PreU chapter 8 communication
Factors that distort the quality of the message, known as_____can interfere with communication at any point in the process.
noise
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? Contact a person skilled in sign language Provide paper and pencil for written communication Assess how the client would like to communicate Use facial and hand gestures
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.
Interpersonal communication, or self-talk, is the communication that happens within the individual.
F
An intimate communication zone occurs during interaction between parents and children, whereas_____ a zone occurs when people interact with close friends.
personal
Paramedics arrive in the emergency department with a client who was in a motor vehicle collision. The paramedic reports that the driver was restrained, the car was traveling about 30 miles per hour (48 km/hr), and the air bags were not deployed. The paramedic continues to report that 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? "Was there any cracking of the windshield?" "Did a police officer take a report at the accident scene?" "Were there any fatalities in the other vehicle?" "All of the people got themselves out of the car?"
"All of the people got themselves out of the car?" Explanation: A validation question or comment serves to validate what the nurse believes the nurse has heard or observed. Asking for additional information that was not reported is not validating the report given by the paramedic.
A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique? Seeking clarification Encouraging elaboration Giving information Giving false reassurance
F
An example of an open-ended question is: "What medicines have you been taking at home?"
T
Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction.
T
To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others? Therapeutic communication Metacommunication Intrapersonal communication Purposive communication
Therapeutic communication Explanation: Therapeutic communication facilitates interactions focused on the client and the client's concerns. Therapeutic communication is purposive, but this is not a discrete category of communication. Intrapersonal communication is communication with oneself, or self-talk. Metacommunication is communication about communication.
The therapeutic communication technique known as____ is the skill of identifying with the way another person feels.
empathy
The nurse makes a contract with the client during which phase of the nurse-client relationship? Orientation phase Termination phase Intimate phase Working phase
Orientation phase The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.
Which activities take 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 client and nurse identify goals of the relationship. The client identifies the goals accomplished in the relationship. The client describes the role that the nurse plays in the relationship.
The client participates actively in the relationship. The client genuinely expresses concerns to the nurse. he working phase of the nurse-client relationship involves the client actively participating in working toward goals and genuinely expressing concerns and feelings to the nurse. The identification of goals and roles of the relationship occurs in the orientation phase. Identifying that goals have been accomplished is characteristic of the termination phase.
In order for a communication process to occur, three components are needed: a source or sender, the message, and the _______, the medium the sender selects to send the message.
channel
A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which statement or question will elicit the most specific information? "Describe why people in glass houses should not throw stones." "What do believe caused this current manic episode?" "Tell me about a time in your life when you were happy." "Are you allergic to any medications?"
"Are you allergic to any medications?" Explanation: The closed question provides the receiver with limited choices of possible responses and might often be answered by one or two words: "yes" or "no." Closed questions are used to gather specific information from a client and to allow the nurse and client to focus on a particular area. The only closed question among the answer options is, "Are you allergic to any medications?" All of the other answer options are open-ended questions, which would be difficult for a person in a state of bipolar mania to answer with specific, succinct, helpful responses.
A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse? "I am so sorry you are going through this. Can we talk?" "Sitting in the dark is not going to cure your cancer. Let's open the curtains." "I know this is hard for you. Is there any way I can help?" "Can you please tell me why you are crying?"
"I know this is hard for you. Is there any way I can help?" Empathy is identifying with the way another person feels. An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. By retaining this quality, you can establish successful helping relationships without appearing cold or stern. The statement "I am so sorry you are going through this" demonstrates sympathy. Sympathy differs from empathy because it shifts the emphasis from the client to the nurse as the nurse shares feelings and personal concerns and projects them onto the client, limiting the ability to focus objectively on the client's needs. Asking about why the client is crying is part of information gathering but is not empathy. Stating that sitting in the dark will not cure cancer is an abrasive statement that may work against the nurse-client relationship. Reference:
A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy? "I see you have been crying. Do you want me to call someone for you?" "I see you are upset. Would you like to talk?" "Don't worry, I have seen lots of people with cancer do fine." "I am sorry to hear you have cancer. I would be upset too, is there anything I can do?"
"I see you are upset. Would you like to talk?" Explanation: Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Acknowledging the client's state, "I see you are upset" and asking the open-ended question, "would you like to talk" best demonstrates the use of empathy and helps the nurse become effective at providing for the client's needs while remaining compassionately detached. Sympathy, such as saying sorry, is not supportive and asking a closed question does not allow the client to express his or her concerns or fears. An offer to call someone is an example of avoidance, and makes the nurse appear uncaring. Telling the client not to worry is an example of giving false reassurance and is nontherapeutic and can give the client false hopes and expectations.
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? "Were these term births?" "All right, you have four children, is that correct?" "How old are your children?" "I understand you have four kids; how many times have you actually been pregnant?"
"I understand you have four kids; how many times have you actually been pregnant?" Explanation: 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. Referenc
A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the sutures removed a week prior, as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response? "It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." "I am sorry it is taking so long and I am hurting you; next time do not wait too long to get sutures removed or the same thing will happen" "It will not hurt if you relax and stop pulling your arm away." "I am sorry it is taking so long. Tell me how you hurt your arm?"
"It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." Explanation: Sharing information about why the removal of the sutures hurts and is taking longer is a teaching moment which helps the client make better decisions about health care. Telling the client not to wait so long for removal is not therapeutic because it diminishes the client's ability to make choices. Changing the subject is not therapeutic and is a way for the nurse to avoid listening and addressing the client's concerns. Telling the client it will not hurt if the client relaxes is an example of false reassurance.
The nurse is caring for a client at the end stage of life. The client is crying and states to the nurse, "I just cannot believe I am going to be leaving my children without a parent. I am not ready to go." What response by the nurse demonstrates the expression of empathy to the client? "This just is not fair at all and I do not understand why this is happening to you." "I am so sorry that I am crying with you when you need my support the most." "It sounds as though you are most concerned about how your children will feel." "This is so sad and I feel so bad that you are in this situation."
"It sounds as though you are most concerned about how your children will feel." The nurse is demonstrating empathy when reiterating what the client is saying. This helps the nurse become effective at providing for the client's emotional needs while maintaining detachment. The other responses indicate that the nurse is feeling sympathy for the client, which includes feeling as emotionally distraught as the client. While this may be an unavoidable response, it may not help the client move through the grieving process as effectively.
A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response? "It is a minimally invasive surgery with rapid recovery time, so you will do fine." "You should follow your physician's recommendation and have the surgery." "When you see the physician this morning, request more information about the surgery." "Share with me the advantages and disadvantages of your options as you see them."
"Share with me the advantages and disadvantages of your options as you see them." When it comes to treatment decisions, the nurse should avoid giving advice, thus reserving the right of each person to make one's own choices on matters affecting health and illness care. The nurse should share information on potential alternatives, promote the client's freedom to choose, and support the client's ultimate decision. Giving advice, avoidance, and providing false reassurance are all nontherapeutic forms of communication. cholelithiasis soi mat
A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client? "You may feel very uncomfortable when the needle goes in, but you should breathe rhythmically." "The procedure may take only 2 minutes, so you might get through it by mentally counting up to 120." "The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." "I will be by your side throughout the procedure; the procedure will be painless if you don't move."
"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position." Explanation: The nurse should provide correct knowledge as well as reassurance. Thoracentesis is a painful procedure and it is important for the client to sit still to avoid injuring the pleura. The nurse should reassure the client that the nurse will be present during the procedure and help the client throughout. Likewise, the nurse should avoid giving false reassurance by saying that the procedure will be painless. Additionally, the nurse should abstain from stating reasons that could scare the client.
When the preoperative client tells the nurse that the client cannot sleep because the client keeps thinking about the surgery, an appropriate reflection of the statement by the nurse is: "You shouldn't be nervous. We perform this procedure every day." "The thought of having surgery is keeping you awake." "It sounds as if your surgery is a pretty scary procedure." "You have a great surgeon. You have nothing to worry about."
"The thought of having surgery is keeping you awake." Explanation: Reflection means repeating or paraphrasing the client's own statement back to the client to verify that the nurse understands what the client is saying. identifying the main emotional themes. Saying that the surgery sounds scary does not accurately reflect this client's statement. The other answers are offering false reassurance, which is not reflection nor therapeutic communication. Reference:
During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is: "Do you have an advanced directive or a living will?" "What did your health care provider tell you about your need to be admitted?" "Are you allergic to any medications?" "Can you tell me the medications you take on a daily basis?"
"What did your health care provider tell you about your need to be admitted?" Explanation: When obtaining a nursing history, use the open-ended question technique to allow the client a wide range of possible responses. The greatest advantage of this technique is that it prevents the client from giving a simple "yes" or "no" answer, which limits the client's response. The questions related to medication use, allergies, and an advanced directive are examples of closed communication, in which only one or a few words are required for an answer.
A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? "I understand your confused, what do you think you should do?" "I understand you are not sure about having the surgery. Why do you think you really do not need the surgery?" "You seem unsure, please let me know if you decide to postpone the surgery until you are no longer unsure." "You seem unsure. Tell me your concerns about your surgery."
"You seem unsure. Tell me your concerns about your surgery." Explanation: To understand the client's perspective, the nurse uses therapeutic communication techniques to encourage verbal expression. The use of active listening facilitates therapeutic interactions. "You seem unsure" demonstrates that the nurse was actively listening and has decoded the content and feelings of the client. "Tell me your concerns about your surgery" is an open-ended statement which will allow the client to express themselves. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situation more realistically. "I understand you are confused" and "I understand that you are not sure" are examples of rescue feelings on behalf of the nurse. Saying I understand implies the nurse has the knowledge to fix the problem, especially followed by an explorative statement. Asking the client what he or she thinks he or she should do or why the surgery is not needed will put the nurse in the position to judge the response. "Please let me know if you decide to postpone the surgery until you are no longer unsure" suggests that the client should postpone the surgery and is an example of giving advice. The nurse should not give opinions, attempt to sway a client's opinion, or avoid an uncomfortable discussion.
A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? "There are many good medications to decrease the pain; it will not be so bad." "Don't worry about labor, I have been through it and it is not so bad." "You're worried about how you will tolerate the pain associated with labor." "I would recommend keeping a positive attitude."
"You're worried about how you will tolerate the pain associated with labor." Reflecting or paraphrasing confirms that the nurse is following the conversation and demonstrates listening, thus allowing the client to elaborate further. False reassurance may initially relieve the client's anxiety, but it actually closes off communication by trivializing the client's unique feelings and discourages further discussion. Using clichés provides worthless advice and curtails exploring alternatives.
In which situation would the SBAR technique of communication be most appropriate? A nurse is teaching a client about the benefits of smoking cessation and the risks of continuing to smoke. A nurse is facilitating a family meeting to coordinate a client's discharge planning. A nurse is calling a physician to report a client's new onset of chest pain. A nurse is explaining the process of bone marrow biopsy to a client who is scheduled for the procedure.
A nurse is calling a physician to report a client's new onset of chest pain. There are numerous applications of the SBAR technique of communication, including nurse-physician communication surrounding acute client developments. The technique is not normally applied in client education or in communication between the health care team and patients' families.
A nurse needs to complete an assessment and vital signs on a client who has Alzheimer disease. How should the nurse approach this client to gain cooperation? Select all that apply. Approach the client from the front. Focus on the nursing tasks. Use the client's name. Speak loudly and clearly. Smile and maintain eye contact.
Approach the client from the front. Use the client's name. Smile and maintain eye contact. Techniques that facilitate communicating with a client who has Alzheimer disease include gaining the client's attention by approaching from the front and using the client's name, smiling to convey friendliness, maintaining eye contact to evaluate the client's attention and comprehension, assuming a relaxed posture to avoid agitating the client, and speaking naturally at a normal rate and volume. It is not effective to focus on nursing tasks and speak loudly and clearly to gain the client's cooperation.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client? Use strategic pauses to allow the client to provide information that will be used to help officials in their investigation. Practice active listening by allowing the client to express fears and concerns then restating in the nurse's own words to demonstrate understanding. Approach the client with empathy and understanding and allow the client to share feelings without being judged. Exhibit a professional demeanor while examining the client and obtaining specimens, asking questions that are not intrusive.
Approach the client with empathy and understanding and allow the client to share feelings without being judged. Rapport is a feeling of mutual trust between nurse and client. Kindness is the quality of being friendly, generous, and considerate. Active listening and the use of silence are communication techniques, but they do not necessarily develop mutual trust between the nurse and client. Reference:
A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client? Use a text-telephone device (TTD) for daily communication. Arrange for a sign language interpreter when discussing treatment. Consult the oncology nurse specialist. Talk with the client's children to determine needs.
Arrange for a sign language interpreter when discussing treatment. Explanation: During the planning step of the nursing process the nurse develops and prioritizes an individualized plan of care in partnership with the client, family, and others as appropriate. The client with mental or physical limitations should be included in the plan as much as possible. A sign language interpreter allows the client to participate fully in the plan of care. Consulting with the client's children is not as beneficial because it places them in the difficult position of translating while experiencing the emotional strain of the parent's illness. A TTD line can assist in communication but is not as helpful as a medical interpreter. Consulting the oncology nurse specialist is not as helpful in communicating with this client as an interpreter.
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? Smile and say, "Don't worry, I am sure the physician is doing a good job." Stand and say, "I can see this interview is making you uncomfortable, so we can continue later." Nod and say, "I agree. If I were you, I would get a new doctor." Be silent and allow the client to continue speaking when ready.
Be silent and allow the client to continue speaking when ready. Explanation: When clients are angry or crying, the best nursing response is to remain nonjudgmental, allow them to express their emotions, and return later with a follow-up regarding their legitimate complaints. Therefore, staying silent and allowing the client to continue speaking when ready is the most appropriate response in this scenario. Giving false reassurance, agreeing, giving advice, or avoiding the subject are traps that block or hinder verbal communication. Reference:
A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point? Reassuring the client that back surgery will likely alleviate the pain completely Being sensitive to the client's emotional barriers Explaining in detail all of the pain management options available Sharing the nurse's own family and personal history of back pain
Being sensitive to the client's emotional barriers Explanation: The nurse should try to establish a good rapport with the client and use therapeutic communication. In doing so, the nurse should be sensitive to all needs of the client-including physical and emotional. The degree to which clients are physically comfortable influences their ability to communicate. Once rapport is established, the nurse and client can communicate about pain management options, although perhaps not in great detail, as the client may not be able to tolerate lengthy explanations. The nurse sharing the nurse's own family and personal history of back pain takes the focus off of the client and is not sensitive to the client's needs. Telling the client that back surgery will likely alleviate pain completely is providing false assurance, as this is not necessarily true.
The nurse communicates with a newly admitted client. Which nonverbal behavior will the nurse note? client's ethnicity client's accent client's religious practices client's gestures
Client's gestures Nonverbal communication refers to the use of body language, such as gestures, facial expressions, posture, space, appearance, body movement, and touch. The other answers refer to aspects of the client's cultural identity rather than nonverbal communication.
A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take? Allow the client's child to interpret. Contact a professional interpreter. Involve a friend who speaks both the dominant and the client's languages. As
Contact a professional interpreter. Explanation: If an interpreter is necessary, the nurse should use a professional interpreter recommended by the facility or agency. It is inappropriate to rely on the client's family members or friends for this service. If the fellow nurse is not fluent in the language, then this nurse is not likely to be effective as an interpreter.
A client has cancer, but the significant other does not want the client to know the diagnosis. The nurse demonstrates sensitivity to the significant other and works with the couple to achieve desired outcomes. What kind of behavior is the nurse exhibiting? Empathy Curiosity Sympathy Humility
Empathy An empathic nurse is sensitive to the client's feelings and problems but remains objective enough to help the client work to attain positive outcomes. Sympathy is the expression of sorrow for someone's situation, involving compassion and kindness. Sympathy shifts the emphasis from the client to the nurse, as the nurse shares feelings and personal concerns and projects them onto the client. Curiosity is a strong desire to know or learn something. Empathy is perceptive awareness of what a client is experiencing. Humility is a modest or low view of one's own importance.
Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached? Commiseration Kindness Empathy Sympathy
Empathy Empathy refers to intuitive awareness of what the client is experiencing. It helps the nurse perform activities and remain emotionally neutral. Sympathy means feeling as emotionally distraught as the client. If the nurse sympathizes with the client, the nurse may feel equally disturbed, and performance may be affected. Kindness and commiseration also have an emotional component attached to them.
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation? Sympathy Pity Indifference Empathy
Empathy The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.
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? Clarification Reflection Restating Encouraging elaboration
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. Reference:
A nurse is asking a colleague about a situation. Which response best demonstrates assertive communication? "I think there is a better way to handle this." "Why are you treating me this way?" "You always act like this." "What is your problem with me?"
I think there is a better way to handle this." Explanation: Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements—"I feel . . ." and "I think . . ."—play an important role in assertive statements. They communicate personal feelings and preferences without expressing a judgment or blaming another person.
The nurse is providing care to an older adult client who has visual and hearing deficits. What action by the nurse is appropriate to help with communication? Speak in a loud voice over the volume of the television set. Remove the COVID protection face mask while speaking with the client. Identify oneself by name and title with each entry into the client's room. Obtain the client's attention by calling out the client's first name.
Identify oneself by name and title with each entry into the client's room. Explanation: To facilitate communication with an older client who has visual and hearing deficits, the nurse identifies oneself by name and title each time the nurse enters the client's room. This assists with the orientation of the client who can place the interaction into proper perspective. The nurse does not remove one's face mask. The face mask is to minimize the risk for COVID for both the nurse and the client. The nurse with permission of the client would decrease the volume of the television set, or even turn the television set off, so as to not compete with the television program. This will facilitate hearing. People with hearing deficits have difficulty distinguishing simultaneous sounds from each other. The nurse will call the client by the client's preferred name. This demonstrates respect for the client. The client's name preference may not be the client's first name.
A client comes into the urgent care center to have sutures removed on an arm. The nurse finds significant crusting along the suture line. The client states not having time to get the sutures removed a week prior, as directed. The nurse soaks the crust and attempts to remove the sutures. As the nurse attempts the suture removal, the client frequently pulls the arm away and tells the nurse, "You are taking too long and it is hurting a little bit. Just pull them out and get it over with." Which statement is an example of appropriate therapeutic response? "I am sorry it is taking so long. Tell me how you hurt your arm?" "It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." "It will not hurt if you relax and stop pulling your arm away." "I am sorry it is taking so long and I am hurting you; next time do not wait too long to get sutures removed or the same thing will happen"
It is taking longer for me to remove the sutures because the delay allowed the crust to form and adhere to the sutures, making it harder and sometimes painful to remove them." Sharing information about why the removal of the sutures hurts and is taking longer is a teaching moment which helps the client make better decisions about health care. Telling the client not to wait so long for removal is not therapeutic because it diminishes the client's ability to make choices. Changing the subject is not therapeutic and is a way for the nurse to avoid listening and addressing the client's concerns. Telling the client it will not hurt if the client relaxes is an example of false reassurance.
A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? Evaluation phase Termination phase Working phase Orientation phase
Orientation phase Explanation: During the orientation phase, the nurse discusses with the client when visits will occur and how long they will last. The working phase is usually the longest phase of the nurse-client relationship. During this phase, the nurse works together with the client to meet the client's physical and psychosocial needs. Interaction is the essence of the working phase. The termination phase occurs when the nurse and client acknowledge that the agreement on which the relationship is based is concluding. There is no evaluation phase of the nurse-client relationship (evaluation is the final step in the nursing process).
A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response? Place a chair next to the bed and then leave the room to allow the parent to grieve. Place a chair next to the bed and encourage the parent to hold the client's hand. Encourage the parent to bring in pictures of the family that can be displayed in the room. Place the client's hand on the parent's hand and reassure the parent that things will be fine.
Place a chair next to the bed and encourage the parent to hold the client's hand. Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. T he nurse may feel it is appropriate to place the client's hand on the parent's hand; however, the nurse should not provide false hope. The nurse should not leave the parent alone to grieve; the nurse should show the parent how to use comforting communication. The client is in a chemically induced coma and will not be able to see pictures that are displayed in the room.
A nurse is caring for a client in a semi-private room. How will the nurse prepare a private environment to discuss the client's plan of treatment? Direct the client in the other bed to walk in the hallway. Ask all visitors to leave the room. Pull the curtain dividing the two beds. Bring the client into the hallway to discuss the treatment plan.
Pull the curtain dividing the two beds. It might not always be possible to carry on conversations alone with the client in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others. Sometimes merely drawing the curtains around the bed in a hospital or long-term care facility, or sitting in a corner of the waiting room or lounge, can provide the sense of privacy that is so important in most interactions. It is not appropriate to ask the client in the other bed or any visitors to leave the room. Personal information should not be discussed in public thoroughfares.
Incivility is rude, disruptive, intimidating, and undesirable behavior directed at another person. incivility là hành vi thô lỗ, gây rối, đe dọa và không mong muốn nhắm vào người khác
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Rapport refers to a feeling of mutual trust experienced by people in a satisfactory relationship.
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A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation? The client stares at the floor and states, "I feel fine." The client smiles at the nurse and states, "I cannot wait to go home." The client is sitting in a chair and states, "I feel a lot better than I did yesterday. The client looks at the nurse and states, "I am still not feeling my best."
The client stares at the floor and states, "I feel fine." Explanation: It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted
A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation? The client stares at the floor and states, "I feel fine." The client smiles at the nurse and states, "I cannot wait to go home." The client looks at the nurse and states, "I am still not feeling my best." The client is sitting in a chair and states, "I feel a lot better than I did yesterday.
The client stares at the floor and states, "I feel fine." Explanation: It often helps nurses to understand subtle and hidden meanings in what the client is saying verbally. For example, in the scenario in which the client stares at the floor while claiming to feel fine, the nurse should investigate further because of the incongruence between the client's verbal and nonverbal communication. In the other three scenarios, the nurse-client communication is effective and no further investigation is warranted.
A client in a mental health unit discusses personal thoughts and feelings with the nurse. The nurse can maintain the circle of confidentiality when reporting this information to which individuals? Select all that apply. The nurse from the oncoming shift The client's physician The unit's mental health technicians The client's closest friend The client's family
The client's physician The nurse from the oncoming shift The unit's mental health technicians Unless the client has specifically given permission to provide information to family and friends, this information should remain among individuals on the health care team who are directly involved with care of the client.
The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities? The nurse stops the instruction and tells the client that a call will be placed to the health care provider to get an order to have a home health nurse administer the medication. The nurse asks the client if he or she is worried about giving oneself an injection. The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. The nurse continues with the instructions and makes a mental note to repeat the initial instructions at the end of the training.
The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe. During the initial phase of the nurse-client relationship the nurse assesses the client's verbal and nonverbal communication. Shaking the head and requests to repeat what has been said points to a hearing deficiency. Facing the client, speaking slowly and clearly, and providing a visual demonstration is effective for communicating with individuals with a hearing impairment. Making a mental note to repeat instructions is a poor nursing action regardless of the communication difficulties of the client, because the nurses failed to let the client know the plan to repeat the instructions. Stopping the instruction and getting a home health nurse to administer the medication demonstrates that the nurse interpreted the client's communication as unwilling or as an inability to self-administer. This misinterpretation may result in an unnecessary healthcare expense. The nurse asking the client if he or she is worried demonstrates that the nurse is ignoring or not paying attention to the client's communication abilities.
A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply. The nurse keeps communication simple and concrete. The nurse maintains eye contact with the client. If there is no response, the nurse does not repeat what is said and takes a break. The nurse communicates in a busy environment to hold the client's attention. The nurse gives lengthy explanations of the care that will be given. The nurse shows patience with the client and gives the client time to respond.
The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete. There are several nursing actions that would be appropriate to facilitate. The nurse would maintain eye contact with the client. The nurse shows patience and gives the client time to respond. The nurse keeps communication simple and concrete. The nurse would not communicate in a busy environment because this could be distracting to the client. The nurse would not give lengthy explanations to the client regarding the care to be given. The nurse would repeat the information if no response was shared by the client. Reference:
The nurse cares for a client who is sharing a personal health story. Which behavior(s) demonstrates active listening? Select all that apply. The nurse makes eye contact while the client is sharing a personal story. The nurse paraphrases what the client has stated before generating a response. The nurse shares a personal story about experiences with hospitalization. The nurse offers multiple solutions while the client is sharing a personal story. The nurse observes the nonverbal behavior of the client as the client speaks.
The nurse makes eye contact while the client is sharing a personal story. The nurse observes the nonverbal behavior of the client as the client speaks. The nurse paraphrases what the client has stated before generating a response. The use of active listening (demonstrating full attention to what is being said, hearing both the content being communicated and the unspoken message) facilitates therapeutic interactions. Giving clients the opportunity to be heard helps them organize their thoughts and evaluate their situations more realistically. By making eye contact, the nurse demonstrates full attention to what the client is sharing. Making observations of the client's nonverbal behavior as the client tells one's story attunes the nurse to personal feelings that may not be stated in the verbally communicated message. Paraphrasing is a skill associated with active listening because it allows the nurse to seek clarification to be certain the client is being understood correctly. Offering multiple solutions does not demonstrate active listening. Finding solutions is a collaborative act between the nurse and the client. It is not appropriate to share a personal story or offer a personal disclosure, because this can place the client in a psychologically unsafe situation or impose the feeling that the client needs to offer support to the nurse.
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship? Evaluation phase Termination phase Orientation phase Working phase
Working phase During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions. The orientation phase involves making introductions and establishing client goals. The termination phase involves evaluating client progress toward goals and concluding the relationship. There is no evaluation phase in the nurse-client relationship.
A nurse touches the client's hand while discussing the client's diagnosis. This action is: a dynamic process. a communication channel. a translation. an auditory channel.
a communication channel. Explanation: A communication channel is a carrier of the message; touch can be a channel. Communication is a dynamic process, but simply touching one's hand is not. Touch is not translation--converting a message from one form to another--but is a channel for the message. Touch is a tactile, not auditory, channel.
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: nurturing. passive. assertive. aggressive.
aggressive. 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.
A nurse has been working on a telemetry unit for 6 months. The nurse arrives at work in the morning and overhears a night shift nurse talking about the new nurse. The night shift nurse is heard saying, "That new nurse is only here to meet a doctor and get married." The best response by the new nurse would be to: ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel. ignore the comment and begin the shift. call hospital security and ask them to take a report. approach and tell the night shift nurse that the night shift nurse is "out of line."
ask to speak to the night shift nurse in private and explain how the comment made the new nurse feel. Assertive behavior is the ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Assertive behaviors, which are one hallmark of professional nursing relationships, are very different from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is expressing feelings and beliefs in a non-defensive manner. "I" statements-"I feel . . ." and "I think . . ."-play an important role in assertive statements. "You" statements are defensive and close lines of communication. The comment should not be ignored or the lateral violence--or displaced hostility toward a peer--will continue. It would be inappropriate to contact hospital security; the matter should be dealt with directly by the new nurse
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? Use facial and hand gestures Contact a person skilled in sign language Provide paper and pencil for written communication Assess how the client would like to communicate
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.
Each of the following facilitates a therapeutic nurse-client relationship except: rephrasing. reflection. closed-ended questions. active listening.
closed-ended questions. Explanation: Rephrasing, reflection, and active listening are essential for accurate assessment and interventions.
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes? asking the client's family to discuss the importance of the prescribed treatment with the client explaining the health consequences of refusing to undergo the prescribed treatment contacting the interprofessional care team to discuss alternative treatment options recommending assessment of the client's cognitive capacity to make health care decisions
contacting the interprofessional care team to discuss alternative treatment options Nursing responsibilities in the nurse-client relationship entail advocating on the client's behalf. For a client who does not consent to a particular type of treatment, for which there may be alternative treatments available, the nurse can establish trust in the nurse-client relationship by advocating for the client's care needs to the client's interprofessional care team. Although it is part of the nurse's scope of practice to provide client education regarding treatment interventions, this is not the action the nurse would take to establish trust with the client. Speaking to the client's family about having this discussion potentially breaches client confidentiality and would serve to decrease trust in the nurse-client relationship. It is not within the nurse's scope to recommend that the client have the cognitive capacity assessed. While it is important to ensure the client has the capability to make informed decisions about treatment, the client's refusal for treatment stems from personal beliefs, not cognitive impairment. Reference:
A nurse is caring for a client admitted to the hospital for dehydration. Which physical findings should the nurse acknowledge as nonverbal communication concerning this diagnosis? slow heart rate and prolonged capillary refill. easy wrinkling of the skin and sunken eyes. (mat trung sau) cold intolerance and brittle nails. pallor and diaphoresis. xanh xao va chay mo hoi
easy wrinkling of the skin and sunken eyes. Most illnesses cause at least some alterations in general physical appearance. Observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy. For example, a person with an insufficient intake of fluids has dry skin that wrinkles easily, eyes that might be sunken and dull in appearance, and poor muscle tone. On the other hand, a person in good health tends to radiate this healthy status through general appearance. Although prolonged capillary refill is consistent with dehydration, slow heart rate is not. Pallor may be associated with dehydration but diaphoresis is not associated with this condition. Cold intolerance and brittle nails are consistent physiologic changes seen in clients with hypothyroidism.
An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should: recommend 40 mg of furosemide be administered because the client had improvement with past administration. detail the client's past medical history and active medication orders. discuss the client's situation and request a chest x-ray to assess lung function. provide detailed findings of the head-to-toe assessment.
ecommend 40 milligrams of furosemide (Lasix) be administered because the client had improvement with past administration SBAR, which stands for Situation, Background, Assessment, and Recommendations, provides a consistent method for hand-off communication that is clear, structured, and easy to use. The S (Situation) and B (Background) provide objective data, whereas the A (Assessment) and R (Recommendations) allow for presentation of subjective information. Discussing the situation occurs during the (Situation) component of SBAR reporting. Detailing the client's past medical history is not a component of SBAR. Providing detailed findings of the head to toe assessment does not occur during SBAR reporting.
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: show the child the intravenous catheter and explain how it works. ask the child's parents to leave the room while the nurse and child talk. provide both verbal and written information to the child. involve the child's stuffed animal in the educational session.
einvolve 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
A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to: have group members issue a written warning to the dominant member. have group members confront the dominant member to promote the needed team work. plan a meeting where the dominant person cannot attend. pick a team leader who is not the dominant member.
have group members confront the dominant member to promote the needed team work. Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial relationship. Planning a secret meeting does not solve the underlying issue. Picking a team leader who is not the dominant member will not address the dominance issue. A written warning would be inappropriate; a verbal communication is what is required among the team.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should: remain honest, open, and frank. ask if the client realizes the infection is a direct result of the drug use. consult with the social worker regarding inpatient drug rehabilitation. ask the client for a urine specimen for urine drug use screening.
remain honest, open, and frank. One key factor to effective communication is to be open, accepting, frank, respectful, and without prejudice. When a client feels that a nurse is being judgmental, the client might withhold significant information. You need to develop sensitivity to the unique challenges presented by each client. A urine drug screen may eventually be ordered but is not necessary at this time. There is no evidence the client wants drug rehabilitation at this time. There is no evidence that the skin infection is secondary to the drug abuse.
The nurse makes a contract with the client during which phase of the nurse-client relationship? Working phase Intimate phase Termination phase Orientation phase
rientation phase Explanation: The orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.
A nurse is interviewing a client for the establishment of long-term care insurance. During the interview, the nurse asks questions regarding the client's past medical history. In this case, the nurse plays the role in the process of communication of the: decoder. sender. receiver. target.
sender. Explanation: The nurse is playing the role of the sender, which is a person or group who has a purpose for the communication and initiates and conveys the message. The receiver, or decoder, is the person or group who receive and interpret, or decode, the message. Target is not a term used to describe a role in the communication process.
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: swaddling the child and gently stroking its head. staring into the neonate's eyes and smiling. softly humming a song near the neonate. offering the neonate infant formula.
swaddling the child and gently stroking its head. Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. I t has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.