B220 Exam 1 Practice NCLEX Questions
A mother whose young daughter has died of leukemia is crying and is unable to talk about her feelings. Which is the best response by the nurse? 1. "Everyone will remember her because she was so cute. She was one of our favorites." 2. "As hard as this is, it is probably for the best because she was in a lot of pain." 3. "She put up the good fight but now she is out of pain and in heaven." 4. "It must be hard to deal with such a precious loss."
1 - "It must be hard to deal with such a precious loss." The nurse's response is empathetic. The response focuses on the feelings surrounding the loss and provides an opportunity for the mother to verbalize.
A nurse is caring for a confused patient with a diagnosis of dementia of the Alzheimer's type. Which should the nurse say when assisting the patient to eat? 1. "Please eat your meat." 2. "It's important that you eat." 3. "What would you like to eat?" 4. "If you don't eat, you can't have dessert."
1 - "Please eat your meat." Confused patients more easily understand simple words and sentences.
A patient is to have arthroscopic surgery of the knee to repair a torn tendon. The patient says, "I don't know if I'll make it through this surgery." Which responses by the nurse may block further communication by the patient? Select all that apply. 1. "The type of surgery you are having is minor." 2. "Surgery often can be frightening." 3. "Everything will be all right." 4. "You are not going to die." 5. "You sound scared."
1 - "The type of surgery you are having is minor." This response minimizes the patient's concerns. It is not minor surgery for this patient. 3 - "Everything will be all right." This response is false reassurance. It denies the patient's concerns about survival and does not invite the patient to elaborate. 4 - "You are not going to die." This response denies the patient's feelings and is false reassurance. Also, it closes communication and does not provide the patient with an opportunity to discuss concern
A nurse is collecting data for an admission nursing history. Which question by the nurse is best to open the discussion? 1. "What brought you to the hospital?" 2. "Would it help to discuss your feelings?" 3. "Do you want to talk about your concerns?" 4. "Would you like to talk about why you are here?"
1 - "What brought you to the hospital?" This is a focused open-ended statement that invites the patient to communicate while centering on the reason for seeking health care.
A patient is admitted to the hospital with cirrhosis of the liver caused by long-term alcohol abuse. Which is the best response by the nurse when the patient says, "I really don't believe that my drinking a couple of beers a day has anything to do with my liver problem"? 1. "You find it hard to believe that beer can hurt the liver." 2. "How long is it that you have been drinking several beers a day?" 3. "Each beer is equivalent to one shot of liquor so it's just as damaging to the liver as hard liquor." 4. "Do you believe that beer is not harmful even though research shows that it is just as bad for you as hard liquor?"
1 - "You find it hard to believe that beer can hurt the liver." This is an example of paraphrasing. It repeats the content in the patient's message in similar words to provide feedback to let the patient know whether the message was understood and to prompt further communication.
An agitated 80-year-old patient states, "I'm having trouble with my bowels." Which responses by the nurse incorporate the interviewing skill of paraphrasing? Select all that apply. 1. "You're having trouble with your bowels?" 2. "It sounds like your bowels are causing you problems." 3. "You sound upset that your bowels are causing difficulties." 4. "It's common to have problems with the bowels at your age." 5. "When did you first notice having trouble with your bowels?"
1 - "You're having trouble with your bowels?" A nurse uses the technique of paraphrasing when restating a patient's comment or using similar words to rephrase what the patient has said. 2 - "It sounds like your bowels are causing you problems." The nurse's statement substitutes the word problems for trouble, which paraphrases the patient's comment.
A patient is extremely upset and mentions something about a work-related issue that the nurse cannot understand. Which is the nurse's best response? 1. "It's natural to worry about your job." 2. "Your job must be very important to you." 3. "Calm down so that I can understand what you are saying." 4. "I'm not quite sure I heard what you were saying about your work."
1 - Communication is inevitable. Theory indicates that all behavior has meaning, people are always behaving, and we cannot stop behaving or communicating; therefore, communication is inevitable.
Which statement about communication should the nurse consider to be accurate? 1. Verbal communication is essential for human relationships. 2. Hands are the most expressive part of the body. 3. Behavior clearly reflects feelings. 4. Communication is inevitable.
1 - Communication is inevitable. Theory indicates that all behavior has meaning, people are always behaving, and we cannot stop behaving or communicating; therefore, communication is inevitable.
A nurse is admitting a patient to the unit who was transferred from the emergency department. Which should the nurse do to facilitate communication? 1. Ensure that the patient has an effective way to communicate with health-care team members. 2. Use interviewing techniques to control the direction of the patient's communication. 3. Minimize energy spent by the patient on negative feelings and concerns. 4. Refocus to the positive aspects of the patient's situation and prognosis.
1 - Ensure that the patient has an effective way to communicate with health-care team members. Communication between the patient and health-care providers is essential, particularly for obtaining subjective data and feedback. Speech, pantomime, writing, touch, and picture boards are examples of channels of transmission (i.e., media used to convey a message).
Which interviewing skill is used when the nurse says, "You mentioned before that you are having a problem with your colostomy." 1. Focusing 2. Clarifying 3. Paraphrasing 4. Acknowledging
1 - Focusing This example of focusing helps the patient explore a topic of importance. The nurse selects one topic for further discussion from among several topics presented by the patient.
Which is being communicated when the nurse leans forward during a patient interview? 1. Aggression 2. Anxiety 3. Interest 4. Privacy
1 - Interest Leaning forward is a nonverbal behavior that conveys involvement. It is a form of physical attending, which is being present to another.
Which nursing actions should the nurse implement when speaking with an older adult whose hearing is impaired? Select all that apply. 1. Limit background noise. 2. Exaggerate lip movements. 3. Lower the pitch of your voice. 4. Stand directly in front of the patient when speaking. 5. Raise the volume of your voice while speaking directly toward the patient's good ear.
1 - Limit background noise. Limiting competing stimuli promotes reception of verbal messages. 3 - Lower the pitch of your voice. Lowering the pitch of the voice may be helpful. Hearing loss in the older adult typically involves a decreased perception of high-pitched sounds. 4 - Stand directly in front of the patient when speaking. Standing directly in front of the patient when speaking focuses the patient's attention on the nurse. A hearing- impaired receiver must be aware that a message is being sent before the message can be received and decoded.
Which statement describes the following proverb? What you do speaks so loudly I cannot hear w hat you say. 1. Hearing ability is an important factor in communicating. 2. Nonverbal messages are often more meaningful than words. 3. Listening to what people say requires attention to what is being said. 4. When people talk too loudly it is hard to understand what is being said.
1 - Nonverbal messages are often more meaningful than words. Nonverbal communication (e.g., body language) conveys messages without words and is under less conscious control than verbal statements. When a person's words and behavior are incongruent, nonverbal behavior most likely reflects the person's true feelings.
A patient is admitted to the hospital with a tentative medical diagnosis and multiple diagnostic tests are performed. Where in the patient's chart can the nurse find documentation about the current medical diagnosis after the diagnostic test results are reviewed by the primary health-care provider? 1. Progress Notes 2. Admission Sheet 3. History and Physical 4. Social Service Record
1 - Progress Notes Generally, the Progress Notes contain documentation by all members of the health-care team. After a patient is admitted and diagnostic tests are completed, the patient's medical diagnosis may change. The ongoing changes and current status of the patient are documented in the Progress Notes.
A risk manager is conducting a retrospective audit of a patient's clinical record to identify the use of unacceptable abbreviations. Which abbreviations did the risk manager identify that are on The Joint Commission's official Do Not Use List? Select all that apply. 1. U 2. cc 3. mg 4. MS 5. QOD 6. 0800 hour
1 - U The abbreviations U and u for units are on The Joint Commission's official Do Not Use List. These abbreviations may be mistaken for the number 0, the number 4, or cc. The word unit should be written out in full. 4 - MS The abbreviation MS for morphine sulfate is on The Joint Commission's official Do Not Use List. MS can be mistaken for morphine sulfate or magnesium sulfate. The name of the medication should be spelled out in full. 5 - QOD The use of the abbreviation QOD for every other day is on The Joint Commission's official Do Not Use List. Other abbreviations for every other day include qod, q.o.d., and QOD, and they are also on The Joint Commission's official Do Not Use List. "Every other day" should be written out in full.
Which abilities of the nurse are important to achieve effective therapeutic communication? Select all that apply. 1. Using interviewing skills 2. Remaining nonjudgmental 3. Sending just verbal messages 4. Being assertive when collecting data 5. Displaying sympathy when communicating
1 - Using interviewing skills Communication is facilitated by interviewing techniques that involve attitudes, behaviors, and verbal messages. Interviewing skills promote therapeutic communication because they are patient centered and goal directed. 2 - Remaining nonjudgmental A nonjudgmental attitude communicates acceptance to the patient, which provides emotional support and precipitates further communication.
The nurse is caring for a postoperative patient who is still having pain despite analgesia administration. Which statement by the nurse best reflects therapeutic communication? 1 "I think your doctor needs to know that you're still in pain." 2 "What do you want me to do about your pain problem?" 3 "When it comes to pain, your doctor tends to undermedicate his patients." 4 "Your pain will be a lot better in the morning."
1 Rationale: Therapeutic communication is goal directed, which in this situation is better pain management for the patient.
A nurse uses reflective technique when communicating with an anxious patient. On which does the nurse focus when using reflective technique in this situation? 1. Feelings 2. Content themes 3. Clarification of information 4. Summarization of the topics discussed
1- Feelings Reflective technique requires active listening to identify the underlying emotional concerns or feelings contained in patients' messages. These feelings are then referred back to patients to promote a clearer understanding of what they have said.
virginia henderson
14 components in maslows hierarchy of needs according to nursing
A patient with a colostomy wants to learn how to irrigate a newly created colostomy. The nurse provides this teaching by developing a therapeutic nurse-patient relationship and implementing teaching strategies. Identify the statements that are included in the working stage of this therapeutic relationship. Select all that apply. 1. "How do you feel about doing this procedure?" 2. "Would you like to try to insert the cone yourself today?" 3. "You did a great job managing the instillation of fluid today." 4. "I am here to help you learn how to irrigate your colostomy." 5. "I'll arrange for a home care nurse to visit you in your home when you are discharge."
2 - "Would you like to try to insert the cone yourself today?" This statement reflects the working stage of a therapeutic relationship. It involves completing interventions that address expected outcomes, such as learning how to perform a colostomy irrigation. 3 - "You did a great job managing the instillation of fluid today." This statement reflects the working stage of a therapeutic relationship. It includes providing feedback and encouragement.
A patient who has had a number of postoperative complications appears upset and agitated, yet withdrawn. Which is the most appropriate statement by the nurse? 1. "You seem distressed. Tell me why you are upset." 2. "You've been having a pretty rough time of it since surgery." 3. "It's not uncommon to have complications after the kind of surgery that you had." 4. "I'm not sure that I know everything that has been happening. Tell me what has happened to you since surgery."
2 - "You've been having a pretty rough time of it since surgery." This is an example of the therapeutic interviewing skill of an open-ended statement. It demonstrates that the nurse recognizes what the patient is going through, and the statement encourages free verbalization by the patient. At the very least it demonstrates caring and concern.
Which is the nurse doing when using the interviewing technique of attentive listening? 1. Identifying the patient's concerns and exploring them with why questions 2. Determining the content and feeling of the patient's message 3. Employing silence to encourage the patient to talk 4. Using nonverbal skills to display interest
2 - Determining the content and feeling of the patient's message Attentive listening is the active use of all the senses to comprehend and appreciate the patient's verbal and nonverbal thoughts and feelings.
A nurse must conduct a focused interview to complete an admission history. Which interviewing technique should the nurse use? 1. Probing 2. Clarification 3. Direct questions 4. Paraphrasing statements
2 - Direct questions A focused interview explores a particular topic or obtains specific information. Direct questions meet these objectives and avoid extraneous information.
A nurse is developing a therapeutic relationship with a patient with emotional needs. Which nursing interventions are essential during the working stage of the relationship? 1. Establish a formal or informal contract that addresses the patient's problems. 2. Implement nursing actions that are designed to achieve expected patient outcomes. 3. Develop rapport and trust so the patient feels protected and an initial plan can be identified. 4. Clearly identify the role of the nurse and establish the parameters of the professional relationship.
2 - Implement nursing actions that are designed to achieve expected patient outcomes. During the working stage of the therapeutic relationship, nursing interventions have a twofold purpose: assisting patients to explore and understand their thoughts and feelings and facilitating and supporting patients' decisions and actions.
A patient appears tearful and is quiet and withdrawn. The nurse says, "You seem very sad today." Which interviewing approach did the nurse use? 1. Examining 2. Reflecting 3. Clarifying 4. Orienting
2 - Reflecting Reflective technique refers to feelings implied in the content of verbal communication or in exhibited nonverbal behaviors. Patients who are crying, quiet, and withdrawn often are sad
A nurse is working with an older adult with a cognitive impairment who is having a tantrum and acting hostile toward other patients in the dayroom. Which approach by the nurse is most appropriate to handle this situation? 1 Asking three other staff members to help put the patient back to bed 2 Using the patient's favorite crackers to distract him from the other patients 3 Explaining to the patient how he will benefit by behaving better 4 Asking the family how they managed the tantrums while the patient was still living at home
2 Rationale: Distraction is often effective for this type of patient. Strategies that may have worked before may not be as effective now. There is no time to call the family when the patient is already hostile. A show of force could make the patient agitated.
A nurse is working with a potentially threatening patient. Which nursing intervention is most appropriate? 1 Speaking clearly and slightly louder so the patient does not need the nurse to repeat what was said. 2 Positioning himself or herself near the exit of the room to prevent being blocked by the patient. 3 Bringing in other team members so the patient knows there are others to help him or her gain control. 4 Asking the patient which comfort measures he or she uses when he or she becomes out of control.
2 Rationale: Speaking louder and bringing in other team members may be perceived as threatening and may cause the patient's behavior to become out of control faster. The patient may not be aware of his or her behavior; therefore asking about comfort measures to relieve the threatening behavior may also cause him or her to escalate. The nurse may need to leave the room quickly. By positioning himself or herself near the door, he or she should not be trapped by the patient.
Which stage of an interview establishes the relationship between the nurse and the patient? 1. Preinteraction stage 2. Orientation stage 3. Examining stage 4. Working stage
2. Orientation stage The purposes of the orientation stage of an interview are to establish rapport and orient the interviewee. A relationship is established through a process of creating goodwill and trust. The orientation stage focuses on explaining the purpose and nature of the interview and what is expected of the patient.
A young adult who had a leg amputated because of trauma says, "No one will ever choose to love a person with one leg." Which is the best response by the nurse? 1. "You are a good-looking person, and you will have no trouble meeting someone who cares." 2. "You may feel that way now, but you will feel differently as time passes." 3. "Do you feel that no one will marry you because you have one leg?" 4. "How do you see your situation at this point?"
3 - "Do you feel that no one will marry you because you have one leg?" This is an example of paraphrasing, which restates the patient's message in similar words. It promotes communication.
A patient with chest pain is being admitted to the emergency department. When asked about next of kin the patient states, "Don't bother calling my daughter; she is always too busy." Which is the best response by the nurse? 1. "She might be upset if you don't call her." 2. "What does your daughter do that makes her so busy?" 3. "Is there someone else that you would like me to call for you?" 4. "I can't imagine that your daughter wouldn't want to know that you are sick."
3 - "Is there someone else that you would like me to call for you?" This response lets the patient know that the message has been heard and moves forward to meet the need to notify a significant other of the patient's situation.
A patient says, "I am really nervous about having a spinal tap tomorrow." Which is the best response by the nurse? 1. "I'll ask the doctor for a little medication to help you relax." 2. "Patients who have had a spinal tap say it is not that uncomfortable." 3. "It's all right to be nervous, and I don't remember anyone who wasn't." 4. "Your physician is excellent and is very careful when spinal taps are done."
3 - "It's all right to be nervous, and I don't remember anyone who wasn't." This statement is therapeutic. It recognizes the patient's feelings, gives the patient permission to feel nervous, and reassures the patient that one's behavior is not unusual. This statement sets the groundwork for the next statement, such as, "Let's talk a little bit about the spinal tap and the concerns you may have."
A patient states, "I can't believe that I couldn't even eat half my breakfast." Which statements by the nurse use the interviewing skill of reflection? Select all that apply. 1. "Let's talk about your inability to eat." 2. "What part of your breakfast were you able to eat?" 3. "You appear startled that you did not finish your tray of food." 4. "How long have you been unable to eat most of your breakfast?" 5. "You seem surprised that you were unable to eat all your breakfast."
3 - "You appear startled that you did not finish your tray of food." This statement is an example of reflective technique because it focuses on the feeling of being startled. 5 - "You seem surprised that you were unable to eat all your breakfast." This statement is an example of reflective technique because it focuses on the feeling of surprise.
A nurse is using military time when entering information into a patient's clinical record. For example, the clock below indicates that the time is 0708 a.m. Which number in military time should the nurse enter to document a wound irrigation that was implemented at 9 p.m.? 1. 0900 2. 1900 3. 2100 4. 2300
3 - 2100 2100 is 9 p.m. The large font numbers reflect a.m. The small font numbers reflect p.m.
A nurse is caring for a patient who is blind in the left eye and visually impaired in the right eye. Which actions should the nurse employ to promote communication with this patient? 1. Touch the patient's left arm before initiating a conversation 2. Ensure that the door to the patient's room is on the patient's left side 3. Close the window curtains and dim the lights before speaking with the patient 4. Knock on the door and request permission to enter before approaching the patient
3 - Close the window curtains and dim the lights before speaking with the patient Humor is an interpersonal tool and a healing strategy. It releases physical and psychic energy, enhances well- being, reduces anxiety, increases pain tolerance, and places experiences within the context of life.
Which is the purpose of the use of humor by a nurse when interacting with a patient? 1. Diminish feelings of anger 2. Refocus the patient's attention 3. Maintain a balanced perspective 4. Delay dealing with the inevitable
3 - Delay dealing with the inevitable Knocking on the door before entering the room alerts the patient to the fact that someone is at the door and requesting permission to enter the room demonstrates respect and provides for privacy.
A nurse is attempting to develop a helping relationship with a patient who was recently diagnosed with cancer. Which factors are unique to this helping relationship? Select all that apply. 1. The patient is permitted to assume the dominant role. 2. The nurse and the patient equally share information. 3. The interaction is specific to the patient. 4. The interaction is guided by a purpose. 5. The needs of both participants are met.
3 - The interaction is specific to the patient. The helping relationship (interpersonal relationship, therapeutic relationship) is a personal, patient-focused, process. The patient is the center of the health team and therefore the focus of any nurse-patient interaction. 4. The interaction is guided by a purpose. Nursing interventions should be designed to achieve desirable patient outcomes. Nursing care is purposeful and goal directed.
A visitor from another country became ill and required hospitalization. He is having difficulty getting the staff to understand his needs. Which approach by the nurse demonstrates the most cultural sensitivity? 1 Asking one of the patient's family members to help with the communication process 2 Using good eye contact while speaking clearly with easily understood words 3 Obtaining a medical interpreter to facilitate the communication process 4 Touching the patient more often while assessing him to make him feel that the nurse cares about him
3 Rationale: Direct eye contact and excessive touch can be offensive to persons from certain cultures. The patient's right to privacy must be guarded; therefore the use of a medical interpreter provides for correct, confidential communication.
Which initial approach would be best when working with an anxious patient? 1 Tell the patient that everything he or she says will be kept private. 2 Ask the patient what he or she believes is causing his or her anxiety. 3 Watch the patient's behavior for the amount of anxiety being exhibited. 4 Explain what the patient can expect in terms that he or she can understand.
3 Rationale: The nurse needs to first assess the level of anxiety so appropriate communication techniques and strategies can be used. The patient may not have the insight to understand what is currently causing his or her behavior.
A patient recovering from a bilateral mastectomy for breast cancer tearfully tells the nurse that she is feeling depressed and worthless as a woman. Which communication phrase is not effective? 1 "Many women have body image concerns after undergoing this surgery." 2 "Tell me more about how you feel." 3 "Why do you feel depressed and worthless?" 4 "How long have you been feeling this way?"
3 Rationale: The use of "why" questions may cause defensiveness in the patient and hinder communication. The other options promote communication by encouraging the patient to communicate.
A nurse is changing a patient's dressing over an abdominal wound. Which level of space around the patient is entered during the dressing change? 1. Public 2. Social 3. Intimate 4. Personal
3. Intimate Physically caring for a patient involves inspection and touch that invades the instinctual, protective distance immediately surrounding an individual. Intimate space (physical contact to 11⁄2 feet) is characterized by body contact and visual exposure.
A patient is exhibiting anxious behavior and states, "I just found out that I have cancer everywhere and I don't have very long to live. My life is over." Which is the best response by the nurse? 1. "It might be good if your family were here right now. Shall I call them?" 2. "What might be the best way to approach this terrible news?" 3. "That is so sad. You must feel like crying." 4. "It sounds like you feel hopeless."
4 - "It sounds like you feel hopeless." This is an example of reflective technique because the nurse incorporated the patient's feelings into the response. When no solutions to a problem are evident, a person becomes hopeless (i.e., despairing, despondent).
A patient states, "My wife is going to be very upset that my prostate surgery probably is going to leave me impotent." Which is the best response by the nurse? 1. "I'm sure your wife will be willing to make this sacrifice in exchange for your well-being." 2. "The surgeons are getting great results with nerve-sparing surgery today." 3. "Your wife may not put as much emphasis on sex as you think." 4. "Let's talk about how you feel about this surgery."
4 - "Let's talk about how you feel about this surgery." The patient may be using projection to cope with the potential for impotence. This response indicates that it is acceptable to talk about sexuality and invites the patient to verbalize concerns.
A nurse plans to foster a therapeutic relationship with a patient. Which is important for the nurse to do? 1. Work on establishing a friendship with the patient. 2. Use humor to defuse emotionally charged topics of discussion. 3. Sympathize with the patient when the patient shares sad feelings. 4. Demonstrate respect when discussing emotionally charged subjects.
4 - Demonstrate respect when discussing emotionally charged subjects. Emotionally charged topics should be approached with respectful, sincere interactions that are accepting and nonjudgmental and that will promote further verbalizations.
A patient states, "Do you think I could have cancer?" The nurse responds, "What did the doctor tell you?" Which interviewing approach did the nurse use? 1. Paraphrasing 2. Confrontation 3. Reflective technique 4. Open-ended question
4 - Open-ended question This open-ended statement invites the patient to elaborate on the expressed thought with more than a one- or two-word response.
A patient states, "I think that I am dying." The nurse responds, "You believe that you are dying?" Which interviewing approach did the nurse use? 1. Focusing 2. Reflecting 3. Validating 4. Paraphrasing
4 - Paraphrasing The nurse's response is an example of paraphrasing because it uses similar words to restate the patient's message.
Which approach reflects an obstacle to effective nurse-patient communication? 1 Discussing fears about a patient with members of the health care team 2 Obtaining information about a critically ill patient from his or her family 3 Admitting a mistake to a patient's family 4 Avoiding issues that are uncomfortable for a patient
4 Rationale: A therapeutic nurse-patient relationship is goal directed. It can also include the need to help a patient discuss any pertinent topics, whether comfortable or uncomfortable.
A patient recovering from a recent amputation of his foot because of diabetes has been very withdrawn and not sleeping or eating well. Which initial nursing intervention would be most effective to help him with his depression? 1 Suggesting the use of antidepressant medication to his health care provider 2 Spending time with the patient and telling him how lucky he is that he was able to keep most of his leg 3 Talking with physical therapy about how soon he can be fitted for a prosthesis 4 Encouraging the patient to talk about his feelings while allowing angry outbursts
4 Rationale: Even though being positive about the situation is a strategy, this patient is grieving for the loss of his extremity and is depressed. Antidepressant medications are not given initially. The patient needs the opportunity to express feelings, especially anger, which is normal behavior. The health care provider, not the physical therapist, would be consulted about when he would be evaluated for a prosthesis.
A patient is exhibiting signs and symptoms of anxiety. What should be the first step in establishing communication with him or her? 1 Providing good personal hygiene 2 Letting the patient make as many choices as possible 3 Being nonjudgmental and accepting of feelings 4 Exhibiting appropriate nonverbal behaviors and active listening skills
4 Rationale: Patients with anxiety need assistance in clarifying factors that cause the anxiety and coping more effectively. Active listening helps to identify the source of the anxiety. Meeting basic needs and being nonjudgmental and accepting of feelings is important but not your first step. Ultimately once a cause for anxiety is known, you can help the patient by letting him or her make as many choices about care as possible
The nurse is preparing to provide patient education. Which question is most appropriate for the nurse to ask? 1 Are you ready to learn now? 2 Can you use a computer? 3 Is your family here to learn also? 4 How do you best learn?
4 Rationale: The method of instruction should be based on the patient's preferred method of learning. It can incorporate a variety of methods that would be appropriate for the information being conveyed and how the patient learns best. The other options are either demeaning (option 1), too narrow in scope and closed ended (option 2) or family-centered instead of patient-centered (option 3).
Which statement demonstrates the most effective strategy for providing teaching to a depressed patient? A. Information is given to the patient in small amounts. B. Information is given to the patient in written form. C. Patients who are depressed do not benefit from health teaching. D. Patients who are depressed respond better to the NAP for health teaching.
A When providing health teaching to a depressed patient, it is important to provide the information in small amounts, as patients with depression tend to have poor concentration and limited memory as symptoms of their condition. Consequently, giving too much information at a time may prove to be an ineffective strategy.
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to the nurse, "How is Mary doing? She is my best friend and is seen at your clinic every week." Which is the MOST APPROPRIATE nursing response? A "I can not discuss any patient situation with you." B "If you want to know about Mary, you need t ask her yourself." C "Only because you're worried about a friend, I'll tell you that she is improving." D "Being her friend, you know she is having a difficult time and deserves her privacy."
A The nurse is required to maintain confidentiality regarding the patient and the patient's care. Confidentiality is basic to the therapeutic relationship and is a patient's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain patient confidentiality.
assault
A threatened or attempted physical attack by someone who appears to be able to cause bodily harm if not stopped
Libel
A written defamation of a person's character, reputation, business, or property rights.
A nursing instructor assigns their clinical group the task of writing a journal depicting the student's clinical day. What is the most likely rationale for this assignment? a. Journaling allows reflection, an important critical thinking skill. b. Journaling gives you time to review what happened in your clinical. c. Journaling is a way to organize your thoughts about your experiences. d. Journaling teaches open-mindedness, a critical thinking disposition.
ANS: A Critical thinking requires reflection on what occurred, how data were processed, and how decisions were made. Journaling is one method of developing critical thinking skills. Journaling does give nurses time to review what happened in their clinical, but this statement does not go far enough in explaining the importance of the journal-writing process. Journaling may be a way to organize thoughts about one's experiences, but this statement is too narrow an explanation and does not account for the critical aspect of reflection. Open-mindedness is a critical thinking disposition that allows one to be tolerant of divergent views. Journaling can assist with developing this disposition, but only if what is written reflects that specific topic.
A home care nurse receives a physician order for a medication that the patient does not want to take because the patient has a history of side effects from this medication. The nurse carefully listens to the patient, considers it in light of the patient's condition, questions its appropriateness, and examines alternative treatments. This nurse would most likely a. call the physician, explain rationale, and suggest a different medication. b. consult an experienced nurse on whether there are other similar treatments. c. hold the drug until the physician returns to the unit and can be questioned. d. question other staff as to the physician's acceptance of nursing input.
ANS: A Determining how best to proceed on behalf of a patient's best health care outcomes may require clinical judgment. At the committed level of critical thinking, the nurse chooses an action after all possibilities have been examined. A home care nurse who is using good clinical judgment techniques should have confidence in their decision and may not have another nurse available as this is an autonomous setting. Holding the drug might jeopardize the patient's health, so this is not the best solution. The nurse working at this level of critical thinking makes choices based on careful examination of situations and alternatives; whether or not the physician is open to nursing input is not relevant.
A new graduate nurse (GN) is working with an experienced nurse to chart assessment findings. The GN notes that the physical therapist wrote on the chart that the patient is lazy and did not want to participate in assigned therapies this AM. The experienced nurse asks the GN what may be going on here. What is the best explanation for this statement? a. Data on the chart can sometimes be documented in a biased manner. b. Data on the chart changes as the patient's condition changes. c. Data on the chart is usually accurate and can be verified from the patient. d. Reading the chart is not a wise use of time as this can be time consuming and tedious.
ANS: A It is important that the nurse records only what is assessed, without adding judgments or interpretations to the record. Data do indeed change (and need to be charted) as the patient's condition changes, but this would not be the best answer to this question. Assessment data may at times be difficult to obtain, but that would not occur often enough to warrant a warning about the difficulty in charting it. Also, obtaining data is clearly a different activity from charting it. Charting can be time consuming and tedious, but this is not the most complete answer to this question.
A student nurse is studying clinical judgment theories and is working with Tanner's Model of Clinical Judgment. The student nurse can generalize the process as a. a reflective process where the nurse notices, interprets, responds, and reflects in action. b. one conceptual mechanism for critiquing ideas and establishing goal-oriented care. c. researching best practice literature to create care pathways for certain populations. d. assessing, diagnosing, implementing, and evaluating the nursing care plans.
ANS: A Looking across theories and definitions of clinical judgment, they all have in common the ability to reflect on data and choose actions. Reflection also considers evaluating the result of the actions to determine whether they were effective. Although critiquing ideas and establishing goal-oriented care could be considered part of a generalized statement of critical thinking, this is not broad enough without the reflection and evaluation. Clinical judgment would most likely be used to create care paths derived from the evidence; however, this is not the cornerstone of the Tanner Model. Clinical judgment is used when engaging in the nursing process, but this is too narrow in focus to capture the essence of critical thinking definitions and theories. Critical thinking is not synonymous with the nursing process.
A nurse has committed a serious medication error and has reported their error to the hospital's adverse medication error hotline as well as to the unit manager. The manager is a firm believer in developing critical thinking skills. From this standpoint, what action by the manager would best nurture this ability in the nurse who made the error? a. Have the nurse present an in-service related to the cause of the error. b. Instruct the nurse to write a paper on how to avoid this type of error. c. Let the nurse work with more experienced nurses when giving medications. d. Send the nurse to refresher courses on medication administration.
ANS: A Nurturing critical thinking skills is done in part by turning errors into learning opportunities. If the nurse presents an in-service on the cause and prevention of the type of error committed, not only will the nurse learn something but many others nurses on the unit will learn from it to. This is the best example of developing critical thinking skills. This option would allow the nurse to learn from the mistake, which is a method of developing critical thinking skills, but the paper would benefit only the nurse, so this option is not the best choice. Letting the nurse work with more experienced nurses might be a good option in a very limited setting, for example, if the nurse is relatively new and the manager discovers a deficiency in the nurse's orientation or training on giving medications in that system. Otherwise, this option would not really be beneficial. Sending the nurse to refresher courses might be a solution, but it is directed at the nurse's learning, not critical thinking. The nurse might feel resentful at having to attend such classes, but even if they were helpful, only this one nurse is learning. Going to generic classes also does not address the specific reason this error occurred, and thus might be irrelevant. Critical thinking and learning can be enhanced by a presentation to the staff on the causes of the error.
A GN appears to be second-guessing herself and is constantly calling on the other nurses to double-check their plan of care or rehearse what they will say to the doctor before she call on the patient's behalf. This seems to be annoying some of the nurse's coworkers. The nurse manager's best response to this situation is to a. explain to coworkers that this is a characteristic of critical thinking and is important for the GN to improve reasoning skills. b. agree with the staff and have someone follow and work more closely with a preceptor. c. have a talk with the nurse and suggest asking fewer questions. d. tell the staff that all new nurses go through this phase, and ignore their behavior.
ANS: A Reflection-on-action is critical for development of knowledge and improvement in reasoning. It is where learning from practice is incorporated into experience. Inquisitiveness is a characteristic of critical thinking and reflects a desire to learn even when the knowledge may not appear readily useful. The manager should promote this. Suggesting the nurse work more closely with a preceptor implies that the manager thinks the nurse needs to learn more and increase confidence. In reality, this nurse is demonstrating a characteristic of critical thinking. Suggesting that the nurse ask fewer questions would hamper the development of the nurse as a critical thinker. All new nurses do go through a phase of asking more questions at one time, but dismissing the nurse's behavior with this explanation is simplistic and will discourage critical thinking.
The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among health care team members? a. The occurrence of a patient event resulting in death or serious injury b. Decreased ability to document expenses of care provided c. Longer time to begin surgical cases d. Increased time to discharge patients to outpatient care
ANS: A The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.
After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations
ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting
ANS: A. The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.
A nurse has designed an individualized nursing care plan for a patient, but the patient is not meeting goals. Further assessment reveals that the patient is not following through on many items. Which action by the nurse would be best for determining the cause of the problem? a. Assess whether the actions were too hard for the patient. b. Determine whether the patient agrees with the care plan. c. Question the patient's reasons for not following through. d. Reevaluate data to ensure the diagnoses are sound.
ANS: B Having patient and/or family provide input to the care plan is vital in order to gain support for the plan of action. The actions may have been too difficult for the patient, but this is a very narrow item to focus on. The nurse might want to find out the rationale for the patient not following through, but instead of directly questioning the patient, which can sound accusatory, it would be best to offer some possible motives. Reevaluation should be an ongoing process, but the more likely cause of the patient's failure to follow through is that the patient did not participate in making the plan of care.
A patient has been admitted for a skin graft following third degree burns to the bilateral calves. The plan of care involves 3 days inpatient and 6 months outpatient treatment, to include home care and dressing changes. When should the nurse initiate the educational plan? a. After the operation and the patient is awake b. On admission, along with the initial assessment c. The day before the patient is to be discharged d. When narcotics are no longer needed routinely
ANS: B Initial discharge planning begins upon admission. After the operation has been completed is too late to begin the discharge planning process. The day before discharge is too late for the nurse to gather all pertinent information and begin teaching and coordinating resources. After a complicated operation, the patient may well be discharged on narcotic analgesics. Waiting for the patient to not need them anymore might mean the patient gets discharged without teaching being done.
A nurse manager has recently overheard several negative comments made by nurses on the unit about other nurses on the unit. The manager recognizes that the nurses are exhibiting what type of behavior that is detrimental to collaboration? a. Vertical violence b. Lateral violence c. Descending violence d. Personal violence
ANS: B Lateral violence undermines collaboration and occurs nurse-to-nurse. Vertical or descending violence implies one participant has a higher status than another. Personal violence falls in a legal category, and while it will hinder collaboration, it is not specific to coworkers.
The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first? a. Post educational posters about how well collaboration is being performed b. Highlight that no single profession can meet the needs of all patients c. Provide meetings for each department on how their role affects patients d. Begin implementing evaluations of collaborative skills on annual performance reviews
ANS: B Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.
A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"
ANS: B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.
After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."
ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.
A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement
ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.
Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.) a. Prescribing a new medication dose b. Health promotion activities c. End-of-life comfort decisions d. Interpreting laboratory results e. Lifestyle changes to improve health
ANS: B, C, E Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.
An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."
ANS: C The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.
A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing
ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.
The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take? a. Teach the patient muscle strengthening and stretching exercises. b. Tell the patient to make plans to move to an assisted-living facility. c. Discuss resources to help the patient and make appropriate referrals. d. Ask the patient to come in for daily physical therapy.
ANS: C To honor the patient's request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient's request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.
A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate? a. Interprofessional collaboration b. Shared governance collaboration c. Interorganizational collaboration d. Mentoring collaboration
ANS: D Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goal.
Which statement correctly describes the nurses' role in collaboration? a. State boards of nursing mandate that collaboration can only occur in hospitals. b. Collaboration should occur only with physicians. c. Collaboration occurs only between nurses with the same level of education. d. Collaboration may occur in health-related research.
ANS: D Nurses collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working towards meeting patient goals. Collaboration occurs in any health care setting as well as community and home settings.
Which patient scenario describes the best example of professional collaboration? a. The nurse, physician, and physical therapist have all visited separately with the patient. b. The nurse, physical therapist, and physician have all developed separate care plans for the patient. c. The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation. d. The nurse and physician discuss the patient's muscle weakness and initiate a referral for physical therapy.
ANS: D Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions.
The nurse is implementing a plan of care for a patient newly diagnosed with type 2 diabetes mellitus. The plan includes educating the patient about diet choices. The patient states that they enjoy exercising and understand the need to diet; however, they can't see living without chocolate on a daily basis. Using the principles of responding in the Model of Clinical Judgment, how would the nurse proceed with the teaching? a. The nurse explains to the patient that chocolate has a high glycemic index. The nurse then focuses on foods that have low glycemic indexes and provides a list for the patient to choose from. b. The nurse explains that the patient may eat whatever they would like as long as the patient's glucose reading and A1c remain stable. c. The nurse derives a new nursing diagnosis of Knowledge Deficit and readjusts the plan of care to include additional sessions with the registered dietician. d. The nurse examines the patient's daily glucose log and incorporates the snack into the time of day that has the lowest readings. The nurse then follows up and evaluates the response in 1 week.
ANS: D Responding entails adjusting the plan of care to the particular patient issue through one or more nursing interventions. In this case, the nurse is working with the patient's wishes, knowing that the patient will most likely cheat. The patient will be allowed to "cheat." The plan will be evaluated to be sure the snack does not elevate the glucose excessively and be readjusted if warranted. While it is true that most chocolate has a high glycemic index, providing a list of foods that do not include the one thing the patient enjoys will most likely lead to nonadherence to the diet. Advising the patient that they can have whatever they want to eat may lead to further dietary indiscretions and cause side effects such as obesity or high glucose readings. Knowledge Deficit is an inaccurate diagnosis for this patient as evidenced by the patient stating they understand the need to exercise and the need to diet.
A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement? a. "I will have to do whatever the physician says I need to do." b. "Once a plan is developed, it cannot be changed." c. "My insurance will not pay if I don't do what you want me to do." d. "We can work together to adjust my plan as we need to."
ANS: D Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient's ability to complete prescribed care, although they do reimburse for standard care given.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations
ANS: D. The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.
A nurse in a sub-acute unit in a skilled nursing facility is caring for a patient who recently had the surgical creation of a colostomy. Place the following nursing actions in the order that reflects the nurse-patient communication process, beginning with the first stage and progressing to the last stage. 1. Provide positive feedback to the patient for successful performance of a colostomy irrigation. 2. Assist the patient to learn how to perform colostomy self-care. 3. Review all the information on the patient's clinical record. 4. Explore the reasons for the nurse-patient interaction. 5. Summarize the goals and objectives achieved. 6. Introduce self to the patient.
Answer: 3 6 4 2 1 5 3. During the preinteraction stage of the communication process, the nurse gathers information about the patient. This stage occurs before meeting the patient. 6. During the orientation stage of the communication process, the nurse introduces himself or herself to the patient and begins to establish a rapport with the patient. 4. During the orientation stage of the communication process, the nurse and patient exchange information, clarify roles, and identify goals and objectives of the interaction. 2. During the working stage of the communication process, the nurse and patient work toward meeting the patient's needs. The nurse may function as a caregiver, counselor, teacher, resource person, etc. 1. During the working stage of the communication process, the nurse provides feedback about the patient's performance. 5. During the termination stage of the communication process, the nurse summarizes what has been accomplished, reinforces past learning, arranges for available resources, and concludes the interpersonal relationship.
An 81-year-old pt, scheduled for a long orthopedic procedure, appears to have a low BMI. In addition to the BMI value, which additional pt info is most important for the nurse to report to the surgeon & perioperative team as indicating an increased risk for skin breakdown? A. Negative nitrogen balance B. Previous abdominal surgery C. Allergy to latex products D. Change in mental status upon admission
Answer: A Rationale: A negative nitrogen balance can be a sign of inadequate protein intake & malnutrition, resulting in a low BMI. These factors contribute to skin breakdown. Although the change in mental status can increase the risk for skin breakdown after surgery if the pt is not aware of the need to change position, it is not the most critical risk factor @ this time. The allergy to latex products is critical info to communicate to the perioperative team but does not contribute to skin breakdown.
Bc of an unexpected emergency case, a pt scheduled for colon surgery @ 8 AM has been rescheduled for 11 AM. What is the nurse's best action r/t preoperative prophylactic antibiotic administration according to the Surgical Care Improvement Project (SCIP) guidelines? A. Administer the preoperative antibiotic @ 7 AM as originally prescribed. B. Administer the antibiotic @ the same time as the other prescribed preoperative drugs. C. Adjust the antibiotic administration time to be within 1 hr before the surgical incision. D. Hold the preoperative antibiotic until the pt is actually in the operating room & has been anesthetized.
Answer: C Rationale: A goal of prophylaxis is to establish bactericidal tissue & serum levels @ the time of skin incision. The SCIP recommendations are that the antibiotic be administered 1 hr before the actual surgical incision. Giving the drug @ 7 AM seriously interferes c maintaining the blood (serum) level @ the proper level when the surgery is actually taking place. Administering the antibiotic /c the other preoperative drugs may or may not be within the recommended time frame. Waiting until the pt is anesthetized is too late for best antibiotic action & peak serum levels.
The preoperative admitting nurse notices that the pt scheduled for total joint replacement surgery in 2 hrs has a smell of alcohol on his breath even though he has just stated that he has fasted completely for the past 10 hrs. What is the nurse's best 1st action? A. Accept the pt's statement & continue the preoperative prep. B. Report the discrepancy to the surgeon & anesthesiologist STAT. C. Tell the pt the observation & provide the opportunity for him to explain. D. Remind the pt that alcohol consumption may require changes in anesthesia procedure.
Answer: C Rationale: Although alcohol consumption before a surgical procedure /c anesthesia can cause serious problems, the nurse should not "jump to conclusions" /c his or her observations. Before informing the surgeon & anesthesiologist, the nurse should provide the pt w/ the opportunity to explain the alcohol smell on his breath. Some mouthwashes contain chemicals & alcohol that could leave a perceptible odor. Also, the nurse could be mistaken about the odor.
The nurse is completing the sexual history section of the admission assessment. The client tells the nurse "I don't want to talk about this. This is private between my spouse and me." Which nurse response reflects empathy? A "Yes, I know just how you feel." B "I know some of these questions are difficult for you." C "I am a professional nurse and I know what I am doing." D "I understand this is difficult for you to talk about, but I have to complete the admission assessment."
B 1. "Yes, I know just how you feel." This response shifts the focus from the client to the nurse, which is nontherapeutic. 2. "I understand this is difficult for you to talk about, but I have to complete the admission assessment." The nurse's need to complete the admission assessment does not take precedence over the client's feelings. 3. "I know some of these questions are difficult for you." This statement is empathic and acknowledges the client's feelings. 4. "I am a professional nurse and I know what I am doing." This statement negates the client's feelings and is nontherapeutic.
You are the nurse assigned to care for a 4-year-old child who was involved in an automobile accident. She is withdrawn and is not communicating readily with the staff. What strategy can you use to interact with her? A. Ask her open-ended questions. B. Give her paper and crayons. C. Ask her family for help. D. Consult the staff psychologist.
B When interacting with children, it is important to understand the child's developmental level and to select the most age-appropriate communication techniques. Drawing is an appropriate pre-reading communication technique for a 4-year-old child.
The use of facial expressions and gestures communicates: A Personality traits. B Interest in, and attraction to, another person. C Rejection. D Emotions.
D 1. Personality traits. Voice quality and tone reflect an individual's personality. People who vary their tone and increase their rate of speech are viewed as active and dynamic. 2. Interest in, and attraction to, another person. Body position reveals an individual's interest in or attraction to another person. The person who sits or stands far away from another person attempts interpersonal distance. Sitting in close proximity to another person usually indicates attraction. 3. Emotions. Facial expressions are the most important nonverbal communication and convey emotions. 4. Rejection. Averting eye contact with another individual conveys the message of rejection of the other person's request.
To provide effective feedback to a client, the nurse will focus on: A The client. B Making inferences of the behaviors observed. C Providing solutions to the client. D The present and not the past.
D 1. The client. To provide nonthreatening feedback, the focus should be on the behavior and not the client. 2. The present and not the past. Focusing on the here and now makes the feedback more meaningful. Feedback should be given as soon as it is appropriate to do so. 3. Providing solutions to the client. Assisting the client with identifying possible alternatives or goals for a problem is more effective than giving the client the answers. Providing solutions to the client gives the message that the client is not capable of doing so. 4. Making inferences of the behaviors observed. Inferences imply conclusions and assumptions and don't give the client an opportunity to explain a situation.
A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A "Does your husband treat you like this very often?" B "What do you think is your role in this relationship?" C "Why do you think he behaved like that?" D "Describe what happened during your time with your husband."
D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
Which nursing statement is a good example of the therapeutic communication technique of focusing? A "Describe one of the best things that happened to you this week." B "I'm having a difficult time understanding what you mean." C "Your counseling session is in 30 minutes. I'll stay with you until then." D "You mentioned your relationship with your father. Let's discuss that further."
D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.
The pt states the surgeon discussed the addition of a 2nd procedure to the 1 indicated on the consent. The pt is visibly upset that the consent he is asked to sign /c the surgical resident reflects only 1 procedure & cannot understand why the nurse & resident do not have the authority to "fix" the consent. In addition, he states he will not take his wedding ring off bc it has never left his hand since his wife put it there 30 yrs ago. 3. What remedy would you propose to prevent such occurrences in the future?
Discuss the occurrence with the perioperative team, review existing policy, and make changes as needed. Propose a process for facilitating communication among departments and team members.
The pt states the surgeon discussed the addition of a 2nd procedure to the 1 indicated on the consent. The pt is visibly upset that the consent he is asked to sign /c the surgical resident reflects only 1 procedure & cannot understand why the nurse & resident do not have the authority to "fix" the consent. In addition, he states he will not take his wedding ring off bc it has never left his hand since his wife put it there 30 yrs ago. 4. How will you respond to the pt's unwillingness to remove his wedding ring?
Explain to him that removal of the ring is not necessary if the finger is not the operative site. Tape the ring in place if agency policy permits. If the agency does not permit this action, explain why & have his wife keep the ring with her until she sees him after surgery.
The pt states the surgeon discussed the addition of a 2nd procedure to the 1 indicated on the consent. The pt is visibly upset that the consent he is asked to sign /c the surgical resident reflects only 1 procedure & cannot understand why the nurse & resident do not have the authority to "fix" the consent. In addition, he states he will not take his wedding ring off bc it has never left his hand since his wife put it there 30 yrs ago. 1. How would you address the pt's immediate concern regarding the consent?
Focus your answer on the safety aspect of the situation while acknowledging the pt's frustration. Inform the pt that you will contact the surgeon to clarify the consent in terms of accuracy and that neither you nor the surgical resident not have the authority to alter the consent without the surgeon's knowledge. Document it in the medical record.
battery
Illegal touching of another person
Slander
Spoken defamation
The nurse and physician are explaining the home care that will be needed by a patient after discharge. The patient's spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse? a. "Let me review what is needed again." b. "It is important that you do what the physician has prescribed." c. "What concerns do you have about the prescribed care?" d. "I can come back after you talk with your spouse about the care."
The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leaving the patient and spouse with the situation unresolved fosters distrust and more anger.
The pt states the surgeon discussed the addition of a 2nd procedure to the 1 indicated on the consent. The pt is visibly upset that the consent he is asked to sign /c the surgical resident reflects only 1 procedure & cannot understand why the nurse & resident do not have the authority to "fix" the consent. In addition, he states he will not take his wedding ring off bc it has never left his hand since his wife put it there 30 yrs ago. 2. Under what conditions could the 2nd procedure be performed?
The second procedure could be performed if a new consent is developed with both procedures listed & signed by the patient. This new consent can only be used if the patient is not under the influence of preoperative drugs that could cloud his judgment & if the patient has received adequate information regarding both procedures to be able to make an informed choice.
Which of the following is an example of a therapeutic communication technique? Choose all that apply. A. Listening B. Restating C. Giving advice D. Reflecting E. Clarifying
abde Giving advice is nontherapeutic and can serve as a barrier to communicating with patients. The other listed techniques are considered to be therapeutic.
Which of the following is an example of a nontherapeutic communication technique? Choose all that apply. A. Challenging B. Defending C. Focusing D. Paraphrasing E. Disapproving
abe Focusing and paraphrasing are therapeutic communication techniques. The other techniques are considered to be nontherapeutic.
sister callista roy
adaptation model was
primary roles of a nurse
advocate,leader,change agent,manager,researcher collabortor, delegator
criteria for a profession
altruism, body of knowledge,accountability,higher ed,autonomy, diversity,code of ethics, professional organization,licensure and diveresity
values
are enduring ideas about what a person considers is good, best and the right thing to do, and their opposites the bad, the worst, and wrong things to do.
higher order beliefs
are ideas derived from a person first order beliefs, using either inductive or deductive reasoning
A client states: "I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is the therapeutic response? a. "That's not true." b. I have a hard time believing that is true." c. "Surely you don't really believe that." d. "I will help you search this room so that you can see there is no camera."
b. voicing doubt. Expressing uncertainty as to the reality of the client's perceptions; often used with clients experiencing delusional thinking.
message
content transmitted through communication
qsen
delivering patient centered care, working as part of a disciplinary team , practicing evidence based medicine , focusing on quality improvement , safety and information technology and lastly safety as competency
florence nightingale
emphasized clean , water and air and also prevention
sender
encode messages by translating their thoughts and feelings into communication with a reciever
E
establishing eye contact (E)
clara barton
founder of the red cross
jean watson
health and healing , based on caring
referent
initiating event or thought that leads one person to interact with another
hidegard peplau
interpersonal process between nurse and patient
stereotype
is a conceptualized depiction of a person a group or event that is thought to be typical of all others in that category
prejudice
is a preformed opinion, usually an unfavorable one about an entire group of people that is based on insufficient knowledge ,irrational feelings or inaccurate steorotypes
ebp
is an integration of the best available research evidence with clinical judgement about a specific patient situation
value system
is set of somewhat constant values and measures that are organized heirchally into a belief system on a continuum of relative importance
L
leaning forward toward the client (L)
belief
mental representation of reality or a persons perception about what is right or what the person expects to happen in a given situation
channel
messages are conveyed and received through a variety of these
reciever
must actively listen in a convo to decode or sort out the meaning of what is being communicated
lena higabee
naval nurse core
eriksons psychosocial therapy
nurses use concepts of developmental theory to care for their patients at various stages in life
autonomy
nursing professionals make independent decisions within there scope of practice and are responsible for the results and consequences of those decisions
O
open posture when interacting with the client (O)
altruism
practitioners motivation is public service of personal gain
manager
promoting , restoring and maintaining the patients health requires coordinating all of the health care providers services
R
relaxing (R)
feedback
restating the message so the sender knows the receiver understood
S
sitting squarely facing the client (S)
rosenstocks health belief model
the model dresses possible reasons for why a patient may not comply with recommended health promotion behaviors
nursing
the protection promotion and optimization of health and abilities ,prevention of illness and injury,alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals ,families, communities and populations
lewins change theory
unfreezing, moving or change, freezing
first order beliefs
what is correct real or true in early childhood directly through experiences and indirectly from authority figures.
A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat? A Using open-ended questions and silence B Sharing personal preference regarding food choices C Documenting reasons why the patient does not want to eat D Offering opinions about the necessity of adequate nutrition
A
A patient being seen in the emergency department immediately after being sexually assaulted appears calm and controlled. The nurse analyzes this behavior as indicating which defense mechanism? A Denial B Projection C Rationalization D Intellectualization
A Denial is refusal to admit to a painful reality and may be a response by a victim of sexual abuse. In this case the patient is not acknowledging the trauma of the assault either verbally or nonverbally. Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else. Rationalization is justifying the unacceptable attributes about oneself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.
The nurse in the mental health unit recognizes which of the following as therapeutic communication techniques? Select all that apply. A Restating B Listening C Asking the patient "Why?" D Maintaining neutral responses E Providing acknowledgment and feedback F Giving advice and approval or disapproval
ABDE Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.
A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."
ANS: A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.
Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis
ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.
A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."
ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.
A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."
ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R
ANS: B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"
ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.
Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."
ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.
A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."
ANS: C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition
ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.
The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"
ANS: C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.
What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information
ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.
A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"
ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.
In the symbolic interactionist view of communication, how is the meaning of the message determined? A It is predetermined by the person initiating the interaction. B It is mutually negotiated between the individuals involved in the interaction. C It is based on the recipient's perception and interpretation. D It is transferred from the sender to the receiver.
B 1. It is predetermined by the person initiating the interaction. The symbolic interactionist views communication as a simultaneous process that is influenced by both individuals. 2. It is based on the recipient's perception and interpretation. An individual's perception does influence communication, but is not the basis of the interactionist view of communication. 3. It is transferred from the sender to the receiver. Communication is not transferred between people; the meaning of the message is negotiated between the individuals involved in the communication. 4. It is mutually negotiated between the individuals involved in the interaction. The meaning of the message is mutually agreed upon between the individuals involved in the process.
The nurse is interacting with a client and observes the client's eyes moving from side to side prior to answering a question. The nurse interprets this behavior as: A The client responding to auditory hallucinations. B The client processing auditory information. C The client engaging in intrapersonal communication. D The client being bored with the interaction.
B 1. The client responding to auditory hallucinations. Eye movement side to side is an example of eyes accessing cues to an individual's thinking process and is not necessarily indicative of auditory hallucination. 2. The client processing auditory information. An individual processing auditory information usually moves the eyes from side to side. 3. The client being bored with the interaction. Rolling of the eyes is typically observed in an individual who is bored with a situation. 4. The client engaging in intrapersonal communication. A person engaging in intrapersonal communication usually focuses the eyes down in the direction of the nondominant hand.
The nonverbal communication that expresses emotion is: A Body positioning. B Eye contact. C Facial expressions. D Cultural artifacts.
C Rationale: 1. Body positioning. Body position is an indication of how open one person is to another person or how interested or attractive one person is to another. 2. Cultural artifacts. Cultural artifacts are items in contact with interacting people that may function as nonverbal stimuli, e.g., nose or eyebrow piercing. 3. Facial expressions. Facial expressions communicate emotions and are the single most important source of nonverbal communication. 4. Eye contact. Eye contact projects an interest in communicating with a person; averting eye contact implies rejection.
A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B "Remember, clients, not nurses, are responsible for their own choices and decisions." C "Just keep the client's best interests in mind and do the best that you can." D "Set a goal to continue to work on this aspect of your practice."
B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.
The nurse is discussing problem-solving strategies with a client who recently experienced the death of a family member and the loss of a full-time job. The client says to the nurse, "I hear what you're saying to me, but it just isn't making any sense to me. I can't think straight now." The client is expressing feelings of: A Hostility. B Overload. C Disqualification. D Rejection.
B Rationale: 1. Rejection. Rejection conveys the message "you're wrong." 2. Overload. Overload results from sensory input exceeding the tolerance level of the receiver. 3. Disqualification. When a person communicates in such a way as to invalidate messages sent or received from another person, this is known as disqualification. 4. Hostility. The client is expressing a sense of feeling overwhelmed and is not communicating hostile feelings.
According to the therapeutic communication theory, what criteria must be met for successful communication? A Nonverbal communication is consistent with verbal communication. B The communication needs to be efficient, appropriate, flexible, and include feedback. C The individuals communicating with each other must share a similar perception of the conversation. D The communication must be intrapersonal, interpersonal, group, or societal in nature.
B Rationale: 1. The communication must be intrapersonal, interpersonal, group, or societal in nature. Therapeutic communication theory believes communication occurs in four different settings: intrapersonal, interpersonal, group, and societal. 2. The communication needs to be efficient, appropriate, flexible, and include feedback. The formal criteria for successful communication are efficiency, appropriateness, flexibility, and feedback. 3. Nonverbal communication is consistent with verbal communication. Nonverbal communication can contradict the verbal message. 4. The individuals communicating with each other must share a similar perception of the conversation. Perception is highly personal and internal.
The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is MOST APPROPRIATE for this phase? A Planning short-term goals B Making appropriate referrals C Developing realistic solutions D Identifying expected outcomes
B Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected outcomes, evaluating future needs, making appropriate referrals and dealing with the common behaviors associated with termination. The remaining options identify tasks appropriate for the working phase of the relationship.
A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A "The smoke was too thick. You couldn't have gone back in." B "You're feeling guilty because you weren't able to save your children." C "Focus on the fact that you could have lost all four of your children." D "It's best if you try not to think about what happened. Try to move on."
B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.
A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A "It would be best to do that in order to increase independence." B "Why would you want to leave a secure home?" C "Let's discuss and explore all of your options." D "I'm afraid you would feel very guilty leaving your parents."
C The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.
A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A "How would your family feel if you died?" B "You feel worthless now, but that can change with time." C "You've been feeling sad and alone for some time now?" D "It is great that you have come in for help."
C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.
A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A The therapeutic technique of "giving advice" B The therapeutic technique of "defending" C The nontherapeutic technique of "presenting reality" D The nontherapeutic technique of "giving false reassurance"
D The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.
What is the purpose of a nurse providing appropriate feedback? A To give the client good advice B To advise the client on appropriate behaviors C To evaluate the client's behavior D To give the client critical information
D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.
A patient's unresolved feelings related to loss would be MOST LIKELY observed during which phase of the therapeutic nurse-patient relationship? A Trusting B Working C Orientation D Termination
In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. The remaining options are not specifically associated with this issue of unresolved feelings.
The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation
ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A "You seem to be motivated to change your behavior." B "How will these changes affect your family relationships?" C "Why don't you make a list of the behaviors you need to change." D "The team recommends that you make only one behavioral change at a time."
A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.
During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A "Don't worry. Everything will be alright." B "You appear uptight." C "I notice you have bitten your nails to the quick." D "You are jumping to conclusions."
A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.
The nurse is caring for a client who is hard of hearing. To facilitate communication with the client, the nurse will: A Make sure the client can see her lips move when she is speaking. B Ask closed-ended questions. C Stand 5 to 8 feet from the client when speaking. D Speak slowly, using monosyllabic words whenever possible.
A 1. Stand 5 to 8 feet from the client when speaking. The ideal distance to stand when speaking to a client who is hard of hearing is 3 to 6 feet. 2. Speak slowly, using monosyllabic words whenever possible. It is important to speak at a natural rate. People comprehend faster than they speak. Using monosyllabic words may be insulting to the client. 3. Ask closed-ended questions. Asking closed ended questions will impede communication. 4. Make sure the client can see her lips move when she is speaking. Clients who are hard of hearing may need to see the other person's lips moving to know they are speaking. They may also read lips in an attempt to understand what is being said.
A patient admitted to a mental health unit for treatment of psychotic behavior spends hours at the locked exit door shouting. "Let me out. There's nothing wrong with me. I don't belong here." What defense mechanism is the patient implementing? A Denial B Projection C Regression D Rationalization
A Denial is refusal to admit to a painful reality, which is treated as if it does not exist. In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other persons, objects, or situations. Regression allows the patient to return to an earlier, more comforting, although less mature, way of behaving. Rationalization is justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller and the listener.
A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY? A Contact the patient's health care provider (HCP). B Call the patient's family to arrange for transportations. C Attempt to persuade the patient to stay for only a few more days. D Tell the patient that leaving would likely result in an involuntary commitment.
A In general, patients seek, voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patient's' permission. While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to staying "a few more days" has little value and will not likely be successful. Many states require that the patient submit a written release notice to the facility staff members, who reevaluate the patient's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.
When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? A Monitor closely for harm to self or others. B Assist in completing an application for admission. C Supply the patient with written information about their mental illness. D Provide an opportunity for the family to discuss why they felt the admission was needed.
A Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patient's' admission.
A client with a history of major depression tells the nurse "I wish I weren't alive. I have been a failure my entire life and I am totally useless to anyone." The most therapeutic response to the client is: A "You've been feeling like a failure your entire life?" B "You shouldn't talk like that. You're not a failure." C "Once the antidepressants start working you will feel better about yourself." D "Things could be worse. You should be grateful for what you have."
A Rationale: 1. "You shouldn't talk like that. You're not a failure." Telling clients how they should or should not feel invalidates their feelings and is nontherapeutic. 2. "Once the antidepressants start working you will feel better about yourself." The client's depressive symptomatology should improve with antidepressants. However, this response is not the most therapeutic at this time. 3. "Things could be worse. You should be grateful for what you have." This response minimizes the client's feelings and can be perceived as punitive. 4. "You've been feeling like a failure your entire life?" This response restates what the client said and in doing so encourages the client to continue talking.
After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A The nontherapeutic technique of giving approval B The nontherapeutic technique of interpreting C The therapeutic technique of presenting reality D The therapeutic technique of making observations
A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.
A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A "You appear to be talking to someone I do not see." B "Please describe what you are seeing." C "Why do you continually look in the corner of this room?" D "If you hum a tune, the voices may not be so distracting."
A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A Restatement B Offering general leads C Focusing D Accepting
A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.
Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A "We've discussed past coping skills. Let's see if these coping skills can be effective now." B "Please tell me in your own words what brought you to the hospital." C "This new approach worked for you. Keep it up." D "I notice that you seem to be responding to voices that I do not hear."
A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A "Can you tell me why you said that?" B "Keep your chin up. I'll explain the procedure to you." C "There is always an explanation for both good and bad behaviors." D "Are you not understanding the explanation I provided?"
A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.
A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A "Touch carries a different meaning for different individuals." B "Touch is often used when deescalating volatile client situations." C "Touch is used to convey interest and warmth." D "Touch is best combined with empathy when dealing with anxious clients."
A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.
Which of the following individuals are communicating a message? (Select all that apply.) A A mother spanking her son for playing with matches B A teenage boy isolating himself and playing loud music C A biker sporting an eagle tattoo on his biceps D A teenage girl writing, "No one understands me" E A father checking for new e-mail on a regular basis
ABCDE The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting
ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.
Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."
ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.
A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."
ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.
During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."
ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"
ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.
A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."
ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.
Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."
ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.
A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."
ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.
When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed
ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."
ANS: D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.
A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."
ANS: D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations
ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.
A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"
ANS: D The nurse's statement, "Things will look better tomorrow after a good night's sleep." is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.
A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."
ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."
ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.
When interviewing a client, which nonverbal behavior should a nurse employ? A Maintaining indirect eye contact with the client B Providing space by leaning back away from the client C Sitting squarely, facing the client D Maintaining open posture with arms and legs crossed
C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A S B O C L D E E R
B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).
After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A "Do you believe that I was the cause of your blood test being canceled?" B "I see that you are upset, but I feel uncomfortable when you swear at me." C "Have you ever thought about ways to express anger appropriately?" D "I'll give you some space. Let me know if you need anything."
B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.
Which nursing statement is a good example of the therapeutic communication technique of offering self? A "I think it would be great if you talked about that problem during our next group session." B "Would you like me to accompany you to your electroconvulsive therapy treatment?" C "I notice that you are offering help to other peers in the milieu." D "After discharge, would you like to meet me for lunch to review your outpatient progress?"
B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.
Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A "My sister has the same diagnosis as you and she also hears voices." B "I understand that the voices seem real to you, but I do not hear any voices." C "Why not turn up the radio so that the voices are muted." D "I wouldn't worry about these voices. The medication will make them disappear."
B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.
A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A Making observations and the defense mechanism of suppression B Verbalizing the implied and the defense mechanism of denial C Reflection and the defense mechanism of projection D Encouraging descriptions of perceptions and the defense mechanism of displacement
B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.
A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A "What occurred prior to the rape, and when did you go to the emergency department?" B "What would you like to talk about?" C "I notice you seem uncomfortable discussing this." D "How can we help you feel safe during your stay here?"
B The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.
The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. A Libel B Battery C Assault D Slander E False Imprisonment
BCE False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a patient from leaving the hospital if the patient has been admitted voluntarily and if no agency or legal policies exist for detaining the patient. Assault and battery are related to the act of restraining the patient in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the patient
A patient diagnosed with terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A "Have you shared your feelings with your family?" B "I think we should talk more about your anger with your family." C "You're feeling angry that your family continues to hope for you to be cured?" D "You are probably very depressed, which is understandable with such a diagnosis."
C Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feeling, this is non-therapeutic in the one-to-one relationship.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A Reflecting B Making observations C Formulating a plan of action D Giving recognition
C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.
Which statement demonstrates the BEST understanding of the nurse's role regarding ensuring that each client's rights are respected? A "Autonomy is the fundamental right of each and every client." B "A patient's rights are guaranteed by both state and federal laws." C "Being respectful and concerned will ensure that I'm attentive to my patient's rights." D "Regardless of the patient's conditions, all nurses have the duty to respect patient rights."
C The nurse needs to respect and have concern for the patient; this is vital to protecting the patient's rights. While it is true the autonomy is a basic client right, there are other rights that must also be both respected and facilitated. State and federal laws do protect a patient's rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. It is a fact that safeguarding a patient's rights are a nursing responsibility, but stating that fact does not show understanding or respect for the concept.
Nurse Patrick is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A "Do you know why you are here?" B "Are you feeling depressed or anxious?" C "Yes, I see. Go on." D "Can you chronologically order the events that led to your admission?"
C The nurse's statement, "Yes, I see. Go on." is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information.
A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A Requesting an explanation B Belittling the client C Making stereotyped comments D Probing
C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.
The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A To reframe the client's thoughts about mental health treatment B To put the client at ease C To explore a subject, idea, experience, or relationship D To communicate that the nurse is listening to the conversation
C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.
Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A "You did not attend group today. Can we talk about that?" B "I'll sit with you until it is time for your family session." C "I notice you are wearing a new dress and you have washed your hair." D "I'm happy that you are now taking your medications. They will really help."
C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.
When the community health nurse visits a patient at home, the patient states, "I haven't slept the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient. A "I see." B "Really?" C. "You're having difficulty sleeping?" D "Sometimes, I have trouble sleeping too."
C. "You're having difficulty sleeping?" The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.
On review of the patient's record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior? A Fearfulness regarding treatment measures. B Anger and aggressiveness directed toward others. C An understanding of the pathology and symptoms of the diagnosis. D A willingness to participate in the planning of the care and treatment plan.
D In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patient's understanding of their illness, only of their desire for help.
A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A "You have everything to live for." B "Why do you see yourself as a failure?" C "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"
D Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings. In addition, use of the word "why" is nontherapeutic.
A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B "It is important for you to discontinue these ritualistic behaviors." C "Why are you asking for help if you won't participate in unit therapy?" D "Let's figure out a way for you to attend unit activities and still wash your hands."
D The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.
A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A "Why do you continue to alienate your peers by your angry outbursts?" B "You accomplish nothing when you lose your temper like that." C "Showing your anger in that manner is very childish and insensitive." D "During group, you raised your voice, yelled at a peer, left, and slammed the door."
D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.
Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A Encouraging comparison B Exploring C Formulating a plan of action D Making observations
D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.
A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A "It's quite common for clients to feel that way after a lengthy hospitalization." B "Why don't you talk to your mother? You may find out she doesn't feel that way." C "Your mother seems like an understanding person. I'll help you approach her." D "You feel that your mother does not want you to come back home?"
D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.
An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A "Why did you use the client's name on your clinical worksheet?" B "You were very careless to refer to your client by name on your clinical worksheet." C "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." D "It is disappointing that after being told, you're still using client names on your worksheet."
The instructor's statement, "Surely you didn't do this deliberately, but you breached confidentiality by using the client's name." is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.
