only appropriate for interactions of a very personal nature.

Formal Teaching

Planned, organized conveying of information. See also informal teaching.

Androgogy

Principles of teaching adult learners.

While obtaining a client's past medical history, the nurse repeats the content of the client's message to verify understanding. The nurse is using which technique?

Restatement

Ch. 7 Learning Objectives questions #7: List at least five factors that affect oral communication.

Some factors that may affect oral communication include 1. language compatibility 2. verbal skills 3. hearing and visual acuity 4. motor functions involving the throat, tongue, and teeth 5. sensory distractions 6. and interpersonal attitudes.

The client recently immigrated to the United States from Mumbai, India. She was just admitted to the nurse's unit postoperatively following gallstone removal. She does not speak English. When using the hospital's interpretive services, which is most important?

Speak directly to the client.

The nurse-client relationship is dependent on communication. Effective communication between the nurse and the client includes which of the following? Select all that apply.

Spoken words Sight Touch Observation

Ch. 7 Learning Objectives questions #10: Differentiate task-related touch from affective touch

Task-related touch involves the personal contact required when performing nursing procedures. Affective touch is used to demonstrate concern or affection.

Pedagory

Teaching children or people with cognitive ability comparable to children.

Gerogogy

Techniques that enhance learning among older adult.

Learning Style

That manner in which a person best comprehends new information.

Which activity takes place during the working phase of the nurse-client relationship? Select all that apply.

The client participates actively in the relationship. The client genuinely expresses concerns to the nurse.

The nurse has entered a client's room after receiving a morning report. The nurse rapidly assessed the client's airway, breathing, and circulation and greeted the client by saying "Good morning." The client has made no reciprocal response to the nurse. How should the nurse best respond to the client's silence?

The nurse should ask appropriate questions to understand the reasons for the client's silence.

Collaborator

Use of a team effort to achieve client care outcomes

Proxemics

Use of space when communicating.

Paralanguage

Vocal sounds that communicate a message but that are not words.

Which phase of the nurse-client relationship involves the mutual planning of care and putting the plan into action?

Working

NCLEX-Style Review Questions (PrepU)#3: The nurse is caring for a client who seems depressed. What statement is the best example of therapeutic communication at this time?

You seem depressed.

A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:

allow the client to set the pace.

A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult:

an audiologist

Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?

analysis

Active listening

demonstrating full attention to what is being said; hearing both the consent being communicated and the unspoken message

An experienced nurse is orienting a new nurse to the unit. The experienced nurse tells the new nurse that to be an effective caregiver, the new nurse needs to:

develop good communication skills

Which communication technique is being utilized when the nurse states, "That's not true, where did you get that idea"?

disagreeing

The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique?

encouraging elaboration

A nurse is discharging a client terminates the nurse-client relationship. Which action should the nurse perform in this phase?

examine goals of the relationship to determine whether they were achieved

When assessing a client's nonverbal communication, the nurse will assess which characteristic as the most expressive part of the body?

facial expressions

A nurse is working on a medical surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which information will the nurse consider when deciding what nursing actions to delegate to the LPN/LVN? (Select all that apply.)

hospital policy client stability scope of practice LPN/LVN proficiency level

Which action by the nurse will facilitate the nurse-client relationship during the orientation phase?

introducing oneself to the client by name

The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?

speak directly to the client